F.J. Díaz González

Benign symmetrical lipomatosis with mediastinal involvement and growth retardation

Abstract Benign symmetrical lipomatosis (BSL) is a rare disease characterized by symmetrical deposition of adipose tissue in the neck and upper trunk. Deltoid region and upper arm fatty deposits are rarely found and involvement below the torso is very uncommon. 1 The disorder was first mentioned by Brodie in 1846 and Madelung published details of a series of 33 cases in 1888. 2 Launois and Bensaude established BSL as a unique clinical entity in 1898. 3 The disorder occurs in both sexes, but is most commonly found in middle-aged men. The condition has been referred to as Madelungs disease, Launois and Bensaude syndrome, Buschkes disease, lipoma diffusa symmetrica, and benign symmetrical lipomatosis. 4 The report describes a case with involvement of the upper mediastinum and growth retardation.

Colgajo miomucoso de buccinador en la reconstrucción de defectos del área maxilofacial

espanolEl colgajo miomucoso de buccinador (CMB) constituye una alternativa valida para la reconstruccion de defectos intraorales de tamano moderado. Se caracteriza por su buena plegabilidad, excelente color y textura, ademas de una minima morbilidad de la zona donante. En el presente trabajo se describen las particularidades anatomicas de dicho colgajo, asi como las diferentes tecnicas quirurgicas que pueden emplearse para su obtencion. Su utilizacion en diferentes defectos de la cavidad oral, ilustra la versatilidad del mismo. Presentamos 4 casos de reconstruccion de defectos del area maxilofacial: dos pacientes con carcinoma de mucosa epidermoide de suelo de boca, un paciente con melanoma de mucosa y un paciente con fisura palatina. Se obtuvieron resultados optimos en cuanto a cobertura del defecto postquirurgico, estetica y funcion. En todos los casos la morbilidad de la zona donante fue minima. Dadas sus particularidades anatomicas, debe realizarse una cuidadosa tecnica de obtencion del mismo. La proximidad del CMB a la gran mayoria de los defectos de la cavidad oral y su aceptable espesor, hace del mismo una opcion reconstructiva eficaz, sobre todo en aquellos pacientes en los que el tamano del defecto y/o la existencia de patologia asociada desaconsejan el uso de otros colgajos. EnglishThe buccinator myomucosal flap (BMF) constitutes a valid alternative for the reconstruction of moderate defects of the oral cavity. It is characterized by a good pliability, excellent color and texture and minimum donor site morbidity. In this report, the anatomical particularities and the different surgical techniques for BMF are described. Its use in patients with different defects of the oral cavity illustrates its versatility. We present 4 cases of reconstruction of defects of the maxillofacial area: two cases consisting in squamous cell carcinoma of the floor of the mouth, another patient with melanoma of the oral mucosa and one patient with a palatine fissure. All of them underwent primary reconstruction by means of BMF. Good results were obtained in relation to covering of the defect, aesthetics and function. Morbidity was minimal in the donor site. Due to its anatomical features, an adequate surgical technique must be performed. Proximity of the BMF to the vast majority of defects of the oral cavity, and its acceptable thickness, show the flap to be a reliable reconstructive procedure. This is especially valid in those patients where the size of the defect and the existence of comorbidity advise against the use of other flaps.

