Caracterización y retos en la clasificación de fracturas malares. Serie de casos en un hospital de tercer nivel en la ciudad de Cali, Colombia / Characterization and challenges in the classification of malar fractures. Case series in a third level hospital in the city of Cali, Colombia

Introducción y objetivo: Las fracturas del malar son las fracturas faciales más frecuentes después de las nasales y se asocian preferentemente a accidentes de tránsito. En nuestro medio no disponemos de trabajos que exploren las caracteriticas de esta condicion. Nuestro objetivo es caracterizar las condiciones asociadas a las fracturas malares en la ciudad de Cali, Colombia. Material y método: Estudio observacional descriptivo en pacientes que consultan en el Hospital Universitario del Valle y atendidos por Cirugía Plástica entre agosto de 2019 y marzo de 2020 con diagnóstico de fractura malar por escáner facial. Registramos las variables edad, sexo, origen, procedencia, escolaridad, ocupacion, estado civil, mecanismo de trauma, ciudad del trauma, clasificacion de fracturas del malar, lateralidad, fractura del arco cigomático y fracturas faciales asociadas. No incluimos análisis sobre el manejo de las fracturas. Resultados: Identificamos 25 fracturas malares en 24 pacientes. El 88% en mayores de 18 años; 83.3% varones; el grupo etáreo con más casos fue el de 21-30 años (25%). La causa más común fue el trauma contuso (50%), seguido por las caídas (21%) y accidentes de tránsito (21%). La fractura malar tipo 3 impactada según Knight y North fue la más común (36%). Conclusiones: Encontramos que, en nuestro estudio, el trauma contuso fue la causa más frecuente de fractura malar. Consideramos que la información obtenida puede ser util para que la autoridad local se plantee estrategias para reducir su incidencia. Al clasificar el patron de fractura no se encuentra un tipo único de fractura, sino de combinaciones, lo que nos lleva a pensar que se requiere una nueva clasificación. (AU)

Background and objective: Malar fractures have been described as the most frequent facial fractures after nasal ones. These are frequently associated with traffic accidents. In our environment we do not have studies that explore the characteristics of this condition. Our objective is to characterize the conditions associated with malar fractures in the city of Cali, Colombia. Methods: A descriptive observational study is carried out in patients who consult at the Hospital Universitario del Valle and are cared for by the Plastic Surgery Section between August 2019 and March 2020, with a diagnosis of malar fracture in the facial scan. The variables age, sex, origin, education, occupation, marital status, mechanism of trauma, city of trauma, classification of malar fractures, laterality, fracture of the zygomatic arch and associated facial fractures were recorded. Analysis of the management of fractures is not included. Results: We identified 25 malar fractures in 24 patients; 88% in people over 18 years old; 83.3% were men; the age group with the most cases were 21-30 years old (25%); the most common cause was blunt trauma (50%), followed by falls (21%) and traffic accidents (21%). Type 3 malar fracture impacted according to Knight and North was the most common (36%). Conclusions: Blunt trauma is the most frequent cause of malar fracture in our study. The information obtained can be useful for the local authority to consider strategies to reduce its incidence. When classifying the fracture pattern, a single type of fracture is often not found and, on the contrary, there were combinations which leads us to think that a new classification is required. (AU)

A Report of 736 High-Definition Lipoabdominoplasties Performed in Conjunction with Circumferential VASER Liposuction.

BACKGROUND: Several innovations and modifications to the abdominal lipectomy procedure have been performed through the years. Despite recent improvements, the lack of natural results, including high scars, navel deformities, and "tense" abdomen, are still challenging. The objective of this study is to present an alternative technique of combined 360-degree truncal liposuction with abdominal definition, abdominoplasty, and neoumbilicoplasty. METHODS: From January of 2005 to June of 2017, 736 VASER-assisted lipoabdominoplasties were performed. Only healthy women with a body mass index below 33 were included. A three-step procedure was performed: (1) truncal liposculpture, (2) dermolipectomy and plication of the rectus abdominis muscle, and (3) neoumbilicoplasty through a butterfly technique. The follow-up included photographs and medical assessment with a mean of 2 years (up to 5 years). A nonstandardized survey was performed to self-evaluate the results. RESULTS: Six hundred seventy patients answered the survey (91 percent). Six hundred fifteen patients were satisfied with the procedure (91.79 percent). Minor complications were reported: seroma in 7.3 percent, prolonged bruising in 10 percent, and swelling in 18 percent. Neither flap necrosis nor infections were reported. Neoumbilicoplasty was performed in all patients. Additional procedures were required in 4.6 percent. CONCLUSIONS: Ultrasound-assisted lipoabdominoplasty is an alternative lipectomy technique that prevents stigmata of the procedure. The abdominal definition improves the shape and recreates the superficial anatomy. Neoumbilicoplasty shape, form, and choice of its position over the abdominal wall provide significant improvements in results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.