Versatilidad anatómica del colgajo lateral del brazo. Estudio cadavérico en una muestra de población colombiana / Anatomical versatility of the lateral arm flap. Cadaver study in a sample of the Colombian population

Introducción y objetivo: El colgajo lateral del brazo es un recurso de cobertura para el cirujano de mano que tiene una amplia variedad de usos y aplicaciones por su versatilidad y facilidad de recolección con poca morbilidad del sitio donante. El objetivo de este estudio es documentar las principales variantes anatómicas y establecer puntos de referencias para el desarrollo y mejoramiento de las técnicas quirúrgicas actuales en una muestra de población colombiana. Material y métodos: Estudio descriptivo anatómico de 10 miembros superiores de cadáveres frescos congelados en los que realizamos disecciones para documentar las principales perforantes del colgajo lateral del brazo en población colombiana. Tomamos mediciones de distancia de las perforantes al epicóndilo lateral y sacamos proporciones según porcentajes del tamaño de la extremidad. Igualmente, cuantificamos número de perforantes en cada cuadrante y diámetro de los pedículos. Resultados: En el colgajo lateral del brazo, el orden de aparición de las perforantes de distal a proximal correspondió al 13, 19, 26 y 35% de la distancia del brazo (entre el epicóndilo y el acromion); en el segundo cuadrante encontramos la mayoría de las perforantes, la segunda y la cuarta, tuvieron menor variación con respecto a las demás perforantes, los pedículos proximales presentaron un mayor diámetro que los distales. Encontramos el nervio radial a la salida del tabique intermuscular en promedio a 14.08 cm (+/- 0.83) del epicóndilo, siendo esta referencia clave para una disección cuidadosa con el fin de evitar la lesión del mismo. Conclusiones: En nuestra población de estudio, el colgajo lateral del brazo posee una gran versatilidad, con un buen número de perforantes para su nutrición que le permite al cirujano múltiples opciones de cobertura...(AU)

Background and objective: The lateral arm flap is a coverage resource for the hand surgeon that has a wide variety of uses and applications due to its versatility and ease of collection with little morbidity from the donor site. The aim of this research is to carry out dissections of the lateral arm flap in cadavers of the Colombian population to describe the main anatomical vari-ants and establish reference points for the development and improvement of current surgical techniques. Methods: Anatomical descriptive study of 10 upper limbs from fresh-frozen cadavers in which dissections were performed to document the main perforators of the lateral flap of the arm in the Colombian population. Distance measurements were taken from the perforators to the lateral epicondyle and ratios were obtained according to percentages of limb size. Likewise, the number of perforators in each quadrant and the diameter of the pedicles were quantified. Results: The results showed that in the lateral arm flap the order of appearance of the perforators from distal to proximal corresponds to 13, 19, 26 and 35% of the distance of the arm (between the epicondyle and the acromion); most of the perforators were found in the second quadrant, the second and fourth have less variation compared to the other perforators, the proximal pedicles have a larger diameter than the distal ones, the radial nerve was found at the exit the intermuscular septum on average 14.08 cm (+/- 0.83) from the epicondyle, this is a key reference for a careful dissection in order to avoid injury to it. Conclusions: In our study population, the lateral arm flap is highly versatile with a good number of perforators for its nutrition, which allows the surgeon multiple coverage options. The bone perforators of the distal humerus must be protected in the most distal portion to avoid complications such as bone necrosis, especially in children...(AU)

Terminal nerve entry points' locations to muscles of the thigh for selective peripheral neurectomy in the adult population: a cadaveric study.

PURPOSE: Spasticity is the result of a variety of lesions to the central nervous system and one of the most common causes of disability worldwide. Selective peripheral neurectomy (SPN) is a surgical procedure that permanently decreases focal spasticity. The authors' objective is to provide recommendations, in terms of probabilities, for locating terminal motor entry points to muscles of the thigh, as alternatives for proximal incision sites to SPN. METHODS: The femoral, obturator, and sciatic nerves, and its corresponding motor rami, were systematically dissected on cadaveric specimens, and terminal motor entry points to each muscle of the thigh were located and carefully measured, relative to the length of the thigh. Measurement distributions were obtained and normal transformations were used when necessary. RESULTS: In 23 adult cadaveric specimens, 779 motor rami were dissected. Entry points' locations are presented as a percentage of the length of the thigh in means and standard deviations, which roughly corresponds to 64 and 95% probability of finding a motor entry point. CONCLUSION: Alternative incisions directly over the motor entry points, for the muscles of the thigh, may be helpful when considering SPN as treatment for focal spasticity. A prior degree of certainty of the location of the nerve to be severed may simplify surgical approach.

