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RESUMEN La incontinencia urinaria de esfuerzo es frecuente en las mujeres desde la adultez media. La técnica más frecuente para tratar estos casos es el cabestrillo sintético. Sin embargo, el cabestrillo autólogo tiene buenos resultados comparables con el material sintético en los diversos estudios publicados. Presentamos un caso tratado con cabestrillo de fascia lata, describiendo la técnica y evolución.
ABSTRACT Stress urinary incontinence is common in women from middle adulthood onwards. The most frequent technique to treat these cases is the synthetic sling. However, the autologous sling has good results comparable with the synthetic material in the various studies published. We present a case treated with fascia lata sling, describing the technique and evolution.
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Introdução: A paralisia facial necessita de um tratamento multidisciplinar e as opções cirúrgicas são individualizadas para cada paciente e conforme a experiência da equipe médica. O Retalho Ortodrômico Temporal (ROT) é uma forma de correção bem documentada na literatura, com resultados satisfatórios. Um dos passos de sua realização é a coleta da fáscia lata para ponte entre o tendão temporal e os lábios. O objetivo é propor uma padronização da quantidade necessária de fáscia lata e técnica de coleta simplificada. Métodos: Descrição cirúrgica da medida de fáscia necessária para o procedimento e sua coleta. Resultados: Procedimento replicável e seguro conforme experiência do autor sênior. Conclusão: A tática de coleta proposta pode facilitar a realização deste procedimento e torná-lo mais seguro para os pacientes em diferentes serviços de saúde.
Introduction: Facial paralysis requires a multidisciplinary treatment, and surgical options are individualized for each patient according to the medical team's experience. The Temporal Orthodromic Flap (TOF) is a well-documented form of correction in the literature, with satisfactory results. One of the steps of its accomplishment is the collection of the fascia lata to bridge between the temporal tendon and the lips. The objective is to propose a standardization of the required amount of fascia lata and a simplified collection technique. Methods: Surgical description of the fascia measure necessary for the procedure and collection. Results: Replicable and safe procedure according to the senior author's experience. Conclusion: The proposed collection tactic can facilitate the performance of this procedure and make it safer for patients in different health services.
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Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 ( p = 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences ( p = 0.001; p = 0.005; and p = 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p = 0.003; 30 to 60°, p = 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.
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Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.
Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p= 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p= 0,001; p= 0,005; e p= 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p= 0,003; 30 a 60°, p= 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.
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Humanos , Articulação do Ombro/lesões , Resultado do Tratamento , Cápsula Articular/patologia , Fascia Lata/transplante , Lesões do Manguito Rotador/cirurgiaRESUMO
Introducción: El osteoma osteoide es un tumor óseo benigno, que no tiene potencial de crecimiento por lo que su tamaño no supera 1,5 cm pese a que la esclerosis que lo rodea le da un aspecto mayor. Afecta con mayor frecuencia a los varones jóvenes, y la mayoría de las veces aparece en las tres primeras décadas de la vida. Objetivos: Mostrar las repercusiones biomecánicas derivadas de un osteoma osteoide en el trayecto de la cintilla iliotibial y sus influencias por cadenas musculares descendentes sobre el miembro inferior. Presentación del caso: Se presenta una paciente de 24 años que acude a la consulta por presentar dolor a nivel de la cara externa del fémur derecho desde hace dos años; que se agudiza fundamentalmente con la marcha. Tras realizar las pertinentes exploraciones y pruebas diagnósticas por imagen, no se observan hallazgos clínicos significativos, por tanto se pauta tratamiento antiinflamatorio por vía oral y se efectúa estudio biomecánico y postural en el cual se detecta pie valgos bilaterales, inestables, con mayor relevancia en el pie derecho. La paciente acude nuevamente al no encontrar mejoría, se realiza telemetría del miembro inferior y resonancia magnética del fémur derecho. La imagen para diagnóstico da como resultado la presencia de una masa compatible con un osteoma osteoide de 11 x 4 mm en el tercio proximal lateral del fémur derecho. Conclusiones: Una lesión neoplásica que afecte al trayecto de un grupo muscular con repercusión biomecánica puede realizar compensaciones a diferentes niveles, por tanto, es necesaria la actuación de un equipo multidisciplinario para restablecer la marcha. Las sinergias entre el tratamiento conservador y quirúrgico provocan un mayor porcentaje de éxito(AU)
