Craniofacial Fibrous Dysplasia: Experience at San José Hospital, Bogotá, Colombia.

INTRODUCTION: Fibrous dysplasia is a disorder in which normal bone is gradually replaced by immature fibro-osseous tissue, with an incidence of less than 7% of all benign bone tumors. The management of this disease is a challenge for plastic surgeons and neurosurgeons. GOAL: To describe the diagnostic, therapeutic, and outcome approach of patients with craniofacial fibrous dysplasia seen at the Plastic Surgery Service of the Hospital San José in Bogotá, Colombia. METHODS: This is a descriptive and retrospective case series study of patients diagnosed with monostotic and polyostotic fibrous dysplasia treated at the Plastic Surgery Department of Hospital San José during the period from January 1, 2010, to July 31, 2023. RESULTS: All (n=10) of the patients had monostotic craniofacial fibrous dysplasia. The most affected bones in patients with monostotic fibrous dysplasia were zone I bones (n=10, 100%), followed by zone II bones (n=2, 20%). Patients with zone I and II involvement manifested throbbing headaches associated with phosphenes and tinnitus (n=8, 80%) and pain during occlusion associated with edema in the affected cheek (n=5, 50%). Physical examination showed that patients with orbital wall involvement (zone I bone) had ocular dystopia (n=7, 70%).Regarding the treatment received by the patients, 90% (n=9) of the patients received surgical management as primary treatment, with orbitotomy, replacement, and/or remodeling of the roof and lateral wall of the orbit with bone graft, drilling, canthoplasty, ciliary suspension being the most frequently performed procedure (n=6, 60%). Of the patients, 20% (n=2) required reintervention. CONCLUSIONS: FD is a slowly progressive benign fibro-osseous disease that requires a timely, individualized, and multidisciplinary diagnosis and treatment to obtain favorable clinical and surgical results.The mainstay of treatment is surgery as a preventive measure since it is important to avoid future functional alterations that, depending on the location of the dysplasia, would cause a high risk of alteration of adjacent structures.

Monolayer acellular dermal matrix for reconstruction of face burn: A case report.

Introduction: Facial burns constitute a severe medical and psychological challenge, dramatically affecting patients' quality of life. We present an innovative approach involving the use of a monolayer acellular matrix-specifically the INTEGRA® Dermal Regeneration Template Single Layer-to optimize skin grafting outcomes in a facial burn patient. Case report: The case revolves around a 45-year-old woman suffering a facial burn due to a clothes iron accident. Following escharectomy, dermabrasion, and homologous tissue graft placement, a monolayer acellular dermal matrix was strategically applied to the right malar area. Subsequently, we conducted a reconstruction with partial-thickness grafts. The integration of grafts with the acellular dermal matrix was seamless, absent of complications. The patient's healing process was marked by significant improvement, devoid of infections, bleeding, or any need for graft resection. Discussion: This case underscores the profound benefits of using a monolayer dermal matrix in facial burn reconstruction. Despite necessitating surgical expertise and meticulous wound preparation, this approach substantially reduced operating room time and improved clinical outcomes. This study illuminates the potential of acellular dermal matrix application in facial burn reconstruction, paving the way for further research and clinical advancements in this area.

Autologous fat grafting as a novel technique for primary essential cutis verticis gyrata.

Background: Cutis verticis gyrata (CVG) is a condition of excessive skin growth and excessive laxity of the scalp, leading to deep furrows and folds that resemble the gyri and outer surface of the brain. Approaches for the treatment of CVG range from conservative to surgical, the last one being the predominant way of treating the condition, however, the surgery proposed in the recent literature may not be suitable for patients who desire a less invasive approach. Aim: To report the first case of autologous fat injection as a novel treatment option for primary essential CVG. Methods: A 51 -year-old Colombian man, with no medical records was treated with a scalp injection of autologous fat, with previous failed treatment with pressure therapy apply directly on skin is described. Results: A successful cosmetic improvement and a less invasive approach was reached after two sessions of autologous fat grafting. Conclusion: This method allowed excellent cosmetic outcomes while preserving the option of subsequent surgical repair in refractory cases.

Negative Pressure Wound Therapy as an Artificial Leech to Save a Congestive Flap: Case Report.

Historically, patients with lower limb defects have represented a challenge for plastic surgeons because of their higher rate of complications. One of the main complications is venous congestion. Recently, various studies have suggested the use of negative pressure wound therapy as a salvage flap therapy, showing promising results. In this case report, we will outline the case of an elderly patient with different comorbidities in whom we used negative pressure wound therapy (as an artificial leech) to reverse venous congestion in the flap, with a satisfactory clinical outcome and without any more surgical procedures.

