Clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis / 中华烧伤杂志

Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.

Association of anti-nuclesome and anti C1q antibodies with lupus nephritis in an Egyptian cohort of patients with systemic lupus erythematosus

Abstract Introduction: Anti-nucleosome and anti-C1q antibodies demonstrated an association with the development of glomerulonephritis in systemic lupus erythematosus (SLE). Some investigators have proposed that monitoring anti- C1q and anti-nucleosome antibodies might be valuable for making predictions about lupus nephritis (LN) and assessment of disease activity as a non-invasive biological marker of renal disease. Objectives: The current study was proposed to investigate the presence of anti-C1q and anti-nucleosome antibodies in the sera of Egyptian patients with SLE and their association with LN. Methods: Eighty patients with SLE were included. Patients were classified into, a LN group including 40 cases with active LN (based on the results of renal biopsy and renal SLEDAI≥4) and a non renal SLE group including 40 patients (with no clinical or laboratory evidence of renal involvement that were attributed in the past or present to SLE). They were subjected to full medical history taking, clinical examination, routine laboratory investigations, measurement of antinuclear antibody (ANA), anti-ds DNA, anti-C1q & anti-nucleosome antibodies. Results: Anti-C1q antibody showed a statistically significant association with the presence of vasculitis and nephritis while anti-nucleosome antibody didn't show a significant association with the presence of any clinical features. Double positivity of anti-nucleosome and anti-C1q antibodies showed a statistically significant association with the presence of vasculitis and photosensitivity, high ECLAM score, elevated ESR, low serum albumin and low C3 levels. Conclusion: Serum anti-C1q antibody has a significant association with LN while double positive antibodies have a significant association with vasculitis and low C3 levels in Egyptian patients with SLE.

Avaliação volumétrica e funcional do músculo glúteo máximo submetido a gluteoplastia de aumento com implantes de silicone / Volumetric and functional evaluation of the gluteus maximus muscle after augmentation gluteoplasty using silicone implants

A operação para aumento de glúteos com implantes teve início no fim da década de 1960, entretanto a técnica intramuscular, considerada padrão atualmente, foi descrita cerca de 30 anos depois. Cirurgiões e pacientes apresentam crescente interesse na realização do aumento de glúteos haja vista que sua frequência apresenta aumento nos últimos anos. A utilização de implantes intramusculares que superam o volume do músculo em mais de cinquenta por cento configura uma situação nova que deve ser estudada. O tecido muscular estriado esquelético apresenta grande suscetibilidade para atrofia secundariamente à compressão, e sendo o glúteo máximo um músculo importante na manutenção da postura ereta, deambulação, corrida e salto, é necessário pesquisar possíveis alterações musculares decorrentes da operação. O objetivo deste estudo é avaliar o volume e força do músculo glúteo máximo ao longo de 12 meses após a introdução de implantes intramusculares, o posicionamento destes implantes no interior da musculatura e mudanças antropométricas obtidas com a operação. Foram selecionadas 48 mulheres, 24 candidatas a gluteoplastia de aumento com implantes compuseram o grupo de estudo e 24 candidatas a mamoplastia de aumento compuseram o grupo controle de acordo com os critérios de inclusão e exclusão. As pacientes foram avaliadas em quatro momentos diferentes: pré-operatório e após três, seis e 12 meses da operação. Em todas as etapas foi realizada avaliação clínica nutricional, tomografia computadorizada com reconstrução 3D e teste isocinético. Todas as pacientes permaneceram afastadas de atividades físicas durante três meses após a operação. Foram utilizados implantes glúteos em gel coesivo de base oval e superfície lisa com volumes de 350 cm3 e 400 cm3. O nível de significância estatística foi mantido em 5%. As pacientes candidatas a gluteoplastia apresentaram valores da relação entre as medidas da cintura e do quadril maiores que aquelas do grupo controle...

