Aplicaciones clínicas del colgajo en cono / Clinical applications of the cone shaped flap

Presentamos nuestra experiencia con el uso de un colgajo previamente descrito, el colgajo denominado en cono por la forma final que obtiene, como la de un barquillo de helado con su bocado. Consta de 2 colgajos acoplados: uno de rotación local y otro un avance en V-Y, ambos fasciocutáneos. Realizamos un análisis retrospectivo de 108 pacientes intervenidos entre 2000 y 2013 por lesiones en diferentes partes del organismo, con edades comprendidas entre los 20 y los 52 años, de los cuales 99 fueron varones, y en los que empleamos este tipo de colgajo. Los defectos cubiertos afectaban a las piernas en el 27% de los casos, tobillos en el 10%, planta del pie en el 9%, al talón en el 8% y a otras localizaciones en el resto de los pacientes. Del total, 80 colgajos tuvieron buena evolución (74%), 11 sufrieron dehiscencia mayor (10,2 %), 13 dehiscencia menor (12%) y 4 necrosis (3,7 %). Los resultados confirman que el colgajo en cono es versátil, reproducible, sencillo y seguro de realizar, y permite al cirujano plástico resolver problemas quirúrgicos complejos de forma muy segura y a bajo costo (AU)

We present our experience with a previously described flap, the shaped cone flap, to cover skin defects. This flap due its name to the shape, similar to an ice cream cone, that is formed by locally rotated and V-Y advance flaps joined together, being both fasciocutaneous flaps. We perform a retrospective analysis of 108 patients operated on between 2000 and 2013, aged 20 to 52 years, 99 males, treated with a cone shaped flap. The defects covered were located in the leg in 27%, in the ankle in 10%, in the sole of the foot in 9%, in the heel in 8% and in other locations in the rest of patients. Eighty flaps (74%) had a good evolution, 11 (10,2%) had a major dehiscence, 13 (12%) had a minor dehiscence and 4 flaps (3,7 %) had necrosis. We confirm the cone shaped flap as an easy and safe alternative for reconstruction that avoid complications in most of the cases and with a low surgical cost (AU)

Experiencia en el tratamiento de quemaduras de cuero cabelludo / Scalp burns treatment experience

El cuero cabelludo es la barrera más externa y más importante del cráneo y del cerebro. Si bien las quemaduras de esta zona son raras, cuando se producen suelen estar causadas por alta tensión eléctrica, fuego, líquidos hirvientes u otras fuentes de calor. El objetivo de este trabajo es presentar una serie de casos de quemaduras de cuero cabelludo tratadas en los últimos10 años en el Hospital del Trabajador de Santiago (Chile).Se trata de un estudio descriptivo retrospectivo en el que se analizó la información demográfica y terapéutica de los pacientes que requirieron hospitalización al tiempo que se revisó la literatura al respecto. En total se registraron 2.266 consultas por quemaduras en la cabeza, de las cuales 34 fueron del cuero cabelludo y11 requirieron hospitalización; la mayoría fueron quemaduras eléctricas, 4 casos y por fuego, otros 4 casos. En el tratamiento, destacó el uso en 1 caso de colgajo libre asociado a colgajos locales de avance. En el tratamiento de las secuelas se utilizaron expansores y posteriormente colgajos locales de avance. Sólo una pequeña parte de los pacientes que consultan por quemaduras en la cabeza corresponden a quemaduras del cuero cabelludo. La mayoría son tratadas de forma ambulatoria y no requieren acciones mayores. Los pacientes con quemaduras eléctricas suelen requerir tratamientos más agresivos. Para el tratamiento de las secuelas son preferibles los expansores y los colgajos de avance (AU)

