Dynamic Eye Closure Restoration in Facial Palsy with Neurotized Platysma Muscle Graft in Rats.

BACKGROUND: One of the most devastating deficits of facial paralysis is eyelid dysfunction, which is controlled by the orbicularis oculi muscle (OOM), as it leads to loss of the protective mechanism of the eye. This study used a rat model to assess the functional outcomes of neurotized platysma muscle grafts (PMGs) for OOM replacement. METHODS: Forty male Sprague-Dawley rats with iatrogenic right eyelid dysfunction were divided into five groups: one control group and four groups utilizing PMG with different sources of nerve innervation. Eyelid function recovery was assessed at 2, 4, 6, and 8 weeks. The PMGs were harvested for pathological examination at the end of the study. RESULTS: All rats except those in the control group and one from the group using ipsilateral frontal and upper zygomatic frontal nerve branches directly neurotized to the PMG (nerve-to-muscle) recovered eyelid closure function within 8 weeks of the study period. The mean recovery time was 3.87 ± 1.28 weeks. A total of 87.5% of rats that had the contralateral zygomatic branch as the donor nerve regained the consensual corneal reflex (p-value < 0.001). CONCLUSION: Replacement of neurotized PMG for OOM function is successful in a rat model. Using the upper zygomatic branch as the donor nerve, it was possible to restore the consensual corneal reflex. This method shows promise for further human studies.

Integrating Fat Graft with Blepharoplasty to Rejuvenate the Asian Periorbita.

BACKGROUND: Contemporary periorbital rejuvenation is undergoing a paradigm shift to an approach that prioritizes volume preservation and/or augmentation. However, the technical difficulties of using traditional fat grafting techniques in this area and the distinct ethnic features make periorbital rejuvenation in Asians especially challenging. Here, the authors present their approach to enhance the periorbita and outcomes. METHODS: A retrospective chart review was performed for 33 consecutive patients who underwent microautologous fat transplantation (MAFT) to the periorbita using the MAFT gun device combined with excisional blepharoplasty. Additionally, preoperative and postoperative photographs were analyzed by external evaluators to grade the aesthetic outcomes and fat resorption rates. RESULTS: Three months after surgery, patients looked on average 5.4 ± 3.4 years younger, and the aesthetic result was graded 7.4 ± 2 in a one-to-ten scale. The fat resorption rate was 19.6% ± 3.5% at 3 months and 32.2% ± 3.9% after 12 months (range: 12-24 months; P = 0.007). The overall morbidity rate was 12% (4 patients), including 1 visible lump (3%), an overcorrection case (3%) in the lower eyelid, and 2 palpable lumps in the upper eyelid (6%) which were not visible. One case of lower eyelid hollowness required secondary fat grafting. CONCLUSIONS: Traditional blepharoplasty procedures can be combined with fat grafting techniques to address volume loss and tissue descend while keeping ethnic identity. A fat injection device like the MAFT gun is safe and effective and provides long-term predictable outcomes for fat grafting around the periorbital thin skin.

Abordaje quirúrgico combinado como alternativa mínimamente invasiva en el tratamiento de la Gangrena de Fournier / Combined surgical approach as a less invasive alternative for the treatment of Fournierʼ s Gangrene / Abordagem cirúrgica combinada como alternativa menos invasiva no tratamento da Gangrena de Fournier

Introducción y Objetivo. La Gangrena de Fournier es una fascitis necrotizante del perineo y genitales externos que presenta una morbi-mortalidad elevada debido a su diagnóstico tardío y a las comorbilidades comúnmente asociadas en estos pacientes. Terapias adyuvantes como la presión negativa y los sustitutos dérmicos, han mostrado eficacia en el tratamiento de pacientes con defectos complejos de tejidos blandos y forman parte de nuestro protocolo de tratamiento actual. El objetivo de este estudio es describir la utilidad de nuestro abordaje quirúrgico combinado en la Gangrena de Fournier. Material y método. Presentamos un trabajo retrospectivo en el que describimos 3 pacientes varones tratados por defectos complejos de tejidos blandos secundarios a Gangrena de Fournier mediante nuestro protocolo de tratamiento quirúrgico que comprende: una primera etapa de control de la herida mediante desbridamientos agresivos y terapia de presión negativa, seguido de una etapa de contemporización que combina la utilización de matriz dérmica y terapia de presión negativa, y por último una etapa de reconstrucción para dar cobertura final al defecto. Resultados. Los 3 pacientes presentaron compromiso extenso de la región perineal y de las regiones adyacentes incluyendo genitales externos y miembros inferiores. Todos fueron tratados con éxito mediante el abordaje que describimos, sin secuelas funcionales y manteniendo el contorno a la región. Conclusiones. El abordaje utilizado en nuestros 3 casos representó una alternativa terapéutica eficaz. La combinación de terapia de presión negativa y matriz dérmica nos permitió un manejo simplificado de la herida y una reconstrucción con mayor seguridad y mínima morbilidad mediante cierre primario de las heridas y avance de colgajos locales (AU)