The gluteal augmentation surgery using implants began in the late 1960s, however intramuscular technique, which is considered standard today, was described about 30 years later. Plastic surgeons and patients have increased interest in gluteal augmentation given the fact that the operation has been more frequently in recent years. The use of intramuscular implants that overcomes the muscle volume in more than fifty percent configures a new situation that should be studied. The skeletal muscle tissue shows high susceptibility to atrophy secondary to compression, and the gluteus maximus is an important muscle in the maintenance of erect posture, walking, running and jumping, it is necessary to investigate possible muscle changes resulting from the operation. The objective of this study is to assess the volume and strength of the gluteus maximus muscle during 12 months after the introduction of the implants, the position of these implants within the muscles and anthropometric changes obtained with the operation. 48 women were selected, 24 candidates for gluteal augmentation composed the study group and 24 candidates for breast augmentation composed the control group according to the criteria of inclusion and exclusion. The patients were evaluated at four different moments: pre-operatively and after three, six and 12 months of the operation. At all stages of the study, was carried out nutritional evaluation, CT with 3D reconstruction and isokinetic testing. All patients remained away from physical activities for three months after the operation. Cohesive gel, oval base and smooth surface gluteal implants were used with volumes of 350 cm3 and 400 cm3. The level of statistical significance was 5%. The patients who were candidates for gluteoplasty presented bigger waist to hip ratio than those of the control group...

Suspension of the tongue to the digastric tendon following resection of the anterior mandibular arch for oral cancer prevents postoperative tongue fall and avoids the need for tracheostomy.

Background: Resection of the anterior arch of the mandible leads to tongue fall and postoperative stridor because of the detachment of tongue musculature from the mandible. In this article, a simple method of tongue suspension is described which would prevent such complications and the need for tracheostomy. Settings and Design: This study was carried out on patients with oral cancer requiring resection of the anterior arch of the mandible as a part of the surgical resection at a tertiary centre. Materials and Methods: This study was performed on 32 patients with oral cancer requiring resection of the anterior arch of the mandible as a part of the surgical resection. Following an appropriate resection of the oral cancer (including the anterior mandibular arch) and neck dissection, a silk suture is used to loop the tongue musculature on either side to the intermediate tendon of the digastric muscle. Result: This technique of tongue suspension was used in 32 patients who required resection of the anterior mandibular arch for oral cancer. Prophylactic tracheostomy was not performed. One patient developed stridor at extubation and required temporary tracheostomy. All other patients could be successfully extubated within 12 h of surgery and none experienced postoperative stridor or sleep apnea. One other patient required temporary tracheostomy for pulmonary toilet as he developed aspiration pneumonitis related to nasogastric feed. Conclusion: This simple method of tongue suspension to the digastric tendon prevents postoperative tongue fall and obviates the need for tracheostomy in most instances.

Latissimus dorsi transposition for sequelae of obstetric palsy / Transferencia del músculo dorsal ancho en secuelas obstétricas del plexo braquial

Background: In obstetric palsy, limitation in the external abduction and rotation of the shoulder is the most frequent sequelae. Glenohumeral deformity is the result of muscular imbalance between the external and internal rotators. Releasing the contracted muscles and transferring the latissimus dorsi are the most common surgeries in this case. Patients and methods: We operated on 24 children between 4 and 8 years of age with obstetric palsy sequelae to elevate the subscapularis muscle off the anterior surface of the scapula posteriorly and transfer the latissimus dorsi. The patients received a minimum of 2 years of follow up. They were evaluated based on Mallet’s and Gilbert’s classifications. Results: All of the patients recovered within the above mentioned classifications. Out of 22 children evaluated via Mallet’s classification, all improved from 3 to 4 on that scale. With respect to Gilbert’s classification, 16 children improved one degree and 8 improved 2 degrees. All of the patients’ parents were satisfied with the results. Discussion: The benefit from releasing contracted muscles and muscle transfer to improve shoulder abduction in the sequelae of obstetric palsy has been amply reported in the literature. The results we had from elevating the subscapularis muscle off the anterior surface of the scapula and transferring the latissimus dorsi were good. Children who were difficult to classify based on the described scale were taken note of and some sub-classifications for Gilbert’s descriptions were proposed. Patients must be selected carefully. To transfer the latissimus dorsi, it is necessary to have good passive mobility in abduction, a minimum of 20º of external rotation and no joint deformities. When negative external rotation is found, the subscapularis muscle should be released. When there is glenohumeral joint deformity in older children, other methods are recommended, such as rotational humeral osteotomy.

