Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for esophago-gastric replacement due to esophago-gastric necrosis after caustic ingestion / Faringo-íleo-colo-anastomose com suprimento sanguíneo microvascular para substituição esofagogástrica por necrose esofagogástrica após ingestão cáustica

ABSTRACT Background : Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit. Aim : To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis Method: The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction. Result: This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life . The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished. Conclusion: The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.

RESUMO Racional: A necrose esofagogástrica completa após ingestão cáustica é um cenário cirúrgico desafiador para a reconstrução do trânsito digestivo alto. Objetivo: Apresentar uma técnica cirúrgica para reconstrução do trato digestivo superior após esofagectomia total e gastrectomia por necrose esofágica e gástrica. Método: O trânsito foi restabelecido por interposição faringo-íleo-cólica com anastomose arterial e venosa microcirúrgica com aumento do suprimento sanguíneo. Adicionalmente, anastomose colo-duodeno-anastomótica e íleo-transversa foram realizadas para reconstrução completa do trânsito digestivo. Resultado: Este procedimento foi aplicado em um homem de 41 anos com tentativa de suicídio pela ingestão de líquido cáustico alcalino (hidróxido de sódio concentrado). Ocorreu necrose total do esôfago e do estômago, o que exigiu inicialmente esofagogastrectomia total, fechamento ao nível do esfíncter cricofaríngeo e jejunostomia para alimentação enteral produzindo qualidade de vida altamente deteriorada. O procedimento foi realizado mais tardiamente e não houve maiores complicações pós-operatórias precoces e tardias e condições nutricionais normais foram restabelecidas. Conclusão: O procedimento é viável e deve ser manejado por equipe multidisciplinar a fim de restabelecer a qualidade de vida normal.

Zetaplastia na retração axilar: técnica e tática para facilitar o aprendizado dos residentes / Z-plasty in axillary retraction: techniques and strategies to facilitate learning by medical residents

Introdução: São apresentados dois casos de retração em região axilar após queimadura em que a correção cirúrgica foi realizada empregando-se zetaplastias múltiplas. Apresentamos uma tática de marcação que visa facilitar o aprendizado desse procedimento pelos residentes de Cirurgia Plástica. Métodos: Dois pacientes com retrações axilares e de membros superiores após queimadura com líquido aquecido foram submetidos à correção cirúrgica empregando-se a zetaplastia múltipla. A tática de planejamento proposta nesse estudo preconiza primeiro a marcação do retalho triangular localizado no ponto médio da retração axilar, o qual irá avançar e cruzar o eixo da cicatriz, e a partir daí o desenho dos retalhos subsequentes com ângulo de 60° entre si. Acreditamos que essa sistematização da marcação facilita o planejamento e aprendizado da plástica em Z. Resultados: Os pacientes apresentaram adequadas amplitude de movimento e recuperação funcional do membro acometido no pós-operatório. Não houve necrose das extremidades dos retalhos, que preconizamos serem cuidadosamente trabalhadas e um pouco arredondadas; e a execução do procedimento foi simples devido à tática de marcação que aplicamos. Conclusão: A tática de marcação que apresentamos é reprodutível e de fácil aprendizado. A zetaplastia múltipla foi eficaz em restabelecer a amplitude de movimento das áreas com sequela de queimadura tratadas com esse método.

Introduction: Herein, we present two cases of post-burn retraction of the axillary region, which were subsequently surgically corrected using multiple Z-plasties. We present a marking strategy to facilitate the learning of this procedure by plastic surgery residents. Methods: Two patients with axillary and upper limb retractions due to burns with hot liquids were surgically treated using multiple Z-plasties. The strategy proposed in this study recommends the marking of the triangular flap located at the midpoint of the axillary retraction, which then advances and crosses the axis of the scar. Then, subsequent flaps are made at an angle of 60° to each other. We believe that this systematization of marking facilitates the planning and learning of Z-plasty. Results: The study patients achieved an adequate range of motion and functional recovery of the affected limb postoperatively. We observed no cases of necrosis of the flap ends, which should be carefully worked and slightly rounded. The execution of the procedure was simple using the suggested marking strategy. Conclusion: The presented marking strategy was reproducible and easy to learn. Multiple Z-plasties were effective in restoring the range of motion of the areas affected by burns that were treated using this method.

