Crecimiento guiado en extremidades inferiores / Guided growth in lower extremities

El crecimiento guiado es una opción quirúrgica de uso creciente para la corrección de las deformidades angulares de extremidades inferiores en pacientes esqueléticamente inmaduros. Es posible de realizar en múltiples planos o segmentos, con excelentes resultados. Su uso más frecuente es en deformidades del plano coronal alrededor de la rodilla. La epifisiodesis permanente se puede realizar en pacientes dentro de los dos años previos al término del crecimiento longitudinal del segmento a tratar, considerando la epifisiodesis temporal para los pacientes con más de 2 años de crecimiento restante.En casos leves a moderados las tasas de éxito llegan incluso al 100% en algunas series, en tanto, pacientes con enfermedad de Blount, obesidad, edad esquelética avanzada o deformidades severas, tienen menos posibilidades de lograr una corrección completa.Independientemente de la técnica quirúrgica, es necesario una adecuada planificación preoperatoria, educación familiar y un seguimiento estricto para así minimizar las complicaciones y permitir una excelente corrección de la deformidad con una morbilidad mínima.

Guided Growth is a surgical option of increasing use for the correction of angular deformities of the lower extremities in skeletally immature patients. It is possible to perform in multiple planes or segments, with excellent results. Its most frequent use is in deformities of the coronal plane around the knee. Permanent epiphysiodesis can be performed in patients within 2 years before the end of longitudinal growth of the segment to be treated, considering temporary epiphysiodesis for patients with more than 2 years of remaining growth.In mild to moderate cases, the success rates reach even 100% in some series, while patients with Blount's disease, obesity, advanced skeletal age or severe deformities are less likely to achieve a complete correction.Regardless of the surgical technique, adequate preoperative planning, family education and strict follow-up are necessary to minimize complications and allow excellent correction of the deformity with minimal morbidity

Aplasia congênita da cútis em membros inferiores: relato de caso / Aplasia cutis congenita on the lower limbs: a case report

INTRODUÇÃO A Aplasia Congênita da Cútis (ACC) é uma doença rara caracterizada pela ausência de uma parte da pele ao nascimento, seja em área localizada ou generalizada. A incidência é de 0,1 a cada 100.000 nascimentos, tendo como acometimento principal o couro cabeludo, ocorrendo de forma isolada nesta localização em 60% dos casos. As causas não são claras, mas fatores genéticos, teratógenos (álcool, cocaína, maconha, heroína, misoprostol, metimazol, carbimazol, herpes simples congênito, varicela congênita, etc.), comprometimento da irrigação sanguínea para a pele, trauma, bandas amnióticas e desordens cromossômicas (trissomia do 13) estão associados com as lesões. RELATO DO CASO: Paciente do sexo feminino, nascida de parto vaginal com 36 semanas e três dias, e peso adequado para a idade gestacional. Referenciada ao nosso serviço após sete dias de nascimento, constando ausência total do tegumento cutâneo em ambas as pernas, com acometimento de aproximadamente 17% da superfície corpórea, segundo a tabela de queimados de Lund e Browder. A má formação consistia na ausência total de pele e tecido celular subcutâneo. Face a extensão e localização da lesão, optou-se pelo tratamento por enxerto de pele parcial, permitindo, dessa forma, preencher a totalidade do defeito. CONCLUSÃO: Devido à raridade da ACC e ao pequeno número de pacientes nas séries publicadas na literatura, a padronização do tratamento ainda é incipiente e o que existe são recomendações. Ainda são necessários estudos que abordem desde a etiologia da doença até a avaliação dos métodos de tratamento.

INTRODUCTION Aplasia cutis congenita (ACC) is a rare disease characterized by the absence of a part of the skin at birth that may be either localized or widespread. The incidence of this disease is 0.1 per 100,000 births. It mainly involves the scalp alone in 60% of the cases. The causes are unclear; however, genetic factors, teratogens (alcohol, cocaine, marijuana, heroin, misoprostol, methimazole, carbimazole, congenital herpes simplex, congenital varicella, and others), impaired blood supply to the skin, trauma, and amniotic band and chromosomal disorders (trisomy 13) are associated with the wounds. CASE REPORT: A female patient was delivered vaginally at 36 weeks 3 days of gestation, with appropriate weight for the gestational age. She was referred to our service after 7 days of birth, presenting total absence of skin integument on both legs, with impairment of approximately 17% of the body surface according to the Lund and Browder chart. The malformation consisted of the total absence of skin and subcutaneous tissue. Given the extent and localization of the wound, treatment with a partial skin graft was elected, thereby filling the totality of the defect. CONCLUSION: Owing to the rarity of ACC and the small number of patients in the series published in the literature, standardization of treatment is still incipient. Currently, only recommendations are available. Further studies are needed in order to investigate the etiology of the disease and to evaluate treatment methods.