Use of an Adipofascial Superficial Circumflex Iliac Artery Perforator Flap to Improve Contour Following Resection of Upper Extremity Amniotic Band Constriction: A Report of Two Patients.

Amniotic band syndrome (ABS) is a congenital disease that causes a variable degree of deformity and tissue disruption. Surgical excision of fibrotic tissue and advancement of local flaps is the gold standard for constriction bands of the upper limb. We report the use of an adipofascial Superficial Circumflex Iliac Artery perforator (SCIP) flap to improve contour following amniotic band resection in the upper extremity in two patients with ABS. The use of this microsurgical technique can be considered in the occasional patient when there is a deficit of soft tissues after release of the contracture band that cannot be addressed with locally available tissue.

Descripción de una técnica quirúrgica para mejorar la fijación y la reducción interna en fracturas de radio distal / New surgical technique to improve functional results in distal radius fractures

Las fracturas del extremo distal del radio tienen una gran importancia en la traumatología debido a su incidencia y a las diferentes opciones de manejo. Actualmente, hay una gran tendencia al manejo mediante una reducción abierta y fijación con placas bloqueadas palmares. Cuando se realiza un procedimiento quirúrgico, el resultado debe ser lo más anatómico posible. En algunos casos, después de hacer las diferentes maniobras de reducción, no se logra el objetivo de llevar la carilla articular del radio a su posición anatómica. Cuando este objetivo no se logra, se propone una técnica quirúrgica que puede ayudar en la consecución de la alineación adecuada de la carilla articular del radio. En este artículo explicamos la técnica quirúrgica denominada “tornillo poste”, que nos da una opción más para mejorar la reducción de la fractura de radio distal. Esta es una técnica fácil y reproducible que, usando las placas palmares bloqueadas (fijación angular estable), nos ayuda a hacer la corrección de los últimos grados de la reducción de las fracturas del radio distal, y nos permite una colocación segura de los tornillos distales, debido a que el ángulo de colocación de estos se aleja de la superficie articular.

Casos clínicos para docencia en ortopedia oncológica / Clinical reports to education for orthopedic oncology

Las neoplasias óseas son infrecuentes, con una incidencia menor del 0,01%. Por esta razón, el ortopedista general puede tener dificultad en identificar los síntomas y signos que sugieren una neoplasia ósea y practicar un tratamiento inapropiado o tardío. El propósito de este artículo es presentar una serie de casos de pacientes con complicaciones oncológicas y su manejo.

SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up.

PURPOSE: This study evaluated the long-term (5-year) durability of radiofrequency energy delivery for fecal incontinence. METHODS: This was an extension of the follow-up from our original prospective study in which patients who suffered from fecal incontinence were treated with the SECCA system for radiofrequency energy delivery to the anal canal muscle. The Cleveland Clinic Florida Fecal Incontinence Scale (0-20), fecal incontinence-related quality of life score, and Medical Outcomes Study Short-Form 36 were administered to five years. Differences between baseline and follow-up were analyzed by using paired t-test. RESULTS: A total of 19 patients were treated and followed for five years, including 18 females (aged 57.1 (range, 44-77) years). The mean duration for fecal incontinence was 7.1 (range, 1-21) years. At five-year follow-up, the mean fecal incontinence score had improved from 14.37 to 8.26 (P<0.00025) with 16 patients (84.2 percent) demonstrating>50 percent improvement. All fecal incontinence-related quality of life scores improved, including lifestyle (2.43 to 3.15; P<0.00075), coping (1.73 to 2.6; P<0.00083), depression (2.24 to 3.15; P<0.0002), and embarrassment (1.56 to 2.51; P<0.0003). The social function component of the Short-Form 36 improved from 38.3 to 60 (P<0.05). There was a trend toward improvement in the mental component summary of the Short-Form 36 from 38.1 to 48.14. There were no long-term complications. CONCLUSIONS: Significant and sustained improvements in fecal incontinence symptoms and quality of life are seen at five years after treatment with the SECCA system. This treatment should be considered for patients suffering from fecal incontinence not amenable to surgery and who have failed conservative management.

