Cirugia Plastica Ibero-Latinoamericana

Online ISSN: 0376-7892
Publications
Article
La abdominoplastia es el procedimiento de elección para corregir la flacidez abdominal, la lipodistrofia supra e infraumbilical y la diástasis de los rectos abdominales. Los nuevos métodos añaden liposucción para definir el contorno corporal. Presentamos una estandarización de medidas para lograr una cicatriz abdominal baja y pexia pubiana en casos de lipodistrofias tipo III y IV de Matarasso. Realizamos un estudio observacional, descriptivo y retrospectivo, evaluando las historias clínicas y las fotografías sobre 420 mujeres, con edades entre 18 y 63 años, intervenidas entre 2004 y 2011. Basamos la técnica quirúrgica en los siguientes principios: referencias anatómicas; medidas estandarizadas con la paciente de pie sobre zapatos de tacón alto para el trazado de una incisión suprapúbica baja, siguiendo diseño de los autores; pexia de pubis y región inguinal; cicatriz suprapúbica baja cubierta por un biquini estándar. El 70,95 % de los casos (298 pacientes) correspondieron a abdomen grado IV de lipodistrofia, el 28,57 % (120 pacientes) al grado III y el 0,47 % (2 pacientes) al grado II según Matarasso. Las complicaciones más frecuentes fueron: seroma, (4,04 % ), alteraciones cicatríciales (7,37 % ), necrosis parcial y epidermolisis (2,38 % ) y estenosis umbilical (1,19 % ). Como conclusión creemos que la estandarización de medidas para el diseño de la cicatriz en la abdominoplastia permite obtener resultados estéticos predecibles y funcionales buenos: cicatriz baja cubierta por un biquini o ropa interior estándar, cicatriz umbilical ovalada, pexia de pubis y excelente definición del contorno abdominal y corporal, con baja tasa de complicaciones.
 
Article
El objetivo de la presente revisión sistemática es determinar si los lipoinjertos enriquecidos con células madre derivadas del tejido adiposo son superiores a los injertos de tejido graso convencionales en el tratamiento de la lipoatrofia facial. Realizamos una búsqueda sistemática de publicaciones en las bases de datos: MEDLINE, SCOPUS, OVID SP, SCIELO y EMBASE y posteriormente, una valoración basada en criterios actuales de medicina basada en la evidencia de las publicaciones encontradas por dos revisores independientes; las discrepancias en el análisis se resolvieron por acuerdo. Los criterios de inclusión fueron: ensayos clínicos aleatorizados, series clínicas y reportes de casos en humanos, excluyendo los ensayos en animales. Encontramos 6 publicaciones que cumplían con los criterios previamente mencionados. Entre éstas se incluyeron 2 ensayos clínicos aleatorizados controlados que recogían la superioridad de los lipoinjertos enriquecidos con células madre derivadas del tejido adiposo en el tratamiento de la lipoatrofia facial en términos de resistencia a la reabsorción (preservación del volumen) y menor necesidad de nuevos lipoinjertos, en comparación con los lipoinjertos convencionales. Concluimos diciendo que existen publicaciones con buenos niveles de evidencia que sugieren que los lipoinjertos enriquecidos con células madre derivadas del tejido adiposo son superiores a los lipoinjertos convencionales en el tratamiento de la lipoatrofia facial. No obstante, son estudios de reciente publicación y aún es necesario tener seguimientos a más largo plazo y con mayor número de pacientes para mejorar los ya buenos niveles de evidencia disponibles.
 
A. Incisión inguinal y obtención de la muestra de tejido adiposo. B. Fragmentación del tejido. C. Sutura de la incisión. 
Article
El tratamiento de lesiones con pérdida de tejido cutáneo ha mejorado notablemente con el advenimiento de la bioingeniería tisular. Una alternativa en desarrollo es la utilización de sustitutos dérmicos combinados con células troncales derivadas del tejido adiposo autólogo. Estudios previos nos muestran que con esta técnica es posible optimizar la angiogénesis y la síntesis de colágeno, sin embargo potenciar la epitelización es un tema pendiente por resolver. En el presente estudio evaluamos la progresión y diferenciación epitelial en un período de tiempo prologando. Obtuvimos las células troncales a partir del tejido adiposo (ASC) de la región inguinal de 4 ratas Sprague Dawley. Cultivamos las células frescas en una matriz de Integra® durante un período total de 48 horas, y las marcamos con un vector lentiviral-GFP (proteína fluorescente verde). Posteriormente, injertamos en las mismas ratas la matriz dérmica con células troncales y un implante contralateral sin células, como control. A las 4 semanas, evaluamos el avance epitelial mediante planimetría de superficie e histología. Los resultados macroscópicos muestran que el cierre de la herida por contracción de los bordes no tiene diferencias significativas (82,63% ± 3,4% vs. 80,66% ± 3,89%; p=0,08), pero el cierre por epitelización fue significativamente mayor en el lado intervenido con ASCs (93,47% ± 5,98% vs. 79,88% ± 6,28%; p=0,0028). Todas las muestras obtuvieron tinción positiva para el anticuerpo anti-citoqueratina 34βE12 y el avance epitelial lineal cuantificado por microscopía resultó significativamente mayor en el lado con ASCs (6408 ± 275μm vs. 5375 ± 250μm; p < 0,001). Identificamos las células GFP positivas formando parte de la dermis regenerada, no así en la epidermis. En conclusión, las células troncales derivadas del tejido adiposo autólogo sembradas en una matriz de Integra® aumentan la formación epitelial significativamente, probablemente por un mecanismo de inducción más que de diferenciación.
 
