ABSTRACT
Resumen Objetivo: Investigar con cuál técnica quirúrgica, cierre directo o con parche de Goretex, las hernias diafragmáticas congénitas operadas tienen más recidiva. Metodología: Los datos de los pacientes sometidos a reparación por hernia diafragmática congénita en el Hospital Nacional de Niños, entre enero 2008 y el 31 diciembre de 2017, fueron revisados retrospectivamente. De los 94 pacientes, solo 59 cumplen con los criterios de inclusión. Para la comparación de las variables cuantitativas se empleó pruebas de T de Student e intervalos de confianza al 95 %; las variables cualitativas se analizaron por la prueba de Fisher con un nivel de significancia de 0,05. Resultados: La mayoría de las hernias diafragmáticas operadas fueron izquierdas (78 %) y posterolaterales (91 %). La técnica de reparación más frecuente utilizada fue el cierre directo (68%). Hubo más recidivas posteriores a cierre con parche de Goretex. Se presentaron entre 1 y 12 meses postoperatorio. No hubo diferencia estadísticamente significativa entre recidivas con técnica de cierre directo versus cierre con parche de Goretex. Conclusión: Realizar un cierre directo del diafragma es una buena opción quirúrgica para reparación de hernia diafragmática congénita. No hubo en este estudio diferencias estadísticamente significativas en cuanto a recidiva entre utilizar técnica con cierre directo o con parche.
Abstract Objective: To investigate with which surgical technique, direct closure or use of a Goretex patch, congenital diaphragmatic hernias recurre more. Methodology: The data of the patients who underwent repair of congenital diaphragmatic hernia at the National Children's Hospital from January 2008 to December 31, 2017, were reviewed retrospectively. Of the 94 patients, only 59 met the inclusion criteria. For the comparison of the quantitative variables, Student's t-test and 95% confidence intervals were used, the qualitative variables were analyzed by the Fisher's test with a significance level of 0.05. Results: Most of the operated diaphragmatic hernias were left 78% and posterolateral 91%. The most frequent repair technique used was direct closure, 68%. There were more recurrences after closing when a Goretex patch was used. They occurred between 1 and 12 months post-operatively. There was no statistically significant difference between recurrences with the direct closure technique versus closure with the Goretexpatch. Conclusion: Performing a direct closure of the diaphragm is a good surgical option for surgical repair of congenital diaphragmatic hernias. There were no statistically significant differences in relapse in this study between using the direct closure or patch technique.
Subject(s)
Humans , Child, Preschool , Child , Polytetrafluoroethylene/therapeutic use , Hernia, Diaphragmatic/surgery , Costa RicaABSTRACT
BACKGROUND AND OBJECTIVES: The radial forearm flap is thin, pliable, and versatile, and it forms a relatively long and large vascular pedicle which facilitates the microvascular anastomosis much easier. Additionally, it can act as a sensate flap to transprt sensory innervation to the grafted site. But, there are a number of problems associated by skin graft regarding the donner site such as the delayed wound healing due to poor skin graft reception, disability of the hand and esthetically unpleasing appearance, etc. To avoid these potential problems, we used V-Y ulnar advancement flap method to close the donor defect of the radial forearm flap directly and compared this procedure with skin graft method. MATERIALS & METHOD: We reviewed retrospectively 3 cases of floor of mouth cancer and 1 case of tonsil cancer. They were 3 female patients and 1 male patient aged from 60 to 73. RESULTS: We obtained successfully results, both functionally and cosmetically, except for one who died of acute respiratory failure on the second postoperative day. CONCLUSION: This method avoids the complications of the split skin grafting for the radial flap donor site, and the donor site sequelae of the split skin graft. It can be used in the reconstruction of small defects in the oral cavity and oropharyngeal defects after tumor excision.