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BACKGROUND: Early onset facial paralysis is usually managed with cross-face nerve grafts, however the low number of axons that reach the target muscle may result in weakness or failure. Multiple-source innervation, or 'supercharging', seeks to combine the advantages of different donor nerves while minimizing their weaknesses. We propose a combination of cross-face nerve grafts with local extra-facial nerve transfers to achieve earlier facial reanimation in our patients. METHODS: A retrospective cohort including all patients with early unilateral facial palsy (<12 months evolution) who underwent triple nerve transfer between 2019 and 2021 was conducted. We performed single-stage procedure including zygomatic-to-zygomatic and buccal-to-buccal cross-face grafts, a nerve-to-masseter to bucozygomatic trunk transfer, and a mini-hypoglossal to marginal branch transfer. Results were evaluated using the clinician-graded facial function scale (eFACE). RESULTS: Fifteen patients were included (eight females, seven males), mean age at the time of surgery was 48.9 ± 13.3 years. Palsy was right-sided in eight cases. The mean time from palsy onset to surgery was 5.5 ± 2.8 months. Patients showed improvement in static (70.8 ± 21.9 vs. 84.15 ± 6.68, p = 0.002) and dynamic scores (20 ± 16.32 vs. 74.23 ± 7.46, p < 0.001), as well as periocular (57.33 ± 15.23 vs. 74 ± 7.18, p = 0.007), smile (54.73 ± 11.93 vs. 85.62 ± 3.86, p < 0.001), mid-face (46.33 ± 18.04 vs. 95 ± 7.21, p < 0.001) and lower face scores (67.4 ± 1.55 vs. 90.31 ± 7.54, p < 0.001). CONCLUSION: The triple nerve transfer technique using cross-face nerve grafts, the nerve-to-masseter, and the hypoglossal nerve, is an effective and reproducible technique to obtain middle and lower face reanimation in cases of early facial palsy.
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Paralisia Facial , Transferência de Nervo , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Paralisia Facial/cirurgia , Transferência de Nervo/métodos , Estudos Retrospectivos , Nervo Facial/cirurgia , Músculo Masseter , SorrisoRESUMO
BACKGROUND: Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft. METHODS: Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019. RESULTS: Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0 mm and levator function was< 1 mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5 mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve. CONCLUSION: This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery.
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Blefaroplastia , Blefaroptose , Humanos , Masculino , Feminino , Adulto , Blefaroptose/cirurgia , Blefaroplastia/métodos , Estudos Retrospectivos , Projetos Piloto , Resultado do Tratamento , Músculos Oculomotores/cirurgiaAssuntos
Neoplasias da Mama , Drenagem , Humanos , Feminino , Drenagem/métodos , Técnicas de Sutura , Mastectomia , Mesentério/cirurgia , Neoplasias da Mama/cirurgiaRESUMO
BACKGROUND: Postgraduate training in plastic surgery is heterogeneous between countries, with exposure to aesthetic surgery being a reflection of this. Fellowships in Mexico have usually consisted of tutorial teaching, providing graduates with experience but a lack of formal structure. The aim of his work is to present a University-backed program focused on aesthetic surgery and propose the expansion of this kind of program. METHODS: A retrospective cross-sectional review of surgical cases was performed over a five-year period from 2015 to 2019. Data were obtained from the senior surgeon's practice charts. Information was recorded using a data sheet including patients' demographic characteristics, procedures performed and type of anesthesia applied. Descriptive analyses of patient demographic and clinical characteristics were performed. Continuous variables are expressed in central tendency measures, and categorical values are presented as percentages. RESULTS: 1282 procedures were performed on 885 patients, 797 females (90%) and 88 males (10%). Mean age was 44.6 ± 13.8 years. Case load consisted in 545 breast procedures (42.5%), 372 body contour surgeries (29.0%), 305 facial aesthetic procedures (23.8%) and 60 miscellaneous procedures (4%). The most common surgeries were breast augmentation (249, 19.4%), alloplastic breast reconstruction (165, 12.8%), blepharoplasty (163, 12.7%), liposuction (151, 11.7%), and abdominoplasty (107, 8.3%). CONCLUSIONS: A University backed program focused on aesthetic surgery is feasible and desirable in multiple national and international institutions. 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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Internato e Residência , Cirurgia Plástica , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Cirurgia Plástica/métodos , Estudos Retrospectivos , Bolsas de Estudo , Estudos Transversais , EstéticaRESUMO
