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Introducción: La úlcera por presión de talón es de difícil resolución por ser zona de apoyo especialmente cuando existe exposición de calcáneo. Una solución para esta patología es el colgajo fasciocutáneo en cono que es fácil, reproducible y segura. Material y Método: Se operó a 12 pacientes con este tipo de úlcera entre 2016 y 2022, siendo 10 hombres y 2 mujeres con edades entre 35 y 65 años portadores de paraplejia. En 6 de Ellos hubo osteomielitis de calcáneo que requirió de tratamiento antibiótico por 6 semanas. En todos ellos se practicó el colgajo en cono, descrito por el autor principal. Técnica quirúrgica: Primeramente, se realiza desbridamiento quirúrgico de la zona afectada. Posteriormente se practica el colgajo en cono que consiste en dos colgajos fasciocutáneos: uno de rotación, que cubre la lesión, el defecto dejado por éste es cubierto con un colgajo en avance en V-Y. Resultados: Todos los colgajos sobrevivieron sin signos de necrosis. No hubo recurrencia de las úlceras. La osteomielitis cedió con tratamiento antibiótico. Discusión: La exposición del calcáneo producto de una úlcera por presión de talón es de difícil tratamiento por ser una zona de apoyo constante. El tratamiento con el colgajo fasciocutáneo en cono ha probado ser de fácil resolución, reproducible y seguro para cubrir exposición de calcáneo. Conclusión: El tratamiento quirúrgico de la úlcera por presión de talón con el colgajo en cono es un procedimiento efectivo, reproducible, seguro y sin recidiva en nuestra casuística.

Introduction: The heel pressure sore is common in patients without sensivity such as paraplejic ones. When the calcaneous bone is exposed, with or without osteomielytis, a flap have to be used. In our experience the fasciocutaneous cone flap have been a good solution. Material and Method: Since 2016 and 2022 we have operated on 12 patients with heel pressure sore in paraplejic patients. In six of them we found osteomyelitis so the antibiotics were administred for six weeks without recurrence. There were 10 men and two women. Ages vary from 35 to 65 years old. Patients were para and tetraplejic ones. All were treated with de fasciocutaneous cone flap. Surgical technique. The area of pressure sore was treated with surgical debridment. After that, the fasciocutaneous cone flap was built. The cone flap consist in two flap: the first is a rotation and advance flap and the second is a V-Y advance flap that covers the defect made for the first one. Results: All the flaps survive with no necrosis, covering the complete defect. In case of osteomyelitis the antibiotics were administred for six weeks without recurrence. Discussion: Calcaneous exposure of the heel pressure sore needs coverage with a flap. The cone flap give good blood supply in patients with or whitout osteomyelitis with good results. This kind of flap is reliable, easy to perform and reproducible. Conclusión: The surgical technique of cone flap, for treatment of heel pressure sores, is reliable, sure, reproducible and whitout recurrence in our experience.

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It is broadly described that almost every step of the regeneration process requires proper levels of oxygen supply; however, due to the vascular disruption in wounds, oxygen availability is reduced, being detrimental to the regeneration process. Therefore, the development of novel biomaterials combined with improved clinical procedures to promote wound oxygenation is an active field of research in regenerative medicine. This case report derives from a cohort of patients enrolled in a previously published ongoing phase I clinical trial (NCT03960164), to assess safety of photosynthetic scaffolds for the treatment of full skin defects. Here, we present a 56 year old patient, with a scar contracture in the cubital fossa, which impaired the elbow extension significantly affecting her quality of life. As part of the treatment, the scar contracture was removed, and the full-thickness wound generated was surgically covered with a photosynthetic scaffold for dermal regeneration, which was illuminated to promote local oxygen production. Then, in a second procedure, an autograft was implanted on top of the scaffold and the patient's progress was followed for up to 17 months. Successful outcome of the whole procedure was measured as improvement in functionality, clinical appearance, and self-perception of the treated area. This case report underscores the long-term safety and applicability of photosynthetic scaffolds for dermal regeneration and their stable compatibility with other surgical procedures such as autograft application. Moreover, this report also shows the ability to further improve the clinical outcome of this procedure by means of dermal vacuum massage therapy and, more importantly, shows an overall long-term improvement in patient´s quality of life, supporting the translation of photosynthetic therapies into human patients.

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Insufficient oxygen supply represents a relevant issue in several fields of human physiology and medicine. It has been suggested that the implantation of photosynthetic cells can provide oxygen to tissues in the absence of a vascular supply. This approach has been demonstrated to be successful in several in vitro and in vivo models; however, no data is available about their safety in human patients. Here, an early phase-1 clinical trial (ClinicalTrials.gov identifier: NCT03960164, https://clinicaltrials.gov/ct2/show/NCT03960164) is presented to evaluate the safety and feasibility of implanting photosynthetic scaffolds for dermal regeneration in eight patients with full-thickness skin wounds. Overall, this trial shows that the presence of the photosynthetic microalgae Chlamydomonas reinhardtii in the implanted scaffolds did not trigger any deleterious local or systemic immune responses in a 90 days follow-up, allowing full tissue regeneration in humans. The results presented here represent the first attempt to treat patients with photosynthetic cells, supporting the translation of photosynthetic therapies into clinics. Clinical Trial Registration: www.clinicaltrials.gov/ct2/show/NCT03960164, identifier: NCT03960164.