Retalho de Bernard-Webster para reconstrução do lábio inferior após exérese de carcinoma espinocelular: uma análise dos resultados funcionais / Use of Bernard-Webster flap for lower lip reconstruction after excision of squamous cell carcinoma: analysis of functional results

INTRODUÇÃO Defeitos dos lábios inferiores após exéreses de carcinoma espinocelular (CEC) vêm sendo reparados com inúmeras técnicas cirúrgicas. No entanto, a reconstrução funcional de defeitos de espessura total do lábio inferior continua a ser um desafio. O objetivo deste estudo, portanto, foi descrever as estratégias cirúrgicas para a reconstrução de defeitos de espessura total do lábio inferior, subsequentes a exéreses cirúrgicas de CEC, bem como avaliar resultados funcionais. MÉTODO: Trata-se de um estudo retrospectivo de todos os pacientes com defeitos de espessura total de lábio inferior após exérese de CEC maiores que um terço do lábio, reconstruídos com retalhos de Bernard-Webster, no período de 2011 a 2014. Os resultados funcionais (funções esfincteriana, motora e sensorial) foram avaliados de acordo com critérios previamente utilizados. RESULTADOS: Seis defeitos labiais foram reconstruídos com retalhos de Bernard-Webster, sem complicações. No período pós-operatório, os pacientes relataram incontinência para líquidos (16,67%), incontinência salivar intermitente (16,67%) e dificuldade para abrir a boca completamente (33,33%). Os testes revelaram déficits sensoriais nas regiões mentoniana (100%) e de lábio inferior (33,33%). Houve recuperação completa de todas as alterações funcionais, em média, três meses após as intervenções cirúrgicas. Os resultados funcionais tardios foram considerados satisfatórios. CCONCLUSÕES: O retalho de Bernard-Webster mostrou-se uma excelente alternativa para reparar defeitos que comprometem mais de um terço do lábio inferior, pois permitiu a utilização de tecidos vizinhos semelhantes, pôde ser realizado em tempo único e foi funcionalmente eficaz.

INTRODUCTION Defects in the lower lips after the excision of squamous cell carcinoma (SCC) are usually repaired using several surgical techniques. However, the functional reconstruction of full-thickness defects in the lower lip remains a challenge. Therefore, the objectives of this study were to describe surgical strategies for the reconstruction of full-thickness defects of the lower lip after surgical excision of the SCC and evaluate the functional results. METHODS: This was a retrospective study of all patients with full-thickness defects in the lower lip after excisions of SCC that were greater than one third of the lip that were repaired using the Bernard-Webster flap between 2011 and 2014. The functional results (sphincteric, motor and sensory function) were evaluated according to previously used criteria. RESULTS: Six lip defects were reconstructed without complications using Bernard-Webster flaps. During the postoperative period, the patients reported liquid incontinence (16.67%), intermittent salivary incontinence (16.67%), and difficulty fully opening the mouth (33.33%). The tests revealed sensory deficits in the labiomental areas (100%) and lower lip (33.33%). There was full recovery of all functional changes an average of 3 months after surgery. The observed late functional results were considered satisfactory. CONCLUSIONS: The Bernard-Webster flap was an excellent alternative to repairing the defects that affect more than one third of the lower lip since it allowed the use of similar local tissues, a single surgery could be performed, and the result was functionally efficient.

Utilidad de la hemiepifisiodesis en el manejo del Genu Valgo en la osteodistrofia renal / Usefulness of hemiepiphysiodesis for the management of Genu valgum in renal osteodystrophy

Introducción: La osteodistrofia renal provoca desejes progresivos en los miembros inferiores, siendo la deformidad más frecuente el genu valgo. El crecimiento guiado (hemiepifisiodesis) es útil en la corrección de deformidades angulares en la edad pediátrica. El objetivo de este trabajo es evaluar los resultados y complicaciones de esta técnica quirúrgica aplicada a fisis patológicas. Materiales y métodos: Se presentan 11 pacientes (20 rodillas) con diagnóstico de insuficiencia renal crónica y genu valgo, tratados en nuestro servicio con hemiepifisiodesis transitoria. Se colocaron placas en 8 en 3 pacientes (5 rodillas) y en 8 pacientes, grapas (15 rodillas). Se evaluó el eje mecánico radiográfico pre y post operatorio y las complicaciones relativas a cada implante. Resultados: Se logró la corrección completa en 4 pacientes, 1 caso sobrellevó deformidad rebote, y en los restantes se obtuvo mejoría sin llegar a la normalización óptima del eje mecánico. Conclusiones: La corrección obtenida se relaciona claramente con la normalidad de la función renal. Los pacientes trasplantados consiguieron normalización en el crecimiento óseo remanente. No tuvimos diferencia en los resultados ni en las complicaciones entre los dos tipos de implantes empleados.

