Tratamiento con soportes plantares en la enfermedad de Müller-Weiss. Reporte preliminar / Treatment with plantar supports in Müller-Weiss disease. Preliminary report

Resumen: El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.

Abstract: The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.

Eficacia del bloqueo poplíteo por vía lateral / Effectiveness of the blockade popliteal for via lateral

Introducción: Los bloqueos nerviosos periféricos son un componente aceptado en la práctica médica desde el área quirúrgica, el control del dolor crónico y el posoperatorio. Objetivo: Evaluar la eficacia del bloqueo poplíteo por vía lateral en los pacientes intervenidos por afecciones en el pie y tobillo. Métodos: Se realizó un estudio analítico transversal en los pacientes intervenidos por afecciones en el pie y tobillo en el período de septiembre 2015 a septiembre 2018. Se constituyó el universo con 431 pacientes y la muestra por 209. Resultados: Más de las tres cuartas partes de los pacientes intervenidos por afecciones del pie y del tobillo a los que se les aplica el bloqueo se encuentran por encima de la quinta década de la vida. La mayor parte de ellos corresponden al rango de 51 Kg a los 70 Kg, con cuatro a seis cm de profundidad de la aguja para la localización del nervio basado en la ecuación de la recta. Es 19 veces más probable en ellos la ausencia de dolor en las primeras seis horas del posoperatorio después del bloqueo y más probable el éxito de la técnica propuesta con la determinación de la profundidad en cm de la aguja basado en la ecuación de la recta, con odds ratio de 31. Conclusiones: Se evaluó de eficaz el bloqueo poplíteo por vía lateral en la mayor parte de pacientes intervenidos por afecciones en el pie y tobillo(AU)

Background: the blockades nervous peripherals are a component accepted in the medical practice, from the surgical area, control of the chronic pain and postoperatory. Objective: to evaluate the effectiveness of the blockade popliteal for via lateral in the patients intervened by affections in the foot and ankle. Methods: it was carried out a study transversal analytic of patients intervened by affections in the foot and ankle in the period from September 2015 to September 2018. The universe was constituted with 431 patients and the sample by 209. Results: more than the fourth three parts of the patients intervened by affections of the foot and of the ankle to those that are applied the blockade popliteal for via lateral they are above the fifth decade of the life. Most of the patients belong together to the range from 51 to the 70 Kgs with four to six cm of depth based on the equation of the straight line. It is more probable 19 times in the patients the pain absence in the first six hours of the post operatory after the blockade and more probable the success of the technique proposal with the determination of the depth in cm of the needle based before on the equation of the straight line described with odds ratio of 31. Conclusions: the evaluation of the effectiveness of the blockade popliteal for via lateral increases the anesthesiologist's therapeutic arsenal and it redounds in benefits for the patient during the perioperatorio, the application of this technique in appropriate clinical situations adds alternative valuable to the anesthetic attendance(AU)

Melioidosis en Colombia, descripción de un caso clínico y consideraciones epidemiológicas / Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Resumen La melioidosis es una enfermedad infecciosa causada por Burkholderia pseudomallei cuyo diagnóstico clínico puede ser difícil debido a su variada presentación clínica y a las dificultades del diagnóstico microbiológico, por lo cual pueden requerirse técnicas moleculares para su adecuada identificación una vez se sospecha su presencia. Son pocos los antibióticos disponibles para el tratamiento de esta enfermedad y, además, deben usarse durante un tiempo prolongado. Aunque se conoce por ser endémica en Tailandia, Malasia, Singapur, Vietnam y Australia, en Colombia se han reportado algunos pocos casos. Se presenta un caso de melioidosis en la región norte de Colombia, se hace una revisión de las características clínicas y el tratamiento, y se describe la epidemiología local de esta enfermedad.

Abstract Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.

Unusual size, topography, and surgical resolution of an acquired fibrokeratoma

Abstract: Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.

Hallux rigidus: artropatía degenerativa metatarsofalángica del primer radio. Propuesta terapéutica. Osteotomías de Watermann-Diebold más Akin modificadas / Hallux rigidus: metatarsophalangeal degenerative arthropathy of the first ray. Watermann-Diebold osteotomy + Akin Osteotomy modified