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The Poly Implant Prosthèse (PIP) implants were withdrawn from the market in 2010 due to the use of a nonmedical grade silicone filler. In 2012, the French medical authorities and the International Confederation of Societies of Plastic, Reconstructive and Aesthetic Surgery recommended the extraction of PIP implants. However, during the duration of this scandal, each country in the world did not agree with a uniform procedure, and this rule was not implemented in its entirety. Although laboratory test results on PIP implants were negative for cytotoxicity and genotoxicity, there are many reports in the literature of several complications associated with PIP implants, including high rupture rates and the fact that they are 3 to 5 times more likely to produce local tissue reactions. On the other hand, the development of more strange and worse prognosis complications, such as the development of squamous carcinoma associated with the use of silicone implants (not necessarily related to PIP implants), is less known. To date, only 6 cases have been reported, and all are related to breast augmentation. The authors made the first report of primary gluteal squamous cell cancer related to rupture and delayed removal of PIP silicone buttock implants.

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Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.

Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.

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OBJECTIVE: The efficacy of 5% lidocaine medicated plaster (LMP) has previously been demonstrated in post-traumatic localized neuropathic pain. This study evaluated the use of LMP in localized neuropathic pain secondary to traumatic peripheral nerve injury. PATIENTS AND METHODS: This prospective observational study enrolled patients with traumatic injuries to peripheral nerves that were accompanied by localized neuropathic pain of more than 3 months duration. Demographic variables, pain intensity (measured using the numeric rating scale; NRS), answers to the Douleur Neuropathique 4 (DN4) questionnaire, and the size of the painful area were recorded. RESULTS: Nineteen patients were included, aged (mean ± standard deviation) 41.4 ± 15.7 years. Nerve injuries affected the upper (eight patients) or lower (11 patients) limbs. The mean duration of pain before starting treatment with LMP was 22.6 ± 43.5 months (median 8 months). Mean baseline values included: NRS 6.7 ± 1.6, painful area 17.8 ± 10.4 cm(2) (median 18 cm(2)), and DN4 score 6.7 ± 1.4. The mean duration of treatment with LMP was 19.5 ± 10.0 weeks (median 17.4 weeks). Mean values after treatment were: NRS 2.8 ± 1.5 (≥3 point reduction in 79% of patients, ≥50% reduction in 57.9% of patients) and painful area 2.1 ± 2.3 cm(2) (median 1 cm(2), ≥50% reduction in 94.7% of patients). Functional improvement after treatment was observed in 14/19 patients (73.7%). CONCLUSION: LMP effectively treated traumatic injuries of peripheral nerves which presented with chronic localized neuropathic pain, reducing both pain intensity and the size of the painful area.

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INTRODUCTION: Dermal substitutes, such as Integra(®) introduced as a new alternative to our surgical arsenal and its use in burn treatment, in both acute and chronic phases, have gained great importance. OBJECTIVE: The aim of the experiment is to describe the results of the functional evaluation of patients with burned hands treated with Integra(®) in both acute and chronic phases. MATERIAL AND METHODS: A retrospective review of a transversal cohort. Patient characteristics evaluated were sociodemographic characteristics, burn mechanism, burn extension and depth, treatments received previous to Integra(®) and complications related to its use. Clinical and photographic evaluations were performed evaluating skin elasticity, range of articular movement, prehensile strength, pain and functional evaluation using the validated 400 Point Evaluation Test. RESULTS: A total of 17 burned hands in 14 right-handed patients, were treated with Integra(®), three being bilateral hand burns. Eleven were treated in the acute phase and in nine in the scar reconstruction phase. Range of articular motion was complete in 15 of 17 hands. In 88% of the hands, flexible skin coverage was achieved. No statistically significant difference was observed in prehension strength of the burned hand versus the contralateral non-burned hand. Sixteen hands had a painless evolution. The 400 Point Evaluation score was 92.8 ± 6.3% (80 - 100%). Nearly four-fifths (79%) of the patients returned to normal active working activities.

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OBJECTIVE: To evaluate the use of 5% lidocaine medicated plaster (LMP) for treating painful scars resulting from burns or skin degloving. PATIENTS AND METHODS: This was a prospective, observational case series study in individuals with painful scars <70 cm(2) in area, caused by burns or skin degloving. The study included a structured questionnaire incorporating demographic variables, pain evaluation using the numeric rating scale (NRS), the DN4 questionnaire, and measurement of the painful surface area. Patients with open wounds in the painful skin or with severe psychiatric disease were excluded. RESULTS: Twenty-one men and eight women were studied, aged (mean + standard deviation) 41.4 ± 11.0 years, with painful scars located in the upper extremity (n = 9), lower extremity (n = 19), or trunk (n = 1). Eleven patients (37.9%) had an associated peripheral nerve lesion. The scars were caused by burns (n = 13), degloving (n = 7), and/or orthopedic surgery (n = 9). The duration of pain before starting treatment with lidocaine plaster was 9.7 ± 10.0 (median 6) months. The initial NRS was 6.66 ± 1.84 points, average painful area 23.0 ± 18.6 (median 15) cm(2), and DN4 score 4.7 ± 2.3 points. The duration of treatment with LMP was 13.9 ± 10.2 (median 11) weeks. After treatment, the NRS was reduced by 58.2% ± 27.8% to 2.72 ± 1.65. The average painful area was reduced by 72.4% ± 24.7% to 6.5 ± 8.6 (median 5) cm(2). Nineteen patients (69%) showed functional improvement following treatment. CONCLUSION: LMP was useful for treating painful scars with a neuropathic component, producing meaningful reductions in the intensity of pain and painful surface area. This is the first time that a decrease in the painful area has been demonstrated in neuropathic pain using topical therapy, and may reflect the disease-modifying potential of LMP.