Complete depigmentation of a small aperture corneal inlay implanted for compensation of presbyopia / Despigmentação completa de um implante corneano de pequena abertura para correção da presbiopia

ABSTRACT We describe a case of late-onset remarkable depigmentation of a small aperture corneal inlay implanted for presbyopia compensation. The patient was a participant in a clinical trial designed to evaluate the safety and efficacy of the AcuFocusTM ACU-10R160, which is a 10 µm-thick polyimide film tinted with an organic dye. Inlay implantation occurred under mechanical microkeratome Lasik flaps set for a depth of 120 µm. The patient returned to the clinic 11 years after surgery and reported loss of near-vision acuity. Clinical examination showed the complete absence of pigments in the device and the total loss of the initial effect on near vision, despite normal distance vision. Manifest refraction remained stable during the follow-up period. Scheimpflug images characterized the loss of the small aperture effect on incoming light. Confocal analysis revealed small hyper-reflective round images on the endothelium and no signs of inflammation.

RESUMO Descrevemos um caso de importante despigmentação de início tardio de implante corneano de pequena abertura implantada para compensação de presbiopia. O paciente foi um dos participantes de ensaio clínico destinado a avaliar a segurança e eficácia do AcuFocusTM ACU-10R160, uma película de poliimida de 10 microns de espessura, tingida com um corante orgânico. A implantação ocorreu sob um flap de Lasik criado por microcerátomo mecânico ajustado para profundidade de 120 µm. O caso aqui descrito foi avaliado 11 anos após a cirurgia, relatando diminuição de acuidade de visão para perto. O exame clínico mostrou ausência total de pigmentos no dispositivo e perda total do efeito inicial na visão de perto, apesar da visão normal para distância. A refração manifesta permaneceu estável durante o período de seguimento. As imagens de Scheimpflug caracterizaram a perda do efeito da abertura pequena na luz entrante. A análise de microscopia confocal revelou pequenas imagens hiper-reflexivas redondas sobre o endotélio, sem sinais de inflamação.

Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence

Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79) years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74) months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25) mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2%) were dry (11 patients, 0 pads; 5 patients using safety pads), 3 patients (14%) had mild and 2 (9.8%) had moderate degree post-prostatectomy urinary incontinence (PPI). The average maximum urine flow rate of the patients was 15.6±4.7 (10-31) mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI. .

Evaluation of intrastromal corneal ring segments for treatment of post-LASIK ectasia patients with a mechanical implantation technique.

Aim: To evaluate the clinical outcomes of Keraring segment implantation in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasia, using a mechanical implantation technique. Materials and Methods: Twelve eyes of 10 patients with post-LASIK ectasia were enrolled. Intracorneal ring segments (ICRS) were implanted after dissection of the tunnel using Tunc's specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric (K) readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3, 6, and 12-month follow-ups were completed, and statistical analysis was performed. Results: The mean preoperative UDVA for all eyes was 1.28 ± 0.59 logMAR. At 12 months, the mean UDVA was 0.36 ± 0.19 logarithm of the Minimum Angle of Resolution (logMAR) (P=0.002), and the mean preoperative CDVA was 0.58 ± 0.3 logMAR, which improved to 0.15 ± 0.12 (P=0.002) at 1 year. There was a significant reduction in cylindrical refractive and spherical equivalent refractive error from –5.29 ± 2.47 diopters (D) and –5.54 ± 5.04 D preoperatively to –1.47 ± 0.71 D and –0.74 ± 1.07 D (P=0.001, P=0.002), respectively, at 1 year. In the same period, the mean K- readings improved from 47.93 ± 4.84 D to 40.87 ± 2.36 D (P=0.002), and the mean ISAI improved from 5.34 ± 3.05 to 2.37 ± 1.68 (P=0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during or after surgery. Conclusion: ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for post-LASIK ectasia. All parameters showed improvement at 1-year follow-up.

