Procuramiento y uso de aloinjertos cutáneos de piel total criopreservados obtenidos de pacientes sometidas a abdominoplastía / Procurement and use of cryopreserved whole skin cutaneous allografts obtained from patients undergoing abdominoplasty

Resumen Introducción: Los aloinjerto cutáneos (AC) son excelentes sustitutos cutáneos temporales, sin embargo, la donación y procura de piel cadavérica, fuente habitual de AC, es baja. Objetivo: Evaluar la factibilidad de utilizar la piel proveniente de abdominoplastías como fuente de AC y su eficacia clínica. Materiales y Método: Entre el 17 de agosto de 2020 al 28 de febrero de 2021 se analizó una cohorte prospectiva de 14 pacientes femeninas sometidas a abdominoplastía por motivos estéticos, que aceptaron donar la piel del colgajo cutáneo abdominal redundante, la cual fue criopreservada. Se utilizaron los AC de piel total criopreservados (ACPTC) en 10 pacientes con diagnósticos de: pie diabético (4), laparostomía contenida (2) herida compleja extremidad inferior (2), sarcoma de cuero cabelludo recidivado (1) y melanoma (1). Resultados: Se obtuvieron 14 colgajos de piel total, los cuales fueron procesados obteniendo una superficie promedio de 302 cm2 y 8,3 láminas de distintos tamaños de utilidad clínica por paciente. En todos los pacientes en que se utilizó ACPTC hubo un prendimiento inicial del AC para posteriormente, en promedio 21 días, presentar una escara necrótica que al ser retirada presentaba un tejido vital adherido al receptor rico en fibroblastos, siendo algunos pacientes auto injertados y otros manejados con cicatrización por segunda intención como tratamiento definitivo. Discusión: Los ACPTC proporcionan una cobertura intermedia, pues una parte se integra en forma definitiva, actuando como un andamiaje biológico para la formación de una interfase sobre la cual se puede autoinjertar o dejar evolucionar con cicatrización por segunda intención y una parte es rechazada. Conclusión: La procura de piel de donante vivo, en pacientes sometidos a cirugías de contorno corporal es un proceso factible, fuente de ACPTC, los cuales permiten una nueva cobertura intermedia con múltiples aplicaciones clínicas.

Introduction: Skin allografts (SA) are outstanding temporary skin substitutes; however, cadaveric skin donation and procurement, a common source of SA, remains low. Aim: To evaluate the feasibility and clinical efficacy of using skin from abdominoplasties as a source of SA. Materials and Method: A prospective cohort was analyzed from August 17th, 2020 and February 28th, 2021, with 14 female patients submitted to abdominoplasty surgeries for aesthetic motives, who authorized skin donation from the redundant abdominal flap which was posteriorly cryopreserved. Cryopreserved total skin allografts (CTSA) was used in 10 patients with the following diagnoses: diabetic foot (4), contained laparostomy (2) complex wound of the lower limb (2), relapsing sarcoma of the scalp (1), and melanoma (1). Results: 14 CTSA were obtained, which were processed, obtaining an average area of 302 cm2 and 8.3 sheets of different sizes and clinical applications from each patient. In all patients who received CTSA, an initial attachment was observed, followed by the appearance of a necrotic scar in an average of21 days. The peeling of the latter revealed a vital tissue tightly adhered to the receptor and rich in fibroblasts. Some of the patients received autografts, and others were managed with secondary intention scarring as a definite treatment. Discussion: CTSA provide an intermediate coverage since one part is definitely adhered to, acting as a biologic scaffolding for the formation of an interface that can be autografted or left for a secondary intention scarring, and the host rejects the other portion. Conclusión: skin procurement from a living donor in patients submitted to body contour surgeries is a feasible process and significant source of CTSA, which permits a new intermediate coverage with multiple clinical uses.

Cura quirúrgica de pseudoartrosis atrófica infectada de diáfisis tibial / Surgical Cure of Infected Atrophic Nonunion of the Tibial Shaft