El hallux rigidus es una afección de la articulación metatarsofalángica (MTF) del primer radio con limitación de la dorsiflexión, que evoluciona hacia la artrosis y la disfunción global del antepié. Frecuentemente afecta a población adulta joven y deportista. En la presente evaluación, proponemos como objetivo exponer los resultados a corto y mediano plazo del tratamiento en estadíos I y II combinando una doble osteotomía: distal metatarsiana (Watermann-Diebold), que libera el bloqueo dorsal y de la falange proximal del hallux (Akin de acortamiento), que descomprime axialmente el radio sin crear una insuficiencia de propulsión, posibilitando el retorno deportivo. Materiales y métodos: Se utilizó la clasificación clínico-radiológica de Regnauld para estatificar la enfermedad. Se tallo osteotomía distal metatarsiana a cuña sustractiva dorsal (Watermann-Diebold) combinada con una osteotomía proximal de la primera falange (Akin de acortamiento), fijadas con tornillos canulados de doble rosca. Se hicieron controles radiográficos en el postoperatorio inmediato, a las tres, seis y doce semanas y al año. La evaluación funcional se basó en el score AOFAS aplicado a las articulaciones metatarsofalángica e interfalángica del hallux. Resultados: Se evaluaron a 8 pacientes deportistas recreacionales tratados entre abril de 2009 y febrero de 2011, con un seguimiento entre 7 y 29 meses. La edad media fue de 42 años (entre 33 y 55 años), 5 mujeres y 3 varones. Los deportes que practicaban eran futbol en el caso de los varones y corredores de fondo y medio fondo las mujeres. De los 8 pacientes, 3 fueron clasificados como grado I, y 5 como grado II. El score AOFAS preoperatorio fue de 65 puntos y el postoperatorio de 78.80. Con una p= 0.001 y un intervalo de confianza 95 por ciento (9.17 - 21.07). Traducido clínicamente en una moderada recuperación en la excursión articular y reducción del dolor. Todos se reintegraron a la actividad deportiva. Conclusión: Si bien es una serie pequeña, la combinación de las osteotomías de Watermann-Diebold y Akin para pacientes adultos jóvenes deportistas en estadíos I y II Regnauld, descarga axialmente el primer rayo, disminuye el bloqueo dorsal mejorando la movilidad, alivia el dolor y permite la reincorporación a la práctica deportiva

Objective evaluation of plantar hyperhidrosis after sympathectomy

OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

Linfangioma microcístico acral: diagnóstico diferencial em lesões verrucosas de extremidades / Acral microcystic lymphangioma: differential diagnosis in verrucous lesions of the extremities

Linfangioma é uma má-formação originária da migração anormal de tecido linfático, levando a falhas na comunicação e na drenagem da linfa. Apresenta-se mais comumente como vésico-pápulas agrupadas de conteúdo translúcido na pele ou mucosas. A apresentação inicial na forma de placa verrucosa limitada a um único pododáctilo é atípica e reforça a relevância deste relato. Ainda que considerado lesão benigna, o linfangioma, a depender de sua localização e dimensão, pode apresentar dor local ou infecções recorrentes, com interferência substancial na qualidade de vida. Relatamos caso de linfangioma circunscrito a pododáctilo de surgimento tardio na idade adulta, na forma de placa verrucosa - apresentação atípica confirmada apenas após histopatológico. A excisão cirúrgica garantiu resposta estética e funcional satisfatória.

Lymphangiomas are a malformation caused by the abnormal migration of lymphatic tissue, leading to failures in the communication and drainage of the lymphatic system. They usually present as groups of translucent papules and vesicles in the skin or mucous membranes. Presentation as a verrucous plaque limited to a single toe is unusual and emphasizes the relevance of this case report. Although considered a benign lesion, depending on the site affected by the lymphangioma and its size, it may lead to localized pain or recurrent infections, substantially affecting the patient's quality of life. The present case report describes a patient with lymphangioma of late onset developing in adulthood in the form of a verrucous plaque confined to a single toe. Diagnosis of this unusual presentation could only be confirmed following histopathology. Surgical excision resulted in a satisfactory functional and cosmetic outcome.

Reconstrucción de partes blandas de la planta del pie: retrospective analysis of 12 patients / Soft tissue reconstruction of the sole: retrospective analysis of 12 patients

Background: An adequate reconstruction of foot soft tissue, specially in the sole, is crucial to restore functional capacity. Aim: To report the experience with reconstruction of sole soft tissues. Material and Methods: Retrospective analysis of 12 patients aged 19 to 72 years (seven males), subjected to reconstruction of soft tissue defects in the sole. Results: The lesions were secondary to excisions of malignant melanomas in seven patients, old traumatisms in two patients, a burn lesion in one patient and a diabetic ulcer in one patient. The reconstruction techniques used were skin grafts in one patient, local flaps in eight and free flaps in three patients. Five patients experienced complications and one of these required a new reconstructive surgery. Functional recovery was adequate in 11 patients. Conclusions: Reconstructive surgery of the sole can achieve an adequate functional recovery in most operated patients.

