Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico / Proposal of an informed consent form to obtain audiovisual material from patients

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

[Proposal of an informed consent form to obtain audiovisual material from patients]. / Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico.

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Reconstrucción mamaria terciaria con tejido autógeno tras reconstrucción fallida con implantes / Tertiary breast reconstruction with autologous tissue after failed reconstruction with implants

Objetivo: Analizar nuestra experiencia en la reconstrucción mamaria terciaria tras el fracaso de procedimientos basados en implantes. Material y métodos: Entre 2005 y 2014, los autores (BH y CA) realizaron reconstrucción mamaria terciaria en 17 casos utilizando el colgajo de perforantes de arteria epigástrica inferior profunda (DIEP). Se revisaron en forma retrospectiva las fichas clínicas de dichas pacientes, registrando edad, comorbilidades, índice de masa corporal (IMC), presencia de cicatrices abdominales, historia de radioterapia y quimioterapia. Asimismo, se registraron los detalles de las cirugías realizadas, tanto de la reconstrucción con implante como de la reconstrucción terciaria. Resultados: Las complicaciones más frecuentes que motivaron el cambio de estrategia reconstructiva fueron: contractura capsular, rotura, exposición/infección del implante, dolor crónico y el fracaso de la expansión de la piel. En la reconstrucción terciaria se utilizó el colgajo DIEP en todos los casos, presentando pérdida parcial del colgajo un solo caso, sin pérdidas totales del mismo. Conclusiones: Las opciones actuales en reconstrucción terciaria con tejido autógeno incluyen principalmente colgajos perforantes, siendo el colgajo DIEP el más utilizado. De acuerdo con los resultados de esta serie y lo reflejado en la literatura, creemos que la reconstrucción terciaria es un procedimiento seguro, con una tasa de complicaciones similar a las de reconstrucción primaria y secundaria, y que otorga una serie de beneficios a las pacientes afectadas.

Objective: Analyze our experience on tertiary breast reconstruction after failed implant-based procedures. Methods: Between 2005 and 2014, the authors (BH and CA) performed tertiary breast reconstruction with the deep inferior epigastric artery perforator flap (DIEP) flap in 17 cases. The medical charts of these patients were retrospectively reviewed, registering age at tertiary reconstruction, comorbidities, body mass index (BMI), presence of abdominal scars and history of radiotherapy and chemotherapy. Likewise, details from surgeries were also gathered, both form the implant-based procedures and tertiary autologous reconstruction. Results: Complications motivating the change of reconstructive strategy included capsular contracture, implant rupture, implant exposure/infection, chronic pain and failure of skin expansion. Regarding tertiary reconstruction, the DIEP flap was used in all cases with one partial flap loss and no total failures. Conclusions: Current options for autologous tertiary reconstruction include mainly perforator flaps with the DIEP being by far the most utilized. Additionally, tertiary reconstruction is a safe procedure, with a rate of complications similar to that of primary and secondary free flap breast reconstruction.

Reconstrucción mamaria: estado actual del tema / Breast reconstruction: state of the art

Nowadays most plastic surgery units worldwide perform breast reconstruction and hence basic updated knowledge in the topic is mandatory for every plastic surgeon and trainee. Breast reconstruction may be performed either immediately after mastectomy or in a delayed fashion. Each of these timings has its advantages and drawbacks and albeit there are a number of factors influencing the decision to perform one or another, probably the most important one has to do with the delivery of radiotherapy. In this sense, while in patients who are candidates for post mastectomy radiation, a delayed reconstruction is strongly recommended, in those without adjuvancy, immediate reconstruction is a very good alternative. In general terms, breast reconstruction techniques fall into one of three groups: those using alloplastic materials only; those performed with autologous tissue only; and those using a combination of both alloplastics and autologous tissue. Again the administration of radiotherapy, as well as patient and surgeon-related factors, play a fundamental role when choosing anyone technique. Finally, during the last years there has been growing interest and evidence on the use of acellular dermal matrices for breast reconstruction, which have expanded the armamentarium of techniques available for these patients. The following paper aims to provide an updated review on breast reconstruction regarding timing of reconstruction, techniques available, the influence of radiotherapy and the use of acellular dermal matrices.

