IV Reunión de consenso de la Sociedad Española de Trasplante Hepático (SETH) 2012. Trasplante hepático con injertos no convencionales: bipartición hepática (split) y donante en asistolia / IV Consensus meeting of the Spanish Society of Liver Transplantation (SETH) 2012. Liver transplant with non-conventional grafts: Split liver transplantation and non-heart beating donors

El desequilibrio entre el número de candidatos a trasplante hepático y el número de injertos hepáticos disponibles conduce a la mortalidad en lista de espera para trasplante. Dos posibles fuentes de aumentar el número de injertos hepáticos son la bipartición hepática y los donantes en asistolia. Ambas fueron estudiadas en una reunión de consenso de la Sociedad Española de Trasplante Hepático en octubre de 2012. Este artículo recoge las conclusiones de esta reunión

The disbalance between the number of candidates to liver transplant and the number of liver grafts leads to waiting list mortality. Two potential ways of increasing the number of liver grafts are split liver transplantation and the transplantation of grafts from non-heart beating donors. Both of them were discussed in a consensus meeting of the Spanish Society of Liver Transplantation in October 2012. This paper outlines the conclusions of that meeting

Reconstrucción de la subunidad estética de la ceja con un colgajo temporal en isla de cuero cabelludo / Aesthetic reconstruction of the eyebrow unit using a temporal island scalp flap

La reconstrucción de las cejas juega un papel importante en la Cirugía Reconstructiva facial, debido a que la ausencia o deformidad de las mismas altera la expresión y las características de la cara, ejerciendo una influencia poderosa en la apariencia de la región periorbitaria, así como en el aspecto y en la autoestima de los pacientes. Describimos una técnica quirúrgica basada en el empleo de un colgajo temporal en isla de cuero cabelludo para la reconstrucción de la subunidad estética de la ceja y presentamos 3 casos de pacientes con defectos alopécicos de las cejas reconstruidos mediante dicha técnica (AU)

Eyebrow reconstruction plays an important role in facial Reconstructive Surgery. Absence or deformity of the eyebrows alter the expression and other features in the face exerting a powerful influence in the appearance of the periorbital region, so in the aspect as well as in the self-esteem of the patients. This paper describes the use of a temporal island scalp flap technique to reconstruct the eyebrow unit and we present 3 patients who underwent eyebrows reconstruction with this technique (AU)

Morphometric analysis of the extensor tendons of the hallux and potential implications for tendon grafting

Although several tendon sources are available for reconstructive surgical procedures, all have one or more shortcomings. The aim of this work was to evaluate if the extensor tendons of the hallux showed anatomical characteristics that could make them an additional source for tendon grafting procedures.The authors performed a detailed morphometric analysis of the extensor tendons of the hallux in 26 lower limbs in order to evaluate the putative association of anatomical variants with hallux valgus, and to attempt to assess the feasibility of using part of the extensor apparatus of the hallux as a source of tendon for grafting procedures.An accessory extensor hallucis longus ten-don was found in 92.3% of cases. The extensor hallucis brevis tendon length was 10.5 ± 0.6 cm; its width was 0.5 ± 0.1 cm, and its thickness varied between 1-2 mm, making it a potentially good candidate as a source of ten-don grafts. Several anatomical variations were observed, namely the fusion of the tendons of the extensor hallucis brevis and the accessory extensor hallucis longus muscles in the distal part of the foot.This new therapeutic option, if implemented, would possibly increase the supply of autogenous donor tissue for reconstructive procedures, thereby enhancing the reconstructive surgeon’s armamentarium (AU)

No disponible

Colgajo sensible basado en perforantes de la arteria sural lateral / A sensate lateral sural artery muscle perforator flap

