Medidas para optimizar cuidados post rinoplastia. Revisión sistemática de la literatura / Measures to optimize rhinoplasty post operative care, systematic review of the literature

Introducción: El cuidado postoperatorio de la rinoplastia ha evolucionado, paralelamente, al desarrollo de la técnica quirúrgica. Existen varias recomendaciones, sin embargo, hay una gran variabilidad interprofesional de las indicaciones post quirúrgicas. Objetivo: Realizar una revisión sistemática de la literatura científica sobre los cuidados post operatorios de la rinoplastia. Material y Método: Para la realización de este estudio se llevaron a cabo búsquedas en PubMed y en Cochrane Database of Systematic Reviews con los perfiles: ([rhinoplasty] AND [post operative care]) y ([rhinoplasty] AND [post surgical care]). Se seleccionaron los artículos publicados en los últimos 10 años, desde 2013 hasta 2023, ambos inclusive. Resultados: Los documentos analizados recogen la evidencia de los diferentes métodos de cuidados post quirúrgicos en rinoplastia. Estos confirman la utilización de corticoides en el período postoperatorio, así como el reposo en 90° y exponen la variabilidad interprofesional que existe en el protocolo postquirúrgico de esta cirugía. Conclusión: El uso de corticoides y el reposo en 90° disminuyen las complicaciones postquirúrgicas de la rinoplastia. Debe existir una clara información sobre lo que el paciente debe esperar post cirugía. El uso de opioides debe ser restringido y la analgesia debe ser multimodal. Es preciso realizar estudios futuros con mayor nivel de evidencia y tener protocolos uniformes para la práctica clínica.

Introduction: The postoperative care of rhinoplasty has evolved along with the development of the surgical technique. There are several recommendations, however there is enormous interprofessional variability of post-surgical indications. Aim: To carry out a systematic review of the scientific literature on rhinoplasty postoperative care. Material and Method: To carry out this study, searches were carried out in PubMed and in the Cochrane Database of Systematic Reviews with the profiles: ([rhinoplasty] AND [post operative care]) and ([rhinoplasty] AND [post surgical care]). Articles published in the last 10 years were selected, from 2013 to 2023, both inclusive. Results: The documents analyzed collect the evidence of the different methods of post-surgical care in rhinoplasty, they confirm the use of corticosteroids in the postoperative period as well as rest at 90° and expose the interprofessional variability that exists in the post-surgical protocol of this surgery. Conclusion: The use of corticosteroids and rest at 90° reduce the post-surgical complications of rhinoplasty. There must be clear information about what the patient should expect post surgery. The use of opioids must be restricted and analgesia must be multimodal. It is necessary to carry out future studies with a higher level of evidence and have uniform protocols for clinical practice.

Manifestaciones clínicas de la deficiencia de factor XII en un lactante

RESUMEN Introducción: El factor XII o factor de Hageman pertenece al sistema de contacto al ser iniciador de la vía intrínseca de la coagulación. Concentraciones bajas de este factor se asocian a tiempo de tromboplastina parcial activado prolongado, sin embargo, no se producen manifestaciones hemorrágicas como ocurre en la deficiencia de otros factores. Objetivo: Describir las manifestaciones clínicas de un lactante con diagnóstico de deficiencia de factor XII de la coagulación. Presentación del caso: Se presenta un lactante de 10 meses que tuvo aparición espontánea de equimosis y se diagnosticó un déficit de factor XII. Conclusiones: Aunque no es común, la deficiencia del factor XII puede estar asociada a manifestaciones hemorrágicas como equimosis tal como se describe en el presente caso.

ABSTRACT Introduction: Factor XII or Hageman factor belongs to the contact system as it is the initiator of the intrinsic coagulation pathway. Low concentrations of this factor are associated with prolonged activated partial thromboplastin time, however, hemorrhagic manifestations do not occur as occurs in the deficiency of other factors. Objective: Describe the clinical manifestations of an infant diagnosed with coagulation factor XII deficiency. Case presentation: A 10-month-old infant who had spontaneous onset of ecchymosis and a factor XII deficiency was diagnosed. Conclusions: Although not common, factor XII deficiency may be associated with hemorrhagic manifestations such as ecchymosis, as described in the present case.

