Experience in the management of acute wounds by dog bite in a hospital of third level of plastic and reconstructive surgery in Mexico.

BACKGROUND: Dog bite injuries represent an important public health problem, involving all levels of care. They can vary in severity, from superficial wounds (skin and subcutaneous tissue) to devitalization and tissue loss, with the presence of systemic infections, aestethic and functional sequels that require specialized treatment. OBJECTIVE: To describe and share the 7-year experience in the management of dog bite wounds in a plastic and reconstructive surgery referral center in Mexico. METHOD: A retrospective study was conducted where all patients with dog bite wounds that came to the plastic and reconstructive emergency department were enrolled from July 2010 to August 2017. The collected patient demographic characteristics included age, age group, and sex. The collected injury variables included anatomical location, wound characteristics, antibiotic therapy and therapeutic management. RESULTS: A total of 416 patients were enrolled, 63% of the dog bites occurred in children under 18 years of age. The majority of the wounds were found in an isolated anatomical region 88.2%. The most frequent location was the face in 61.3%. Of all the cases 74.3% were treated only with primary wound closure, 21.4% also required some reconstructive surgical procedure, 2.9% did not require wound closure, and 1.4% were hospitalized. All patients received prophylactic antibiotics. 2% reported infection after the management with primary wound closure. CONCLUSIONS: The right management of dog bite wounds in all the health care levels improve the patient prognosis. Complex dog bite wounds must be treated immediately by the plastic and reconstructive surgery department in second or third levels of healthcare. Most of the wounds can be managed by primary closure and other reconstructive techniques with confidence.

ANTECEDENTES: Las heridas por mordedura de perro constituyen un problema de salud pública creciente que involucra a todos los niveles de atención. Pueden variar en gravedad, desde heridas superficiales (piel y tejido subcutáneo) hasta desvitalización y pérdida de tejidos, con presencia de infecciones, complicaciones y secuelas estéticas y funcionales que requieren tratamiento especializado. OBJETIVO: Describir la experiencia de 7 años en el manejo de heridas por mordedura de perro y proponer un algoritmo de manejo en un centro de referencia en cirugía plástica y reconstructiva en México. MÉTODO: Se realizó un estudio retrospectivo en el que se incluyeron todos los registros de pacientes con heridas por mordedura de perro entre julio de 2010 y agosto de 2017. Las variables recabadas fueron edad, sexo, localización anatómica, características de la herida y manejo terapéutico. RESULTADOS: Se obtuvo un total de 416 pacientes. El 63% de las lesiones ocurrieron en menores de 18 años. La mayoría de las heridas (88.2%) fueron aisladas en una región anatómica. La localización más frecuente fue la cara (61.3%). De todos los casos, el 74.3% se resolvieron solo con cierre primario, el 21.4% requirió además algún proceso reconstructivo, el 2.9% no requirió cierre y el 1.4% de los pacientes fueron hospitalizados. Todos los pacientes recibieron antibióticos profilácticos. El 2% reportaron infección posterior al manejo con cierre primario. CONCLUSIONES: El correcto abordaje de las heridas por mordedura de perro en todos los niveles de atención mejora el pronóstico de los pacientes. Las heridas complejas deben ser manejadas inmediatamente en un centro de segundo o tercer nivel con cirugía plástica y reconstructiva. La mayoría de las heridas por mordedura de perro pueden ser reparadas con cierre primario y otras técnicas reconstructivas con seguridad.

Cicatrización normal y patológica: una revisión actual de la fisiopatología y el manejo terapéutico / Current concepts of the approach and treatment of normal and pathological wound healing: a literature review

El conocimiento del proceso de cicatrización normal y patológica es fundamental para todas las especialidades médicas y quirúrgicas que tratan heridas agudas y crónicas, ya que del efecto de estos procesos dependerá el resultado final del tratamiento quirúrgico. En cada tejido y órgano dentro del organismo existen diferentes mecanismos que regulan la función y homeostasis celular, como sucede en el proceso de cicatrización, en donde participan y contribuyen una serie de fases y factores mediados por células y señales químicas. Una cicatrización aceptable es aquella que deja una adecuada cicatriz externa, devuelve la normalidad anatómica y funcional del tejido, con lo que se espera llegar a tener un resultado final con éxito; Sin embargo se debe entender que este proceso es complejo, y pueden también existir variantes anormales, determinadas por ciertos factores que intervienen para dar resultado a una cicatriz patológica, para lo cual existen diferentes tipos de tratamientos específicos y coadyuvantes para cada una de ellas. Objetivo: Conocer los conceptos actuales en el abordaje y tratamiento de la cicatrización normal y patológica, ofreciendo al cirujano una guía práctica basada en los fundamentos de las investigaciones científicas actuales. Material y métodos: Se realizó una revisión bibliográfica de artículos recientes acerca de cicatrización publicados entre 2010 a 2018, con alto nivel de evidencia

The knowledge of normal and pathological wound healing process is essential for all the medical and surgical specialties that treat acute and chronic wounds, because the final result will depend on the effect of these processes. In each tissue and organ within the organism there are different mechanisms that regulate cellular function and homeostasis, as in the wound healing process, where a series of phases and factors mediated by cells and chemical signals participate. Acceptable wound healing, although it leaves an external scar, restores the anatomical and functional homeostasis of the tissue,which is expected to have a successful result; However, it must be understood that this is a complex process, and therefore may also exist abnormal variants, determined by certain factors that lead to pathological wound healing, hence different types of treatments and coadjuvants therapies are available. Objective: Comprehend the current concepts in the approach and treatment of normal and pathological wound healing, offering the surgeon a practical guide based on state of the art evidence, Material and Methods: A literature review of recent articles published between 2010 and 2018 was carried out, with a high level of evidence

Soft tissue reconstruction with omental free flap in complex upper extremity injuries: report of 13 cases.

Although there is a wide list of free flaps options for soft tissue reconstruction of complex upper extremity injuries, the omental flap has some useful anatomical and biochemical advantages. We report 13 patients who underwent hand or upper extremity reconstruction with omental free flaps. Nine patients had extensive tissue damage, resulting with digital cyanosis and hypothermia, and some of them with areas of cutaneous necrosis, or avulsed tissues with tendons and bones exposed or infected. The remaining four patients had minor extensive tissue damage without circulatory problems. Patient's average age was 34.6 years. Twelve flaps were harvested through laparotomy and one laparoscopically. All flaps were covered with a skin graft. None of the flaps were lost. The average follow-up time was 20 months. There was one major and two minor donor site complications. One patient had minor loss of the skin graft in the recipient site, and two required minor additional surgeries to improve the appearance or function of the hand or upper extremity. There were no late abdominal complications in any patient. The morphological appearance and functional results were favorable in 11 of them, and permitted their reincorporation into society without the need for additional complex surgeries. Only two patients had a poor outcome. Our experience confirms that the omental flap may be a good option for reconstruction of some complex hand and upper extremity injuries.