Colgajo de vasto lateral de pedículo distal para cobertura de lesiones complejas de rodilla

El tratamiento de las heridas complejas articulares se muestra siempre complicado, el abordaje razonable conjunto por traumatólogos y cirujanos plásticos mejora el resultado clínico, funcional y estético. Presentamos el caso de un paciente politraumatizado con pérdida de sustancia a nivel de la rodilla secundaria a artritis séptica, necrosis de patela y exposición de cóndilos femorales que fue tratado mediante colgajo muscular de vastus lateralis de pedículo distal. El vastus lateralis permite la cobertura eficiente de l articulación expuesta sin afectar la extensión de la rodilla y dejando mínima secuela estética.The treatment of the joint complex wounds is difficult. A good clinic, functional and aesthetic outcome is possible when multidisciplinary approach by orthopaedics and plastic surgeons is carried out. We report a case of a patient with multiple fractures who presents a severe loss of soft tissue at the knee. This lesion was due to a septic arthritis with patellar necrosis and condillar exposition. The treatment was made by a distally pedicled vastus lateralis muscular flap. This flap lets efficient coverage for the exposed joint as well as the integrity of the extensión knee function without aesthetic seque

Osteomielitis crónica de extremidades inferiores en pacientes ancianos: colgajo sóleo, una opción efectiva

La osteomielitis crónica (OC) en extremidades inferiores afecta al hueso y tejidos blandos circundantes, produciéndose úlceras crónicas que exponen el hueso necrosado. El tratamiento de la OC combina: antibióticos, desbridamiento-estabilización ósea, y una adecuada cobertura cutánea. La reconstrucción de las pérdidas de sustancia localizadas en el tercio medio de la pierna puede realizarse con colgajos fasciocutáneos, colgajos libres, colgajos en piernas cruzadas y colgajos locales musculares. La edad avanzada del paciente es un factor importante a considerar para la indicación de la técnica reparadora. El colgajo sóleo tiene múltiples ventajas: rica vascularización, corto tiempo quirúrgico, postoperatorio cómodo para el paciente y mínima limitación funcional. Presentamos 2 casos de pacientes ancianos con defectos osteocutáneos tibiales secundarios a OC, en ambos casos la cobertura del defecto se realizó con el colgajo muscular sóleo, la evolución clínica fue favorable y la recuperación funcional total.Cronic osteomyelitis (CO) in lower legs involves tibial-fibular bones and soft tissues around, with cronic ulcers by necrosed bone exposure. CO treatment combines: antibiotics, removes necrotic bone, bony stabilization and an adequate soft tissue coverage. Soft tissue loss reconstruction in the medium third of the legs can be made with fasciocutaneous flaps, free flaps, cross leg flaps and local muscle flaps. Elderly age is an important condition for the reconstruction procedure indication. Soleus muscle flap has multiple advantages: great blood supply, short surgical time, comfortable postoperative and minimum functional sequels. Two cases: Both elderly patients with osteocutaneous defects in tibia, by CO. Treatment coverage was performed with soleus muscle flap. Clinic course increased positively and the patients got completely functional restitution

Traumatismos de partes blandas en la muñeca: cobertura fasciocutánea

Las pérdidas de sustancia traumática localizadas en la muñeca afectan frecuentemente a los tendones, vasos y nervios. Estas lesiones requieren un tratamiento reparador de las estructuras lesionadas y una cobertura adecuada que permita el deslizamiento de los tendones, y proporcione protección neurovascular segura. El colgajo fasciocutáneo basado en perforantes de la arteria cubital aporta piel, tejido subcutáneo y fascia sobre las estructuras expuestas en la muñeca tanto en la cara palmar como dorsal. Presentamos cuatro casos de traumatismos de partes blandas en la muñeca, en ellos tras la reparación neurotendinosa requerida, se optó por la cobertura final mediante el colgajo fasciocutáneo cubito-dorsal. Destacamos la versatilidad de estos colgajos, su fácil ejecución, mínima secuela estética y la posibilidad de iniciar precozmente el tratamiento rehabilitador, consiguiendo así una mejor recuperación funcional del paciente.Traumatic soft tissue loss in wrist usually involves tendons, vessels and nerves. These injuries need the adequate reconstructive treatment and the safe coverage which lets to slide the tendons and it gives a safe protection to neurovascular structures. The fasciocutaneous flap based in perforator branches of the ulnar artery brings skin, fat and fascia enough over the exposed tissues in the dorsal or volar surface of the wrist. We report four cases of traumatic lesions in soft tissues of the wrist, in all of them the fasciocutaneous dorsal cubital flap was the option for the end coverage. We emphasize the versatility of these flaps, its easy ejecution, the minimal aesthetic sequel and the early rehabilitation beginning, so we obtain the best functional restitution for the patien

