Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft / Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p= 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p= 0,001; p= 0,005; e p= 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p= 0,003; 30 a 60°, p= 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.

The Effect of Fibroblast Growth Factors in Grafted Fascia into the Vocal Fold of Rabbits

Abstract Introduction The human larynx is a very important organ for communication. Many conditions lead to scarring of the vocal folds, decreasing voice quality. Objective We aimed to determine whether fibroblast growth factors (FGFs) may influence tissue integration of grafted fascia into the vocal folds of an animal model. Methods This is an experimental animal study with 12 adult rabbits that were submitted to a grafting fragment obtained from superficial cervical fascia into the vocal fold lamina propria, bilaterally. The right vocal fold was injected with FGFs. The animals were sacrificed after 1 month or 12 months, depending on the group they were assigned to, and a histological analysis of their vocal folds was performed.We analyzed the histological changes (such as the presence of fibrosis and neovascularization) induced by the acute or chronic inflammatory reactions. Results The FGFs induced acute inflammatory changes in all animals after 1 month of the initial experiment. The presence of FGFs triggered more fibrosis than the expected due to the surgical procedure itself when compared with the control side of all animals after 12 months of the initial experiment. Conclusions Fibroblast growth factors alone do not represent a good therapeutic option in phonosurgery, since we observed higher levels of fibrosis in the vocal fold lamina propria. Further studies combining more substances may be necessary to elucidate the best option to be used in this kind of surgery. (AU)

Resolución de úlcera trocantérea mediante colgajo musculocutáneo de fascia lata en isla con cierre en V-Y / Trochanteric ulcer reconstruction by tensor fascia lata musculocutaneous island flap with a V toY closure

Introducción. La úlcera trocantérea es una de las lesiones por presión más frecuente y está asociada generalmente a bursitis, por lo que su tratamiento es complejo. Materiales y Métodos. Se presenta el caso de un paciente masculino de 29 años, con antecedente de lesión medular asociada a paraplejía fláccida con desarrollo de úlcera trocantérea derecha elíptica vertical. Fue abordado de forma multidisciplinaria y resuelto con resección de la patología y reconstrucción con colgajo musculocutáneo de fascia lata. Resultado. El paciente fue dado de alta al 21 día posoperatorio. No presentó dehiscencias, infecciones de la herida ni recidiva al cumplirse 6 meses de la cirugía y el resultado estético y funcional fue satisfactorio. Conclusión. El colgajo musculocutáneo de fascia lata ascendido y con cierre de V en Y es una opción segura, versátil y reproducible para la resolución de úlceras trocantéreas. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas.

Background. Trochanteric ulcer is one of the most frequent pressure sore and is usually related with bursitis, therefore its treatment is complex. Material and Methods. We present a case of a 29 year-old male patient with medical history of spinalcord injury (SCI) related to flaccid paraplegia and the development of right trochanteric vertical elliptical sore. He was treated by a multidisciplinary team and solved by the resection of the pathology and immediate reconstruction with tensor fascia lata (TFL) musculo cutaneous flap. Results. The patient was discharged from the institution on the 21st postoperative day. With a follow-up of a 6 months period, complications such as wound infection, suture dehiscense or recurrence were not observed. Aesthetic and functional results were satisfactory. Conclusion. Ascended TFL flap with a V-Y closure is a reproducible, reliable and versatile procedure for the coverage of trochanteric pressure sore defects. However all surgical techniques tages must be considered in order to avoid complications and recurrence of the disease

Ptosis Repair Using Preserved Fascia Lata with the Modified Direct Tarsal Fixation Technique