A meta-analysis of pre-and postoperative corticosteroids for reducing the complications following facial reconstructive and aesthetic surgery / Uma meta-nálise sobre o uso de corticosteroides pré e pós-operatórios para reduzir as complicações após cirurgia estética e reconstrutiva facial

Abstract Introduction Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. Objective We conducted this systematic review and meta-analysis to determine the effect of preand postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of preor postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. Results Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo −0.82, 95% CI (−1.37, −0.26), and -0.95, 95% CI (−1.32, −0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. Conclusion This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.

Resumo Introdução O edema e a equimose no pós-operatório da cirurgia plástica facial constituem um problema preocupante para pacientes e cirurgiões. Considera-se que a administração de corticosteroides diminua o período de recuperação e reduza essas complicações. Os dados sobre a eficácia da administração de corticosteroides permanecem controversos entre os cirurgiões. Objetivo Fizemos essa revisão sistemática e metanálise para determinar o efeito da administração de corticosteroides nos períodos pré- e pós-operatório sobre as complicações pós-operatórias em pacientes submetidos à cirurgia reconstrutiva facial apoiada em diferentes análises de subgrupos. Método Foi feita uma busca abrangente de artigos nos bancos de dados PubMed, Cochrane Central, Scopus e Ebsco até outubro de 2019. Incluímos todos os ensaios clínicos cujos pacientes foram submetidos a qualquer tipo de cirurgia plástica facial para estudar o efeito dos corticosteroides nas complicações pós-operatórias. Fizemos a análise de subgrupos de acordo com os tipos e as doses de preparação de corticosteroides, além de uma análise de subgrupos de uso de corticosteroides pré ou pós-operatório. Todas as análises estatísticas foram feitas no software RevMan. Resultados Dezenove estudos foram incluídos nesta revisão sistemática, mas apenas 10 deles foram elegíveis para a metanálise. Os escores de edema periorbital e equimoses reduziram significantemente no grupo de corticosteroides em comparação com o placebo: -0,82, IC95% (-1,37, -0,26) e -0,95, IC95% (-1,32, -0,57), respectivamente. Essas diferenças significantes não se mantiveram nos dias 3 e 7. Doses menores de corticosteroides (8 mg e 10 mg) foram associadas a menores diferenças no escore médio de edema e equimoses palpebrais superiores e inferiores, enquanto as doses mais altas foram associadas a diferenças maiores. Além disso, o corticosteroide pré-operatório reduziu significantemente o sangramento intraoperatório quando comparado ao placebo para doses maiores > 50 mg por dia (p < 0,0001), mas não para 8 mg de corticosteroide (p = 0,06). O uso de corticosteroides no pós- e pré-operatório foi associado a uma diminuição maior de edema e equimoses do que no pré-operatório isoladamente. Conclusão Esta metanálise abrangente confirma um benefício estatisticamente significante do uso de corticosteroides no pré-operatório. Além disso, a manutenção dos esteroides no pós-operatório está associada à redução das complicações em longo prazo. Doses mais altas de corticosteroides estão associadas a uma redução mais significativa no edema e nas equimoses, mas estudos adicionais são recomendados para determinar os efeitos colaterais pós-operatórios como infecção do sítio cirúrgico e atraso na cicatrização.

Uso do taping linfático na prevenção da formação de equimoses em abdominoplastia e lipoaspiração / Use of lymphatic taping to prevent the formation of ecchymosis in abdominoplasty and liposuction

Introdução: Uma das intercorrências mais comuns em pós-operatório de cirurgia plástica de lipoaspiração e abdominoplastia é a equimose, e seu tratamento e prevenção fazem parte da rotina do fisioterapeuta dermatofuncional. O objetivo é avaliar a ocorrência de equimose de pacientes submetidas à abdominoplastia e/ou lipoaspiração tradicional de abdome e flancos, e correlacionar estatisticamente essas ocorrências com o tratamento de taping linfático no transoperatório. Métodos: Ensaio clínico controlado, composto por 20 pacientes do sexo feminino, com idade entre 20 e 60 anos divididos em dois grupos: 10 no grupo controle (GC) e 10 no grupo experimental (GE). Todas as mulheres que apresentavam indicação cirúrgica de abdominoplastia e/ou lipoaspiração de abdome e flancos. O GC foi apenas avaliado no pré-operatório e no 4º dia de pós-operatório, enquanto o grupo GE foi avaliado no pré-operatório, recebeu tratamento transoperatório com aplicação de taping linfático e foi reavaliado no 4º dia de pósoperatório. Resultados: O grupo experimental apresentou uma melhor resposta na resolução da equimose (p=0,01) quando comparado ao grupo controle. Conclusão: Neste estudo, o uso do taping linfático no transoperatório de abdominoplastia e lipoaspiração, reduziu ou anulou a formação de equimose no pós-operatório, contribuindo para a diminuição do número de atendimentos fisioterapêuticos, incidência de quadro álgico e acelerando assim o restabelecimento dos pacientes no pósoperatório das cirurgias de abdominoplastia e/ou lipoaspiração.

