Craniofacial Fibrous Dysplasia: Surgical Management and Long-Term Outcomes at a Referral Center in Mexico City.

Background Craniofacial fibrous dysplasia (CFD) is an uncommon benign condition in which a bone is replaced by fibrous tissue. An adequate clinical characterization considering the number of affected bones and functional impairment is important to determine the most effective surgical intervention for its management. This study aims to present our institution's experience in the evaluation and management of CFD. Methods This was a retrospective study that included patients with CFD managed at our institution. Data included demographic characteristics, afflicted bones, surgical procedures performed, and recurrence. Results are presented as mean and percentages. Recurrence-free years and association between the type of surgery and recurrence was evaluated. Results Eighteen patients were included (11 females, 61%). The zygomatic, maxillary, and frontal bones were the most commonly affected with eight (18%) cases each. The most common procedure was bone burring, with 36 procedures. Recurrence was more prevalent after burring (58.3%) and occurred earlier than in the bone resection group (13 vs. 15 years, p > 0.05). Conclusion Surgery continues to be the cornerstone of CFD treatment. Bone burring is effective for debulking and contouring but increases the risk for recurrence. An individualized approach should be tailored according to the anatomical location of the disease, type of CFD, behavior of the lesion, and accompanying clinical complaints.

Linfedema escrotal masivo: Reporte de caso y revisión de la literatura / Massive scrotal lymphedema: case report and literature review

El lindefema masivo localizado es una condición rara pero su incidencia se encuentra en aumento. El linfedema puede ser primario o secundario a infecciones, radioterapia, cirugías, cáncer, enfermedades del sistema inmune o a compresión. Algunos autores han sugerido un incremento en su incidencia debido a la epidemia de obesidad. El linfedema escrotal produce una morbilidad importante debido a mala higiene, infecciones, incontinencia urinaria, disfunción sexual, pérdida de la libido e inclusive limitación en la deambulación. Las opciones de tratamiento no quirúrgico de la linfedema incluyen el drenaje linfático manual, prendas de compresión, terapia física y ejercicio. Usualmente, el tratamiento conservador falla debido a la dificultad anatómica que presenta la región genital para la aplicación de dichas terapias. El tratamiento quirúrgico puede ser efectivo en casos graves y moderados. Existen diferentes variantes a la técnica quirúrgica, pero la resección del tejido afectado y la reconstrucción con tejido sano es primordial. El pronóstico de esta patología tiende a ser bueno; sin embargo, se reporta una alta tasa de recidiva.

Massive localized lymphedema is a rare but rising condition that could be primary in nature or secondary to infections, radiation, surgery, malignancies, autoimmune or compression. Some authors have suggested and increased incidence due to the raising epidemic of obesity. Scrotal lymphedema causes significant morbidity such as poor hygiene, infections, urinary incontinence, sexual dysfunction, loss of libido and a limited ambulation. Although non operative treatment options for lymphedema include manual lymph drainage, compression garments, exercises, sequential gradient pump. Usually, non-operative techniques fail due to the difficult in the anatomic area. Surgical treatment can be effective in moderate to severe cases of giant scrotal lymphedema. There are many variations of the surgical technique, however, resection of the affected tissue and reconstruction with healthy skin is primordial. The prognosis tends to be good, although there is reported a significant amount of relapse, mostly dependent on the weight lost and diet of the patients

Experience in the management of acute wounds by dog bite in a hospital of third level of plastic and reconstructive surgery in Mexico.

BACKGROUND: Dog bite injuries represent an important public health problem, involving all levels of care. They can vary in severity, from superficial wounds (skin and subcutaneous tissue) to devitalization and tissue loss, with the presence of systemic infections, aestethic and functional sequels that require specialized treatment. OBJECTIVE: To describe and share the 7-year experience in the management of dog bite wounds in a plastic and reconstructive surgery referral center in Mexico. METHOD: A retrospective study was conducted where all patients with dog bite wounds that came to the plastic and reconstructive emergency department were enrolled from July 2010 to August 2017. The collected patient demographic characteristics included age, age group, and sex. The collected injury variables included anatomical location, wound characteristics, antibiotic therapy and therapeutic management. RESULTS: A total of 416 patients were enrolled, 63% of the dog bites occurred in children under 18 years of age. The majority of the wounds were found in an isolated anatomical region 88.2%. The most frequent location was the face in 61.3%. Of all the cases 74.3% were treated only with primary wound closure, 21.4% also required some reconstructive surgical procedure, 2.9% did not require wound closure, and 1.4% were hospitalized. All patients received prophylactic antibiotics. 2% reported infection after the management with primary wound closure. CONCLUSIONS: The right management of dog bite wounds in all the health care levels improve the patient prognosis. Complex dog bite wounds must be treated immediately by the plastic and reconstructive surgery department in second or third levels of healthcare. Most of the wounds can be managed by primary closure and other reconstructive techniques with confidence.

