Abdominal Hypertension after Abdominal Plication in Postbariatric Patients: The Consequence in the Postoperative Recovery.

Background Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. Methods This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. Results We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m 2 ; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. Conclusion Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps.

BACKGROUND: Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported. METHODS: We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia. RESULTS: The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps. CONCLUSIONS: A better understanding of the fat layers' thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.

Repair of a complex abdominal wall defect with anterolateral thigh flap: a good surgical alternative.

INTRODUCTION: Reconstruction of the abdominal wall with major defects usually represents a surgical challenge, especially in cases where the defects are recurrent and have a large size that avoids the use of adjacent tissues for an adequate closure. According to each region the abdomen topography is divided into three regions: upper, middle and lower. Several reconstructive alternatives have been described according to the affected area of the abdomen that include the separation of the muscularis aponeurotic components of the abdominal rectus sheath, the flap of the rectus abdominus muscle with or without cutaneous island, the flap dependent on the dorsal muscle and muscular or musculocutaneous thigh flaps to reconstruct the lower area of the abdomen which is called anterolateral thigh (ALT) flap. The ALT flap has become the best option for large recurrent defects in any of the thirds due to its great versatility. CASE REPORT: We present the case of a 50-year-old patient with an abdominal wall defect, loss of domain and exposure of prosthetic material. Patient had a surgical history of open cholecystectomy, necrosectomy due to acute pancreatitis with open abdomen management and attempted repair of the abdominal defect twice with mesh placement. The abdominal wall was reconstructed with an ALT free flap with a fascia lata component with anastomosis to superior epigastric vessels in a successful manner. Nowadays patient remains without evidence of recurrence of the hernia at 1 year follow-up. DISCUSSION/CONCLUSION: The aim of this paper is to illustrate the ALT flap with a fascia lata component anastomosed to the superior epigastric vessels as a good option to reconstruct complex defects of the upper third of the abdomen.

INTRODUCCIÓN: La reconstrucción de la pared abdominal con grandes defectos suele representar un desafío quirúrgico, sobre todo cuando los defectos son recurrentes y tienen un gran tamaño que dificulta la utilización de tejidos adyacentes para un cierre adecuado. La pared abdominal anterior se divide en tres regiones para su reconstrucción; superior, media e inferior. De acuerdo con cada región se han descrito diferentes técnicas de reconstrucción de pared, como la separación de componentes musculoaponeuróticos de la vaina de los rectos abdominales, el colgajo del músculo recto abdominal con o sin isla cutánea, el colgajo dependiente del músculo dorsal ancho y colgajos musculares o músculocutáneos del muslo para reconstruir el tercio inferior del abdomen, llamado colgajo anterolateral de muslo (ALT, por sus siglas en inglés). El ALT se ha convertido en una buena alternativa para los grandes defectos recurrentes en cualquiera de los tercios debido a su gran versatilidad. CASO CLÍNICO: Presentamos el caso de un paciente de 50 años con un defecto de pared abdominal, pérdida de dominio y exposición de material protésico (malla). Tenía el antecedente quirúrgico de colecistectomía abierta, necrosectomía por pancreatitis aguda con manejo de abdomen abierto (incisión en línea media supra-infraumbilical) e intento de reparación del defecto abdominal en dos ocasiones con colocación de malla (que se encontraba expuesta). El defecto existente se desmanteló y resecó en bloque desde el interior de la pared abdominal, dejando bordes aponeuróticos sanos, quitando todo el tejido cicatricial, la malla y los bordes cutáneos enfermos. Se realizó la reconstrucción de la pared abdominal con ALT con un componente de fascia lata con anastomosis a vasos epigástricos superiores, de manera exitosa. Actualmente no hay evidencia de recurrencia del defecto herniario tras 1 año de seguimiento. DISCUSIÓN/CONCLUSIÓN: El objetivo de este trabajo es describir el ALT con componente de fascia lata con anastomosis a los vasos epigástricos superiores como una buena alternativa para reconstruir defectos de pared complejos del tercio superior del abdomen.

Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal. Reporte de un caso / Internal Hernia Strangulated by Plastron in the Distal Third of the Cecal Appendix. Case Report

Resumen Las hernias internas son causa infrecuente de obstrucción intestinal con una incidencia del 0.2-0.9%, por lo que su diagnóstico temprano representa un reto. El órgano más frecuentemente herniado es el intestino delgado, lo que confiere un gran espectro de síntomas, desde dolor abdominal ligero hasta datos de abdomen agudo1,2. Se presenta el caso de una paciente de 8 años de edad con sintomatología digestiva inespecífica; se realizó diagnóstico transoperatorio en el que se encontró hernia interna estrangulada por plastrón en el tercio distal del apéndice. Se realizó apendicectomía y a los cuatro días se dio de alta sin complicaciones.

Abstract Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen1,2. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

Dimensional Error in Rapid Prototyping with Open Source Software and Low-cost 3D-printer.

Rapid prototyping models (RPMs) had been extensively used in craniofacial and maxillofacial surgery, especially in areas such as orthognathic surgery, posttraumatic or oncological reconstructions, and implantology. Economic limitations are higher in developing countries such as Mexico, where resources dedicated to health care are limited, therefore limiting the use of RPM to few selected centers. This article aims to determine the dimensional error of a low-cost fused deposition modeling 3D printer (Tronxy P802MA, Shenzhen, Tronxy Technology Co), with Open source software. An ordinary dry human mandible was scanned with a computed tomography device. The data were processed with open software to build a rapid prototype with a fused deposition machine. Linear measurements were performed to find the mean absolute and relative difference. The mean absolute and relative difference was 0.65 mm and 1.96%, respectively (P = 0.96). Low-cost FDM machines and Open Source Software are excellent options to manufacture RPM, with the benefit of low cost and a similar relative error than other more expensive technologies.