Tanning Beds, Rue, and Major Burns: An Alarming Association.

Skin contact with phytotoxic chemicals present in Ruta graveolens L. and UV light exposure might cause a nonallergic contact dermatitis known as phytophotodermatitis. We present a major burns case report associated with the use of rue (an herb used in Colombia for cultural beliefs) before entering a tanning bed. The patient presented superficial wounds that evolved to deeper ones in a phytophotodermatitis reaction that acted as a chemical burn. The patient presented an estimated percentage of total burn surface area of 85% with second-degree burns. It took two and a half months to apply multiple debridements and bandage coverage before discharge. One month later, the patient presented a dark purplish pigmentation mainly in the lower limbs. Since ancient times, rue has been used as part of medical pharmacy, insecticidal activities, and for superstitious purposes. In many countries, rue is used as part of an elixir that helps with bad luck, envy, and anguish, and the risks associated with those uses are unknown. This is a critical and alarming public health problem. Awareness of possible complications that could develop after rue and tanning beds should encourage patients and physicians to prevent and treat this dangerous combination.

Music therapy and music medicine interventions with adult burn patients: A systematic review and meta-analysis.

BACKGROUND: Pain is one of the most common and most difficult symptoms to manage in adult burn patients in the Intensive Care Unit (ICU). Insufficient or unsuccessful pain management can negatively affect physiological, psychological, and social health in burn patients, both during and after hospitalization. Music therapy and music medicine interventions have been shown to positively affect pain and mental health in this population. This systematic review and meta-analysis provide an update of Randomized Controlled Trials (RCTs) using music therapy or music medicine interventions in adult burn patients. METHODS: A variety of databases were searched from their beginning to June 2020, including PsycINFO and PsycArticles (via APAsycNET), PubMed and MEDLINE (via OvidSP), Scopus, Web of Science, and the Cochrane Library. Data of all articles meeting the inclusion criteria were extracted, organized, and processed according to the PRISMA guidelines. Statistical analysis was performed using Q-test and I2 statistics. RESULTS: 10 RCTs with a total of 1061 participants were included. The results of the meta-analysis showed a statistically significant reduction of pain (I2 = 96.03%, P < 0.001), anxiety (I2 = 98.85%, P < 0.002), and improved relaxation (I2 = 87.19%, P < 0.001) favoring music interventions compared to control groups. CONCLUSIONS: This review provides preliminary evidence for the effectiveness of music interventions for adult burn patients. However, more high-quality RCTs are needed to safely establish guidelines for music therapists and other health care professionals in using music for health purposes with this population.

The Effect of Music Therapy on Perceived Pain, Mental Health, Vital Signs, and Medication Usage of Burn Patients Hospitalized in the Intensive Care Unit: A Randomized Controlled Feasibility Study Protocol.

Background: Burn patients experience major physiological and psychological stressors during treatment and rehabilitation, including elevated levels of pain, anxiety, stress, or depression. Music interventions inclusive of music therapy (MT) have been shown to improve such symptoms, but rigorous clinical trials investigating specific music therapy methods in adult burn patients are scarce. Methods: This is a single center Randomized Controlled Trial (RCT) protocol with two parallel arms. Participants are 81 adult burn patients admitted to the Intensive Care Unit (ICU) of the University Hospital Fundación Santa Fe de Bogotá in Colombia. The intervention consists of a Music Assisted Relaxation (MAR) protocol, a music therapy technique composed of entrained live music combined with a guided relaxation and/or the use of imagery. The effects of the MAR will be compared to a control group (treatment as usual) over a period of maximum 2 weeks or six interventions. The primary outcome measure is perceived background pain, as measured with a Visual Analog Scale (VAS) before and after each intervention. Secondary outcomes are anxiety and depression levels; vital signs; and the use of pain medication. Additionally, some patients in the intervention group will be invited to participate in electroencephalography, electromyography, and electrocardiography recordings during the MAR. Discussion: This study protocol follows the SPIRIT guidelines for defining items of clinical trials and is the first study in Colombia to evaluate the effects of music therapy for adult burn patients. With this RCT it is hoped to gather new knowledge about the potential of music therapy to help critical care patients cope and recover from their injuries during the hospitalization in the ICU. Trial registration: www.clinicaltrials.gov, Identifier: NCT04571255. Protocol version: V1.0, May 24th 2021.

Effect of Negative Pressure Wound Therapy in Electrical Burns.