Introduction: Ecchymosis is one of the most common complications in the postoperative period of plastic liposuction and abdominoplasty surgery. Its treatment and prevention are part of the routine of the dermatofunctional physiotherapist. The objective is to evaluate the occurrence of ecchymosis in patients undergoing abdominoplasty and/ or traditional liposuction of the abdomen and flanks and statistically correlate these occurrences with the treatment of lymphatic taping during the operation. Methods: Controlled clinical trial, composed of 20 female patients, aged between 20 and 60, divided into 10 in the control group (CG) and 10 in the experimental group (EG). All women had a surgical indication of abdominoplasty and/or liposuction of the abdomen and flanks. The CG was only evaluated preoperatively and on the 4th postoperative day, while the EG group was evaluated preoperatively, received transoperative treatment with application of lymphatic taping and was reevaluated on the 4th postoperative day. Results: The experimental group presented a better response in the resolution of ecchymosis (p=0.01) when compared to the control group. Conclusion: In this study, the use of lymphatic taping during the transoperative period of abdominoplasty and liposuction reduced or annulled the formation of ecchymosis in the postoperative period, contributing to the decrease in the number of physical therapy visits, the incidence of pain and thus accelerating the reestablishment of patients from abdominoplasty and/or liposuction surgeries.

Iliac ecchymosis, a valuable sign for hollow viscus injuries in blunt pelvic trauma patients / 中华创伤杂志(英文版)

PURPOSE@#Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury. CT has been applied for several decades to evaluate blunt pelvic trauma patients. However, it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury (HVI), especially in the early stage after injury. The delayed diagnosis of HVI could result in a high morbidity and mortality. The bowel injury prediction score (BIPS) applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary. We recently found another clinical variable (iliac ecchymosis, IE) which appeared at the early stage of injury, could be predicted for HVI. The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI, and thus reduce complications and mortalities.@*METHODS@#We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital. The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention. The exclusion criteria were abdominal CT insufficiency before operation, abdominal surgery before CT scan, and CT mesenteric injury grade being 5. The MBIPS was defined as BIPS plus IE, which was calculated according to 4 variables: white blood cell counts of 17.0 or greater, abdominal tenderness, CT scan grade for mesenteric injury of 4 or higher, and the location of IE. Each clinical variable counted 1 score, totally 4 scores. The location and severity of IE was also noted.@*RESULTS@#In total, 635 cases were hospitalized and 62 patients were enrolled in this study. Of these included patients, 77.4% (40 males and 8 females) were operated by exploratory laparotomy and 22.6% (8 males and 6 females) were treated conservatively. In the 48 patients underwent surgical intervention, 46 were confirmed with HVI (45 with IE and 1 without IE). In 46 patients confirmed without HVI, only 3 patients had IE and the rest had no IE. The sensitivity and specificity of IE in predicting HVI was calculated as 97.8% (45/46) and 81.3% (13/16), respectively. The median MBIPS score for surgery group was 2, while 0 for the conservative treatment group. The incidence of HVI in patients with MBIPS score ≥ 2 was significantly higher than that in patients with MBIPS score less than ≤ 2 (OR = 17.3, p < 0.001).@*CONCLUSION@#IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity, which is a valuable sign for HVI in blunt pelvic trauma patients. MBIPS can be used to predict HVI in blunt pelvic trauma patients. When the MBIPS score is ≥ 2, HVI is strongly suggested.