Bone-anchored titanium implants for auricular rehabilitation: case report and review of literature / Implantes osseointegrados de titânio para reabilitação auricular: relato de caso e revisão da literatura

CONTEXT AND OBJECTIVE: Osseointegrated implants have acquired an important role in the prosthetic rehabilitation of patients with craniofacial defects. The main indications are lack of local tissue for autogenous reconstruction, previous reconstruction failure and selection of this technique by the patient. This paper presents a clinical case and discusses indications and advantages of the osseointegrated implant technique for retention of auricular prostheses. TYPE OF STUDY: Case report, Universidade Federal de São Paulo (UNIFESP). METHODS: A female patient received three auricular implants after surgical resection of a hemangioma in her left ear. The time taken for osseointegration of the temporal bone was three months. After fabrication of the implant-retained auricular prosthesis, the patient was monitored for 12 months. RESULTS: The clinical parameters evaluated showed good postoperative healing, healthy peri-implant tissue, good hygiene and no loss of implants. Good hygiene combined with thin and immobile peri-implant soft tissues resulted in minimal complications. Craniofacial implant integration appears to be site-dependent; increasing age affects osseointegration in the temporal bone. The frequency of adverse skin reactions in peri-implant tissues is generally low. CONCLUSION: The surgical technique for rehabilitation using implant-retained auricular prostheses seems to be simple. It is associated with low rates of adverse skin reactions and long-term complications. Prostheses anchored by osseointegrated implants seem to provide better retention than do prostheses supported on spectacle frames, less risk of discoloration through the use of adhesives and better esthetic results than do prostheses anchored in the surgical cavity

CONTEXTO E OBJETIVO: Os implantes osseointegrados adquiriram papel importante na reabilitação protética de pacientes com defeitos craniofaciais. As principais indicações são ausência local de tecidos para reconstrução autógena, falha anterior de reconstrução e opção do paciente. Este artigo apresenta um caso clínico e discute as indicações e vantagens da técnica de implantes osseointegrados para a retenção de próteses auriculares. TIPO DE ESTUDO E LOCAL: Relato de caso clínico, Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Paciente do sexo feminino recebeu três implantes na região auricular após ressecção cirúrgica de hemangioma na orelha esquerda. O tempo de osseointegração no osso temporal foi de três meses. Após a confecção de prótese auricular implanto-suportada, a paciente foi observada por 12 meses. RESULTADOS: Os parâmetros clínicos analisados mostraram boa cicatrização pós-operatória, saúde dos tecidos adjacentes ao implante, boa higiene e nenhuma perda de implantes. A boa higiene combinada a pouca espessura e imobilidade dos tecidos moles perimplantares resulta em poucas complicações. A integração dos implantes craniofaciais parece variar conforme o local, e a idade avançada afeta a osseointegração no osso temporal. A frequência de reações adversas cutâneas nos tecidos perimplantares é geralmente baixa. CONCLUSÃO: A técnica cirúrgica para a reabilitação com próteses auriculares implanto-suportadas parece ser simples e está associada a baixos índices de reações cutâneas adversas e complicações no longo prazo. As próteses ancoradas por implantes osseointegrados parecem proporcionar melhor retenção do que as próteses suportadas nas armações de óculos, menor possibilidade de descoloração pelo uso de adesivos e melhores resultados estéticos do que as próteses ancoradas na cavidade cirúrgica.