Electrical burns are capable of damaging cells through both thermal and nonthermal mechanisms. The complexity of these wounds, the deterioration in time, and the conversion during the first days make managing them a challenge. Negative pressure wound therapy (NPWT) is a technology that can be used as a tool to improve outcomes in patients with burns in the acute and reconstructive phases of the treatment. We describe 2 cases in which we apply this technology in electrical injuries. We present 2 cases of patients with electrical burns who underwent NPWT with instillation (NPWTi) with saline solution in the acute phase, to block the conversion of the burn and to improve the granulation tissue and in the reconstructive phase, as a tool to improve the grafts take. Both patients showed early formation of granulation tissue adequate for surgical reconstruction, and neither of them presented loss of skin grafts. In the acute phase, NPWT with instillation when applied in these patients showed fast formation of granulation tissue adequate for early reconstruction, whereas NPWT in the reconstructive phase when applied to bolster grafts showed improvements in grafts take. NPWT is a useful tool to support the surgical management of the electrical injuries during the acute phase to prepare the wound for early reconstruction and after the skin grafts reconstruction to improve the grafts take.

SenSARS: A Low-Cost Portable Electrochemical System for Ultra-Sensitive, Near Real-Time, Diagnostics of SARS-CoV-2 Infections.

A critical path to solving the SARS-CoV-2 pandemic, without further socioeconomic impact, is to stop its spread. For this to happen, pre- or asymptomatic individuals infected with the virus need to be detected and isolated opportunely. Unfortunately, there are no current ubiquitous (i.e., ultra-sensitive, cheap, and widely available) rapid testing tools capable of early detection of SARS-CoV-2 infections. In this article, we introduce an accurate, portable, and low-cost medical device and bio-nanosensing electrode dubbed SenSARS and its experimental validation. SenSARS' device measures the electrochemical impedance spectra of a disposable bio-modified screen-printed carbon-based working electrode (SPCE) to the changes in the concentration of SARS-CoV-2 antigen molecules ("S" spike proteins) contained within a sub-microliter fluid sample deposited on its surface. SenSARS offers real-time diagnostics and viral load tracking capabilities. Positive and negative control tests were performed in phosphate-buffered saline (PBS) at different concentrations (between 1 and 50 fg/mL) of SARS-CoV-2(S), Epstein-Barr virus (EBV) glycoprotein gp350, and Influenza H1N1 M1 recombinant viral proteins. We demonstrate that SenSARS is easy to use, with a portable and lightweight (< 200 g) instrument and disposable test electrodes (

New Technique for Closure of Alveolar Cleft With Umbilical Cord Stem Cells.

This article presents the case of a newly born female patient with a cleft of the primary palate (alveolar cleft), with an in utero diagnosis of the described cleft, from whom umbilical cord stem cells are obtained and cryopreserved. The patient is managed with nasoalveolar molding, and at 5 months of age, she is taken to surgery for cheiloplasty and gingivoperiostioplasty with umbilical cord stem cells. A radiographic and CT follow-up is carried out on the described cleft.

Manejo de quemaduras faciales de segundo grado con membrana amniótica preservada en glicerol 85% / Managing of second-degree facial burns with amniotic membrane preserved en 85% glycerol

Introducción y Objetivo: El 70% de los grandes quemados presentan compromiso de la cara y su tratamiento quirúrgico depende de la profundidad de la quemadura; generalmente, en las de espesor profundo se indica escisión tangencial temprana y cobertura inmediata una vez el paciente se encuentre reanimado; en las de espesor parcial se indica dermoabrasión y cobertura con diferentes agentes tópicos, apósitos sintéticos o biológicos. Sin embargo, las curaciones con agentes tópicos son dolorosas y frecuentes, y muchos de los apósitos sintéticos y biológicos son costosos y poco accesibles para algunos sistemas de salud. El objetivo de este estudio es evaluar el uso de membrana amniótica preservada en glicerol como apósito biológico temporal en el tratamiento de quemaduras faciales de segundo grado, superficial y profundo. Material y Método: Estudio descriptivo observacional prospectivo mediante serie de 53 casos consecutivos. Empleamos como cobertura temporal membrana amniótica preservada en glicerol al 85% procedente del Banco de Tejidos del Instituto Distrital de Ciencia, Biotecnología e Innovación en Salud (IDCBIS) de la Secretaría de Salud de Bogotá (Colombia), en forma expuesta, inmediatamente después de dermoabrasión mecánica en pacientes con quemaduras faciales de espesor parcial superficial y profundo. Resultados: Con una sola aplicación, sin necesidad de ningún tipo de tópicos y vendajes secundarios, los pacientes epitelizaron entre el 5 y el 10° día sin graves secuelas cicatriciales; algunos tuvieron un periodo de hospitalización superior a 10 días debido a mayor extensión con compromiso de otras áreas corporales; ningún paciente presentó infección y todos manifestaron ausencia de dolor postoperatorio. Conclusiones: El uso de membrana amniótica como apósito biológico temporal en el tratamiento de las quemaduras faciales de espesor parcial superficial y profundo es un recurso económico, efectivo y accesible en países que cuentan con disponibilidad del banco de piel. Su aplicación tras dermoabrasión evitó la realización de curaciones diarias, controló el dolor y promovió la epitelización de la zona quemada