Background and Objective. Fournier´s gangrene is a necrotizing fasciitis of the perirectal, perianal and genital areas with a high morbimortality rates due to late diagnosis and associated patient´s comorbidities. Adjuvant therapies including vacuum therapy and acellular matrix have proved to be effective in the treatment of complex soft tissue defects and now are part of our treatment protocol for this condition. The purpose of this study was to describe the advantages of our surgical approach applied in patients with complex perineal defects secondary to Fournier’s gangrene Methods. We conduct a retrospective study describing 3 consecutive cases in males treated for complex soft tissue defects due to Fournier’s gangrene according to our surgical protocol. It consists of a step-by-step approach that begins with aggressive surgical debridement and vacuum in the first stage, continues with an intermediate stage based on the combination of dermal regeneration template and negative pressure wound therapy to prepare for the reconstruction phase where final defect coverage is accomplished. Results. Our 3 patients presented with extensive perineal and regional compromise including external genitalia and lower limbs. All3 cases were successfully treated with this approach leaving no functional sequela and restoring contour. Conclusions. This approach proved to be an efficient treatment alternative for Fournier’s gangrene. The combination of negative pressure wound therapy and acellular matrix simplified wound caring and led to safer and less morbid reconstructions by primary wound closure and regional advancement flaps (AU)

Introdução e Objetivo: A Gangrena de Fournier é uma fasceite necrotizante do períneo e genitália externa que possui alta morbidade e mortalidade devido ao diagnóstico tardio e às comorbidades associadas nesses pacientes. Terapias adjuvantes como VAC(R) (KCI USA, Inc., San Antonio,TX) e os substitutos dérmicos como Integra(R) (Integra LifeSciences Corporation, Plainsboro, NJ) tem mostrado eficácia no manejo de pacientes com defeitos complexos de partes moles e formam parte de nosso protocolo de tratamento atual para esta condição. O objetivo deste estudo foi descrever a utilidade da nossa abordagem cirúrgica no tratamento da Gangrena de Fournier. Material e método. Neste trabalho retrospectivo descrevemos três casos de defeitos complexos de partes moles secundários à Gangrena de Fournier tratados mediante nosso protocolo de tratamento. Esta abordagem cirúrgica compreende uma primeira etapa de controle da ferida mediante desbridamentos agressivos e terapia de pressão negativa VAC(R), seguido de uma etapa de contemporização que combina a utilização de terapia VAC(R) e matriz dérmica Integra(R), e por último uma etapa de reconstrução para obter cobertura final do defeito. Resultados. Apresentamos três pacientes consecutivos com acometimento diverso da região perineal e regiões adjacentes incluindo genitália e membros inferiores. Todos foram tratados com sucesso mediante esta abordagem sem deixar seqüelas funcionais e devolvendo o contorno à região. Conclusão: A abordagem utilizada nos três casos representou uma alternativa terapêutica eficaz. A combinação de terapia VAC(R) e Integra(R) permitiu um manejo simplificado da ferida, uma reconstrução com maior segurança e mínima morbidade mediante fechamento primário das feridas e avanço de retalhos locais

Tratamiento de la enfermedad pilonidal crónica. Comparación de 3 técnicas quirúrgicas / Treatment of chronic pilonidal disease. Comparison of 3 surgical techniques

Introducción: actualmente no existe una técnica “gold standard” para el tratamiento definitivo de la enfermedad pilonidal crónica. Las técnicas empleadas en nuestro servicio son la técnica de Karydakis, Colgajo Romboidal y una variante de la técnica de Soll y col. a la que denominamos “Técnica de preservación cutánea”. Objetivo: evaluar y comparar la eficacia de las técnicas de Karydakis (TK), Colgajo de Limberg (CL) y de Preservación cutánea (PC) en el tratamiento de la enfermedad pilonidal crónica. Material y Métodos: estudio retrospectivo sobre 136 pacientes operados por enfermedad pilonidal crónica en el Sanatorio Allende, entre Enero del 2006 y Septiembre del 2013, basado en revisión de historias clínicas y entrevista telefónica. Se incluyeron 125 pacientes, 38 operados mediante CL, 50 con TK, y 37 con PC. Se excluyeron 11 pacientes por enfermedad pilonidal supurada. Las variables de evaluación primarias fueron el tiempo operatorio, complicaciones postoperatorias, tasa de recidiva; y las secundarias fueron el tiempo de reincorporación a actividades normales y deportivas, y el grado de satisfacción del paciente. Los test estadísticos empleados fueron el análisis de varianza, el postest de Tukey y Chi-cuadrado. Resultados: el tiempo quirúrgico fue menor en el grupo TK (37 min) en comparación con el grupo CL (53 min) (p0.05) aunque la reincorporación a actividades deportivas fue más prolongada en el grupo TK (43 días) respecto de los otros dos grupos (32 días) (p=0,042)...