Lipoenxertia subcicatricial associada à rigottomy: uma análise clínica e microestrutural / Subcicatricial fat grafting associated with rigotomy: a clinical and microstructural analysis

INTRODUÇÃO: O aumento da sobrevida na fase aguda do paciente grande queimado faz também aumentar a prevalência das sequelas cicatriciais estético-funcionais. Ao pensarmos na relevância clínica da lipoenxertia subcicatricial, necessita-se da compreensão e avaliação microscópica das reais alterações após o procedimento. MÉTODOS: Foram selecionados oito pacientes, vítimas de queimadura por álcool, com tempo médio após queimadura de 12 meses (10-14 meses), sendo submetidos à lipoenxertia subcicatricial associada à Rigottomy. Foram realizadas biópsias cutâneas no pré e pós-operatório tardio com 14 semanas. Avaliados os quesitos: 1 - Melhora estético funcional da cicatriz pela escala de Vancouver; 2 - Análise quantitativa e qualitativa do colágeno cicatricial; 3 -Análise imunohistoquímica da vascularização cicatricial com anti-fator de crescimento derivado do endotélio vascular (antiVEGE). RESULTADOS: Ao compararmos o período pré e pós-lipoenxertia, pôde-se avaliar que houve melhora estético-funcional significativa e, microscopicamente, redefinição entre os limites da derme papilar e reticular; redução quantitativa e reorganização do colágeno, além do decréscimo da vascularização tecidual pela análise imunohistoquímica. CONCLUSÃO: O princípio básico de todo processo cicatricial fisiológico é reestabelecer a homeostasia local, ou seja, as etapas exageradamente intensificadas levam a alterações clínicas catastróficas. Ao realizar a lipoenxertia subcicatricial associada à Rigotomia, foi verificada, neste estudo, a melhora qualitativa e quantitativa do tecido. Sendo assim, torna-se evidente o futuro promissor deste procedimento para a complementação terapêutica das patologias cicatriciais.

INTRODUCTION: The increase in survival of large burn patients during the acute phase has also increased the prevalence of esthetic-functional scarring sequelae. With regard to the clinical relevance of subcicatricial fat grafting, the actual changes after the procedure need to be understood and microscopically evaluated. METHODS: Eight patients with alcohol burns, with an average time after burn of 12 months (10-14 months), who underwent subcicatricial fat grafting associated with rigotomy were selected. Skin biopsies were performed in before and 14 weeks after operation. The following issues were assessed: 1) esthetic-functional improvement of the scar, by using the Vancouver scar scale; 2) quantitative and qualitative analyses of cicatricial collagen; 3) immunohistochemical analysis of scar vascularization with anti-vascular endothelial growth factor (anti-VEGF) antibody. RESULTS: When comparing the pre- and post-fat grafting period, a significant esthetic-functional improvement and, microscopically, a redefinition of the boundaries of the papillary and reticular dermis were observed, as well as quantitative reduction and reorganization of collagen, in addition to the decrease of the vascularization of the tissue through immunohistochemical analysis. CONCLUSION: The basic principle of the whole physiological healing process is to reestablish local homeostasis, that is, excessively intensified steps that lead to severe clinical changes. When subcicatricial fat grafting associated with rigotomy was performed, qualitative and quantitative improvements of the tissue were verified in this study. Thus, it becomes evident that this procedure can complement the treatment of cicatricial pathologies.