PURPOSE: To evaluate the clinical outcome of frontalis sling operation using preserved fascia lata with modified direct tarsal fixation in congenital ptosis patients. METHODS: Forty-seven congenital ptosis patients (60 eyes) who underwent a frontalis sling operation using preserved fascia lata with modified direct tarsal fixation method between March 2001 and December 2008 with a mean follow-up time of 52 months (range, 26 to 122 months) were included in this study. The medical records were reviewed retrospectively. RESULTS: A retrospective chart review was conducted in patients who were diagnosed with congenital ptosis and underwent frontalis suspension surgery using preserved fascia lata with modified direct tarsal fixation from 2001 through 2008 at Dong-A University Hospital. The patients were 34 males and 14 females. The age of the patients ranged from 1 to 18 years with an average age of 4.51 years. At a mean follow-up of 60 months, good final results were achieved in 46 eyes (76.6%), fair in 8 eyes (13.3%), and poor in 6 eyes (10%). The poor results consisted of undercorrection of 1 eye and recurrence in 5 eyes. The accumulative survival rate was 87.2%, with all recurrences occurring within 12 months postoperatively. CONCLUSIONS: Frontalis sling operation by preserved fascia lata with modified direct tarsal fixation appears to be an effective treatment for severe congenital ptosis, showing good long term results.

Surgical application of fascia lata as a pericardial substitute in rabbits / Aplicação cirúrgica de fascia lata como substituto do pericárdio em coelhos

PURPOSE: To use fascia lata instead of pericardium and observe the presence of adhesions. METHODS: Twenty rabbits were divided into two group of ten. In group A, a 1×1 cm segment of pericardium was excised and resutured. In group B excised pericardium was substituted for autologous fascia lata. RESULTS: In the comparison of microscopic adhesion rate between two groups A, B after eight weeks, there was no significant statistical difference. CONCLUSION: Fascia lata is safe and it can be substituted for pericardium especially in repeat sternotomy in repairing congenital heart defects to avoid heart injury.

OBJETIVO: Utilizar fascia lata em vez de pericárdio e observar a presencça de aderências. MÉTODOS: Vinte coelhos foram distribuidos em dois grupos de dez. No grupo A, um 1×1 cm de segmento de pericárdio foi retirado e resuturado. No grupo B pericárdio retirado foi substituído por fáscia lata autóloga. RESULTADOS: Na comparação da taxa de aderência microscópica entre dois grupos A, B, após oito semanas, não houve diferença estatisticamente significante. CONCLUSÃO: A fascia lata é segura e pode ser substituta do pericárdio, especialmente em nova esternotomia na reparação de defeitos cardíacos congênitos para evitar lesão cardíaca.

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

OBJECTIVE: The aim of this study was to evaluate the treatment of patients with chronic lesions in the posterolateral corner of the knee with reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament and with autografts of the biceps femoris and fascia lata. METHOD: A total of 129 patients with injuries of the posterolateral corner of the knee that lasted for more than three weeks and were associated with the lesion of at least one of the cruciate ligaments were included. All of the patients were operated on consecutively in the same hospital between March 2004 and April 2009. Clinical evaluation using the Lyshom scale and the International Knee Documentation Committee (IKDC, item 4, assessment ligament) protocol was performed in 114 patients for whom there were complete data available. RESULTS: There was significant improvement in the Lyshom score and improved stability according to the IKDC protocol in the pre- compared to postoperative varus stress test at 30 degrees and the posterolateral rotation test. CONCLUSIONS: Surgical reconstruction of the posterolateral corner of the knee with biceps femoris tendon and fascia lata autografts is effective in stabilizing the posterolateral corner of the knee.

Utilización de membrana de fascia lata y hueso en polvo liofilizado en cirugía apical: caso clínico / The use of fascia lata membrane and freeze drying bone powder in apical surgery: a clinical case

En un paciente con patología apical y endodoncia previa en la pieza 1.2, se realizó cirugía apical que incluyó el agregado de una membrana biológica reabsorbible de fascia lata entre el colgajo de espesor total y el tejido óseo. En medio de ellos, se colocó hueso en polvo humano liofilizado con el objetivo de proveer una adecuada recuperación del tejido óseo perirradicular. Luego, se efectuó el control clínico y radiográfico del paciente durante 24 meses.

