Comparison of Nasal Analysis by Photographs (2D) against Low-cost Surface Laser Imaging (3D) and against Computed Axial Tomography Imaging.

Introduction In aesthetic surgery, we have a few evaluation tools that numerically and objectively measure the changes we make in patients. This article aimed to evaluate the nasal systematic analysis and compare findings between the three systems of nasal evaluation: photographs 2D, 3D surface imaging with the Kinect system, and 3D CT scan imaging. Methods We designed a longitudinal and descriptive prospective study with simple non-blind randomization. To compare the systematic nasal analysis between the three methods. If the findings are similar, all three methods would be useful in independent clinical scenarios. Results A total of 42 observations were included finding a minimum age of 21 with a mean of 28 years old. Also, 64% were female, 93% had adequate facial proportions, and 50% were Fitzpatrick III. For outcome statistics, we found differential nasal deviation between 3D images with a mean of 6.53 mm. While when comparing the nasal dorsum length, we found a statistical significance of p = 0.051. When comparing the nasal dorsum length index, we found no significant difference p = 0.32. Also, we did not find statistical significance when comparing the nasofrontal angle and tip rotation angle p = 1 for both. Conclusion We found that the population we serve has characteristics of Hispanic mestizo nose. The three methods seem to evaluate systematic nasal analysis in a very similar way, and any of them can be used depending on the scenario and the needs of plastic surgeons.

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Auricular Total Reconstruction with Radial Forearm Prelaminated Flap Assisted by 3D Surface Imaging and 3D Printing.

The anatomic position of the auricle leaves it vulnerable to traumatic lesions. In most cases, the best reconstructive outcome is accomplished using a temporoparietal flap with a costal cartilage frame and a partial thickness skin graft. Exceptional cases may require different approaches because the reconstructive goals could be more structural than aesthetic. An important factor in this regard is the mechanical properties of the skin that will provide coverage. This study aimed to share a particular case of total auricular reconstruction assisted by 3D surface imaging and 3D printing in a radial forearm free flap. We present a 58-year-old man with a history of having tympanic barotrauma causing hearing loss, burdening him with the use of auricular devices for hearing assistance. Seven days before presenting for the initial treatment, he sustained ear trauma while performing mechanical reparations in a car. The wheel was activated, causing a total amputation of the right ear. He first went to another hospital' where they performed primary closure and then referred him to our unit. The team performed a prelaminated radial forearm free flap assisted by 3D scanning and planning. A detailed comparison between the left ear and the result of the reconstruction was measured and described. The radial forearm prelaminated free flap is a viable structural alternative with the disadvantage of poor auricular definition in some cases.

Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps.

BACKGROUND: Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported. METHODS: We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia. RESULTS: The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps. CONCLUSIONS: A better understanding of the fat layers' thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.

16 Sesamoid bones in the hands of healthy patient: case report

The sesamoid bones are round or oval bones that are located within tendons, and most theories consider that sesamoid bones in humans develop in response to local mechanical stress on a joint. Although their function is not well understood, it is known that they act as a pulley modifying the angle of movement and their insertion. They are mostly inconsistent, which is why they tend to be supernumerary and are located in different parts of the body at the level of the extremities, with the patella being the largest, most constant and best known. The prevalence and distribution of sesamoids in the hand varies between different populations and sex. They are rarely reported since they are only considered anatomical variants, but clinically there are several pathologies related to the sesamoid bones in the hand such as: trauma, degenerative disorders, giant cell tumors, osteochondroma, avascular necrosis, tendon ruptures, genetic disorders and attention should be paid in patients with acromegaly where their length is increased. In this article, we report a total of 16 sesamoid bones, symmetrically distributed 8 ineach hand of a healthy individual treated in the Plastic Surgery Department of the "Dr. Rubén Leñero" Hospital in Mexico City. In the literature reviewed, we did not find a report with the presence of so many sesamoid bones in both hands, which motivated us to report it

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Reparación aguda de los tendones flexores / Acute flexor tendon injury repair

Para la correcta ejecución de la Cirugía de Mano es necesario conocer su anatomía, fisiología, biomecánica, así como las diferentes técnicas quirúrgicas. La función principal del tendón es la transmisión de fuerza desde el vientre muscular de origen hacia el hueso final donde se inserta; en el caso de los tendones flexores, la fuerza muscular da como resultado la flexión de los dedos. El objetivo del presente trabajo es conocer la anatomía de los tendones flexores de la mano, el diagnóstico de sus principales lesiones y repasar las principales técnicas quirúrgicas para su tratamiento. El autor lleva a cabo una revisión de los principios básicos de cicatrización tendinosa, de la identificación de las zonas de lesión de los tendones flexores de la mano, de los métodos para su diagnóstico, de las técnicas quirúrgicas para su tratamiento y de su manejo postoperatorio, basándose en los hechos históricos más importantes relativos a todos estos conocimientos y a sus propias aportaciones y experiencia (AU)

In order to archive a correct execution of Hand Surgery, to know the anatomy, physiology, biomechanics and specific surgical techniques is mandatory. The main function of tendons is strength transmission from its origin in the muscular body to the insertion at bone. In flexor tendons, muscular strength has as a result finger flexion. The aim of this paper is to know the anatomy of the flexor tendons of the hand, the diagnostic of their main injuries and to review the most important surgical techniques for their treatment. The author review the basic principles about tendon healing, the identification of the zones of flexor tendons lesions in the hand, the methods for diagnostic, the surgical techniques for treatment, and the postoperative management, based on the most important historic advances and on his own experience and contributions (AU)