Abordaje y tratamiento de un paciente con trauma laríngeo externo de grado IV, según la clasificación de Schaefer-Fuhrman: reporte de un caso / Approach and treatment of a patient with grade IV external laryngeal trauma, according to Schaefer-Fuhrman's classification: a case report

RESUMEN Introducción: El trauma laríngeo externo es una lesión infrecuente. Según la clasificación de Schaefer-Fuhrman, el grado V se refiere a la separación laringotraqueal completa. En el contexto del trauma, la mortalidad es del 80 %. Hasta la fecha, no se han publicado reportes de casos similares con resultados favorables. El objetivo de este estudio es describir la evolución de un paciente con trauma laríngeo externo de grado IV. Presentación del caso: Se presentó un paciente masculino de 22 años con una lesión completa de cartílago tiroides y apertura de laringe y faringe. El paciente fue sometido a una traqueostomía y faringostomía. El día 4 de internación, se lo desvinculó de la ventilación mecánica, y el día 8, se le realizó una gastrostomía. El día 11, se solicitó una prótesis para la reconstrucción laríngea, y el paciente fue trasladado a cuidados intermedios. A los 15 días, adquirió la independencia funcional. El día 59, se llevó a cabo una cirugía de reconstrucción, y el día 71, el paciente logró tolerar la oclusión de la cánula con protección de la vía aérea. Luego de 48 horas, cumplió con los criterios de decanulación, y el día 79, logró la decanulación. Conclusión: Se describe a un paciente con trauma laríngeo externo de grado IV, según la clasificación de Schaefer-Fuhrman, que es una lesión asociada con una alta morbimortalidad. No obstante, este estudio destaca resultados favorables tanto en términos de sobrevida como de recuperación funcional.

ABSTRACT Introduction: External laryngeal trauma is an uncommon injury. According to Schaefer-Fuhrman's classification, grade V refers to the complete laryngotracheal disruption. In the trauma context, the mortality rate is 80 %. To date, no case reports with favorable outcomes have been published. The aim of this study is to describe the clinical course of a patient with grade IV external laryngeal trauma. Presentation of the case: A 22-year-old male patient presented with a complete lesion of the thyroid cartilage and larynx and pharynx opening. The patient underwent a tracheostomy and pharyngostomy. On day 4 of hospitalization, the patient was withdrawn from mechanical ventilation, and on day 8, a gastrostomy was performed. On day 11, a prosthesis for laryngeal reconstruction was requested, and the patient was transferred to intermediate care. On day 15, he gained functional independence. On day 59, a reconstruction surgery was performed, and on day 71, the patient tolerated occlusion of the cannula with airway protection. After 48 hours, he met the decannulation criteria, and on day 79, he was decannulated. Conclusion: We described a patient with grade IV external laryngeal trauma, according to Schaefer-Furhman's classification, which is an injury associated with high morbimortality. Nevertheless, this study emphasizes favorable outcomes in terms of both survival and functional recovery.

Quadrant Flap for Fingertip Reconstruction in Macrodactyly: Technique and Case Report.

Macrodactyly is a serious and rare disease and considered one of the most difficult pathologies to treat. There is no rule and the treatment for each patient must be tailor-made, depending on the location and degree of macrodactyly. Although amputation is a valid option for adult patients, nail preservation and reconstruction are important and has a direct impact on the treatment outcome, both aesthetically and on the patient's self-esteem. We have used a wide, z-shaped fingertip flap associated with the preservation of a nail quadrant, bone shortening and distal interphalangeal arthrodesis. We have obtained good functional and aesthetic outcomes with this 'quadrant flap' technique. The technique allows decreasing digit size and volume and reconstruction of the nail complex and finger pulp. Level of Evidence: Level V (Therapeutic).

Abordaje transconjuntival en comparación con abordaje subciliar para el tratamiento de fracturas orbitarias / Transconjunctival versus subciliary approach for the treatment of orbital fractures

RESUMEN: Introducción: Los abordajes transconjuntival preseptal y subciliar han sido ampliamente utilizados para el manejo quirúrgico de las fracturas orbitarias. Sin embargo, aún existe incertidumbre sobre las complicaciones asociadas a cada uno de estos abordajes. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios. Realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos seis revisiones sistemáticas que en conjunto incluyeron 21 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados. Concluimos que el abordaje transconjuntival preseptal podría disminuir tanto la incidencia de ectropión como de un resultado estético insatisfactorio, pero la certeza de la evidencia es baja. Además, este abordaje probablemente disminuye el riesgo de complicaciones intra y postoperatorias, tales como diplopía, parestesia transitoria, equimosis, exposición escleral, laceración del plato tarsal y laceración palpebral inferior. Por otro lado, el abordaje transconjuntival podría aumentar el riesgo de entropión, pero la certeza de la evidencia también es baja.