¿Cúan segura es la dermatología quirúrgica?. Trabajo de investigación prospectivo sobre sus complicaciones realizado en una sala de procedimientos / How safe is dermatologic surgery? Prospective reserach work on complications in dermatologic surgery located in an office-based setting

Antecedentes: Aunque las complicaciones globales en la dermatología quirúrgica referidas en la bibliografía mundial son bajas (1,64- 4,58%), las publicaciones regionales con datos prospectivos sobre ellas son escasas y, a nivel nacional, inexistentes. Objetivos: Estimar la incidencia de complicaciones intraquirúrgicas (CI) y posquirúrgicas (CP) en los procedimientos de cirugía dermatológica y caracterizarlas en el ámbito de una sala de procedimientos de un hospital de referencia de la Ciudad Autónoma de Buenos Aires. Diseño: Trabajo de investigación descriptivo, prospectivo, observacional y longitudinal. Materiales y métodos: Se recolectó información demográfica del paciente y operativa en el momento del procedimiento quirúrgico. Se clasificaron las complicaciones quirúrgicas que se presentaron hasta un mes posterior al procedimiento en los pacientes intervenidos en la sección de Dermatología Quirúrgica del Hospital F. J. Muñiz, en el período comprendido entre febrero de 2015 y marzo de 2018. Resultados: Se halló una incidencia de 0% (IC 95%: 0 a 0,4) para las CI y de 4,4% (IC 95%: 3,2 a 5,9) para las CP en una serie de 765 pacientes (937 procedimientos). La CP más frecuente fue dehiscencia (68%), seguida de infección (16%), variantes de sangrado (9%) y necrosis (7%). Ninguna fue grave ni incluyó muerte, hospitalización o secuelas permanentes. Conclusiones: La dermatología quirúrgica en el ámbito de una sala de procedimientos es segura y el porcentaje de complicaciones es bajo comparable con lo publicado en la bibliografía internacional. (AU)

Background: Although the global complications in surgical dermatology referred to in the worldwide literature are low (1.64- 4.58%), regional publications with prospective data on them are scarce and nationally non-existent. Objectives: Estimate the incidence of intra-surgical complications (IC) and post-surgical complications (PC) in dermatological surgery procedures and characterize them within the scope of a reference hospital in the Autonomous City of Buenos Aires. Design: Descriptive, prospective, observational and longitudinal research work. Materials and methods: Demographic information of the patient and operative data were collected at the time of the surgical procedure. Surgical complications that occurred up to one month after the procedure on patients undergoing surgery in the surgical dermatology section of the F. J. Muñiz Hospital between February 2015 to March 2018 were classified. Results: The incidence found was 0% (95% CI 0-0.4) for IC and 4.4% (95% CI 3.2-5.9) for PC in a series of 765 patients (937 procedures). The most frequent PC was dehiscence (68%), followed by infection (16%), bleeding variants (9%) and necrosis (7%). Neither the PC were severe, not included death, hospitalization or permanent sequelae. Conclusions: Office based dermatologic surgery is safe and the percentage of complications is low, comparable to that published in the international literature. (AU)

A 5 year retrospective study on epidemiological pattern of ocular trauma

Background: One of the delicate structure in the human body is eye and trauma to the eye is essentially a very grave matter. Major cause of preventable monocular blindness and visual impairment in the world is ocular trauma. So any injury to the eye must be deemed to be an ocular emergency and should be handled with utmost care. Despite its public health importance, there is relatively less population based data on the magnitude and risk factors for ocular trauma specially from developing countries. The objective of the study was to find out the epidemiological pattern of ocular trauma.Methods: The present study was 5 year retrospective study of all the patients who reported directly with ocular injury or referred from the casualty to the department of ophthalmology from January 2013 to January 2018. Various parameters like age, sex, mode of injury, type of injury etc. of all patients seen during this period were analyzed.Results: Total of 4192 ocular trauma patients were seen during study period. Maximum number of ocular trauma patients i.e. 1146 were seen in age group of 21-30 years. Males i.e. 3490 outnumbered females in the present study. Road traffic accidents were the most common cause of ocular trauma and accounts for 1760 cases. Most common reported ocular trauma was periorbital oedema/ecchymosis followed by laceration. Surgical intervention was done in 1660 cases whereas 2532 were managed medically.Conclusions: From present study, we may conclude that the maximum number of ocular trauma patients were seen in the age group of 21-30 years with more preponderance in males. Road traffic accidents were the most common cause of ocular trauma. The fact that the lifetime prevalence of ocular trauma is higher than that of eye diseases, which can be decreased by implementing the traffic rules with strict force and imposing heavy fine and license cancellation for drunken driving.