Histological analysis of autologous fascia graft implantation into the rabbit voice muscle / Análise histológica em músculo vocal de coelhos submetidos a implante de fáscia lata autóloga

The ideal approach for the treatment of glottal insufficiency remains a challenge for laryngologists. AIM: This experimental study assessed the histological changes and fibrosis caused by autologous fascia lata grafts into the rabbit voice muscle. STUDY DESIGN: A clinical and experimental study. METHODS: A 0.2 × 0.2 cm fragment of autologous fascia lata was grafted into the right voice muscle of 14 adult rabbits. Animals were euthanized 30 or 60 days post-procedure and histology of the excised vocal folds was carried out. RESULTS: No extensive edema, necrosis or foreign body-type reaction was observed at any time. No significant inflammatory reaction or fibrosis was seen at 30 or 60 days. CONCLUSION: The presence of fascia lata in the rabbit voice muscle had no significant influence on inflammation, and does not increase fibrosis. Rabbit voice muscle shows good tolerance to fascia lata grafting.

A apropriada abordagem no tratamento da insuficiência glótica causada por paralisa, cicatriz e atrofia de prega vocal é um desafio ao laringologista. OBJETIVO: O presente estudo avaliou as alterações histológicas e fibrose desencadeadas pelo enxerto autólogo de fáscia lata no músculo vocalde coelhos. FORMA DE ESTUDO: Clínico e Experimental. MATERIAL E MÉTODO: Foi realizado um estudo experimental com 14 coelhos adultos que foram submetidos a implante de fáscia lata autóloga medindo 0,2 x 0,2cm, no músculo vocal direito. Os animais foram sacrificados após 30 e 60 dias do procedimento, suas laringes removidas e submetidas a estudo histológico. RESULTADOS: Não foi observado edema extenso, área de necrose ou reação inflamatória do tipo corpo estranho. A reação inflamatória observada após 30 e 60 dias foi leve, bem como a fibrose desencadeada. CONCLUSÃO: A presença de fáscia lata autóloga no músculo vocal de coelho não desencadeou fibrose e resposta inflamatória significativa.

Cobertura de úlceras por presión trocantéricas con colgajo de tensor de fascia lata en V-Y / Treatment of trochanteric pressure sores with V-Y and tensor fasciae latae flaps

Background: Trochanter pressure sores can be treated with random, myocutaneous, fasciocutaneous or free flaps. Aim: To report the use of V-Y and tensor fasciae latae flaps for the treatment of trochanteric pressure sores. Material and Methods: Prospective study of 14 males and two females aged 24 to 64 years, with 17 sores. The surgical technique consisted in the design of a V shaped flap with irrigation in its superior base and lower vertex with one of its extremes in contact with the sore. A resection is made until a vital base is obtained, excising the prominent bone until a plane in which healthy tissue is seen. The flap is raised and rotated, covering the defect. A V-Y primary closure without tensión is performed, leaving drainages that are withdrawn ten days later. Results: The complications recorded were three serranas, which were treated using a closed system with external and internal negative pressure. Two wound dehiscence episodes and two hematomas required a surgical correction. Conclusions: This type of flap is other therapeutic alternative for pressure trochanteric sores.