ABSTRACT: Introduction: The preseptal transconjunctival and subciliary approach have been widely used for the surgical management of orbital fractures. However, there is still uncertainty about the complications associated with each of these approaches. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews that included 21 primary studies, four of which correspond to randomized trials. We conclude that the preseptal transconjunctival approach could decrease the incidence of ectropion and an unsatisfactory aesthetic result, but the certainty of the evidence is low. Furthermore, this approach probably decreases the risk of intra and postoperative complications, such as diplopia, transient paresthesia, ecchymosis, scleral show, tarsal plate laceration and lower palpebral laceration. On the other hand, the transconjunctival approach could increase the risk of entropion, but the certainty of the evidence is also low.

Retalho de padrão axial toracodorsal para correção de defeito extenso após excisão de histiocitoma fibroso maligno em canino relato de caso / Axial pattern thoracodorsal flap for treatment of large defect after malignant fibrous histiocytoma resection in a dog - case report

Os retalhos de pele em padrão axial toracodorsal são utilizados em cães para reconstruções do membrotorácico que envolvam desde a região média até a distal do antebraço. Relata-se um caso de excisão de histiocitoma fibroso maligno e reconstituição cirúrgica por meio do retalho supracitado em membro torácico de canino. Foram observadas como complicações edema, infecção, drenagem de líquido transparente da extremidade distal do membro através da interface pele-enxerto, seromae necrose parcial na região do olécrano e distal do retalho. Contudo, a maior parte do flape apresentou adequada cicatrização no leito receptor e o aspecto cosmético foi considerado satisfatório. Aos 40 dias de pós-operatório o animal veio à óbito subitamente. Na necropsia, observou-se miosite necrossupurativa nos membros posteriores em consequência de trombos oriundos de feocromocitoma maligno originário da adrenal direita.AU

Thoracodorsal axial pattern skin grafts are used in dogs for forelimb reconstructions involving since middleup to distal forearm regions. This paper reports a case of malignant fibrous histiocytoma excision in canine forelimb and its surgical reconstruction using thoracodorsal flap. The complications observed are swelling, infection, drainage of clear fluid from the distal limb through the skin-graft interface, seroma and partial flap necrosis. However, most flap area provided adequate healing in the receptor site and its cosmetic appearance was satisfactory. The animal sudden died in the 40th postoperative day. The necropsy showed necrosuppurative myositis in the hind limbs as a result of thrombus originating from a right adrenal malignant pheochromocytoma.

Retalho de padrão axial toracodorsal para correção de defeito extenso após excisão de histiocitoma fibroso maligno em canino – relato de caso / Axial pattern thoracodorsal flap for treatment of large defect after malignant fibrous histiocytoma resection in a dog - case report

Os retalhos de pele em padrão axial toracodorsal são utilizados em cães para reconstruções do membrotorácico que envolvam desde a região média até a distal do antebraço. Relata-se um caso de excisão de histiocitoma fibroso maligno e reconstituição cirúrgica por meio do retalho supracitado em membro torácico de canino. Foram observadas como complicações edema, infecção, drenagem de líquido transparente da extremidade distal do membro através da interface pele-enxerto, seromae necrose parcial na região do olécrano e distal do retalho. Contudo, a maior parte do flape apresentou adequada cicatrização no leito receptor e o aspecto cosmético foi considerado satisfatório. Aos 40 dias de pós-operatório o animal veio à óbito subitamente. Na necropsia, observou-se miosite necrossupurativa nos membros posteriores em consequência de trombos oriundos de feocromocitoma maligno originário da adrenal direita.

Thoracodorsal axial pattern skin grafts are used in dogs for forelimb reconstructions involving since middleup to distal forearm regions. This paper reports a case of malignant fibrous histiocytoma excision in canine forelimb and its surgical reconstruction using thoracodorsal flap. The complications observed are swelling, infection, drainage of clear fluid from the distal limb through the skin-graft interface, seroma and partial flap necrosis. However, most flap area provided adequate healing in the receptor site and its cosmetic appearance was satisfactory. The animal sudden died in the 40th postoperative day. The necropsy showed necrosuppurative myositis in the hind limbs as a result of thrombus originating from a right adrenal malignant pheochromocytoma.