Hernioplastia inguinal con técnica prolene hernia system: evaluación de los resultados a largo plazo / Long term results of inguinal hernia repair with prolene hernia system technique

Introducción: En múltiples trabajos se han evaluado los resultados a corto y mediano plazo de la reparación de la hernia inguinal con la técnica prolene hernia system PHS). Sin embargo, en pocos estudios se han reportado resultados a largo plazo. Objetivos: Evaluar los resultados a largo plazo de la reparación de la hernia inguinal con la técnica PHS. Material y método: Se realizó un estudio prospectivo de 62 enfermos operados con la técnica PHS entre 2001 y 2002. Las complicaciones inmediatas y el dolor fueron evaluadas en todos los enfermos. Se completaron 4 años de seguimiento en 53 pacientes que se analizan en este trabajo (90,1 por ciento). Se evaluó la recurrencia hemiaria, la presencia de dolor crónico (en reposo y en actividad), el rechazo de la malla y la satisfacción con la operación. Resultados: El grupo está formado por 50 hombres (94 por ciento) y 3 mujeres (6 por ciento), con una edad de 53,2 + 8,5 años. En 52 enfermos (98 por ciento) la hernia inguinal fue asintomática. Se repararon 58 hernias en 53 enfermos. Dos enfermos (2,5 por ciento) presentaron complicaciones inmediatas. En el seguimiento a largo plazo, no se ha observado recurrencia, dolor crónico, rechazo de la malla y todos los enfermos están satisfechos con los resultados obtenidos. Conclusiones: La hernioplastia inguinal con técnica PHS presenta buenos resultados en el seguimiento a largo plazo, sin recidiva ni dolor crónico. Los pacientes se encuentran satisfechos con los resultados obtenidos.

Background: Short and mid-term results of inguinal hernia repair with Prolene Hernia System (PHS) have been evaluated. However, few studies have reported long-term recurrence rates. Aim: To evaluate long-term outcomes among patients who underwent inguinal hernia repair with Prolene Hernia System technique. Material and Methods: A prospective study of 62 patients operated with PHS from 2001 to 2002. Pain and immediate complications were evaluated in all patients. Four years follow-up was completed in 53 (90.1 percent) patients, who are the analyzed group. The evaluated issues were hernia recurrence, chronic pain (at rest and in activity), alteration in sexual behavior, mesh rejection and overall satisfaction with the procedure. Results: Fifty men (94 percent) and three women (6 percent), aged 53.2 + 8.5 years were analyzed. In 52 patients (98 percent), inguinal hernia was symptomatic. Fifty eight hernias were repaired on the 53 patients. On immediate follow-up, postoperative complications were observed in two patients (2.5 percent). In long-term follow-up, no patient had hernia recurrence, chronic pain or alterations in sexual behavior. Conclusions: Inguinal hernia repair with PHS has satisfactory long term outcomes.

Ciliary Sulcus Ahmed Valve Implantation

PURPOSE: Ahmed glaucoma valves were implanted into the ciliary sulcus of two patients diagnosed with neovascular glaucoma with favorable outcomes. METHODS: The study patients presented to our hospital with ocular pain caused by increased intraocular pressure (IOP). A thorough history was taken, and an ophthalmic examination was performed. RESULTS: A 71-year-old male patient and a 57-year-old female patient visited our hospital for ocular pain and persistent, elevated IOP. Each were diagnosed with neovascular glaucoma and underwent an Ahmed glaucoma valve implantation to the sulcus. After surgery, the patients maintained stable IOPs without major complications. CONCLUSIONS: The method of Ahmed glaucoma valve implantation into the ciliary sulcus could reduce complications caused by implantation to the anterior chamber. It is thought to be an efficient method for the maintenance of appropriate IOP after surgery.

Asian experience with the Pintucci keratoprosthesis.