Las úlceras por presión trocantéricas representan un problema importante a nivel extra e intrahospitalario. Existen múltiples opciones terapéuticas, ya sean colgajos random, musculocutáneos, fasciocutáneos o libres. El objetivo de este estudio es presentar la técnica quirúrgica del Colgajo en V-Y de Tensor de Fascia Lata. Técnica Quirúrgica: Se diseña un colgajo en V con irrigación por su base superior y vértice inferior, contactando uno de sus extremos con la úlcera. La forma del colgajo es de una V-Y. Se reseca esta hasta obtener un lecho vital, resecando además el hueso prominente hasta un plano en que se visualiza tejido sano. Se levanta y rota el colgajo, cubriendo el defecto. Finalmente, se realiza el cierre primario en VY sin tensión, con drenajes que se retiran a los 10 días. Tratamos 17 úlceras en 16 pacientes. Hubo 3 seromas, los que fueron resueltos con sistema de cierre con presión negativa externa e interna. Además hubo 2 casos de dehiscencia de sutura y 2 hematomas resueltos en quirófano. Este colgajo debe estar presente dentro de las posibilidades terapéuticas que se ofrezcan a pacientes con úlceras trocantéricas por decúbito.

Estudo da técnica da sindesmoplastia extra-articular com fascia lata autógena: modelo em cães / Study of the extra articulate syndesmoplasty technique with autogenous fascia lata: a model in dogs

OBJETIVO: Avaliar a eficácia da técnica extra-capsular para o tratamento de ruptura do ligamento cruzado anterior em cães. MÉTODOS: Foi realizada a reparação cirúrgica extra-articular, sem artrotomia do ligamento cruzado anterior, com a utilização da fáscia lata autógena para estabilização da articulação do joelho em seis animais que apresentaram claudicação grave e movimento de gaveta positivo. RESULTADOS: A técnica cirúrgica extra-articular foi eficaz com boa estabilização articular e evolução satisfatória. CONCLUSÃO: A via extra capsular com uso da fáscia lata para correção da ruptura do ligamento cruzado anterior mostrou-se útil haja vista tratar-se de um procedimento simples e de rápida execução, causando o mínimo dano tecidual e recuperação pós-operatória eficiente.

OBJETIVE: To evaluate extra-capsular technique for the treatment of the anterior cruciate ligament rupture, in dogs. METHODS: It was performed an extra-articulate surgery without arthrotomy of the anterior cruciate ligament by using a strip of the autogenous fascia lata for stabilization of the knee joint in six animals which had severe claudication and drawer movement sign positive. RESULTS: The extra articulate technique was effective with good knee stabilization and satisfactory outcome. CONCLUSION: The use of the fascia lata with an extra capsular technique to fix the rupture of the anterior cruciate ligament seems to be useful once it is a simple and rapid procedure with minimum tissue damage and efficient postoperative recovery.

novel technique of small incision fascia lata harvesting without a faciatome for frontalis suspension procedure

To introduce a small incision technique of fascia lata [FL] harvesting for frontalis suspension blepharoptosis procedure. A skin incision was made in a line between the lateral condyle of the tibia and the anterior superior iliac crest, starting 4- 5 cm above the knee and extending upward 2- 2.5 cm. Approximately 8 cm superior to the first incision, a second skin incision was made with the same length. The FL was dissected from subcutaneous tissue from 1 cm superior to superior border of upper incision to 1 cm inferior to inferior border of lower incision. A 15 mm x 5- 10 mm strip of FL was excised. The fascial defect was left open. Subcutaneous and deep layers were closed with three 4-0 plain catgut sutures and the skin with subcuticular 5-0 prolene sutures. The technique was used in 22 patients from 4 to 47 years of age [Mean: 18.29 +/- 14.20] for 34 frontalis sling procedures. Mean follow-up time was 6.17 +/- 3.21 [3-16] months. Wound hematoma [1/22, 4.5%], wound discharge [2/22, 9%], pain at rest [100%, up to 4 days], pain on walking [20/22, 90%; up to 3 weeks], limping [13/22, 59.1%; up to 7 days] were the main postoperative complications. No significant skin scar was observed and none of the patients needed scar revision. Small incision FL harvesting procedure is a good alternative method when the FL stripper is not available

Avaliação da deposição de colágeno após implante de fáscia lata e de gordura na prega vocal de coelho: estudo histomorfométrico / Assessment of collagen deposits after implant of fascia lata and fat in the vocal folds of rabbits: histomorphometric study