Introduction: actually, there is no consensus as to the optimal surgical operation for sacrococcygeal pilonidal disease. The techniques used in our institution are Karydakis flap reconstruction, Limberg flap transposition, and a modified Soll et al procedure, which includes sinusectomy with primary closure called “Cutaneous preservation technique”. Objectives: to evaluate and to compare the efficacy and morbidity of Karydakis flap reconstruction (KF), Limberg flap transposition (LF) and Cutaneous preservation technique (CP) in the treatment of chronic pilonidal sinus disease. Patients and methods: a retrospective study was performed in 136 consecutive patients operated for chronic pilonidal sinus disease at Sanatorio Allende between January 2006 and September 2013, using KF, LF and CP procedures. Eleven patients were excluded for presenting suppurated pilonidal disease. One hundred and twenty five patients were included, 50 in the KF, 38 in LF and 37 in the CP group. Primary endpoints included operation time, complications and recurrence rates. Secondary end-points were healing time, return to normal and sports activities and degree of patient’s satisfaction. Data was obtained via a revision of digital clinical history and a standardized telephone interview. Statistical tests used were Anova with Tukeypost test and Chi-square test. Results: operating time was shorter in the KT group (37 min) compared with LF group (53min) (p0.05). However, return to sports activities was delayed in KF group (43 days), compared with LF and PC group (32 days) (p=0,042)...

Rol de la TC multicorte con RMP en el diagnóstico de la hernia obturatriz: presentación de un caso / Role of multislice CT with MPR (multi-planar reformation) in the diagnosis of obturator hernia. a case report

La hernia obturatriz (HO) es poco frecuente y representa del 0.05 al 0.4 por ciento del total de hernias. Debido a su rareza y a su presentación inespecífica, el diagnóstico es por lo general tardío y las tasas de mortalidad elevadas (12-70 por ciento). Se presenta un caso típico de HO diagnosticada en el preoperatorio mediante TC Multi-corte con RMP y tratado mediante laparotomía de urgencia con buen resultado. El empleo de TC Multicorte con RMP de abdomen y pelvis, en cuadros de obstrucción intestinal en mujeres añosas, sin antecedente de cirugías previas ni hernias objetivables, tiene gran valor para el diagnóstico preoperatorio precoz de HO y podría contribuir a reducir las elevadas tasas de morbilidad y mortalidad.

Abstract. The obturator hernia (OH) is rare and accounts for 0.05 to 0.4% of all hernias. Because of its rarity and its nonspecific presentation, diagnosis is usually late and has high mortality rates (12-70%). A typical case of OH diagnosed preoperatively by Multislice CT with MPR and treated using emergency laparotomy with good results, is presented. The use of Multislice CT with MPR of the abdomen and pelvis, in symptoms of intestinal obstruction in elderly women with no history of previous surgery or objectified hernias, has great value for early preoperative diagnosis of OH and could help reduce the high rates of morbidity and mortality.

[Mesenteric panniculitis: a case report and a review of the literature]. / Paniculitis mesentérica: presentación de un caso y revisión de la literatura.

Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.

Paniculitis mesentérica: presentación de un caso y revisión de la literatura / [Mesenteric panniculitis: a case report and a review of the literature].

Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.

Paniculitis mesentérica: presentación de un caso y revisión de la literatura. / [Mesenteric panniculitis: a case report and a review of the literature].

Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.

Isquemia arterial aguda del miembro superior por uso de muletas / Isquemia arterial aguda do membro superior por uso de muletas / Crutches induced acute arterial ischemia of the upeer limb

La compresión axilar por el uso de muletas es una causa infrecuente y subdiagnosticada de isquemia arterial aguda del miembro superior. Se presenta el caso de un paciente con isquemia aguda debido a trauma en la confluencia de las arterias axilar y humeral inducido por el uso de muletas. Dicha lesión fue el foco de microembolias que ocluyeron el arco palmar y la arteria humeral. Se diagnosticó con una arteriografía selectiva de la arteria axilar, y se tratómediante un bypass axilo-humeral con prótesis de PTFE anillado de 6 mm, con resultado satisfactorio en el seguimiento clínico a cinco años del postoperatorio.