Introducción: Las limitaciones en la abducción y la rotación externa del hombro son las secuelas más frecuentes en la parálisis obstétrica. Se encuentra deformidad de la articulación glenohumeral como resultado del desequilibrio que existe entre los músculos rotadores externos e internos. Dentro de las cirugías más usadas para corregir las deformidades del hombro están las liberaciones musculares y la transposición del músculo dorsal ancho. Materiales y métodos: El autor operó 24 niños entre los 4 y 8 años de edad, con secuelas de parálisis braquial obstétrica, a quienes se les practicó liberación del subescapular por vía posterior y transferencia del músculo dorsal ancho. Se evaluaron según la escala de Mallet y la de Gilbert, con un seguimiento mínimo de dos años. Resultados: Todos los niños se recuperaron según las escalas mencionadas. En 22 evaluados según Mallet, todos mejoraron del nivel 3 al 4. Según la clasificación de Gilbert, 16 niños mejoraron un grado y 8 niños mejoraron dos grados. Todos los padres estuvieron satisfechos con los resultados. Discusión: Existen muchos informes en la literatura médica sobre los beneficios de liberar los músculos contracturados y de las transferencias musculares en el hombro en las secuelas de parálisis braquial obstétrica. Se obtuvieron buenos resultados en todos los niños. Algunos casos fueron difíciles de clasificar en las escalas usadas, para lo cual se propone una sub-clasificación. Se requiere tener una buena movilidad pasiva, que no haya deformidad articular en el hombro y mínimo 20º de rotación externa, para realizar la transferencia muscular del dorsal ancho. Cuando no se encuentra la rotación externa, se debe hacer la liberación del subescapular. Si hay deformidad de la articulación glenohumeral, no se recomiendan las transferencias musculares y entonces se recurre a osteotomías.

Maniobra digital sobre el músculo dorsal ancho (m latissimus dorsi) para facilitar la disección axilar / Digital maneuver to the dorsal muscle wide (m latissmus dorsi) to facility the axillares dissection

Desde 1990 utilizamos durante la disección axilar en los casos de cáncer de mama, una maniobra que nos permite: identificar mejor la vena axilar en su porción externa, finalizar la disección del músculo dorsal ancho (m. latissimus dorsi), medir el grosor del tejido axilar a disecar y descartar la presencia del arco vascular de Lange, anomalía que puede presentarse en un 5 por ciento a 6 por ciento de los casos. Consideramos que este procedimiento ayuda a simplificar la disección axilar durante el acto quirúrgico. No hemos conseguido publicaciones que describan esta maniobra y hemos decidido hacer esta comunicación.

Since 1990 we used during axillaries dissection in cases of breast cancer, a maneuver that allows us; identify better the axillaries vein in the external portion, finalize the dissection of wide dorsal muscle (M. latissimus dorsi), measure the thickness of the axillary weaves to dissect and discard the presence of the vascular Lange arc, anomaly that can appear in 5 percent to 6 percent of the cases. We considered that this procedure helps to simplify the axillaries dissection during surgical act. We have not obtained publications that describe this maneuver and have decided to make this communication.

Tratamento cirúrgico das úlceras de pressão com retalhos cutâneos e musculocutâneos. Experiência de três anos no Hospital Geral Dr. Waldemar de Alcântara / Treatment of pressure sores with cutaneous and musculocutaneous flap. The experience of Hospital Dr. Waldemar de Alcântara during three years

Introdução: O número de pacientes com alto risco de desenvolver úlceras de pressão está aumentando. Apesar dos avanços no reparo cirúrgico destas lesões, ainda são relatadas taxas de recidiva elevadas. O propósito deste estudo foi descrever a experiência dos autores em reconstruções de úlceras de pressão com retalhos cutâneos e musculocutâneos. Método: Foram realizados 38 procedimentos em 22 pacientes no Hospital Geral Dr. Waldemar de Alcântara, entre janeiro de 2004 e janeiro de 2007. Foram realizadas 14 reconstruções na região sacral, 14 na região trocantérica e 10 na região isquiática. Resultados: Na região sacral, foram utilizados retalhos musculocutâneos do glúteo máximo (71%) e retalhos cutâneos lombo sacrais (28,6%), sem nenhuma recidiva. Na região trocantérica utilizou-se o retalho musculocutâneo do fáscia lata (85,7%) e o retalho ântero-lateral da coxa (14,3%), observando-se taxa de recidivade 26,4%. Para região isquiática foram confeccionados o retalho de Tulenko (40%), o retalho musculocutâneo do tensor do fáscia lata (20%) e o retalho musculocutâneo do grácil (20%). Nesta área observou-se uma taxa de recidiva de 60%. A área doadora dos retalhos foi reparada com avançamento direto (84,2%) ou enxertia cutânea (15,8%). Deiscência de ferida cirúrgica foi observada em 36,8%, sendo que destes casos somente 57,1% necessitaram de ressutura. A taxa geral de satisfação dos procedimentos foi de 73,7%. Conclusão: Os retalhos cutâneos e musculocutâneos proporcionam uma boa opção para reconstrução de úlceras de pressão, com sequela aceitável na área doadora e alta taxa de satisfação.