Extended two-year results of radio-frequency energy delivery for the treatment of fecal incontinence (the Secca procedure).

PURPOSE: This study evaluated the durability and long-term safety of radio-frequency energy delivery for fecal incontinence (Secca procedure). METHODS: This was an extended follow-up of a prospective study in which patients with fecal incontinence of various causes underwent radio-frequency energy delivery to the anal canal muscle. The Cleveland Clinic Florida Fecal Incontinence Scale (0-20), fecal incontinence-related quality-of-life score, and Medical Outcomes Study Short Form 36 were administered at baseline and at 1, 2, 3, 6, 12, and 24 months after the procedure. Differences between baseline and follow-up were analyzed with the Wilcoxon signed-rank test. RESULTS: Ten females (aged 55.9 +/- 9.2 (range, 44-74) years) were treated. At two-year follow-up, the mean Cleveland Clinic Florida Fecal Incontinence Scale score was improved from 13.8 to 7.3 (P = 0.002), with eight patients having scores of < or =10. All fecal incontinence-related quality-of-life score parameters were improved, including lifestyle (from 2.3 to 3.3; P = 0.002), coping (from 1.7 to 2.7; P = 0.002), depression (from 2.4 to 3.4; P = 0.004), and embarrassment (from 1.5 to 2.4; P = 0.008). There was no decrement in effect noted in any parameter between 12 and 24 months (P > 0.2). The social function component of the Short Form 36 improved from 50 to 82.5 (P = 0.04), whereas there was an improvement trend for the mental component summary of the Short Form 36 from 38.3 to 48.1 (P = 0.11). Protective pad use was eliminated in four of the seven baseline users. There were no long-term complications, such as stricture, pain, or constipation. CONCLUSIONS: A significant improvement in symptoms of fecal incontinence and quality of life persists two years after radio-frequency delivery to the anal canal, which demonstrates durability of this intervention.

La agenesia dental y su mecanismo de herencia en siete grupos familiares colombianos / Tooth agenesis and its heredity pattern in seven colombian familiar groups

ANTECEDENTES: La agenesia de uno o más dientes es la anomalía más común en el desarrollo dental del hombre y puede encontrarse ocasionada a un síndrome genético o una característica genética familiar. OBJETIVO: establecer el patrón de herencia de agenesias dentales en algunos grupos familiares colombianos. METODOS: se analizaron siete grupos familiares en los cuales mas de un individuo padecía agenesia dental; se les realizó entonces, un examen odontológico, un estudio con radiografías panorámicas y una consulta genética. RESULTADOS: Se encontró que la ausencia congénita de dientes fue más frecuente en la dentición permanente (94/100) y se observó en 34 individuos, de los cuales fueron mujeres (60/100) y catorce hombres (40/100); al analizar la simetría (unilateral o bilateral) de la agenesia dental, se encontró que 16 pacientes presentaron bilateralidad de los dientes ausentes, frecuentándose más en esta forma los laterales superiores. Los dientes ausentes con mayor frecuencia fueron los laterales superiores (46.1/100), seguidos por los segundos premolares inferiores (7.69/100), excluyendo la agenesia de terceros molares que ocurrió en el 38.46/100 de los individuos. En la familia 5 se encontró asociación de la agenesia dental con microdoncia. Los siete árboles genealógicos analizados cumplieron con los parámetros clásicos de un patrón de herencia autosómico dominante con prenetrancia incompleta y expresividad variable. CONCLUSIONES: La agenesia dental en los siete grupos familiares colombianos predominó en el género femenino y en forma bilateral. Los dientes mas frecuentes con agenesia dental fueron los laterales superiores, seguidos por los terceros molares inferiores, y luego los segundos premolares inferiores. El patrón de herencia predominante fue el autosómico dominante con penetrancia incompleta y expresividad variable.

[Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán]. / Tratamiento quirúrgico de la hemorragia del tubo digestivo bajo. Experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. RESULTS: There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors. CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.