Prediction of Stature with Regression Equation and Multiplication Factor using Foot Length in Adults: A Comparative Study

Introduction: Stature estimation is important in medicolegalinvestigations and anthropological studies. Regressionequation and multiplication factor are used for estimationof stature from body segment. The objective of this studyis to find out any significant difference exists between theregression equation and multiplication factor estimates usingright foot length in predicting the stature.Material and methods: A total of 619 study subjects thatincluded both males and females with age ranged from 18to 59 years were selected for estimation of stature. Simpleregression equation and multiplication factor were formulatedfrom RFL. They were used for estimation of stature of bothmale and female study subjects separately. Then both themethods were analyzed for their accuracy and to find out anydifference between them.Results: It was statistically significant for multiplication factorwhen compared with regression equation for determiningstature from RFL in males (p=0.018) and females (p=0.002).Conclusion: The present study found that multiplicationfactor was better than regression equation in determiningstature from RFL in both sexes among population in Chennairegion

Prevenção e tratamento de equimose, edema e fibrose no pré, trans e pós-operatório de cirurgias plásticas / Prevention and treatment of ecchymosis, edema, and fibrosis in the pre-, trans-, and postoperative periods of plastic surgery

Introdução: A fibrose, o edema intenso e a equimose são as intercorrências que representam um grande desafio ao fisioterapeuta dermatofuncional no pós-operatório de cirurgia plástica de lipoaspiração e abdominoplastia. O objetivo é propor uma abordagem inédita desde o pré, trans e pós-operatório para prevenir e minimizar as fibroses, edema intenso e equimoses, acelerando a recuperação do paciente e reduzindo o número de sessões. Método: Ensaio clínico controlado, composto por 20 pacientes do sexo feminino, com idade entre 18 e 56 anos, divididos em dois grupos: 10 no grupo controle (GC) e 10 no grupo experimental (GE), que apresentavam indicação cirúrgica de abdominoplastia ou lipoaspiração abdominal, associadas ou não, e que se encontravam com no mínimo 7 dias de pré-operatório. Os dois grupos foram avaliados no pré-operatório. O GC recebeu atendimento somente a partir do 4º dia de pós-operatório, enquanto que o grupo GE recebeu atendimento durante o pré, trans e pós-operatório. Resultados: O grupo experimental apresentou uma média menor do número de sessões (p = 0,0032), perimetria menor no 4º dia de pós-operatório (p < 0,05) nos pontos antômicos: sulco inframamário e crista ilíaca, média menor na resolução da fibrose (p = 0,0058) e média menor na resolução da equimose (p = 0,0002) em relação ao grupo controle. Conclusão: Pode-se concluir com este estudo inédito que o tratamento no pré, trans e pós-operatório reduz o edema, a formação de equimose e principalmente a formação de fibrose no pós-operatório. Também diminui o número de sessões fisioterapêuticas e acelera o restabelecimento do paciente no pós-operatório das cirurgias abdominais.

Introduction: Fibrosis, intense edema, and ecchymosis are complications that represent a great challenge to dermatofunctional physiotherapists in the postoperative period of liposuction and abdominoplasty. Here we aimed to propose a new approach in the pre-, trans-, and postoperative periods to prevent and minimize fibrosis, intense edema, and ecchymosis, thereby expediting the patient's recovery and reducing the number of required physiotherapy sessions. Method: This controlled clinical trial included 20 female patients aged 18-56 years who were divided into the control group (CG; n = 10) and experimental group (EG; n = 10). All were scheduled to undergo abdominoplasty or abdominal liposuction at least 7 days after enrollment. The two groups were evaluated preoperatively. The CG received care only from the 4th postoperative day, while the EG received care during the pre-, trans-, and postoperative periods. Results: The EG required fewer mean physiotherapy sessions (p = 0.0032) and had lower perimetry values on the 4th postoperative day (p < 0.05) in the inframammary groove and iliac crest, lower mean resolution of fibrosis (p = 0.0058), and lower mean resolution of ecchymosis (p = 0.0002) compared to the CG. Conclusion: The findings of this unprecedented study indicate that treatment in the pre-, trans-, and postoperative periods reduces edema, ecchymosis, and fibrosis formation in the postoperative period. It also decreases the number of required physiotherapy sessions and accelerates patient recovery from abdominal plastic surgery.