BACKGROUND: Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies. The aim of this work is to evaluate the prevalence of upper extremity malformations in patients with Moebius syndrome, clarify its various clinical presentations, and present treatment strategies for their management. METHODS: This is a retrospective, cross-sectional study including patients with Moebius syndrome and upper extremity malformations between 2012 and 2019. Data include demographic characteristics, Moebius syndrome subtype, type of malformation, affected extremity, and surgical procedures underwent. Quantitative data were recorded as mean (standard deviation [SD]), and qualitative data were expressed in terms of totals and percentages. Statistical association between Moebius syndrome subtype and development of upper extremity anomalies was evaluated using binary logistic regression. RESULTS: Twenty-five out of 153 patients (16.3%) presented upper extremity malformations (48% male). Mean age of presentation was 9.08 ± 9.43 years. Sixty-eight percent of the malformations were unilateral. The most common presentations included Poland syndrome and simple syndactyly with 8 cases each (32%), followed by 5 cases of brachysyndactyly (20%), 3 cases of amniotic band syndrome (12%), and 1 case of cleft hand (4%). No statistical association was found between Moebius syndrome subtype and odds ratio for development of upper extremity anomalies. Thirteen patients (52%) underwent reconstructive procedures. CONCLUSION: Poland syndrome and syndactyly are the most common anomalies in patients with Moebius syndrome. Patients may present with a wide range of hand malformations, each patient should be carefully evaluated in order to determine whether surgical treatment is needed and to optimize rehabilitation protocols.
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Deformidades da Mão , Síndrome de Möbius , Síndrome de Poland , Recém-Nascido , Humanos , Masculino , Criança , Adolescente , Feminino , Síndrome de Möbius/epidemiologia , Síndrome de Möbius/cirurgia , Síndrome de Möbius/complicações , Estudos Retrospectivos , Prevalência , Estudos TransversaisRESUMO
BACKGROUND: Facial paralysis is a frequent disabling entity that causes a negative impact on the cosmetic, functional, social, psychological and economic aspects of the patient. Surgical treatment aims to restore the patient to her previous life with the fewest possible sequelae. OBJECTIVE: Describe the experience of surgical management and propose a treatment algorithm. METHOD: A retrospective study was carried out from 2017 to 2019 of the records of patients with facial nerve involvement. The variables were age, sex, etiology, affected side and procedures performed. RESULTS: 108 patients were obtained. The most frequent cause was development facial paralysis (41,8%), followed by resection of intracranial tumors (29%). A total of 225 procedures were performed, average per patient of 2.7. The most performed dynamic procedure was the gracilis-free flap (59%). The most frequent static procedures were the placement of a gold weight (24%) and the recreation of the nasogenian sulcus (13%). CONCLUSIONS: The surgical treatment algorithm will depend on the evolution time, etiology, donor nerves and state of the facial musculature. The gracilis-free flap continues to be the gold standard procedure in facial paralysis reconstruction. Static procedures are additionally required to achieve a satisfactory aesthetic and functional result.
ANTECEDENTES: La parálisis facial es una afección incapacitante que con frecuencia causa un impacto negativo en los aspectos cosméticos, funcionales, sociales, psicológicos y económicos. El tratamiento quirúrgico tiene como objetivo mejorar la calidad de vida dejando la menor cantidad posible de secuelas. OBJETIVO: Describir la experiencia del manejo quirúrgico y proponer un algoritmo de tratamiento. MÉTODO: Se realizó un estudio retrospectivo, de 2017 a 2019, de los expedientes de pacientes con afección del nervio facial. Las variables consideradas fueron la edad, el sexo, la etiología, el lado afectado y los procedimientos quirúrgicos realizados. RESULTADOS: Se obtuvieron 108 pacientes y la causa más frecuente fue la parálisis facial del desarrollo sindrómica (42%), seguida de la resección de tumores intracraneales (29%). Se realizaron 225 procedimientos, con un promedio de 2.7 por paciente. El procedimiento dinámico más realizado fue el colgajo libre de gracilis (59%). Los procedimientos estáticos más frecuentes fueron la colocación de una pesa de oro (24%) y la recreación del surco nasogeniano (13%). CONCLUSIONES: La secuencia del tratamiento quirúrgico dependerá del tiempo de evolución, la etiología, los nervios disponibles y el estado de la musculatura facial. El colgajo libre de gracilis continúa siendo el procedimiento de elección en la reconstrucción de la parálisis facial. Adicionalmente se requieren procedimientos estáticos para lograr un resultado estético y funcional satisfactorio.