Article
El presente trabajo, pretende describir el estado de ansiedad que experimentan los pacientes ingresados en una Unidad de Quemados. Uno de los factores clave en los cuidados del paciente quemado es una buena atención psicológica. La realidad demuestra que es el profesional de enfermería quien observa los síntomas emocionales durante los primeros días de ingreso y trata de responder a esa demanda de cuidado. Pretendemos, a través de la medición del nivel de ansiedad que perciben los pacientes ingresados en la Unidad de Quemados elegida para nuestro estudio durante el primer semestre del año 2009, identificar a aquellos que estén en riesgo de padecer mayores niveles de ansiedad durante su hospitalización, para así poder establecer un plan de cuidados adaptado a las necesidades emocionales de cada uno. Los resultados obtenidos nos permiten concluir que los pacientes quemados ingresados en la Unidad de Quemados presentaron niveles elevados de ansiedad que son superiores entre la población femenina, así como en aquellos pacientes con lesiones de mayor extensión. Determinamos también que los pacientes ingresados por quemaduras en la Unidad de Quemados a estudio fueron mayoritariamente varones, de nacionalidad española, residentes en medio urbano con una media de edad de 50 años, siendo las quemaduras producidas por llama en accidentes domésticos la causa más frecuente.
 
Article
La frente es una de las áreas más difíciles de reconstruir debido a su propia anatomía, la piel es firme, gruesa, y escasamente elástica. Esto ha supuesto un reto para muchos, y a algunos nos ha llevado a tratar de innovar en la reconstrucción de esta zona anatómica. En este artículo, clasificamos imaginariamente las áreas reconstructivas de la frente de acuerdo a las estructuras vecinas y describimos un tipo de reconstrucción para cada zona en la que movilizamos colgajos rectangulares, siguiendo las líneas naturales de la frente.
 
Article
El párpado es una estructura crítica para la protección y función del globo ocular, y parte primordial en la estética facial. Su reconstrucción está determinada por la extensión de la lesión y el compromiso de las diferentes capas. Siempre se preferirán tejidos loco-regionales debido a su mayor similitud y disposición. Los métodos de reanimación palpebral se pueden dividir en estáticos y dinámicos, considerando a estos últimos como el único medio para restaurar el parpadeo. Presentamos un caso de celulitis orbitaria preseptal con lesión de espesor total del párpado superior y su reconstrucción miofuncional utilizando un colgajo frontal. Este colgajo frontal miocutáneo logró la restauración funcional del párpado comprometido mediante la adición de fibras musculares y permitiendo el fenómeno de reinervación.
 
Article
La neuropatía compresiva del nervio ciático es una patología poco frecuente, atribuible a diferentes etiologías. Una causa poco habitual es la compresión extrínseca por tumores de tejidos blandos, como puede ser un lipoma. Presentamos un caso de neuropatía compresiva del nervio ciático a causa de un lipoma en la cara posterior del muslo. Ante la presencia de clínica compresiva del nervio ciático es importante realizar una adecuada evaluación clínica del paciente, así como las pruebas complementarias de imagen y electromiografía que sean necesarias para guiar de una forma acertada el tratamiento. Debemos tener siempre en cuenta que además de las causas comunes de compresión, existen otras causas más infrecuentes que pueden provocar neuropatías compresivas.
 
Article
Presentamos nuestra experiencia con el colgajo de Kirschbaum (colgajo en charretera) en la corrección de retracciones cicatriciales de la región cervical anterior y del tercio inferior de la cara. Llevamos a cabo un estudio retrospectivo sobre una serie de 63 pacientes con retracciones cicatriciales de la región cervical anterior y del tercio inferior facial, operados por el primer autor entre los años 1996 y 2012 dentro del marco de las campañas quirúrgicas desarrolladas a lo largo del país (Perú) en las áreas geográficas con mayor necesidad de atención especializada. En todos los casos empleamos el colgajo en charretera tomado de la región lateral del cuello y de la región deltoidea. Evaluamos a los pacientes mediante el examen físico y la documentación fotográfica obtenida en los periodos pre y postoperatorio. Obtuvimos mejoría en diferentes grados de la limitación funcional de la región cervical y facial en todos los casos operados, con viabilidad total del colgajo en 59 casos (93,65 % ) y parcial en 4 casos (6,34 % ). No hubo ningún caso de pérdida total. Las complicaciones recogidas fueron pocas, principalmente hematomas, 6 casos (9,52 % ) e infección, 2 casos (3,17 % ). Las zonas donantes evolucionaron con cicatriz hipertrófica en 22 de los casos (34,92 % ). En conclusión, nuestra experiencia con el uso de esta técnica quirúrgica ha demostrado ser de utilidad en el tratamiento de las secuelas de quemadura con retracción cicatricial cervical y facial, por lo que consideramos que el colgajo de Kirschbaum es seguro y tiene pocas complicaciones.
 
Article
El uso de tejido abdominal representa una de las primeras líneas de actuación en reconstrucción mamaria con tejido autólogo. En aquellas pacientes en las que no está disponible, el colgajo miocutáneo transverso de gracilis (TMG) representa una opción válida para la creación de una nueva mama. Presentamos una serie de 10 casos de reconstrucción mamaria con TMG con el objetivo de evaluar esta opción quirúrgica. Para ello, administramos a las pacientes intervenidas un cuestionario sobre calidad de la reconstrucción y de la zona donante y valoramos además: la duración promedio de la intervención, el periodo promedio de ingreso hospitalario, las complicaciones sufridas en el área donante y en la mama reconstruida. Para poder comparar los resultados obtenidos con esta técnica, recogimos también los mismos datos en las pacientes sometidas a reconstrucción mamaria con colgajo de músculo dorsal ancho, una alternativa a la reconstrucción con tejido abdominal ampliamente extendida. Exponemos los resultados de la comparación, que obtuvieron resultados superiores en los ítems referentes al aspecto de la mama reconstruida con el colgajo TMG.
 
Severa radiodermitis en región lateral izquierda del cuello.
Diseño del colgajo derecho.
Diseño del colgajo izquierdo. Perforantes señaladas previamente con Doppler.
Article
La cobertura de defectos de tejidos blandos en el tercio distal de la pierna y pie con exposición ósea y tendinosa, representa un reto para el cirujano plástico dado que las opciones reconstructivas para esta zona son limitadas. En la actualidad, este tipo de defectos se tratan frecuentemente con colgajos libres, si bien los colgajos fasciocutáneos continúan siendo una buena alternativa de menor complejidad y mayor disponibilidad en todos los centros, a diferencia de las técnicas microquirúrgicas. El colgajo safeno interno es una de las opciones locales disponibles, de fácil ejecución y escasa morbilidad en el área donante, y el desdoblamiento de los tejidos que lo componen (fascia - piel y subcutáneo) facilita la cobertura de defectos secundarios sin tener que recurrir a un nuevo colgajo, con todo lo que ello implica. Presentamos un caso de colgajo safeno interno desdoblado de una forma no descrita previamente para cobertura de un defecto secundario en tercio distal de la pierna tras fractura abierta y osteosíntesis, cuyos resultados postoperatorios fueron satisfactorios y sin complicaciones tras 18 meses de seguimiento.
 
Article
Diseñamos un osteotomo al que se adapta una guía interna para tratar el dorso nasal (resección de la giba ósea) con exactitud. Este instrumento aporta precisión en la osteotomía de tal forma que permite resecar solo la cantidad exacta de hueso que precise el paciente.
 
Article
Entre las principales causas de la reducción progresiva y sin dolor de la apertura bucal en pacientes jóvenes, se encuentra la denominada hipertrofia del proceso coronoideo. Se trata de una patología secundaria a la elongación anormal del proceso coronoideo por el crecimiento del hueso que provoca una alteración mecánica al abrir la boca. Presentamos nuestra experiencia con la recogida de 5 casos clínicos.
 
Article
The lymphedema may affect any part of the body including the scrotum and penis due to an alteration of the lymphatic drainage, causing great deformities known as elephantiasis. Genital lymphedema may cause severe functional and emotional limitations in patients because they often suffer pain caused by chronic irritation, recurrent infections, incapacity to clean themselves, sexual disfunction, aesthetic deformities and mobility impairment. There is not an ideal medical or surgical treatment for masculine genital lymphedema. In the literature, there is reference to fasciocutaneos flaps from the inner side of the thighs after big resections of scrotal tissue, but thermoregulation may be altered causing sterility. Also skin grafts are described, but they do not supply a stable coverage. Another option is the reconstruction with posterior perineal flaps where perirectal lymphatic vessels are preserved to ensure a lymphatic drainage. We present 2 cases of severe elephantiasic scrotal lymphedema, in which we practised limphangiectomy and reconstruction with perineal local flaps. In both patients results were satisfactory, improving significantly life quality, with no signs of recurrence 1 year after the treatment.
 
B.Resultados a los 20 días con total reepitelización. Observamos ligero eritema residual y discromías. La calidad del tejido cutáneo es buena y sin patología cicatricial. 
A.Quemadura de segundo grado en cara y cuello, después de su completo desbridamiento y durante el goteo de PRP. 
Article
El objetivo del presente trabajo es determinar la eficacia clínica del plasma rico en plaquetas (PRP) en las quemaduras de segundo grado. Estudiamos el tiempo requerido en la reepitelización del tejido dañado, la estancia hospitalaria asociada a la curación de las lesiones y la satisfacción del paciente. Realizamos un estudio prospectivo, observacional y longitudinal, en una muestra de 115 pacientes con quemaduras de segundo grado según la clasificación de Converse-Smith. Las lesiones fueron de menos de 48 horas de evolución, en diferentes zonas de cara y cuerpo. A todos los pacientes se les aplicó de forma ambulatoria PRP por goteo, completándose el tratamiento con la aplicación de gasas parafinadas. El estudio se realizó entre marzo de 2011 y agosto de 2013. Las quemaduras que evolucionaron mejor y de forma más rápida fueron las de cara, seguidas por las de abdomen y, por último, las de extremidades inferiores. En todas, el tiempo de epitelización fue un 30 % inferior que en quemaduras de similar extensión, profundidad y localización, en pacientes anteriormente tratados sin PRP. Los pacientes fueron atendidos ambulatoriamente cuando las lesiones lo permitieron, y si presentaban lesiones más extensas fueron hospitalizados. El tiempo de internamiento en estos casos se redujo como promedio 18 días con respecto al grupo no tratado con PRP. El tiempo de reepitelización, estancia hospitalaria y la satisfacción de los pacientes, alcanzaron significación estadística p< 0,05. En conclusión, creemos que el uso de PRP acorta el tiempo de recuperación en quemaduras de segundo grado, reduce el tiempo de hospitalización y conlleva un alto grado de satisfacción de los pacientes por los resultados obtenidos.
 
Resección de la pieza en monobloque.  
y 2. Marcación del colgajo.  
y 19. Tracción aplicada al colgajo.  
Article
Considered by many surgeons the most secure way that allows the resection of a great amount of tissue with less complication, abdominoplasty in anchor resurge supported in new concepts and a new systematization, what brings better results for patients. Through a bimanual maneuver, based on reduction mammaplasty according to Pitanguy's technique, we changed the dissection way, starting from cephalic to podalic and from lateral to medial, becoming resection of the fat flap more simple, quicker and safer to proceed. We emphasize that the most important point in this technique is don't undermine the remaining flaps to create traction vectors that increase vascular security, and because of it, reduce complications like seroma, hematoma, and flap necrosis. Besides, there is no necessity for blood transfusion. In a 5 year perior, we follow up 108 patients, 59 woman and 49 man, with massive weight loss (between 35 to 145 Kg), ages ranging from 18 to 68 years, who underwent multifunctional abdominoplasty with flap resection ranging from 2.2 to 21.5 Kg. The average hospitalization time was 2 to 7 days, returning to regular activities between 10 to 15 days. By this study we demonstrate that multifunctional abdominoplasty is an easily reproducible technique, that allows it's application in any age and brings more security, not only during the procedure but also in the postoperative period, improving the whole body contour.
 
Article
Considered by many surgeons the most secure way that allows the resection of a great amount of tissue with less complication, abdominoplasty in anchor resurge supported in new concepts and a new systematization, what brings better results for patients. Through a bimanual maneuver, based on reduction mammaplasty according to Pitanguy's technique, we changed the dissection way, starting from cephalic to podalic and from lateral to medial, becoming resection of the fat flap more simple, quicker and safer to proceed. We emphasize that the most important point in this technique is don't undermine the remaining flaps to create traction vectors that increase vascular security, and because of it, reduce complications like seroma, hematoma, and flap necrosis. Besides, there is no necessity for blood transfusion. In a 5 year perior, we follow up 108 patients, 59 woman and 49 man, with massive weight loss (between 35 to 145 Kg), ages ranging from 18 to 68 years, who underwent multifunctional abdominoplasty with flap resection ranging from 2.2 to 21.5 Kg. The average hospitalization time was 2 to 7 days, returning to regular activities between 10 to 15 days. By this study we demonstrate that multifunctional abdominoplasty is an easily reproducible technique, that allows it's application in any age and brings more security, not only during the procedure but also in the postoperative period, improving the whole body contour. © 2008 Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE).
 
Article
Lipoaspiration is actually the most frecuent cosmetic procedure in aesthetic surgery . This work shows our long term experience in body contouring with large volume liposuction (megaliposuction), trying to demonstrate that it can be applied to selected and prepared patients under multidisciplinary direction. A total of 120 patients were operated on the CIMA (Centro Internacional de Medicina avanzada, Barcelona, España) during 1 year period, from November 2004 to November 2005. We practised liposculpture of different areas with an average aspirated volume of 7,5 l (between 6 and 10 l).In this work we discuss some results and we observe the capacity to keep stable hemodinamic controls with changes in pre a postoperative values of hemoglobin and hematocrit, showing that there is not direct, nor absolute relation between the predictable volume of aspirated fat and the loss of blood; however is more important the quality of the aspirated fat and the anatomical areas treated, to reduce the risks and to assure patients' satisfaction.
 
Article
The study of sentinel node (SN) in the management of melanoma requires close collaboration among plastic surgeon, dermatologist, specialist in Nuclear Medicine and pathologist. The authors present a retrospective study in a group of 123 patients with primary cutaneous melanoma who consented to sentinel node biopsy (SLNB) between December 1999 and December 2005 at the University Hospital Cruces (Barakaldo, Bizkaia, Spain). We describe the long-term evolution and the relation between SLNB results and relevant clinical events during follow-up. We removed 294 sentinel nodes; 15 patients had tumour in the centinela node, subsequently developed distant metastasis in 46.6%, compared with 19% in patients with negative SN (p = 0.021). Of the 123 patients studied, 14 died of melanoma (11´4%): 3 in the first year of follow up, 2 in the second, 3 in the third, 2 in the fourth and 2 in fifth year. We corroborate that the SLNB is an easy technique and useful for staging, showing the statistic relationship between positive SN and bad prognostic.
 
Article
Introducción y objetivo En nuestra práctica diaria encontramos variaciones anatómicas que tienen repercusión tanto diagnóstica como terapéutica. Con este artículo ponemos el acento en la importancia de las variaciones anatómicas vasculares, presentando un caso anatómico de arteria mediana persistente que altera la vascularización de los dedos de la mano y que frecuentemente se asocia a la presencia de un nervio mediano bífido. Tras este hallazgo, realizamos una revisión bibliográfica y un estudio clínico para poner en relieve la asociación de esta malformación con el síndrome del túnel carpiano (STC). Material y método Dividimos nuestro estudio en 2 partes: una anatómica y otra clínica. El estudio anatómico de un antebrazo presentó como hallazgo una arteria mediana palmar persistente responsable de la vascularización del 1er y 2º dedos de la mano, asociada a un nervio mediano bífido. Continuamos con una revisión bibliográfica y un estudio prospectivo para conocer el porcentaje de arterias medianas encontradas en la cirugía del STC en pacientes escogidos de manera aleatoria en función de su incorporación a la lista de espera de nuestro hospital durante un periodo de 4 meses. Resultados Fueron intervenidos 128 pacientes de STC encontrando arteria mediana persistente en 3 casos, lo que corresponde a un 2.34% del total valorado. Discusión El porcentaje de presentación de arteria mediana persistente en nuestro estudio coincide con los diversos estudios revisados en adultos. Coincidimos con ellos en la importancia del conocimiento de las variaciones anatómicas por si mismas y de su implicación en la sintomatología del STC. También es importante tenerlas en cuenta cuando nos enfrentamos a una lesión traumática o cuando disecamos un colgajo.
 
Article
The aim of this study is to present our protocol in the surgical treatment of facial paralysis after 140 treated cases since 2000 to 2007. The protocol is based on the results obtained with a new 3-D capture system of the facial movement called "Facial Clima", that could be considered as the adequate tool to assess the outcome of the facial paralysis reanimation surgery. Thus, patients with facial paralysis could be compared among surgical centres such that effectiveness of facial reanimation operations could be evaluated. The results obtained are exposed for smile and lid reconstruction. © 2008 Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE).
 
Article
The success of a microsurgical reconstruction is subordinated to an appropriate planning. Recipient vessel selection of our free flap is primordial. For this work we select 150 patients who underwent 156 free flaps for head and neck reconstruction. The proportion male/female was of 5:1 with an average age of 56 years. Tumoral defects are the most common etiology. Fifty (33.3%) free flaps were performed inmediately and 100 (66.6%) were performed secondarily. Recipient artery selection in order of frequency included the superior thyroid artery followed by the facial artery. We performed 223 venous anastomosis; end-to-end anastomosis to the facial vein and external yugular vein was the most common method of venous revascularization. Four flaps required an interposition vein graft and we performed two cephalic vein transpositions. The overall success rate was of 93%. Eleven flaps failed and there were 3 cases (1.9%) of partial free flap necrosis. Three patients (1.9%) died postoperatively in the hospital.
 