La región de la pantorrilla es un potencial fuente de colgajos cutáneos relativamente finos, incluso en personas obesas. Este colgajo es una opción a tener en cuenta si el procedimiento reconstructivo requiere que el paciente permanezca en posición prona. Los colgajos musculo cutáneos de gemelo han sido considerados desde hace tiempo fiables, y ahora, con los avances en colgajos de perforantes, es posible elegir elevar un colgajo de perforantes de la arteria suralmedial (PSM) o bien de la arteria sural lateral (PSL)respetando la función del músculo que en estos casos queda excluido del colgajo. Aunque el colgajo PSM ha sido el más ampliamente usado, si se demuestra la existencia de una perforante musculo cutánea del músculo gastrocnemio lateral, también puede usarse el colgajo PSL. Este último tiene la ventaja de ser un colgajo sensitivo si se incluye el nervio cutáneo sural lateral (AU)

The calf region is a potential source for relatively thin cutaneous flaps, even in obese individuals. This can be an especially valuable option if the defect requires that the patient remain in a prone position. Whereas gastrocnemius musculocutaneous flaps have long been recognized to be reliable, with the advent of the muscle perforator flap concept, now instead a medial sural artery perforator [MSAP] or lateral sural artery perforator [LSAP] flap can be selected with preservation of function of the excluded muscle. Although the MSAP flap has been most commonly used, if an appropriate major musculocutaneous perforator of the lateral gastrocnemius muscle exists, a LSAP flap can be used. The latter has the advantage of being a sensate flap by inclusion of the lateral sural cutaneous nerve (AU)

Colgajo libre radial de doble paleta cutánea para reconstrucción de lengua y suelo de boca / Double pad radial free flap to reconstruct touque and floor of the mouth

Introducción. La cirugía reconstructiva tras la exéresis de tumores malignos que afectan a la lengua y al suelo de boca, continúa siendo uno de los grandes retos de la cirugía oral y maxilofacial. La mayor recuperacióndel habla y de la deglución, van a ser los objetivos finales de toda la reconstrucción de la cavidad oral. Presentamos un nuevo diseño del colgajo libre radial para la cirugía reconstructiva del carcinoma lengua y suelo de boca. Material y método. Nuestra serie consta de tres pacientes diagnosticados de carcinoma epidermoide de lengua y suelo de boca. Tras la cirugía oncológica ablativa, se reconstruyó el defecto oral con un colgajo libre radial de doble paleta cutánea con zona intermedia desepidermizada microvascularizado. Resultados. La movilidad de la lengua de nuestros pacientes fue suficiente y adecuada, consiguiéndose una buena calidad de vida. No hubo pérdida de la comida u otros fluidos a través del tracto respiratorio. Conclusiones. Con el colgajo radial de doble paleta cutánea microvascu-larizado, se consigue una buena recuperación funcional tanto en el habla como en la deglución en los pacientes, por lo que creemos que debería estandarizarse su uso en la cirugía recons-tructiva oral tras la exéresisde tumores malignos de lengua y suelo de boca (AU)

The firearm injuries are not very common in our country, and the experience in its management is limited. Inthis review we show the experience of our Service in this wounds and review the literature to systematize the initial management of the firearm injuries in maxillofacial region. Material and Methods: We present six patients treated in our Service in 2002. We study the demographics characteristic, aetiology, lesions patterns and treatment. Results: Five male and a female were treated of firearm lesions during this period, with a mean age of 38 years (range 13-74). Most frequent aetiology was the aggression. Only one patient required emergency airway control with tracheotomy. No complications were noted after primary surgical treatment and onlyone patient needed secondary surgical intervention. Discussion: There are controversy in definitive surgical treatment in patients with high-energy lesions in maxillofacial region, because the literature describe two forms of management. The first way is the primary reconstruction with microvascular techniques, or secondary reconstruction after desbridement, stabilization of existing bone and primary closure of soft tissue. We think that the choice of treatmentmust be individualized, and we choose the secondary reconstruction as early as possible after primary stabilization of wounds (AU)

Zonas donantes para injertos cutáneos de espesor parcial: manejo posquirúrgico o postinjerto / Donor sites for partial thickness skin grafts: postsurgical or postgraft management

No disponible

No disponible

Tratamiento quirúrgico de la mediastinitis en pacientes con esternotomía media: opciones y resultados / Surgical treatment of mediastinitis in patients with medial sternotomy: options and results

El manejo óptimo de las mediastinitis postesternotomía es un tema controvertido. Desde 1993 hemos utilizado el desbridamiento agresivo y el cierre con colgajos musculares. Los pacientes remitidos a nuestro Servicio fueron pacientes previamente tratados con métodos conservadores por el Servicio de Cirugía Cardiaca y por tanto sólo recibimos los casos que no respondieron o aquellos en los que el esternón había sufrido una destrucción tan importante que dificultaba su estabilización. Dicinueve pacientes fueron reconstruidos con colgajos musculares o musculocutáneos: 7 con músculo recto abdominal único, 1 con músculo pectoral único, 9 con ambos músculos pectorales y 2 con un músculo recto abdominal y un pectoral. La mortalidad intraoperatoria fue nula; la postoperatoria, dentro de un periodo de 30 días, fue de 4 pacientes, tuvimos complicaciones en 5 casos. En este artículo explicamos nuestros criterios, describimos las técnicas empleadas y analizamos nuestros resultados y como éstos han hecho variar nuestras indicaciones (AU)

The best management of mediastinitis from deep sternal wound infection is a controversial topic. Since 1993 we have used the aggressive debridement and the closure with muscular flaps. The patients submitted to our Service were previously treated with conservative methods in the Cardiac Surgery Department and therefore we only receive those that didn’t respond to this treatment or those in which the sternum had suffered such an important destruction that it prevented its stabilization. Nineteen patients were reconstructed with muscular or myocutaneous flaps: 7 with single abdominal rectum muscle flap, 1 with single pectoral muscle flap, 9 with both pectoral muscles, and two with an abdominal rectum and a pectoral muscle flaps. There was no mortality during surgery, the postoperative mortality, in a period of 30 days, was 4 patients, and complications appeared in 5 patients. In this article we explain our approaches, we describe the employed techniques and we analyze our results and how these ones have changed our indications (AU)

Reconstrucción compleja de la cavidad oral mediante dos colgajos simultáneos de peroné y radial / Complex reconstruction of the oral cavity by means of the combination of two simultaneous free fíbula and radial flaps

El objetivo del presente trabajo es valorar los resultados funcionales y estéticos de reconstrucciones complejas orofaciales, realizadas mediante la asociación de dos colgajos libres simultáneos de peroné y radial. Se ha realizado este tipo de reconstrucción en tres pacientes con buenos resultados funcionales y estéticos. La reconstrucción con dos colgajos libres está indicada en defectos complejos en los que la reconstrucción con un solo colgajo no obtendría resultados estéticos y funcionales adecuados. Cada colgajo se selecciona por sus características que lo hacen ideal para cada tipo de defecto, óseo y de partes blandas con la finalidad de conseguir un resultado estético y funcional superior al que se obtendría con un solo colgajo (AU)

[Experimental studies and clinical application of quickly prefabricated random skin flap].

OBJECTIVE: To enlarge the ratio of length to width of a prefabricated random skin flap in a short period, in order to meet a special clinical need. METHODS: A white rat and a white mini-pig was chosen for an animal model for the experiment. They were divided into the experimental group and the control. The prefabricated flap was formed as the planned design. In the experimental group, the flaps were treated with a desired pressure in certain intervals at the planned part of the flap. We estimated and inspected the digitized perfusion of flap microcirculation, and made overcong and wide random skin flap survive within 24 hours, and this technique was finally used for the clinical wound treatment. RESULTS: As expected, the survival area of the flap in the experimental group was significantly larger than the control. This technique was successfully used to repair the defects of the special sites in plastic and reconstructive surgery. CONCLUSION: The method of quickly prefabricated random flap could enlarge the ratio of length to width of the flap and put the flap in shape in short time. With the digitized estimating and inspecting, this method could obviously improve the survival area of the random flap and could also be very useful for the clinical treatment.

[Clinical application of the fibrous capsule to prevent muscle tendon adhesion].

OBJECTIVE: To observe the effect of fibrous capsule to prevent the flexor tendon adhesion. METHODS: Six bum patients with 33 digits were treated with the fibrous capsule of the expanded flaps which was used to wrap the exposed flexor tendon in zone III in order to prevent the flexor tendon adhesion. RESULTS: From 1999-2001 ,all of the patients were followed up to 1-3 years. The functions, assessed with the TAM method, were excellent in 18 digits, fair in three and poor in one. The excellent and good rate was 87.88%. CONCLUSION: The fibrous capsule could be used to prevent or reduce the tendon adhesion.

[The usage of inferior turbinate mucosal flap for repairing cleft lip].

OBJECTIVE: To evaluate a technique for decreasing the tension of the nasal floor during the procedures of repairing complete clef lip. METHODS: With the designation of an inferior turbinate mucosal flap combined with an oral mucosal flap in the splitting side, the tension was effectively decreased and the nasal floor was closed easily. Eighteen patients was selected for the treatment with this technique since 2000. The follow-ups were 10 to 24 months. RESULTS: All of the patients showed wound healing well with the significant improvement in the donor site. CONCLUSION: The above mentioned technique may effectively decrease the tension and be used to close the nasal floor safely. It could also reduce the incidence of the complications.

Hidrosadenitis axilar severa: opciones quirúrgicas / Severe axilar hidrosadenitis: surgical options

En los cuadros severos de hidrosadenitis ( hidradenitis supurativa) axilar con un área infeccioso inflamatoria extendida y retracciones secundarias que limitan la capacidad funcional articular del hombro, la mejor solución pasa por el desbridamiento radical de todo el área afecta y su posterior cobertura con tejido de buena calidad. Los colgajos locales basados en perforantes torácico laterales y toracodorsales con distintos diseños y los derivados de la arteria circunfleja escapular con la Variante bilobulada escápulo - paraescapular para los casos extremos, ofrecen posibilidades locales de muy buena calidad para defectos de todas las dimensiones. Se presentan cinco casos de hidrosadenitis axilar mostrando las posibilidades de cobertura con los colgajos citados (AU)

Respuesta al comentario del Dr. Pellicer Artigol

No disponible

Comentario al trabajo "Optimización del colgajo de gracilis libre"

No disponible

Optimización del Colgajo de Gracilis Libre / Experience with the Gracilis Muscle Free Flap

El colgajo de músculo gracilis tiene una anatomía constante, es fácil de disecar y deja una mínima secuela. A pesar de estas ventajas no es un músculo popular. Entre los inconvenientes que se le achacan están: su corto pedículo vásculo-nervioso, el pequeño calibre arterial y la dificultad para adaptarlo al defecto por su forma de huso. Nuestro objetivo es presentar soluciones para estos problemas, basándonos en una experiencia de 18 casos para cobertura de extremidades y para rehabilitación dinámica. En nuestra práctica el colgajo de gracilis es de primera elección para defectos pequeños y medianos en los que se necesite un músculo. Desbanca a otros como el recto abdominal o e1 serrato por ser menor su secuela funcional y estética (AU)

An easy and safe method to store and disinfect explanted skull bone.

In our department extensive decompression craniectomies became the treatment of choice for patients with massive cerebral oedema following either trauma or acute cerebral infarction. The remarkable survival rates of this neurosurgical technique created the problem of adequate vault defect reconstruction. To evaluate the biological safety of using stored autologous skull flaps for this purpose, we compared three different disinfection methods. Skull bone fragments stored at -21 degrees C for different periods of time were artificially contaminated with clinically relevant strains of Serratia marcescens, Enterococcus faecium and Staphylococcus aureus. As potential methods for disinfection we tested immersion in 3% H2O2, boiling in normal saline for 15 and 30 minutes and a special process of steam disinfection at a temperature of 75 degrees C for 20 minutes. We were able to demonstrate that only steam disinfection completely eliminated the bacterial strains tested. Refrigeration plus steam disinfection of autologous skull bone prior to re-implantation seems to offer reliable safety for its use for defect closure. It is available at reasonable cost in many hospitals and does not require a bone bank.