Introduction: Osteoid osteoma is a benign bone tumor, which has no growth potential, consequently its size does not exceed 1.5 cm despite the fact that the surrounding sclerosis gives it a larger appearance. It most often affects young men, most often appearing in the first three decades of life. Objectives: To show the biomechanical repercussions derived from an osteoid osteoma in the trajectory of the iliotibial band and its influences by descending muscle chains on the lower limb. Case report: We report a 24-year-old female patient who came to the consultation due to pain on the external face of her right femur for two years. This pain worsened mainly by walking. After carrying out the pertinent explorations and diagnostic imaging tests, no significant clinical findings were observed, therefore, oral anti-inflammatory treatment was prescribed and biomechanical and postural study was carried out, which showed bilateral, unstable valgus foot, with higher relevance on the right foot. The patient came again when she had no improvement, telemetry of her lower limb and magnetic resonance imaging of her right femur were performed. The diagnostic image revealed the presence of a mass compatible with an 11 x 4 mm osteoid osteoma in the proximal lateral third of her right femur. Conclusions: A neoplastic lesion that affects the trajectory of a muscle group with biomechanical repercussions can carry out compensations at different levels, therefore, the action of a multidisciplinary team is necessary to restore gait. Synergies between conservative and surgical treatment lead to a higher success rate(AU)
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Humanos , Feminino , Adulto , Osteoma Osteoide/cirurgia , Osteoma Osteoide/diagnóstico por imagem , Fenômenos BiomecânicosRESUMO
This study aims to present an alternative technique with the use of a transobturator hybrid sling (autologous fascia lata with a synthetic sling) in two patients with complex urethral diverticulum (CUD), urinary stress incontinence (SUI) and a large incisional infraumbilical hernia. Staged procedures could be performed, but considering the risk of persistence or worsening SUI, and no standard management strategy of SUI associated with CUD; simultaneous treatment was proposed. It is preferable to use autologous materials in such cases. However, the presence of incisional hernia protruded with its content covering the suprapubic area prohibits the retropubic sling technique due to visceral lesion risk. The diverticulum and SUI were repairs in the same surgery using a hybrid transobturator. The technique used for obtaining the fascia lata followed the literature, and a 6 cm segment was acquired. The patients were re-prepared in a lithotomy fashion, and diverticulectomy was performed. The segment of fascia lata was fixed to the mesh and sling was manipulated so that its middle part (fascia) rested directly below the urethra. After 6 months post-operatively, patients referred significant improvement in urinary symptoms. Patients have not had any storage symptoms, International Consultation on Incontinence Questionnaire - Short Form = zero, no SUI, and have not had any mesh-related complications. In conclusion, the present study evaluated a new technique for the treatment of CUD with SUI in a particular clinical scenario. Other studies with extended follow-up periods and larger sample sizes should be performed in this subset of patients.
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The purpose of this work was to evaluate the behavior of different membranes and bone filling materials used to fill critical defects in rabbit calvaria. Four defects were prepared in the cranial calvaria of female rabbits. They were randomly divided into three subgroups according to the type of barrier membrane to be used. Four animals carried cross-linked bovine collagen membranes (Mem-Lok, Bio-Horizons, Birmingham, AL, USA)), four human fascia lata membranes (Tissue, Inbiomed SA, Córdoba, Argentina) and four human chorioamniotic membranes (Tissue. Inbiomed SA, Córdoba, Argentina). The defects were filled with the deproteinized bovine bone particulate Bio-Oss® (Geistlich-Pharma AG, Wolhusen, Switzerland), with particulate human hydroxyapatite MinerOss® (Bio-Horizons, Birmingham, AL, USA), with particulate dental material (Tissue Bank Foundation, Inbiomed S.A., Córdoba, Argentina), and the last one was left without the addition of filler material. In the first group of four specimens, a resorbable cross-linked bovine collagen membrane was placed over the skull and defects, without additional fixing. In the second group, a human fascia lata membrane was placed, without additional fixing. In the third group, a human chorioamniotic membrane was placed, without additional fixing. The animals were sacrificed at 4 and 8 weeks. The highest percentages of relative radiological density (average) were recorded considering the amnio-chorionic membranes (83.63%) followed by collagen (81.44%) and finally the fascia lata membranes (80.63%), but the differences were not statistically significant (p > 0.05). The sites grafted with a decellularized tooth (96.83%) and Bio-Oss (88.42%), recorded the highest percentages of radiological density but did not differ significantly from each other (subset 2). The three membranes used did not show statistical differences between them, in any of the two time periods used. There were statistical differences between the filling materials evidencing the presence of a large quantity of calcified material in the defects treated with particulate tooth and deproteinized bovine bone and while smaller amounts of calcified material were registered in the case of defects treated with human hydroxyapatite and those that were not treated.
