Abordaje multidisciplinar en el paciente con linfedema: de la rehabilitación a la microcirugía / Multidisciplinary approach in the lymphedema patient: From rehabilitation to microsurgery

El linfedema es una enfermedad crónica con una elevada incidencia en nuestra sociedad. En este trabajo presentamos una revisión bibliográfica con los últimos avances en técnicas de imagen y tratamiento quirúrgico con técnicas reconstructivas del linfedema (anastomosis linfático-venosas, trasplante vascularizado de ganglios linfáticos y cirugía profiláctica del linfedema). Además, se establece un protocolo basado en el trabajo de un equipo multidisciplinar (compuesto por rehabilitadores, cirujanos plásticos, radiólogos y médicos nucleares) que optimiza el tratamiento de estos pacientes.(AU)

Lymphedema is a chronic disease with a high incidence in our society. In this paper, we present a review with the latest advances in imaging techniques and surgical reconstructive treatment of lymphedema (lymphovenous anastomosis, vascularized lymph node transfer, and prophylactic lymphedema surgery). In addition, a protocol is established based on a multidisciplinary team (composed of physiatrists, plastic surgeons, radiologists and nuclear medicine radiologists) to optimize the treatment of these patients.(AU)

[Multidisciplinary approach in the lymphedema patient: From rehabilitation to microsurgery]. / Abordaje multidisciplinar en el paciente con linfedema: de la rehabilitación a la microcirugía.

Lymphedema is a chronic disease with a high incidence in our society. In this paper, we present a review with the latest advances in imaging techniques and surgical reconstructive treatment of lymphedema (lymphovenous anastomosis, vascularized lymph node transfer, and prophylactic lymphedema surgery). In addition, a protocol is established based on a multidisciplinary team (composed of physiatrists, plastic surgeons, radiologists and nuclear medicine radiologists) to optimize the treatment of these patients.

Patient satisfaction in a Spanish burn unit.

BACKGROUND: As a result of the Spanish healthcare system overhaul, quality of care is becoming increasingly important. All burn service providers are required to measure patient satisfaction with care as an imperative need. Nevertheless, there are very few papers regarding patient satisfaction in burn units or in plastic surgery in general. The aim of this study is to examine patient satisfaction in our burn unit and to identify areas for improvement. MATERIALS AND METHODS: Participants were all patients admitted to the Burn Unit at the Getafe University Hospital (Madrid, Spain) between January 2014 and December 2016. Patient satisfaction was assessed using the SERVQHOS questionnaire and Kano methodology. The SERVQHOS questionnaire was given to all patients at the time of discharge with completion thereof voluntary and anonymous. The Kano model consisted of an in-depth personal interview with patients and their relatives to identify patient requirements. Further, we developed a Kano questionnaire and analysed the results to prioritise the requirements for development activities. RESULTS: A total of 164 SERVQHOS questionnaires were collected, which means 58% of the discharged patients who were asked to participate returned the questionnaire. Mean overall satisfaction score was 3.7 (range 1-4). Ninety-seven per cent of patients would not hesitate to recommend the hospital to others, 90% believed they had stayed in the hospital for the time necessary and 89% did not have any pain relief problems. The issues that were rated the worst by users were those related to objective quality such as room conditions, location directions, ease of discharge from the hospital and employee appearance. The best-valued aspects were those related to subjective quality such as willingness to help patients, ability to inspire trust and confidence, courtesy and personal attention. CONCLUSIONS: Patients hospitalised in our burn unit are highly satisfied with the care they receive, especially with regard to subjective quality. The evaluation of the satisfaction outcomes helped us to identify several strengths and weaknesses in the healthcare services we provide as well as strategies to improve the weaknesses. Evaluating care quality and patient satisfaction in any burn unit is appropriate and recommendable given that it offers clients' first-hand opinions.

