¿Cómo nos ven? Percepción de la población española sobre la especialidad de Cirugía Plástica, Estética y Reparadora / How do people see us? Spanish population's perception of Plastic, Aesthetic and Reconstructive Surgery

Introducción y objetivo: Diversas disciplinas se recogen bajo la especialidad Cirugía Plástica, Estética y Reparadora, sin embargo, en opinión de los autores, se ha ido desvirtuando la percepción que la población tiene sobre esta especialidad. El objetivo de este estudio es conocer la percepción de la población española no sanitaria acerca la especialidad de Cirugía Plástica. Material y método: Estudio observacional, descriptivo, de corte transversal, realizado a través de un cuestionario de 21 preguntas y dirigido a población española no sanitaria o cuya actividad laboral no se desarrollase en un hospital. Resultados: Participaron en el estudio 1038 personas, 80% género femenino y 18% masculino. La distribución de edad fue similar en todos los grupos, excepto los de 25-34 años que tuvieron mayor representación. La mayor parte con estudios superiores. Hubo participantes de todas las Comunidades Autónomas; la más representada fue Galicia con un 53%. El 12% tenía antecedente de intervenciones por Cirugía Plástica en la sanidad pública o mutua laboral, y por Cirugía Estética el 14%. La mayor parte (69%) contempla la subespecialización en Cirugía Plástica tras finalizar la especialidad en Cirugía General como una de las vías de obtención del título, y menos del 40% conoce las vías reales de acceso a la especialidad. Más de un cuarto pensaba que la Cirugía Plástica y la Medicina Estética eran lo mismo, y solo la mitad conocía la existencia de cirujanos plásticos en los hospitales públicos y sabiendo cuál es su campo de trabajo. (AU)

Background and objective: A variety of surgical fields are collected under the specialty Plastic, Aesthetic and Reconstructive Surgery, however, in the authors' opinion, population's perception about this area has been distorted over the years. The aim of this study is to know the perception of the Spanish non-health population about the specialty of Plastic Surgery. Methods: An observational, descriptive, cross-sectional study, was carried out through a questionnaire of 21 questions aimed at a Spanish non-health population or whose work activity was not carried out in a hospital. Results: Participate in the study 1038 people, 80% female gender and 18% male. The age distribution was similar in all groups except for those aged 25-34 who had a higher representation. The majority had higher education. There were participants from all the Autonomous Communities, Galicia being the most represented with 53%. Twelve per cent of participants had a history of interventions by Plastic Surgery in public or mutual health, while Aesthetic Surgery was 14%. Most of the participants (69%) contemplate the subspecialization in Plastic Surgery after finishing the specialty in General Surgery as one of the ways to obtain the title, whereas less than 40% of the participants knew the real ways of access to the specialty. More than a quarter of the participants thought that Plastic Surgery and Aesthetic Medicine were the same, and only half were aware of the existence of plastic surgeons in public hospitals and knowing what their field of work is. (AU)

Impacto de la pandemia COVID-19 en la actividad asistencial urgente de Cirugía Plástica: el confinamiento domiciliario y la nueva normalidad / Impact of the COVID-19 pandemic on urgent Plastic Surgery healthcare: lockdown and the new normal