La reconstrucción mamaria constituye una parte importante de la práctica de muchos servicios y unidades de cirugía plástica y por tanto resulta muy necesario que tanto cirujanos plásticos con experiencia como aquellos en formación tengan conocimientos básicos actualizados sobre el tema. La reconstrucción mamaria puede llevarse a cabo de forma inmediata después de la mastectomía o de forma diferida. Cada una de estas modalidades tiene ventajas y desventajas. Si bien existen distintos factores para elegir uno u otro timing, la necesidad de radioterapia postmastectomía es probablemente el factor más importante a considerar. De esta manera, en términos generales, se recomienda realizar una reconstrucción diferida en pacientes subsidiarias de irradiación, mientras que en pacientes sin indicación de dicha adyuvancia, la reconstrucción inmediata es una muy buena alternativa. Dentro de las técnicas de reconstrucción, existen tres grandes grupos: las que utilizan materiales aloplásticos únicamente; las que utilizan tejidos autólogos; y las que usan ambos elementos. La decisión de cuál técnica utilizar estará influenciada por factores tanto de la paciente como del cirujano y el centro hospitalario. Durante los últimos años ha habido un interés creciente en el uso de matrices dérmicas acelulares en reconstrucción mamaria que han permitido ampliar el arsenal de alternativas terapéuticas que ofrecer a las pacientes mastectomizadas. El siguiente trabajo tiene por objetivo presentar una revisión actualizada de la literatura sobre reconstrucción mamaria en cuanto a tiempos de reconstrucción, técnicas más frecuentes, influencia de la radioterapia y el uso de matrices dérmicas acelulares.

Prevalencia de dolor crónico neuropático en pacientes quemados: utilización del instrumento DN4 para su diagnóstico / Prevalence of neuropathic chronical pain in burnt patients: use of DN4 tool for diagnosis purposes

Introducción: El dolor en los pacientes quemados es uno de los más complejos, intensos y prolongados en el tiempo. La tendencia mundial muestra una disminución de ña tasa de mortalidad con aumento de los sobrevivientes por quemaduras. Se sabe que los pacientes, luego del alta, siguen sintiendo dolor. Quisimos saber la prevalencia de Dolor Neuropático, utilizando para su diagnóstico un Cuestionario-instrumento (DN4). Material y Método: estudio clínico, descriptivo, prospectivo de prevalencia. Incluyó 34 pacientes a los que se les aplicó el DN4 para diagnóstico de Dolor Neuropático. Egresados del Servicio de Cirugía Plástica y Quemados del Hospital del Trabajador de Santiago, controlados en el Policlínico de Rehabilitación. Resultados: 97.1 por ciento fueron hombres, edad 38.1 años. Superficie Corporal Quemada de 16.8 +/- 19.7 por ciento. Agentes causales: Eléctricas, 53.6 por ciento; térmicas, 40.5 por ciento; y químicas, 3.2 por ciento. El DN4 fue positivo 88.2 por ciento. Intensidad del dolor de moderado a severo. El Dolor Neuropático se asoció más a quemaduras de menor extensión. Conclusión: El diagnóstico de dolor crónico de tipo neuropático, utilizando el instrumento DN4 ocupó un alto porcentaje (88.2 por ciento) de nuestros pacientes estudiados. Asociándose más a los pacientes con quemaduras de menor extensión. Este dolor es de intensidad moderada a severa y que requiere ser tratado.

Introduction: pain a patients with burns is one of the most complex, intense and prolongued in time. The world trend shows a reduction in mortality rate with increasing number of survivors. It is known that after medical discharge, patients still suffer from pain. We wished to know the prevalence of neuropathic pain using for diagnosis purposes a Questionnaire - tool called DN4. Material and Method: Clinical, descriptive prospective study of prevalence. The study comprised 34 patients with whom the DN4 was used for Neuropathic pain diagnosis purposes. Discharged from the Hospital del Trabajador de Santiago Plastic Surgey and Burnt Unit with controls at the Rehabilitation Clinic. Results: 97.1 percent male patients whose average age was 38.1 years. Burned Corporal Area 16.8 +/- 19.7 percent. Causes: Electrical, 56.3 percent; thermic, 40.5 percent; and chemical, 3.2 percent. DN4 was positive in 88.2 percent. Pain intensity from moderate to accute. Neuropathic pain was associated to less wide burns. Conclusion: Neuropathic type chronic pain diagnosis with the help of DN4 resulted in a rather high percentage (88.2 percent) of the patients in this study, proving to be more in association to patients with less wide burns. This is a moderate from accute pain and requires treatment.