PURPOSE: To report the outcome of a retrospective study of the Pintucci Biointegrable Keratoprosthesis (PBIKP) in Asian eyes. MATERIALS AND METHODS: This was a retrospective analysis of 31 eyes of 31 consecutive patients, who underwent surgery with implantation of the PBIKP. The age ranged from 7 years to 65 years, with a mean age of 34 years. The indications for the PBIKP were chemical burns (11 cases); highly vascularized failed grafts (11 cases); severe dry eyes with total vascularized cornea (6 cases); miscellaneous (3 cases). Twenty eight bilaterally blind Asian patients, with vision not exceeding hand motion close to face in the better eye, underwent the classical two-stage procedure to implant the PBIKP. In another three patients, the PBIKP was implanted as a one-stage procedure. All 31 eyes were unsuitable for keratoplasty or had repeated failed keratoplasties. All patients were followed up for periods ranging from 6 months to 7 years, with a mean of 3.2 years. RESULTS: No eye had infection or retro prosthetic membrane, which were common complications in other Keratoprostheses designs. Twenty-four of 31 eyes improved to greater than finger counting at 1.5 metres, enabling the patients to function independently. Four of 31 eyes (13%) improved to 20/200 or better. Twelve of 31 eyes had significant complications. However only a few were vision- threatening. CONCLUSION: With careful patient selection, the PBIKP could prove to be a useful modality of treatment for bilaterally corneally blind Asian patients, whose vision cannot be improved with conventional medical or surgical treatments.

Surgical Outcomes in Correction of Brown Syndrome

PURPOSE: To evaluate the outcomes of surgery for Brown syndrome. METHODS: We reviewed the charts of 15 patients who underwent surgery for Brown syndrome. The limitation of elevation in adduction (LEA) ranged from -2 to -4 degrees. A superior oblique muscle (SO) tenotomy was performed in 4 patients, a silicone expander was inserted in the SO of 9 patients, and a SO recession was performed in 2 patients. The results of surgery were analyzed with a follow-up period of more than 6 months, 42.3+/-48.42 months on average. RESULTS: Nine female patients and 6 male patients with unilateral Brown syndrome were selected for this study. The left eye was the affected eye in 9 patients. The degree of preoperative LEA was -2 to -4 in 4 patients in whom SO tenotomy was performed, -3 to -4 in 9 patients treated with the silicone expander, and -2 to -4 in 2 patients treated with SO recession. The LEA was released after surgery in all patients without postoperative adhesion. However, unilateral overaction of the inferior oblique muscle due to excessive weakening of the SO occurred in 1 patient with tenotomy (25%) and in 1 patient with insertion of a silicone expander (11%). CONCLUSIONS: LEA was released after tenotomy, insertion of a silicone expander and recession of the SO in 13 of 15 patients with Brown syndrome. SO palsy due to overcorrection and under-correction with postoperative adhesion should be avoided.

Ahmed Valve Implantation for Refractory Glaucoma following Pars Plana Vitrectomy

PURPOSE: To evaluate the effectiveness of Ahmed valve implantation for refractory glaucoma following pars plana vitrectomy. METHODS: Seventeen eyes of 15 patients suffering from secondary glaucoma following pars plana vitrectomy underwent Ahmed valve implantation. All the eyes were in critical condition, and intraocular pressure could not be controlled with anti-glaucoma medications. Success was characterized by an intraocular pressure less than 22 mmHg and greater than 6 mmHg, regardless of anti-glaucoma medication usage. RESULTS: The total success rate was 83.4% at 6 months and 76.4% at the final visit. The reduction in intraocular pressure and the number of medications used postoperatively were both statistically and clinically significant (p< 0.005). Postoperative complications included: transiently increased intraocular pressure, transient hyphema, early postoperative hypotony, choroidal detachment, malposition of the valve tip, and phthisis bulbus. CONCLUSIONS: Ahmed valve implantation is a safe and effective method for refractory glaucoma following vitrectomy.

Clinicopathologic Findings after Nasolacrimal Polyurethane Stent Implantations

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS: This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS: During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatroy reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.

