Morphometrics of T11-L5 Vertebrae in Jordanian Population: CT Scan-Based Study / Morfometría de las Vértebras T11-L5 en una Población Jordana: Estudio Basado en Tomografía Computarizada

SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.

Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.

Pedículo Renal: Análisis de sus Variantes / Renal Pedicle: Analysis of their Variants

Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describen las relaciones intrínsecas del pedículo renal (PR) a partir de dos planos coronales, siendo la PER el elemento que limita entre ambos. Trivedi et al. (2011) demostró relaciones entre los elementos del PR que no coinciden con las descripciones aportadas por dichos autores.Conocer las posibles variantes en las relaciones intrínsecas del PR es de suma importancia en prácticas quirúrgicas como el trasplante renal (García de Jalón Martínez et al., 2003; Batista Hernández et al., 2010). Por lo tanto, el objetivo del presente trabajo fue analizar las variables relaciones entre los elementos que conforman el PR en la región yuxtahiliar del riñón. Se estudiaron 23 PR, formolizados al 10 % y provistos por el Equipo de Disección de la Segunda Cátedra de Anatomía de la Universidad de Buenos Aires. Se clasificaron los PR en dos grupos. En el Grupo I, las afluentes de origen de la vena renal (AOVR) se hallaban en el mismo plano coronal. En el grupo II, las AOVR se encontraban en diferentes planos coronales. Cada grupo fue subdividido en distintos patrones. Los patrones I y II, de mayor incidencia, fueron asociados al grupo I y los patrones III, IV y V al grupo II. En el patrón I, las AOVR eran anteriores a la pelvis renal (PER) y posteriores a la arteria prepiélica (APP). En el patrón II, las AOVR eran anteriores a la PER y a la APP. Los patrones I y II conforman el grupo I y presentaron mayor número de incidencia en nuestra investigación. Existen también variantes que inciden con menor frecuencia que dichos patrones, estas comprenden el grupo II de la clasificación planteada en el presente trabajo.

SUMMARY: Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describe the intrinsic relationships of the renal pedicle (PR) from two coronal planes, the renal pelvis (PER) being the element that limits between both. Trivedi et al. (2011) showed relationships between the elements of the RP that do not coincide with the descriptions provided by these authors. Knowing the possible variants in the intrinsic relationships of the RP is of the utmost importance in surgical practices such as renal transplantation (García de Jalón Martínez et al., 2003). Therefore, the objective of this study is to analyze the variable relationships between the elements that make up the RP in the juxtahilar region of the kidney. 23 RP were studied, formalized at 10 % and provided by the Dissection Team of the Second Chair of Anatomy of the University of Buenos Aires. PRs were classified into two groups. In Group I, the tributaries of origin of the renal vein (RVOA) were in the same coronal plane. In group II, the AOVRs were in different coronal planes. Each group was subdivided into different patterns. Patterns I and II, with the highest incidence, were associated with group I and patterns III, IV and V with group II. In pattern I, the VROA were anterior to the renal pelvis (PER) and posterior to the prepelvic artery (PPA). In pattern II, AOVRs were prior to PER and APP. Patterns I and II make up group I and presented a higher number of incidence in our investigation. There are also variants that occur less frequently than these patterns, these comprise group II of the classification proposed in this work.

Colgajo microquirúrgico antebraquial en cirugía reconstructiva / Antebrachial microsurgical flap in reconstructive surgery

El colgajo antebraquial anterior es una excelente área dadora para transferir tejido. A lo largo de los años el colgajo antebraquial libre ha tomado fuerza dado que proporciona la cantidad de tejido a donar, su localización y, por sobre todo, la facilidad de disección, que se necesita para cubrir diferentes defectos en todo el cuerpo. Además, debe optimizar los resultados funcionales y estéticos. El sitio receptor debe cumplir en la medida de lo posible, utilizando colgajos con características similares, restablecer la integridad estructural o la función. Material y métodos. Se han realizado desde marzo 2021 a marzo del corriente año un total de 26 colgajos antebraquial libre. Los pacientes de esta serie fueron 80% hombres y 20% mujeres con un rango de edad de 25 a 73 años. Se utilizó tanto para patologías oncológicas, traumáticas e incluso colgajo de elección en pacientes trans para la creación del falo. Se tuvo en cuenta la utilización de la mano no hábil del paciente para así disminuir los riesgos de secuelas funcionales. Este colgajo aporta buen volumen de isla de piel, su pedículo es constante y confiable. La disección del colgajo, en manos entrenadas, acorta los tiempos quirúrgicos y demostró ser útil en muchísimas zonas receptoras del cuerpo. Resultados. Se logró el aporte de tejido necesario en todas las patologías a tratar, utilizando como zonas receptoras diferentes tipos de pedículos. También se logró un buen resultado tanto estético como funcional, volviendo a dar al paciente una calidad de vida aceptable. Conclusiones. El colgajo antebraquial libre ha demostrado ser útil en diversas patologías a tratar. Buen tegumento, su disección es fácil y accesible para cirujanos reconstructivos que recién comienzan su formación así como para cirujanos ya entrenados. Consta de un pedículo confiable con buen diámetro y longitud, lo cual lo hace aún más verídico para contar como primera opción cuando se lo necesita como colgajo libre.