Avaliação da equimose após osteotomia nasal lateral contínua interna e externa na rinoplastia aberta / Ecchymosis evaluation after internal and external continuous lateral nasal osteotomy in open rhinoplasty

INTRODUÇÃO: O objetivo é avaliar a presença de equimose com 7 e 15 dias após osteotomia nasal lateral interna e externa na rinoplastia aberta. Métodos: Análise prospectiva, dos pacientes submetidos à rinoplastia aberta, com osteotomia nasal lateral com total de 15 pacientes. Os pacientes foram alocados em dois grupos. Aqueles submetidos à osteotomia nasal lateral externa formaram o grupo A (n = 6) e os submetidos à osteotomia interna, o grupo B (n = 9). Foram avaliados com 7 e 15 dias de pós-operatório e registrada a presença ou ausência de equimose. Resultados: Dentro do grupo A evidenciamos no 7º dia de pós-operatório 3 (50%) pacientes com equimose e 3 (50%) sem alteração na tonalidade da pele. Com 15 dias de pós-operatório, o mesmo grupo apresentava 2 (25%) pacientes com equimose e 4 (75%) sem alteração. Já no grupo B foram identificados no 7º dia após o procedimento 3 (33,4%) pacientes com presença de equimose e 6 (66,6%) sem alteração. O mesmo grupo após 15 dias do procedimento apresentou 1 (11,1%) paciente com equimose e 8 (88,9%) sem alteração. Conclusão: Apesar da fratura interna apresentar menor incidência de equimose no sétimo e décimo quinto dias de pós-operatório, não houve relevância estatística na comparação entre as técnicas.

Introduction: The objective is to evaluate the presence of ecchymosis 7 and 15 days after internal and external lateral nasal osteotomy in open rhinoplasty. Methods: A prospective evaluation of 15 patients who underwent open rhinoplasty with lateral nasal osteotomy was conducted. The patients were allocated into two groups. Those who underwent external lateral nasal osteotomy were included in group A (n = 6), while those who underwent internal osteotomy were included in group B (n = 9). The patients were evaluated on postoperative days 7 and 15, and the presence or absence of ecchymosis was recorded. Results: In group A, we observed that on postoperative day 7, 3 patients (50%) had ecchymosis and 3 (50%) showed no changes in skin color. On postoperative day 15, the same group had 2 patients (25%) with ecchymosis and 4 (75%) without changes. On the other hand, in group B, 3 patients (33.4%) had ecchymosis and 6 (66.6%) showed no changes on postoperative day 7. In the same group, 1 patient (11.1%) had ecchymosis and 8 (88.9%) showed no changes 15 days after surgery. Conclusion: Despite the lower incidence of ecchymosis in internal fractures on postoperative days 7 and 15, no statistical significance was observed between the two techniques.

Achenbach's syndrome: Case report and systematic review of the literature / Síndrome de Achenbach: presentación de un caso y revisión sistemática de la literatura

Abstract Introduction: Achenbach's syndrome is a vascular disorder of the hands and feet. It is of unknown etiology and has a benign course. Because of its low prevalence, available literature is limited, and most publications are case reports. No Latin-American publications were found on the subject. The case of a 58 year-old man is presented, along with a systematic review of the literature to describe its clinical characteristics. Methods: A literature search was conducted in PubMed, Embase and Lilacs using free terms and controlled vocabulary (MeSH, Emtree, and DeCS). Results: An analysis was made on a total of 23 articles, 19 of which were case reports, with a total of 46 patients, 43 women and 3 men, from 7 countries. The disorder occurs most often in women over 50 years, and is manifested by the sudden appearance of a blue coloration of the palmar surface of the fingers. It is less common in the feet. Conclusions: Achenbach's syndrome is benign, and does not require medical intervention. Diagnostic methods are of little use. Therefore, identification is important to avoid unnecessary procedures.

Resumen Introducción: El síndrome de Achenbach es un trastorno vascular de manos y pies, de etiología desconocida y de curso benigno. Dada su baja frecuencia de presentación, la literatura disponible es escasa; la mayoría son reportes de casos. No se encontraron publicaciones latinoamericanas sobre el tema. Aquí se presenta un caso clínico, en un hombre de 58 anos, y se hace una revisión sistemática de la literatura para describir sus características clínicas. Métodos: Se realizó una búsqueda de literatura en PubMed, Embase y Lilacs utilizando términos libres y vocabulario controlado (MeSH, Emtree y DeCS). Resultados: Se evaluaron 23 artículos de los cuales 19 fueron reportes de caso. Los reportes de caso muestran la historia de 46 pacientes, 43 mujeres y 3 hombres, en 7 países. El trastorno se presenta más frecuentemente en mujeres mayores de 50 anos y se manifiesta por la aparición súbita de una coloración azul de la cara palmar de los dedos y menos frecuente en los pies. Conclusiones: El síndrome de Achenbach es benigno y no requiere intervenciones médicas. Los métodos diagnósticos son de poca utilidad. Es necesario reconocerlo para evitar procedimientos innecesarios.