Se presenta una casuística de 12 pacientes que requirieron reconstrucción de la planta del pie en el Hospital de la Universidad Católica entre los años 2005 y 2008. La etiología principal fueron lesiones tumorales en 7 casos; las técnicas de reconstrucción fueron: injerto de piel (1 paciente), colgajos locales (8 pacientes) y colgajos libres (3 pacientes). Hubo complicaciones en 5 pacientes, uno de los cuales requirió una nueva cirugía reconstructiva. La recuperación funcional fue adecuada en 11 de los 12 pacientes.

Soft Tissue Reconstruction of the Foot Using the Distally Based Island Pedicle Flap after Resection of Malignant Melanoma

BACKGROUND: We report on our experience with using a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients. METHODS: A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and a lateral supramalleolar flap was used for 3 cases for the lateral arch reconstruction of the mid- and forefoot after wide excision of malignant melanomas. RESULTS: The length of the flap varied from 7.5 cm to 12 cm (mean, 9.6 cm) and the width varied from 6.5 cm to 12 cm (mean, 8.8 cm). Superficial necrosis developed in four flaps, but this was successfully treated by debridement and suture or a skin graft. All thirteen flaps survived completely and they provided good contour, stable and durable coverage for normal weight bearing. CONCLUSIONS: The distally based sural flap is considered to be useful for reconstructing the hindfoot, and the lateral supramalleolar flap is good for reconstructing the lateral archs of the mid- and forefoot after resection of malignant melanoma of the foot.

Hamartoma fibroso de la infancia: informe de un caso / Fibrous hamartoma of infancy: case report

Introducción: El hamartoma fibroso de la infancia es una proliferación benigna de los tejidos blandos, de presentación infrecuente; 91 % de los casos ocurre durante el primer año de edad y afecta más frecuentemente al sexo masculino. Se caracteriza por ser una lesión subcutánea de morfología característica con patrón de crecimiento organoide trifásico. Caso clínico: Lactante masculino de seis meses de edad, con tumor en la región plantar medial del pie izquierdo, el cual fue resecado completamente. En el estudio histopatológico se informó como hamartoma fibroso de la infancia. Conclusiones: Puede localizarse en cualquier sitio anatómico, aunque 5 a 10 % afecta las extremidades inferiores existen pocos casos informados en el pie. En biopsias pequeñas es importante su diagnóstico diferencial con otras lesiones fibroadiposas para el adecuado tratamiento. La resección quirúrgica amplia con márgenes libres de lesión confiere un buen pronóstico a los pacientes.

BACKGROUND: Fibrous hamartoma of infancy (FHI) is an infrequent benign proliferation of the soft tissues. Ninety one percent of cases occur during the first year of life. FHI is characterized as a subcutaneous lesion with characteristic morphology with a triphasic organoid growth pattern. CLINICAL CASE: We present the case of a 6-month-old male infant with a tumor in the medial plantar region of the left foot, which was completely withered. Histopathological study reported a fibrous hamartoma of infancy. CONCLUSIONS: Fibrous hamartoma of infancy most frequently affects males. It may be localized at any anatomic site, although 5-10% of cases affect the lower limbs. Few cases are reported in the foot. This is a lesion with a characteristic morphological pattern; however, in small biopsies, its differential diagnosis is important with other fibroadipose lesions for appropriate treatment. Ample surgical resection with lesion-free borders confers a good prognosis for these patients.

Nuestra experiencia en el tratamiento de la fascitis plantar con tecnica percutanea / Our experience in the treatment of plantar fasciitis with percutaneous technique

Este trabajo pretende mostrar nuestra experiencia en el tratamiento quirúrgico percutáneo de la fascitis plantar con resección del espolón calcáneo y evaluar la eficacia del procedimiento teniendo en cuenta la evolución clínica, radiológica y fundamentalmente la satisfacción del paciente con esta metodología. Se trata de un estudio retrospectivo que incluye 19 pacientes operados entre abril de 2002 y octubre de 2004 cuya sintomatología principal es el dolor en la inserción proximal de la fascia plantar y la presencia del espolón calcáneo objetivado por Rx. Todos fueron previamente tratados con medidas conservadoras por un lapso no menor a 6 meses sin respuesta satisfactoria. Se utilizó un cuestionario para valorar la satisfacción del paciente sometido a esta técnica, descripto por Benton-Weil y colaboradores, obteniéndose un resultado altamente positivo.

Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Tratamento do neuroma de Morton via plantar: avaliação retrospectiva dos resultados cirúrgicos / Norton's neuroma treatment through plantar port: retrospective assessment of surgical outcomes

Com a finalidade de avaliar a eficácia da técnica cirúrgica, envolvendo a neurectomia por via plantar, transversa, fora da zona de carga, em portadores de neuroma de Morton, 217 pacientes foram submetidos a este tratamento.Um total de 264 pés foram observados, sendo 32,2 por cento no pé direito, 46,1 por cento no pé esquerdo e 21,7 por cento bilateralmente.Quanto ao sexo, foram observadas ocorrências de 86,6 por cento no sexo feminino e 13,4 por cento masculino.Quanto a localização, 83,5 por cento (220 neuromas) estavam presentes no terceiro espaço interdigital, 7,5 por cento no segundo espaço, com presença de bilateralidade em 47 pacientes.O tempo médio de acompanhamento foi de 7,5 anos, variando de 4 a 216 meses, com resultado satisfatório e regulares em 95,8 por cento dos pacientes no total, com apenas 11 pacientes (4,2 por cento) insatisfeitos com o tratamento de forma global.Os autores concluem, por tanto, que a neurectomia por via plantar transversa é uma opção satisfatória, com boa visibilização anatômica do neuroma, evoluindo com boa cicatrização, retorno precoce às atividades e satisfação do paciente com o resultado alcançado.

With the objective of assessing the effectiveness of the surgical technique involving neurectomy through plantar, cross-sectional port out of the load zone in individuals with MortonÆs neuroma, 217 patients were submitted to this treatment. A total of 264 feet were observed, being 32.2 percent right feet, 46.1 percent left feet, and 21.7 percent bilaterally. Regarding gender, 86.6 percent of the occurrences were seen in women, and 13.4 percent in men. Regarding the site, 83.5 percent (220 neuromas) were present at the third interdigital space, 7.5 percent at the second space, and 47 patients presented it bilaterally. The average follow-up time was 7.5 years, ranging from 4 to 216 months, with satisfactory and fair outcomes in 95.8 percent of all patients, with only 11 patients (4.2 percent) not satisfied with the overall treatment. The authors conclude, therefore, that neurectomy through cross-sectional plantar port is a satisfactory option, with good anatomical view of the neuroma, evolving well to healing, early return to activities and patient satisfaction with the outcome achieved.

Transferencia de tibial posterior con procedimiento de "Bridle" modificado en pie paralítico fláccido / Posterior tibial transfer with modified

El pie paralítico fláccido tiene como deformidades más frecuentes el equino, varo y marcha en "steppage". Existen múltiples tratamientos quirúrgicos. Recientemente, Rodríguez describe una modificación del procedimiento de "Bridle", en el cual el tibial posterior es transferido al dorso del pie, con inserción ósea en la cuña media y tenodesado con el peroneo longus y el tibial anterior, a modo de "rienda" balanceada con tracción en tres puntos. Objetivos: Evaluar el resultado funcional de pacientes con pie paralítico fláccido flexible y semiflexible operados con procedimiento de "Bridle" modificado. Material y método: Evaluación retrospectiva de pacientes con pie paralítico fláccido tratados con técnica de "Bridle" modificado en el Hospital Clínico PUC entre agosto/2000 y abril/2004. Resultados:6 pacientes, 4 hombres y 2 mujeres, con 6 pies operados. Edad promedio de 27,6 (18-37) años. Seguimiento promedio de 26 meses. AOFAS pre/post cirugía: 32/76. Satisfacción completa en todos los pacientes (escala Kenneth-Johnson). Cinco pacientes regresaron a trabajar. Retorno parcial a actividad deportiva en 3 de 4 pacientes. Complicaciones locales en 1 caso; sin complicaciones sistémicas. Conclusión: existen pocas publicaciones sobre este procedimiento; nuestros resultados son comparables con la literatura. El procedimiento de "Bridle" modificado permite obtener un pie funcional, estable y plantígrado, con satisfacción completa en todos los pacientes.

Hipofosfatemia revertida al extirpar hemangioendotelioma compuesto del dedo mayor del pie / Reversion of hypophosphatemia after the excision of a composite hemangioendothelioma in the great toe

We report a 43 years old male admitted to the hospital for progressive lumbar pain, lasting 20 years, that caused severe disability. On admission the patient had a serum phosphate of 2 mg/dl, an urine phosphate excretion over 300 mg/dl and serum alkaline phosphatases over 750 U/L. Serum intact parathormone was normal and tubular maximum phosphorus/glomerular filtration was 0.7 mg/dl. Bone scintigraphy showed an increased radionuclide uptake in condro-costal joints. Bone densitometry showed femoral osteoporosis. A violet colored mass was detected in a great toe. It was removed and the pathological diagnosis was a composite hemangioendothelioma. After tumor excision, serum phosphate levels returned to normal values and symptoms disappeared within 15 days.