Dismorfia de genitales externos en la población pediátrica / Dysmorphia external genitalia in the pediatric population

El procedimiento estético más común de los genitales femeninos es la reducción de los labios menores (labioplastía). Cada vez son más las niñas y mujeres jóvenes que prestan especial atención a la apariencia estética de sus genitales externos. La causa más común de hipertrofia es probablemente la congénita. Las mujeres afectadas habitualmente sufren vergüenza social y preocupación estética. Existen numerosas técnicas para la corrección quirúrgica en la literatura médica, aunque ningún método es superior a otro. Se presentan dos casos de dismorfia de labios menores en adolescentes. En un caso, de dismorfia congénita, se utilizó la técnica de reducción en ancho y en largo mediante desepitelización y resección en cuña inferior. Esta asociación proporciona un cierre libre de tensión y asegura una vascularización adecuada del borde del colgajo superior, lo que disminuiría el riesgo de dehiscencia de herida. En el otro caso, secuela de trauma, se reimplantó el labio afectado con resección del tercio distal del mismo. En ambas pacientes los resultados estéticos fueron satisfactorios...

The most common cosmetic procedure of the female genitalia is the labia minora reduction (labiaplasty). There are more and more girls and young women, with special attention to the aesthetic appearance of their external genitalia. The most common cause of hypertrophy is likely to congenital. Affected women usually suffer social shame and aesthetic concerns. There are numerous techniques for surgical correction in the medical literature, although no method is superior to another. Two cases of a minor dysmorphic teen lips are presented. In one case, a congenital dysmorphic, we used the reduction technique in width and in length by epithelialization and lower wedge resection. This partnership provides tension-free closure and ensures proper vascularization of the upper edge flap, which would reduce the risk wound dehiscence. In the other case, sequel to trauma, the affected lip were treated with resection of the distal portion. In both patients the aesthetic results were satisfactory...

Sustained benefit lasting one year from T4 instead of T3-T4 sympathectomy for isolated axillary hyperhidrosis

INTRODUCTION: Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary hyperhidrosis at the initial and six-month follow-ups of these patients. OBJECTIVE: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up. METHODS: Sixty-four patients with axillary hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory hyperhidrosis and self-reported quality of life. RESULTS: According to patient reports after one year, all cases of axillary hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory hyperhidrosis was present in 27 patients of the T3-T4 group (87.1 percent) and in 16 patients of the T4 group (48.5 percent). After one year, all T3-T4 patients experienced some degree of compensatory hyperhidrosis, compared to only 14 patients in the T4 group (42.4 percent). In addition, compensatory hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group. CONCLUSION: Both techniques were effective for treating axillary hyperhidrosis, but the T4 group showed milder compensatory hyperhidrosis and greater patient satisfaction at the one-year follow-up.

Simpatectomia torácica por videotoracoscopia para tratamento da hiperidrose primária: estudo retrospectivo de 521 casos comparando diferentes níveis de ablação / Video-assisted thoracic sympathectomy in the treatment of primary hyperhidrosis: a retrospective study of 521 cases comparing different levels of ablation

OBJETIVO: Comparar grau de satisfação dos pacientes simpatectomizados e presença de sudorese reflexa, de acordo com diferentes níveis de ablação. MÉTODOS: Estudo retrospectivo de 521 pacientes com hiperidrose primária, submetidos à simpatectomia torácica no Hospital Monte Sinai e Hospital Universitário da Universidade Federal de Juiz de Fora - UFJF, de janeiro de 2001 a dezembro de 2005. Grupo I (n = 162): termoablação do tronco simpático, tendo T2 como nível mais cranial da ressecção, independentemente de outros níveis seccionados caudalmente. Grupo II (n = 65): termoablação do tronco simpático, tendo T3 como nível mais alto. Grupo III (n = 294): termoablação do tronco simpático, tendo T4 como nível mais alto. RESULTADOS: Pós-operatório ótimo no controle da hiperidrose palmar/axilar em, respectivamente, 94/82 por cento dos pacientes do grupo I, 89/89 por cento do grupo II e 80/80 por cento do grupo III. Sudorese reflexa em 67 por cento dos pacientes dos grupos I e II, caindo para 61,29 por cento no grupo III devido à maior termoablação a partir de T4. Ocorreu sudorese reflexa severa em 32 por cento dos pacientes do grupo I, 9 por cento do grupo II e 4 por cento do grupo III. CONCLUSÃO: A simpatectomia propiciou excelente grau de satisfação e baixo índice de complicações. Não houve diferença na incidência de sudorese reflexa com diferentes níveis seccionados; porém, a intensidade desta complicação se mostrou menor quando optamos por níveis de bloqueio mais baixos, principalmente T4.

OBJECTIVE: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82 percent of the patients of group I, 89/89 percent of those in group II and 80/80 percent of those in group III. Postoperative reflex sweating was observed in 67 percent of the patients in groups I and II, compared with 61.29 percent of those in group III. Severe reflex sweating occurred in 32 percent of the group I patients, 9 percent of the group II patients and 4 percent of the group III patients. CONCLUSION: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.