ANTECEDENTES: Las heridas por mordedura de perro constituyen un problema de salud pública creciente que involucra a todos los niveles de atención. Pueden variar en gravedad, desde heridas superficiales (piel y tejido subcutáneo) hasta desvitalización y pérdida de tejidos, con presencia de infecciones, complicaciones y secuelas estéticas y funcionales que requieren tratamiento especializado. OBJETIVO: Describir la experiencia de 7 años en el manejo de heridas por mordedura de perro y proponer un algoritmo de manejo en un centro de referencia en cirugía plástica y reconstructiva en México. MÉTODO: Se realizó un estudio retrospectivo en el que se incluyeron todos los registros de pacientes con heridas por mordedura de perro entre julio de 2010 y agosto de 2017. Las variables recabadas fueron edad, sexo, localización anatómica, características de la herida y manejo terapéutico. RESULTADOS: Se obtuvo un total de 416 pacientes. El 63% de las lesiones ocurrieron en menores de 18 años. La mayoría de las heridas (88.2%) fueron aisladas en una región anatómica. La localización más frecuente fue la cara (61.3%). De todos los casos, el 74.3% se resolvieron solo con cierre primario, el 21.4% requirió además algún proceso reconstructivo, el 2.9% no requirió cierre y el 1.4% de los pacientes fueron hospitalizados. Todos los pacientes recibieron antibióticos profilácticos. El 2% reportaron infección posterior al manejo con cierre primario. CONCLUSIONES: El correcto abordaje de las heridas por mordedura de perro en todos los niveles de atención mejora el pronóstico de los pacientes. Las heridas complejas deben ser manejadas inmediatamente en un centro de segundo o tercer nivel con cirugía plástica y reconstructiva. La mayoría de las heridas por mordedura de perro pueden ser reparadas con cierre primario y otras técnicas reconstructivas con seguridad.

Cicatrización normal y patológica: una revisión actual de la fisiopatología y el manejo terapéutico / Current concepts of the approach and treatment of normal and pathological wound healing: a literature review

El conocimiento del proceso de cicatrización normal y patológica es fundamental para todas las especialidades médicas y quirúrgicas que tratan heridas agudas y crónicas, ya que del efecto de estos procesos dependerá el resultado final del tratamiento quirúrgico. En cada tejido y órgano dentro del organismo existen diferentes mecanismos que regulan la función y homeostasis celular, como sucede en el proceso de cicatrización, en donde participan y contribuyen una serie de fases y factores mediados por células y señales químicas. Una cicatrización aceptable es aquella que deja una adecuada cicatriz externa, devuelve la normalidad anatómica y funcional del tejido, con lo que se espera llegar a tener un resultado final con éxito; Sin embargo se debe entender que este proceso es complejo, y pueden también existir variantes anormales, determinadas por ciertos factores que intervienen para dar resultado a una cicatriz patológica, para lo cual existen diferentes tipos de tratamientos específicos y coadyuvantes para cada una de ellas. Objetivo: Conocer los conceptos actuales en el abordaje y tratamiento de la cicatrización normal y patológica, ofreciendo al cirujano una guía práctica basada en los fundamentos de las investigaciones científicas actuales. Material y métodos: Se realizó una revisión bibliográfica de artículos recientes acerca de cicatrización publicados entre 2010 a 2018, con alto nivel de evidencia

The knowledge of normal and pathological wound healing process is essential for all the medical and surgical specialties that treat acute and chronic wounds, because the final result will depend on the effect of these processes. In each tissue and organ within the organism there are different mechanisms that regulate cellular function and homeostasis, as in the wound healing process, where a series of phases and factors mediated by cells and chemical signals participate. Acceptable wound healing, although it leaves an external scar, restores the anatomical and functional homeostasis of the tissue,which is expected to have a successful result; However, it must be understood that this is a complex process, and therefore may also exist abnormal variants, determined by certain factors that lead to pathological wound healing, hence different types of treatments and coadjuvants therapies are available. Objective: Comprehend the current concepts in the approach and treatment of normal and pathological wound healing, offering the surgeon a practical guide based on state of the art evidence, Material and Methods: A literature review of recent articles published between 2010 and 2018 was carried out, with a high level of evidence

Surgical Resection of Vascular Lesions Involving the Buccal Fat Pad.

Vascular abnormalities are localized structural irregularities, which are performed during vasculogenesis, angiogenesis, and lymphangiogenesis. The involvement of soft tissue in such vascular malformations is frequent; however, the compromising of the buccal fat pads (Bichat bags) is uncommon, even in specialized centers, such as the plastic clinic of our institution, in which very few patients have been reported in the literature. The purpose of this article is to present a series of 2 patients in which vascular malformations involving the buccal fat pads, which were extracted by intraoral approach.

Viral etiology of lower respiratory tract infections in hospitalized children in Mexico.

BACKGROUND: Respiratory viruses are the main cause of lower respiratory tract infections (LRTI) reported worldwide. The contribution of viral infections to respiratory infections in Mexico has not been fully determined. OBJECTIVE: To determine the contribution of viral infections in hospitalized children with LRTI. METHODS: Children younger than 15 years of age with the admission diagnosis of LRTI were eligible for this study. A nasal wash specimen for virus identification by direct immunofluorescent assay (DFA) was obtained as soon as possible after admission. Clinical and radiographic findings of children with positive and negative detection of viruses were compared. RESULTS: Of 285 subjects admitted to the hospital with LRTI, 265 (93%) had an appropriate specimen for DFA. A viral agent was detected in 125 (47.2%) specimens. Viruses that were identified included respiratory syncytial virus (107), influenza (9) and parainfluenza type 3 (9). Clinical and radiologic diagnoses included bronchiolitis (127), interstitial pneumonia (47) and pneumonia (91). Of the subjects included in the study, 71.3% were younger than 1 year of age. Children with a confirmed viral etiology for their LRTI were younger, had higher respiratory rates on admission and were more likely to present with bronchiolitis than subjects with a negative DFA result. CONCLUSIONS: Respiratory viruses are responsible for at least 47.2% of LRTI requiring hospitalization at our hospital. Respiratory syncytial virus was the most important respiratory agent identified.