The scalp is the most external and important barrier of the skull and brain. Burns in this area are rare, but often caused by high voltage injuries, fire, liquid or other heat sources. The aim of this paper is to present a series of cases of scalp burns of the last 10 years in the Hospital del Trabajador de Santiago (Chile). This is a retrospective and descriptive study. We analyzed the demography and treatment of patients requiring hospitalization and we reviewed the literature. There were 2.266 visits for head burns, of which 34 patients consulted with scalp burns, 11 of them were hospitalized. Most were due to electrical burns, 4 patients, and fire,4 patients. In the treatment, highlighted the use in a case of free flap and local advancement flaps. In the management of sequelae, expanders and then local advancement flaps were performed. Only a small proportion of patients attending with head burns had scalp burns. Most were treated on as outpatient and did not require further action. The group of patients with electrical burns required more aggressive treatments while the management of the sequelaes is done with expanders and local advancement flaps (AU)

Colgajo en hacha de tensor de fascia lata para úlceras por presión trocantereas / Hatchet-Shaped fascia lata tensor flap for the treatment of trochanteric pressure sores

Las úlceras trocantéreas por presión representan un problema importante a nivel extra e intrahospitalario. Existen múltiples opciones terapéuticas, ya sean colgajos randomizados, musculocutáneos, fasciocutáneos o libres. Presentamos la técnica quirúrgica del colgajo en hacha detensor de fascia lata para el tratamiento de esta patología. Consiste en el diseño de un colgajo en V con irrigación por su base superior, que contacta con la úlcera por uno de sus extremos, simulando la forma de un hacha. Resecamos la úlcera hasta obtener un lecho vital, resecando además el hueso prominente dicho hasta un plano en que se visualice tejido sano. Levantamos y rotamos el colgajo cubriendo el defecto. Finalmente se realiza el cierre primario en VY sintensión. La zona donante permite un cierre primario sin tensión. Mantenemos drenajes durante 10 días Este colgajo permite obtener una buena cobertura para úlceras trocantéreas por decúbito con un adecuado resultado cosmético. Recogemos una casuística de 17 úlceras tratadas mediante el colgajo descrito; como complicaciones se presentaron 3 seromas, resueltos con sistema de cierre con presión negativa externa e interna; 2 casos de dehiscencia de sutura y 2 hematomas resueltos en pabellón de cirugía. Creemos pertinente conocer este colgajo que debe estar siempre presente dentro de las posibilidades terapéuticas para pacientes con úlceras trocantereas por decúbito (AU)

The trochanteric pressure sore it’s an important intra and extrahospitalary problem. There are different therapeutic options for this pathology, for example random, musculocutaneous, fasciocutaneous or free flaps. We present the hatchet-shaped fascia lata tensor flap to treat this kind of lesions. We design a V flap with irrigation in the superior base, having one of the extreme in contact with the sore. The shape of the flap is a hatchet. It´s important to get a vitalbed resecting affected tissues and prominent bone; then, the flap stands up and rotates to covering the defect. We carried out primary closure in V-Y without tension. Drains are removed not before 10 days. This flap allows a good coverage for trochanteric decubitussores with an adequate cosmetic result. There have been 3 seromas, solved with internal and external negative pressure system; 2 cases of suture dehiscence and 2 hematomas solved with surgical procedures. The donor site allows primary closure without tension. As a conclusion, we believe that is relevant to know this flap and taking it on count to be offered to patients with trochanteric decubitus sore (AU)

[Anesthesia for electroconvulsive therapy: clinical experience]. / Anestesia en terapia electroconvulsiva. Experiencia clínica.

