Muscle transposition for the treatment of paralytic strabismus. Retrospective review of 23 cases / Transposição muscular para o tratamento do estrabismo paralítico. Revisão retrospectiva de 23 casos

Abstract Introduction: Muscular transposition procedures are used when there is no ocular rotation in a particular direction due to alterations of the extraocular muscles such as paralysis, agenesis or congenital anomalies. The objective of this study is to characterize the patients treated with this procedure and determine the percentage of correction of the deviation angle obtained after surgery in the Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology Unit. "Dra. Ana María Illescas Putzeys", Hospital de ojos y oídos "Dr. Rodolfo Robles V. Methods: A retrospective, descriptive, observational study was conducted with review of records of patients operated on muscle transposition during the years 1999 to 2016. Results: Twenty-three rectus muscle transposition procedures were performed. Thirteen were male (56.5%). The mean age was 42 years. In our series, an average correction of 42 PD (82%) was obtained regardless of the type of paralysis or the surgical procedure performed. Conclusion: In selected cases of paralytic strabismus, the main approach may be only muscle transposition with augmentation (posterior intermuscular fixation suture), with good results, similar to those obtained with muscle transposition using adjuvants such as botulinum toxin treatment.

Resumo Introdução: Os procedimentos de transposição muscular são utilizados quando não há rotação ocular em nenhuma direção determinada devido a alterações dos músculos extraoculares, como paralisia, agenesia ou anomalias congênitas. O objetivo deste estudo é caracterizar os pacientes tratados com este procedimento e determinar a porcentagem de correção do ângulo de desvio obtida após a cirurgia na Unidade Pediátrica de Oftalmologia, Estrabismo e Neuro-Oftalmologia. "Dra. Ana María Illescas Putzeys", Hospital de ojos y oídos "Dr. Rodolfo Robles V. Métodos: Foi realizado um estudo retrospectivo, descritivo, observacional, com revisão dos registros de pacientes operados para transposição muscular nos anos de 1999 a 2016. Resultados: Foram realizados vinte e três procedimentos de transposição do músculo reto. Treze pacientes eram homens (56,5%). A idade média foi de 42 anos. Em nossa série, foi obtida uma correção média de 42 PD (82%), independente do tipo de paralisia ou do procedimento cirúrgico realizado. Conclusão: Em casos selecionados de estrabismo paralítico, a principal abordagem pode ser apenas a transposição muscular com aumento (sutura de fixação intermuscular posterior), com bons resultados semelhantes aos obtidos com a transposição muscular com a utilização de adjuvantes como o tratamento com toxina botulínica.

Modified technique of bilateral gluteus maximus transposition for reconstruction of sphincter for pediatric traumatic fecal incontinence.

PURPOSE: The aim of the study was to report our 13-year experience of 14 children with gluteus maximus muscular transposition to treat post-trauma fecal incontinence and discuss our technical modifications to this surgical procedure. METHODS: Fourteen children (median age: 9.9years) with complete fecal incontinence after traumas received this procedure from December 1998 to February 2011. The major modification of the surgery was that we transposed two thick muscular bundles about 2cm in diameter bilaterally. They surrounded the middle portion of rectum to act as sphincters. We used dynamic defecography and anorectal endosonography to observe the functions of the transposed muscles. Wexner scores, fecal incontinence quality of life questionnaire and self-rated health measurement scale scores had been used to evaluate their life quality. RESULTS: The median follow-up time was 6.3years. Twelve children reported prominently improved fecal controls with reduced stool frequency. Postoperative dynamic defecography and anorectal endosongraphy vividly demonstrated the satisfactory voluntary contractile and relaxed states of the reconstructed muscle. Wexner scores were significantly improved both 1year and 2years after the procedure (P<.05). Two year after surgery, rectal maximum systolic pressure, contraction duration and maximum systolic volume significantly increased compared with the results before and 1year after surgery (P<.05) CONCLUSIONS: This modified technique of bilateral gluteus maximus transposition for reconstruction of sphincter efficiently improved fecal control and life quality for pediatric patients with traumatic fecal incontinence.