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Paralisia Facial , Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , México , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
OBJETIVO: Describir el manejo de las lesiones nerviosas de extremidad inferior atendidas en un centro de referencia en cirugía plástica y reconstructiva en la Ciudad de México. MÉTODO: Estudio descriptivo, transversal y retrospectivo, en el que se evaluaron los expedientes clínicos de pacientes atendidos por lesiones nerviosas de extremidad inferior entre 2010 y 2018. RESULTADOS: Se incluyeron 21 pacientes, 14 hombres (66.6%) y 7 mujeres (33.3%), con una edad promedio de 30.00 ± 8.89 años. Las lesiones en la extremidad derecha fueron más prevalentes (52.3%). El mecanismo de lesión más común fue por herida por proyectil de arma de fuego (28.5%) o por accidente automovilístico (13.6%). Los nervios más afectados fueron el ciático (38.0%) y el peroneo (38.0%), seguidos por el tibial (9.5%), el peroneo y el tibial simultáneamente (9.5%) y el femoral (4.7%). Las medidas de tratamiento más empleadas fueron las transferencias nerviosas (7 casos, 33.3%) y la aplicación de injertos nerviosos para el manejo de brechas (7 casos, 33.3%). CONCLUSIONES: La reparación de las estructuras nerviosas de la extremidad inferior ha recibido poca atención. Sin embargo, nuestro estudio muestra que es posible aplicar diversas estrategias reconstructivas microquirúrgicas, buscando mejorar los desenlaces funcionales de los pacientes. OBJECTIVE: To describe the management of lower extremity nerve injuries at a plastic and reconstructive surgery referral center in Mexico City. METHOD: A descriptive, transversal and retrospective study was performed, evaluating clinical records of patients with lower extremity nerve injuries managed in our center between 2010 and 2018. RESULTS: Twenty-one patients were included, 14 males (66.6%) and 7 females (33.3%); mean age was 30.00 ± 8.89 years. Right-sided injuries were more prevalent (52.3%). The most common etiologies were gunshot injuries (28.5%) and motor vehicle accidents (13.6%). The most frequently affected nerves were the sciatic (38.0%) and the peroneal nerves (38.0%), followed by the tibial (9.5%), simultaneous tibial and peroneal nerve injury (9.5%) and the femoral nerve (4.7%). Nerve transfers (7 cases, 33.3%) and autologous nerve grafts (7 cases, 33.3%) were the preferred surgical techniques for injury management. CONCLUSIONS: Repair of lower extremity nerve injuries has not been popularized, however our study shows that several microsurgical reconstructive strategies are available in order to improve functional outcomes.
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Extremidade Inferior , Encaminhamento e Consulta , Adulto , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , México/epidemiologia , Estudos RetrospectivosAssuntos
COVID-19 , Educação , Procedimentos Cirúrgicos Eletivos , Procedimentos de Cirurgia Plástica , Cirurgia Plástica/educação , Ferimentos e Lesões , Centros Médicos Acadêmicos/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Educação/organização & administração , Educação/tendências , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Internato e Residência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/cirurgiaRESUMO
Carpometacarpal joint dislocations are uncommon hand injuries. These dislocations are usually misdiagnosed due to their non-specific clinical signs and tend to be difficult to identify in simple X-rays. We report our experience in the management of carpometacarpal bone dislocations at a specialized hand surgery center. Patients with carpometacarpal dislocations seen at the emergency department between 2013 and 2017 were included. All patients were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Postoperative functional assessment was performed at 6 and 18 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Eleven patients were included, 8 (72%) were managed with CRPP and the rest required ORIF (28%). For the functional outcome, we found an average DASH score of 27.9 at the 6 months threshold and of 1.5 at the 18 months threshold. Carpometacarpal dislocations are uncommon and easy to misdiagnose; the hand surgeon should have a high clinical suspicion in patients who sustained high-energy trauma, and imaging studies should be thoroughly evaluated. Closed reduction and percutaneous pinning is a safe and effective treatment option, with long-term good functional results.