The anterior antebrachial flap is an excellent donor area for tissue transfer. Over the years the free antebrachial flap has gained strength since it provides the amount of tissue to donate, its location and above all the ease of dissection, which is needed to cover different defects throughout the body. It must also optimize functional and aesthetic results. The receiving site should comply as far as possible, using flaps with similar characteristics, restore structural integrity or function

Morphometric description of thoracic vertebral pedicles in adult Malawian cadavers and implications for transpedicula spine fixation / Descripción morfometrica de los pedículos vertebrales torácicos en cadáveres de Malawi adultos e implicaciones para la fijación transpedicular de la columna

SUMMARY: Thoracic pedicles are important during the surgical repair of the thoracic spine deformities. Individuals show considerable differences in the asymmetric dimensions of the thoracic pedicles across populations. The purpose of this study was to determine the thoracic pedicle size and angle in adult Malawian cadavers and to suggest the clinical implications associated particularly the transpedicular fixation of spinal deformities. Adult thoracic vertebra from undetermined sex specimens (n=227) from the skeletal collection in the Anatomy Division, Biomedical Sciences Department, College of Medicine, University of Malawi were measured to assess the pedicle width, pedicle height, chord length, transverse diameter, interpedicular distance, transverse and sagittal pedicle angles. The mean pedicle width was 4.71 ± 1.83 mm (left side) and 4.82 ± 1.77 mm (right side) and the mean pedicle height was 12.63 ± 2.61 mm (left side) and 12.60 ± 2.54 mm (right side). The mean transverse pedicle angle was 12.22 ± 2.30 degrees (left side) and 12.46 ± 2.34 degrees (right side). The mean sagittal pedicle angle was 9.24 ± 2.67 degrees (left side) and 9.40 ± 2.76 degrees (right side). The mean interpedicular distance was 16.67 ± 2.23 mm. Our sample population generally showed smaller thoracic pedicle dimensions than those reported in other populations. Prior knowledge of the variations regarding the thoracic pedicle dimensions is vital for the determination of the pedicle screw size and design. Most importantly the information helps surgeons during preoperative planning of the transpedicular thoracic spine fixation and radiological interpretation.

RESUMEN: Los pedículos de las vértebras torácicas son importantes durante la reparación quirúrgica de las deformidades de la columna torácica. Los individuos muestran diferencias considerables en las dimensiones asimétricas de las vértebras torácicas entre poblaciones. El propósito de este estudio fue determinar el tamaño y el ángulo los pedículos de las vértebras torácicas en cadáveres de Malawi adultos y sugerir las implicaciones clínicas asociadas a la fijación transpedicular de las deformidades espinales. Se midieron 227 vértebras torácicas de muestras de individuos de sexo indeterminado de la colección esquelética en la División de Anatomía, Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad de Malawi para evaluar el ancho del pedículo, la altura del pedículo, la longitud, el diámetro transversal, distancia interpedicular y ángulos pediculares transversales y sagitales. El ancho medio del pedículo fue de 4,71 ± 1,83 mm (lado izquierdo) y 4,82 ± 1,77 mm (lado derecho) y la altura media del pedículo fue de 12,63 ± 2,61 mm (lado izquierdo) y 12,60 ± 2,54 mm (lado derecho). El ángulo pedicular transverso medio fue de 12,22 ± 2,3 grados (lado izquierdo) y 12,46 ± 2,34 grados (lado derecho). El ángulo pedicular sagital medio fue de 9,24 ± 2,67 grados (lado izquierdo) y 9,40 ± 2,76 grados (lado derecho). La distancia interpedicular media fue de 16,67 ± 2,23 mm. La población de esta muestra mostró dimensiones de los pedículos de las vértebras torácicas generalmente más pequeñas que las informadas en otras poblaciones. El conocimiento previo de las variaciones con respecto a las dimensiones de los pedículos de las vértebras torácicas es vital para la determinación del tamaño y diseño del tornillo pedicular. Lo más importante es que la información ayuda a los cirujanos durante la planificación preoperatoria para la fijación transpedicular de la columna torácica y su interpretación radiológica.

Torsión de pedículo de quiste anexial durante el embarazo: experiencia clínica de manejo conservador / Adnexal torsion in pregnancy: clinical experience of conservative management

Las masas anexiales en el embarazo oscilan entre el 2% a 10%; su torsión es causa rara de abdomen agudo durante el mismo. La conducta frente al diagnóstico fue, tradicionalmente, anexectomía sin detorsión del lado comprometido; posteriormente, detorsión y conservación del anexo torcido. OBJETIVO: describir el valor de la punción y aspiración bajo guía ecográfica como tratamiento, inicialmente temporal, en cuadro de torsión de pedículo de quiste anexial durante el embarazo. MÉTODOS: estudio observacional prospectivo de 9 casos clínicos con diagnóstico de torsión de pedículo de quiste anexial y embarazo sometidos al tratamiento de punción aspiración del quiste torcido bajo guía ecográfica entre el año 2014 a 2019. RESULTADOS: en todos los casos fue posible salvar en anexo comprometido; en dos casos hubo persistencia del quiste que se extirpó durante la cesárea; en el resto, la resolución fue completa. Hubo una pérdida de embarazo atribuible al cuadro clínico. CONCLUSION: la punción-evacuación del quiste simple torcido parece ser una buena alternativa en la resolución del cuadro agudo.