Inclusion of calf implants for the correction of lower limb amyotrophy / Inclusão de implantes de panturrilha na correção das amiotrofias dos membros inferiores

BACKGROUND: Lower limb amyotrophy is a serious deformity that is often disabling and causes esthetic problems such as asymmetries and changes in the shape and contour of the legs. The present study evaluated the use of silicone implants for the correction of lower limb amyotrophy. METHODS: Women who underwent surgical correction of lower limb amyotrophy with silicone implants between 2002 and 2009 at the Plastic Surgery Service of Instituto Ivo Pitanguy at the 38th Nursing Service of Santa Casa da Misericórdia, Rio de Janeiro and at their associated services were retrospectively reviewed. RESULTS: Five cases were studied and the results were retrospectively assessed. Follow-up ranged from 3 months to 2 years after surgery until the last postoperative visit. In 4 of 5 patients, the desired result was obtained after a single surgical procedure, and no patient developed capsular contracture, compartment syndrome, circulatory disorders, neurological disorders, or infections. CONCLUSIONS: Calf augmentation in patients with lower limb amyotrophy did not correct the associated functional deficit, but resulted in a high level of satisfaction with regard to the esthetic improvement of the limb, thus improving the quality of life of these patients.

INTRODUÇÃO: As amiotrofias dos membros inferiores são deformidades por vezes incapacitantes, mas que trazem aos pacientes problemas estéticos, como assimetrias e alterações da forma e contorno das pernas. Este estudo teve como objetivo avaliar a aplicabilidade do uso de implantes de silicone para correção de amiotrofias de membros inferiores. MÉTODO: Estudo retrospectivo de pacientes, todas do sexo feminino, submetidas a correção cirúrgica de amiotrofia de pernas com a utilização de implantes de silicone, entre 2002 e 2009, no Serviço de Cirurgia Plástica do Instituto Ivo Pitanguy, na 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro e em serviços associados. RESULTADOS: Foram analisados 5 casos. A maioria dos resultados foi avaliada de maneira retrospectiva. O tempo de acompanhamento variou de 3 meses a 2 anos, desde a cirurgia até a última consulta pós-operatória. Do total de pacientes, 4 apresentaram resultado desejado em apenas um procedimento cirúrgico e nenhuma paciente apresentou contratura capsular, síndrome compartimental, alterações circulatórias, alterações neurológicas ou infecção. CONCLUSÕES: O aumento das panturrilhas em pacientes portadoras de amiotrofias de membros inferiores não proporcionou modificações no tocante ao deficit funcional prévio. Todavia, essas pacientes, geralmente bastante castigadas pela doença de base, apresentam índice de satisfação muito elevado com a melhoria estética do membro, otimizando, dessa forma, a qualidade de vida dessas pacientes.

Limb Angular Deformity Correction Using Dyna-ATC: Surgical Technique, Calculation Method, and Clinical Outcome

PURPOSE: Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. MATERIALS AND METHODS: The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). RESULTS: All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0degrees on tibiae and 10.0degrees on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. CONCLUSION: We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.

Comparación entre resultados obtenidos en la corrección de valgo tibial proximal en pacientes pediátricos con sistema de grapas y sistema de placas en el Hospital Ortopédico Infantil Caracas Venezuela 2000-2007 / Comparison of results obtained in the proximal tibial valgus correction in pediatric patients with staple system and system of plaques in the Hospital Ortopédico Infantil 2000-2007 Caracas Venezuela

