[Surgical treatment in severe dog bites injures in pediatric children]. / Reconstrucción quirúrgica de las lesiones graves por mordedura de perro en niños.

INTRODUCTION: We report a retrospective study of dog-bitten-children who underwent surgical treatment in our department between 1995 and 2005. We checked the different surgical techniques used to cover the defect as well as short and long-term functional and aesthetic results, considering also infection and hospital stay. MATERIALS AND METHODS: During this period of time, 21 patients received surgical treatment because of dogs bites. Surgical approach was decided considering location and severity of lessions. RESULTS: Our serie consists of 12 males and 9 females. Head (71%) and extremities (23%) were the most frequent affected areas. Primary closure was carried out in 18 cases and in the remaining 3 artificial skin or tissue flaps were needed; in these 3 cases the resulting scar was later removed. Surgical infection occurred in less than 10% of the children and in all cases, long-term aesthetic results were considered excellent. CONCLUSIONS: Primary closure of dog-bites-injures improves functional and aesthetic results and reduces the surgical procedures in those patients.

[Aplasia cutis congenita: surgical treatment and results in 36 cases]. / Revisión de 36 casos de aplasia cutis congénita. Protocolo quirúrgico y resultados.

INTRODUCTION: Aplasia cutis congenita is a rare congenital absence of skin most commonly affecting the scalp. Although most defects are small and superficial, approximately 20% of cases involve absence of the skull. Such defects expose the brain and sagital sinus, with concomitant risk of fatal hemorrage, infection, or both. This anomaly most commonly presents as a solitary defect, but sometimes it may occur as multiple lesions. The lesions are noninflammatory and well demarcated, and range is variable from 0.5 cm to 10 cm or more. Although the majority of these scalp defects occurs sporadically, many family cases have been reported. Multiple causes have been suggested for aplasia cutis: genetic causes, syndromes and teratogens, intrauterine infection -varicella zoster virus, herpes simplex virus-, fetal exposure to cocaine, heroin, alcohol or antithyroid drugs. MATERIALS AND METHODS: A retrospective study of children with Aplasia Cutis Congenita who received treatment in Hospital La Paz, in Madrid between 1995 and 2005 was undertaken. We checked location, moment of the surgery, type of surgery and aesthetic results. RESULTS: In the 20 year period between 1985-2005, we treated 36 patients with Aplasia Cutis. 33 of them have the scalp affected and only in 3 cases the trunk was involved. In 4 cases there was an absence of the skull, two slight and two severe. 3 patients had Adams-Oliver and one Cutis Marmorata Telangiectasica syndrome. Fifteen patients were operated in neonatal period with direct closure or advancement or rotational flaps, and in 17 cases the late treatment included use of tissue expanders to cover definitely the defect. One of the patients died for bleeding of the sagital sinus while was waiting for the secondary closure of the wound, and other patient required complex skull reconstruction to achieve a complete coverage. CONCLUSIONS: In view of our experience and results, we believe that early surgery prevents vital risks, reduces local complications and makes easier the final reconstruction.

Reconstrucción quirúrgica de las lesiones graves por mordedura de perro en niños / Surgical treatment in severe dog bites injures in pediatric children

Objetivo. En este trabajo presentamos la serie de pacientes intervenidos en nuestro hospital por mordeduras de perro y que precisaron tratamiento quirúrgico inmediato bajo anestesia general. Se presentan las diferentes opciones quirúrgicas que hemos utilizado, cierre primario, injerto de piel, cobertura con dermis artificial y expansores titulares. Los resultados se valoran a corto y largo plazo desde el punto de vista funcional y estético, asimismo se valoran la infección, la estancia hospitalaria y la morbilidad de estos pacientes. Material y métodos. Veintiún pacientes ingresados en nuestro hospital entre 1995-2005 precisaron tratamiento quirúrgico tras una agresión por perro. En función de la localización y la gravedad de las lesiones se decidió la técnica quirúrgica a emplear. Resultados. De los 21 pacientes, 12 eran hombres (57%) y 9 mujeres (43%). Las zonas afectadas fueron la cabeza en el 71% de los casos, las extremidades en el 23% de los casos y el resto en otras localizaciones. En 18 pacientes se consiguió la reconstrucción total mediante cierre primario. En 3 casos se utilizaron substitutos dérmicos biosintéticos o injertos de piel y posteriormente expansores cutáneos para extirpación de la cicatriz. Las complicaciones infecciosas fueron inferiores al 10% y los resultados estéticos a largo plazo han sido muy buenos. Conclusiones. El cierre quirúrgico primario de las lesiones graves producidas por mordeduras de perro disminuye las secuelas funcionales y estéticas y el número de intervenciones quirúrgicas en estos pacientes (AU)