A compressão axilar devido ao uso de muletas é uma causa pouco frequente e subdiagnosticada de isquemia arterial aguda do membro superior. Apresenta-se o caso de um paciente com isquemia aguda por trauma da confluência das artérias axilar e femoral induzido pormuletas. Esta lesão foi o foco de microembolias que provocaram a oclusão do arco palmar e da artéria femoral. Foi diagnosticado com uma arteriografia seletiva da artéria axilar, e tratado com um bypass axilo-femoral com prótese de capas de PTFE de 6 mm, com resultado satisfatório no seguimento clínico, cinco anos depois do pós operatório.

Crutch induced axillary trauma represents an infrequent but underdiagnosed cause of acuteischemia to the upper limb. We present a case of acute arterial ischemia caused by trauma of the confluence of the axillary and brachial arteries induced by the use of crutches. This lesion was the origin of microembolisms that occluded both the palmar arch and the brachialartery. The diagnosis was made by a selective arteriography of the axillary artery. An axillobrachial bypass with a 6 mm ringed PTFE prosthesis was performed showing satisfactory resultson his 5 year postoperative clinical follow up.

Suboclusión intestinal secundaria a endometriosis en paciente con Síndrome de V. A. T. E. R. L. S. / Intestinal sub-occlusion secundary to endometriosis in a patient with

We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this cse and others in the literture highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definiteve treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence. VATER association is an acronym for the fllowing non-random association of defects: Vertebral defects, Anal atresia, tracheoesophageal fistula with Esophageal atresia, and Renal or Radial defects. VACTERL association is an expanded acronym to include Cardiac defects and Limb defects. Diagnosis of VACTERL association is made if theree out of seven above defects are present in an infant. The incidence is estimated to be 1.6 cases in 10,000 live births.

Divertículo de la tercera porción del duodeno: presentación de un caso y revisión de la literatura / Diverticulum in the third portion of the duodenum: case report and review of the literature

Introducción: el duodeno representa el segundo sitio más común de desarrollo de divertículos, después del colon. Se encuentran generalmente a 2,5 cm de la ampolla de Vater o en la primera porción duodenal, en casos relativamente raros, se presentan en la tercera y cuarta porción duodenal. Objetivo: presentación de un caso de divertículo en tercera porción duodenal, así como también la metodología diagnóstica y terapéutica para resolverlo. Discusión: el diagnóstico clínico de los divertículos duodenales presenta dificultad debido a que no existe una presentación clínica característica. Sólo el 10% y 25% de los pacientes son sintomáticos. Las manifestaciones clínicas se desarrollan por las complicaciones de las diverticulitis. El diagnóstico se basa en los estudios contrastados como las seriadas esofagogastroduodenales, TAC multicorte, así como también, la realización de una endoscopía, deben contribuir a un diagnóstico acertado. El tratamiento quirúrgico de los divertículos asintomático en pacientes adultos no está justificado, mientras que en el paciente con síntomas el criterio es quirúrgico para evitar complicaciones como: hemorragia, perforación, diverticulitis, pancreatitis y obstrucción. Conclusión: el tratamiento de los divertículos duodenales varía según el tipo, localización y extensión del proceso inflamatorio. La cirugía se encuentra reservada en un 1 al 3% de los pacientes con divertículos duodenales en tercera porción, considerando aquellos enfermos con dolor abdominal persistente o complicaciones asociadas a la diverticulitis.

Introduction: The duodenum is the second most common site of diverticula development after the colon. They are usually found to 2.5 cm of the ampulla of Vater or the first part of the duodenum, in relatively rare cases, occur in the third and fourth duodenal portion. Objective: A case of duodenal diverticulum in the third portion, as well as diagnostic and therapeutic methodology to solve it. Discussion: The diagnosis of duodenal diverticula have difficulty because there is no characteristic clinical presentation. Only 10% and 25% of patients are symptomatic. The clinical manifestatiions are developed by the complications of diverticulitis. The diagnosis is bases on serial contrast studies such as upper GI, multislice CT, and also carrying out an endoscopy, should contribute to an accurate diagnosis. Surgical treatment of asymptomatic diverticula in adult patients is not justified, whereas in patients with symptoms on surgical approach is to avoid complications such as bleeding, perforation, diverticulitis, pancreatitis and obstruction. Conclusion: The treatment of duodenal diverticula varies according to the type, location and extent of the inflammatory process. Surgery is reserved on a 1 to 3% of patients with duodenal diverticula in the third portin, whereas those patients with persistent abdominal pain or complications associated with diverticulitis.