Background and Objective: Seventy percent of the major burn patients have face burns and their surgical management depends on the depth of the burn; usually full thickness burns have to undergo early tangential excision with immediate coverage once the patient is stable and in the partial thickness facial burns the surgical management is dermoabrasion and coverage with topical agents, synthetic dressings or biological dressings. However, the dressing changes with topical agents are painful and frequent procedures and many of the synthetic and biological dressings are expensive and not available for some health systems. The aim of this study was to evaluate the use of amniotic membrane glicerol preserved 85%, as a transient biological dressing in the management of partial and total thickness facial burns. Methods: We developed an observational descriptive prospective study case series of 52 consecutive patients. We used exposed 85% glycerol preserved amniotic membrane as a transient biological coverage provided by the Science, Biotechnology and Innovation District Institute of Health (IDCBIS) of the Health Secretary of Bogotá (Colombia), without secondary dressings, immediately after mechanic dermoabrasion in patients with partial and total thickness facial burns. Results: All the patients epithelialized between the 5th and 10th day with only one application of the amniotic membrane without secondary dressings or topical agents; also the patients did not show wound healing alterations. Some patients stayed in the hospital longer than 10 days because they presented major burns. None of them presented infection and all referred absence of pain during the postoperative period. Conclusions: The use of amniotic membrane as a transient biological dressing for the treatment of partial and total thickness facial burns is an economic, effective and available tool in countries with skin banks. The use of the amniotic membrane after the dermoabrasion avoids daily wound dressing changes, decreases and controls the pain and promotes wound healing and epithelization

Mandibular Reconstruction in a Patient With Rosai-Dorfman Disease.

OBJECTIVE: The Rosai-Dorfman disease (RDD) is a rare disorder known as sinus histiocytosis with massive lymphadenopathy which affects other organs besides the lymphatic nodes. The most frequent clinical presentation is the skin involvement, but the most serious one is when the central nervous system is compromised. There are not clinical cases in the literature reporting the mandibular involvement and its management. The aim of this study is to report the case of a patient with this disease, her treatment, and her follow-up. STUDY: A 32-year-old woman with RDD, who underwent a right mandibulectomy to treat osteomyelitis, and who suffered hemolytic anemia, lymphoproliferative syndrome, and bacterial meningitis by meningococcus treated successfully, is presented. She also had osteosynthesis plate exposure in 3 occasions. The authors performed a mandibular reconstruction with a fibula free flap. Vertical osteogenic distraction was done to improve the vertical height of the bone for osteointegrated implants and later oral rehabilitation. METHODS: The senior authors performed mandibular reconstruction with a fibula free flap. Vertical osteogenic distraction was performed to improve the vertical height of the bone for osteointegrated implants and later oral rehabilitation. The patient achieved adequate function with a good mandibular height and occlusion. RESULTS: The patient had a follow-up of 6 months. She is highly satisfied with her result. Preoperative and postoperative photos are shown. DISCUSSION: In this rare case, the authors show the difficulties when treating this disease. The follow-up of the patient showed a successful reconstruction with good functional results.

New and Successful Technique for the Management of Parry-Romberg Syndrome's Soft Tissue Atrophy.

