Understanding the dynamics of deceased organ donation and utilization in Colombia / Examen de la dinámica de la donación y utilización de órganos de personas fallecidas en Colombia / Entendendo a dinâmica da doação e do aproveitamento de órgãos de pessoas falecidas na Colômbia

ABSTRACT Objective. To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods. A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results. Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions. About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.

RESUMEN Objetivo. Presentar una descripción integral de la donación, utilización y descarte de órganos en todo el proceso de donación en Colombia. Métodos. Estudio retrospectivo de 1 451 donantes posibles, distribuidos en tres regiones de Colombia, que fueron evaluados en el 2022. Se describen las características generales, el diagnóstico y las causas de contraindicación de los donantes potenciales. Resultados. De los 1 451 donantes posibles, 441 (30,4%) cumplían con los criterios de muerte encefálica y constituyeron el conjunto de donantes potenciales. Las familias consintieron la donación de órganos en 141 casos aptos desde el punto de vista médico, mientras que en 60 casos se recurrió a la presunción legal, con lo que se llegó a 201 donantes aptos (13,9%). De estos, 160 (11,0%) fueron donantes reales (en los que se les practicó una incisión quirúrgica para la extracción de órganos o se obtuvo al menos un órgano). En última instancia, hubo 147 donantes utilizados (10,1%) (de los que se trasplantó al menos un órgano). Se observaron diferencias estadísticamente significativas entre las regiones en cuanto a edad, sexo, diagnóstico de muerte encefálica y vía crítica del donante. Se trasplantaron un total de 411 órganos procedentes de 147 donantes utilizados; los riñones fueron los órganos obtenidos y trasplantados con mayor frecuencia, ya que supusieron 280 (68,1%) del total de órganos, seguidos del hígado (85, 20,7%), el corazón (31 , 7,5%), los pulmones (14, 3,4%) y el páncreas (1, 0,2%). La tasa de descarte de los donantes fallecidos disponibles fue del 8,1%. Conclusiones. Aproximadamente una décima parte de los donantes son utilizados, de hecho, para realizar trasplantes. Estos datos destacan las áreas en las que se han obtenido buenos resultados y aquellas en las que se presentan desafíos, lo cual proporciona una base para futuras mejoras en Colombia.

RESUMO Objetivo. Obter uma visão geral e abrangente da doação, do aproveitamento e do descarte de órgãos em todo o processo de doação na Colômbia. Métodos. Estudo retrospectivo de 1 451 possíveis doadores em três regiões da Colômbia que foram avaliados em 2022. Foram descritas as características gerais, o diagnóstico e os motivos para a contraindicação de potenciais doadores. Resultados. Dentre os 1 451 possíveis doadores, 441 (30,4%) preencheram os critérios de morte encefálica, formando o grupo de potenciais doadores. Em 141 casos considerados clinicamente aptos, as famílias consentiram com a doação de órgãos, e em 60 casos utilizou-se o princípio da presunção legal, resultando em 201 doadores elegíveis (13,9%). Desses, 160 (11,0%) foram doadores efetivos (ou seja, doadores nos quais foi feita uma incisão cirúrgica com a intenção de remover um órgão ou pessoas com pelo menos um órgão removido). Por fim, foram identificados 147 doadores utilizados (10,1%) (ou seja, que doaram pelo menos um órgão que foi transplantado). Foram encontradas diferenças estatisticamente significantes entre idade, sexo, diagnóstico de morte encefálica e itinerário crítico de doação entre as regiões. Um total de 411 órgãos foram transplantados de 147 doadores utilizados. Os rins foram os órgãos mais frequentemente removidos e transplantados, representando 280 (68,1%) do total, seguido de 85 fígados (20,7%), 31 corações (7,5%), 14 pulmões (3,4%) e 1 pâncreas (0,2%). A taxa de descarte de doadores falecidos com órgãos removidos foi de 8,1%. Conclusões. Cerca de um décimo dos doadores são efetivamente usados para fins de transplante. Nossos achados destacam áreas de sucesso e desafios, oferecendo uma base para futuras melhorias na Colômbia.