The adnexal masses in pregnancy range from 2% to 10%; the adnexal torsion is a rare cause of acute abdomen during pregnancy. Surgical management traditionally involved adnexectomy without detorsion of the compromised structure; recently conservative surgery was proposed which consists in detorsion and conservation of the affected annex. OBJETIVE: to describe the value of ultrasound guided fine needle puncture and aspiration as the initially treatment in pedicle torsion of adnexal cyst during pregnancy. METHODS: prospective observational study of 9 patients that had the diagnosis of pedicle torsion of adnexal cyst during pregnancy who underwent ultrasound guided fine needle aspiration as a treatment of the adnexal cyst torsion between 2014 and 2019. RESULTS: in all cases it was possible to save the compromised structure; in two cases we observed recurrence of the cyst, that was subsequently removed during a caesarean section in both cases; in the rest of the patient's resolution was complete. Spontaneous abortion was seen in one of the patients, this event was not related to the invasive procedure. CONCLUSION: ultrasound guided fine needle aspiration of an adnexal who has suffered of pedicle torsion seems to be a good alternative for the management of this acute condition.

Anatomía morfométrica de importancia clínica del atlas en relación a la estabilización del complejo atlantoaxial y occipitocervical / Morphometric anatomy of clinical importance of the atlas in relation to the stabilization of the atlantoaxial and occipitocervical complex

RESUMEN: Evaluar de manera integral los parámetros morfométricos de la vértebra atlas (C1) en la población mexicana de relevancia en la realización de procedimientos quirúrgicos de la unión craneocervical con el fin de proveer datos cuantitativos indispensables para su realización. Para este estudio se utilizaron un total de 576 vértebras C1 secas de población mexicana contemporánea. Se realizaron 11 mediciones respecto a la morfología de C1. Las mediciones se efectuaron bilateralmente utilizando un vernier digital milimétrico con una precisión de 0,01 milímetros y se aplicó un análisis estadístico. Un total de 576 vértebras atlas (C1), fueron medidas de manera bilateral, todas nuestras mediciones se reportaron en milímetros. El promedio del ancho de las masas lateral fue de 14,87 mm ± 1,38 mm. El promedio de la altura de las masas laterales fue de 4,05 mm ± 0,93 mm. El promedio del ancho del foramen transverso fue de 5,93 mm ± 0,98 mm. El promedio del largo del foramen transverso fue de 6,96 mm ± 0,98 mm. El promedio de la altura del foramen transverso fue de 5,76 mm ± 1,31 mm. El promedio del ancho del surco de la arteria vertebral fue de 18,87 mm ± 1,3 mm. El promedio de la distancia entre la línea media y el margen medial del surco de la arteria vertebral sobre la superficie anterior del arco posterior de C1 en su cara superior fue de 12,47 mm ± 3,14 mm. El promedio de la distancia entre la línea media y el margen medial del surco de la arteria vertebral sobre la superficie posterior del arco posterior de C1 en su cara superior fue de 18,75 mm ± 3,94 mm. El promedio de la distancia entre la línea media y el margen lateral del surco de la arteria vertebral sobre la superficie anterior del arco posterior de C1 en su cara superior fue de 19,7 mm ± 2,52 mm. El promedio de la distancia entre la línea media y el margen lateral del surco de la arteria vertebral sobre la superficie posterior del arco posterior de C1 en su cara superior fue de 29,52 mm ± 3,23. Nuestro estudio demuestra que las mediciones realizadas en nuestra población presentan diferencias significativas respecto a lo reportado actualmente en la literatura. Es necesario contar con un conocimiento de la morfología vertebral en nuestra población para disminuir la ventana de error al realizar procedimientos quirúrgicos que involucren este segmento.

SUMMARY: To evaluate in an integral way the morphometric parameters of the atlas (C1) vertebra in the Mexican population of relevance in performing surgical procedures of the craniocervical junction in order to provide quantitative and essential data for its realization. For this study, a total of 576 dry C1 vertebrae of contemporary Mexican population were used. Eleven measurements were carried out regarding the morphology of C1. The measurements were made bilaterally using a millimeter digital vernier with an accuracy of 0.01 millimeters and a statistical analysis was applied. A total of 576 atlas vertebrae (C1) were measured bilaterally, all our measurements were reported in millimeters. The average width of the lateral masses was 14.87 mm ± 1.38 mm. The average height of the lateral masses was 4.05 mm ± 0.93 mm. The average width of the transverse foramen was 5.93 mm ± 0.98 mm. The average length of the transverse foramen was 6.96 mm ± 0.98 mm. The average height of the transverse foramen was 5.76 mm ± 1.31 mm. The average width of the groove of the vertebral artery was 18.87 mm ± 1.3 mm. The average distance between the midline and the medial edge of the vertebral artery groove on the anterior surface of the posterior arch of C1 on its superior surface was 12.47 mm ± 3.14 mm. The average distance between the midline and the medial border of the vertebral artery groove on the posterior surface of the posterior arch of C1 on its upper face was 18.75 mm ± 3.94 mm. The average distance between the midline and the lateral border of the vertebral artery groove on the anterior surface of the posterior arch of C1 on its superior surface was 19.7 mm ± 2.52 mm. The average distance between the midline and the lateral border of the vertebral artery groove on the posterior surface of the posterior arch of C1 on its superior surface was 29.52 mm ± 3.23. Our study shows that the measurements made in our population present differences with respect to what is currently reported in the literature. It is necessary to have knowledge of vertebral morphology in our population to reduce the error window when performing surgical procedures involving this segment.