Introducción: La fractura de un hueso se define como la solución de continuidad de cierta porción ósea. Las fracturas diafisarias representan un bajo porcentaje de todas las fracturas, y el hueso tibial es el más afectado, debido a su escasa vascularidad, poca protección y existencia de diversos factores que hacen más propensos algunos problemas como pseudoartrosis y osteomielitis, que complican el tratamiento. Objetivo: Demostrar la eficacia de los resultados clínicos funcionales con la cura quirúrgica de pseudoartrosis infectada de diáfisis tibial con aporte de injerto óseo heterólogo de cadáver, y autoinjerto cortical esponjoso de cresta iliaca. Presentación del caso: Se presenta el caso de un paciente varón de 42 años que ingresa con diagnóstico de fractura expuesta II postraumática. Se realiza fijación externa en 2 ocasiones, con un intervalo de 6 días para corrección de valgo. El paciente se ausenta de sus controles clínicos y reingresa después de 10 meses aproximadamente por diagnóstico de pseudoartrosis atrófica infectada de tibia izquierda, según clasificación anatómica de Cierny-Mader IV. Se hospitaliza para cura quirúrgica y reconstrucción con aloinjerto óseo y autoinjerto de cresta iliaca, lo que da lugar a la consolidación y controles favorables. Actualmente el paciente ha recuperado la funcionalidad de su pierna izquierda, y queda como secuela una fístula con exposición de aloinjerto. Conclusiones: La cura quirúrgica de pseudoartrosis infectada de diáfisis tibial con aporte de injerto óseo heterólogo de cadáver, y autoinjerto cortical esponjoso de cresta iliaca presenta buenos resultados clínicos y funcionales, lo que constituye un método eficaz(AU)

Introduction: The fracture of a bone is defined as the solution of continuity of a certain bone portion. Diaphyseal fractures represent a low percentage of all fractures, and the tibial bone is the most affected, due to its scarce vascularity, little protection and the existence of various factors that make them more prone to some problems such as pseudoarthrosis and osteomyelitis, which complicate treatment. Objective: To demonstrate the efficacy of functional clinical results with the surgical cure of infected pseudoarthrosis of the tibial shaft with the contribution of heterologous cadaveric bone graft, and cortical cancellous autograft of the iliac crest. Case report: The case of a 42-year-old male patient admitted with a diagnosis of post-traumatic exposed fracture II is reported here. External fixation was performed on 2 occasions, with an interval of 6 days for valgus correction. The patient was absent from his clinical check-ups and was readmitted after approximately 10 months due to a diagnosis of infected atrophic nonunion of the left tibia, according to the anatomical classification of Cierny-Mader IV. He was hospitalized for surgical cure and reconstruction with bone allograft and iliac crest autograft, resulting in consolidation and favorable controls. Currently, the patient has recovered the functionality of his left leg, and a fistula with allograft exposure remains. Conclusions: Surgical treatment of infected tibial shaft pseudoarthrosis with provision of heterologous cadaveric bone graft and cortical cancellous autograft of iliac crest presents good clinical and functional results, which constitutes an effective method(AU)

Reconstrucción del ligamento cruzado anterior con autoinjerto vs aloinjerto / COMPARATION OF THE RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT WITH AUTOGRAFT VS. ALLOGRAFT

Introducción: La reconstrucción del ligamento cruzado anterior (LCA) se basa en reemplazar la ruptura del ligamento con un injerto, fijando los extremos de la tibia y fémur, mediante la colocación de un injerto, de tipo autoinjerto o aloinjerto. Objetivo general: Comparar la reconstrucción ligamentaria del cruzado anterior con autoinjerto vs aloinjerto. Material y métodos: Estudio cuasiexperimental, comparativo, longitudinal, prospectivo, heterodémico y unicéntrico, que se realizó en la consulta externa del Hospital Ángeles de Puebla, durante el periodo del 1 de noviembre a abril del 2018, evaluando en el postoperatorio inmediato y a los 9 meses con la escala de Lysholm, escala visual Análoga (EVA) y Escala de Tegner. Resultados: se analizaron a 50 pacientes, 25 pacientes se les realizó autoinjerto en el 80% menores de 29 años y el 20% mayores de 30 años, el 68% fueron del sexo masculino, 32% femenino, el 52% presentaron afectaciones en el lado derecho y el 80% fue por lesión deportiva. Los pacientes con aloinjerto fueron 25, 60% menores de 29 años y 40% mayores de 30 años, el 56% del sexo masculino, el 44% del femenino, 56% con afectación del lado izquierdo y el 60% por accidente. Se empleó la prueba estadística U de Mann Whitney para comparar la funcionalidad articular basal y a los 9 meses con la Escala Funcional de Lysholm, identificando que los pacientes con aloinjerto tuvieron mayor funcionalidad (p=0.0001), menor intensidad de dolor empleando la escala de EVA (p=0.050) y mayor nivel de actividad con la escala de Tegner, pero no significativa (p=0.148). Conclusiones: Se concluye que los pacientes con reconstrucción del ligamento cruzado anterior con aloinjerto, tuvieron mayor funcionalidad articular, evaluado por la escala de Lysholm, menor intensidad de dolor por escala EVA y se recupero el nivel de actividad física con la Escala de Tegner