Introducción y objetivo: Las medidas de distancia social y el confinamiento domiciliario llevado a cabo durante los primeros meses de la pandemia COVID-19 han tenido un gran impacto sobre la carga asistencial en los servicios de urgencias. El objetivo de este estudio es examinar el efecto que esta situación ha tenido en el volumen y características de las urgencias que precisaron valoración por Cirugía Plástica en nuestro centro durante los meses de confinamiento domiciliario y un año después. Material y método: Estudio retrospectivo de pacientes valorados de forma urgente por Cirugía Plástica en el Complejo Hospitalario Universitario de A Coruña (España) entre los meses de marzo y junio de 2019, 2020 y 2021. Resultados: Fueron valorados 1511 pacientes de forma urgente: 552 en el periodo estudiado en 2019, 446 en 2020, y 513 en 2021. La media de edad durante el periodo de confinamiento fue superior (p=0.018). No hubo diferencias por sexo. Existió una disminución de consultas por traumatismo de cabeza y cuello (p=0.047) y miembro superior (p=0.175) durante el confinamiento, y de pacientes quemados en el periodo estudiado en 2021 (p<0.001). Se redujeron de forma significativa las cirugías (p=0.029) e ingresos (p=0.008) en 2021 respecto a la etapa prepandemia. Conclusiones: Durante el confinamiento, objetivamos en nuestro centro hospitalario una disminución del número de pacientes, manteniendo una proporción similar de ingresos y cirugías. Durante el mismo periodo en 2021 hubo una reducción significativa de los ingresos, su duración y de las cirugías. Los motivos de consulta que se redujeron significativamente fueron los traumatismos de cabeza y cuello en 2020 y las quemaduras en 2021 y se redujeron de forma no significativa las consultas urgentes en fin de semana durante el confinamiento. (AU)

Background and objective: Social distancing measures and lockdown accomplished during first months of COVID-19 pandemic have had an impact on the healthcare burden of emergency departments. The aim of this study is to examine the effect this situation had in volume and management of plastic surgery patients in the emergency departments during the lockdown and a year after.Methods: A retrospective chart review of patients who needed Plastic Surgery consultation in the ED at the A Coruña Universitary Hospital, Spain, between March and June of 2019, 2020 and 2021 was performed. Results: 1511 patients were urgently evaluated between March and June of 2019, 2020 and 2021: 552 in 2019, 446 in 2020 and 513 in 2021.The mean age during lockdown was superior (p=0.018). No difference was found in relation to sex. Facial (p=0.047) and upper limb (p=0.175) trauma consults decreased during lockdown, and burn patients decreased in the same period in 2021 (p<0.001). Admissions (p=0.008) and urgent surgeries (p=0.029) decreased significantly in 2021 in relation to before pandemic. Conclusions: During lockdown, we observed a decrease in the number of patients in our hospital center, maintaining a similar proportion of admissions and surgeries. During the same period in 2021, there was a significant reduction in admissions, their duration and surgeries. The reasons for consultation that decreased significantly were head and neck injuries in 2020 and burns in 2021, and urgent consultations on weekends during confinement were reduced in a non-significant way. (AU)

Factores relacionados con el riesgo de reintervención en pacientes operados de reducción cerrada de fractura de huesos propios / Factors related to the risk of reoperation in patients operated on for closed reduction of nasal bone fractures

INTRODUCCIÓN Y OBJETIVO: La fractura de huesos nasales es la fractura facial más frecuente. En relación a la cirugía, la técnica habitualmente empleada ante ella es la reducción cerrada bajo anestesia local o general. Presentamos nuestra experiencia en pacientes intervenidos de fractura de huesos nasales y valoramos el riesgo de reintervención en relación al tipo de técnica anestésica empleada. MATERIAL Y MÉTODO: Recopilamos datos de manera retrospectiva de pacientes intervenidos de reducción cerrada de fractura nasal en nuestro centro entre diciembre de 2014 y junio de 2019. Estudiamos la variable cualitativa analizada (la reintervención) con el test exacto de Fisher y las variables cuantitativas analizadas (días desde el traumatismo hasta cirugía y grados de desviación nasal) con el test U de Mann-Whitney. RESULTADOS: Incluimos 128 pacientes (91 hombres y 37 mujeres). La causa de fractura más frecuente fue la agresión, seguida por el traumatismo por caída y los deportes. Las fracturas por agresión se produjeron con mayor frecuencia los sábados y domingos entre las 3 y las 5 horas de la madrugada. Las fracturas por caída los lunes y martes a la 1 del mediodía. En 99 casos la cirugía se llevó a cabo en las primeras 24 horas, y en 29 pasado ese tiempo. Con respecto a la técnica anestésica, 9 pacientes fueron intervenidos bajo anestesia local, 24 bajo sedación y 95 bajo anestesia general. Tres de los intervenidos con anestesia local y 4 con anestesia general precisaron reintervención por mal resultado tras la primera cirugía. Ninguno de los pacientes intervenidos con sedación fue reintervenido. CONCLUSIONES: En nuestra experiencia, la reducción de la fractura nasal bajo sedación tiene buenos resultados, por lo que consideramos que es una buena alternativa en los casos de fractura nasal quirúrgica para reducir los efectos adversos de la anestesia general