Introduction. We report a retrospective study of dog-bitten- children who underwent surgical treatment in our department between 1995 and 2005. We checked the different surgical techniques used to cover the defect as well as short and long-term functional and aesthetic results, considering also infection and hospital stay. Materials and methods. During this period of time, 21 patients received surgical treatment because of dogs bites. Surgical approach was decided considering location and severity of lessions. Results. Our serie consists of 12 males and 9 females. Head (71%) and extremities (23%) were the most frequent affected areas. Primary closure was carried out in 18 cases and in the remaining 3 artificial skin or tissue flaps were needed; in these 3 cases the resulting scar was later removed. Surgical infection occurred in less than 10% of the children and in all cases, long term aesthetic results were considered excellent. Conclusions. Primary closure of dog-bites-injures improves functional and aesthetic results and reduces the surgical procedures in those patients (AU)

Revisión de 36 casos de aplasia cutis congénita. Protocolo quirúrgico y resultados / Aplasia cutis congenita: surgical treatment and results in 36 cases

Introducción/Objetivo. La aplasia cutis es una rara enfermedad congénita caracterizada por ausencia de una porción de piel, sobre todo a nivel del cuero cabelludo. Aunque la mayoría de los defectos son pequeños y superficiales, aproximadamente un 20% de los casos incluye ausencia de hueso. Este tipo de lesión expone el cerebro y el seno sagital superior con el riesgo consiguiente de infecciones, hemorragias o ambas. Esta anomalía se presenta generalmente de forma aislada, pero en ocasiones pueden aparecer múltiples lesiones. El defecto es una lesión de tipo no inflamatorio y bien delimitada, que tiene una extensión variable desde 0,5 cm a 10 o más centímetros. Aunque la mayoría de las veces, esta lesión aparece de forma aislada, se han descrito muchos casos familiares. Se postulan múltiples etiologías para explicar la aplasia cutis incluyendo factores genéticos, sindrómicos y teratógenos (infecciones intrauterinas como VVZ, VHS; cocaína, heroína, alcohol y fármacos antitiroideos). El objetivo de este trabajo es presentar nuestro protocolo quirúrgico y experiencia en el tratamiento de esta anomalía. Pacientes y métodos. Hemos revisado 36 pacientes con Aplasia Cutis Congénita tratados en nuestro hospital en los últimos 20 años (1985- 2005). Recogimos datos sobre la localización de esta malformación cutánea, momento de intervención, técnica quirúrgica utilizada y resultado estético. Resultados. De todos los pacientes revisados, 33 tenían afectación del cuero cabelludo y 3 presentaban lesión a nivel del tronco. En 4 pacientes, el defecto incluía al diploe craneal y existía un encefalocele asociado, de carácter leve en dos casos y severo en otros dos. Tres pacientes eran portadores del Síndrome de Adams Oliver y uno de Cutis Marmorata Telangiectásica Congénita. En 15, el tratamiento quirúrgico se llevó a cabo en el periodo neonatal (cierre primario del defecto, colgajo de rotación, injerto…) y en 17 el tratamiento diferido incluyó la aplicación de expansores tisulares para la cobertura definitiva de la zona alopécica. Uno de los pacientes falleció por rotura del seno longitudinal a la espera de epitelización espontánea y otro precisó derivación ventrículo- peritoneal, extirpación del encefalocele y cobertura con colgajo libre para cierre del defecto. Conclusiones. A la vista de nuestra experiencia parece evidente que la cobertura precoz del defecto no solo disminuye el riesgo vital, sino que además reduce significativamente las complicaciones locales y facilita la reconstrucción definitiva (AU)

Introduction. Aplasia cutis congenita is a rare congenital absence of skin most commonly affecting the scalp. Although most defects are small and superficial, approximately 20% of cases involve absence of the skull. Such defects expose the brain and sagital sinus, with concomitant risk of fatal hemorrage, infection, or both. This anomaly most commonly presents as a solitary defect, but sometimes it may occur as multiple lesions. The lesions are noninflamatory and well demarcated, and range is variable from 0,5 cm to 10 cm or more. Although the majority of these scalp defects occurs sporadically, many family cases have been reported. Multiple causes have been suggested for aplasia cutis: genetic causes, syndromes and teratogens, intrauterine infection -varicella zoster virus, herpes simplex virus-, fetal exposure to cocaine, heroin, alcohol or antithyroid drugs. Materials and methods. A retrospective study of children with Aplasia Cutis Congenita who received treatment in Hospital La Paz, in Madrid between 1995 and 2005 was undertaken. We checked location, moment of the surgery, type of surgery and aesthetic results. Results. In the 20 year period between 1985-2005, we treated 36 patients with Aplasia Cutis. 33 of them have the scalp affected and only in 3 cases the trunk was involved. In 4 cases there was an absence of the skull, two slight and two severe. 3 patients had Adams-Oliver and one Cutis Marmorata Telangiectasica syndrome. Fifteen patients were operated in neonatal period with direct closure or advancement or rotational flaps, and in 17 cases the late treatment included use of tissue expanders to cover definitely the defect. One of the patients died for bleeding of the sagital sinus while was waiting for the secondary closure of the wound, and other patient required complex skull reconstruction to achieve a complete coverage. Conclusions. In view of our experience and results, we believe that early surgery prevents vital risks, reduces local complications and makes easier the final reconstruction (AU)