Reconstrucción mamaria postmastectomía. Análisis y resultados en un hospital de tercer nivel en México / Postmastectomy breast reconstruction. Analysis and outcome in a tertiary care hospital in Mexico

Introducción y Objetivo: El tratamiento de las neoplasias mamarias así como de ciertos padecimientos benignos requieren, en muchos casos, una mastectomía unilateral o bilateral con resección de la piel, glándula mamaria y complejo pezón-areola. La reconstrucción mamaria es una parte importante del tratamiento multidisciplinario para lograr la reintegración de las mujeres a una vida normal. El objetivo de nuestro estudio fue reportar los resultados de los diferentes tipos de reconstrucción mamaria en pacientes con cáncer de mama, así como otros padecimientos benignos, en un hospital de alta especialidad del Occidente de México. Material y Método: Serie de casos en la que incluimos pacientes sometidas a reconstrucción mamaria entre el 1 enero de 2006 y el 31 de diciembre de 2012 con diferentes procedimientos, evaluando el tipo de cirugía inicial, tipo de reconstrucción, procedimientos complementarios y morbilidad. El seguimiento de las pacientes fue de 24 meses. Resultados: Recogimos 170 pacientes con un promedio de edad de 46.12 ± 8.2 años. Las técnicas más utilizadas fueron: reconstrucción con implante expansor tipo Becker (48.8%), expansor tisular (11.2%), colgajo miocutáneo de recto abdominal transverso (8.8%), implantes definitivos (8.8%) y reconstrucción con dorsal ancho más implante o expansor (8.8%). Se presentaron complicaciones en 20 pacientes (11.8%). Conclusiones: Nuestros resultados son satisfactorios ya que la morbilidad temprana y tardía son aceptables, pero, perfectibles. Con el advenimiento de extensas campañas de detección oportuna esperamos aumentar los procedimientos conservadores por cirugía temprana y los procedimientos oncoplásticos durante la mastectomía sin necesidad de esperar periodos prolongados para la reconstrucción

Background and Objective: Treatment of mammary neoplasms as well as certain benign conditions require, in many cases, a unilateral or bilateral mastectomy with resection of the skin, the mammary gland and the nippleareola complex. Breast reconstruction is an important part of the multidisciplinary treatment to achieve the reintegration of women into a normal life. The aim of our study was to report the results of the different types of breast reconstruction in patients with breast cancer as well as other benign conditions in a highly specialized hospital in Western Mexico. Methods: Case series of patients undergoing breast reconstruction from 1 January 2006 to 31 December 2012 were included with different procedures evaluating the type of initial surgery, type of reconstruction, complementary procedures and morbidity. The follow-up of the patients was 24 months. Results: One hundred and seventy patients were included. The average age was 46.12 ± 8.2 years. The most used techniques were: reconstruction with expander Becker type implant (48.8%), tissue expander (11.2%), transverse rectus abdominus mucocutaneous flap (8.8%), definitive implants (8.8%) and wide dorsal reconstruction plus implant or expander (8.8%). Complications occurred in 20 patients (11.8%). Conclusions: Our results are satisfactory, since early and late morbidity are acceptable, but, perfectible. With the advent of extensive early detection campaigns, we hope to increase conservative procedures for early and oncoplastic procedures during mastectomy, without the need to wait for long periods for reconstruction

Bone regeneration in mandibular fractures after the application of autologous mesenchymal stem cells, a randomized clinical trial.