Torsión de pedículo de quiste anexial durante el embarazo: experiencia clínica preliminar al manejo conservador / Adnexal torsion in pregnancy: preliminary clinical experience to conservative management

Objetivo: describir la utilidad de los signos clínicos, la ecografía y el Doppler color para el diagnóstico y manejo posterior en el embarazo. Método: estudio observacional, retrospectivo de cinco casos clínicos inicialmente diagnosticados como torsión de pedículo de quiste anexial y embarazo, sometidos a cirugía. Resultados: en el 80% de los casos hubo un diagnóstico preoperatorio correcto. En todos los casos de torsión de pedículo se identificó preoperatoriamente el signo directo de torsión. Hubo un caso de falso positivo de una paciente con la triada clásica y flujo vascular muy escaso en su pared, interpretado como signo indirecto de torsión de pedículo no corroborado en la cirugía. En un caso de torsión, se identificó señal Doppler Color normal en la pared del quiste. Conclusión: al diagnóstico ecográfico y clínico se correlacionó casi con todos los casos de torsión de pedículo de quiste anexial en el embarazo. El Doppler color no aportó mayor información al obtenido por la clínica y la ecografía. El manejo quirúrgico por laparotomía trajo consigo algunas complicaciones como la pérdida del anexo comprometido, aborto, mayor estancia hospitalaria.

Objetive: describe the usefulness of clinical signs, ultrasound and color Doppler for diagnosis and subsequent management in pregnancy. Method: retrospective observational study of 5 clinical cases initially diagnosed as torsion of pedicle of adnexal cyst and pregnancy, undergoing surgery management. Results: in 80% a correct preoperative diagnosis was made. In all cases, the direct sign of pedicle torsion was identified preoperatively, There was a false positive case of patient with the classic triad and very little vascular flow in its wall, interpreted as an indirect sign of pedicle torsion not corroborated in surgery. In 1 torsion case of pedicle of adnexal cyst, normal Color Doppler signal was identified in the cyst wall. Conclusion: ultrasound scan and clinical diagnosis correlated almost with all cases of adnexal cyst pedicle torsion in pregnancy. The Color Doppler did not provide more information than that obtained by the clinic and the ultrasound. The surgical management by laparotomy brought with it some complications such as the loss of the committed annex, abortion, longer hospital stay.

Axis Screw Fixation ­ A Step-by-Step Review of the Surgical Techniques

In this article, we present the techniques of axis screw fixation (laminar, pars, pedicle and transarticular screws), discussing the indications and contraindications of each one, as well as surgical tips and anatomical landmarks.

No presente artigo, apresentamos as técnicas de fixação do áxis com parafusos (lamina, parafusos de pars, pedículo e transarticular), discutindos as indicações e contraindicações das mesmas, assim como dicas cirúrgicas e parâmetros anatômicos relevantes.

Utilización de modelos de simulación para el control del pedículo pulmonar en cirujanos en formación / Use of simulation models for control of pulmonary pedicle in training surgeons

Introducción: Las lesiones del tórax constituyen una causaimportante de morbilidad y mortalidad. El cirujano debe conocerla anatomía de la región afectada a la perfección y susvariaciones anatómicas, ya que el control del pedículo pulmonaren tiempo correcto aumenta las chances de sobrevida delpaciente.Objetivo: Demostrar la necesidad de modelos experimentalespara el control del pedículo pulmonar en cirujanos en formación.Material y métodos: Se evaluó a 12 cirujanos en formación en ladisección anatómica en 15 cadáveres formolizados al 10% y laidentificación de estructuras anatómicas normales del pedículopulmonar y variaciones del mismo (Junio/2012-Septiembre/2012)...

Introduction: Chest injuries are a major cause of morbidity and mortality. Surgeons must perfectly know the anatomy of theaffected anatomical region and its anatomical variations since control of pulmonary pedicle at the right time increases thechances of patient’s survival.Objectives: Demonstrate the need for experiemtnal models forthe control of pulmonary pedicle in training surgeons.Material and Methods: 12 training surgeons were evaluated inthe anatomical dissection in 15 corpses formolized at 10% and inthe identification of normal anatomical structures of pulmonary pedicle and its variations (June/2012-September/2012) Control techniques of pulmonary vessels were performed by clampingand rotating in 3 corpses and the surgical technique were reproduced in live pigs models during Surgical Conferences and Workshops (October/2012-June/2013)...