Introduction: The number of patients in high risk of developing pressure ulcer is increasing. Despite of advances with new surgery techniques, high rates of relapse are reported. The purpose of this study was to describe the authors’s experience with pressure sores reconstruction. Methods: Thirty eight procedures were realized in 22 patients between January/2004 and January/2007 at Hospital Geral Dr. Waldemar de Alcântara. Results: Fourteen reconstructions were made in the sacral region, 14 in the trochanteric region and 10 in the sciatic region. In the sacral region, the gluteus maximus musculocutaneous flaps (71%) and lumbosacral cutaneous flaps (28.6%) were used, with no recurrence. In trochanteric region, the fascia lata musculocutaneous flaps (85.7%) and cutaneous anterolateral thigh flaps (14.3%) were used, observing a rate of recurrence of 26.4%. For sciatic region, the Tulenko flaps (40%), fascia lata musculocutaneous flaps (20%) and gracilis musculocutaneous flaps (20%) were used. There was a recurrence rate of 60% in this area. The donor site of the flaps were repaired with direct advancement (84.2%) or skin grafting (15.8%). Surgical wound dehiscence was observed in 36.8%, although only 57.1% of these cases needed surgical repair. The overall rate of satisfaction with these procedures was 73.7%. Conclusion: The cutaneous and musculo cutaneous flaps provide a good option for reconstruction of pressure sores, with acceptable morbity at the donor site and high satisfaction rate.

An Unusual Variation of Deltoid Muscle

An unusual anatomic variation of the deltoid muscle was found in a 45-year-old female cadaver during dissection of the right upper extremity. The posterior fibers of the right deltoid muscle were enclosed in a distinct fascial sheet and the deltoid muscle was seen to arise from the middle 1/3 of the medial border of the scapula. There was no accompanying vascular or neural anomaly of the deltoid muscle. To the best of our knowledge; unilateral posterior separation of the deltoid muscle with a distinct fascia has not been described previously. While dissecting deltoid; posterior deltoid; or scapular flaps; the surgeon needs to look out for this variation because it may cause confusion

Reconstrução mamária com retalho autólogo estendido do grande dorsal - experiência inicial / Breast reconstruction with an extended autologous latissimus dorsi flap - initial experience

Em nosso meio, a reconstrução da mama com retalho do músculo grande dorsal tem sido sempre realizada com a colocação de prótese de silicone. É apresentada a experiência inicial de quatro casos de reconstrução da mama com retalho autólogo do grande dorsal, sem a utilização de próteses. São discutidas as vantagens dessa abordagem sobre a técnica convencional em casos selecionados e detalhada a técnica utilizada.

Usually, breast reconstruction with latissimus dorsi flap is commonly done with a silicon implant. We present the initial experience of 4 cases of breast reconstruction with an extended autologous latissimus dorsi flap, without the use of implants. Advantages of this technique over the classic one are discussed, and the technique is detailed.

Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular / Genioplasty for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome and mandibular retrognathia