Les dislocations des articulations carpométacarpiennes sont des blessures peu courantes de la main. Elles sont généralement mal diagnostiquées en raison de leurs signes cliniques non spécifiques et ont tendance à être difficiles à dépister au moyen d'une simple radiographie. Les auteurs rendent compte de leur expérience dans la prise en charge des dislocations des os carpométacarpiens dans un centre spécialisé de chirurgie de la main. Les patients atteints d'une dislocation carpométacarpienne vus à l'urgence entre 2013 et 2017 étaient inclus dans l'étude. Tous les patients ont subi une réduction fermée et un embrochage percutané (RFEP) ou une réduction ouverte et une fixation interne (ROFI). L'évaluation fonctionnelle postopératoire a eu lieu au bout de six et 18 mois au moyen du score d'incapacité du bras, de l'épaule et de la main (DASH). Onze patients ont participé : huit (72 %) ont subi une RFEP et les autres ont dû subir une ROFI (28 %). Le score DASH moyen du résultat fonctionnel s'établissait à 27,9 au seuil de six mois et à 1,5 à celui de 18 mois. Puisque les dislocations carpométacarpiennes sont rares et faciles à mal diagnostiquer, le chirurgien de la main devrait en présumer la possibilité chez les patients victimes d'un traumatisme de forte énergie, et les études d'imagerie devraient faire l'objet d'une évaluation approfondie. La RFEP est une possibilité de traitement sécuritaire et efficace qui donne de bons résultats fonctionnels à long terme.
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Introduction The masseter nerve has been used as a donor nerve for facial reanimation procedures due to the multiple advantages it offers; it has been generally considered that sacrifice of the masseter nerve does not alter the masticatory apparatus; however, there are no objective studies to support this claim. Objective To evaluate the impact that the use of the masseter nerve in dynamic facial reconstruction has on the electrical activity of the masseter muscle and on bite force. Materials and Methods An observational and prospective longitudinal study was performed measuring bite force and electrical activity of the masseter muscles before and 3 months after dynamic facial reconstructive surgery using the masseter nerve. An occlusal analyzer and surface electromyography were employed for measurements. Results The study included 15 patients with unilateral facial paralysis, with a mean age of 24.06 ± 23.43. Seven patients were subjected to a masseter-buccal branch nerve transfer, whereas in eight patients, the masseter nerve was used as a donor nerve for gracilis free functional muscle transfer. Electrical activity of the masseter muscle was significantly reduced after surgery in both occlusal positions: from 140.86 ± 65.94 to 109.68 ± 68.04 ( p = 0.01) in maximum intercuspation and from 123.68 ± 75.64 to 82.64 ± 66.56 ( p = 0.01) in the rest position. However, bite force did not show any reduction, changing from 22.07 ± 15.66 to 15.56 ± 7.91 ( p = 0.1) after the procedure. Conclusion Masseter nerve transfer causes a reduction in electromyographic signals of the masseter muscle; however, bite force is preserved and comparable to preoperative status.
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BACKGROUND: Moebius syndrome is a clinical entity characterized by bilateral facial and abducens nerve palsies; other cranial nerver might be affected as well. So far, no studies have reported the electromyographic responses of the facial musculature in this group of patients. OBJECTIVE: The objective of our study is to describe the electromyographic responses of the facial muscle and the main donor nerves for facial reanimation in patients with Moebius syndrome. METHOD: We analyzed electromyographies from the facial, hypoglossal, masseterine (trigeminal) and accessory nerves from patients with Moebius syndrome treated between 2010 and 2016. Results are presented as percentages and central tendency measures. RESULTS: 24 patients were included, mean age 11.79 ± 9.39 years. The facial nerve showed complete unilateral recruitment in 4 patients, partial bilaterally in 11, 7 showed no activity bilaterally and two had unilateral inactivity. The masseterine was normal in 14 patients, had partial recruitment bilaterally in 4 and unilaterally in 4 cases. The accessory nerve was normal in 20 patients, showed partial recruitment bilaterally in 3 and unilaterally in 1 patients. The hypoglossal was normal in 22 patients, and altered in 2 cases. CONCLUSION: Patients with Moebius syndrome show several degrees of alteration in electromyographic evaluation of the facial nerve. Electromyography is a useful tool in evaluating potential motor donor nerves for facial reanimation surgery.
