Transferencias tendinosas en síndrome interóseo posterior evolucionado. Análisis de un caso y revisión bibliográfica / Tendon transfer in advanced posterior interosseous nerve syndrome. Case report and bibliographic review

El síndrome interóseo posterior es una neuropatía compresiva poco frecuente, de etiología variable, dentro de la que se reconocen causas tumorales, inflamatorias, alteraciones anatómicas como la hipertrofia de la arcada de Frohse, luxaciones radiocubitales e idiópática. El tratamiento quirúrgico mediante neurolisis tiene altas tasas de éxito con remisión de la sintomatología, siendo poco frecuente la necesidad de realización de transferencia tendinosa. Revisamos la bibliografía de los últimos 15 años, encontrando solo 4 artículos que comentan las trasferencias tendinosas. Presentamos un caso de síndrome interóseo posterior severo y evolucionado en el que se realiza neurolisis y transferencias tendinosas en el mismo acto, con buenos resultados

Posterior interosseous syndrome is a rare compressive neuropathy, with variable etiology, such as tumors, inflammatory disease, anatomical alterations, hypertrophy of Frohse arcade, radiocubital dislocations and idiopathic. Surgical treatment has high rates of success in symptom remission. Need of performing tendon transfer is rare. We carried out review of bibliography of last 15 years, finding only 4 publications in this regard. In this paper we present a clinical case of sever and evolved posterior interosseous syndrome in whom neurolisis and tendon transfer were performed in the same act; acceptable outcomes were obtained

Colgajos locorregionales para defectos complejos de pierna y pie: uso actual en hospitales públicos de Montevideo, Uruguay / Locoregional flaps for complex leg and foot defects: valid options in public hospitals of Montevideo, Uruguay

INTRODUCCIÓN Y OBJETIVO: Las heridas complejas de pierna y pie representan un desafío para la Cirugía Plástica, más aún cuando se asocian a fracturas expuestas dada la escasa disponibilidad de tejido local y regional. En estos casos suele plantearse la indicación de colgajos microquirúrgicos. En nuestro medio, donde la infraestructura aún está en desarrollo y no siempre se cuenta con equipamiento, horas de bloque quirúrgico para cirugías prolongadas, personal de enfermería capacitado, y hay poca colaboración de los pacientes para la recuperación, es frecuente optar por colgajos fasciocutaneos y musculares pediculados para la reconstrucción de estos defectos a pesar de que también esté indicado un colgajo libre. El objetivo de este trabajo es mostrar nuestra experiencia en hospitalespúblicos de Montevideo, Uruguay, en reconstrucción de pierna y pie utilizando colgajos locorregionales con buenos resultados y tiempo de recuperación aceptable. MATERIAL Y MÉTODO: Realizamos un estudio descriptivo retrospectivo de 7 casos de diferentes opciones terapéuticas de colgajos locorregionales fasciocutáneos y musculares para cobertura de diferentes defectos complejos de pierna y pie, en el Hospital de Clínicas y en el Instituto Nacional de Ortopedia y Traumatología de Montevideo. Seleccionamos los casos dentro de las etiologías más frecuentes de heridas en esta topografía que requieren reconstrucción por Cirugía Plástica y representan el modelo de colgajo realizado en cada tipo de herida descrito (topografía, tamaño y tejidos expuestos). RESULTADOS: Presentamos 7 pacientes de entre 21 y 80 años de edad, en los que se realizaron colgajos musculares de gemelo interno, externo, hemitríceps, hemitríceps con tibial anterior, hemisoleo, fasciocutáneo de transposición y fasciocutáneo en isla sural. Los resultados fueron aceptables en cuanto a ausencia de complicaciones de los colgajos, no necesidad de revisiones y tiempo de recuperación de 2 a 6 meses. CONCLUSIONES: Los colgajos locorregionales descritos proporcionan cobertura satisfactoria en defectos complejos de pierna y pie cuando los colgajos microquirúrgicos, aún estando indicados, no pueden realizarse por déficit de material, infraestructura o personal de la salud, así como por falta de colaboración del paciente para la recuperación. Las opciones planteadas pueden formar parte del algoritmo terapéutico en centros que comparten la misma epidemiología y recursos que los nuestros