Injerto libre braquial medial

espanolIntroduccion. Entre las reconstrucciones de defectos titulares de cabeza y cuello, el injerto libre microvascularizado braquial medial no ha adquirido mucha popularidad debido a las variaciones anatomicas que se reflejan en la vascularizacion de este. Nuestro objetivo es realizar una descripcion de la anatomia y tecnica quirurgica, asi como una revision de la literatura describiendo las ventajas y desventajas de este tipo de injerto. Material y metodo. Presentamos el caso de una paciente con carcinoma epidermoide de mucosa yugal izquierda con afectacion ganglionar ipsilateral. Se procedio a su reseccion con margenes mas diseccion cervical funcional. La reconstruccion del defecto se llevo a cabo mediante un injerto libre microvascularizado braquial medial de brazo izquierdo. Discusion. Pensamos que el injerto libre braquial medial de brazo se trata de una opcion mas segura a la hora de la reconstruccion de defectos cervicofaciales, aportando una serie de ventajas entre las que destacan: no sacrificio de una arteria Terminal, cierre primario de la zona donante, minimo defecto estetico, y poseer una piel fina, elastica y sin vello. EnglishIntroduction. Free medial microvascularized arm grafs have not become very popular for the recosntruction of head and neck defects due to anatomic variations in their vascularization. Our objective was to describe the an anatomy and surgical technique and to review the literature on the advantages and disvantages of free medial arm grafts. Material and methods. We report the case of a patient with squamous cell carcinoma of the left jugal mucosa with same-side lymph node involvement. The tumor was resected with margins and a functional cervical dissection was performed. The defect was reconstructed using a free medial microvascularized graft from the left arm. Discussion. We believe that free medial arm grafts are a safer option for the recosntruction of cervicofacial defects and they offer advantages, among which can be highlighted: not sacrificing a terminal artery, primary closure of the donor zone, minimal esthetic defect, and yielding fine, elastic, hairless skin.

Expansión tisular en la reconstrucción de defectos craneofaciales

espanolLos expansores cutaneos son una alternativa reconstructiva de los defectos craneofaciales. Su objetivo es la dilatacion progresiva de una zona de piel hasta conseguir un tamano suficiente para cubrir el defecto. La eleccion del defecto a reconstruir mediante expasion tisular y el manejo correcto del expansor son factores importantes que el cirujano debe conocer para conseguir un buen resultado tanto estetico como funcional. Se realiza un estudio retrospectivo de 9 pacientes con defectos craneofaciales tratados con expansores cutaneos en los ultimos 5 anos. Se realiza un analisis descriptivo de la muestra, evaluando los resultados obtenidos y las complicaciones surgidas durante la expansion. Se analizan diversos aspectos (tecnica quirurgica, localizacion del defecto, situacion del expansor, tamano del mismo y ritmo de expansion) que pueden influir en el resultado final de la tecnica. En el 88.88% de los casos el origen de los defectos craneofaciales es la reseccion de lesiones tumorales. En el 80% de los casos el resultado final estetico y funcional es bueno. En 3 pacientes surgieron complicaciones: ulceracion de la piel expandida, cristalizacion del liquido del expansor y perforacion del mismo. Las dos primeras obligaron a retirar el expansor y la tercera a adelantar la cirugia pero con buen resultado final. En nuestra experiencia los expansores cutaneos son una buena alternativa en la reconstruccion de ciertos defectos craneofaciales con buen resultado estetico y funcional. EnglishTissue expanders are one alternative for craniofacial defects. Its objective is the progressive dilation of a region of skin until it achieves a sufficient size to cover the defect. The selection of the defect to reconstruct by tissue expansion and the correct handling of the expander are important factors that the surgeon should know in order to achieve a good result both aesthetically and functionally. We have performed a retrospective study of 9 patients with craniofacial defects, treated with tissue expanders in the last five years. We have done a descriptive analysis, evaluating the results obtained and the complications during the expansion. We analyzed diverse aspects (surgical technique, region of the defect, localization of the expander, expander size and the rate of the expansion) that can influence the final result. In 88.88% of the cases, the origin of the craniofacial defects is the removal of tumoral lesions. In 80% of the cases, the final aesthetic and functional result is satisfactory. We found complications in 3 patients: ulceration of the expanded skin, crystallization of the expander liquid and expander perforation. The first two ones required removal the expander and the trird one necessitated anticipate the surgery, but with a good final result. In our experience, the tissue expanders are a good alternative in the reconstruction of certain craniofacial defects with satisfactory aesthetic and functional results.