ANTECEDENTES: El síndrome de Moebius es una entidad clínica caracterizada por parálisis bilateral congénita del nervio facial y el abducens. Adicionalmente se pueden encontrar afectados otros pares craneales. Actualmente no existen estudios que reporten la respuesta electromiográfica de la musculatura facial en esta población. OBJETIVO: Describir la respuesta electromiográfica de la musculatura facial y de los principales nervios donadores para reconstrucción facial dinámica en pacientes con síndrome de Moebius. MÉTODO: Se analizaron electromiografías de los nervios facial, hipogloso, maseterino (trigémino) y accesorio en pacientes con síndrome de Moebius atendidos entre 2010 y 2016. Los resultados se presentan en porcentajes y medidas de tendencia central y de dispersión. RESULTADOS: Se incluyeron 24 pacientes, con una edad promedio de 11.79 ± 9.39 años. El nervio facial presentó reclutamiento unilateral completo en 4 pacientes, parcial bilateral en 11 pacientes, en 7 pacientes ausencia de reclutamiento bilateral e inactividad unilateral en 2 pacientes. El maseterino tuvo reclutamiento completo en 14 pacientes, parcial bilateral en 4 pacientes y parcial unilateral en 4 pacientes. El nervio accesorio mostró reclutamiento completo en 20 pacientes, parcial bilateral en 3 pacientes y parcial unilateral en 1 paciente. El hipogloso mostró actividad normal en 22 pacientes, parcial bilateral en 1 paciente y parcial unilateral en 1 paciente. CONCLUSIÓN: Los pacientes con síndrome de Moebius presentan alteraciones en los registros electromiográficos del nervio facial. La electromiografía permite identificar los nervios donadores para realizar la reconstrucción dinámica.
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Eletromiografia , Músculos Faciais/fisiopatologia , Nervo Facial/fisiopatologia , Síndrome de Möbius/fisiopatologia , Cuidados Pré-Operatórios/métodos , Doenças do Nervo Abducente , Nervo Acessório/fisiopatologia , Criança , Estudos Transversais , Nervo Facial/cirurgia , Feminino , Humanos , Nervo Hipoglosso/fisiopatologia , Masculino , Nervo Mandibular/fisiopatologia , Síndrome de Möbius/cirurgia , Estudos RetrospectivosRESUMO
Resumen Las hernias internas son causa infrecuente de obstrucción intestinal con una incidencia del 0.2-0.9%, por lo que su diagnóstico temprano representa un reto. El órgano más frecuentemente herniado es el intestino delgado, lo que confiere un gran espectro de síntomas, desde dolor abdominal ligero hasta datos de abdomen agudo1,2. Se presenta el caso de una paciente de 8 años de edad con sintomatología digestiva inespecífica; se realizó diagnóstico transoperatorio en el que se encontró hernia interna estrangulada por plastrón en el tercio distal del apéndice. Se realizó apendicectomía y a los cuatro días se dio de alta sin complicaciones.
Abstract Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen1,2. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.
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Hemifacial microsomia (HFM) is a malformation characterized by asymmetric facial growth with mandibular and muscular involvement. There are no reports focused on the functional status of the masticatory system of patients with HFM. The objective of this work evaluate bite force and electrical activity of masseter muscle in children with HFM, and compare them to healthy controls. A cross-sectional study was performed to compare bite force and electrical activity of masseter muscle between subjects with HFM and healthy children. Mean bite force (MBF) and surface electromyography (EMG) on maximum intercuspation (MIC) and rest position (RP) from both sides of the face were recorded. Comparative statistics between HFM patients and controls were performed using the Mann-Whitney test, Wilcoxon's signed rank test was used to compare the microsomic and healthy hemifaces. Twenty children with HFM and 10 controls were included, average age was 7.2 years (range 3-14). MBF did not show statistical significance between both groups. Surface EMG signal at MIC was significantly diminished when compared to the healthy side (p = .003) and to the control group (p = .016), this significance was also present at RP when comparing the affected and non-affected sides of the face (p < .01) but not against the controls (p = .08). This study showed that patients with HFM had diminished EMG values of the masseter muscle on the affected side, compared to healthy individuals, but bite force did not show significant alterations.
