Reconstrucción del pezón. Análisis comparativo de experiencia con dos técnicas: injerto de segmento de pezón contralateral y colgajo V-C / Nipple reconstruction. Comparative analysis of experience with two techniques: contralateral nipple segment graft and V-C flap

Introducción y objetivo: La reconstrucción del complejo areola-pezón es la culminación del proceso de reconstrucción mamaria. Genera pacientes más satisfechas y aporta beneficios psicológicos. Sin embargo, las pacientes están más satisfechas con la reconstrucción del montículo mamario. La reconstrucción del pezón sigue siendo un tema pendiente de resolución. Existen numerosas técnicas publicadas. En este trabajo evaluamos nuestra experiencia con dos técnicas usadas frecuentemente: el injerto de un segmento del pezón sano y el colgajo V-C, para determinar cuál nos ofrece mejores resultados. Material y método: Estudio retrospectivo de pacientes intervenidas de reconstrucción mamaria heteróloga en el Complejo Hospitalario Universitario de A Coruña (España) entre 2010 y 2014, en las que se efectuaron dos técnicas de reconstrucción del pezón: colgajo V-C e injerto de segmento de pezón contralateral, analizando los parámetros posición, diámetro, proyección, color y sensibilidad, tanto por el personal médico como por las pacientes y sometiendo los resultados obtenidos a estudio estadístico. Resultados: Analizamos 25 pacientes (16 injertos y 9 colgajos). La posición fue adecuada en todos los casos. Los parámetros diámetro y proyección no mostraron diferencias estadísticamente significativas entre ambas técnicas. Sí se observaron en el color y la sensibilidad. Los pezones reconstruidos con colgajo V-C tenían un color más claro y eran menos sensibles. Conclusiones: En nuestra revisión de casuística personal, la reconstrucción del pezón mediante injerto de un segmento del pezón contralateral sano ofrece mejores resultados en cuanto a color y a sensibilidad que la reconstrucción con un colgajo V-C en pacientes con reconstrucción heteróloga del montículo mamario. (AU)

Background and objective: Nipple-areola complex reconstruction is the culmination of the mammary reconstruction process. It generates more satisfied patients and brings psychological benefits. However, patients are more satisfied with the reconstruction of the breast mound. The reconstruction of the nipple is a pending issue. There are many published techniques. In this study we evaluate our experience with two techniques frequently used for nipple reconstruction: contralateral nipple segment graft and V-C flap, to determine which one offers us better results. Methods: Retrospective study on patients who undergone heterologous mammary reconstruction operated at the University Hospital Complex of A Coruña (Spain), between 2010 and 2014, using two techniques of nipple reconstruction: V-C flap and contralateral nipple segment graft. Parameters such as position, diameter, projection, color and sensitivity were assessed, both by the medical staff and by the patients, and the results obtained were submitted to statistical study. Results: A total of 25 patients (16 grafts and 9 flaps) were stu- died. Nipple position was adequate in all cases. Diameter and projection showed no statistically significant differences between the two techniques. However, significant differences were observed in color and sensitivity. Reconstructed V-C flap nipples were lighter in color and less sensitive. Conclusions: In our personal casuistry review, nipple reconstruction by grafting a healthy contralateral nipple segment offers better results in terms of color and sensitivity than the reconstruction with a V-C flap in patients with heterologous reconstruction of the breast. (AU)

The Use of Antidotes for Calcium Gluconate Extravasation: An Experimental Study in Mice.

BACKGROUND: Calcium gluconate extravasation is a process that can cause serious lesions, such as necrosis and calcification of the soft tissues. The aim of the present study was to analyze the beneficial effects of four possible local antidotes for calcium gluconate extravasation: hyaluronidase, sodium thiosulfate, triamcinolone acetonide, and physiologic saline solution. METHODS: Seventy-four BALB/c mice were used in the study. The substances selected for use in this study were calcium gluconate (4.6 mEq/ml), hyaluronidase (1500 IU/ml), sodium thiosulfate (25%), triamcinolone acetonide (40 mg/ml 0.5 mg/kg), and saline solution 0.9%. Five minutes were allowed to lapse after the calcium gluconate infiltration, and then an antidote was infiltrated. After 3 weeks, a skin biopsy was performed and a radiographic and histologic study was carried out. RESULTS: Only in the group infiltrated with sodium thiosulfate did all skin lesions disappear after the 3-week period after infiltration. In the radiographic study, calcium deposits larger than 0.5 mm were observed in 40 percent of cases without an antidote, in 33 percent with triamcinolone acetonide, in 13 percent with a saline solution, and in none with thiosulfate and hyaluronidase. In the histologic study, calcium deposits were found in 53 percent of cases without antidote, 100 percent of cases with triamcinolone acetonide, 33 percent of cases with saline solution, and 13 percent of cases with sodium thiosulfate or hyaluronidase. CONCLUSION: Sodium thiosulfate and hyaluronidase prevent the development of calcium deposits after calcium gluconate extravasation.