Article
Presentamos el caso de una adolescente africana de 16 años de edad afectada por albinismo óculo-cutáneo, que desarrolló un carcinoma epidermoide en pabellón auricular derecho que requirió escisión radical y reconstrucción con colgajo TRAM libre. El albinismo es un trastorno metabólico genético que consiste en la incapacidad hereditaria para sintetizar melanina. Tiene dos variantes clínicas: el albinismo ocular y el albinismo óculo-cutáneo. En determinados países africanos, los pacientes afectos por esta enfermedad son socialmente rechazados y por ello no se les presta un control sanitario adecuado. Por esta razón el tumor llevaba varios años de evolución y cuando la paciente fue vista en nuestro centro, existía una infiltración profunda con afectación severa de la base del cráneo. La compleja anatomía de las estructuras vitales en esta región hace que la resección quirúrgica de los tumores sea complicada. Comentamos las peculiaridades en la reconstrucción de casos complejos en la base lateral del cráneo con proyección a la zona temporal.
 
Article
Our cleft lip and palate surgical missions began as a way to address the needs of the most vulnerable population in southeastern Mexico, because this anomaly occurs in 1 of 700 births in our country. This population usually has no health insurance, and few plastic surgeons in the country treat cleft lip and palate. We began our Cleft Lip and palate Clinic in the year 2000, in the city of Merida, Yucatan, at the "Dr Agustin O'Horan Hospital" of the Ministry of Health of the State of Yucatan. The name of our clinic is "Todo por una sonrisa" (A Smile is everything). The clinic works every day, continuously, and we operate on average 3 to 4 cleft lip or palate cases every week. We also have a surgical mission every year, and in the southeastern states of Mexico we have also organized 22 cleft lip and palate surgical missions. All missions have been performed in hospitals which have one or more plastic and/or maxillofacial surgeons, even if they don't have a cleft lip and palate clinic. All patients operated along 17 years of experience and 40 missions had cleft lip or palate, sequels of these, with or without other congenital anomalies.
 
Article
Background and Objective. The skull defects in our center result from descompressive craniectomy after trauma, bony involvement by tumors or infarction, and the cranioplasty will be mandatory if the patient have the syndrome of the trephined or wish to improve their appearance. The ideal material for cranioplasty there will be biocompatible, simple to manufacture, and biomechanically reliable, at least. In our Department, the skull reconstruction is performed with methylmethacrylate prosthesis, designed by stereolithography, and then covered with an onlay fascia lata tendon graft. In our experience this kind of skull reconstruction has been demonstrated secure, predictable and satisfactory results. Methods.We report our initial experience using this technique with a retrospective analysis of 32 patients operated from January 1996 to June 2014 by a multidisciplinary team in the General Hospital of Mexico Dr. Eduardo Liceaga. Results. There were no significant complications related to infection, hematoma or seroma. The aesthetic results have been considered acceptable, to excellent. Conclusions. In our patient series using this technique we collected an extremely low complication rate and an excellent grade of patient satisfaction on long-Term follow up.
 
Article
Abdominoplasty has been done with standard and new surgical methods in the last years, with great changes in results as in morbidity. The block resection techniques provide more natural results with less morbidity and faster execution time, joining the goals from the standard and new abdominoplasty. Our purpose was to show the efficiency and results of block resection abdominoplasty technique. A total of 1170 patients who underwent abdominoplasty either alone or combined with additional surgery between January 1992 and December 2009, were included. A retrospective study was conducted. Combined surgeries included breast reduction, mastopexy, facelift, breast implants, blepharoplasty, rhinoplasty, lipoplasty, vascular surgery, hysterectomie and other gynaecologic surgeries, and ventral hernia. From the total 1170 patients, 632 underwent abdominoplasty alone and 538 were in the abdominoplasty combined group. Complication rate was between 0,09 y 4,87%, according to each complication founded. This review showed the technique's efficiency and the natural results achieved even in combined procedures. Patients who underwent abdominoplasty with previous block resection techniques were satisfied with their outcomes and the complication rate was in acceptable levels. So, abdominoplasty with previous block resection is a very safe, efficient and fast procedure who brings a very pleasant and natural abdominal shape.
 
Article
Abdominoplasty has been done with standard and new surgical methods in the last years, with great changes in results as in morbidity. The block resection techniques provide more natural results with less morbidity and faster execution time, joining the goals from the standard and new abdominoplasty. Our purpose was to show the efficiency and results of block resection abdominoplasty technique. A total of 1170 patients who underwent abdominoplasty either alone or combined with additional surgery between January 1992 and December 2009, were included. A retrospective study was conducted. Combined surgeries included breast reduction, mastopexy, facelift, breast implants, blepharoplasty, rhinoplasty, lipoplasty, vascular surgery, hysterectomie and other gynaecologic surgeries, and ventral hernia. From the total 1170 patients, 632 underwent abdominoplasty alone and 538 were in the abdominoplasty combined group. Complication rate was between 0,09 y 4,87%, according to each complication founded. This review showed the technique's efficiency and the natural results achieved even in combined procedures. Patients who underwent abdominoplasty with previous block resection techniques were satisfied with their outcomes and the complication rate was in acceptable levels. So, abdominoplasty with previous block resection is a very safe, efficient and fast procedure who brings a very pleasant and natural abdominal shape.
 
