Uso de lipoinjertos para el manejo de cicatrices patológicas en una población pediátrica / Use of fat graft for treatment of pathological scars in a pediatric population

INTRODUCCIÓN Y OBJETIVO: Debido a implicaciones cosméticas y funcionales, las cicatrices en los niños son una preocupación para pacientes y familiares. Existen múltiples líneas de tratamiento con efectividad variable. La transferencia de tejido adiposo es una alternativa relativamente nueva en el tratamiento de diferentes alteraciones, incluyendo las cicatrices, debido a que este tejido contiene entre otros elementos factores de crecimiento, angiogénicos y antiapoptóticos, además de una reserva de células madre mesenquimales con capacidad de replicarse indefinidamente y diferenciarse en varios tipos celulares que pueden favorecer la reorganización y regeneración de los tejidos. Mostramos los resultados del uso de lipoinjertos autólogos para el tratamiento de cicatrices patológicas en una serie de pacientes pediátricos. Basamos su empleo en los efectos satisfactorios encontrados sobre cicatrices en adultos, con la finalidad de exponer este método como alternativa en el tratamiento en niños, teniendo en cuenta que es una técnica emergente para esta condición en este grupo etario. MATERIAL Y MÉTODO: Estudio retrospectivo, observacional, no aleatorizado, en pacientes pediátricos sometidos a lipoinjertos autólogos para el manejo de cicatrices patológicas durante el periodo comprendido entre enero de 2016 y enero de 2018. Las cicatrices fueron evaluadas antes del procedimiento y en controles postoperatorios a 3 y 6 meses por medio de la escala de Vancouver. Los datos obtenidos fueron analizados estadísticamente mediante la prueba de rangos de Wilcoxon. RESULTADOS: Incluimos en el estudio 9 pacientes, 5 mujeres y 4 varones, con edades entre 2 y 17 años (media de 8.8 años). Identificamos una reducción estadísticamente significativa en los promedios de las variables vascularización, elasticidad y en la puntuación total de la escala de Vancouver (valor p <0.05) después del tratamiento con lipoinjertos. Todos los pacientes presentaron disminución de por lo menos 1 punto en el total de la escala al final del periodo de evaluación. La variable con mayor disminución a los 6 meses fue la elasticidad, y la que tuvo menor cambio fue el grosor/altura. Ningún paciente presentó complicaciones tempranas o tardías durante el seguimiento. CONCLUSIONES: Los datos obtenidos sugieren que también en pacientes pediátricos, las cicatrices presentan una mejoría clínica posterior a la aplicación de injertos grasos (especialmente en la elasticidad), basada en la disminución de puntuación en la escala de Vancouver

BACKGROUND AND OBJECTIVE: Due to the cosmetic and functional implications, scars in children represent a concern for patients and their parents. Currently, there are multiple lines of treatment with variable effectiveness. Adipose tissue transfer is a relatively new alternative in the treatment of different alterations including scars, because this tissue contains among other elements growth, angiogenic and antiapoptotic factors, in addition to a reserve of mesenchymal stem cells with the ability to replicate indefinitely and differentiate into several cell types that can promote the reorganization and regeneration of tissue. We show the results of the use of fat graft for treatment of pathological scars in a series of pediatric patients. We base its use on the satisfactory effects found on scars in adults to suggest this method as an alternative in the management in children, considering that this technique represents an emerging treatment for the management of this condition in this age group. METHODS: Retrospective, observational, non-randomized study, carried out in pediatric patients underwent to autologous fat grafts for the management of pathological scars during the period from January 2016 to January 2018. The scars were treated with autologous fat grafts and evaluated before the procedure and 3 and 6 postoperative months, using the Vancouver scale. The data obtained were statistically analyzed using the Wilcoxon rank test. RESULTS: Nine patients were included in the study (5 women and 4 men) with an age range of 2 to 17 years (average 8.8 years). A statistically significant reduction in the averages of the variables vascularization, elasticity and in total score of the Vancouver scale (p value <0.05) after treatment with fat graft was identified. All patients showed a decrease of at least 1 point in the total of the Vancouver scale at the end of the evaluated period. The variable with the greatest decrease in the score at 6 months was elasticity and the one with the least change was thickness/height. No patient presented complications early or late during the follow-up period. CONCLUSIONS: The data obtained suggest that also in pediatric patients, the scars show a clinical improvement after the application of fat grafts (especially in elasticity), based on the decrease in the score on the Vancouver scale

Lessons Learned in Posttraumatic Reconstruction of Labial Defects in Children.

There is no universal technique for reconstructing the different types of labial defects. The etiology, the size and location, the layers compromised and the depth of the defect are the main determinants of the technique to be chosen. The aesthetic form and the function recovery must be the main objective of the therapeutic process.Scarce studies concentrate into the pediatric population and the operational resolution of complex, full-depth defects. The oral contingence, articulation and facial expression (mimicking) are amongst the most important functions of the lower third of the face, and, in terms of reconstruction, they represent a difficult task for the plastic surgeon. In our case, the experience has taught us about new tools, useful and potentially replicable to guide the reconstruction of our infantile population. The authors present different techniques from five different cases, using loco-regional options that spare microsurgical solutions.

Sequence of Surgical Reconstruction in a Child With Cleft Lip and Palate Associated With Congenital Facial Teratomas.

We describe a case of left homolateral complete cleft lip/palate associated with a congenital left maxillary teratoma and left orbital teratoma. The patient required step-by-step reconstruction that first included resection of the 2 teratomas in consideration of cleft lip repair, cleft palate repair, and correction of the left periorbital anomalies, which were performed later. After performing all the necessary procedures, complete resection of the tumors and correction of the anomalies associated with the lip, palate, and left orbit were achieved. The rare occurrence of this type of association and its devastating effect on a patient's growth, aesthetics, and function of craniofacial elements require careful surgical planning to enable restoration of the anatomy and proper functional development. At follow-up, the patient showed significant improvement in the functional and aesthetic aspects.

Anatomical and Clinical Study of the Posterior Auricular Artery Angiosome: In Search of a Rescue Tool for Ear Reconstruction.

BACKGROUND: The retroauricular tissues have been used for a long time for ear reconstruction, but the anatomical bases of flaps of this region are not completely clear. The aim of this study was to estimate blood supply area and location of this on the skin and fascia retroauricular dependent of posterior auricular artery (PAA) to establish safe margins to design flaps for auricular reconstruction. METHODS: Dissection under magnification (×3.5) of the PAA through a cervical approach; injection of methylmethacrylate in the PAA as a staining technique; retroauricular approach to identify the territory of irrigation of PAA in the retroauricular skin and fascia; measuring and location of the stained area; and report of 2 cases of ear reconstruction with fasciocutaneous and fascia flaps based on PAA, designed according to the anatomical study. RESULTS: In a sample of 10 cadaveric specimens, the PAA irrigated an area of the retroauricular skin and fascia of 10.7 cm length × 7.07 cm wide equivalent to 60.44 cm2 (95% CI, 37.07-83.81), with a distribution posterior to external auditory canal of 7.15 cm (95% CI, 5.53-8.77) and posterior to the helix insertion of 6.12 cm (95% CI, 4.89-7.35). In the 2 patients treated with fascia and fasciocutaneous flaps based on the PAA, these were good options for ear reconstruction. CONCLUSION: A fascia or fasciocutaneous flap from the retroauricular region based on PAA within the dimensions and location found in this study will be a safe option for reconstruction of the ear.