Colgajo de Mustardé como tratamiento de un carcinoma basocelular. A propósito de un caso

Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.

Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.

Reconstrucción palpebral luego de una resección total por cáncer / Palpebral reconstruction after total resection due to cancer

Introducción: La incidencia de los tumores malignos palpebrales varía según las diferentes razas. Su frecuencia aumenta con la edad y su aparición está relacionada con factores genéticos, virales y ambientales. Objetivo: Presentar un caso con una lesión tumoral en el párpado inferior al que se le realizó la reconstrucción palpebral luego de una resección parcial por cáncer con técnica combinada que incluyó Mustardé e injerto de mucosa. Presentación de caso: Paciente masculino de 76 años de edad con antecedentes de salud. Hace un año atrás comenzó a presentar una lesión endurada en el párpado inferior izquierdo hacia el canto interno del ojo, que fue aumentando de volumen, con una ulceración posterior. En el examen físico se observó una lesión ulcerada y sucia de aproximadamente 2 ( 2,5 cm, que comprometía los 2/3 mediales del parpado inferior, incluyendo la vía conducto lagrimal. Tras la intervención quirúrgica la extirpación creó un defecto correspondiente a la ausencia en todos los planos anatómicos en casi la totalidad del párpado inferior izquierdo, por lo que se planeó un colgajo de avance de la mejilla. El estudio histopatológico confirmó un carcinoma epidermoide completamente resecado. Conclusiones: Esta cirugía combinada permitió una exéresis amplia del tumor con el margen oncológico requerido y la sustitución aproximada de las estructuras del párpado. Se lograron una funcionabilidad adecuada y una cubierta del globo ocular óptima en su porción inferior, además de armónico con el contralateral(AU)

Introduction: The incidence of palpebral malignant tumors varies according to different races. Its frequency increases with age and its occurrence is related to genetic, viral and environmental factors. Objective: To present a case with a tumor lesion in the lower eyelid, who underwent palpebral reconstruction after a partial resection due to cancer with a combined technique including Mustardé and mucosal graft and its clinical evolution. Case presentation: 76-year-old male patient with a medical history. One year ago he began to present an indurated lesion on the left lower eyelid towards the inner canthus of the eye that was increasing in volume, with subsequent ulceration. Physical examination revealed an ulcerated and dirty lesion of approximately 2 ( 2.5 cm involving the medial 2/3 of the lower eyelid, including the lacrimal duct. After surgery the excision created a defect corresponding to the absence in all anatomic planes in almost the entire left lower eyelid, so a cheek advancement flap was planned. Histopathologic study confirmed a completely resected epidermoid carcinoma. Conclusions: This combined surgery allowed wide excision of the tumor with the required oncologic margin and approximate replacement of the eyelid structures. Adequate functionality and optimal eyeball cover was achieved in its lower portion, as well as harmonic with the contralateral one(AU)

Otoplastia en oreja prominente / Otoplasty in prominent ear

La oreja alada es la deformidad congénita más frecuente en cabeza y cuello, con una incidencia de 5% en la población caucásica. Queda definida por una distancia entre el hélix y la mastoides mayor a 21 mm o un ángulo mayor a 90° entre la concha auricular y la fosa escafoidea, siendo causada en el 70% de los casos por un antihélix mal plegado. Su corrección, a través de la otoplastia, se vuelve fundamental en prevenir los impactos psicológicos, siendo indicada antes de los 6 a 7 años, cuando la oreja ha alcanzado un ancho similar a la oreja adulta. El abordaje quirúrgico se divide en aquellas técnicas incisionales y no incisionales, cuya tasa de éxito y complicaciones como el otohematoma, necrosis de cartílago y deformidad irreversible, entre otras, son variables. La recidiva varía entre 6% a 12,5%, según el abordaje, no existiendo a la fecha una única técnica de elección. En el presente trabajo se discutirán cuatro técnicas principales: Incisionless, Furnas, mustardé y técnica de los pilares.

The prominent ear is the most common congenital deformity in head and neck, with an incidence of 5% in the Caucasian population. It is defined by a distance between the helix and the mastoid greater than 21 mm or an angle greater than 90° between the concha and the scaphoid fossa, being caused in 70% of the cases by a misfolded antihelix. Its correction, through the otoplasty, becomes essential in preventing psychological impact, being indicated before the age of 6 or 7, when the ear has reached a similar width of an adult ear. The surgical access is classified on incisionless and non-incisionless techniques, where the success rate and complications like hematoma, cartilage necrosis and irreversible deformity, among others, are variables. Recurrence varies between 6%-12.5%, depending on the approach, and to date there is no single technique of choice. In this revision, we will discuss the four principal techniques: Incisionless, Furnas, Mustardé and the abutment technique.