Las deformidades axiales de los miembros inferiores, motivo de consulta habitual, no corregen espontáneamente si son persitentes y sginificativas. La epifisiodesis produce la corrección grudual de la deformidad en un procedimiento mínimamente invasivo, en pacientes esqueléticamente inmaduros, en genu valgum y varum, con grapas o placas y tornillos. Según las observaciones clínicas, las placas permiten un mejor resultado en tiempo más corto, menor daño a la fisis y menos riesgo de complicaciones o falla de material en comparación con las grapas. La comparación de las técnicas en engrapado y placa en la resolución de deformidades en valgo de tibia proximal en los pacientes pediátricos en el Hospital Ortopédico Infantil, durante el periodo 2000 al 2007. Estudio retrospectivo simple y comparativo, se evaluaron 36 pacientes de ambos sexos con el diagnostico de Valgo Proximal Tibial, idiopáticos o asociados a otras patologías, que fueron tratados en el Hospital Ortopédico Infantil durante 2000 al 2007 con las técnicas de grapa y placa, mediante revisión de controles pre y postoperatorios de la historia clínica, y por medición radiológica de los ángulos FDLm, TPMm y MAD en radiogrfías panorámicas pre y postoperatorias. Se estudiaron 36 pacientes de ambos sexos, (16 varones y 20 niñas), promedio de edad de 10 años +/- 3,3 años. Existen similitudes en los primeros 12 meses en esta muestra, pero a partir de ese momento la Placa alcanza los valores de corrección antes que las grapas. Según la pendiente Y, la placa se proyecta para correcciones de 6,62 mm cada 6 meses, en cambio la grapa se proyecta para correciones de 5,72 mm cada 6 meses. Los valores del ángulo se estabilizan con la placa, y en cuanto a la grapa, se continúa la corrección en sentido contrario. La pendiente Y indica que la placa corrige -1,95º cada 6 meses, y la grapa corrige -2,95º cada 6 meses hacia el varo. Según la prueba ANOVA, combinando las variables Tiempo-Material, la placa alcanza....

The axial deformities of the lower limbs, common reason for consulation, will not correct spontaneously if they are persistent and significant. Epiphysiodesis produce gradual correction of deformity in a minimally invasive procedure in skeletally immature patients in valgum and genu varum with staples or plates and screws. According to clinical observations, the plates allow a better result in shorter time, less damage to the physis and less risk of complications or failure of material compared with the staples. Comparison of stapling techniques and plaque in the resolution of valgus deformity of proximal tibian in pediatric patients at Children's Orthopedic Hospital during the period 2000 to 2007. A retrospective and comparative simple, we evaluated 36 patients of both sexes with a diagnosis of Proximal Tibial Valgus, idiopathic or associated with other diseases, which were treated at the Children's Orthopedic Hospital during the period 2000 to 2007 with the techniques staple and plate by reviewing pre-and postoperative checks of medical record, and radiological measurements of the angeles FDLm, TPMm, and MAD in pre-and postoperative panoramic radiographs. We studied 36 patients of both sexes (16 boys and 20 girls), mean age 10 +/- 3,3 years. There are similarities in the first 12 months in this sample, but from that moment on the plate reaches the values of correction rather than staples. According to the slope and The plate is projected to corrections from 6,62 mm every 6 months, however the clip is projected to corrections of 5,72 mm every 6 months. The angle values are e¡stabilized with the plate, and as for the clip, continue the correction in the opposite direction. The slope indicates that the board and fixes -1,95º every six months, and the clip fixes -2,95º every six months into varus. According to the ANOVA test, combining the time-material variables, the plate reaches the expected correction before on the staple, the period aroun 12 months would.....

Congenital anterior tibiofemoral subluxation

Congenital anterior tibiofemoral subluxation is an extremely rare disorder. All reported cases accompanied by other abnormalities and syndromes. A 16-year-old high school girl referred to us with bilateral anterior tibiofemoral subluxation as the knees were extended and reduced at more than 30 degrees flexion. Deformities were due to tightness of the iliotibial band and biceps femuris muscles and corrected by surgical release. Associated disorders included bilateral anterior shoulders dislocation, short metacarpals and metatarsals, and right calcaneuvalgus deformity

Alteraciones de las extremidades inferiores en el síndrome de Prune-Belly / Alterations of the lower extremities in the Prune-Belly syndrome

El síndrome de Prune-Belly es una rara condición congénita de causa desconocida, que fue descrita por primera vez en 1839. Tiene una prevalencia de 20:1 en hombres versus mujeres, situación probablemente debida a un defecto superficial en el cromosoma X. Se caracteriza por: 1) ausencia de la pared abdominal en forma completa o parcial. 2) criptorquidia y 3) anomalías del tracto urinario. A veces, también está asociado a algunas anomalías ortopédicas debidas a la presencia de oligohidroamnios, pero raramente ocurren anormalidades de las extremidades inferiores. El pronóstico es malo sólo un 20 por ciento sobreviven al parto y un 50 por ciento muere dentro de los primeros 5 años de vida principalmente debido a las consecuencias de falla renal.Reportamos el caso de un niño con síndrome de Prune-Belly con una amputación congénita de una de sus extremidades inferiores que fue manejada con punción vesical en el período antenatal.