Article
The goal of this paper is to study the classical factors related to Dupuytren Disease in the patients of our region as well as the clinical evolution of the process with the aim to compare this results with another published, specially with north European and north American studies. We followed a retrospective analysis of 184 patients diagnosed of Dupuytren Disease in our Department and an study of their clinical history looking for factors described in the medical literature in relation with the process. The results showed that 86% of patients were males with most common diagnosis in the 5th or 6th decade of the life; 64,5% were working or had had a work related with chronic hand trauma; 16% recognized familiar antecedents; 43,5% had an usual consume of alcoholic drinks; 51% smoked cigarettes; 0% suffered diabetes mellitus 1 and 28,8% diabetes mellitus 2; 1,6% epilepsy; 19% some kind of peripherical vasculopaty; 6.4% some kind of autoimmune disease; 0% degerative neurophaty; 10,3% Tunnel Carpal Syndrome; 32,1% hyperlipemia; 28,8% hyperuricemia; 3,8% liver disease; 77,7% right hand affectation, 70,1% left hand affectation and 47,3% bilateral affectation in the moment of diagnosis, most commonly affected palmar radio were 4th and 5th. Ectopic fibromatoses were an unusual found. As a conclusion, genre, age and clinical findings in our patients seem to be similar to the results presented in North American and north European series. Factors involved in the increase of oxygen free radicals like cigarettes, alcoholic drinks, diabetes melitus, hyperuricemia or peripherical vascular disease, appears in an important amount of our patients with Dupuytren Disease.
 
Distribución de casos diaria en la Comunidad de Madrid. Fuente: Ministerio de Ciencia e Innovación. Gobierno de España.
Evolución diaria de casos COVID-19 en el hospital Vall d'Hebrón, del 17 de marzo al 14 de abril.
Article
On March 11th, a pandemic situation caused by the virus SARS-Cov-2 was declared, challenging health-care systems all over the world. Therefore, a reorganization of national health-care systems had to be performed in order to deal with this disease. In this context, new recommendations have appeared for the management of surgical patients, postponing elective surgeries. However, urgency in the treatment of burn patients is justified, even in those cases affected by the virus. The coincidence of the precocity and intensity with which the pandemic affected Spain, with the existence of scarce evidence regarding burn unit organization, caused that reorganization of each center had to be performed from scratch, adapting their particular circumstances. In this article, we expose the organizational schemes and the experience of 5 burn units, 4 in Spain and 1 more in Chile, in their adaptation to the COVID-19 pandemic.
 
Article
There are many ways to remodel and embellish a nasal tip. At times, we cannot find the way without eliminating all the excess, that is, nasal tip surplus. And this may be the case in primary or secondary rhinoplasty. At first, it seems that everything can be relaid and remodelled, yet sometimes when we uncover the tip, we discover that the reality is a mass of broken or bowed cartilages which are hard to put right. For this reason in 1987 we began to remove all the alar cartilages in one secondary rhinoplasty case with a totally unattractive look. The result after one year was correct from the aesthetic and functional viewpoint, and it still looks right. There was no collapse with nasal respiratory failure and, aesthetically, the shape was maintained. We covered the crus medialis with a small 2-layered temporal fascia patch. From this point onwards, and only in very special cases, we proceed as follows: total amputation of the alar cartilages, including the domes, or the domes are maintained by preserving the fibre-adipose tissue of the tip by suturing at the centre of the extreme crus medialis and covering it with temporal fascia, depending on the thickness of the skin on the tip. This technique is mainly indicated for secondary rhinoplasty with completely destroyed cartilages of the nasal tip and for certain primary rhinoplasty cases of excessively wide and bulbous nasal tip, but always using open rhinoplasty. Our philosophy is, therefore, refinement and beauty for the nasal tip with a solid, equilateral base... No prejudices, no taboos.
 
Article
Background and Objective. The lip and palate clefts are congenital malformation that affects the maxillofacial region. Their etiology is multifactorial with such as genetics as environmental factors. For the caucuses race it's estimated a incidence of 1:700 per births, number that decreases in other populations. The masculine sex is affected more frequently, only in the case of isolated palate cleft there's a predominance of the feminine sex. Because of the embryologic development, the side that is more affected is the left side. The present study has as objective the knowledge of distribution and frequency of malformations treated in a Mexican public hospital and to compare with other international populations. Methods. We conduct an observational, descriptive, transverse and retrospective study, where we evaluated the total of clinic records of patients attended in the Pediatric Reconstructive Surgery Service in Morelia, Michoacán, México, between 1989-2012. The bibliographic investigation was made at MEDLINE, LILACS and SciELO. Results. We got a total recruit of 800 clinical records, 460 (57.5%) male patients and 340 (42.5%) female. The most frequent affection was the combination of lip and palate with 448 (56%) cases. Situation that was similar to previous studies of Bolivia, Sudan and Mexico. It was not possible to determine the incidence because our hospital is only a pediatric institute. Conclusions. The data recollection at our center showed predominance in male patients, the most frequent malformation was unilateral lip and palate cleft and left side. We conclude that the epidemiologic distribution of the lip and palate clefts found at the Lip and Palate Cleft Clinic at Morelia, Michoacán, México, is at a medium position compared with other international populations.
 
Article
This paper presents an epidemiological and statistical study about de incidence of bums in the autors' regional area (Galicia, Spain), based on data fron the Public and concerted hospital of the Gallician Health Service (SERGAS) in the years 1996 and 1997. By the study of these data, the authors evaluate the needing of a new Severe Bum Unit in their region and points to its posible sitting based on the casuistic.
 
Article
Thoracic reconstruction represents a surgical challenge. Often, the deffects are not only large, but also complex, involving all layers of the thoracic wall. The authors reviewed the medical records of the patients who underwent thoracic reconstruction, operated in cooperation with the Cardiothoracic Surgery Department, between 1998 and 2008, in Coimbra University Hospital, Portugal.
 
Article
Treatment with fillers for aesthetic purposes or to replace subcutaneous fat loss produced by muscle atrophy is one of the aesthetic procedures more frequently carried out in Spain. Knowledge of the properties of the products, the injection technique, correct location of the area and awareness of the potential side effects and risks involved are important at the time of selecting this therapy, with the aim of obtaining good results with minimum of adverse effects. The selection of one type of filler or another will depend on the evaluation of the area to be filled, the experience of each professional and following the advice and specific techniques that each product requires. An adequate training, assessment and experience will represent a successful outcome.
 