BACKGROUND/AIM: Facial injury in adults can commonly result in fractures of the mandible. Autologous mesenchymal stem cells (AMSCs) transplantation is proposed as an alternative to conventional graft treatment to improve bone regeneration. The aim was to evaluate the effectiveness of AMSCs application in mandibular fractures to reduce regeneration time and increase bone quality. MATERIALS AND METHODS: This study was a single-blind controlled clinical trial conducted in patients with mandibular angle fractures. Patients were divided into two groups: study group fracture reduction plus application of AMSCs and control group only fracture reduction. AMSCs were obtained from adipose tissue 24 h before the procedure. Intensity and density were evaluated in normal bone and fractured bone at 4 and 12 weeks after surgery using panoramic radiography and computed tomography. RESULTS: A total of 20 patients, 10 in each group, were included. The study group had a mean age of 31.2 ± 6.3 years, and the control group mean age was 29.7 ± 7.2 years. All patients were male. Bone quality measured in grey levels at week 4 was 108.82 ± 3.4 vs 93.92 ± 2.6 (P = 0.000) using panoramic radiography and 123 ± 4.53 vs 99.72 ± 5.72 (P = 0.000) using computed tomography. At week 12, the measurements were 153.53 ± 1.83 vs 101.81 ± 4.83 (P = 0.000) using panoramic radiography and 165.4 ± 4.2 vs 112.9 ± 2.0 (P = 0.000) using tomography in the study and control groups, respectively. CONCLUSION: Similar ossification values were obtained after 4 weeks when the use of AMSCs was compared to simple fracture reduction. However, after 12 weeks, the AMSCs group had a 36.48% higher ossification rate.

Effect of surgically removing subcutaneous fat by abdominoplasty on leptin concentrations and insulin sensitivity.

The aim of this study was to identify the effect of surgically removing subcutaneous fat by abdominoplasty on leptin concentrations and insulin sensitivity. An open clinical trial with a noninterventional parallel group was carried out in 12 obese women. After randomization, 6 volunteers were selected for abdominoplasty, and the other 6 women were considered as the noninterventional group. A metabolic profile, including leptin concentrations, and insulin tolerance test to assess insulin sensitivity were performed on all volunteers before intervention or nonintervention and 40-50 days afterward. A significant reduction in body mass index (30.7 +/- 0.9 versus 29.6 +/- 0.7 kg/m; P = 0.02) and in leptin concentrations (41.3 +/- 10.6 versus 32.0 +/- 10.2 ng/mL; P = 0.02) was observed after abdominoplasty. Insulin sensitivity did not change after intervention. In conclusion, surgically removing subcutaneous fat by abdominoplasty decreased leptin concentrations, with no change in insulin sensitivity.

[Variation of intraabdominal pressure caused by abdominoplasty in healthy women]. / Variación de la presión intraabdominal causada por abdominoplastia en mujeres sanas.

OBJECTIVE: To study pressure changes of the abdominal compartment during abdominoplasty in healthy women. PATIENTS AND METHODS: A prospective cohort of 14 women between 30 and 57 years old, who underwent abdominoplasty for aesthetic purposes wer included in this study. All patients were free of any associated medical disorder with a body mass index less than 30 kg/m2. The surgical procedure consisted of the plication of internal borders of the abdominal anterior rectal muscles with non absorbable sutures. Lipectomies were performed according to the flap shape and were sutured in two planes. Abdominal pressure was indirectly measured through the urinary bladder (Kron's technique). before the surgical procedure, after the plication of the aponeurotic muscle plane and after the adipocutaneous flap closure. A full written agreement was obtained from all patients before the surgical procedure. RESULTS: Average age was 39.5+/-8.06 years. The anterior rectal muscle diastasis was 6.2+/-2.17 cm and the plicature 8.0+/-2.0 cm. The basal pressure was 0.1+/-0.3 mm Hg, whereas, after the plication it increased to 4.9+/-0. 7 mm Hg. An intraabdominal pressure was of 6.56+/-1.1 mm Hg was found after the adipocutaneous closure the A significant statistical difference (p < or = 0.001) was found. We did not observe any pulmonary complication during the first 30 days following the surgical procedure. CONCLUSIONS: In our series, the closure of the adipocutaneous flaps increased the intraabdominal pressure 31%, but no pulmonary complication was observed during the follow-up period. Since intraabdominal pressure above 10 mm Hg induces hemodynamic changes and lung restriction, the increment produced after the adipocutaneous closure should be considered to prevent morbidity associated to intraabdominal hypertension.