Mamoplastias redutoras e mastopexias realizadas no HC-UNICAMP: análise comparativa entre duas técnicas / Reduction mammoplasties and mastopexies performed at HC-UNICAMP: comparative analysis between two techniques

Introdução: Diferentes técnicas para mamoplastia redutora e mastopexia são descritas na literatura, visando a resultados que reconstituam o polo superior, ofereçam melhor projeção e proporcionem tratamento adequado para a ptose mamária. No entanto, devemos nos atentar para a segurança da técnica, com manutenção da vascularização, inervação dos tecidos e possibilidade de amamentação. Análise comparativa com pacientes operadas pela técnica com retalho de pedículo inferior e pacientes operadas pela técnica com sutura circular em bolsa. Métodos: Análise de 85 pacientes submetidas à mamoplastia redutora ou mastopexia sem implantes, entre janeiro de 2011 e dezembro de 2012, no Hospital de Clínicas da Unicamp. Foram excluídos 31 pacientes, as quais foram submetidas apenas à mamoplastia redutora pela técnica de Pitanguy (sem utilização de retalhos ou sutura circular). Dentre as 54 pacientes restantes, cinco foram posteriormente excluídas devido ao não comparecimento à consulta ou à não realização da ultrassonografia pós-operatória. Foram agrupadas 16 pacientes submetidas à sutura circular contínua e 33 pacientes operadas pela técnica de pedículo inferior. Resultados: Dados demográficos foram semelhantes nos dois grupos. Maior número de pequenas complicações e resultados insatisfatórios foi observado no grupo submetido à técnica de pedículo inferior, bem como maior índice de achados ultrassonográficos relevantes no pós-operatório. Conclusão: A técnica de sutura circular contínua apresentou elevado índice de satisfação, menor número de complicações e resultados mais duradouros quando comparados com a técnica de pedículo inferior, durante o período analisado.

Introduction: Several reduction mammoplasty and mastopexy techniques are described in the literature, with the aim of reconstituting the upper pole, offering better projection, and providing adequate treatment for breast ptosis. However, particular attention should be devoted to the safety of the technique, with maintenance of vascularization, tissue innervation, and the capability of breastfeeding. Female patients operated on with the inferior pedicle flap technique were compared with those operated on with purse-string circular suturing. Methods: Eighty-five patients who had undergone reduction mammoplasty or mastopexy without implants, between January 2011 and December 2012 at Unicamp's Clinical Hospital, were evaluated. Thirty-one patients who only underwent reduction mammoplasty by Pitanguy's technique (without the use of flaps or circular sutures) were excluded. Of the remaining 54 patients, five were subsequently excluded for not attending medical appointments or failure to have postoperative ultrasonography. A group of 16 patients who had undergone circular suturing and a group of 33 operated on by the inferior pedicle technique were considered. Results: Demographic data were similar for both groups. A higher number of minor complications and unsatisfactory results were observed in the group that underwent the inferior pedicle technique, who also had a higher rate of relevant post-operative ultrasonography events. Conclusion: The circular suturing technique resulted in a high satisfaction rate, lower number of complications, and longer lasting results than the inferior pedicle technique, during the period analyzed in this study.

Multiple anatomical variations of the hepatic pedicle: case report and clinical application / Múltiples variaciones anatómicas del pedículo hepático: reporte de caso y aplicación clínica

The knowledge in detail of the anatomy of the hepatic pedicle is critical when operating it and its surroundings. The presence of anatomic variations is higher at the arterial component level than at the bile component level or venous component level, which in the 90% of the cases it appears as the classic description. The presented case in this work implies a very low frequency of appearance. For this reason, the surgeon must be alert at the moment of making a decision so as to avoid injuries that may put the patient´s life at risk.

El conocimiento en detalle de la anatomía del pedículo hepático es fundamental al momento de intervenir quirúrgicamente sobre el mismo y su vecindad. La presencia de variaciones anatómicas es mayor a nivel del componente arterial, luego biliar y finalmente venoso, el cual en el 90% de los casos se dispone de acuerdo con la descripción clásica. El caso presentado en este trabajo supone una muy baja frecuencia de aparición, siendo precisamente estas disposiciones poco habituales las que obligan al cirujano a mantenerse alerta en el momento de actuar para evitar injurias que puedan comprometer la vida del paciente.