Case for diagnosis. Systemic light chain amyloidosis with cutaneous involvement

Abstract: Systemic light chain amiloydosis is a rare disease. Due to its typical cutaneous lesions, dermatologists play an essential role in its diagnosis. Clinical manifestations vary according to the affected organ and are often unspecific. Definitive diagnosis is achieved through biopsy. We report a patient with palpebral amyloidosis, typical bilateral ecchymoses and cardiac involvement, without plasma cell dyscrasia or lymphomas. The patient died shortly after the diagnosis.

Clinical study on the perioperative psychological intervention and intraoperative perfusion of total saponins in patients with breast hematoma and skin stasis after operation / 中国生化药物杂志

Objective To study the clinical treatment effect of intraoperative perfusion of Panax notoginseng saponins on the postoperative mammary gland hematoma and skin ecchymosis. Methods A total of 100 patients who underwent breast minimally invasive surgery from August 2015 to May 2016 in Wenling First People's Hospital were randomly divided into control group and experimental group 50 cases in each group.The control group underwent intraoperative perfusion of Panax notoginseng saponin,on the basis of this, the experimental group were given psychological intervention, pay attention to the psychological state of the patients, strengthen the communication and exchanges with the patients, increased the patient's treatment confidence and treatment compliance. The clinical indicators of the experimental group and the control group were compared. Results After the corresponding treatment, the incidence of postoperative hematoma in the experimental group (4.0%) was significantly lower than in the control group (12.0%), the difference was statistically significant (P<0.05). The probability of skin staining in control group (26.0%) was significantly higher than that in the experimental group (8.0%), the difference was statistically significant (P<0.05). Conclusion Breast minimally invasive biopsy perioperative psychological intervention, intraoperative perfusion of panax notoginseng saponins can reduce the incidence of postoperative mammary gland hematoma, skin ecchymosis.

Clinical study on the perioperative psychological intervention and intraoperative perfusion of total saponins in patients with breast hematoma and skin stasis after operation / 中国生化药物杂志

Objective To study the clinical treatment effect of intraoperative perfusion of Panax notoginseng saponins on the postoperative mammary gland hematoma and skin ecchymosis. Methods A total of 100 patients who underwent breast minimally invasive surgery from August 2015 to May 2016 in Wenling First People's Hospital were randomly divided into control group and experimental group 50 cases in each group.The control group underwent intraoperative perfusion of Panax notoginseng saponin,on the basis of this, the experimental group were given psychological intervention, pay attention to the psychological state of the patients, strengthen the communication and exchanges with the patients, increased the patient's treatment confidence and treatment compliance. The clinical indicators of the experimental group and the control group were compared. Results After the corresponding treatment, the incidence of postoperative hematoma in the experimental group (4.0%) was significantly lower than in the control group (12.0%), the difference was statistically significant (P<0.05). The probability of skin staining in control group (26.0%) was significantly higher than that in the experimental group (8.0%), the difference was statistically significant (P<0.05). Conclusion Breast minimally invasive biopsy perioperative psychological intervention, intraoperative perfusion of panax notoginseng saponins can reduce the incidence of postoperative mammary gland hematoma, skin ecchymosis.

Oculoectodermal syndrome: twentieth described case with new manifestations

Abstract Oculoectodermal syndrome is a rare disease characterized by the association of aplasia cutis congenita, epibulbar dermoids, and other abnormalities. This report describes the twentieth case of the disease. We report a 4-year-old female child who presented with the classical features of the syndrome: aplasia cutis congenita and epibulbar dermoids. Our case expands the clinical spectrum of the disease to include: diffuse hyperpigmentation (some following the Blaschko´s lines); hypopigmented skin areas on the trunk; arachnoid cyst on the right fronto-parietal border; rounded left side of the hippocampus; and dermoid cyst underlying the bulb-medullary transition. Our patient also reported infantile hemangioma on the right wrist and verrucous hemangioma on the left leg, the latter not previously described in the literature.

Effect of Lateral Osteotomy in Subperiostal Plan in Reducing Severity of Periorbital Edema and Ecchymosis after Rhinoplasty.