Article
Intrahospitalary infection in burned patients is one of the most important causes of morbidity and mortality. This study characterizes the admitted burn victims and the presence of inner-hospital infection at the National Burn Victims Unit, San Juan de Dios Hospital, Costa Rica, between 2003 and 2005. We made a descriptive analyze of intrahospital infection in the burned area according characteristics of the patients and their burn(s), as well as the total number of days of hospital stay, using a prospective cohort. The accumulated incidence for intra hospital infection in the burned area was 19.0%. In the months following the beginning of the school year, the number of burn victims admitted in the hospital increased. Age, total burnt surface, the number of burnt body segments, the depth of the burn and the days of hospital stay varied significantly between infected and not infected individuals. The cause of the burn and the victim's gender did not reveal any relevant differences between the groups of patients. For patients that developed intrahospital infection in the burned area, electricity was the most frequent causing agent, as was hot water for patients without intra hospital infection in the burned area. As a conclusion, physiopathologic characteristics of the burns favor the occurrence of the intra hospital infection in the burned area; furthermore, there are factors than can and must be taken into account to control and prevent intrahospital infection in the burned area and its effects.
 
Article
In burn victims, different factors such as age, gender and days of hospitalization among others, are influential in the development of inner-hospital infections (IHI). Due to a higher incidence of IHI in burn victims, it is pretended to identify which factors influence the presence and prediction of inner-hospital infections in the burned area (IHIBA). This study is a retrospective cohort that recruited 298 registries of medical reports from patients admitted into the National Burn Victims Unit at San Juan de Dios Hospital (NBVU-HSJD), Costa Rica, and following a previous report in this journal. The odds ratio (OR) were calculated for each risk factor in a univariated analysis, and defined as principal exposition variables were the total burn surface (TBS) and the depth of the burn (DB). It was deduced from this calculation that the type of accident did not show any association with IHIBA. Subsequently, a multivariate logistic not conditioned study was carried out, in which, the following risk factors were introduced: TBS, DB, age, number of burnt body segments (NBBS), days of hospital stay previous to the IHIBA (DHSP-IHIBA) and the burn's causing agent. Confusing and modifying variables of effect were also considered, respectively, for the NBBS and the DHSP-IHIBA. It was concluded that the main predicting variables for the IHIBA were TBS (OR=3.02; 1.20-7.84), DB (OR=11.44; 4.90-26.71), NBBS (OR= 2.80; 1.13-6.95), and DHS- IHIBA (9 to 14 days: OR=2.43; 0.52-11.29, > 19 days: OR=31.89; 2.17-467.68). Even though it didn't show statistical relevance, the age was introduced in the model, due to the fact that the risk factor increased with time (>64 years old: OR= 3.15; 0.61-16 29). It was concluded that burn victims present endogenous and exogenous characteristics for the development of the IHIBA and by getting to know those characteristics, we can help to lessen the incidence of IHIBA, promoting measures for its control and prevention in the treatment of the patients at the NBVU-HSJD.
 
Article
Lesser saphenous venofasciocutaneous flap is used for leg reconstruction with success in diverse latitudes with different results. The aim of this article is to describe the patient population who have underwent leg reconstruction with this flap in the Plastic Surgery Unit, San Juan de Dios Hospital in San José, Costa Rica, from March 2004 to March 2009 and the adverse effects suffered (necrosis and nosocomial infection). We applied the technique to a total of 14 patients, whose average age was 46.6 years and predominant sex was male (71.4 %). Flap necrosis occurred in 50 % of cases and 28.6 % of them were total. Nosocomial infection also in this type of procedure was 33.3 %. We conclude that lesser saphenous venofasciocutaneous flap is a useful tool for reconstruction of leg, but we should be especially careful to avoid possible complications that could affect the outcome of the procedure.
 
Article
Reimplantation is indicated in all cases of thumb amputation as this digit plays a key role in hand function. The aim of the present study is to review all cases of thumb reimplantation carried out during the last 6 years at Virgen del Rocío University Hospital in Seville, Spain. Data regarding the type of injury, the amputation level, the use of venous grafts and the type of osteosynthesis were collected in all cases. Survival rates reached 74.19%. We can conclude that survival rates in patients undergoing thumb reimplantation are high and even a better outcome can be obtained in injuries without crushing lesions. The use of venous grafts is also associated with a better surgical outcome in amputations due to crushing or avulsion mechanisms.
 
Article
In order to know if present training of Plastic, Aesthetic and Reconstructive Surgery in Spain is the appropriate, we decided to process a survey that was sent to the residents of the Spanish National Health Service in 2009. The questionnaire was sent by post to the Plastic Surgery Departments where we had previously made telephonic contact with the educational tutors (153 questionnaires were sent in total). We received 53. We also inquired about the hypothetical sitting of an exam at the end of the trainee period that could award an extra diploma (independent of the official specialist one) guaranteed by the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE) We report the statistical results and the conclusions we have obtained after the analysis of these data.
 