A utilização da radioterapia no tratamento do carcinoma de células escamosas cutâneo felino avançado / Radiation therapy for the treatment of feline advanced cutaneous squamous cell carcinoma

Avaliou-se a eficácia da radioterapia no tratamento de felinos portadores de carcinoma de células escamosas cutâneo avançado. Um protocolo de fracionamento padrão de radioterapia foi aplicado em seis gatos portadores de uma ou mais lesões cutâneas de carcinoma de células escamosas, em um total de sete lesões neoplásicas, confirmadas por meio de análise histológica. Uma lesão foi classificada como T2 e seis como T4, segundo o sistema de estadiamento da Organização Mundial de Saúde para tumores epidermais de felinos. Os animais foram submetidos a doze frações radioterápicas de 4 Gy, realizadas três vezes por semana, utilizando-se um equipamento de ortovoltagem. Utilizaram-se energia de 120 Kv, 15mA e filtro 2mm de alumínio, o cone usado foi de 6x8cm, e a distância foco-pele foi de 30cm. As lesões foram acompanhadas durante todo o tratamento radioterápico e 30 e 60 dias após o seu término. Neste estudo, 87% das lesões resultaram em remissão completa, e 13%, em remissão parcial. Os efeitos colaterais do tratamento radioterápico, de acordo com a tabela de critérios de toxicidade aguda da Veterinary Radiation Therapy Oncology Group, foram leves e reversíveis em todos os casos, e incluíram eritema cutâneo, epilação e rinite. Considerou-se a radioterapia segura para felinos com carcinoma de células escamosas cutâneo, levando a efeitos colaterais leves, e pode representar uma boa opção terapêutica.

The efficacy of radiation therapy for feline advanced cutaneous squamous cell carcinoma was evaluated. A full course radiation therapy protocol was applied to six cats showing single or multiple facial squamous cell carcinomas, in a total of seven histologically confirmed neoplastic lesions. Of the lesions, one was staged as T 1 , and six as T 4 according to WHO staging system of epidermal tumors. The animals were submitted to twelve radiation fractions of 4 Gy each, on a Monday-Wednesday-Friday schedule, and the equipment used was an orthovoltage unit. Energy used was 120 kV, 15 mA and 2 mm aluminum filter. The cats were evaluated duri ng the treatment and 30 and 60 days after the end of the radiation therapy. In this study, 87% of the lesions had complete remission and 13% partial remission to the treatment. Side effects were considered mild according to Veterinary Radiation Therapy Onc ology Group Toxicity criteria, and included erythema, epilation and rhinitis. Radiation Therapy was considered safe for feline cutaneous squamous cell carcinoma, leading to mild side effects and can represent a good therapeutic option.

Use of an autologous bioengineered composite skin in extensive burns: Clinical and functional outcomes. A multicentric study.

OBJECTIVE: We report clinical and functional outcomes obtained after application of an autologous bioengineered composite skin (ABCS) produced in a single Spanish tissue-engineering unit. MATERIALS/METHODS: Twenty-five burned patients treated with ABCS from 1999 to 2007 in five burn centres were included in the study. Mean age was 29 years (SD 11), with mean total body surface area (TBSA) burned being 74% (SD 17) and mean full-thickness injury of 61% (SD 19) of TBSA. RESULTS: The mean area initially engrafted with ABCS was 24% (SD 13) of TBSA, with a final take of 49% (SD 30, range 0-100%). ABCS achieved permanent coverage of a mean of 11% (SD 8) of TBSA. In subset analyses, lack of pre- and post-application wound bed infection and lack of serious acute systemic complications at the time of engraftment were significantly associated with better ABCS take. CONCLUSIONS: Final take obtained with ABCS could be improved with the use of non-cytotoxic topical antibiotics following engraftment. The use of plasma to prepare ABCS reduces production costs: cost-effectiveness ratio is not a limitation for its use. In terms of patient satisfaction, cosmetic/functional outcomes (general appearance, texture, flexibility, sensitivity and colour) of ABCS and split-thickness autografts are not different statistically.

Tratamento hipofracionado de radioterapia em felinos portadores de carcinoma epidermóide facial / Hypofractionated radiation therapy for the treatment of feline facial squamous cell carcinoma

Avaliou-se a eficácia do protocolo radioterápico hipofracionado no tratamento de felinos portadores de carcinoma epidermóide facial. Um protocolo hipofracionado de radioterapia foi aplicado em cinco gatos portadores de um ou mais carcinomas epidermóides faciais, em um total de 10 lesões neoplásicas, confirmadas por meio de análise histológica. Duas lesões foram classificadas como T1, quatro como T2, duas como T3 e duas como T4. Os animais foram submetidos a quatro frações radioterápicas de 7,6 a 10gy, com intervalo de uma semana entre elas, utilizando-se um acelerador linear com feixe de elétrons. O acompanhamento dos animais foi realizado semanalmente durante o tratamento e aos 30 e 60 dias após o término da radioterapia. Neste estudo, 40 por cento das lesões resultaram em remissão completa, 40 por cento em remissão parcial e 20 por cento não apresentaram resposta ao tratamento. A taxa de resposta encontrada nessa pesquisa foi baixa, porém o protocolo de hipofracionamento radioterápico foi seguro para gatos com carcinoma epidermóide facial e resultou em efeitos colaterais leves/moderados.