New bone formation in the female rabbit tibia

O presente estudo constitui em se fazer uma avaliação da neoformação óssea em enxertos de PVP (polivinilpirrolidona) colocados em tíbias de dez coelhas. Os animais foram submetidos à cirurgia de ooforectomia para a indução de um quadro osteopênico e analisados densitometricamente no início do experimento, aos três meses e aos sete meses. Durante as dezesseis semanas de osteointegração, os animais foram submetidos a injeções subcutâneas de três marcadores ósseos, em intervalos semanais, por quatro semanas cada um; em seguida, foram sacrificados, previamente à terceira análise densitométrica, para avaliação histológica do material. Foi observada a presença de formações osteóides e tecido ósseo mineralizado envolvendo o enxerto, inclusive na região medular, em menor quantidade nos animais osteopênicos, o que indica a boa qualidade osteocondutora do PVP e a eficácia na indução de osteopenia pela menor quantidade de material ósseo encontrado. No material sem enxerto, observou-se um tecido mais desorganizado no grupo ooforectomizado, reiterando a eficácia da ooforectomia.

Obstrucción colorrectal maligna: tratamiento con endoprótesis metálicas autoexpandibles / Colorectal obstruction: treatment with expandible stent endoprosthesis

Objetivo: evaluar la utilidad de las endoprótesis metálicas autoexpandibles en el tratamiento de la obstrucción colorrectal secundaria a una neoplasia maligna. Material y métodos: se instalaron un total de doce endoprótesis en doce pacientes bajo fluorscopica, en dos casos asistido por endoscopía. Los pacientes presentaban signos clínicos y radiológicos de una obstrucción intestinal a nivel colorrectal. Las indicaciones de instalación fueron: tratamiento paliativo en 10 pacientes con evidencias de enfermedad tumoral a distancia (9) o pelvis congelada (1) y en 2 pacientes como método de descompresión prequirúrgica. Se utilizaron prótesis metálicas autoexpandibles (Wallstent 20 x 55 mm). Resultados: la colocación de la endoprótesis fue exitosa en 12 pacientes, que se recuperaron de su obstrucción colónica dentro de las 24 horas siguientes. Conclusión: la instalación de endoprótesis autoexpandibles en pacientes con obstrucción intestinal a nivel colorrectal es un método mínimamente invasivo, efectivo como tratamiento paliativo en aquellos pacientes de alto riesgo para una intervención quirúrgica. Por otra parte, éste procedimiento también permite la preparación preoperatoria del colon y así proceder en una sola etapa quirúrgica

The use of a modular titanium endoprosthesis in skeletal reconstructions after bone tumor resections: method presentation and analysis of 37 cases

We analyzed 37 patients who underwent segmental wide resection of bone tumors and reconstruction with a modular titanium endoprosthesis at the Orthopaedic Oncology Group, between 1992 and 1998. Twelve patients were male and 25 were female, with a mean age of 30 years (9 - 81). The mean follow-up was 14 months (2 - 48). The diagnoses were: steosarcoma (14 cases), metastatic carcinoma (10), Ewing's sarcoma (4), giant cell tumor (4), malignant fibrous histiocytoma (3), chondrosarcoma (1), and aneurysmal bone cyst (1). Eleven articulated total knee, 8 partial proximal femur with bipolar acetabulum, 8 partial proximal humerus, 3 total femur, 2 partial proximal tibia, 2 diaphyseal femur, 2 diaphyseal humerus, and 1 total proximal femur with cementless acetabulum endoprosthesis implant procedures were done. The complications related to the procedure included: infection (5 cases), dislocation (3), module loosening (1), and ulnar nerve paresthesia (1). We used the following criteria for the clinical evaluation: presence of pain, range of motion, reconstruction stability, surgical and oncologic complications, and patient acceptance. The results were good in 56.8 per cent of the cases, regular in 32.4 per cent and poor in 10.8 per cent.

