Colgajo dorsal ancho preservador de músculo para la reconstrucción de defectos en la extremidad inferior en niños.

OBJETIVO: Evaluar los resultados estéticos y funcionales, así como el grado de satisfacción, posteriores a la reconstrucción de defectos de la extremidad inferior en niños con colgajo de dorsal ancho preservador del músculo como una alternativa para estos casos. MÉTODO: Se incluyeron pacientes menores de 18 años con defectos en la extremidad inferior tratados en un periodo de 3 años. Se realizó colgajo dorsal ancho preservador de músculo en todos los pacientes. Se valoraron la apariencia estética, la fuerza muscular del área donadora y la función en el área receptora a los 3 meses de realizado el colgajo. RESULTADOS: Se realizaron 13 colgajos de dorsal ancho preservadores de músculo. La apariencia estética de las áreas donadora y receptora fue satisfactoria en la mayoría de los casos. La mayoría de los pacientes presentaron una fuerza muscular normal (M5) en el sitio donador y pudieron deambular. CONCLUSIONES: El colgajo de dorsal ancho preservador de músculo tiene un grado de satisfacción muy elevado, excelente simetría y preservación de la función muscular del sitio donador. Es una técnica ideal en defectos tisulares importantes de la extremidad inferior en la población pediátrica. OBJECTIVE: To evaluate the aesthetic and functional outcomes as well as the degree of postoperative satisfaction of the lower limb's defects reconstruction with a muscle-sparing latissimus dorsi flap in children in order to propose this kind of reconstruction as a secure alternative. METHOD: In this study were included patients under 18 years with lower limb's defects treated over a period of 3 years. A muscle-sparing latissimus dorsi flaps was performed in all patients. After three months the flap was performed, it was evaluated the donor's area muscular strength, recipient area function and aesthetic appearance. RESULTS: They were made 13 muscle-sparing latissimus dorsi flaps. In most cases, the donor and recipient area has satisfactory aesthetic appearance, most of the patients had a normal muscular strength (M5) in donors area and were able to walk. CONCLUSIONS: The reconstruction using a muscle-sparing latissimus dorsi flap has a very high level of satisfaction, excellent symmetry, and preservation of donor area muscle function. It is an ideal technique for major tissue defects of lower limb in children.

[Case report: Rapidly growing abdominal wall giant desmoid tumour during pregnancy]. / Reporte de caso: tumor desmoides gigante de pared abdominal con rápido crecimiento durante el embarazo.

BACKGROUND: Desmoid tumours are one of the rarest tumours worldwide, with an estimated yearly incidence of 2-4 new cases per million people. They are soft tissue monoclonal neoplasms that originate from mesenchymal stem cells. It seems that the hormonal and immunological changes occurring during pregnancy may play a role in the severity and course of the disease. CLINICAL CASE: The case is presented on 28-year-old female in her fifth week of gestation, in whom an abdominal wall tumour was found attached to left adnexa and uterus while performing a prenatal ultrasound. The patient was followed up under clinical and ultrasonographic surveillance. When she presented with abnormal uterine activity at 38.2 weeks of gestation, she was admitted and obstetrics decided to perform a caesarean section. Tumour biopsy was taken during the procedure. Histopathology reported a desmoid fibromatosis. A contrast enhanced abdominal computed tomography scan was performed, showing a tumour of 26×20.5×18cm, with well-defined borders in contact with the uterus, left adnexa, bladder and abdominal wall, with no evidence of infiltration to adjacent structures. A laparotomy, with tumour resection, hysterectomy and left salpingo-oophorectomy, components separation techniques, polypropylene mesh insertion, and drainage was performed. The final histopathology report was desmoid fibromatosis. There is no evidence of recurrence after 6 months follow-up. CONCLUSIONS: Desmoid tumours are locally aggressive and surgical resection with clear margins is the basis for the treatment of this disease, using radiotherapy, chemotherapy and hormone therapy as an adjunct in the treatment.

[Case report: Occlusion and intestinal necrosis by obturator hernia]. / Reporte de caso: oclusión y necrosis intestinal por hernia del obturador.

BACKGROUND: Obturator hernia is a rare variety of abdominal hernia, it accounts for 0.07%-1.0% of all hernias, and occurs most often in women of advanced age and multiparous. CLINICAL CASE: A 78-year-old female was admitted to the Emergency Department due to nausea, vomiting, complaints of abdominal discomfort and obstipation for the last 7 days. Abdominal CT scan showed dilated small bowel loops and multiple air-fluid levels near to a small bowel loop obturator hernia, between external obturator and pectineus muscle. Emergency laparotomy was performed and during the surgery, loop of small intestine was revealed herniated into the obturator foramen, 130cm from the angle of Treitz. Necrosis of small intestine was found, without perforation. Resection of the 10cm affected jejunal segment was performed and a side-to-side bowel anastomosis was fashioned. Also simple suture closure of obturator foramen was performed. CONCLUSION: Obturator hernia is relatively rare. However physicians should keep it in mind and have clinical suspicion for obturator hernia as a cause of intestinal obstruction in female, elderly and multiparous patients in order to make an appropriate diagnosis and avoid bowel ischaemia.

[Epidemiology of gunshot wounds in the University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León]. / Epidemiología de las lesiones por proyectil de arma de fuego en el Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León.

