Selección de vasos receptores en reconstrucción microquirúrgica de cabeza y cuello. Análisis en 156 colgajos libres / Recipient vessel selection in head and neck microsurgical reconstruction. Study of 156 free flaps

El éxito de una reconstrucción microquirúrgica se subordina a una adecuada planificación. Escoger adecuadamente los vasos que nutrirán nuestro colgajo libre es primordial. Para este trabajo seleccionamos 150 pacientes en los que se realizaron 156 colgajos libres en el área de cabeza y cuello. La proporción varón/mujer fue de 5:1 y la edad media de 56 años. La etiología más frecuente del defecto fue tumoral. Cincuenta colgajos se realizaron de forma inmediata al defecto (33.3%) y en 100 casos (66.6%) de forma secundaria. La arteria receptora más usada fue la tiroidea superior seguida de la facial. Se suturaron un total de 223 venas; la más frecuente fue la vena facial seguida de la yugular externa. Se realizaron, asímismo, 4 injertos venosos y 2 transposiciones de vena cefálica. La tasa global de supervivencia fue del 93%. Hubo 11 necrosis totales, 3 (1.9%) necrosis parciales y 3 (1.9%) muertes postoperatorias en el hospital (AU)

The success of a microsurgical reconstruction is subordinated to an appropriate planning. Recipient vessel selection of our free flap is primordial. For this work we select 150 patients who underwent 156 free flaps for head and neck reconstruction. The proportion male/female was of 5:1 with an average age of 56 years. Tumoral defects are the most common etiology. Fifty (33.3%) free flaps were performed inmediately and 100 (66.6%) were performed secondarily. Recipient artery selection in order of frequency included the superior thyroid artery followed by the facial artery. We performed 223 venous anastomosis; end-to-end anastomosis to the facial vein and external yugular vein was the most common method of venous revascularization. Four flaps required an interposition vein graft and we performed two cephalic vein transpositions. The overall success rate was of 93%. Eleven flaps failed and there were 3 cases (1.9%) of partial free flap necrosis. Three patients (1.9%) died postoperatively in the hospital (AU)

Reconstrucción de la zona Donante del Colgajo de Antebrazo Libre radial mednate Colgajo de avance – rotación cubita / Reconstruction of the Radial Forearm Free Flap with Ulnar Rotation

En la clínica diaria, ha sido criticado en muchas ocasiones por las potenciales complicaciones de su zona donante. Estas son: fallo del injerto de piel, retardo de cicatrización, exposiciones y adherencias tendinosas. Describimos un método rápido y seguro para el cierre del defecto con un colgajo cubital de avance ­ rotación. Lo hemos usado en 9 pacientes, sobre 66 colgajos radiales realizados, para reconstrucción faringoesofágica, postmaxilectomía y paladar. En todos los casos los tendones flexores en la muñeca han sido satisfactoriamente cubiertos. Gracias a la movilización precoz que permite esta técnica, no ha habido rigideces ni adherencias tendinosas, con balance articular normal en todos los pacientes. Como complicaciones puede haber linfedema temporal y alteraciones sensitivas en la superficie volar de antebrazo. El cierre de la zona donante del colgajo "chino" libre mediante colgajo cubital resuelve satisfactoriamente las potenciales complicaciones de rigideces, exposición tendinosa y disfunción manual que se pueden dar con otras técnicas de cobertura (AU)

Been criticized for the poor quelity of its donor site. Potencial problems include skin graft failure, deleyed wound healing, and Rendon exposure and adhesion. A quick and safe method of closure of the large donor site defect creared by the harvest of a RFFF for head and neck reconstruction is described, This flap has been used in 9 of 66 patients who underwent RFFF reconstruction of the pharyngoesophagus, posnnaxillectomy and palate. In all cases the flexor tendons at the wrist were successfully covered. All patients obtained a full range of motion in the wrist and hand without tendon adhesión. The procedure required significant skin mobilization with the potencial disadvantages of denervation of the volar forearm and temporary Iymphedema, Closure of the RFFF donar site with an ulnar rotation­advancement flap can avoid problerns of delayed healing, tendon adhesion, and wrist stiffness (AU)

Tumores Oseos Benignos en Cirugía de Mano / Bone tumors in hand surgery

Los tumores de origen óseo a nivel de la mano son bastante frecuentes. El propósito de este trabajo es exponer nuestra experiencia en el diagnóstico y tratamiento de los mismos. Se presenta una serie de 73 pacientes con el diagnóstico de tumores de origen óseo de naturaleza benigna localizados en la mano y los dedos, en el periodo de tiempo comprendido entre los años 1985 y 2000, ambos inclusive (AU)