Vários materiais têm sido injetados ou inseridos em pregas vocais na tentativa de solucionar a incompetência glótica. Contudo, poucos são os estudos que avaliam o processo cicatricial decorrente da enxertia destes materiais. Objetivo: O objetivo desta pesquisa foi avaliar a concentração de colágeno após enxerto microcirúrgico de fáscia muscular e gordura na prega vocal de coelho. Forma de estudo: experimental. Material e Método: Dezenove coelhos foram submetidos à inserção de enxerto na prega vocal direita, sendo nove de fáscia e dez de gordura. A prega vocal esquerda foi submetida ao mesmo procedimento, sem enxertia. Os coelhos foram sacrificados após 90 e 180 dias. O colágeno foi analisado morfometricamente através do método da Picrossírius-polarização com a utilização do software Image Pro Plus. Resultados: Houve aumento do colágeno em todos grupos enxertados quando comparados com o grupo controle. A concentração do colágeno encontrada nos coelhos submetidos a enxerto de gordura foi significativamente maior quando comparados à concentração do colágeno nos coelhos submetidos a enxerto de fáscia muscular, tanto com 90 quanto com 180 dias. Conclusão: A enxertia de gordura e fáscia lata na prega vocal de coelho promoveu maior deposição de colágeno do que no grupo controle, sendo mais exuberante na inserção de gordura.

Several materials have been injected or introduced in the vocal folds in attempt of solving the glottic insufficiency. However, few studies have evaluated the cicatricial process due to the implantation of these materials. Aim: The objective of this research was to evaluate the concentration of collagen after microsurgery graft of muscular fascia and fat in the vocal folds of rabbit. Study design: experimental. Material and Method: Nineteen rabbits were submitted to the graft insert in the right vocal fold, being nine of fascia and ten of fat. The left vocal fold was submitted to the same process, except for the insertion of fat or fascial graft. The rabbits were sacrificed after 90 and 180 days. The collagen was analyzed through the method of the Picrosirius-polarization using the Image Pro Plus software. Results: There was prevalence of the collagen in all grafted groups when compared with the group control. The concentration of the collagen found in the rabbits submitted to fat graft was significantly larger when compared to the concentration of the rabbits submitted to graft of muscular fascia, either with 90 as with 180 days. Conclusion: The fat and muscular fascia implantation in the vocal folds of rabbit promoted production of collagen, being more intense with fat.

Implante de fáscia lata e de gordura na prega vocal de coelho: análise quantitativa do processo inflamatório / Fat and fascia lata implantation in rabbit vocal fold: quantitative analysis of the inflammatory process

Enxertos de gordura e fáscia muscular têm sido usados como opção de tratamento para a insuficiência glótica. O objetivo desse estudo foi quantificar o processo inflamatório no músculo vocal de coelhos nos quais gordura e fáscia foram introduzidos unilateralmente, comparando-os entre si e com o grupo controle, formado pelas pregas vocais contra-laterais. Em 4 grupos foram divididos 24 coelhos, sacrificados em 90 e 180 dias após a enxertia. A inserção de gordura resultou em uma reação inflamatória celular maior que a inserção da fáscia muscular aos três meses, entretanto não foi significativa aos 6 meses. Consideramos a fáscia menos reativa que a gordura como enxerto de pregas vocais / Fat and muscular fascia grafts have been used as treatment for gllottic insufficiency. The aim of this study was to quantify the inflammatory process in the vocal muscle of the larynx from the rabbits in which unilateral fat and fascia were introduced, comparing them to each other and to the control group, formed by the contralateral vocal folds. Twenty-four rabbits were allocated into 4 groups to be sacrificed 90 and 180 days after the implantation. Fat insertion resulted in a higher cellular inflammatory reaction then muscular fascia at 3 mounts, but there was not such a difference at 6 months. We consider fascia relatively less reactive than fat for implantation into vocal fold...