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Introducción. La úlcera trocantérea es una de las lesiones por presión más frecuente y está asociada generalmente a bursitis, por lo que su tratamiento es complejo. Materiales y Métodos. Se presenta el caso de un paciente masculino de 29 años, con antecedente de lesión medular asociada a paraplejía fláccida con desarrollo de úlcera trocantérea derecha elíptica vertical. Fue abordado de forma multidisciplinaria y resuelto con resección de la patología y reconstrucción con colgajo musculocutáneo de fascia lata. Resultado. El paciente fue dado de alta al 21 día posoperatorio. No presentó dehiscencias, infecciones de la herida ni recidiva al cumplirse 6 meses de la cirugía y el resultado estético y funcional fue satisfactorio. Conclusión. El colgajo musculocutáneo de fascia lata ascendido y con cierre de V en Y es una opción segura, versátil y reproducible para la resolución de úlceras trocantéreas. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas.
Background. Trochanteric ulcer is one of the most frequent pressure sore and is usually related with bursitis, therefore its treatment is complex. Material and Methods. We present a case of a 29 year-old male patient with medical history of spinalcord injury (SCI) related to flaccid paraplegia and the development of right trochanteric vertical elliptical sore. He was treated by a multidisciplinary team and solved by the resection of the pathology and immediate reconstruction with tensor fascia lata (TFL) musculo cutaneous flap. Results. The patient was discharged from the institution on the 21st postoperative day. With a follow-up of a 6 months period, complications such as wound infection, suture dehiscense or recurrence were not observed. Aesthetic and functional results were satisfactory. Conclusion. Ascended TFL flap with a V-Y closure is a reproducible, reliable and versatile procedure for the coverage of trochanteric pressure sore defects. However all surgical techniques tages must be considered in order to avoid complications and recurrence of the disease
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Humanos , Masculino , Adulto , Paraplegia/cirurgia , Bursite/terapia , Procedimentos de Cirurgia Plástica/métodos , Úlcera por Pressão/terapia , Fascia Lata/transplante , Fêmur/lesões , Retalhos de Tecido Biológico/transplante , Técnicas de Fechamento de FerimentosRESUMO
Introdução: A ptose palpebral é uma afecção comum na prática clínica na qual uma perfeita avaliação torna-se mandatória. Definimos ptose quando a margem palpebral encontra-se abaixo de 2 mm da junção córneo escleral e pode ser classificada em leve, moderada e grave. Existem inúmeras técnicas de reparo e a escolha dependerá da classificação da função do músculo levantador. Métodos: Foram analisados de forma prospectiva, no período de março de 2013 a maio de 2015, quatorze (n = 14) pacientes submetidos ao tratamento cirúrgico de ptose palpebral moderada e grave (n = 21). Inúmeros fatores foram estudados, tais como grau de ptose e função do músculo elevador da pálpebra, tipo de técnica de reparo, complicações imediatas e tardias, etc. Resultados: Quatorze pacientes foram opera-dos, totalizando 21 pálpebras, sendo que, 85% foram de etiologia adquirida e 15% congênita. Com relação ao grau de ptose, 64,3% (n = 9) foram moderadas e 35,7% (n = 5) graves. No que tange à função do músculo levantador, encontramos função boa 28,5% (n = 4), moderada 28,5% (n = 4) e pobre 43% (n = 6). Em relação às com-plicações, 2 casos de hiperemia conjutival e um caso de edema. Obtivemos um alto índice de satisfação com 85,7% (n = 12), com baixas taxas de complicações. Conclusão: A ptose palpebral é uma enfermidade comum na prática clínica e exige por parte do cirurgião um perfeito conhecimento anatômico da delicada estrutura palpebral e também de sua fisiopatologia. Uma perfeita avaliação desse paciente torna-se mandatória para o emprego do tratamento mais adequado.