Unidade de Tratamento de Queimaduras da Universidade Federal de São Paulo: estudo epidemiológico / Burn Care Unit of São Paulo Federal University: an epidemiological profile

INTRODUÇÃO: As queimaduras são traumas graves, que geram 100 mil atendimentos hospitalares por ano, no Brasil. As Unidades de Queimados são fundamentais para o tratamento desses pacientes e a produção de conhecimento sobre o tema. MÉTODO: O estudo estabeleceu o perfil de atendimento em cada ano de funcionamento da unidade no período de 2009 a 2012, e comparou, entre esses anos, a quantidade de pacientes internados, a procedência, os graus de queimadura, a idade, a superfície corporal queimada, os dias de internação, os tipos de procedimentos cirúrgicos, os agentes e a mortalidade. Para avaliação das possíveis associações, foi utilizado o teste do Qui-quadrado. RESULTADOS: Foram internados 321 pacientes. Em 2009, 70% dos pacientes apresentavam queimadura de II grau e, em 2012, 66% dos pacientes tinham queimadura de III grau. Em 2009, 37% vieram referenciados de outros serviços, e em 2012, 72%. A idade média dos pacientes foi de 29 anos em 2009 e 44 anos, em 2012. A superfície corporal queimada no início era de 13%, e em 2012, foi 8%. O tempo de internação subiu de 11 para 21 dias. Em 2009, realizaram-se 50 procedimentos cirúrgicos. Em 2012, foram 103. O agente causal mais encontrado foram os líquidos inflamáveis e a mortalidade global caiu de 7% para 4%, ao longo dos anos. CONCLUSÃO: Houve um aumento na quantidade de pacientes referenciados e complexos, com queimaduras de maior grau, exigindo mais procedimentos e maior hospitalização, ao longo dos anos. A taxa de mortalidade diminuiu, refletindo melhora técnica da Unidade, que se estabeleceu como referência regional no tratamento de queimados.

INTRODUCTION: Burns constitute severe trauma and account for 100,000 hospital visits per year in Brazil. Burns units are essential for the treatment of these patients and the generation of knowledge on this subject. METHOD: This study established the annual profile of burn unit attendance between 2009 and 2012. During these years of activity, we compared the number of hospitalized patients, patient origin, burn degree, age, burn body surface area, days of hospitalization, types of surgical procedures, agents, and mortality. Possible combinations were evaluated with the chi-square test. RESULTS: A total of 321 patients were hospitalized. In 2009, 70% of the patients presented secon-degree burns; in 2012, 66% of the patients presented third-degree burns. In 2009, 37% of the patients were referred to other services; in 2012, 72% were referred. The average patient age was 29 years old in 2009 and 44 years old in 2012. Burn body surface was 13% in 2009 and 8% in 2012. Hospitalization time increased from 11 to 21 days. A total of 50 surgical procedures were performed in 2009, while 103 were performed in 2012. Flammable liquids were the most commonly observed causal agents. The overall mortality rate decreased from 7% to 4% over the study period. CONCLUSION: There was an increase in the number of referred and complex patients with higher degree burns who required longer hospital stays and a greater number of procedures over the years. The decreased mortality rate reflected the technical improvement of the unit that was established as a regional reference for the treatment of burn victims.

Transplante de membrana amniótica em casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson / Amniotic membrane transplantation for severe acute cases of chemical ocular burn and Stevens-Johnson syndrome