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Força de Mordida , Eletromiografia , Síndrome de Goldenhar/fisiopatologia , Músculo Masseter/fisiopatologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , MasculinoRESUMO
RESUMEN Introducción: La oreja de Stahl presenta una baja incidencia, aún en centros especializados de reconstrucción auricular. Se caracteriza por presentar un remanente cartilaginoso anormal que se extiende desde el antihélix hasta el borde del hélix, formando una tercer crura. Caso clínico: Varón de 17 años de edad, con deformidad auricular caracterizada por hipoplasia de la raíz del antihélix y presencia de una tercer crura, que comunica el antihélix al hélix. Se realiza resección de la tercer crura y reconstrucción cartilaginosa del pabellón auricular, logrando una adecuada reconstrucción, con buen resultado estético, sin alteración de tamaño en comparación con la oreja contralateral. Conclusiones: Esta es una rara deformidad auricular, muchas veces subdiagnosticada, incluso en centros especializados. Puede acarrear trastornos y estigmas sociales importantes al paciente. El tratamiento quirúrgico es manejo preferencial, y se centra principalmente en la corrección de la tercer crura.
ABSTRACT Introduction: Stahl's ear presents a low incidence, even in specialized ear reconstruction centers. It is characterized by an abno rmal cartilaginous remnant, extending from the antihelix to the edge of the helix, forming a third crura. Case report: A 17-year-old man presented an ear deformity characterized by hypoplasia of the root of the antihelix and the presence of a third crura, which communicates the antihelix to the helix. A resection of third crura and cartilaginous reconstruction of the auricular pavilion was performed, achieving an adequate reconstruction, with good aesthetic results, without size alteration in comparison to the contralateral ear. Conclusions: Stahl's deformity is a rare ear deformity that can lead to significant social disruption and stigma. Surgical treatment is the preferential option for handling this deformity, and focuses mainly on the correction of the third crura.
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Resumen Introducción La reconstrucción auricular traumática es un reto para el cirujano plástico. Su objetivo es reproducir y recrear la forma y topografía de la región auricular, haciendo que los estigmas propios de la reconstrucción sean mínimos. Caso clínico Se presenta el caso de un paciente varón de 5 años de edad, con lesión por mordedura de perro en la oreja derecha, y lesión corto-contusa en pabellón auricular con pérdida de cobertura cutánea, pérdida parcial de cartílago auricular y exposición cartilaginosa a nivel de hélix y porción retroauricular. Se realizó reconstrucción auricular mediante reparación auricular y colgajo retroauricular. En un segundo tiempo quirúrgico, se realizó sección de la base del colgajo, y se logró un adecuado contorno auricular, así como cobertura cutánea definitiva Conclusiones Las lesiones auriculares, por su situación anatómica, son frecuentes en la práctica profesional de un cirujano plástico y reconstructivo. Existen múltiples técnicas quirúrgicas para la reconstrucción de defectos auriculares, sin embargo, el colgajo retroauricular ofrece una técnica sencilla y versátil.
Abstract Introduction Traumatic auricular reconstruction is a challenge for the plastic surgeon. The purpose of this reconstruction is to reproduce and recreate the shape and topography of the auricular region, diminishing the typical stigmas of a reconstruction. Clinical case The case of a 5-year-old male patient with right bite of a dog in a right ear presenting a short-contusional lesion in the auricular hall with loss of cutaneous cover, partial loss of atrial cartilage and cartilage exposure At the level of helix and retroauricular portion. Auricular reconstruction is performed by atrial repair and retroauricular flap. In a second surgical time, a section of the base of the flap is performed, achieving a suitable atrial contour and definitive skin coverage. Conclusions Auricular injuries, due to their anatomical situation, are frequent in the professional practice of a plastic and reconstructive surgeon. There are multiple surgical techniques for the reconstruction of atrial defects, however, the retroauricular flap offers a simple and versatile technique.
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Vascular abnormalities are localized structural irregularities, which are performed during vasculogenesis, angiogenesis, and lymphangiogenesis. The involvement of soft tissue in such vascular malformations is frequent; however, the compromising of the buccal fat pads (Bichat bags) is uncommon, even in specialized centers, such as the plastic clinic of our institution, in which very few patients have been reported in the literature. The purpose of this article is to present a series of 2 patients in which vascular malformations involving the buccal fat pads, which were extracted by intraoral approach.