A Síndrome da Apnéia-Hipopnéia do Sono Obstrutiva (SAHSO) é um doença de fisiopatologia complexa, e sua etiologia é multifatorial e não entendida completamente. Cirurgia com avanço do músculo genioglosso é indicado em obstrução na região de hipofaringe. OBJETIVO: Avaliar a eficácia e complicações da técnica de mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva (SAHSO). MÉTODOS: Polissonografia, exame físico e análise cefalométrica foram realizados em 10 pacientes não-obesos, que apresentavam SAHSO leve ou moderada, índice de apnéia-hipopnéia (IAH) entre 5 e 30, obstrução de hipofaringe e retrognatismo mandibular. RESULTADOS: IAH pré-operatório médio foi de 12,4±4,6 diminuindo a média pós-operatória para 4,4±5,7 (p < 0,001). Quando 50 por cento de redução do IAH pré-operatório foram escolhidos como parâmetro, o índice de sucesso foi de 70 por cento. A análise cefalométrica revelou um aumento do espaço aéreo posterior (EAP) em todos os pacientes, a média pré-operatória foi de 7,9±2,3mm para uma média pós-operatória de 10,8±2,5mm (p < 0,001). CONCLUSÃO: Mentoplastia para avanço do músculo genioglosso parece reduzir os sinais da SAHSO, podendo ser considerada uma opção com tratamento cirúrgico em pacientes com obstrução na hipofaringe. Os dados coletados indicam esse procedimento como opção em pacientes com SAHSO e retrognatismo mandibular.

Obstructive sleep apnea syndrome is a complex disease, which the etiology is multifactorial and incompletely understood. Surgery with genioglossus advancement is indicated in hypopharynx obstruction. AIM: evaluate the efficacy and complications of genioplasty technique for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: polysomnography, physical examination and cephalometric analysis were performed in 10 non-obese patients, who presented mild or moderate OSAHS, an apnea-hypopnea index (AHI) between 5 and 30, with hypopharynx obstruction and mandibular retrognathia. RESULTS: the AHI preoperative mean of 12.4±4.6 decreased to a postoperative mean of 4.4±5.7 (p < 0,001). When 50 percent reduction of preoperative AHI was chosen as a parameter, its rate was 70 percent (7/10). Cephalometric analysis revealed an increase in the posterior airway space (PAS) in all patients, from a preoperative mean value of 7.9±2.3mm to a postoperative mean value of 10.8±2.5mm (p < 0,001). CONCLUSION: genioplasty for genioglossus advancement seemed to reduce OSAHS signs, thus, it can be considered as an option for the surgical treatment of patients with hypopharynx obstruction. Data collected supports this surgical procedure as an option in patients with OSAHS and mandibular retrognathia.

Experimental model of gastroesophageal reflux in rats

OBJETIVO: Desenvolver um modelo experimental de refluxo gastroesofágico em ratos. MÉTODOS: Sessenta ratos, Wistar, foram operados e distribuídos em três grupos de vinte animais. Os animais foram submetidos a miectomia total do esôfago em um grupo(A), e em outro grupo foram submetidos a miectomia parcial(B). O terceiro grupo foi o grupo controle(C). Para avaliar o refluxo gastroesofágico realizou-se o estudo radiológico contrastado do esôfago. O estudo anátomo-patológico do esôfago foi utilizado para avaliar esofagite. RESULTADOS: Durante os 30 dias de pós-operatório, 14 animais do grupo A apresentaram refluxo de Bário no esôfago. Em 07 animais do grupo B e em 02 do grupo controle, foram observados a presença de Bário no esôfago. O resultado do histopatológico foi controverso. Observou-se perda ponderal importante nos ratos submetidos a miectomia total, porém não existiu diferença estatística. CONCLUSÃO: A miectomia total realizada no terço inferior do esôfago provocou refluxo gastroesofágico na maioria dos animais.

Does cigarette smoking affect muscle flap survival? an 8 year experience over 261 consecutive cases in southern Iran

Smoking has been shown to be a complicating factor in normal wound healing. Both nicotine and carbon monoxide adversely affect multiple stages of the healing process. From 1991 to 1999, 407 muscle flap procedures were performed on 374 patients in a single surgical unit. A retrospective review of 261 patients was completed. Patients were divided into three groups: Group A, no smoking history; group B, smokers for at least one year, and group C, active smokers up to the time of surgery. Patients were excluded who had diabetes, had a recurrent malignancy, or used steroids. A total of 261 patients were included in the study. The age, sex, number of patients and primary operative indications were matched in the 3 groups. Active smokers were shown to have a complication rate significantly higher in the immediate post-operative period compared with non-smokers and smokers who had quit. The most common complications were partial muscle necrosis and partial skin graft loss. This series suggests that active smoking at the time of muscle transposition significantly increases the rate of post-operative complications

