Reconstrucción del pene oculto del adulto: experiencia en un mismo centro / Adult Buried Penis Reconstruction: a single center experience

Introducción. El pene oculto del adulto se presenta como una patología con prevalencia en ascenso, por el incremento de pacientes obesos y diabéticos. Representa un desafío para la reconstrucción en cirugía plástica y urología. El objetivo de este trabajo es describir la experiencia del Hospital Alemán de Buenos Aires en la resolución quirúrgica de esta patología. Métodos y resultados. Durante el año 2019 se realizaron dos cirugías reconstructivas de pacientes con pene oculto del adulto a cargo del Servicio de Cirugía Plástica del Hospital, en conjunto con el Servicio de Urología. El procedimiento fue segmentado en tres partes: Liberación del cuerpo peneano del panículo adiposo, dermolipectomía suprapúbica, y finalmente injerto del pene con piel de espesor total. El tiempo promedio de cirugía fue de 4 horas, sin complicaciones intraoperatorias. En ambos casos hubo prendimiento parcial del injerto, con la necesidad de tratamiento tópico con crema de colagenasa para estimular la cicatrización por segunda intención. La satisfacción funcional de los pacientes fue del 100% en ambos casos; la satisfacción estética fue incompleta. La recuperación de la erección y la función sexual fue completa para ambos. Conclusiones. La reconstrucción del pene oculto del adulto implica el trabajo multidisciplinario sobre una patología con resolución quirúrgica, con buenos resultados funcionales, aunque no exento de complicaciones estéticas.

Introduction. Adult buried penis represents a disease with increasing prevalence, after the ascending incidence of obese and diabetic patients. It represents an urologic and plastic surgery challenge. The aim of this paper is to describe the experience of German Hospital in Buenos Aires on the surgical resolution of this pathological entity. Methods and results. During year 2019 two adult buried penis surgeries were held by the Plastic Surgery service, with participation of the Urology service. The procedure was divided in three steps: Release of the penis from the adipose panicle; suprapubic dermolipectomy; and finally full-thickness skin graft on the penis body. The average surgery time was four hours. In both cases there was partial intake of the skin graft, which needed collagenase topical treatment to stimulate second intention healing. Functional satisfaction was 100% in both cases; aesthetical satisfaction was incomplete. Recovery of penile erection and sexual function was complete in both cases. Conclusions. Adult penis reconstruction implies an interdisciplinary work on a surgically correctable anomaly, with good functional results, although not exempt of aesthetical complications

Reconstrucción palpebral inferior mediante colgajo de periostio y colgajo de Mustardé / Lower palpebral reconstruction by periosteum flap and Mustardé flap

Paciente masculino de 68 años con carcinoma basocelular lobulado recidivado en inferior izquierdo con colgajo de Hughes hace 5 años y posterior recidiva al siguiente año con escisión en cuña. Actualmente, con una segunda recidiva, se realiza una resección amplia del 75% del total del párpado cuya congelación informa márgenes libres, reconstruido en el mismo acto quirúrgico: la lamela posterior con colgajo pediculado de periostio y la anterior con un colgajo de Mustardé. El paciente evoluciona con un buen sostén y posición palpebral, sin recurrencia del tumor.

A 68-year-old man with recurrent lobulated basal cell carcinoma of the left lower eyelid. She has a history of reconstruction of the lower left eyelid with Hughes flap 5 year sago and later recurrence the following year with wedge excision. Currently, with a second recurrence, resection was performed under frozen section technique and the defect of 75% width free of tumor, is reconstructed in the same surgical act: the posterior lamella with a pedicled periosteal flap and the anterior with a Mustardé flap. One year follow-up, the patient evolves with good support and eyelid position, without recurrence of the tumor.

Antiseptic-impregnated central venous catheters: their evaluation in burn patients.