Bone tumors are relatively common at hand. The purpose of this arride is to report our experience in the diagnosis and treatment of those tumors.We present 73 cases ofbenign bone rumors localizated at hand and fingers over the period from 1985 to 2000 ( both years included) (AU)

Infecciones de la mano / Hand infections

Presentamos una revisión de 45 pacientes ingresados por uno de los siguientes tipos de infección en la mano: celulitis (24), absceso (13), paroniquia (3), panadizo (2), tenosinovitis (2) y tularemia (1). La causa más frecuente fue una herida traumática (54 por ciento) y el tiempo medio de ingreso de 8 días. Se realizó cultivo en el 62 por ciento de los casos, encontrándose S. Aureus como gérmen más frecuente en el 44 por ciento. El antibiótico más empleado fue una combinación de Amoxicilina/ac. clavulánico en el 85 por ciento de los pacientes. En el 47 por ciento de los casos se realizó tratamiento quirúrgico para drenaje y/o desbridamiento, destacando 2 complicaciones importantes: una necrosis del 3º dedo de la mano derecha, que precisó amputación a nivel de la articulación metacarpofalángica y una necrosis en el dorso del pulgar derecho, que se cubrió con un colgajo en isla (colgajo en cometa) (AU)

[Etiology and treatment of penoscrotal skin defects]. / Etiología y tratamiento de las pérdidas cutáneas penoescrotales.

OBJECTIVE: The influence of the type and extent of debridement on survival of patients with Fournier's gangrene and the efficacy of reconstruction with grafts and residual skin are analyzed. METHODS: The study comprised 43 patients; 35 Fournier's gangrene, 7 trauma and one tumor. The patients with gangrene were treated by debridement, drainage, amputation and antibiotics. Cutaneous grafts and residual skin were used to repair the defect in a second stage procedure. No testicular avulsion was found in the trauma cases. The penile and scrotal injuries were sutured. One burial and one local flap were performed in two penoscrotal avulsions. Skin from the penis was used to repair partial scrotal defects and grafts were applied on the penis. RESULTS: Mortality (21%) was high in partially debrided Fournier's gangrene, penis amputation and in cases undergoing only drainage. Skin grafts for total loss of penoscrotal cover and penile skin flaps for partial scrotal defects achieved good results. Tension suture was unfavorable in the penis, but was well-tolerated in the scrotum. Burial and local skin flaps were not good solutions. Poor results were obtained by conserving residual skin and grafting only the defect. CONCLUSIONS: Early, wide and repeated debridement procedures reduced the mortality in patients with gangrene, and the best results of reconstruction were obtained with split-thickness skin grafts for total loss of penoscrotal cover and penile skin flaps for partial defects of the scrotum.

[Turner's syndrome: growth, endocrinological study and other aspects]. / El síndrome de Turner: Crecimiento, estudios hormonales y otros aspectos.

OBJECTIVE: This was work was designed to analyze, in a group of patients with Turner's syndrome treated at our hospital, the following issues: 1. To follow the evolution of several common values of body growth from birth to adult life, as well as the influence of growth hormone therapy. 2. To determine the changes in gonadotrophins and alterations of the thyroid gland. 3. To define the relationship between the karyotype and the development of menarche. MATERIALS AND METHODS: Neonatal growth values were obtained from 32 patients. Body size before and after the treatment with growth hormone was determined in 20 cases. We determined the values of TSH/T41 and FSH/LH in 35 and 34 cases, respectively. In 34 patients older than 15 years and not treated with estrogens, we evaluated the relationship between the karyotype and the presence of menarche/amenorrhea. RESULTS: Mean values of body length, weight and cranial perimeter were 477 mm, 2,877 g and 335 mm, respectively. These values were below those of the normal population, especially for those patients with a 45.X karyotype. The mean height for adult patients was 141.6 cm (range 133.3- 152 cm). After 2 years of treatment with growth hormone the growth velocity changed from -0.25 to +3.55 SD. We did not find pathological values for TSH or T4 (3.3 mU/l and 1.85 ng%, respectively). The LH and FSH values were higher in 64% and 88% of the patients, respectively. These differences were higher in patients older than 13 years, which showed values of 20 and 60 U/l. Twenty-three percent of the patients had the menarche and none were 45.X. CONCLUSION: The early detection of Turner's syndrome permits the physician to follow these patients, improving their growth and their endocrinological control.