BACKGROUND AND OBJECTIVE: Nasal bone fracture is the most frequent facial fracture. In relation to surgery, the most frequently employed technique is closed reduction under local or under general anesthesia. We present our experience with patients who underwent nasal bone fracture surgery and the risk of reintervention in relation to the type of anesthetic technique used. METHODS: Data were collected retrospectively of patients who underwent closed reduction of nasal fracture in our center between December 2014 and June 2019. Qualitative variable analyzed (reintervention) were studied with Fisher's exact test and the quantitative variables analyzed (days from trauma to surgery and degrees of nasal deviation) with the Mann-Whitney U test. RESULTS: One hundred and twenty-eight patients (91 men and 37 women) were included in the study. The most frequent cause of fracture was aggression, followed by falls and sports. Aggression fractures occurred most frequently on Saturdays and Sundays between 3 and 5 a.m. Fall fractures occurred most frequently on Mondays and Tuesdays at 1 p.m. In 99 cases the surgery was performed in the first 24 hours, while in 29 cases it was performed after that time. Regarding the anesthetic technique, 9 patients were operated under local anesthesia, 24 under sedation and 95 under general anesthesia. Three of the patients operated with local anesthesia and 4 with general anesthesia required reoperation because of poor results after the first surgery. None of the patients operated with sedation were reoperated. CONCLUSIONS: In our experience, nasal fracture reduction under sedation has good results making it a good alternative in cases of surgical nasal fracture reducing the deleterious effects of general anesthesia

Trends in burn injuries in Galicia (Spain): An epidemiological study.

The treatment of burns is one of the earliest medical activities on record, probably because of the powerful impact of their physical consequences among other sequelae. The aim of the present paper is to perform an epidemiological study of burn patients. The data were obtained by reviewing the medical histories of all those patients admitted or treated in the Outpatients Department of the Burn Unit of our hospital between 2013 and 2017. A sample was gathered of 1401 patients, made up of 716 males (51.11%) and 685 females (48.89%), in a ratio of males to females of 1.05, with a mean age of 40.74 years old. The burns were mainly suffered in a domestic setting (60.96%), mostly as a result of contact with hot liquids. Most of the burns were second degree superficial burns (60.03%), and affected a mean total body surface area (TBSA) of 4.61%. They were most often produced on the hands. It was found that the frequency of burns increased during the summer and during the main mealtimes of the day. These data may be used to make specific plans of prevention, and as a basis for new studies and databases to be made.

Experiencia en el manejo de metástasis cerebrales tratadas con radiocirugía estereotáctica / Experience with the radiosurgical treatment of brain metastases