Central venous catheter-related infections are an important source of morbidity and mortality in burn patients. Antiseptic impregnated catheters have been recommended to prevent infections related to central venous lines in high-risk patients who require short-term catheters. This prospective, randomized, and controlled study compared the efficacy of standard and antiseptic devices in reducing catheter-related infections in burn patients. Twenty-two patients were included in the study with an average age of 47.6 yr and an average burned total body surface area of 38.7%. Thirty-eight silver-sulphadiazine, chlorhexidine catheters were compared with 40 non-antiseptic catheters. No differences in bacteraemia or colonization rates were observed between standard and antiseptic-coated catheters. Antiseptic catheters were more effective in reducing S. epidermidiscolonization than standard catheters (4% vs 31%, p < 0.01). However, Gram-negative bacilli were responsible more often than Gram-positive cocci for catheter tip colonization (53% vs 46%) and they were responsible for all the bacteraemias (5.1%) related to catheters in the present study. We conclude that antiseptic-impregnated catheters could be more effective for Gram-positive cocci and could therefore be less effective in patients with high Gram-negative bacilli bloodstream infection prevalence, as burn patients are.

Peri-Operative Bacteraemia in Burn Patients. What Does it Mean?

Bacteraemias during burn wound manipulation are frequent, especially following burn wound excision. However, these bacteraemias seem not to have any clinical consequences, and their treatment is therefore controversial. Over a 20-month period 35 surgical debridement procedures were recorded prospectively in 18 burn patients. Blood culture samples were drawn before, during, and after surgical excision. Bacteraemias were found in ten out of the 35 patients (28%), and 16 of the 105 blood samples (15%) were positive. All three blood samples were positive in one case ("primary bacteraemia"), while others were "transient bacteraemia". Six positive blood cultures were considered to be "bacteraemias induced by wound manipulation" and seven "bacteraemias of unknown source". Bacteraemias of unknown source were not recorded at any time while "bacteraemias induced by wound manipulation" were recorded after day 5 post-burn. Patients with more than 40% TBSA had 4.3 times more bacteraemic risk than patients with less extensive TBSA. Blood pressure and white blood cell variations were observed in bacteraemic patients but without any clinical relevance. We conclude that bacteraemic rates were high and that there were two different patterns of bacteraemia- both transient and with no clinical relevance.

Pulsed electromagnetic fields in experimental cutaneous wound healing in rats.

Electromagnetic fields are now being used in many diseases such as osseous, ligamental, cartilaginous, or nervous reparation, diabetes, and myocardial or cerebral ischemia. Although many publications show the usefulness of magneto-therapy, discrepancies exist about the utility of electromagnetic fields in skin wound healing. The objective of this work was to study the effect of pulsed electromagnetic fields on wound healing in rats. Twenty-two male Wistar rats were used; a circular lesion was made in the back of each animal. They were divided into three groups: group C (control) with sham treatment (n = 8), group NF, treated with topical nitrofurazone solution (n = 7), and group PEMF, treated with pulsed electromagnetic fields of 20 mT (n = 7). The treatments were 35 minutes twice a day. The absolute and relative values of the area and perimeter of the wounds showed significantly lower values in the PEMF group at days 7, 14, and 21 compared with those in group C (p < 0.01, analysis of variance), whereas the PEMF group showed significantly lower values at day 21 only compared with the NF group (p < 0.01, analysis of variance). The results suggest a significant beneficial stimulation in the wound healing process in rats treated with PEMF, which could lead to the development of a practical tool for research and clinical use.

[Effect of magnetic fields on skin wound healing. Experimental study]. / Efecto de campos magnéticos sobre la cicatrización de la piel estudio experimental.

Although there are many publications on the usefulness of magneto-therapy, discrepancies exist about the utility of electromagnetic fields in skin wound healing. The objective of this work was to study the effect of electromagnetic fields on wound healing in rats. Thirty six male Wistar rats were used; a rectangular lesion was made in the back of each animal (4.2 cm x 2.3 cm). They were divided into 3 groups: group C (control) with sham treatment; group C50, treated with continuous electromagnetic fields of 5 mT (50 Gauss) and group P200, treated with pulsed electromagnetic fields of 20 mT (200 G). The treatments were of 30 minutes a day during 21 days. The corporal weights (Table 1) and the wound longitudinal and transversal maximal axis (Figures 1, 2) were weekly recorded and the data was evaluated by analysis of variance. On day 14, the P200 group showed the maximal longitudinal axis which was smaller than that of group C (p < 0.01). On day 21 in both treated groups the maximal longitudinal axis was smaller than that of group C (p < 0.01); besides the axis was smaller in the P200 group than in the C50 group (p < 0.05). No statistical differences were observed in the remaining data. The results showed a facilitating effect of electromagnetic fields on wound healing in rats. Pulsed electromagnetic fields seem to have a precocious and larger healing effect than continuous electromagnetic fields.