[Reduction of lymphatic drainage posterior to modified radical mastectomy with the application of fibrin glue]. / Reducción del drenaje linfático posterior a mastectomía radical modificada con la aplicación de gel de fibrina.

OBJECTIVE: Our objective was to investigate the effectiveness of fibrin glue to reduce hemato-lymphatic fluid production after modified radical mastectomy (MRM) in women with breast cancer. MATERIAL AND METHODS: A total of 43 women treated surgically were randomly assigned to receive 10 ml of fibrin glue at the end of the breast resection plus closed suction drains (n = 22), or drain system only as a control group (n = 23). Outcome variables were fluid collected in the drainage system measured each 24 h. Drains were removed when a 50 ml output per day was obtained. Seroma formation and flap complications were also investigated. RESULTS: The average age was 48.36 +/- 8.9 years for the study group and 52.87 +/- 9.74 years for the control group (p = 0.11). Body mass index (BMI) ranged between 22 and 35 kg/m2: 28.1 +/- 2.7 vs. 29.92 +/- 4.0 kg/m2 (p = 0.27). A reduction of the fluid drained was observed from the first postoperative day in the study group in contrast with the control (174.55 +/- 64.69 vs. 281.22 +/- 116.91, p = 0.001). A correlation between the BMI and the exposed surgical area was also statistically significant (p < 0.002), as well as the day the drains were extracted (p < 0.05). The incidence of seroma formation was 9% in the study group and 34.78% in the control, a statistically significant finding (p < 0.05). CONCLUSIONS: Fibrin glue locally applied to the surgical wound under the flap and axilla significantly reduced the amount and duration of lymphatic fluid produced after MRM with axillary dissection. Also, a significant reduction in the incidence of seromas was observed.

[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.

Clinical experience using the dorsal reverse metacarpal flap for the treatment of congenital syndactyly: report of four cases.

Skin grafts and local flaps are conventional methods of repair for simple complete syndactyly, but the results obtained are not always as functional and aesthetic as desired and frequently leave postoperative scars and residual syndactyly. In this article, we describe a new surgical technique for the correction of syndactyly that utilizes a metacarpal dorsal reverse flap to provide skin coverage to the interdigital space and also to 1 side of the finger, therefore avoiding the use of skin grafts and resulting postoperative scar contracture. We report 4 cases using this procedure, with a 12-month follow up. The technique is safe, easily performed, and reproducible and requires a single surgical procedure. It uses donor tissue identical in color, texture, and thickness, which renders acceptable cosmesis and good hand function.