Objetivos: Analizar la supervivencia de una cohorte de pacientes con metástasis cerebrales tratados con radiocirugía y determinar qué factores pueden influir en los resultados. Pacientes y método: Estudio retrospectivo descriptivo sobre una cohorte de 126 pacientes diagnosticados de metástasis intracraneal tratados con radiocirugía. Se excluyeron aquellos casos en los que se realizó cirugía (antes o después de la radiocirugía). Se analizó la supervivencia en función de factores clínicos (edad, sexo, tumor primario), radiológicos (número, localización y volumen de las lesiones) y de radioterapia (dosis de tratamiento, radioterapia holocraneal). Se realizó análisis univariante y multivariante de regresión de Cox. Resultados: Entre febrero de 2008 y abril de 2015 se trataron 225 metástasis cerebrales en 126 pacientes con edad media de 59,8 ± 11,6 años. La mediana de supervivencia fue de 8,2 meses. La supervivencia global a los 6, 12 y 24 meses fue del 60,3, del 31,5 y del 12,8%, respectivamente. Los orígenes más frecuentes fueron pulmonar (59,5%) y mama (14,3%), y la localización principal, los hemisferios cerebrales (77%). El volumen medio fue de 10,35cc (0,2-43,5). Se encontraron como factores significativos de supervivencia, entre otros: edad menor de 60años (p = 0,046), sexo femenino (p < 0,001), cáncer de mama (p < 0,001); KPS > 80 (p = 0,001), puntuación en la escala SIR > 6,5 (p = 0,031), escala GPA ≥ 2,5 (p = 0,003). Conclusiones: La radiocirugía es una técnica adecuada para el tratamiento de las metástasis cerebrales, y entre los factores pronósticos encontrados destacan la edad menor de 60 años, el sexo femenino y las mejores puntuaciones en las escalas de Karfnosky, SIR y GPA

Objective: To analyse the survival rate of a cohort of patients with intracranial metastases treated with radiosurgery, and to determine the factors that influence the results. Patients and method: Retrospective analysis performed on a cohort of 126 patients undergoing radiosurgery for brain metastases. Patients treated with surgery before or after radiosurgery were excluded. Survival is analysed based on clinical (age, sex, primary tumour), radiological (number, location and volume of lesions), and radiotherapy factors (treatment dose, holocraneal radiation). Univariate and multivariate analyses were performed to determine significant prognostic factors. Results: A total of 225 brain metastases in 126 patients, with a mean age of 59.8 ± 11.6 years, were treated between February 2008 and April 2015. The mean survival was 8.2 months. The overall survival rates at 6 months, 1 year, and 2 years were 60.3%, 31.5%, and 12.8%, respectively. Lung (59.5%) and breast (14.3) were the most common primary tumours, and the most common site for metastases was the cerebral hemisphere (77%) and the average volume was 10.35 cc (0.2-43.5). Significant survival factors were: age under 60 (P = .046), female (P < .001), breast cancer (P < .001), KPS > 80 (P = .001), SIR6 > 5 (P = .031), and GPA ≥ 2.5 (P = .003). Conclusions: Radiosurgery is an appropriate technique for the treatment of brain metastases, and the main prognostic factors include being age under 65, female, breast cancer, and good scores on Karnofsky, SIR, and GPA scales

[Experience with the radiosurgical treatment of brain metastases]. / Experiencia en el manejo de metástasis cerebrales tratadas con radiocirugía estereotáctica.

OBJECTIVE: To analyse the survival rate of a cohort of patients with intracranial metastases treated with radiosurgery, and to determine the factors that influence the results. PATIENTS AND METHOD: Retrospective analysis performed on a cohort of 126 patients undergoing radiosurgery for brain metastases. Patients treated with surgery before or after radiosurgery were excluded. Survival is analysed based on clinical (age, sex, primary tumour), radiological (number, location and volume of lesions), and radiotherapy factors (treatment dose, holocraneal radiation). Univariate and multivariate analyses were performed to determine significant prognostic factors. RESULTS: A total of 225 brain metastases in 126 patients, with a mean age of 59.8±11.6years, were treated between February 2008 and April 2015. The mean survival was 8.2 months. The overall survival rates at 6months, 1year, and 2years were 60.3%, 31.5%, and 12.8%, respectively. Lung (59.5%) and breast (14.3) were the most common primary tumours, and the most common site for metastases was the cerebral hemisphere (77%) and the average volume was 10.35 cc (0.2-43.5). Significant survival factors were: age under 60 (P=.046), female (P<.001), breast cancer (P<.001), KPS >80 (P=.001), SIR6 >5 (P=.031), and GPA ≥2.5 (P=.003). CONCLUSIONS: Radiosurgery is an appropriate technique for the treatment of brain metastases, and the main prognostic factors include being age under 65, female, breast cancer, and good scores on Karnofsky, SIR, and GPA scales.