OBJECTIVE: To assess the utility of propofol and succinylcholine in obtaining optimal convulsions and assuring patient safety during electroconvulsive therapy. PATIENTS AND METHODS: This was a prospective observational study of patients undergoing electroconvulsive therapy under general anesthesia with propofol and succinylcholine. We recorded patient characteristics, doses of propofol and succinylcholine, electroencephalographically-recorded duration of convulsions, and complications. Descriptive statistics were compiled and the data were subjected to analysis of correlations, comparison with the Student t test for independent samples, the Mann-Whitney U test, and analysis of variance. RESULTS: We studied 108 patients, 62% women and 38% men, 80% classified as ASA 1 and 20% as ASA 2. The patients underwent 844 sessions of electroconvulsive therapy; their mean (SD) age was 39.95 (18.09) years. The doses of propofol and succinylcholine were 1.34 (0.32) mgxkg(-1) and 1.35 (0.26) mgxkg(-1), respectively. The mean recorded duration of the first convulsion (29.87 [22.42] seconds) was negatively correlated with age (r = -0.12) and unrelated to propofol dose (r = 0.06) or body weight (r = 0.02). Male and schizophrenic patients had longer-lasting convulsions (P < .01). Cardiovascular complications occurred in 2.4% and psychomotor agitation in 1.4%; there were no respiratory complications, musculoskeletal injuries, nausea, or vomiting. CONCLUSIONS: Electroconvulsive therapy can be safely applied in an operating room or similar space undergeneral anesthesia and with a neuromuscular blockade in order to prevent psychological or musculoskeletal trauma. Propofol did not affect the convulsions at the dosages administered.

Anestesia en terapia electroconvulsiva. Experiencia clínica / Anesthesia for electroconvulsive therapy: clinical experience

OBJETIVO: Valoramos el efecto de la anestesia con propofoly succinilcolina (Sch) en obtener convulsiones óptimasy mantener la seguridad del paciente durante laterapia electroconvulsiva (TEC).PACIENTES Y MÉTODOS: Realizamos un estudio prospectivoobservacional en pacientes sometidos a TECbajo anestesia general con propofol y Sch. Registramosvariables demográficas, dosis de propofol y Sch, númerode estímulos aplicados, duración electroencefalográfica(EEG) de las convulsiones y complicaciones. Utilizamosestadísticas descriptivas, análisis de correlación, t de studentpara muestras independientes, ANOVA de una víay Mann-Whitney.RESULTADOS: Estudiamos 108 pacientes, 62% mujeresy 38% hombres, 80% ASA I y 20% ASA II, sometidos a844 sesiones de TEC, con una edad de 39,95 ± 18,09años. Las dosis de propofol y Sch fueron 1,34 ± 0,32 mgkg-1 y 1,35 ± 0,26 mg kg-1, respectivamente. La duraciónEEG de la primera convulsión (29,87 ± 22,42 segundos)tuvo una correlación negativa con la edad (r = -0,12), notuvo correlación con la dosis de propofol (r = 0,06) ni conel peso corporal (r = 0,02). Los pacientes hombres y losportadores de esquizofrenia tuvieron convulsiones demayor duración (p < 0,01). Hubo complicaciones cardiovasculares(2,4%) y agitación psicomotora (1,4%); nohubo complicaciones respiratorias, ni traumatismosmusculoesqueléticos, ni náuseas ni vómitos.CONCLUSIONES: La TEC es un procedimiento segurorealizado en el quirófano o en un área similar, con anestesiageneral y bloqueo neuromuscular para prevenir eltrauma psicológico y musculoesquelético. A las dosisadministradas el propofol no afectó las convulsiones (AU)

OBJECTIVE: To assess the utility of propofol and succinylcholine in obtaining optimal convulsions and assuring patient safety during electroconvulsive therapy. PATIENTSANDMETHODS: This was a prospective observational study of patients undergoing electroconvulsive therapy under general anesthesia with propofol and succinylcholine. We recorded patient characteristics, doses of propofol and succinylcholine, electroencephalographically-recorded duration of convulsions, and complications. Descriptive statistics were compiled and the data were subjected to analysis of correlations, comparison with the Student t test for independent samples, the Mann-Whitney U test, and analysis of variance. RESULTS: We studied 108 patients, 62% women and 38% men, 80% classified as ASA 1 and 20% as ASA 2. The patients underwent 844 sessions of electroconvulsive therapy ;their mean (SD) age was 39.95 (18.09) years. The doses of propofol and succinylcholine were 1.34 (0.32) mg·kg–1 and 1.35 (0.26) mg·kg–1, respectively. The mean recorded duration of the first convulsion (29.87 [22.42] seconds) was negatively correlated with age (r = –0.12) and unrelated to propofol dose (r = 0.06) or body weight (r = 0.02). Male and schizophrenic patients had longer-lasting convulsions (P < .01). Cardiovascular complications occurred in 2.4% and psychomotor agitation in 1.4%; there were no respiratory complications, musculoskeletal injuries, nausea, or vomiting. CONCLUSIONS: Electroconvulsive therapy can be safely applied in an operating room or similar space under general anesthesia and with a neuromuscular blockade in order to prevent psychological or musculoskeletal trauma. Propofol did not affect the convulsions at the dosages administered (AU)