Aplicação estética e reconstrutora da mamoplastia com pedículo areolado / Aesthetic and reconstructive application of mammoplasty with the inferior dermal pedicle technique

Introdução: A mamoplastia redutora é uma das mais frequentes cirurgias realizadas no âmbito da cirurgia plástica, sendo que diversas técnicas são descritas. A técnica do pedículo inferior areolado é uma técnica pouco difundida no Brasil, que pode ter aplicação tanto em cirurgias estéticas quanto reconstrutoras. O objetivo deste estudo foi analisar os resultados de mamoplastias realizadas com esta técnica. Métodos: Análise retrospectiva de prontuários, contato telefônico com as pacientes e análise fotográfica, identificando perfil das pacientes, finalidade da cirurgia, complicações, grau de satisfação e grau de sensibilidade do complexo aréolo-papilar (CAP). Resultados: No período analisado, 74 pacientes foram submetidas à mamoplastia com a técnica do pedículo inferior areolado (42 mamoplastias redutoras estéticas, 13 mamoplastias para reconstrução imediata de mama pós-ressecções segmentares, e 19 mamoplastias de simetrização pós-reconstrução com outras técnicas). Complicações ocorreram em 20 pacientes. Em relação à avaliação da satisfação pelas pacientes, o resultado foi considerado ótimo em 62,16% dos casos, bom em 25,67%, e regular em 12,17%. Quanto à sensibilidade do CAP, 72,97% das pacientes referiram não haver perda da sensibilidade, 20,27% referiram pequena diminuição, 6,76% referiram diminuição significativa e nenhuma relatou perda total da sensibilidade. Conclusões: A técnica de mamoplastia redutora com pedículo inferior areolado apresenta boa aplicabilidade, tanto em cirurgias estéticas quanto reconstrutoras, seja em reconstruções imediatas (quadrantectomias superiores) ou em simetrizações, principalmente pós TRAM. Apresenta alto grau de satisfação com o resultado, baixa taxa de complicações, alta preservação da sensibilidade do CAP e boa manutenção do resultado.

Introduction: Reduction mammaplasty is one of the most common surgeries performed in the field of plastic surgery, and several techniques have been described. The inferior dermal pedicle technique, which is relatively unknown in Brazil, may have applications in both aesthetic and reconstructive surgery. The aim of the current study was to analyze the results of mammaplasty performed with this technique. Methods: Data were collected from a retrospective analysis of medical records. Study data also included data obtained through telephone contact with patients, photographic analysis, and patient profiles, as well as data on the purpose of the surgery, complications, satisfaction with results, and degree of sensitivity of the nipple-areolar complex (NAC). Results: During the study period, 74 patients underwent mammaplasty with the inferior pedicle technique (42 aesthetic reduction mammaplasties, 13 mammaplasties for immediate breast reconstruction following segmental resections, and 19 post-reconstruction symmetrization mammaplasties with other techniques). Complications occurred in 20 patients. Regarding the assessment of satisfaction by the patients, the outcome was rated as excellent in 62.16% of cases, good in 25.67%, and fair in 12.17%. In terms of the sensitivity of the NAC, 72.97% of patients reported no loss of sensitivity, 20.27% reported a small loss, 6.76% reported significant loss, and no patients reported a total loss of sensitivity. Conclusions: The inferior pedicle reduction mammaplasty technique has good applicability both in aesthetic reconstructive surgeries and in immediate reconstructions (upper quadrantectomies) or symmetrizations, especially after the use of a transverse rectus abdominis myocutaneous flap. The technique offers a high degree of satisfaction with the results, a low rate of complications, a high degree of preservation of the sensitivity of the NAC, and good maintenance of the results.

Axis instrumentation: surgical results / Instrumentação do áxis: resultados cirúrgicos

OBJECTIVE: Evaluate the surgical results of axis screw instrumentation. METHODS: Retrospective evaluation of the clinical and radiological data of patients submitted to axis fixation using screws. RESULTS: Seventeen patients were surgically treated. The mean age was 41.8 years (range: 12-73). Spinal cord trauma was the most common cause of instability (8 patients - 47%). Bilateral axis fixation was performed in all cases, except one, with laminar screw (total of 33 axis screws). Seven patients (41.1%) underwent bilateral pars screws; laminar screws were used in six cases and pedicular screws were used in two. In two cases, we performed a hybrid construction (laminar + pars and pedicle + pars). There was no neurological worsening or death, nor complications directly related to use axis screws. CONCLUSION: Axis instrumentation was effective and safe, regardless of the technique used for stabilization. Based on our learnt experience, we proposed an algorithm to choose the best technique for axis screw fixation.

OBJETIVO: Avaliar os resultados cirúrgicos da instrumentação com parafusos do áxis. MÉTODOS: Avaliação retrospectiva de dados clínicos e radiológicos de pacientes submetidos à instrumentação com parafusos do áxis. RESULTADOS: Dezessete pacientes foram tratados cirurgicamente. A média de idade foi de 41,8 anos (faixa: 12-73 anos). Trauma na coluna foi a causa mais comum de instabilidade (8 casos - 47%). Fixação bilateral do áxis foi realizada em todos os casos, exceto em um, com parafuso de lâmina (total de 33 parafusos). Em sete pacientes (41,1%), foram usados parafusos de pars; em seis, parafusos de lâmina; e em dois, de pedículos. Em dois casos, foi utilizada uma combinação de técnicas (pars + lâmina e pars + pedículo). Não houve piora neurológica nem complicações diretas em decorrência do uso dos parafusos. CONCLUSÃO: A instrumentação do áxis foi eficaz e segura independentemente da técnica escolhida para estabilização. Com base em nossa experiência, foi proposto um algoritmo para auxílio na escolha da melhor técnica a ser empregada.