[Comparing two methods of fascia lata use for frontalis suspension]

To compare the results of two different methods of frontalis suspension using fascia lata in congenital ptosis. In randomized clinical trial, double triangle sling was compared with single triangle sling using fascia lata. Eight patients with unilateral and 11 patients with bilateral congenital ptosis were randomly assigned for each procedure. There was no statistically significant difference between the two groups in terms of age and sex. Mean increase in interpalpebral fissure was 4.35 +/- 2.32 mm in the double triangle group and 4.36 +/- 1.89 mm in the single triangle group. Increase in palpebral fissure was statistically significant in both groups [P=0.00] but there was no difference between the two groups regarding functions during [lid fissure height] and cosmetic [lid margin contour] results and early or late complications during follow up. Single triangle sling method using fascia lata is safe, easy, and fast with acceptable results and can be used instead of conventional double triangle fascia lata sling for treatment of low function ptosis

Enxerto de fáscia lata autógena em ferimentos penetrantes provocados no esôfago cervical de cäes / Auntogenous graft of fascia lata in the penetrating provoked injuries of the cervical esophagus of dog

O objetivo da pesquisa foi estudar a eficácia do enxerto autógeno de fáscia lata, para tratar ferimentos penetrantes provocados no esôfago cervical de cães. Foram estudados comparativamente dois procedimentos operatórios para se corrigir lesões orificiais provocadas na parede do esôfago cervical do cão com uma área padronizada de 3,12 cm2. Foram operados 40 cães, divididos em 2 grupos iguais denominados, grupo A (sutura) e grupo B (enxerto). Cada grupo foi subdividido em dois sub grupos denominados A1, A2 e B1, B2, com 10 animais cada para serem reoperados no 7§ e no 30§ P.O. respectivamente. No grupo controle, (A) foi aplicada a sutura em plano único extramucoso com pontos simples de náilon 5-zeros. No grupo experimento (B) aplicou-se para ocluir o defeito provocado um enxerto de fáscia lata, suturado à borda da parede do esôfago com pontos simples extramucoso em plano único, com fio de náilon 5-zeros. Comparou-se os achados macroscópicos e microscópicos dos dois grupos não se observando diferença estatística significante, mas quanto ao aspecto clínico, os animais do grupo A apresentaram resultados melhores no que se refere a formação de fístulas apresentando um caso, enquanto o grupo B apresentou cinco casos. Concluiu-se que a fáscia lata não é eficaz para tratar ferimentos penetrantes no esôfago cervical de cães.

Tratamiento quirúrgico de los tumores de la pared abdominal / Surgical treatment for tumors of the abdominal wall

Los tumores de la pared abdominal son poco frecuentes, predominan los tumores metastásicos a las vías de accesos a la cavidad peritoneal. Se presenta la técnica quirúrgica de extirpación de los tumores de la pared abdominal, así como la reparación con injerto libre o pediculado de fascia lata. En el lapso de 1970 a 1990, se han tratado 32 pacientes con esta técnica. 11 tumores de niños de tipo desmoide, 5 desmoides en mujees adultas y 6 tumores de tipo sarcoma en adultos y 10 tumores de tipo sarcoma en adultos y 10 tumores metastásicos implantados en las incisiones de laparotomía. Se comenta el posible aumento de implantes tumorales, por la información de la literatura de la presencia de este fenómeno en los puertos de entrada de los trócares de cirugía laparoscópica. Se informa de los posibles mecanismos de producción de este fenómeno y las posibles limitaciones que el manejo de las neoplasias de la cavidad abdominal por cirugía laparoscópica

Manejo quirúrgico de ptosis severa. Fijación al frontal con fascia lata. Reporte de 20 casos / Surgical treatment of severe ptosis. Fascia lata frontal fixation. A 20 cases report

