César Casado-Pérez

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts. Clinical cases of HAT published between 1999 and 2011 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Infectious, metabolic, and oncological complications because of IS therapy were recorded. Twenty‐eight patients were reported in 56 clinical manuscripts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (±19.04) points on the DASH score after HAT (P = 0.005). Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. The presence of intrinsic muscle function was observed in 57% of the recipients. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. Three grafts were lost to follow‐up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Fifty‐two complications caused by IS agents were reported, and they were successfully managed medically or surgically. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols.

Safety of salvaging impending flap congestion in breast reconstruction by venous supercharging of the cephalic vein.

AbstractAutologous flap breast reconstruction is an established technique that carries a risk of vascular failure. We evaluated the safety of salvaging impending venous congestion by using the cephalic vein for supercharging autologous abdominal flaps. Our main outcome measures were flap survival, triggering or impairing lymphedema as measured by the physician or reported by the patient, and scar severity as measured by the Vancouver scar scale. We were able to save 100% of the flaps, but could not find any statistical association with or without increased lymphedema before and after the procedure. One patient reported that lymphedema worsened. The patients accepted the scars (mean Vancouver scar scale score, 5.7). In sum, using the cephalic vein to improve venous drainage of autologous breast reconstruction was safe and did not trigger or impair lymphedema, but scarring in the upper arm was unavoidable.

Preservación en frío y rechazo crónico, desarrollo de un modelo de trasplante de extremidad posterior en ratas

Composite tissue allotransplantation has become a clinical reality nowadays, with more than 150 transplants performed in the last 15 years. Chronic allograft...

Factores relacionados con la cirugía secundaria en la reconstrucción mamaria autóloga con tejido libre abdominal

Breast reconstruction using abdominal free flaps has become the therapeutic choice at our center when a lot of tissue is needed, The completion of this recon...

Estimación del gasto energético en el paciente quemado mediante la utilización de ecuaciones predictivas; revisión bibliográfica

INTRODUCTION The estimation of the caloric requirements of the burn patient is based on the measurement of his resting energy expenditure (REE) via indirect calorimetry, which is not available in all Burn Units, or its estimation by means of predictive equations. GOALS we analyze the history and state of art of the use of REE predictive equations in burn patients, and determine their validity. METHODS bibliographic review of the studies and reviews written in English and Spanish between 1989 and 2013. RESULTS More than 190 equations have been designed to estimate energy expenditure. These equations can be imprecise because they are based on measurements with a heterogeneous methodology and in heterogeneous groups. We describe the different parameters that are used in the different equations (stress and activity factors, total burn surface area, post-burn day, lean body mass), the influence of age in the calculation of the caloric requirements, and the most commonly used equations nowadays. We also describe the articles that evaluate the accuracy of the predictive equations when compared to REE indirect calorimetry measurements. CONCLUSIONS Predictive equations are not precise in general in the burn patient. Until more accurate predictive equations are developed, we recommend calculation of the nutritional requirements in burn patients based on the energy expenditure measurement via indirect calorimetry.

Cierre de zona donante de colgajo libre radial de antebrazo con colgajo de rotación-avance basado en perforantes cubitales

The radial forearm free flap transfer is known in clinical practice because of its wide use in several reconstructive procedures. However, it is also popular...