The efficacy of hypofractionated radiation protocol for feline facial squamous cell carcinoma was evaluated. Hypofractionated radiation therapy was applied to five cats showing single or multiple facial squamous cell carcinomas, in a total of ten histologically confirmed neoplastic lesions. Of the lesions, two were staged as T1, four as T2, two as T3, and two as T4. The animals were submitted to four radiation fractions from 7.6 to 10 grays each, with one week intervals. The equipment was a linear accelerator with electrons beam. The cats were evaluated weekly during the treatment and 30 and 60 days after the end of the radiation therapy. In this study, 40 percent of the lesions had complete remission, 40 percent partial remission, and 20 percent did not respond to the treatment. Response rates were lower as compared to other protocols previously used. However, hypofractionated radiation protocol was considered safe for feline facial squamous cell carcinoma.

Pseudarthrosis of the capitate.

Nonunion of an isolated fracture of the capitate is an infrequent condition. The authors present a patient who had few symptoms. Computed tomography showed more bone destruction than the standard X-ray. The nonunion healed with the use of a cancellous bone graft.

The coordinate movement of the interphalangeal joints. A cinematic study.

No agreement exists on how coordinate flexion and extension movements of the interphalangeal joints of the long fingers of the hand are performed. A cinematic study in 18 healthy volunteers was done to assess the objective sequence of beginning and ending of movement in the eight free movements of the hand in which these joints flex and extend. The results show that the proximal interphalangeal joint is the one that first initiates the four analyzed movements in which these interphalangeal joints flex and the four movements in which these interphalangeal joints extend. The distal interphalangeal joint is the one that ends first in these two groups of movements. These results confirm that the coordinated movements of the interphalangeal joints may be explained based exclusively on the tendinous system and especially on the setup and balance that exists between the components of the extensor apparatus (longitudinal sliding of the central slip and lateral bands and either the dorsal to palmar or palmar to dorsal displacement of the lateral bands with respect to the rotation axis of the proximal interphalangeal joint).

Elbow anchylosis due to postburn heterotopic ossification.

In a retrospective study performed on 2280 patients that had had major thermal injuries, six patients experienced elbow anchylosis due to heterotopic ossification (two of them bilaterally). In every patient the ossification was localized at the posterior-medial aspect of the elbow. The treatment of this complication consisted of resection of the bone mass and transposition of the ulnar nerve. Mobilization was begun early, and rehabilitation was kept up for at least 4 months. The results obtained have been evaluated following the criteria of Merle d'Aubigné and Cañadell, who consider a very good result a gain of more than 60% in the arch of flexion-extension of the elbow; good, between 40% and 60%; fair between 20% and 40%; and poor, a gain of less than 20%. In five of the patients (six elbows), the result was very good with an average gain of 73.6% (minimum, 61.5%, maximum, 84.6%). In one patient the result was poor with gain of less than 20%. The incidence of this complication, its treatment, and the results obtained are analyzed.

Flexor tendon synovial sheath haemangioma mimicking subacute tenosynovitis.

A case of haemangioma arising from the synovial sheath of the flexor tendons of the ring finger is described. The initial symptoms were those of subacute tenosynovitis. The tumour did not affect the flexor tendons and could be completely resected with functional recovery.

Tendon reconstruction for postburn boutonnière deformity.

A surgical procedure in which a tendon graft is used to reconstruct the hood of the proximal interphalangeal joint for the correction of the postburn boutonnière deformity is described. The intent is to use the potential of the lateral bands for simultaneous extension of the interphalangeal joints, avoiding their excessive palmar displacement. The technique has been employed in 22 fingers with satisfactory results, except in the small finger.