Pediculo-Iliac Screw Fixation in Vertically Unstable Posterior Pelvic Ring Injury / 대한정형외과학회잡지

Herein, we report 5 cases of vertically unstable posterior pelvic ring injuries treated by pediculoiliac fixation. We enrolled 5 patients (male 3, female 2) with vertically unstable posterior pelvic ring injuries treated by pediculo-iliac fixation. Prior to and following the surgery, radiologic results were compared using Matta and Saucedo's method and the clinical results before and after surgery were compared using the Postel score. The outcomes of radiological evaluation were anatomic reduction in 3 cases and nearly anatomic in 1. The mean postel score at last follow up was very good in 4 cases and poor in 1 case. Lumbosacral pediculo-iliac screw fixation enables early ambulation and it is considered a useful method.

Morphometric Study of Cervical Vertebrae C3-C7 in a Population from Northeastern Mexico / Estudio Morfométrico de las Vértebras Cervicales C3-C7 en una Población del Noreste de México

Knowing the dimensions of the vertebral elements is very important for the development of instrumentation related to the cervical spine. Ethnic variations have been reported in these dimensions and, to date, there have been no morphometric studies of this area performed on the Mexican population. We conducted a morphometric study of 150 cervical vertebrae (C3-C7) obtained from a northeastern Mexican population to determine the dimensions of the bodies, pedicles, laminae, spinous processes, and superior and inferior articular processes. We did not find significant differences (p<0.05) in measurements taken of the left and right sides. The dimensions of the vertebral bodies were larger at lower levels. The pedicles of the C3 vertebra were larger in all dimensions compared to the other vertebrae. The largest height of the laminae was observed at C7 and the largest transverse length was observed at C5. The dimensions of the bodies, spinous processes, and laminae increased from C3-C7, whereas the dimensions of the pedicles and superior and inferior articular process height decreased toward the lower cervical levels.

Las mediciones de los elementos vertebrales son importantes para la instrumentación de columna cervical. Se han reportado variaciones étnicas en estas medidas y en la actualidad no existen estudios morfométricos en la población mexicana. Se realizó un estudio morfométrico en 150 vértebras cervicales (C3-C7) para determinar las medidas de los cuerpos, pedículos, láminas, procesos espinosos y articulares superiores e inferiores. No se encontraron diferencias significativas (p<0.05) en las medidas tomadas entre ambos lados. Las dimensiones de los cuerpos vertebrales se incrementan en niveles más bajos. Los pedículos de la vértebra C3 son mayores en todas sus dimensiones. La mayor altura de las láminas se observó en C7 y la mayor longitud transversal en C5. Las dimensiones del cuerpo, procesos espinosos y láminas se incrementan de C3-C7, mientras las dimensiones de los pedículos, altura de procesos articulares superiores e inferiores disminuyen en los niveles cervicales más bajos.

Aspectos morfológicos, morfométricos e ultraestruturais do baço de ratos após o clampeamento total do pedículo hepático / Morphologic, morphometric, and ultrastructural aspects of the spleen of rats after hepatic pedicle total clamping

Avaliaram-se as alterações morfológicas, morfométricas e ultraestruturais que ocorreram no baço devido à isquemia produzida pelo clampeamento total do pedículo hepático. Para tanto, foram utilizados 40 ratos machos, distribuídos em quatro grupos de 10 animais. O grupo-controle (C) não foi submetido à isquemia, e os grupos tratados (E1, E2e E3) foram submetidos ao clampeamento por 10, 20 e 30 minutos, respectivamente. Fragmentos do baço foram retirados e analisados histologicamente pela microscopia de luz (hematoxilina-eosina, ferrocianeto-férrico) e pela microscopia eletrônica de transmissão. Os resultados demonstraram que 10 minutos de clampeamento do pedículo hepático são suficientes para apresentar sinais de congestão esplênica e 20 e 30 minutos promovem intensa digestão de hemácias pelos macrófagos, com presença de grânulos de ferro (hemossiderina) no parênquima esplênico.

The macro and microscopic alterations that occurred in the spleen during an ischemia produced by the hepatic pedicle total clamping were studied. Forty male rats were distributed in four groups of 10 animals each. The control group (C) was not submitted to ischemia and the treated groups (E1, E2, and E3) were submitted to the clamping during 10, 20, and 30 minutes, respectively. Spleen fragments were collected and histologically analyzed by the light microscopy (eosin-hematoxilin and ferric ferrocyanide) and by the transmission electron microscopy. The results showed that 10 minutes of hepatic pedicle total clamping was enough produce signs of splenic congestion and 20 and 30 minutes promoted intense red bood cels digestion by the macrophages with the presence of iron granules (hemosiderin) in the splenic parenchyma.