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Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/cirurgia , Bochecha/irrigação sanguínea , Bochecha/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Malformações Vasculares/cirurgia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Ritidoplastia/efeitos adversos , Escleroterapia/efeitos adversosRESUMO
BACKGROUND: Acute upper extremity injuries remain one of the most common consultations in the emergency departments for plastic surgery services. These injuries can affect a person's quality of life and negatively affect work-related or social interactions if not properly managed. We aim to evaluate our experience and management in a specialized referral center in Mexico City. METHODS: A retrospective review was performed. All patients with hand trauma managed by our service from July 2010 to June 2015 were included; their demographic characteristics were described as well as the most common patterns of injury, management, and outcome. RESULTS: A total of 4751 patients with injuries in the upper extremities were included, 77% were males with a mean age of presentation of 26.9 ± 17.9 years; the age group most commonly affected was between 16 to 30 years (39%); 54% of the cases affected the right hand. Lacerative wounds were the most common mechanism of injury (60.7%), followed by blunt trauma (28.7%). Management was surgical in 87% of the cases. CONCLUSIONS: Upper extremity trauma encompasses a wide range of clinical presentations, from simple lacerations to catastrophic injuries that require extensive or multiple reconstructive procedures. The clear understanding of the trauma mechanisms and how they are related with certain patterns of injury might maximize awareness and guide a surgeon's management effectively.
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Traumatismos do Braço/epidemiologia , Traumatismos do Braço/cirurgia , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/cirurgia , Procedimentos de Cirurgia Plástica , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Adulto , Traumatismos do Braço/etiologia , Criança , Estudos Transversais , Feminino , Traumatismos da Mão/etiologia , Hospitais Gerais , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Mozart ear is a rare auricular deformity; clinically the auricle is characterized by the bulging appearance of the anterosuperior portion of the auricle due to fusion of the crura of the antihelix, an inversion in the normal form of the cavum conchae resulting in its convexity and a slit-like narrowing of the orifice of the external auditory meatus.A retrospective review of clinical and photographic records of patients attended at the ear reconstruction clinic of our hospital between June of 2010 and May 2016 was performed; out of 576 consecutive patients only 3 fulfilled the inclusion criteria, with a prevalence of 0.5%. The authors present these patients.Surgical interventions mainly focus on the correction of the convex concha; however, the procedure should be tailored to the severity of the deformity and the wishes of the patient.
Assuntos
Pavilhão Auricular , Procedimentos de Cirurgia Plástica/métodos , Criança , Pré-Escolar , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Cartilagem da Orelha/cirurgia , Feminino , Humanos , Masculino , Seleção de Pacientes , Fotografação , Exame Físico , Estudos Retrospectivos , Cirurgia Plástica/métodosRESUMO
INTRODUCTION: Extended major histocompatibility complex (MHC) haplotypes are associated with several autoimmune diseases, and these appear to depend on ancestry. OBJECTIVE: To evaluate the association of extended MHC gene frequencies, ancestry, and acute rejection. MATERIAL AND METHODS: 127 living kidney transplant recipients who underwent kidney transplantation in Mexico City between January 2004 and October 2007 with follow up until October 2008. The primary outcome was biopsy proven acute rejection. Ancestry was considered as either Amerindian or admixtures with Caucasian, African or Oriental genes. Allele and haplotype frequencies were estimated for HLA A, B and DR loci. Hardy Weinberg (HW) and delta values were analyzed to test for linkage disequilibrium (LD). RESULTS: There were no significant differences in the baseline characteristics between groups. 50% were men, and 28, 61 and 10% of the patients shared zero, one or two haplotypes, respectively. The whole population was Hispanic and born in Mexico. Median PRA was 0%. Allelic variance in all MCH loci was in HW equilibrium, 14% developed acute rejection. There was a high frequency of Amerindian haplotypes; admixture genes and LD were higher in the group with acute rejection. When compared to the group without acute rejection, the haplotype A1*B8*DR3 was more frequent in donors in whom their recipients had acute rejection (p = 0.008), while A28*B39*DR4 was more common in the recipients with acute rejection (p = 0.003). Multivariate Cox regression models did not attenuate these associations. CONCLUSIONS: Ancestry and LD may be associated with risk of acute rejection and may therefore be useful in directing immunosuppression.