Colgajo libre de piel para defecto de cubrimiento de piel peneana – reporte de caso

Introducción Reportar el caso de un paciente con lipogranuloma esclerosante de pene llevado a corrección de curvatura peneana compleja, con injerto de espesor parcial y posterior retracción secundaria, que generó curvatura peneana impidiendo el coito y que al momento de corrección quirúrgica, se generó un defecto de cubrimiento dérmico que requirió el uso de colgajo con piel de la pared abdominal. Materiales y Métodos Hombre de 46 años con antecedente de resección de lipogranuloma esclerosante en cara dorsal del pene resecado en el año 2006 y disfunción eréctil en manejo con terapia intracavernosa con prostaglandina E2; con necesidad de injertos de piel de abdomen en 2 oportunidades para cubrimiento de defecto de piel, con posterior fibrosis y curvatura peneana dorsal de aproximadamente 60° asociado a dolor con la erección. Llevado a corrección de curvatura peneana compleja en Hospital Universitario Mayor- Méderi. Se realiza plicatura de la túnica albugínea con técnica de Yachia hasta la verificación de corrección de curvatura dorsal en un 90%. Se identifica área con defecto de cubrimiento, por lo cual se levanta colgajo en región hipogástrica abdominal y se realiza anclaje del colgajo en borde distal del defecto de cubrimiento. Seis semanas después, es llevado a segundo tiempo quirúrgico, con liberación y remodelación del colgajo y se realiza el anclaje del colgajo en el borde proximal del defecto. Tres meses después, se revalúa el paciente encontrándose cubrimiento completo del área cruenta en región dorsal del pene. Se induce erección con alprostadil intracavernoso evidenciándose curvatura peneana dorsal de menos de 5°. Discusión Los pacientes con lipogranuloma esclerosante del pene generan placas en túnicas peneanas que al momento de ser resecadas, pueden requerir el uso de segmentos de piel para cubrimiento con injertos o colgajos pediculados en un terreno con alta probabilidad de daño por isquemia de dichos tejidos. En los casos en los que ocurre contracción del injerto se generan curvaturas peneanas que en caso de que impidan el coito requieren corrección de la misma. El uso de injertos autólogos o aloinjertos ha presentado resultados satisfactorios, sin embargo, puede requerir dos tiempos quirúrgicos para la obtención de tejido. En pacientes en quienes la piel peneana no es suficiente para cubrir el defecto, la segunda opción es la piel escrotal, que conserva características similares, así como una excelente vascularización. Cuando no se cuenta con piel escrotal en buen estado, se usa un injerto de piel de espesor total como última opción con resultados satisfactorios. Conclusiones Actualmente, el uso de piel de abdomen en esos defectos de piel no tiene amplia acogida dada la presencia de anexos dérmicos que terminan generando un aspecto estético no óptimo, sin embargo, se evidencia en este caso, que es un tejido que se adapta fácilmente a su nueva ubicación y permite el fin último, que es lograr una adecuada función del órgano receptor.Introduction Report the case of a patient with penile sclerosinglipogranuloma who was taken to corrrection of complex penile curvature with split-thickness graft with later secondary retraction that caused penile curvature preventing intercourse and during surgical mangement generated a skin coverge defect that required the use of free skin flap from the abdominal wall. Material and Methods 46 year old men with a history of surgical resection of sclerosinlipogranuloma in dorsal penile resected in 2006 and erectile dysfunction managed with intracavernous therapy with prostaglandin E2; that required abdominal skin grafts in 2 opportunities for skin defect coverage, with subsequent fibrosis and dorsal penile curvature of 60 degrees associated with pain during erection. Carried complex penile curvature correction in Hopsital Universitario Mayor– Méderi. Plication of the tunica albuginea with Yachia technique is performed until correction of dorsal curvature in 90%. Coverage defect area is identified, so that flap of hypogastric abdominal region is lifted and anchored in the distal edge of coverage defect. 6 weeks later is taken to second surgical procedure, with release and remodeling of the flap and anchorage of it in the proximal edge of the defect. 3 months after, the patient is reassessed finding complete coverage of the area on the dorsal surface of the penis. Erection is induced by intracavernousalprostadil showing dorsal penile curvature of less than 5 degrees. Discussion Patients with sclerosing penile lipogranuloma undergo plaques in penile layers that when resected may require the use of skin grafts or pedicle flaps for coverage in an area with high probability of ischemia in these tissues. In cases in which the graft contraction result in penile curvature, that in the event of preventing coitus require surgical correction thereof. The use of autologous grafts or allografts have shown satisfactory results, but may require two surgical procedures to obtain adecuate tissue. In patients in whom the penile skin is not enough to cover the defect, the second option is scrotal skin, which retains similar characteristics, as well as an excellent vascularization. When there is no adecuate scrotal skin, full thickness skin grafting as last option is used with satisfactory results. Conclusions Currently, the use of abdominal skin in these skin defects has no wide acceptance because of the presence of dermal annexes, ending in a suboptimal aesthetic appearance, however, it is evident in this case, is a tissue that is easily adapted to its new location and allows the latter, which is to achieve adequate organ receptor function