Tratamiento del síndrome de vena cava superior maligno con stents autoexpandibles / Treatment of superior vena cava syndrome with endovascular stent placement

Debido al avance en técnicas de intervencionismo en los últimos años, se ha desarrollado una alternativa terapéutica que permite la repermeabilización completa de la vena cava superior (VCS) a través del uso de endoprótesis vasculares (stents) autoexpansibles. Esta técnica permite la resolución del síndrome de VCS en forma inmediata como tratamiento paliativo o adyuvante de otras modalidades terapéuticas en obstrucciones secundarias a patología maligna. Objetivo: comunicar los resultados de la primera serie consecutiva de pacientes con síndrome de VCS tratados con ésta técnica en nuestro país. Pacientes y métodos: once pacientes con síndrome de VCS, 8 con diagnóstico de cáncer de pulmón (4 adenocarcinomas, 4 epidermoides), 2 cánceres de mama y 1 paciente con un linfoma no Hodgkin fueron tratados con la implantación de stents autoexpandibles. Todos los procedimientos se realizaron en la sala de angiografía digital por punción percutánea de la vena femoral (10 casos) o basílica (1 caso) y cateterismo selectivo de la VCS. Resultados: la técnica resultó exitosa y la colocación correcta en todos los casos. En el 91 por ciento, los síntomas desaparecieron completamente, en el 9 por ciento restante (n=1) se observó una marcada mejoría sin obtener remisión completa. No se registraron recidivas. La sobrevida media fue 8 meses (rango 2-22). No se observó morbilidad ni mortalidad atribuibles al procedimiento. Conclusión: la colocación de stents es un procedimiento seguro y eficaz para el tratamiento de la obstrucción maligna de la VCS

Hernioplastias con prótesis de polipropileno: experiencia del Hospital Clínico San Borja-Arriarán / Hernioplasty with polypropylene prosthesis: experience of the San Borja-Arriarán clinical hospital

El presente trabajo, tiene como objetivo conocer la experiencia del Hospital San Borja-Arriarán en la herniopiastia con mallas de polipropileno, evaluando complicaciones asociadas y conocer la magnitud de las revividas. Se revisan retrospectivamente, 60 pacientes intervenidos con prótesis para reparación herniaria desde enero de 1990 a abril de 1995, según protocolo y seguimiento con examen personalizado del 73,3 por ciento de los pacientes, con promedio de 29,3 meses (3 a 75 meses). El 88 por ciento corresponde a hernias incisionales y las restantes a inguinales, crurales y umbilicales (7 por ciento, 3 por ciento, 2 por ciento, respectivamente), todas ellas con una o más recidivas. Morbilidad 22 por ciento, con 1 0 por ciento de fístulas por material de sutura, 3,3 por ciento infección de herida operatoria, 1,6 por ciento rechazo de malla. Recidiva de 3 pacientes (5 por ciento) la que se objetiva entre los 26 y 48 meses post operatorios. Mortalidad de 1 caso (1,7 por ciento)

Una Prótesis Sencilla para Amputados Miembro Inferior

Se presenta la técnica de construcción de un tipo de prótesis sencilla para amputados de miembro inferior. La trajedia de Armero movilizó ayudas internacionales económicas y técnicas, entre estas: OPERRATION HANDICAP INTERNATIONALE, con sede en Lyon(Francia) que realiza programas de rehabilitación del aparato locomotor para países en desarrollo: Cambodia, Thailandia, Chad, etc. Entre marzo 3 de 1986 y mayo 9 de 1987 se registraron 108 pacientes. Las causas más frecuentes de amputación fueron el trauma y las heridas por arma de fuego o arma cortante. Hasta mayo de 1987 se habían entregado 90 prótesis distribuidas así: 47 tibiales y 43 femorales. Los beneficiados del programa fueron 78 hombres y 12 mujeres. El 61 por ciento de los pacientes que recibieron el beneficio oscilaron entre los 30 y los 50 años de edad. Se trata de una prótesis de fácil construcción que utiliza materiales locales(madera, caucho de llanta usada, láminadeacero y cuero). El propósito es mostrar una solución al alcance de nuestros pacientes más pobres que son los habitualmente manejados en los hospitales