OBJETIVO: Investigar o potencial terapêutico do transplante de membrana amniótica nos casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson. MÉTODOS: Foram analisados retrospectivamente os prontuários de oito pacientes, com um total de dez olhos, submetidos a transplante de membrana amniótica para tratamento de queimadura ocular química e síndrome de Stevens-Johnson na fase aguda entre janeiro de 1999 e maio de 2008 no Departamento de Oftalmologia da UNIFESP. Dados referentes a sexo, idade, grau da queimadura, etiologia, olho acometido, achados oftalmológicos, extensão da membrana amniótica, operações adicionais, tempo em dias entre a lesão e a cirurgia, acuidade visual antes e depois da cirurgia, defeito epitelial em dias, complicações e tempo de seguimento em meses foram coletados. RESULTADOS: A idade média dos pacientes foi de 35,7 ± 23,04 anos, dos quais seis eram homens e dois eram mulheres. Três pacientes (quatro olhos) apresentaram síndrome de Stevens-Johnson e cinco pacientes (seis olhos) apresentaram queimadura ocular química. O defeito epitelial foi cicatrizado em média de 27,8 ± 4,7 dias (variando de 20 a 35 dias). Todos os pacientes evoluíram com deficiência límbica em seguimento médio de 7,8 ± 2,8 meses (variando entre cinco e doze meses) e quatro olhos desenvolveram simbléfaro. CONCLUSÕES: Os resultados sugerem que o transplante de membrana amniótica representa um aditivo que pode ser realizado nos casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson com a finalidade de promover a epitelização e suprimir a inflamação e suas consequências, se comparado a outros trabalhos que trataram casos semelhantes com terapia medicamentosa somente. Por outro lado, não é capaz de evitar a deficiência límbica nesses casos, que futuramente necessitarão de transplante de células-tronco do limbo ou outras cirurgias para correção da superfície ocular.

PURPOSE: To study the therapeutic potential of amniotic membrane transplantation in cases of severe acute chemical ocular burn and Stevens-Johnson syndrome. METHODS: We retrospectively reviewed the records of eight patients, with a total of ten eyes, submitted to amniotic membrane transplantation for treatment of ocular chemical burns and Stevens-Johnson syndrome in the acute phase between January 1999 and May 2008 in the Ophthalmology Department of UNIFESP. Data relating to sex, age, degree of chemical burns, etiology, affected eye, ophthalmological findings, extension of amniotic membrane, surgeries, additional time between the injury and surgery in days, visual acuity before and after surgery, epithelial defect healing (days), complications and time of follow-up in months were collected. RESULTS: The average age of patients was 35.7 ± 23.04 years, with six men and two women. Three patients (four eyes) had Stevens-Johnson syndrome and five patients (six eyes) had chemical ocular burn. The epithelial defect was healed at an average of 27.8 ± 4.7 days (ranging from 20 and 35 days). All patients presented limbal stem cell deficiency in a median follow-up of 7.8 ± 2.8 months (ranging from six and twelve months) and four eyes developed symblepharon. CONCLUSIONS: The results suggest that the amniotic membrane transplantation represents an additive that can be carried out in the serious cases of ocular chemical burn and Stevens-Johnson syndrome with the finality of promoting the epithelialization and abolishing the inflammation and its consequences, if compared with other studies that treated similar cases with medical therapy only. On the other hand, it is not possible to avoid the limbic deficiency in these cases, which in the future will need limbal stem cell transplantation or other surgeries for correction of the ocular surface.

Efficacy of amniotic membrane patching for acute chemical and thermal ocular burns.

OBJECTIVE: To study the efficacy of amniotic membrane patching (AMP) for acute chemical and thermal ocular burns and compare the results with a control group. MATERIAL AND METHOD: Fifteen patients (21 eyes) with acute ocular burn severity grading of II to IV were retrospectively reviewed. Thirteen eyes were treated with preserved AMP while eight eyes were treated with conventional treatment. Outcomes and complications were evaluated and compared between eyes in the AMP group and the control group with the same severity of burn. RESULTS: In the AMP group, the mean age was 36.9 +/- 11.7 years (range, 20-58). The mean follow-up time was 8.0 +/- 6.8 months (range, 1-20). Complete epithelialization was achieved in 69.2% (9/13 eyes) in total, 100% (5/5 eyes), 100% (3/3 eyes) and 20% (1/5 eyes) in grade II, III and IV respectively. Mean epithelial healing time in the AMP group was 10.4 +/- 5.8 days (range, 4-20). Comparison of grade 2 and 3 burns showed that the AMP group in which patching was performed within 5 days resulted in faster epithelial healing, less corneal haze and limbal deficiency than in the group in which patching was performed after 5 days, and the control group (mean epithelial defect 7.0 +/- 2.0, 19.5 +/- 0.7, 9.9 +/- 10.8 days respectively). CONCLUSION: Adjunctive treatment of ocular burns with AMP promoted rapid epithelial healing and reduced corneal complication. Surgery performed in the early stage tended to yield a better outcome.