Comparative Analysis of the Treatment of Skin Lesions of the Lower Limbs with Sural Flap versus Propeller Flap / Análise comparativa do tratamento de lesões cutâneas dos membros inferiores com retalho sural versus retalho propeller

Abstract Objective The objective of the present study was to prospectively compare the sural and propeller flaps for soft-tissues coverage of the lower extremity. The following variables were evaluated: incidence of complete or partial flap loss and donor area morbidity (primary closure versus skin graft). Methods Prospective and randomized analysis of data collected from all patients presenting with soft tissue defects of the lower third of the leg and heel treated with reverse sural or propeller flaps. Results Twenty-four patients aged between 4 and 60 years old were evaluated between 2011 and 2017. Complete coverage was obtained in 22 of the 24 patients (91.6%). Two flaps failed (8.4%). The sural flap, being the most popular option, continues to represent a safe and versatile alternative for skin defects of the lower third of the leg and heel region. Likewise, the propeller flap was a comparable option to treat these challenging defects. Conclusion Sural and propeller flaps are good options for soft tissues coverage of the lower extremity, with low complication rates (partial or total flap loss).

Resumo Objetivo O objetivo do presente estudo foi comparar prospectivamente os retalhos sural e propeller para cobertura de partes moles da extremidade inferior. Foram avaliadas as seguintes variáveis: incidência de perda total ou parcial do retalho e morbidade da área doadora (fechamento primário versus enxerto de pele). Métodos Análise prospectiva e randomizada de dados coletados de todos os pacientes apresentando defeitos em tecidos moles da extremidade distal da perna e do retropé submetidos aos retalhos em questão. Resultados Foram avaliados 24 pacientes com idades entre 4 e 60 anos, entre 2011 e 2017. Cobertura completa foi obtida em 22 dos 24 pacientes (91,6%) e observamos falha em 2 retalhos (8,4%). O retalho sural, sendo a opção mais popular, continua a representar uma alternativa segura e versátil para defeitos cutâneos do terço distal da perna e da região do calcanhar. O retalho propeller, da mesma maneira, mostrou-se uma opção comparável para o tratamento destas lesões desafiadoras. Conclusão Os retalhos sural e propeller são boas opções para a cobertura de partes moles da extremidade inferior, demostrando baixas taxas de complicações como perda parcial ou total do retalho.

Transplante capilar com técnica FUE: como eu faço? / FUE hair transplant: how I do it?

O transplante capilar moderno está em constante evolução, e nossa intenção não é apenas demonstrar nossas técnicas e metodologias, mas, principalmente, descrever a dinâmica de todo o processo cirúrgico da técnica FUE (Follicular Unit Extraction), desde a discussão da estratégia cirúrgica com o paciente e a avaliação da área doadora até extração e implantação. É de extrema importância que o dermatologista compreenda a complexidade do procedimento e a necessidade de um treinamento adequado para que um bom resultado seja alcançado.

Modern hair transplant is constantly evolving. We intend to demonstrate our techniques and methodologies, and especially to describe the dynamics of the entire surgical process of the FUE (Follicular Unit Extraction) technique, from the discussion of the surgical strategy with the patient and evaluation of the donor area to extraction and implantation. The dermatologist must understand the complexity of the procedure and the need for adequate training to achieve a good surgical result

Desenlaces a largo plazo en pacientes trasplantados renales con donantes de criterios expandidos: experiencia de 10 años / Long-term outcomes in kidney transplant patients with expanded criteria donors: 10-year experience

Introducción. El trasplante renal es el tratamiento de elección para la enfermedad renal crónica. Debido a la brecha con la disponibilidad de donantes, el uso de criterios expandidos es una opción que busca mejorar la tasa de donación mundial. El objetivo de este estudio fue comparar la sobrevida del injerto y del paciente trasplantado con donante de criterios expandidos versus el donante estándar. Métodos. Cohorte retrospectiva de 1002 pacientes con trasplante renal donde se determinó la sobrevida del injerto renal y del receptor a 10 años después del trasplante. La sobrevida del injerto renal y el receptor fueron estimadas por el método de Kaplan-Meier. Una regresión de Cox fue realizada ajustando el modelo multivariado.Resultados. El análisis incluyó 1002 receptores, con un 18,8 % (n=189) que correspondían al uso de donante de criterios expandidos. El grupo de trasplante renal con donante de criterios expandidos tuvo menor sobrevida del paciente (48,1 % versus 63,8 %) y del injerto (63,3 % versus 74,7 %) en comparación con el grupo de trasplante renal con donantes con criterios estándar a los 10 años después del trasplante. La asociación de trasplante renal con donante de criterios expandidos y muerte o pérdida del injerto renal no fueron significativas cuando se ajustaron las variables en el modelo multivariado. Conclusión. El trasplante renal con donante de criterios expandidos tiene menor sobrevida del receptor y del injerto frente al grupo de trasplante renal con donante estándar. No hubo diferencias estadísticamente significativas en cuanto al trasplante renal con donante de criterios expandidos frente a la pérdida del injerto renal o muerte.

