Cuadernos de Cirugía

Classic abdominoplasty with liposuction contour versus Lipoabdominoplasty. Randomized double-blind

2019-04-12T22:02:55-04:00

With the advent of liposuction in 1980, there was a great progress in addressing the abdominal wall, evolving into new concepts of body contouring, as Lipoabdominoplasty described by Saldanha in 2001. The objective of the study is to compare the results of classical abdominoplasty contour liposuction against Lipoabdominoplasty. Analyzing postoperative, morbidity and satisfaction. All patients operated in the city of Valdivia, excluding patients with BMI greater than 35, associated abdominal hernias, extensive surgical scarring of the abdominal wall were prospectively studied. They were randomly designated using uniform probability distribution. Neither the patient nor the interviewer knew the technique. Statistical analyzes were performed using descriptive statistics and chi square. There were 30 patients per group. Both groups were comparable according to demographic variables. Complications occurred in 16.7% of the interventions. The most frequent was seroma in abdominoplasty group. The degree of satisfaction was high in both groups, however the "tweaks" requested by patients was higher in the classical abdominoplasty group. Our results are comparable with other series, we believe that the highest percentage of seromas was given by the largest sizing fatty dermal flap. Certainly the indication of technical remodeling of the abdominal wall should be analyzed on an individual basis taking into account the different anatomical parameters of each patient.

Sural artery perforator flap of reverse flow, apropos of a case

2019-04-12T22:02:57-04:00

The reconstruction of the foot and leg are a challenge for surgeons. We present a clinical case of a 32 years patient with an external malleolar ulcer in his left ankle. We treated it with a distally based sural flap. In this article we describe the treatment done, detailing the surgical technique. Thereafter, we describe some relevant concepts founded in the literature. We describe the indications, details of the surgical technique and complications of this surgery.

Hypocalcemia: complication in surgery endrocrine-metabolica. A purpose of a case

2019-04-12T22:03:06-04:00

Hypocalcemia is a common metabolic complications in total thyroidectomy and gastric bypass. The mechanism that causes it is different in both clinical entities. The incidence of this complication is variable, the clinical presentation is nonspecific and pharmacological management is not standardized. A case report of a patient of 40 years which were performed both surgeries with the development of postoperative symptomatic hypocalcemia.

Esophageal achalasia

2019-04-12T22:03:13-04:00

Achalasia is a rare disease that affects esophageal motility as result of myenteric denervation of the esophagus and in a large proportion of cases, stomach. Its causes remain still poorly elucidated and its diagnosis remains late, reporting a delay of at least 5 years from the onset of symptoms, often confused with conditions such as gastroesophageal reflux disease, among others. Therefore, it requires a high index of suspicion and a comprehensive study, being esophageal manometry the gold standard. There is no curative treatment today and is focused on the relief of symptoms. The surgical available options are, Heller myotomy, endoscopic dilation, and the most recent peroral endoscopic myotomy (POEM). Medical treatment has not proved successful and today has restricted indications.

Acute colonic diverticulitis: etiology, diagnosis and therapeutic alternatives

2019-04-12T22:03:19-04:00

Diverticular disease of the colon is a quite frecuent pathology in our population, this refers to small outpouchings from the colonic lumen due to mucosal herniation through the colonic wall .Inflammation and/or perforation of the diverticula usually cause a clinical emergency which must be diagnosed and solved optimally. Clinical diagnosis must be confirmed by an abdominal and pelvic computed tomography scanning, according to the findings should be classified and decide on appropriate treatment. Patients with simple diverticulitis, inflammation of diverticulum only, should be hospitalized and treated with bowel rest and intravenous antibiotics. In the presence of complicated diverticulitis (abscess, purulent or fecaloid peritonitis) there are multiple options ranging from: percutaneous abscess drainage, laparoscopic lavage, resection and primary anastomosis, and Hartmann resection. The following article describes the pathogenesis, diagnosis, medical treatment and surgical options for patients with complicated acute diverticulitis.

Resuscitation and management of coagulopathy in trauma

2019-04-12T22:03:27-04:00

Coagulopathy induced by hemorrhagic shock is present in almost 25% of patients admitted for this reason. Once the coagulopathy develops patients morbidity and mortality dramatically increases. The paradigms in trauma patients resuscitation have changed considerably in the last years by changing the use of large volumes of crystalloid with the early use of blood products and other products to try to reverse the coagulopathy and the "triad of death." The aim of this paper is to review the pathophysiology of coagulopathy in trauma and therapy trends to reverse it.

Dermal substitutes defined

2019-04-12T22:03:33-04:00

Many are the pathologies that cause skin defects. The gold standard for skin coverage of these defects is the partial skin graft, but in some cases the results are not appropiate. Dermal substitutes are an alternative for skin coverage that exists today and allow get better functional and aesthetic results. There are many dermal substitutes in the pharmaceutical industry, each one with different characteristics, benefits and complications. This review brings together the most important aspects of dermal substitutes to have a theoretical background on these products that are helpful to treat patients with different pathologies.

Breast Cancer intrainflamatorio

2019-04-12T22:03:39-04:00

Inflammatory breast cancer is a rare disease, but its importance lies in the aggressiveness of its evolution. At the national level there is no accurate statistics on the percentage of inflammatory breast cancer as such. In the Base Hospital of Valdivia, constitute 3.3% of invasive breast carcinomas according to a review of the past 3 years. The diagnosis of this disease is based on clinical suspicion in patients presenting with erythema, edema, cellulitis, nodules, and / or breast induration. The histopathology of the primary tumor and skin allows diagnostic confirmation. As for treatment, there is now consensus that patients should be subjected to a multimodal treatment, starting with neoadjuvant chemotherapy and then perform locoregional therapy. The particularity of this type of cancer is that it has intrinsic biological characteristics of rapid progression and high power spread, which gives a poor prognosis.

Breast implants and cancer

2019-04-12T22:03:46-04:00

The association between breast implants and cancer has been a controversial issue, due to the lack of evidence concerning the safety of these in the long term. The increase of the number of patients who have undergone augmentation mammoplasty and the detection of carcinogenic elements related to the mammary implants lit interest of the scientific community, on its possible association with the cancer. We consider to be very important, a review concerning the actual literature between breast implants and cancer. Some of the problems that have been raised about the use of breast implants are the modifications that are established for the execution of a physical exam, and also the difficulty to analyze a mammography, what makes us think of a delay in the detection of malignant pathology, and therefore a worse forecast and survival. Despite the stated above, several studies have demonstrated that there is no casual association between breast implants and cancer, and the suspicion by physical exam has been favored in the detection of suspicious masses; the stage and the size of the tumor have not presented major differences, in some cases tending to reduce its size. The mammography presents a reduction in its sensibility but it is possible to supplement by introducing combined projections and other image techniques in case of suspicion. The frequency and mortality do not face significant changes compared to the general population. Concerning the relationship between breast implants and extra mammary cancer, taking in consideration that the breast implant is a strange object susceptible to degeneration, capable of producing an immune response and migration of the content, a possible carcinogenic effect in neoplasms at distance is raised. Other studies can be witnessed describing a relation with some types of cancer, although by the existence of bias, these are not conclusive from a statistical point of view. Therefore, it is necessary to perform larger studies that detail in a more complete way the variables previous to the use of mammary implants, and with a better study methodology.