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.

Phacoemulsification after penetrating keratoplasty with autologous limbal transplant and amniotic membrane transplant in chemical burns.

We report a patient who had earlier penetrating keratoplasty with amniotic membrane transplant and autologous limbal cell transplant for chemical injury who underwent cataract surgery by phacoaspiration. A posterior limbal incision with corneal valve was made superotemporally with extreme caution to avoid damage to the limbal graft. Aspiration flow rates and vacuum were kept low to avoid any turbulence during surgery. A 6.0 mm optic diameter acrylic foldable intraocular lens was inserted in the bag. The patient achieved a best-corrected visual acuity of 6/12 at 10 months' follow-up with a clear corneal graft. We conclude that caution during wound construction and phacoaspiration can help preserve corneal and limbal graft integrity in patients undergoing cataract surgery after corneal graft and limbal transplantation.

Early results of penetrating keratoplasty following limbal stem cell transplantation.

PURPOSE: To describe the early results of penetrating keratoplasty (PKP) in patients who had earlier received limbal transplantation (LT). METHODS: Prospective, non-comparative interventional case series comprising of four patients with limbal stem cell deficiency (LSCD) due to chemical injury (Cases 1, 2, 4) and xeroderma pigmentosum (Case 3). Cadaveric kerato-limbal allografts or living-related conjunctival-limbal allografts were done in four eyes followed by PKP for visual rehabilitation 3-4.5 months later. The following details were noted: demographics, primary aetiology, type of limbal transplant (cadaveric or living-related), immunosuppression, vision and ocular surface stability before and after LT and PKP, surgical complications and outcome of PKP. RESULTS: Three eyes received living-related conjunctival-limbal allotransplantation and one received cadaveric kerato-limbal allograft. Duration of follow up after PKP ranged from 4 to 11 months. Visual acuity improved in the early postoperative period in all patients but reduced in 2 due to endothelial rejection and after trans-scleral cyclophotocoagulation for medically uncontrolled glaucoma. The ocular surface remained stable in all patients. All patients were started on immunosuppression on the first postoperative day. This was continued till the last follow-up visit. Post-PKP complications were punctate epithelial keratopathy, corneal allograft rejection and secondary glaucoma (one patient each). CONCLUSION: Satisfactory visual rehabilitation is possible after PKP following LT without compromising ocular surface stability. However, a prolonged and close follow-up is warranted to avert complications.

Serious microstomia resulting from burn by caustic soda: case report / Microstomia grave decorrente de queimadura por soda cáustica: relato de caso

This study reports the case of patient with serious microstomia resulting from burn by caustic soda. It describes a technique for oral commissuroplasty used to treat this important tissue deformity. It also includes a literature review of the topic.

Chemical burns of the eyelids: a prospective study

We present our two-year experience in the management of chemical burns involving the eyelids. The series includes patients with eyelid burns as well as those presenting with post-burn eyelid contractures. Majority of the patients were victims of homicidal incidents with females outnumbering the males. In all patients, the involved eyelids were treated simultaneously by release of contracture and skin grafting. The fibrous tissue response has been observed to be more rapid and florid in chemical burns as compared to flame burns. Early, aggressive intervention is required to prevent serious sequelae which may follow chemical burns of the eyelids

Tratamento de um grande queimado em hospital geral. Relato de um caso / A large burns treatment in a general hospital. Case report

Um grande queimado, com 40 por cento de área corporal comprometida, foi circunstancialmente internado em um Hospital Geral sem unidade de queimados. Foram avaliados os problemas e as soluções encontradas no curso deste tratamento. Após 62 dias de internação e três cirurgias, com uma rotina orientada pelo Método Copenhagen, a paciente apresentou restabelecimento satisfatório, retornando a seu domicílio.