Correlaçäo entre os aspectos ultra-sonográficos e morfológicos da cicatrizaçäo de uma lesäo muscular em coelhos / Correlation between the ultrasonografic and morphologic aspects of muscular lesion cicatrization in rabbits

O ultra-som é usado frequentemente no diagnóstico da lesäo muscular e no acompanhamento da cicatrizaçäo da mesma. O objetivo desta pesquisa foi verificar a correlaçäo entre a imagem ultra-sonográfica com a imagem macroscópica tendo, finalmente, o estudo histológico correspondente. Foram utilizados 30 coelhos da raça Nova Zelândia, submetidos a lesäo completa do músculo tibial cranial, sendo avaliados com ultra-som (7,5MHz e 10 MHz), fotografias durante o ato operatório (macroscopia) e estudo histológico (microscopia), em diferentes períodos da cicatrizaçäo (1, 2 e 3 semanas). Conclui-se que existe correlaçäo entre as imagens ultra-sonográficas, macroscópicas e microscópicas.

Tratamiento quirúrgico de las lesiones musculares / Surgical treatment for muscular injuries

En este trabajo se pretende determinar cuando está indicado el tratamiento quirúrgico de las lesiones musculares, como realizarlo en cada caso específico, el manejo postoperatorio y lo que se puede esperar de esta forma de tratamiento. Por lo que realizamos este reporte de 19 pacientes deportistas con lesiones musculares operados en el primer semestre de 1997, con diferentes tipos de lesiones en diferentes músculos y por lo tanto con diferentes técnicas quirúrgicas, obteniendo solo dos complicaciones mínimas y por lo tanto buenos resultados en términos generales, ya que siempre se logró suprimir el dolor reduciendo la tensión en el foco de la lesión, vaciando la cavidad o liberando terminaciones nerviosas comprimidas, englobadas o adheridas a la cicatriz, así como evitar la formación de un granuloma cicatricial, y devolver a las fibras musculares una tensión que las hiciera eficaces, reduciendo también el tiempo de incapacidad de los deportistas con las consecuencias que esto acarrea.

Clasificación de las lesiones del supraespinoso basada en la correlación RM-hallazgo operatorio / Clasification of the supraespinatus lesions based on the correlation between MRI and surgical findings

Objetivo: evaluar la sensibilidad de la RM en el diagnóstico de lesiones del supraespinoso y presentar una clasificación basada en la correlación RM-hallazgo operatorio. Material y métodos: 39 pacientes con sospecha clínica de lesión del manguito rotador fueron estudiados con RM y luego intervenidos quirúrgicamente. Todos los exámenes de RM fueron interpretados por dos médicos radiólogos que, al momento de efectuar el diagnóstico, desconocían el resultado de la cirugía. Posteriormente, se correlacionaron los hallazgos de la RMI con los intraoperatorios. La clasificación utilizada divide las lesiones del supraespinoso en dos grupos: con continuidad tendinosa (tendinosis y ruptura parcial) y sin continuidad tendinosa (ruptura total). A su vez, las rupturas totales pueden ser con escasa retracción y con gran retracción. Resultados: todos los pacientes tuvieron rupturas completas. Treinta y ocho rupturas fueron correctamente diagnosticadas por RM con una sensibilidad del 97,4 por ciento. Doce rupturas tuvieron escasa retracción y veintisiete, gran retracción. Cinco pacientes presentaron criterios de irreparabilidad. Conclusión: la RM es un excelente método para el diagnóstico de lesiones del manguito rotador. La clasificación basada en la correlación RM-hallazgo operatorio, brinda un diagnóstico preciso y da una visión integrada de las lesiones del supraespinoso. De ésta manera, el médico traumatólogo tratante puede determinar si una lesión es pasible de tratamiento médico o quirúrgico y, si es quirúrgico, determinar el tipo de cirugía (cirugía a cielo abierto o artroscopía)

Utilização do músculo grande dorsal contralateral após amputação interescápulo-torácica: relato de caso / The use of the contra lateral latissimus dorsi muscle after forequarter amputation: a case report

Relata-se um caso de amputação interescápulo-torácica por condrosarcoma escapular, onde foi utilizado, na reparação da perda de substância torácica, retalho muscular do grande dorsal contralateral, com base em seu pedículo secundário, não descrito anteriormente na literatura para esta finalidade.