Reconstrucción palpebral inferior mediante colgajo de periostio y colgajo de Mustardé / Lower palpebral reconstruction by periosteum flap and Mustardé flap

Paciente masculino de 68 años con carcinoma basocelular lobulado recidivado en inferior izquierdo con colgajo de Hughes hace 5 años y posterior recidiva al siguiente año con escisión en cuña. Actualmente, con una segunda recidiva, se realiza una resección amplia del 75% del total del párpado cuya congelación informa márgenes libres, reconstruido en el mismo acto quirúrgico: la lamela posterior con colgajo pediculado de periostio y la anterior con un colgajo de Mustardé. El paciente evoluciona con un buen sostén y posición palpebral, sin recurrencia del tumor.

A 68-year-old man with recurrent lobulated basal cell carcinoma of the left lower eyelid. She has a history of reconstruction of the lower left eyelid with Hughes flap 5 year sago and later recurrence the following year with wedge excision. Currently, with a second recurrence, resection was performed under frozen section technique and the defect of 75% width free of tumor, is reconstructed in the same surgical act: the posterior lamella with a pedicled periosteal flap and the anterior with a Mustardé flap. One year follow-up, the patient evolves with good support and eyelid position, without recurrence of the tumor.

Effectiveness of levator muscle resection combined with Mustarde's double Z-plasty for blepharophimosis-ptosis-epicanthus inversus syndrome / 中国修复重建外科杂志

Objective: To investigate the effectiveness of levator muscle resection combined with Mustarde's double Z-plasty to correct blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Methods: Between March 2015 and June 2017, one-stage operation of levator muscle resection combined with Mustarde's double Z-plasty were performed on 26 children with bilateral BPES. There were 16 boys and 10 girls with an average age of 7 years (range, 4-14 years). All patients marked the four typical signs of BPES. There were 7 cases accompanied with a low nasal bridge, and 20 cases with amblyopia and strabismus. The length of eye fissure was (19.5±4.5) mm, the width of eye fissure was (2.5±1.6) mm, the diameter of inner canthus was (42.1±6.5) mm, and the muscular strength of levator palpebrae superioris was (5.5±1.3) mm. Results: All the incisions healed by first intention. Twenty-three patients were followed up 2-12 months, with an average of 10 months. Among which, 2 cases were less corrected, 3 cases were over corrected, 6 cases had poor curvature of the eyelid. No eyelid internal and external pronation or keratitis occurred. Amelioration of blepharoptosis and epicanthus was achieved in the other patients, and the double eyelid fold was naturally smooth. At 7 days after operation, the length of eye fissure was (27.2±1.9) mm, the width of eye fissure was (12.5±1.3) mm, and diameter of inner canthus was (29.4±2.6) mm, which were superior to preoperative values ( t=0.127, P=0.042; t=0.341, P=0.029; t=0.258, P=0.038). There was no angular deformity caused by the width and length regressions of eye fissures. Conclusion: The levator muscle resection combined with Mustarde's double Z-plasty can effectively correct BPES and obtain good effectiveness.

Retalhos cutâneos de avanço de ambas hemifaces para reconstrução do nariz após múltiplos carcinomas basocelulares no dorso nasal / Bilateral facial cutaneous flaps for nose reconstruction after multiples basal cell

Os autores relatam caso de múltiplos carcinomas basocelulares no dorso nasal, tratados comcrioterapia, cirurgia e uso tópico de 5-fluoracil. Os múltiplos tumores não foram recidivas detumores anteriores, mas decorrentes da qualidade da pele do dorso nasal. Isto ficou evidentena biopsia após a ressecção cirúrgica, demonstrando ausência de comprometimento nasmargens da ressecção. A ulceração por uso prolongado do 5-fluoracil ocorreu pela ação doquimioterápico sob o tecido normal. A retirada da pele do dorso até a base da pirâmide nasalfoi realizada para evitar novos tumores sobre a mesma. A reconstrução por dois retalhoscutâneos de hemiface permitiu a reparação do nariz, sem comprometer o contorno facial.

The authors report a case of multiples basal cell carcinoma (BCC) over the dorsum treatedwith criotherapy, surgery and 5-fluoracil. They were not recurrence of former tumors occurringdue to the poor skin quality. It was clearly showed through the biopsy exhibitingno BCC at the margin of resection. The wound caused by excessive use of 5-fluoracil wasdue to chemotherapy action over the normal skin. Removal of the skin from the dorsumto the base of the nose was performed to avoid new BCC. Reconstruction using cutaneousflaps on both sides of the face restored the nose and facial contour.

