ABSTRACT
OBJECTIVE: The aim this study was to demonstrate the utility and suitability of octyl-2-cianocrylate in cutaneus repair of different conditions in the pediatric population. Octyl-2-cianocrylate is a topical tissular adhesive which can be used on skin and which has been tested in surgical practice as a wound sealant, avoiding the use of conventional sutures. MATERIAL AND METHODS: We applied octyl-2-cianocrylate in 100 patients with skin wounds smaller than 5 cm. The patients were distributed as follows: Emergency department: simple sharp wounds in the face and extremities (20 patients); surgical block: surgical wounds in 80 patients with the following conditions: inguinal hernia (20 patients), cryptorchidism (20 patients), umbilical hernia (10 patients), hypospadias (17 patients), post-hypospadias fistula repair (8 patients) and cleft lip (5 patients). The results were analyzed in terms of efficacy, cosmetic result, procedure time, material used, and patient comfort. CONCLUSIONS: Octyl-2-cianocrylate was easier to use than conventional sutures in all its applications, requiring less time than conventional sutures and therefore lowering the cost per procedure.
Subject(s)
Cyanoacrylates , Tissue Adhesives , Child , Child, Preschool , Humans , Infant , Skin/injuries , Surgical Procedures, Operative , Wounds, Stab/therapyABSTRACT
An 11 year-old girl had an urinary diversion because of a complex uropathy with vesical sphincter dyssinergism. Her inexpressive face with lost eyes and forced gestures, especially when smiling--her smile looking rather like weeping--was the clue to the diagnosis of Ochoa's syndrome. She underwent psoic bladder fixation, right ureteral reimplantation, bladder neck loosening and cystostomy undiversion. At follow-up, renal function deteriorated. She has recently received a kidney transplantation in another institution, and is now symptom-free.
Subject(s)
Smiling , Urologic Diseases/surgery , Child , Female , Humans , SyndromeABSTRACT
Se trata del caso de una paciente de 11 años de edad portadora de una derivación urinaria por una uropatía compleja debido a una disinergia vésico-esfinteriana. La facies inexpresiva, con mirada perdida y gesticulaciones forzadas sobre todo al sonreír (la sonrisa parecía un llanto) junto a la uropatía grave, permitió catalogarla como síndrome de Ochoa. Se le practicó una fijación psoica de la vejiga, un reimplante ureteral derecho, una liberación del cuello vesical y el cierre de la cistostomía. En la evolución empeoró la función renal. Recientemente ha recibido un trasplante renal en otro centro y la paciente se encuentra asintomática (AU)
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Subject(s)
Child , Female , Humans , Smiling , Syndrome , Urologic DiseasesABSTRACT
La estenosis uretral, después de la fístula, es la complicación más frecuente que presentan los pacientes intervenidos de hipospadias. Su incidencia oscila entre un 4 por ciento-12 por ciento dependiendo de la técnica quirúrgica empleada. Su trata-miento en la mayoría de las ocasiones es sencillo, siendo suficiente la dilatación de la zona estenosada en una o varias sesiones. Sin embargo en otros casos, sobre todo en los pacientes con hipospadias graves en los que ha sido preciso la disección y resección amplia de los tejidos fibrosos para corregir la incurvación y en los multitratados, la dilatación de la zona estenosada es difícil. Presentamos 3 pacientes afectos de hipospadias graves (escrotales y perineales) multioperados, que presentaron como complicación en el post-operatorio estenosis uretral a distinto nivel. Sometidos a programa de dilataciones periódicas durante varios meses no se consiguió solucionar la estenosis. Se intervinieron para intentar ampliar la zona estenosada. En dos la ampliación se hizo con un injerto libre de mucosa oral y en el tercero se utilizó un colgajo local. Al poco tiempo de la ampliación, se estenosaron de nuevo, no respondiendo de nuevo al programa de dilataciones. Ante la persistencia de la sintomatología y la dureza de las cicatrices de la zona estenosada, se inyectó Triamcinolona D.C.I. acetónido (Trigon Depot) corticoesteroide de acción prolongada, sobre la zona de máxima fibrosis uretral, con la idea de reproducir el efecto reblandecedor que tiene sobre las cicatrices cutáneas hipertróficas y queloideas. Los tres pacientes fueron tratados con inyecciones repetidas de triamcinolona con un intervalo entre ellas de 2 a 3 meses. El periodo de seguimiento de estos pacientes oscila entre 5 y 20 meses, encontrándose todos libres de sintomatología y con un buen chorro miccional (AU)
Subject(s)
Adolescent , Male , Humans , Child , Triamcinolone Acetonide , Postoperative Complications , Urethral Stricture , Glucocorticoids , Delayed-Action Preparations , Hypospadias , Severity of Illness IndexABSTRACT
Urethral stenosis is, after the fistula, the most frequent complication in patients undergoing hypospadias repair. Incidence ranges between 6% and 10% depending on the surgical technique. Treatment of this complication with simple dilation of the narrowed segment is enough in most cases. However, dilation of the stricture may be difficult in patients with severe hypospadias that required wide dissection and excision of fibrotic tissue to repair a large deviation and also in patients who had previously multiple operations. We report 3 patients with severe hypospadias (scrotal and perineal) with history of multiple operations for that condition and postoperative urethral stenosis at different sites. All patients had periodical dilations for several months without any improvement. Surgical treatment was indicated to enlarge the stenotic segment. Enlargement was performed using oral mucosa graft in two cases and a local flap in the third one. Urethral stricture recurred in all cases very soon after the plasty and repeated dilations did not improve the symptoms. In the presence of hard scar tissue it was decided to inject triamcinolone DCI acetoide (Trigon depot), a long acting steroid, into the segment where the fibrotic narrowing was more severe, in an effort to obtain the same results reported in the treatment of hypertrophic scars and keloids. All the patients had repeated triamcinolone injections of hypertrophic scars and keloids. All the patients had repeated triamcinolone injections every 2-3 months. Follow-up ranges between 5 and 20 months and all of them are free of symptoms.
