Aplicaciones clínicas del colgajo en cono / Clinical applications of the cone shaped flap

Presentamos nuestra experiencia con el uso de un colgajo previamente descrito, el colgajo denominado en cono por la forma final que obtiene, como la de un barquillo de helado con su bocado. Consta de 2 colgajos acoplados: uno de rotación local y otro un avance en V-Y, ambos fasciocutáneos. Realizamos un análisis retrospectivo de 108 pacientes intervenidos entre 2000 y 2013 por lesiones en diferentes partes del organismo, con edades comprendidas entre los 20 y los 52 años, de los cuales 99 fueron varones, y en los que empleamos este tipo de colgajo. Los defectos cubiertos afectaban a las piernas en el 27% de los casos, tobillos en el 10%, planta del pie en el 9%, al talón en el 8% y a otras localizaciones en el resto de los pacientes. Del total, 80 colgajos tuvieron buena evolución (74%), 11 sufrieron dehiscencia mayor (10,2 %), 13 dehiscencia menor (12%) y 4 necrosis (3,7 %). Los resultados confirman que el colgajo en cono es versátil, reproducible, sencillo y seguro de realizar, y permite al cirujano plástico resolver problemas quirúrgicos complejos de forma muy segura y a bajo costo (AU)

We present our experience with a previously described flap, the shaped cone flap, to cover skin defects. This flap due its name to the shape, similar to an ice cream cone, that is formed by locally rotated and V-Y advance flaps joined together, being both fasciocutaneous flaps. We perform a retrospective analysis of 108 patients operated on between 2000 and 2013, aged 20 to 52 years, 99 males, treated with a cone shaped flap. The defects covered were located in the leg in 27%, in the ankle in 10%, in the sole of the foot in 9%, in the heel in 8% and in other locations in the rest of patients. Eighty flaps (74%) had a good evolution, 11 (10,2%) had a major dehiscence, 13 (12%) had a minor dehiscence and 4 flaps (3,7 %) had necrosis. We confirm the cone shaped flap as an easy and safe alternative for reconstruction that avoid complications in most of the cases and with a low surgical cost (AU)

Colgajo en hacha de tensor de fascia lata para úlceras por presión trocantereas / Hatchet-Shaped fascia lata tensor flap for the treatment of trochanteric pressure sores

Las úlceras trocantéreas por presión representan un problema importante a nivel extra e intrahospitalario. Existen múltiples opciones terapéuticas, ya sean colgajos randomizados, musculocutáneos, fasciocutáneos o libres. Presentamos la técnica quirúrgica del colgajo en hacha detensor de fascia lata para el tratamiento de esta patología. Consiste en el diseño de un colgajo en V con irrigación por su base superior, que contacta con la úlcera por uno de sus extremos, simulando la forma de un hacha. Resecamos la úlcera hasta obtener un lecho vital, resecando además el hueso prominente dicho hasta un plano en que se visualice tejido sano. Levantamos y rotamos el colgajo cubriendo el defecto. Finalmente se realiza el cierre primario en VY sintensión. La zona donante permite un cierre primario sin tensión. Mantenemos drenajes durante 10 días Este colgajo permite obtener una buena cobertura para úlceras trocantéreas por decúbito con un adecuado resultado cosmético. Recogemos una casuística de 17 úlceras tratadas mediante el colgajo descrito; como complicaciones se presentaron 3 seromas, resueltos con sistema de cierre con presión negativa externa e interna; 2 casos de dehiscencia de sutura y 2 hematomas resueltos en pabellón de cirugía. Creemos pertinente conocer este colgajo que debe estar siempre presente dentro de las posibilidades terapéuticas para pacientes con úlceras trocantereas por decúbito (AU)

The trochanteric pressure sore it’s an important intra and extrahospitalary problem. There are different therapeutic options for this pathology, for example random, musculocutaneous, fasciocutaneous or free flaps. We present the hatchet-shaped fascia lata tensor flap to treat this kind of lesions. We design a V flap with irrigation in the superior base, having one of the extreme in contact with the sore. The shape of the flap is a hatchet. It´s important to get a vitalbed resecting affected tissues and prominent bone; then, the flap stands up and rotates to covering the defect. We carried out primary closure in V-Y without tension. Drains are removed not before 10 days. This flap allows a good coverage for trochanteric decubitussores with an adequate cosmetic result. There have been 3 seromas, solved with internal and external negative pressure system; 2 cases of suture dehiscence and 2 hematomas solved with surgical procedures. The donor site allows primary closure without tension. As a conclusion, we believe that is relevant to know this flap and taking it on count to be offered to patients with trochanteric decubitus sore (AU)

[Thyroid profile in normal pregnancy]. / Perfil tiroideo de la embarazada normal.

The aim of this study was to update the thyroid hormone profile in normal pregnant women with adequate iodine nutrition, to analyze the physiological changes that occur during pregnancy and to know the role that TBG and bHCG exert on these changes. One hundred six pregnant women without goiter, former thyroid diseases or positive antimicrosomal antibodies were studied. Fifty three of them were prospectively followed during the gestational period. Thirty age matched non pregnant women were studied as a control group. Serum T3t, T4t, T41, conventional and IRMA TSH, rT3, TBG, bHCG, antimicrosomal antibodies and urinary iodine content were measured. Median urinary iodine content was 18.9 ug/ml in pregnant women, discarding iodine deficiency, the main observed changes occurred between weeks 6 and 14 with significant elevations of T3t, T4t, T41, rT3, TBG and bHCG and TSH decrease. There was a positive correlation between TBG and T3t and T4t indicating a causal relationship. There was a negative correlation between T41 and TSH and between TSH and bHCG and a positive correlation between T41 and bHCG, suggesting a thyroid stimulator effect of bHCG which would raise T41 and thus inhibit TSH secretion.