Propósito. Evaluar el resultado funcional y cosmético utilizado la técnica de fijación al frontal con fascia lata autógena en casos de eptosis severa con mala o nula función del músculo elevador del párpado. Material y método. Incluimos a 15 pacientes (20 ojos) operados en el periodo de enero de 1994 a diciembre de 1995. La técnica quirúrgica usada fue fijación al frontal con fascia lata. Se valoró el estado pre y postquirúrgico de apertura palpebral, surco supratarsal, posición compensadora de la cabeza y complicación mayor tanto palpebral como de la pierna. Resultados. Incluimos doce hombres (80 por ciento) y 3 mujeres (20 por ciento). La afección fue unilateral en 10 pacientes (66.6 por ciento) y bilateral 5 (33.3 por ciento). El seguimiento promedio fue de 4.4 meses. Seis ojos con cirugía previa. El diagnóstico fue ptosis congénita 13 ojos (65 por ciento), ptosis residual 5 ojos (25 por ciento) y ptosis recidivante un ojo (5 por ciento). El promedio de apertura palpebral prequirúrgica de 4.10 ñ 1.44 mm fue significativamente menor al promedio de apertura palpebral posquirúrgica 8.25 ñ 1.48 mm. El valor medio de la función del elevador prequirúrgico de 2.8 ñ 1.6 mm es significativamente mayor que el postquirúrgico de 2.0 ñ 1.4 mm. La cosmesis fue excelente en 13 ojos (65 por ciento), buena en 5 ojos (25 por ciento) y regular en 2 ojos (10 por ciento). Ninguna complicación mayor palpebral o del miembro donador se presentó. Conclusión. La fijación al frontal con fascia lata proporciona un resultado predecible y ajustable, consméticamente aceptable para disminuir las líneas de tensión de la piel y facilitar la formación del surco palpebral, dando resultados estable en los pacientes con blefaroptosis con nula función del músculo elevador del párpado superior

Autoinjerto de fascia lata en hernioplastías: informe preliminar / Autologue fascia lata for hernia repair: preliminary report

Del 1 de febrero de 1992 al 31 de julio de 1995, fueron intervenidos ocho hombres y una mujer con edad promedio de 65-66 años -rango de 41 a 78 años-, a quienes se les repararon hernias de la pared abdominal, utilizando autoinjerto libre de fascia lata. A los ocho hombres les fueron operados 9 sacos inguinales directos, con otro saco indirecto combinado en 3 de ellos. Siete sacos eran recidivados, tratándose de segunda recidiva en poco más de la mitad. A la mujer, se le reparó una hernia incisional hipogástrica grande. Hubo complicaciones postoperatorias en tres enfermos: atrofia testicular en uno de ellos, y en los otros dos, sepsis tardía en el área inguinal sin infección del injerto. Hasta la fecha, se han observado dos recidivas (22.22/100) en los 9 sacos inguinales reparados utilizando fascia lata

Estudio comparativo entre fascia lata de banco y prolene en el tratamiento de la ptosis con técnica suspensoria / Comparative study between bank's fascia lata and prolene in the treatment of ptosis with suspension technic

Pacientes con ptosis severas y mala función el elevador requieren, como única alternativa, la suspensión frontal. Diversos materiales se han presentado en la bibliografía para este procedimiento. Presentamos en este trabajo un estudio comparativo entre 20 pacientes en los que se usó fascia lata cadavérica (Grupo A) de 3 orígenes: comercial, de banco de fascia de EE.UU. y de banco de fascia local y 13 pacientes en los que se usó Prolene 2-0, 1-0 y 4-0 (Grupo B). El seguimiento promedio fue de 18 meses (rango entre 8 y 30 meses), para el grupo A y de 15,8 (rango entre 7 y 29 meses) para el grupo B. Los resultados nos permiten afirmar que la fascia lata de banco es mejor alternativa que el Prolene, cuando no podemos disponer de fascia lata autógena