Síndrome del apex orbitario postraumático / Orbital apex post-traumatic síndrome

Introducción y Objetivo. El síndrome del ápex orbitario (SAO) es un cuadro grave pero afortunadamente poco frecuente que implica un compromiso de la órbita con afectación del nervio óptico en el ápex. El diagnóstico suele ser difícil y el tratamiento complejo, debiendo incluir medidas de soporte y protección ocular, medicamentos endovenosos como diuréticos y/o corticoides, y en algunos casos llega a necesitar descompresión quirúrgica precoz. El pronóstico depende del tipo y complejidad de la lesión pero también de la precocidad con que se inicie el tratamiento médico o quirúrgico para evitar lesiones irreversibles de las estructuras intraorbitarias derivadas del aumento de la presión en el compartimento. Este trabajo pretende evaluar los casos de síndrome del ápex orbitario postraumático diagnosticados y tratados en nuestro centro hospitalario. Material y Método. Llevamos a cabo una revisión retrospectiva de las bases de datos. Describimos el diagnóstico clínico y por imagen, el tratamiento realizado, las diversas formas de evolución de los pacientes y las secuelas. Resultados. Encontramos y evaluamos un total de 3 casos registrados entre 2007 y 2013, con edades entre 28 y 72 años; 2 hombres y 1 mujer. El origen del síndrome fue un traumatismo de alta energía sobre la región orbitaria/ malar de la cara en todos los casos. Un paciente no precisó tratamiento quirúrgico urgente y los otros 2 necesitaron tratamiento quirúrgico precoz. En 2 casos no se documentaron secuelas permanentes, sin embargo 1 desarrolló ceguera irreversible. Conclusiones. El SAO es una entidad proco frecuente relacionada con traumatismos faciales de alta energía. Su sospecha diagnóstica es indispensable para el enfoque adecuado del tratamiento y suele estar apoyada por medios radiológicos disponibles en cualquier hospital. El tratamiento debe ser precoz para evitar secuelas permanentes; debe incluir estabilización del paciente garantizando la permeabilidad de la vía aérea, corticoides a altas dosis, antibióticos profilácticos y cirugía de revisión de la órbita, que puede ser diagnóstico-terapéutica en casos de oftalmoplejia total con exoftalmos progresivo (AU)

Background and Objective. Orbital apex syndrome (OAS) is a serious and infrequent condition affecting the orbit with involvement of the optic nerve at the apex level. Diagnosis is often difficult and complex. Treatment includes supportive measures and eye protection, intravenous medications such as diuretics and/or corticosteroids and in some cases early surgical decompression is necessary. The prognosis will depend of the type and complexity of the lesion, but also on the precocity of medical or surgical treatment to avoid the irreversible damage of the intraorbital structures, derived from the increase of the pressure inside the compartment. This paper aims to retrospectively review the cases of post-traumatic orbital apex syndrome diagnosed and treated in our hospital. Methods. We conduct a retrospective review of our data base and describe the clinical and imaging diagnosis, the treatments performed, the different forms of evolution and the sequel of this syndrome. Results. Three cases were registered and evaluated between 2007 and 2013. The ages of the patients ranged from 28 to 72 years; 2 men and 1 woman. The origin of the syndrome was in all cases high energy trauma on the orbital/ malar region of the face. One patient did not require urgent surgical treatment, but the other 2 cases required early surgical treatment. In 2 cases no permanent sequel was documented, however 1 of them remained with irreversible blindness. Conclusions. OAS is an infrequent entity related to high energy facial trauma. Diagnostic suspicion is essential for an adequate approach to treatment and is usually supported by radiological means available at any hospital. Treatment should be done early to avoid the permanent consequences. This should include stabilization of the patient ensuring airway permeability, highdose corticosteroids, prophylactic antibiotics and orbital revision surgery, which may be diagnostic-therapeutic in cases of total ophthalmoplegia with progressive exophthalmos (AU)

Lesions Associated With Calcium Gluconate Extravasation: Presentation of 5 Clinical Cases and Analysis of Cases Published.

INTRODUCTION: Calcium gluconate extravasation is a process, which, while not common, occurs more frequently in neonatal intensive care units. The aim of this study is to present a number of cases of calcium gluconate extravasation, which have occurred in our hospital, and to carry out a review of those clinical cases published in the literature to obtain relevant epidemiological data. METHODS: Data were gathered on the medical histories of 5 patients who presented lesions secondary to calcium gluconate extravasation in our center. A review of the literature was also performed to include clinical cases of calcium gluconate extravasation already published. RESULTS: Data were collected on 60 cases published in 37 articles. Most patients (55%) were neonates. The average age of these neonates was 8 days. The commonest location of injuries was the back of the hand and wrist (42%). The 2 most frequent symptoms were the appearance of erythema (65%) and swelling/edema (48%) followed by the appearance of skin necrosis (47%), indurated skin (33%), and yellow-white plaques or papules (33%). Most cases are cured within a period of 3 to 6 months. Fifty percent of patients required surgery, and in 13% of cases, skin grafts were performed. The most frequent histological finding was the presence of calcium deposits. Other histological findings described were the presence of necrosis, lymphohistiocytic infíltrate, and granulomas. Most histological findings were located in the dermis. Most x-rays showing calcium deposits had been performed at 3 to 4 weeks. CONCLUSIONS: Calcium gluconate extravasation is a process, which, although infrequent, is associated with serious skin and soft-tissue lesions, mainly affecting infants. Further studies are needed to determine possible specific procedures to be carried out in these cases.

Intraneural Venous Malformations of the Median Nerve.

Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation.