ABSTRACT
Introducción: La reconstrucción de los huesos del cráneo es un procedimiento complejo y representa un reto para el grupo médico tratante; generalmente se realiza en pacientes con pérdida de la bóveda craneana secundaria a procesos infecciosos crónicos no controlados o por osteorradionecrosis, lo que implica mayor posibilidad de fracaso o rechazo de los materiales utilizados para la reparación del defecto. La selección del material para sustituir la bóveda craneana es difícil debido a la diversidad de productos existentes; el material debe ser inerte, ligero, fácil de colocar y adaptable al defecto, con lo cual se ofrece mejores resultados estéticos y funcionales. Con el diseño por computadora del implante es posible ofrecer un implante individual y específico para cada defecto y paciente. Caso clínico: Mujer con diagnóstico de estesioneuroblastoma tratada con resección craneofacial anterior y radioterapia; como complicación presentó osteomielitis y osteorradionecrosis y, consecuentemente, pérdida de la bóveda craneana en la región frontal; este defecto fue reconstruido con un implante de poli-éter-éter-cetona diseñado por computadora con base en el defecto evaluado por tomografía computarizada. Se muestran los resultados obtenidos. Conclusiones: El implante diseñado por computadora realizado con poli-éter-éter-cetona es una alternativa segura, fácil de usar y con gran adaptabilidad a los defectos de la bóveda craneana.
BACKGROUND: Reconstruction of the bones of the skull is a complex procedure and represents a challenge for the surgical team. It is generally performed in patients who have loss of the cranial vault secondary to chronic infection or uncontrolled osteoradionecrosis, indicating a greater chance of failure or rejection of the materials used for repair of the defect. Selection of material to replace the cranial vault is complex due to the diversity of existing products. The ideal material is inert, lightweight, easy to fit and adaptable to the defect, offering the best aesthetic and functional results. Computer design of the implant makes this process easier by providing an implant specific to each individual patient and defect. CLINICAL CASE: We report the case of a patient who was diagnosed with esthesioneuroblastoma and was treated with anterior craniofacial resection and radiotherapy. Osteomyelitis and osteoradionecrosis were consequent complications with loss of the cranial vault in the frontal region. The defect was reconstructed with a polyetheretherketone (PEEK) computer-designed implant based on the defect evaluated by computed tomography. Results obtained are shown below. CONCLUSIONS: The PEEK computer-designed implant is a safe and easy to use alternative with great adaptability to cranial vault defects.
Subject(s)
Humans , Female , Middle Aged , Biocompatible Materials , Skull/surgery , Ketones , Osteomyelitis/surgery , Osteoradionecrosis/surgery , Polyethylene Glycols , Prostheses and Implants , Plastic Surgery Procedures/methodsABSTRACT
The open abdomen (OA) strategy is accepted in the treatment of extremely ill surgical patients. Its usage has increased in the last decade as the understanding of its functions, advantages and disadvantages increases. Unfortunately, it continues to be associated with very high morbidity and mortality, and the different techniques used to protect the intra-abdominal contents cannot be standardized for all surgical circumstances. The objective is to review the origins, actual indications and controversies of the staged abdominal repair (STAR) and to report on the latest and most used techniques to ensure an optimal temporary abdominal closure (TAC). A search was done in Medline and Ovid for articles with key words of open abdomen, temporary abdominal closure and staged abdominal repair. We found the use of the technique is justified in patients with trauma, abdominal compartment syndrome and patients with severe intra-abdominal sepsis. The technique used for TAC must always be individualized for each clinical circumstance. The best reported results have been obtained with the vacuum pack technique. In our own experience and as a general rule we discouraged the use of mesh to protect intra-abdominal contents. The strategy of OA is useful in complex surgical situations in extremely ill patients. Its use must be very carefully evaluated, knowing the potentially serious complications that the patient may develop with its use.
Subject(s)
Humans , Abdomen/surgery , Surgical Procedures, Operative/methodsABSTRACT
Gaspare Tagliacozzi es tan conocido por sus grandes aportaciones como pionero de la Cirugía Plástica, que ha opacado en buena parte otra actividad trascendental que desarrolló, durante casi 30 años fue profesor de Cirugía y Anatomía en Bolonia. El objetivo de este artículo es analizar su actividad docente, considerada igualmente importante, y recrear mediante recursos pictóricos, tres momentos históricos importantes en la vida académica de este personaje. Gaspare Tagliacozzi nació en Bolonia en 1545. Es considerado padre de la cirugía plástica. Obtuvo el grado de Doctor en Medicina y Filosofía en la universidad. Fue nombrado profesor de Cirugía en 1576, actividad que realizó hasta su muerte en 1599. Publicó su libro De Curtorum Chirurgia per Insitionem considerado el primer tratado exclusivo de Cirugía Plástica. Como profesor, Tagliacozzi realizó disecciones formales en la universidad. Su éxito docente lo revela su estipendio: él comenzó ganando 100 liras, que se elevaron a 1140. Sus aportaciones, junto a las de muchos otros (Vesalio, Aldrovani, Falopio, Eustaquio etc.) dieron brillo a los conocimientos anatómicos.
Gaspare Tagliacozzi is known because of his great contributions to plastic surgery. He is considered a pioneer in the field, which has had more influence in his career than his other transcendental activity as a surgery and anatomy teacher in Bologna for almost 30 years. The aim of the present manuscript is to analyze his teaching activities which were equally important for us, and to recreate, with pictorial means, three unpublished historic moments in the life of this great man of science. Gaspare Tagliacozzi was born in Bologna in 1545 and is considered the father of plastic surgery. He obtained a degree in medicine and philosophy at the University. He was named surgery professor in 1576, and worked as such until his death in 1599. His De Curtorum Chirurgia per Insitionem treatise was published in 1589 and was considered the first exclusive treatise on plastic surgery. Bologna built a permanent operating theater (amphitheater) within the Archiginnasio in 1595. Because of his success, he increased his earnings; his first university teaching salary was 100 lire, but his earning increased to 1,140 lire later. Tagliacozzi's contributions, together with that of others such as Vesalius, Aldrovandi, Fallopian and Eustachian advanced the field and knowledge of anatomy.