Introduction. Kidney transplantation is the treatment of choice for chronic kidney disease. Due to the gap with donor availability, the use of expanded criteria is an option that seeks to improve the global donation rate. The objective of this study was to compare the survival of the graft and the transplanted patient with an expanded criteria donor versus the standard donor. Methods. Retrospective cohort of 1002 kidney transplant patients where survival of the kidney graft and the recipient was determined at 10 years after transplantation. The survival of the kidney graft and the recipient were estimated by the Kaplan-Meier method. A Cox regression was performed by fitting the multivariate model. Results. The analysis included 1002 recipients with 18.8% (n=189) corresponding to the use of an expanded criteria donor. The expanded criteria donor kidney transplant group had lower patient (48.1% versus 63.8%) and graft (63.3% versus 74.7%) survival compared to the donor kidney transplant group with standard criteria at 10 years post-transplant. The association of kidney transplantation with expanded criteria donor and death or loss of the kidney graft were not significant when the variables were adjusted in the multivariate model. Conclusion. Kidney transplantation with an expanded criteria donor has a lower recipient and graft survival compared to the standard kidney transplant group. There were no statistically significant differences in expanded criteria donor kidney transplantation versus kidney graft loss or death.

Feasibility of TRPM8 Agonist Agent for Management of Skin Graft Donor Site

Hair Diameter Variation in Different Vertical Regions of the Occipital Safe Donor Area

BACKGROUND: Little is known concerning hair diameter variation within the safe donor area for hair transplantation surgery. Thicker or thinner hair may be needed, depending on the recipient area, hairline design, and the purpose of surgery. METHODS: Twenty-seven patients (7 men and 20 women; mean age, 28 years; range, 20–47 years) were included in this study. The midoccipital point was used as the reference point on the horizontal plane at the upper border of the helical rim. The target area width was 15 cm (7.5 cm to the right and left of the reference point) and the height was 8 cm (2 cm above and 6 cm below the reference point). The study area was divided horizontally into 3 5-cm sections (A, B, C) and vertically into 4 2-cm sections (1–4), creating a total of 12 zones. Ten anagen hairs were randomly obtained from each zone and their diameters were measured. RESULTS: Hair diameter in the 4 vertical sections varied significantly, gradually decreasing from sections 1 (superior) to 4 (inferior) in all 3 horizontal sections (A, B, and C). CONCLUSIONS: Our results suggest that sections 1 and 2 of the occipital safe donor area would be useful for obtaining thicker hair, such as in procedures to treat male- and female-pattern hair loss, whereas hair from zones 3 and 4 could be useful for transplantation surgery requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction. Our results may be clinically valuable for planning hair transplant surgery and choosing the optimal donor region.

Donor-Site Morbidity after Partial Second Toe Pulp Free Flap for Fingertip Reconstruction

BACKGROUND: In this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes. METHODS: A single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance. RESULTS: The review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0-10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients. CONCLUSIONS: The partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.

Management of the Accidental STSG Donor Site Injury: Case Reports

When the split thickness skin graft (STSG) was harvested from the patient's posterior thigh in supine position, an accidental donor site injury could occur by postural instability with the raised leg of patient. The idea of partial return of the harvested graft to the donor site, spraying fibrin sealant and using skin fragments have been individually introduced as the management of donor site injury created during harvest of the STSG. However, in our knowledge, there has been no attempt to combine the three ideas and apply to the accidental STSG donor site injury. We present the fragments regraft technique, with deliberately leaving some of harvested skin, cutting the remnant skin into small pieces, and immediately returning the skin fragments by spraying fibrin sealant on the damaged donor site wound. This method could be considered as a treatment option to prevent delayed wound healing of STSG donor site injury, especially when elderly or debilitated patients who are suspected of a delayed wound healing and poor-quality skin.

A Rabbit Model of Fat Graft Recipient Site Preconditioning Using External Negative Pressure

BACKGROUND: Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. METHODS: Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. RESULTS: The fat survival rate of the experimental group (75.4%+/-3.9%) was higher than that of the control group (53.1%+/-4.3%) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups. CONCLUSIONS: Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

Heterogeneous living donor hepatic fat distribution on MRI chemical shift imaging