Comparação entre otoplastia com e sem raspagem de cartilagem: ensaio clínico ramdomizado / Comparison of cartilage scoring and cartilage sparing otoplasty: randomized clinical trial

Introdução: um do principais componentes da orelha proeminente é o apagamento da anti-hélice.Muitas técnicas foram descritas para a correção desse defeito, entre elas a raspagem da cartilagem. Atribui-se a essa técnica uma anti-hélice de aspecto natural e uma menor incidência de recidivas de seu apagamento, no entanto tal procedimento não é isento de complicações. Objetivo: comparação entre otoplastia com e sem raspagem anterior da cartilagem. Métodos: 25 pacientes submetidos a otoplastia foram divididos aleatoriamente por sorteio em dois grupos. O procedimento foi semelhante, exceto pela raspagem de cartilagem que não foi realizada no grupo 1 e foi realizada no grupo 2. O período de acompanhamento foi de 15 dias e foram avaliadas características epidemiológicas, morfológicas, cirúrgicas e complicações. Resultados: os pacientes do grupo 2 apresentaram tempo cirúrgico 7 superior aos pacientes do grupo 1. A avaliação clínica observou que o edema era maior no grupo 2. A incidência de complicações enre os grupos foi semelhante. Conclusão: a raspagem anterior de cartilagem é um procedimento cirúrgico seguro, não aumentando a incidência de complicações precoces, nos pacientes submetidos a otoplastia.

Background: one of the main components of the prominent ear is the loss of the anti-helical fold. Many techniques had been published for the correction of this defect; one of them is the scoring of the cartilage. This technique had been associated with a natural looking ear and lower incidence re-operations; however such procedure is not free of complications. Objective: comparison of cartilage scoring and cartilage sparing otoplasty. Methods: 25 patients submitted to otoplasty had been divided randomly in two groups. The procedure was similar; except for the cartilage scoring that was not carried through in group 1 and was carried through in group 2. The follow up period was of 15 days and had beenevaluatedepidemiologists, morphologicandsurgical characteristic, as well as complications. Results: the patients of group 2 presented a surgical time 7 superior to the patients of group 1. By clinical evaluation it was observedthatedemawasgreateringroup2. Theincidence of complications between the groups was similar. Conclusions: anterior cartilage scoring is a safe surgical procedure, not increasing the incidence of early complications in the patients submitted to otoplasty.

Otoplastia pela técnica combinada Stenstrõm-Mustardé-Furnas: Análise de 44 casos / Otoplasty by a combined Stenstrom-Mustardé-Furnas technique: An analysis of 44 cases

Em um estudo retrospectivo, foram analisados 44 pacientes operados pela técnica combinada de Stenstrõm-Mustardé-Furnas para correção de orelhas em abano, durante o período de julho de 2001 a julho de 2002, no Hospital São Lucas, da PUCRS. O seguimento pós-operatório foi de 6 a 12 meses sendo encontrados 3 casos de assimetrias (6,82), 5 de extrusão de pontos (11,36), 3 casos de necrose parcial de pele da antihélix (6,82) e nenhum caso de hematoma ou infecção. 42 pacientes (95,45) encontravam-se satisfeitos com a cirurgia. Os resultados são comparados com dados de literatura, concluindo-se ser um procedimento seguro, de aplicação simples e com bom resultados estéticos e baixo índice de recidiva e complicações, correspondendo aos achados descritos na literatura.

A retrospective study analysed 44 patients undergone to corrective otoplasty with the Stenstrõm-Mustardé-Furnas technique, between July 2001 and July 2002, in the Hospital São Lucas da PUCRS. Follow-up range from 6 to 12 months. Were found 3 cases of assimetry (6,82), 5 cases of suture extrusion (11,36) 3 cases of antihelix skin necroses (6,82) and neither case of hematoma or infection. 42 patients (95,45) were satisfied with the surgery. The results are compared with the literature data, and concluded to be a safety surgery, with good results and low recidive rate.

Surgical Correction of the Blepharophimosis Syndorome

During the past decade the syndorome of blepharoptosis, blepharophimosis, epicanthus inversus and telecanthus(blepharophimosis syndrome)have become recognized as a distinct tetrad based upon clinical and hereditary characteristics. Early surgery is recommended to minimize being teased at school altough the final results surgical correction may be better in older children and in adults. We treated nine patients with epicanthus by Mustarde's quadrilateral flap or Y to V flap Medial canthal tendon is shortened by tucking for telecanthus. Blepharoptosis is corrected by frontalis suspension using preserved dura or preserved fascia lata as a sling material. We experience satisfactory results in nine patients by this technique without serious postoperative complications.