Obliteración de fracturas de seno frontal con colgajos pediculados

El compromiso del seno frontal con fractura de sus paredes es un tipo de lesión infrecuente, en torno al 5-12% de todas las fracturas faciales. Suele asociarse a lesiones intracraneales, oftalmológicas y a otras fracturas máxilofaciales y cuando conlleva fractura de la pared posterior de seno frontal requiere tratamiento inmediato, siendo necesaria la obliteración del seno frontal debido a la comunicación con meninges y lóbulo frontal, con el riesgo infeccioso que ello representa. Tratamos 18 pacientes con traumatismos craneofaciales y fracturas del seno frontal con compromiso de su pared posterior en el periodo comprendido entre 2007 y 2011; 8 mujeres y 10 varones con edades comprendidas entre los 15 y los 64 años. Todos los casos fueron tratados con reducción y osteosíntesis por vía abierta con distintos abordajes y realizamos en todos colgajos pediculados de vecindad. La vitalidad de los colgajos fue del 100% . Certificamos el posicionamiento correcto mediante tomografía axial computarizada. El tratamiento de las fracturas del seno frontal con compromiso de su pared posterior o del conducto nasofrontal requiere obliteración con tejido vascularizado para evitar comunicaciones con la cavidad nasal

Bilateral Anatomic Variation of Anterolateral Thigh Flap in the Same Individual

Background:. Anterolateral thigh flap has gained popularity for its use as a soft-tissue flap for reconstruction of regional and distal defects. There is discrepancy between the predominant skin vessels-musculocutaneous or septocutaneous. The purpose of this study was to demonstrate anatomic variation of bilateral anterolateral thigh flap vasculature in the same individual. Methods:. We performed an observational retrospective case series study in 11 patients and an observational prospective study in 7 cadavers to confirm our findings. Results:. We found bilateral anatomic variation in the main cutaneous branch of the descendent branch of the lateral circumflex femoral artery between both thighs in the same individual. In 72.2% of cases, we observed that the main cutaneous branch was septocutaneous in 1 thigh and musculocutaneous in the contralateral thigh; in 16.7%, the main cutaneous branches were musculocutaneous in both thighs, and in 11.1%, the main cutaneous branches were septocutaneous in both thighs. Conclusions:. Significant anatomic variation exists between the right and the left cutaneous branches of deep circumflex femoral arteries. Hence, preoperative imaging by computed tomography angiography (CTA) aids in determination of the vascular anatomy of the descending branch of the lateral circumflex femoral artery and in selection of septocutaneous branches, thereby reducing operative time

Retirada de implantes mamarios y corrección simultánea con colgajo dermoglandular inferior. Técnica de mastopexia con autoprótesis

Plastic surgeons are frequently faced during consultation with patients who want or need breast implant explantation. Some of these patients reject the idea of a prosthetic replacement, but are demanding with the postoperative cosmetic result. We describe the technique used in 68 consecutive cases and our results to deal with breast alterations after breast implant explantation, leaving a decreased mammary volume, ptosis and a loosy cutaneous excedent. With this technique of explantation and simultaneous breast correction with de-epithelialized dermoglandular flap, "authoprosthesis", associated with simultaneous fat grafting, we can get a good result regarding the shape, projection and coning of the explanted breast, with high patient satisfaction

The v-y latissimus dorsi musculocutaneous flap in the reconstruction of large posterior chest wall defects.

Posterior chest wall defects are frequently encountered after excision of tumors as a result of trauma or in the setting of wound dehiscence after spine surgery. Various pedicled fasciocutaneous and musculocutaneous flaps have been described for the coverage of these wounds. The advent of perforator flaps has allowed the preservation of muscle function but their bulk is limited. Musculocutaneous flaps remain widely employed. The trapezius and the latissimus dorsi (LD) flaps have been used extensively for upper and middle posterior chest wounds, respectively. Their bulk allows for obliteration of the dead space in deep wounds. The average width of the LD skin paddle is limited to 10-12 cm if closure of the donor site is expected without skin grafting. In 2001 a modification of the skin paddle design was introduced in order to allow large flaps to be raised without requiring grafts or flaps for donor site closure. This V-Y pattern allows coverage of large anterior chest defects after mastectomy. We have modified this flap to allow its use for posterior chest wall defects. We describe the flap design, its indications, and its limitations with three clinical cases. 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 at www.springer.com/00266