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Introducción y objetivo: La sindactilia es la anomalía congénita más frecuente de la extremidad superior. El compromiso del primer espacio es una patología rara pero genera importante deterioro funcional, por lo que el tratamiento quirúrgico es esencial para restaurar la función de prensión del pulgar. Están descritas múltiples estrategias quirúrgicas para lograr un primer espacio adecuado (igual o mayor a 90°), que incluyen desde colgajos locales y/o zetaplastias en sindactillias incompletas, hasta el uso de colgajos libres de antebrazo o expansores tisulares para sindactilias completas, con resultados funcionales variables y posible compromiso de zonas dadoras. Centramos nuestro trabajo en el empleo de la técnica de Miura modificada, presentado 2 casos clínicos. Material y método: Describimos el uso de la técnica Miura modificada en 2 pacientes de 14 y 5 meses de edad respectivamente, para la resolución de sindactilia congénita completa del primer espacio sin asociación a mano hendida. Resultados: El seguimiento fue de 40 meses para el caso 1 y de 26 meses para el caso 2. No hubo complicaciones tempranas ni tardías ni evidencia de retracción de la cicatriz, manteniendo la amplitud del primer espacio de 90° en ambos pacientes, con buen resultado funcional y estético. Conclusiones: En nuestra experiencia, el uso de la técnica de Miura modificada es una alternativa interesante para el tratamiento de la sindactilia del primer espacio no asociada a mano hendida, con un colgajo vascularmente seguro, de diseño sencillo, con buenos resultados funcionales y mínimas consecuencias estéticas.(AU)

Background and objective: Syndactyly is the most frequent congenital anomaly of the upper limb. Syndactyly of the first space is rare, but compromises functionality, so surgical treatment is essential to restore the thumb grip function. Multiple surgical strategies to achieve adequate space (equal to or greater than 90 °) have been described. These techniques include from the use of local flaps and/or zetaplasties in incomplete syndactyly, until the use of remote flaps from the forearm and tissue expanders if it is a completely absent space, with variable functional results and/or involvement of donor areas. This paper focus on the use of modified Miura technique and presents 2 clinical cases. Methods: The use of modified Miura technique in 2 patients, 14 and 5 months old respectively, is described in the resolution of complete congenital syndactyly of the first space not associated with a cleft hand,Results: Follow-up was 40 months for case 1 and 26 months for case 2. There were no early or late complications or evidence of scar retraction, maintaining the width of the first 90° space in both patients, with good functional and aesthetic results at long term follow up. Conclusions: In our experience, the use of the modified Miura technique is an interesting alternative for the treatment of first space syndactyly not associated with cleft hand, with a vascularly safe flap, of simple design, with good functional results and minimal aesthetic consequences.(AU)

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Microtia poses a great challenge in auricular reconstruction, due to a great number of anatomical details on the anterior aspect, and its tridimensional shape. Numerous techniques have been described in an attempt to optimize results. We have designed a hollow tridimensional silicon template to serve as an intrasurgical guide for ear's anatomy, size and projection, according to the normal side, which allows better results of auricular reconstruction. It also can be used as a customized post-operative compression method. We believe it could be a valuable tool for microtia reconstruction surgery. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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ABSTRACT: The Pierre Robin sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and airway obstruction. Conservative management in Pierre Robin sequence consists of nasogastric tube feeding and positioning of the neonate (prone or lateral position) that facilitates the anterior position of the tongue or the application of continuous positive nasal pressure. In case of failure of this treatment, emergency tracheostomy and/or mandibular distraction must be performed.Mandibular distraction is a standard technique used by craniofacial surgeons to achieve an anteroposterior horizontal lengthening of the mandibular body, correcting the posterior position of the base of the tongue and thus retropharyngeal enlargement of the airway.The authors present 2 clinical cases of hypertrophy of the sublingual salivary glands with the use of mandibular distractors in SPR patients with severe airway obstruction.

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BACKGROUND: Upper limb (UL) function is compromised in university students due to prolonged academic activities and excessive use of electronic devices. However, it is unknown whether this relationship was affected by the COVID-19 pandemic situation. AIM: To determine the risk factors associated with reduced UL functionality in university students in a pandemic situation due to COVID-19. MATERIAL AND METHODS: Cross-sectional study that included 621 university students from the northern, central and southern areas of Chile. Physical variables, musculoskeletal, anthropometric and sociodemographic history were evaluated through self-reported questionnaires. RESULTS: The factors with the higher association with a lower UL functionality were pain (Odds ratio (OR) = 17.6; 95% confidence intervals (CI) = 5.2-60; p < 0.01) and injury (OR = 10.4; 95% CI = 3.9-28.3; p < .001). Also, a low weight (OR = 10.5; 95% CI = 2.2-49.6; p < 0.01) and a quarantine lasting for five or more weeks (OR = 9.1; 95% CI = 1,1-77.2; p = 0.043) were considered risk factors. The lower probability was observed in male participants (OR = 0.2; 95% CI = 0.1-0.51; p < 0.01) and in those with a moderate/high muscular condition (OR = 0.3; 95% CI = 0.1-0.9; p = 0.031. CONCLUSIONS: The identification of these modifiable risk factors can help to implement preventive or rehabilitative actions at home or universities.

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Background: Upper limb (UL) function is compromised in university students due to prolonged academic activities and excessive use of electronic devices. However, it is unknown whether this relationship was affected by the COVID-19 pandemic situation. Aim: To determine the risk factors associated with reduced UL functionality in university students in a pandemic situation due to COVID-19. Material and Methods: Cross-sectional study that included 621 university students from the northern, central and southern areas of Chile. Physical variables, musculoskeletal, anthropometric and sociodemographic history were evaluated through self-reported questionnaires. Results: The factors with the higher association with a lower UL functionality were pain (Odds ratio (OR) = 17.6; 95% confidence intervals (CI) = 5.2-60; p < 0.01) and injury (OR = 10.4; 95% CI = 3.9-28.3; p < .001). Also, a low weight (OR = 10.5; 95% CI = 2.2-49.6; p < 0.01) and a quarantine lasting for five or more weeks (OR = 9.1; 95% CI = 1,1-77.2; p = 0.043) were considered risk factors. The lower probability was observed in male participants (OR = 0.2; 95% CI = 0.1-0.51; p < 0.01) and in those with a moderate/high muscular condition (OR = 0.3; 95% CI = 0.1-0.9; p = 0.031. Conclusions: The identification of these modifiable risk factors can help to implement preventive or rehabilitative actions at home or universities.

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