Introduction: Eyelid ptosis is a common condition in clinical practice for which a complete evaluation is mandatory. Ptosis is defined when the eyelid margin is 2 mm below the corneoscleral junction and can be classified as mild, moderate, and severe. There are numerous repair techniques, and the choice will depend on the classification of the function of the levator muscle. Methods: We evaluated prospectively, from March 2013 to May 2015, 14 patients who underwent surgical treatment of moderate and severe ptosis (n = 21). Several factors were studied, such as degree of ptosis and function of the eyelid levator muscle, type of repair technique, and immediate and late complications. Results: Fourteen patients (21 eyelids) underwent operation. The etiology was acquired in 85% of the cases and congenital in 15%. With respect to the degree of ptosis, 64.3% (n = 9) of the cases were moderate and 35.7% (n = 5) were severe. With respect to the muscle function of the levator, good, moderate, and poor functions were observed in 28.5% (n = 4), 28.5% (n = 4), and 43% (n = 6) of the cases, respectively. With regard to complications, 2 cases of conjunctival hyperemia and one case of edema were observed. We obtained a high satisfaction rate of 85.7% (n = 12), with low complication rates. Conclusion: Eyelid ptosis is a common presentation in clinical practice and requires on the part of the surgeon a detailed anatomical knowledge of the delicate structure of the eyelid and its pathophysiology. A complete evaluation of these patients is mandatory for the employment of the most appropriate treatment.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , História do Século XXI , Procedimentos Cirúrgicos Oftalmológicos , Blefaroptose , Estudos Prospectivos , Blefarofimose , Doenças Palpebrais , Fascia Lata , Miastenia Gravis , Procedimentos Cirúrgicos Oftalmológicos/métodos , Procedimentos Cirúrgicos Oftalmológicos/reabilitação , Blefaroptose/cirurgia , Blefaroptose/reabilitação , Blefarofimose/cirurgia , Blefarofimose/reabilitação , Doenças Palpebrais/cirurgia , Doenças Palpebrais/reabilitação , Fascia Lata/anatomia & histologia , Fascia Lata/anormalidades , Fascia Lata/cirurgia , Miastenia Gravis/cirurgia , Miastenia Gravis/terapiaRESUMO
Resumen Introducción: La fascia lata es la parte más externa de la aponeurosis del muslo. Se trata de una membrana gruesa y resistente que posee elasticidad, flexibilidad y memoria. Actualmente es utilizada en el área médica para el tratamiento de defectos abdominales, incontinencia urinaria, ptosis palpebral y, en odontología, se utiliza para regeneración tisular guiada, coberturas radiculares, aumento de reborde y preservación de alveolo. Método: Se ha realizado una búsqueda electrónica en las bases de datos de Medline, PubMed y SciELO con el término fascia lata. Fueron incluidos textos compie-tos en idioma español e inglés que abarcan desde 1983 hasta 2015. La característica principal de estos textos es que exploran el uso de fascia lata en el área médica y odontológica. Discusión: Durante la realización de este trabajo surgieron situaciones limitantes debido a la escasa cantidad de artículos, investigaciones y casos clínicos documentados enfocados al uso de la fascia lata en el área odontológica. Conclusiones: La fascia lata es un material reabsorbible. biocompatible, que es bien tolerado por el lecho receptor, goza de características de seguridad y larga duración en su uso dentro de las especialidades medicas y odontológicas.
Abstract Introduction: Fascia lata is the most extreme section of the thigh's aponeurosis. It is a thick and resistant membrane possessing elasticity, flexibility and memory. It is presently used in the medical world to treat abdominal defects, urinary incontinence, and palpebral ptosis. In dentistry it is used in guided tissue regeneration, root coverage, ridge increase and socket (alveolus) preservation. Method: An electronic search was conducted in the following databases: Medline, PubMed and Sei ELO, with the term fascia lata. Full texts in English and Spanish were included in timeline spanning from 1983 to 2015. Main characteristic selected for these texts was they explored use of fascia lata and medical and dental areas. Discussion: Limiting situations arose during the execution of this project due to the scarcity found in articles and research papers and documented clinical cases targeting use of fascia lata ion dental areas. Conclusions: Fascia lata is a resorbable, biocompatible material, well tolerated by the recipient bed; when used in medical and dental specialties it exhibits characteristics of accuracy (security) and long duration.