BACKGROUND: The incidence of deaths and injuries associated with gunshot wounds deserves special attention, mainly because of its repercussions on hospital resources and the diagnosis and treatment protocols. OBJECTIVE: To perform an analysis on the epidemiological factors associated with gunshot wounds. MATERIAL AND METHODS: An analysis was made of multiple variables of all patients diagnosed with gunshot wounds during the period between 2005 and 2015. RESULTS: A total of 605 cases were found, and an additional sub-group of 314 cases was obtained for a deeper analysis. The overall mortality rate was 7.9%. The main anatomical region was the abdomen, with 44%. A total of 324 laparotomies were performed, 124 incisions of the thoracic wall, and 72 vascular examinations. In the sub-group of 314 cases, a 16.9% and 42% of laparotomies and vascular examinations, respectably, were reported without evidence of injury to internal organs. DISCUSSION: Morbidity and mortality increases when 2 or more wounds are present with multiple organ injuries, in patients with multiple transfusions, or in those transferred to the intensive care unit. CONCLUSIONS: The incorporation of a physical evaluation format by all the departments involved is suggested for patients that are attended with gunshot wounds, in order to obtain more epidemiological information of these injuries for further studies.

Bloqueo laparoscópico de plano abdominal transverso versus guiado por ultrasonido para el manejo del dolor postoperatorio en pacientes de colecistectomía laparoscópica / Transversus abdominis laparoscopic plane block versus guided with ultrasound for the management of postoperative pain in patients with laparoscopic cholecystectomy

Antecedentes: La analgesia efectiva es parte esencial en el manejo postoperatorio. Existe la necesidad de brindar técnicas de anestesia regional para minimizar el uso de opioides, y proveer una alternativa a los bloqueos regionales. Existen 2 técnicas para el bloqueo del plano transverso abdominal: la guiada por ultrasonido (BUPTA) y la laparoscópica (BLPTA), sin que actualmente se demuestre de una forma clara la superioridad de alguna de estas en la colecistectomía laparoscópica. Objetivo: Investigar los beneficios del BLPTA comparado con el BUPTA y la analgesia convencional comúnmente utilizada en pacientes que son sometidos a colecistectomía laparoscópica. Material y métodos: Se seleccionaron 45 pacientes y se dividieron en 3 grupos: 14 controles, 12 BUPTA y 19 BLPTA. Resultados: Se relacionó un mayor tiempo quirúrgico para el BUPTA (92 min) contra el BLPTA (74 min) y las convencionales (70 min). El dolor postoperatorio con el BUPTA y el BLPTA resultó ser menor comparado con el grupo control. Sin embargo, no se encontró significación estadística entre los 3 grupos. No se reportaron complicaciones durante los procedimientos quirúrgicos. Discusión: Las principales ventajas del BLPTA son la colocación bajo visión directa, el menor tiempo de aplicación y una reducción del dolor postoperatorio, siendo su principal desventaja la curva de aprendizaje que requiere. Conclusiones: El BLPTA y el BUPTA son un procedimiento efectivo para la analgesia posquirúrgica en pacientes sometidos a colecistectomía laparoscópica en comparación con la analgesia intravenosa.

Background: The effectiveness of the analgesia is essential in the postoperative management, importance exists in finding regional anesthetic techniques in order to minimize the use of opioids and promote a better alternative to regional blocks. Two techniques exist for the abdominal plane block (APB), one guided by ultrasound (UB) and the laparoscopic (LB) approach no clear benefit exists from on or the other in laparoscopic cholecystectomy patients. Objective: Determine which method results with mayor benefits in postoperative pain. Material and methods: 45 patients were selected and divided in 3 groups, control, UB and LB. Results: Longer operating times (94 min) were found for the UB group, for the LB and control group similar times were found (74 and 70 min). Less postoperative pain was found in the APB groups compared to control, however this was not statistical significance. No complications were found in the procedures. Discussion: The main advantages of the LB is infiltration under direct vision, faster learning curve and better application times. Conclusions: Both APB showed to be effective methods in the management of postoperative pain in patients postoperated of laparoscopic cholecystectomy compared to intravenous analgesia.

Reparación laparoscópica de hernia de Morgagni en un adulto: reporte de caso / Laparoscopic repair of hernia of Morgagni in adult life: case report

Antecedentes: La hernia de Morgagni (HM) es una anomalía rara que constituye el 2-5% de las todas las hernias diafragmáticas, siendo rara su evolución hasta la edad adulta. Caso clínico: Paciente masculino de 34 años que padece durante 3 años cuadros de mareos, diaforesis y disnea de leve a intermitente. En examen físico se ausculta hemitórax derecho hipoventilado. Se le realiza telerradiografía de tórax y tomografía axial computada (TAC), realizando diagnóstico de HM. Se repara quirúrgicamente mediante abordaje laparoscópico exitoso. Discusión: La HM corresponde a un defecto congénito de la cara anteromedial del diafragma, cuya presentación es infrecuente en el adulto. Comprende menos del 5% de las hernias diafragmáticas congénitas. Conclusión: Este reporte de caso confirma el concepto de la literatura sobre las ventajas conocidas del tratamiento laparoscópico de esta rara patología.

Background: Morgagni hernia (MH) is a rare anomaly that constitutes 2-5% of all diaphragmatic hernias, the evolution until adult life is rare. Clinical case: 34 year old patient who referred 3 years with mild effort dyspnea. During physical exploration right hemithorax was found with hypoventilated. Chest x-ray showed right diaphragmatic herniation. Computer tomography (CT) diagnosed Morgagni herniation. The patient was programmed for laparoscopic repair with double layer mesh and it was fixated with tackers. Discussion: Morgagni herniation corresponds to a genetical defect in the anteromedial diaphragm, this presentation is rare in adults. It represents 5% of congenital hernias. Conclusion: Laparoscopic repair takes much less time to operate, faster recovery time and less postsurgical pain with short hospital stay.