Skin Free Flap for Penile Skin Covering Defect – Case Report

Introducción Reportar el caso de un paciente con lipogranuloma esclerosante de pene llevado a corrección de curvatura peneana compleja, con injerto de espesor parcial y posterior retracción secundaria, que generó curvatura peneana impidiendo el coito y que al momento de corrección quirúrgica, se generó un defecto de cubrimiento dérmico que requirió el uso de colgajo con piel de la pared abdominal. Materiales y Métodos Hombre de 46 años con antecedente de resección de lipogranuloma esclerosante en cara dorsal del pene resecado en el año 2006 y disfunción eréctil en manejo con terapia intracavernosa con prostaglandina E2; con necesidad de injertos de piel de abdomen en 2 oportunidades para cubrimiento de defecto de piel, con posterior fibrosis y curvatura peneana dorsal de aproximadamente 60° asociado a dolor con la erección. Llevado a corrección de curvatura peneana compleja en Hospital Universitario Mayor- Méderi. Se realiza plicatura de la túnica albugínea con técnica de Yachia hasta la verificación de corrección de curvatura dorsal en un 90%. Se identifica área con defecto de cubrimiento, por lo cual se levanta colgajo en región hipogástrica abdominal y se realiza anclaje del colgajo en borde distal del defecto de cubrimiento. Seis semanas después, es llevado a segundo tiempo quirúrgico, con liberación y remodelación del colgajo y se realiza el anclaje del colgajo en el borde proximal del defecto. Tres meses después, se revalúa el paciente encontrándose cubrimiento completo del área cruenta en región dorsal del pene. Se induce erección con alprostadil intracavernoso evidenciándose curvatura peneana dorsal de menos de 5°. Discusión Los pacientes con lipogranuloma esclerosante del pene generan placas en túnicas peneanas que al momento de ser resecadas, pueden requerir el uso de segmentos de piel para cubrimiento con injertos o colgajos pediculados en un terreno con alta probabilidad de daño por isquemia de dichos tejidos. En los casos en los que ocurre contracción del injerto se generan curvaturas peneanas que en caso de que impidan el coito requieren corrección de la misma. El uso de injertos autólogos o aloinjertos ha presentado resultados satisfactorios, sin embargo, puede requerir dos tiempos quirúrgicos para la obtención de tejido. En pacientes en quienes la piel peneana no es suficiente para cubrir el defecto, la segunda opción es la piel escrotal, que conserva características similares, así como una excelente vascularización. Cuando no se cuenta con piel escrotal en buen estado, se usa un injerto de piel de espesor total como última opción con resultados satisfactorios. Conclusiones Actualmente, el uso de piel de abdomen en esos defectos de piel no tiene amplia acogida dada la presencia de anexos dérmicos que terminan generando un aspecto estético no óptimo, sin embargo, se evidencia en este caso, que es un tejido que se adapta fácilmente a su nueva ubicación y permite el fin último, que es lograr una adecuada función del órgano receptor.Introduction Report the case of a patient with penile sclerosinglipogranuloma who was taken to corrrection of complex penile curvature with split-thickness graft with later secondary retraction that caused penile curvature preventing intercourse and during surgical mangement generated a skin coverge defect that required the use of free skin flap from the abdominal wall. Material and Methods 46 year old men with a history of surgical resection of sclerosinlipogranuloma in dorsal penile resected in 2006 and erectile dysfunction managed with intracavernous therapy with prostaglandin E2; that required abdominal skin grafts in 2 opportunities for skin defect coverage, with subsequent fibrosis and dorsal penile curvature of 60 degrees associated with pain during erection. Carried complex penile curvature correction in Hopsital Universitario Mayor– Méderi. Plication of the tunica albuginea with Yachia technique is performed until correction of dorsal curvature in 90%. Coverage defect area is identified, so that flap of hypogastric abdominal region is lifted and anchored in the distal edge of coverage defect. 6 weeks later is taken to second surgical procedure, with release and remodeling of the flap and anchorage of it in the proximal edge of the defect. 3 months after, the patient is reassessed finding complete coverage of the area on the dorsal surface of the penis. Erection is induced by intracavernousalprostadil showing dorsal penile curvature of less than 5 degrees. Discussion Patients with sclerosing penile lipogranuloma undergo plaques in penile layers that when resected may require the use of skin grafts or pedicle flaps for coverage in an area with high probability of ischemia in these tissues. In cases in which the graft contraction result in penile curvature, that in the event of preventing coitus require surgical correction thereof. The use of autologous grafts or allografts have shown satisfactory results, but may require two surgical procedures to obtain adecuate tissue. In patients in whom the penile skin is not enough to cover the defect, the second option is scrotal skin, which retains similar characteristics, as well as an excellent vascularization. When there is no adecuate scrotal skin, full thickness skin grafting as last option is used with satisfactory results. Conclusions Currently, the use of abdominal skin in these skin defects has no wide acceptance because of the presence of dermal annexes, ending in a suboptimal aesthetic appearance, however, it is evident in this case, is a tissue that is easily adapted to its new location and allows the latter, which is to achieve adequate organ receptor function

Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture

Objective: To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP).Methodology: This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, 20-mm stones and complete information.Results: Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10-7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33-7.59, p = 0.009).Conclusions: Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.Keywords: antibiotics; bacteria; infections; sepsis; urolithiasis

Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture

Abstract Objective To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). Methodology This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20‐mm stones and complete information. Results Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10–7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug‐resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33–7.59, p = 0.009). Conclusions Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60‐min preoperative prophylaxis