UNLABELLED: Parry-Romberg syndrome (PRS) is an infrequent, acquired disorder characterized by progressive hemiatrophy of the skin and soft tissue of the face and, in some patients, results in atrophy of muscles, cartilage, and the underlying bony structures.The disease process exhibits varying speeds of development, with onset occurring in early infancy or adolescence. Clinicians have classically reserved treatment until the end of the process. Various treatment modalities have been attempted with differing results. Described treatments include free tissue transfer (omentum, rectus, latissimus, serratus, diep, scapula, and parascapular), pedicled flaps, autologous tissue (dermis-fat, bone and cartilage, and fat), and biomaterials (silicone, polyethylene, and Alloderm).In this article, the authors present a patient of Parry-Romberg syndrome in a young boy who had undergone a free flap previously, which failed to fill the atrophy of the right hemifacial soft tissues. The authors used Integra, which is a bilayer porous matrix of cross-linked bovine tendon collagen and glycosaminoglycan, and a semipermeable polysiloxane (silicone layer) and fat grafts enriched with Harvest PRP, to produce volume and symmetric contour on the affected side. The patient had a follow up of 2 years with excellent esthetic and functional results. OBJECTIVE: The authors present a technique of volume replacement in patients with hemifacial atrophy because of Parry-Romberg syndrome, which has never been reported before in the international literature. STUDY: Microsurgical reconstruction is considered the gold standard to restore facial symmetry. Given a free flap morbidity and risk of complications, some patients opt for less extensive procedures. The authors present the case of a 12-year-old boy with a history of Parry-Romberg syndrome with resultant right hemifacial atrophy. Consistent with the usual pattern of atrophy, the onset of the patient's disease began at the age of 5 years. METHODS: The senior authors used a combination of a stacked Integra cheek implant and fat grafts enriched with Harvest PRP to produce volume and symmetric contour on the affected side. The patient was discharged home the next day after the surgical procedure from the recovery room, without complications. RESULTS: The patient was followed for 2 years. He has had no complications and maintains an excellent symmetric result. The patient is highly satisfied with his result and has not required any further surgery. Preoperative and postoperative photos at year of follow up are presented. DISCUSSION: Less invasive treatment options exist for hemifacial atrophy from Parry-Romberg syndrome.

Unusual Dermatological Manifestations of Gout: Review of Literature and a Case Report.

BACKGROUND: Gouty panniculitis is a rare clinical manifestation of gout, characterized by deposits of monosodium urate crystals in the hypodermis. Our aim was to describe atypical and rare clinical presentations of gouty tophi. METHODS: We searched relevant English and Spanish literature of unusual gout manifestations using the following keywords: giant, gout, panniculitis, gouty panniculitis, gouty tophi, rare manifestations of gout, gouty, tophi, tophus, monosodium urate, uric acid, and unusual. Well-described case reports, case series, and review articles were evaluated and included in the literature review. RESULTS: International literature has reported fewer than 10 cases of gouty panniculitis worldwide. In this case report, the patient presents a rare manifestation of gouty panniculitis, with typical joint injuries, gouty tophi in both lower and upper extremities, chronic gouty tophi in the nose, for which only 3 cases have been reported in literature, and great hypertrophy of adipose tissue in the lower back. CONCLUSIONS: Tophi can be found in atypical locations, which increase morbidities and deformities caused by the disease. We report an interesting case of gouty panniculitis associated with great hypertrophy of the adipose tissue, a rare manifestation of gout, and unusual locations of tophi. These clinical manifestations in our patient have not been recorded before, which leads us to think that we are in the presence of a new dermatological manifestation of gout.

Prevalence of Obstructive Sleep Apnea After Orticochea Pharyngoplasty for Velopharyngeal Insufficiency Management.

BACKGROUND AND PURPOSE: The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with velopharyngeal insufficiency after at least 1 year of the surgical procedure. DESIGN: Case series prospective descriptive study. MAIN OUTCOME MEASURES: At FISULAB, a rehabilitation center for patients with cleft palate, we studied 37 patients who were treated elsewhere with Orticochea pharyngoplasty for velopharyngeal insufficiency; these patients may or may not have had clinical symptoms related to OSA. All participants underwent a polysomnography sleep study, which was also done in different institutions. We applied the Epworth Sleepiness Scales during the clinical investigation because it is an effective instrument used to measure average daytime sleepiness. Another questionnaire to identify cases of OSA was used. Among other variables studied, the apnea/hypopnea index was the main outcome, while age and type of cleft were secondary variables. RESULTS: From 37 patients who were studied (100%), we obtained the following results: normal apnea/hypopnea index: seven patients (18.9%); mild apnea/hypopnea index: 14 patients (37.8%); moderate apnea/hypopnea index: eight patients (21.6%); and severe apnea/hypopnea index: eight patients (21.6%). CONCLUSIONS: In this study, we found that more than three quarters (81%) of the patients who were treated for velopharyngeal insufficiency with Orticochea pharyngoplasty presented obstructive sleep apnea when analyzing the apnea/hypopnea index in the polysomnography sleep study.

Sphenoid sinus and sphenoid bone fractures in patients with craniomaxillofacial trauma.

Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.