Introduction: The reconstruction of the anterior cruciate ligament (ACL) is based on replacing the rupture of the ligament with a graft, fixing the ends of the tibia and the femur, by means of the placement of a graft, autograft or allograft type. Course objective: To compare the anterior cruciate ligament reconstruction with autograft vs allograft. Material and methods: Quasi-experimental, comparative, longitudinal, prospective, heterodémic and unicentric study, which was carried out in the outpatient clinic of Hospital Angeles de Puebla, during the period from November 1 to April 2018, evaluating in the immediate postoperative period and at 9 months with the Lysholm scale, Analog Visual Scale (EVA) and Tegner Scale. Results: 50 patients were analyzed, 25 patients underwent autograft in 80% in 29 years and 20% in 30 years, 68% were men, 32% women, 52% had affectations in the right side and 80% were due to injuries Sports Patients with allograft were 25, 60% younger than 29 years and 40% older than 30 years, 56% men, 44% women, 56% left side and 60% accidental. The Mann Whitney U statistical test was used to compare the baseline joint functionality and at 9 months the Lysholm Functional Scale, identifying that patients with allograft had greater functionality (p=0.0001), less pain intensity using the EVA scale (p=0.050) and higher level of activity with the Tegner scale (p=0.148) Conclusions: It is concluded that patients with reconstruction of the anterior cruciate ligament with allograft, had greater efficiency in joint functionality, evaluated by the Lysholm scale and with less pain intensity

Caso Clínico: Uso de Aloinjerto Óseo Estructural en Tumor de Células Gigantes de Fémur / Case Report: Use Of Structural Bone Allograft In Giant Cell Tumor Of The Femur

INTRODUCCIÓN: El tumor de células gigantes óseo es muy raro y controversial en su comportamiento por lo que es predecible. El diagnóstico requiere biopsia previa antes de proceder al tratamiento.CASO CLÍNICO: Paciente masculino de 43 años de edad, mestizo, sin antecedentes personales o familiares de relevancia. Acude a consulta externa de ortopedia oncológica por presentar masa dura y dolorosa con aumento gradual de tamaño a nivel de rodilla derecha, deformidad, limitación funcional y crepitación. EVOLUCIÓN: El paciente fue sometido a biopsia de lesión a nivel de fémur distal derecho con reporte de anatomía patológica de tumor de células gigantes. Se realizó una resección ósea a nivel de tumor y tratamiento mediante colocación de aloinjerto estructural óseo, con un seguimiento de 2 años y obteniendo como resultado funcional una puntuación de 14/15 según la escala de Makin, se evidencio además osteointegración del injerto al hueso autógeno a los 15 meses. No presento infección, ni reabsorción del injerto, ni fatiga del material.CONCLUSIÓN: La cirugía de conservación de la extremidad utilizando los aloinjertos estructurales es una técnica favorable con funcionalidad y osteointegración adecuada, aumentando las expectativas y calidad de vida. Evitando amputaciones, artrodesis o prótesis tumorales cuyo costo beneficio con los años subsecuentes terminan siendo altos y deteriorando al paciente.

BACKGROUND: Bone giant cell tumor (GCT) is one of the least frequent, most controversial and least predictable tumors in its behavior. We present a case of GCT in the lower limb, which implied the distal femur. The diagnosis required a previous biopsy before proceeding with its en bloc resection, and treatment based on bone allograft. CASE REPORT: Male patient of 43 years of age, mestizo, with no relevant personal or family history. He went to the oncology orthopedics outpatient clinic for presenting a hard and painful mass with gradual increase in size at the level of the right knee, deformity, functional limitation and crepitus in that region, which is why he attends his assessment. EVOLUTION:The patient underwent a lesion biopsy at the level of the distal femur with a pathological anatomy report of giant cell tumor. Bone resection was performed at the tumor level and treatment was performed by allografting the bone structural allograft. A 2-year follow-up was performed and a score of 14/15 according to the Makin scale was obtained as functional results. Osteointegration of the graft to autogenous bone was also evidenced. Excellently at 15 months. We did not find infection, graft resorption or fatigue of the material. CONCLUSIONS: Limb preservation surgery represented by structural allografts is a favorable technique with adequate functionality and osteoingration, increasing the life expectancy of our patients and future revision possibilities. Avoiding amputations, arthrodesis or tumor prosthesis whose cost benefit with the subsequent years end up being high and deteriorating the quality of life in the patient.

Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

Hidradenite supurativa (acne inversa): revisão da literatura e relato de caso sobre o tratamento cirúrgico de lesão pré-esternal / Hidradenitis suppurativa (acne inversa): review of the literature and case report on the surgical treatment of a presternal lesion

A Hidradenite Supurativa é uma doença crônica debilitante, estigmatizante e de difícil tratamento. A doença apresenta várias características clínicas, podendo ocorrer isolada ou simultaneamente em diversas localizações, geralmente simétricas, distribuídas na "linha do leite". Afeta a pele onde há maior quantidade de glândulas apócrinas intertriginosas, em ordem decrescente: axilas, região ano-genital, aréolas e sulco inframamário. Seu curso insidioso inicia com nódulos subcutâneos que se rompem e/ou coalescem, formando abscessos na derme profunda, extremamente doloridos. As lesões frequentemente drenam exudato purulento fétido, com importante prejuízo à qualidade de vida. Com a progressão da doença, ocorre formação de fistulas, comedões, fibrose, contraturas dérmicas e endurecimento da pele. Suas maiores chances de cura estão no diagnóstico precoce e tratamento individualizado, que abrange medidas farmacológicas, comportamentais e cirúrgicas. O tratamento cirúrgico tem sido considerado a medida curativa mais efetiva. A decisão entre as diversas modalidades vai depender do estágio, apresentação e comprometimento local e incluem incisão e drenagem dos abscessos, deroofing, marsupialização, eletrocirurgia, laser Nd:YAG, laser de CO2 e excisão cirúrgica extensa. As opções de reconstrução incluem cicatrização por segunda intenção, enxerto de pele total imediato ou tardio, fechamento primário e retalhos. O caso relatado de lesões préesternais apresentava características clínicas e histológicas compatíveis com HS, sendo esta uma localização incomum na Literatura. O resultado pós-operatório da ressecção de toda a lesão com fechamento primário mostrou-se resolutivo após longo tempo de seguimento. Mais ensaios clínicos randomizados são necessários para estipular o melhor manejo na HS.

Hidradenitis suppurativa is a chronic debilitating and stigmatizing disease that is difficult to treat. The disease presents several clinical characteristics, which may occur alone or simultaneously in various locations, generally symmetrical and distributed in the "milk line". It affects the following areas of the skin where intertriginous apocrine glands are numerous, in the descending order: axilla, anogenital region, areolas, and inframammary crease. Its insidious progression begins with formation of subcutaneous nodules that rupture and/or coalesce, forming extremely painful abscesses in the deep dermis. The lesions often drain foul purulent exudate, with significant damage to quality of life. As the disease progresses, formation of fistulas, comedones, fibrosis, dermal contractures, and hardening of the skin occur. The highest chances of cure are lie in early diagnosis and individualized treatment, which covers pharmacological, behavioral, and surgical measures. Surgical treatment has been considered a more effective curative measure. The decision between the different modalities will depend on the stage, presentation, and local commitment and include incision and drainage of abscesses, deroofing, marsupialization, electrosurgery, Nd:YAG laser, CO2 laser, and extensive surgical excision. The reconstruction options include healing by second intention, immediate or delayed full-thickness skin graft, primary closure, and flaps. The reported case of presternal injuries presented clinical and histological characteristics compatible with hidradenitis suppurativa; this location has been rarely reported in the literature. The postoperative results of complete resection of the lesion with primary closure indicated resolution over a long follow-up period. More randomized clinical trials are needed to determine the best management strategy for hidradenitis suppurativa.

Clinical and biomechanical evaluation of three bioscaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys [Equus asinus]: An experimental study

The present study was designed to carry out an in vivo and in vitro comparative evaluation of three bio-scaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys. Twenty-four clinically healthy donkeys were assigned for three treatment trials [n = 8] using one of three bioscaffold materials [glycerolized bovine pericardium xenograft, tendon allograft and allograft shielding with glycerolized by bovine pericardium]. In addition, eight clinically healthy donkeys were selected to serve as control. Clinical signs of each animal were scored and the sum of all clinical indexes was calculated at each time point of the experiment. Four donkeys from each group were euthanized at 45 and 90 days postoperatively, respectively, for biomechanical and histopathological evaluation of treated superficial digital flexor tendon [SDFT]. The failure stress in allograft shielding group significantly increased compared to the corresponding values of the other groups at 45 [62.7 +/- 6.5 N mm[-2] and 90 [88.8 +/- 3.5 N mm[-2] days postoperatively. The fetlock angle in the allograft shielding group at both 45 [112.8[degree] +/- 4.4] and 90 [123.8[degree] +/- 1.1] days postoperatively showed a significant increase [p < 0.05] relative to the values of the other groups and a significant decrease [p < 0.05] when compared to normal angle [125[degree] +/- 0]. However, the histomorphological finding srevealed no remarkable changes between the treatment groups. In conclusion, the failure stress, fetlock angle and histomorphological findings may provide useful information about the healing characteristics of SDFT tenorrhaphy. The bio-scaffold augmentation devices, either xenogenic or allogenic, provide good alternative techniques accelerating SDFT healing with minimal adhesions in donkeys