BACKGROUND AND OBJECTIVE: Complex leg and foot wounds represent a challenge for Plastic Surgery, and even more so when they are associated with exposed fractures, given the limited availability of local and regional tissue. In these cases, the indication of microsurgical flaps is usually considered. In our environment, where the infrastructure is still under development and equipment is not always available, neither hours of surgical block for prolonged surgeries, trained nursing personnel, added to the little collaboration of patients for recovery, it is frequent to opt for fasciocutaneous flaps and pedicled muscle flaps for reconstruction, even though a free flap is also indicated. The objective of this paper is to show our experience in public hospitals in Montevideo, Uruguay, in leg and foot reconstruction using locoregional flaps, with good results and acceptable recovery time. METHODS: We performed a retrospective descriptive study, in which 7 cases of different therapeutic options were described within the fasciocutaneous and muscular locoregional flaps to cover different complex leg and foot defects, from the Hospital de Clínicas and Instituto Nacional de Ortopedia y Traumatología in Montevideo, Uruguay. The cases were selected within the most frequent etiologies of wounds in this topography that require reconstruction by Plastic Surgery, and represents the flap model performed in each type of wound described (topography, size, exposed tissues). RESULTS: We present 7 patients between 21 and 80 years of age, in whom internal, external twin muscle flaps, hemitriceps, hemitriceps with anterior tibial, hemisoleous, transpositional fasciocutaneous, fasciocutaneous in sural island flaps were performed. The results were acceptable in terms of the absence of flap complications, the lack of flap reviews and based on the recovery time from 2 to 6 months. CONCLUSIONS: The locoregional flaps described provide satisfactory coverage in complex leg and foot defects when the microsurgical flaps, even when indicated, cannot be performed due to deficits in material, infrastructure or health personnel, as well as due to patient's lack of collaboration in recovery. The options proposed may be part of the therapeutic algorithm in centers that share the same epidemiology and resources as ours

The effect of completeness of revascularization on event-free survival at one year in the ARTS trial.

OBJECTIVES: We sought to assess the relationship between completeness of revascularization and adverse events at one year in the ARTS (Arterial Revascularization Therapies Study) trial. BACKGROUND: There is uncertainty to what extent degree of completeness of revascularization, using up-to-date techniques, influences medium-term outcome. METHODS: After consensus between surgeon and cardiologist regarding the potential for equivalence in the completeness of revascularization, 1,205 patients with multivessel disease were randomly assigned to either bypass surgery or stent implantation. All baseline and procedural angiograms and surgical case-record forms were centrally assessed for completeness of revascularization. RESULTS: Of 1,205 patients randomized, 1,172 underwent the assigned treatment. Complete data for review were available in 1,143 patients (97.5%). Complete revascularization was achieved in 84.1% of the surgically treated patients and 70.5% of the angioplasty patients (p < 0.001). After one year, the stented angioplasty patients with incomplete revascularization showed a significantly lower event-free survival than stented patients with complete revascularization (i.e., freedom from death, myocardial infarction, cerebrovascular accident and repeat revascularization) (69.4% vs. 76.6%; p < 0.05). This difference was due to a higher incidence of subsequent bypass procedures (10.0% vs. 2.0%; p < 0.05). Conversely, at one year, bypass surgery patients with incomplete revascularization showed only a marginally lower event-free survival rate than those with complete revascularization (87.8% vs. 89.9%). CONCLUSIONS: Complete revascularization was more frequently accomplished by bypass surgery than by stent implantation. One year after bypass, there was no significant difference in event-free survival between surgically treated patients with complete revascularization and those with incomplete revascularization, but patients randomized to stenting with incomplete revascularization had a greater need for subsequent bypass surgery.