PURPOSE: We evaluated the heterogeneity of steatosis in living donor livers to determine its regional differences. METHODS: Between June 2011 and February 2012, 81 liver donors were selected. Fat fraction was estimated using magnetic resonance triple-echo chemical shifting gradient imaging in 13 different regions: segment 1 (S1), S2, S3, and each peripheral and deep region of S4, S5, S6, S7, and S8. RESULTS: There were differences (range, 3.2%-5.3%) in fat fractions between each peripheral and deep region of S4, S6, S7, and S8 (P < 0.001, P = 0.004, P < 0.001, and P = 0.006). Fat deposit amount in S1, S2, S3 and deep regions of S4-S8 were significantly different from one another (F [4.003, 58.032] = 8.684, P < 0.001), while there were no differences among the peripheral regions of S4-S8 (F [2.9, 5.3] = 1.3, P = 0.272) by repeated measure analysis of variance method. And regional differences of the amount of fat deposit in the whole liver increased as a peripheral fat fraction of S5 increased (R2 = 0.428, P < 0.001). CONCLUSION: Multifocal fat measurements for the whole liver are needed because a small regional evaluation might not represent the remaining liver completely, especially in patients with severe hepatic steatosis.

Análise dos aspectos epidemiológicos dos candidatos à doação de órgãos no Estado do Pará / Analysis of the epidemiological aspects of candidates for organ donation in the state of Pará

JUSTIFICATIVA E OBJETIVOS: A fila para transplante de alguns órgãos é quase seis vezes maior que o número de implantes realizados, sendo uma realidade alarmante e progressiva, com isso objetivou-se analisar aspectos epidemiológicos dos candidatos à doação de órgãos no estado do Pará.MÉTODO: Estudo transversal, com todo potencial doador no Pará, de acordo com o Registro Brasileiro de Transplantes. Baseados no dendrograma foram escolhidos São Paulo e Acre como extremos opostos de desempenho para comparação.RESULTADOS: Foi observado que o número de potenciais doadores,em pmp/ano, no Pará foi 15,4, no Acre 15 e em São Paulo60,5. Dentre as causas de não concretização, a não aceitação familiar no Pará representou 56% do total, no Acre 43% e em São Paulo 39%. Setenta e seis por cento dos doadores paraenses eram do sexo masculino, 42,3% tinham idade entre 18 e 40 anos e 57,7% vítimas de traumatismo cranioencefálico sendo o perfil dos candidatos paraenses.CONCLUSÃO: O desempenho em São Paulo foi muito superior ao dos outros em todos os aspectos, sendo que o principal motivo para não concretização da doação em todos os estados foi negação familiar.

BACKGROUND AND OBJECTIVES: The queue for some organs transplant is almost six times greater than the number of implants performed, being an alarming and progressive situation; therefore, this study aimed to analyze epidemiological aspects of candidates for organ donation in the state of Pará. METHOD: A cross-sectional study was performed, with all potential donors in Pará, according to the Brazilian Registry of Transplants. Based on the dendrogram, the states of Sao Paulo and Acre were chosen as opposite extremes of performance for comparison. RESULTS: We found that the number of potential donors, pmp/year, was of 15.4 in the state of Pará, 15 in the state of Acre and 60.5 in São Paulo. Among the causes for no achievement, no acceptance by the family was of 56% of the total in Pará, 43% in Acre and 39% in São Paulo. Seventy six per cent of donors from Pará were male, 42.3% were between 18 and 40 years of age and 57.7% were victims of traumatic brain injury, this being the profile of the candidates from Pará.CONCLUSION: The performance in São Paulo was far superior to the others in all aspects, with the family denial being the main reason for not accomplishing the donation in all states.

Management of Split Thickness Skin Graft Donor Sites: Comparison of Four Different Dressing Materials

PURPOSE: Split thickness skin graft is a frequently used reconstructive technique in burn wound, but the ideal dressing material of the donor site is yet to be developed. The donor sites have been managed with various dressing materials. The aim of this study is to compare four different dressing materials for management of the donor site in a prospective trial. METHODS: This study is based on 85 patients who had undergone split thickness skin graft from September 2011 to February 2012. The grafts harvested with a same manner and the donor sites were managed with one of the four dressing materials: Aquacel Ag(R), Mepitel(R), Bactigra(R), Op-Site(R). We compared post-operative pain scale, the time required epithelialization, ease of application, post-operative infection and number of dressings. RESULTS: Aquacel Ag(R) was the more painless dressing materials in post-operative day 1, 4, 7, 10 than Mepitel(R), Bactigra(R), Op-Site(R). Number of dressings was more lower for Aquacel Ag(R) with Mepitel(R). Ease of application was more higher for Aquacel Ag(R) with Mepitel(R). But Aquacel Ag(R) was not earliest epithelialization. The incidence of infection was not low in Aquacel Ag(R). CONCLUSION: Aquacel Ag(R) dressing is better than other dressing materials for split thickness skin graft donor site in the number of dressings, ease of application, post-operative pain.