Article
Backgraund and objective. Since its creation in 2010, the Implant Registry Committee of FILACP (Ibero Latin American Federation of Plastic Surgery) an international entity that gathers the 22 National Societies of Plastic Surgery of Spanish and Portuguese language, has worked to know the common preferences and uses among its members in breast augmentation surgery with implants. With this aim, between 2010 and 2020, it carried out a series of periodic surveys to investigate the variables involved in breast surgery with implants carried out by plastic surgeons from Iberolatinamerica and how the incidence of breast implants associated anaplastic large cell lymphoma (BIA-ALCL) and its possible etiopathogenic relationship with certain types of implants might have influenced them. We present in this article the data obtained and analyze the observed trends. Methods. Comparative study of data collected in 4 surveys sent to 5000 FILACP members: the first one presented in 2012, with 25 questions on primary breast surgery with implants and 18 on secondary surgery; the second one presented in 2016 with 31 questions on primary surgery and 52 on secondary surgery; the third one in 2018 with 40 questions on both primary and secondary surgery; and the fourth one in 2020, with 13 general questions. Results. General data reflects a preference of Iberolatinamerican plastic surgeons for the use of round implants, with a tendency to increase the use of smooth cover versus textured implants, with a preferential surgical periareolar approach, submuscular placement, and awareness growing need for surgical capsulectomy in secondary surgeries, and for the pathology study of the removed capsule. They also report a good knowledge of BIA-ALCL and the variables involved in its diagnosis and treatment. As of April 2020, we also collected the cases of BIA-ALCL reported by the FILACP National Societies: 106 cases in 9 countries, with 2 deaths. Conclusions. The trend among our respondents, surely influenced by the knowledge of the factors related to the etiolo- gy of BIA-ALCL, is towards the increasing use of smooth and round-shaped implants, and represents an important and updated estimate of the uses of a highly representative professional collective in an international environment that usually collects only data from anglo-saxon professionals and publications.
 
Article
Resumen Introducción y objetivo. El trauma de miembro superior representa entre el 10% al 40% de las consultas a urgencias en Norteamérica y Europa, causando discapacidad temporal o definitiva importante. En una búsqueda en la literatura regional en Medellín, Colombia, no encontramos datos epidemiológicos al respecto. El objetivo de este estudio es describir las características epidemiológicas del trauma de miembro superior en 6 instituciones de salud locales durante 1 año. Material y método. Estudio retrospectivo, multicéntrico, en el que revisamos las bases de datos de 6 instituciones de salud de referencia de la ciudad de Medellín (Colombia) de pacientes adultos atendidos en urgencias entre enero y diciembre de 2016, cuyo diagnóstico de egreso incluyera códigos relacionados con trauma de miembro superior, así como edad, género, causa, tipo de trauma y segmento afectado. Describimos las características demográficas y clínicas de los pacientes del estudio para toda la muestra y por instituciones y realizamos un análisis exploratorio cualitativo para identificar diferencias entre las variables demográficas y clínicas. Resultados. Identificamos 259.163 consultas por todas las causas y 25.646 consultas por trauma de miembro superior (9.89%). La mayoría fueron varones (70.74%) menores de 40 años (66.4%). Los tipos de trauma más frecuentes fueron heridas y contusiones (68.1%), seguidas de fracturas (17.1%). El trauma con mayor frecuencia se presentó en mano y dedos (31%) causado por accidentes laborales (33%). Conclusiones. El trauma del miembro superior representa una causa importante de morbilidad en nuestro medio que concuerda con los datos reportados previamente. Recomendamos llevar a cabo estudios analíticos que evalúen el impacto a largo plazo de este tipo de trauma en la región.
 
Article
Background and Objective Abdominoplasty and liposuction are among the surgical techniques used for body modeling. The biochemical variations of lipid metabolism play an important role when applying these surgical techniques. Lipids as insoluble components in water, have to be transported in the body linked to other molecules called lipopoproteins, which are the fractions taken into account in our study. Our general objective is to determine the variation of lipid fractions in patients undergoing abdominoplasty in Dr. Salvador Bienvenido Gautier Hospital (Dominican Republic) between January- May 2018. Methods A descriptive, prospective and cross-sectional study was conducted in 15 female patients aged between 25-44 years and a with body mass index below 34.9 kg / m2, who underwent conventional abdominoplasty plus flank liposuction, studying pre-surgical lipid profile the previous day and 30 days post-surgical. Results In relation to age, triglyceride levels below 35 years showed an increase in post-surgery and above 35 years a decrease was observed. Regarding the level of LDL in patients under 30 years and over 40 an increase was observed and between 30-40 decrease was observed. The lipid fractions decreased but not significantly in the cases of liposuction from 500 to 1499 ml. of aspirated fat, and increased in the cases from 2000 to 2500 ml. 30 days after surgery. Triglycerides and total cholesterol decreased in overweight and obese patients and increased in patients with normal body mass index. Total cholesterol was the lipid fraction with the highest rate of reduction at 30 days post-surgery. Conclusions Abdominoplasty plus liposuction produces a mobilization of lipid fractions, so clinically we should be moderate in liposuction and individualize cases that exceed 2000 ml. to control the fractions of lipids and take the necessary corrective measures in each patient.
 
Article
Introducción y Objetivo Algunas intervenciones de Cirugía Plástica, por ser menos prioritarias en un sistema con carencias económicas propias de un país en vías de desarrollo como es Chile, tienen una larga lista de espera en los hospitales públicos. Con un objetivo de servicio público, miembros de la Sociedad Chilena de Cirugía Plástica desarrollan desde hace 2 años un operativo altruista de salud en colaboración con el Ministerio de Salud de Chile. Presentamos en este trabajo la última campaña de cirugía de reducción de mama realizada en 2019. Material y método. Revisión retrospectiva del operativo de salud para cirugía de reducción mamaria en el Hospital de Valdivia (Chile). Mostramos el protocolo de selección de pacientes, las técnicas quirúrgicas utilizadas y la evaluación de Resultados Resultados A lo largo de 2 días fueron intervenidas 15 pacientes por un grupo de 8 especialistas divididos en 2 grupos de trabajo. Las complicaciones, todas ellas mediatas, fueron menores. Conclusiones Si bien estos operativos quirúrgicos no son la solución para las listas de espera de Cirugía Plástica en los hospitales públicos de Chile, ayudan a su mejoría y demuestran ser efectivos con una planificación científica y administrativa adecuada.
 
Top-cited authors
Mario A Trelles
Justo Alcolea
E. Cabrera Sánchez
  • Hospital San Juan de Dios Córdoba
Jaume Masia
  • Hospital de la Santa Creu i Sant Pau
Alicia Dean
  • Hospital Universitario Reina Sofía