Introduction: Osteotomy is the main reason of periorbital edema and ecchymosis after rhinoplasty due to damage of angular vessels and fracture of the nasal bones and frontal process of maxilla. Several methods are suggested for reducing periorbital edema and ecchymosis. The main purpose of this study was to determine the effect of internal lateral osteotomy in subperiosteal plan in reducing periorbital edema and ecchymosis after rhinoplasty. Methods: This double-blinded clinical trial was conducted on 30 patients. Internal lateral osteotomy was performed in one side in subperiosteal plan and opposite side used as a control without elevation of periostium from the bone. The degree of edema/ecchymosis on both sides was compared on the 1st and 7th day postoperatively. Results: The severity of periorbital edema was more significant in one side with periosteal elevation 24 hours after operation (P. value=0.006). However, no significant difference was found in periorbital edema between both sides 7 days after the surgery (P. value=0.098). The severity of periorbital ecchymosis was also more significant in the side with periosteal elevation 24 hours (P. value= 0.023) and seven days after operation (P. value=0.004). Conclusion: Since lateral osteotomy in subperiosteal plan increased periorbital edema and ecchymosis after rhinoplasty, performing lateral osteotomies without subperiosteal tunneling during rhinoplasty operation is suggested.

Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

There are two general categories of lateral osteotomy techniques-the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.

Complicaciones postoperatorias asociadas a la cirugía del tercer molar inferior retenido / Postoperative complications associated with impacted lower third molar surgery

Antecedentes: La cirugía del tercer molar inferior retenido es unprocedimiento de rutina en la práctica de la cirugía bucal. Varias complicaciones surgen como resultado de esta intervención quirúrgica. Entre las más frecuentes se encuentran: dolor, infl amación, trismo, hemorragia, equimosis, alveolitis, infección, parestesia y dificultad para comer. Objetivos: El propósito de este estudio fue evaluar la incidencia de complicaciones postoperatorias en la cirugía del tercer molar inferior retenido en pacientes de la Unidad Académica deOdontología de la Universidad Autónoma de Nayarit a fin de tenerlas en cuenta y tomar las respectivas precauciones, ya sea para tratar de evitarlas en lo sucesivo o bien, para reconocerlas y darles tratamiento. No se incluye dolor, infl amación ni trismo. Material y métodos: Este estudio fue longitudinal y prospectivo de siete días consecutivos y de 30 días en total en 38 pacientes entre 16 y 38 años de edad. Se evaluaron las complicaciones postoperatorias relacionadas con la cirugía del tercer molar inferior. Resultados: Participaron 38 pacientes; 29 del género femenino (76.3 por ciento) y 9 del masculino (23.7 por ciento) de entre 16 y 38 años, con un promedio de edad de 23.16 ± 5.2 años. La complicación más frecuente fue la difi cultad para masticar seguida de equimosis...

Background: Impacted lower third molar surgery is a routine pro-cedure in the practice of oral surgery. However, there are various complications associated with the extraction of impacted mandibular third molars, the most common being pain, swelling, trismus, hemor-rhaging, ecchymosis, dry socket, infection, paresthesia, and diffi culty with chewing. Objectives: The aim of this study was to evaluate the incidence of postoperative complications following impacted lower third molar surgery in patients at the Academic Unit of Dentistry of the Autonomous University of Nayarit, so as to ensure these are taken into account and that the respective precautions are taken, either by attempting to avoid them in the future or to recognize and treat them. Pain, infl ammation and trismus are not analyzed in this paper. Material and methods: A longitudinal prospective study of 38 patients between the ages of 16 and 38 years old (with an average age 23.1) was carried out over seven consecutive days, with follow up examination performed at 15 and 30 days. The postoperative complications associated with lower third molar surgery were assessed. Results: 38 patients took part; 29 females (76.3%) and 9 males (23.7%) between the ages of 16 and 38 years, with a mean age of 23.16 ± 5.2 years old. The most common complication was diffi culty with chewing followed by ecchymosis...

Nuss Procedure and Factor VII Deficiency: A Case Report.

A 19 year-old boy admitted with pain and discoloration on his chest wall 18 months after a Nuss procedure performed for pectus excavatum deformity. His physical examination revealed that this skin lesion was an ecchymosis. We diagnosed a very rare bleeding disorder due to Factor VII deficiency which is a recessively inherited coagulation disorder where even spontaneous bleedings may be seen. We aimed to discuss the management of the patient, if it had been diagnosed preoperatively and the preoperative preparation before the bar removal.