Nocardiosis linfocutánea por Nocardia brasiliensis en un paciente inmunocompetente / Primary lynphocutaneus nocardiosis by Nocardia brasiliensis in an immunocompetent patient

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[Minimally invasive breast surgery. Breast reconstruction using pure muscular latissimus dorsi flap]. / Cirugía mamaria mínimamente invasiva: reconstrucción mamaria mediante colgajo muscular puro del gran dorsal.

INTRODUCTION: Minimally invasive surgical techniques have extended to all the fields of surgery. Breast surgery can also benefit from these concepts because of their special characteristics, reduction of aggressiveness, avoiding or hiding scars. The aim of our work is to introduce a new surgical approach for the resection of a large volume of breast parenchyma, including complete subcutaneous mastectomy and reconstruction using a pure muscular latissimus dorsi flap, with or without prosthetic material, through a minimal cutaneous incision. PATIENTS AND METHOD: Retrospective analysis of our series of 5 cases using our surgical technique which allows us to establish proper indications. We analyse the technical details, complications and results. RESULTS: Five patients were operated using this technique (1 giant hamartoma, 1 multicentred in situ carcinoma with Paget's disease, 1 multicentred infiltrating carcinoma and 2 malignant tumours arising in the external part of the breast). We performed oncological resections (2 partial resections and 3 complete subcutaneous mastectomies) including sentinel lymph node biopsy or total axillary lymphadenectomy. After a mean follow-up of 10 months no local relapses were found and the cosmetic results were excellent. CONCLUSIONS: Minimally invasive surgical techniques through a posterior axillary line vertical incision enable total or partial subcutaneous mastectomy and a breast reconstruction, using muscular flaps or prosthetic material, to be performed.

Cirugía mamaria mínimamente invasiva: reconstrucción mamaria mediante colgajo muscular puro del gran dorsal / Minimally invasive breast surgery. Breast reconstruction using pure muscular latissimus dorsi flap

Introducción. Las técnicas mínimamente invasivas se han extendido a todos los campos de la cirugía, la cirugía mamaria es quizá la cirugía que más se debería beneficiar de estos conceptos, por sus características especiales, reduce la agresión quirúrgica y elimina u oculta cicatrices. El propósito de nuestro trabajo es presentar una nueva técnica quirúrgica para la resección de grandes volúmenes de tejido mamario, incluida la mastectomía subcutánea completa, y reconstrucción mediante un colgajo del músculo gran dorsal con o sin material protésico, a través de una mínima incisión cutánea. Pacientes y metodo. Análisis retrospectivo de nuestra serie de 5 casos clínicos intervenidos con esta técnica, que nos ha permitido ponerla a punto y establecer las indicaciones. Analizamos los detalles técnicos, las complicaciones y los resultados. Resultados. Hemos intervenido a 5 pacientes mediante esta técnica quirúrgica (1 con hamartoma gigante, 1 con carcinoma in situ multicéntrico con enfermedad de Paget, 1 con tumor mamario maligno multicéntrico y 2 con tumoraciones malignas únicas de cuadrantes externos) practicando resecciones oncológicas suficientes (2 resecciones parciales mamarias y 3 mastectomías subcutáneas) e incluían biopsia de ganglio centinela o linfadenectomía axilar completa. Tras un período de seguimiento medio de 10 meses no ha habido recidivas locales y el resultado estético es excelente. Conclusiones. La técnica mínimamente invasiva, a través de una incisión vertical en línea axilar posterior, permite realizar una resección mamaria parcial o completa, así como una reconstrucción inmediata mediante tejido autólogo o material protésico (AU)

Introduction. Minimally invasive surgical techniques have extended to all the fields of surgery. Breast surgery can also benefit from these concepts because of their special characteristics, reduction of aggressiveness, avoiding or hiding scars. The aim of our work is to introduce a new surgical approach for the resection of a large volume of breast parenchyma, including complete subcutaneous mastectomy and reconstruction using a pure muscular latissimus dorsi flap, with or without prosthetic material, through a minimal cutaneous incision. Patients and method. Retrospective analysis of our series of 5 cases using our surgical technique which allows us to establish proper indications. We analyse the technical details, complications and results. Results. Five patients were operated using this technique (1 giant hamartoma, 1 multicentred in situ carcinoma with Paget's disease, 1 multicentred infiltrating carcinoma and 2 malignant tumours arising in the external part of the breast). We performed oncological resections (2 partial resections and 3 complete subcutaneous mastectomies) including sentinel lymph node biopsy or total axillary lymphadenectomy. After a mean follow-up of 10 months no local relapses were found and the cosmetic results were excellent. Conclusions. Minimally invasive surgical techniques through a posterior axillary line vertical incision enable total or partial subcutaneous mastectomy and a breast reconstruction, using muscular flaps or prosthetic material, to be performed (AU)