Disposición anatómica de la arteria hepática desde su origen hasta su distribución en el pedículo hepático / Anatomical arrangement of the hepatic artery from its origin to its distribution in the hepatic pedicle

Identificar las variaciones anatómicas de la Arteria Hepática (AH), según su distribución y disposición en el pedículo hepático. Estudio prospectivo, donde se diseca el pedículo hepático, en 30 cadáveres de ambos sexos, realizándose un registro gráfico y fotográfico. La arteria hepática común nace en un 100 por ciento del tronco celíaco (TC). Sus variaciones son: colaterales de la arteria hepática común (AHC): arteria gastroduodenal nace en el 3.33 por ciento de los casos de la arteria hepática derecha (AHD), la arteria pilórica (AP) nace de la AHD en el 3.33 por ciento de los casos, y de forma accesoria en 5 por ciento de la arteria hepática izquierda (AHI). Las ramas terminales de la arteria hepática propiamente dicha (AHP) tenemos: que AHD emite ramas segmentarías en el 10 por ciento y nace de la arteria mesentérica superior (AMS) en el 3 por ciento de los casos. Con relación a sus ramas colaterales, la arteria cística (AC) recibe rama accesoria en el 6 por ciento proveniente de la AHP. La AHI emite ramas segmentarias extrahepáticamente en el 17 por ciento y en el 15.34 por ciento la AHI nace de la arteria gástrica izquierda como rama accesoria. En 2 por ciento de los casos la arteria hepática presenta trayectoria única, convexidad cefálica y concavidad inferior y emitiendo en el hilio hepático sólo ramas segmentarias. La anatomía clásica está presente en el 60 por ciento de los casos estudiados, sieno sólo el 40 por ciento el que presenta variaciones anatómicas en alguna de sus arterias. Además, debe ser tomando en cuenta que las principales variantes son la encontradas en las ramas colaterales y terminales, de las cuales la AGI es la que presenta mayor variaciones, pero quien presenta mayor variedad de arterias aberrantes es la AHD. Por esta razón, estas variaciones deben ser tomadas en cuenta al momento de realizar procedimientos quirúrgicos desde los menos invasivos hasta el transplante hepático de donante vivo.

Reconstrução nasal com retalho frontal: nossa experiência / Nasal reconstruction with forehead flap: our experience

Introdução: o pai da reconstrução nasal foi Sushuta Samhita que criou a técnica do retalho frontal (retalho indiano) para reparação do nariz amputado como punição ao crime de adultério. (Índia,1000-2000a.C). Objetivos: o estudo visa uma auto-avaliação da técnica de reconstrução nasal com retalho frontal e análise dos resultados obtidos em nosso serviço. Métodos: foi realizado um estudo retrospectivo de nove casos de reconstrução nasal com retalho frontal realizados no Núcleo de Cirurgia Plásticado HUda Universidade Federal de Santa Catarina de Setembro de 2002 a Dezembro de 2006. Resultados: das nove reconstruções nasais com retalho frontal, uma evoluiu com necrose distal do retalho, uma com necrose total e os sete demais com boa evolução. Atualmente os nove pacientes já foram submetidos ao segundo tempo cirúrgico com secção do pedículo e transposição da região proximal do mesmo para região frontal. Discussão: as indicações de reconstrução nasal parciais dacorrem de múltiplas causas, dentre elas, principalmente após ressecção de tumores e após traumas. Normalmente as reconstruções são realizadas em mais de uma etapa até o refinamento e melhor resultado final. No estudo, dos nove casos, oito foram após tratamento de tumores nasais e um após trauma. Em dois casos fez-se necessário o uso do retalho nasogeniano para reconstituição do forro nasal, e, em um caso foi necessário o uso de enxerto de cartilagem conchal para molde do nariz. Foram utilizados pelo menos dois tempos cirúrgicos para reconstrução nasal. Conclusão: a reconstrução nasal visa o restabelecimento de sua unidade estética o mais próximo do natural. Isto posto, em virtude de sua cor e textura, a pele da região frontal consiste na melhor área doadora para retalhos utilizados na reconstrução nasal.

Background: the father of the nasal reconstruction was Sushuta Samhita who created the technique of the forehead flap for mending of nose amputated as a punish mentto the crime ofadultery.(Índia1000-2000b.C) Objectives: the study aims at an auto - evaluation of the technique of the nasal reconstruction with the forehead flap and also an analysis of the results obtained in our service. Methods: It was carried out a retrospective study of nine cases of nasal reconstruction with the forehead flap, which has been made in the Nucleus of Plastic Surgery of the HU of the Federal University of Santa Catarina. Results: one of the nine nasal reconstruction with forehead flap evolved with distal necrosis of the flap, one with total necrosis and the other seven had good evolve. At present, the nine patients have already been in the surgical second stage with the section of the pedicle. Discussion: the partial indications of nasal reconstruction result from multiple causes, among them, mainly after resection of tumors and after traumas. Usually the reconstruction is carried out in more than one stage up to the refinement and better final result. In the study, eight cases were made after a treatment of nasal tumours and one case after a trauma. In two cases it was necessary to use the nasolabial flap to reconstruction of the inner of the nose. One case was necessary to use a cartilage conchal graft to shape the nose. At least, two surgical stages were used to reconstruction nasal. Conclusion: among the possibilities of nasal reconstruction the one which was carried out with the forehead flap is the most suitable because of managing to restore the unity of aesthetic nasal near the natural appearance.