Ingesta de cáusticos: experiencia en el manejo de lesiones agudas y reconstrucciones del tubo digestivo / Caustic ingestion: experience in acute injuries management and digestive tube reconstructions

Entre enero de 1983 y diciembre de 1993 hemos realizado 21 resecciones mayores del tubo digestivo alto en igual número de pacientes que habían ingerido alguna sustancia corrosiva y desarrollado una necrosis química parcial o total del esófago y/o estómago. A 14 enfermos se les debió realizar una esofagogastrectomía total y a los otros 7 una gastrectomía total. Complicaciones postoperatorias mayores se presentaron en 6 pacientes (28.6 por ciento) y 2 fallecieron (9.5 por ciento). Durante el mismo período, realizamos en 37 pacientes igual número de reconstrucciones del tubo digestivo luego de ingesta de corrosivos. Las indicaciones de reconstrucción fueron la resección esofagogástrica previa en 17 pacientes (46 por ciento), estenosis esofágica en 8 (21.6 por ciento), postgastrectomía total en 5 (13.5 por ciento), estenosis mesogástrica en 4 (10.8 por ciento) y estenosis duodenal en 3 (8.1 por ciento). Se realizaron interposiciones de segmentos colónicos en 26 pacientes gastroyeyunoanastomosis en 6, esofagoyeyunoanastomosis en 4 y duodenoyeyunoanastomosis en 1. Complicaciones postoperatorias se observaron en 8 pacientes (21.6 por ciento) y falleció 1 paciente (2,7 por ciento)

Esophagocoloplasty for caustic stricture of the esophagus: changing concepts

A review of 540 patients with caustic esophageal stricture who underwent esophageal replacement over a 20 years period is presented. Their age at the time of esophagocoloplasty varied from 9 months to 18 years [mean 3.4 years]. Simple colon bypass of the strictured esophagus was performed in 455 patients utilizing the retrosternal route. Trans-hiatal esophagectomy with colon interposition was performed in the successive 85 patients. The overall mortality rate was 4.25%. 296 patients were available for periods between 1 and 20 years for evaluation. The isoperistaltic left colon is the best substitute for strictured esophagus in the experience. Prereconstruction feeding catheter gastrostomy is of utmost importance in most of the patients. Over the years, changes in technical measures to reduce colonic graft redundancy, esophagocolic anastomotic leak and stenosis, fear of malignant potentials and complications of left strictured esophagus have been learnt and are the subjects of this review

Quemadura esofásica por cáusticos / Caustic burning of esophagics

Se revisaron 48 pacientes con diagnóstico de quemadura esofágica por cáuticos. De éstos, 21 fueron hombres y 27 mujeres. La causa principal fue accidente en lactantes y preescolares, suicidio en adolescentes femeninas y accidentes bajo efecto del alcohol en hombres adultos. El agente principal la sosa cáustica. La estenosis fue la complicación principal que requirió dilatación en 40 pacientes con resultados buenos sólo en la tercera parte de los casos. Se realizaron l3 trasposiciones de colon: seis con colon derecho, y seis con colon izquierdo y con un transverso. La evolución fue buena en seis pacientes con trasposición izquierda; buena en cinco pacientes con trasposición derecha; sin embargo, ocurrieron una muerte y una estenosis. El único paciente en que se realizó transposición transversa desarrolló estenosis .

Secuela de quemadura química facial: reconstrucción bi-palpebral con colgajo pedio libre / Facial chemical Burn sequela: reconstruction of both eyelids with a free dorsalis pedis flap

Se presenta el caso de un paciente con exenteración de la órbita izquierda como secuela de una quemadura química facial. La reconstrucción de las estructuras palpebrales se llevó a cabo con un colgajo pedio libre con anastomosis a los vasos temporales. En el mismo acto operatorio se constituyó la cara conjuntival con un colgajo rebatido de la región cigomática y se reemplazó la piel cicatrizal de la cara con un colgajo sérvico-facial de avance. Se presenta un post-operatorio alejado con la prótesis ocular definitiva