The incorporation of different sorts of cancellous bone graft and the reaction of the host bone. A histomorphometric study in sheep.

We performed a morphological and histomorphometric analysis of the use of either autografts, or of frozen or freeze-dried cancellous bone allografts in sheep. A cancellous bone defect was created in the lateral portion of the distal epiphysis of the left femur. Four groups of six animals were monitored for 3 months. In the first group, the cavity was filled with autograft, in the second with frozen allograft and in the third with freeze-dried allograft. In the last group, the cavity was not filled and served as control. A study of the host bone showed that the mean trabecular width of the peripheral osteoid was greatest in the control group, while the number of osteoblasts and osteoclasts was significantly lower in the freeze-dried allograft group. However, the different bone grafts that were used to fill the cavity showed a greater trabecular width and area in the autografts. Among the frozen allografts, these measurements were also greater than in the freeze-dried allograft group. The "erosion surface" of the freeze-dried allograft group was also found to be three times greater, and there were a larger number of osteoclasts and osteoclastic nuclei. We concluded that the "lyophilised" allografts were re-absorbed rapidly and that there were no major morphological differences between the frozen allografts and the autograft groups.

Tratamiento quirúrgico de las ulceras por presión en pacientes con daño cerebral irreversible por traumatismo encefalocraneano / Surgical treatment of presure sores in pacients wit postraumatic brain injury

Producto de nuestro moderno estilo de vida, los traumatismos encéfalocraneanos (TEC) son una importante causa de morbimortalidad; afectando especialmente a población joven. Algunos pacientes pueden quedar con graves secuelas neurológicas, en estado vegetativo y permanentemente postrados. Por otra parte, la mejor atención, tanto en fase aguda como crónica, ha mejorado su expectativa de vida, apareciendo complicaciones que plantean nuevos desafíos terapéuticos, entre las que se incluyen las úlceras por presión (UP). Tradicionalmente, en nuestro medio, las UP en estos pacientes han sido tratadas de forma conservadora. Sin embargo, esta conducta. muchas veces implica. curaciones por largos períodos de tiempo, significando un deterioro en la calidad de vida del enfermo, una carga adicional para los familiares y un encarecimiento para las instituciones de salud. Por estos motivos presentamos la experiencia del Hospital del Trabajador de Santiago, en el tratamiento quirúrgico de 7 pacientes con graves secuelas neurológicas post TEC, portadores de UP, 5 sacras y 2 trocantéreas; planteándose la cirugía como una alternativa válida ele tratamiento. Se discuten algunos aspectos relevantes a su evaluación preoperatoria, tipo de cirugía, evolución, complicaciones, resultados y costos (AU)

The craneal trauma is, actually, an important etiology of morbity and mortality, mainly in young people. Some of these patients lay in bed for ever, with importants neurological sequelaes secondary to their brain injury. In the other hand the berter attention in acute as well as cronic phase have improve their expectative of Iife, appearing complications with new challenges such as the pressure sores. Traditionally, in our environment these pressure sores, in the these pauents, have been treated in conservative way. Nevertheless, these treatments mean wounds cares for long times, with a detrimental quality of Iife for the patient, an emotional comminent for their relatives ancl a big investment for the Hospital del Trabajador Santiago. Chile in the surgical treatment of 7 patients with important neurological sequeales post brain injury and with pressure sores: 5 sacral, and 2 trocanterics. Pre operatory evaluation, type of surgery, evolution, complications, results and costare discussed (AU)