Úlceras por presión en pacientes traumatológicos: prevención basada en la evidencia médica

Las úlceras por presión (UPP) suponen una complicación importante que puede afectar a pacientes cuya movilidad está limitada. El tratamiento quirúrgico de las fracturas en pacientes ancianos y el encamamiento prolongado pueden ser predisponentes de lesiones por decúbito. En este trabajo de revisión buscamos las medidas de prevención de UPP basadas en la evidencia médica. La Medicina Basada en la Evidencia (MBE) propone utilizar la mejor evidencia científica y clínica sobre las UPP, según la cual, la prevención es el objetivo fundamental en estos pacientes. Se destaca en la literatura relativa a las úlceras por presión que las medidas de prevención con evidencia médica probada incluyen: valoración integral del paciente, identificación del riesgo, reconocer el estadio de la UPP, aminorar el efecto de la presión, evaluar el estado nutricional, eliminar el exceso de humedad (incontinencia), evitar encamamientos prolongados y preservar la integridad de la piel.Pressure sores are an important complication, which can affects to patients with restricted motion. Surgical treatment of elderly people with fractures in addition prolonged time lying in same position are able to develop bedsores. This review paper searches the prevention features of pressure sores in evidence based medicine. Evidence Based Medicine proposes the best clinical and scientifical evidence available about to pressure sores, being prevention the main goal in these patients. The results founded in the literature relative to pressure sores affirms these are the facts in evidence based medicine: the general approach of the patient, recognising risk, staging pressure sores, reducing pressure effect, assessing nutritional status, avoiding excess moisture (incontinence) reducing bed rest and preserving the integrity of the skin

Vertical biogeographical overview of the Zooplankton community across the Atlantic, Pacific and Indian ocean (35ºN-40ºS)

From December 2010 to June 2011 the mesozooplankton has been sampled at the deep Atlantic, Indian and Pacific Ocean (*). From surface to 3000 m depth a HYDROBIOSS multinet was used distinguishing the epipelagic (77%), mesopelagic (11%) and bathypelagic zones (11%), where five layers were usually sampled (0-200, 200-500, 500-1000, 1000-2000 and 2000-3000 m depth). Among the three oceans, no large differences on abundance were found when taxonomic groups were considered, being always depth the most important factor affecting the vertical zooplankton distribution. The zooplankton abundance strongly decreased with depth and very low abundance was found at deeper waters. Very irregular spatial distribution was observed all across the three oceans, finding the lowest abundance in the south and western Pacific region. Copepods were always the most abundant contributors of the zooplankton community (84%) and more than 260 species identified. They were followed by chaetognaths (5%), siphonophores (3%), ostracods (2%) and euphausiids (1%). In a biogeographical overview, the vertical distribution of the most abundant copepods is analyzed, finding the largest copepods at deeper stratum, where small cosmopolitan copepods were also found

GARBAN: genomic analysis and rapid biological annotation of cDNA microarray and proteomic data

Genomic Analysis and Rapid Biological ANnotation (GARBAN) is a new tool that provides an integrated framework to analyze simultaneously and compare multiple data sets derived from microarray or proteomic experiments. It carries out automated classifications of genes or proteins according to the criteria of the Gene Ontology Consortium at a level of depth defined by the user. Additionally, it performs clustering analysis of all sets based on functional categories or on differential expression levels. GARBAN also provides graphical representations of the biological pathways in which all the genes/proteins participate. AVAILABILITY: http://garban.tecnun.es

Vertical variability of trophic positions of zooplankton in the deep Ocean

Zooplankton plays a key role in oceanic ecosystems. However, the trophic ecology of organisms in deep layers of the ocean is poorly known. In this study we analyze the variability of trophic positions of zooplankton collected across three ocean basins in the epi-, meso and bathypelagic domains. Stable carbon and nitrogen isotopes were used as indicators of the sources of nutrients and positions within the food web. The enrichment in heavy nitrogen isotopes with depth and the correlation between surface and deep samples revealed that deep zooplankton was supported by local epipelagic production, subsequently processed through the water column. In addition the nitrogen isotope enrichment of carnivores vs. omnivores was consistent across ocean biomes and water layers, suggesting a similar trophic structure of the pelagic food web in the deep ocean despite variations in the nitrogen sources. Siphonofora, Chaetognata and Myctophida were the top predators while Calanoid Copepoda and Mysidacea displayed the lowest trophic positions. In contrast, carbon isotopes did not show significant variations with depth or trophic groups implying low influence of coastal production in deep ocean food webs