María Elsa Calderón G

Mamoplastía de reducción: resultados desde la perspectiva del paciente. Validación lingüística y psicométrica del Breast Q Reduction and Mastopexy Module Instrument

Validation of the Spanish version of the breast Q reduction and mastopexy module xxxx Background: The Breast Q Reduction and Mastopexy Module evaluate breast related quality of life from the perspective of the patients. Body self-image, social performance, sexuality and physical symptoms are assessed. Aim: To translate the Breast Q Reduction and Mastopexy Module to Spanish and validate the translated version to be used in Chile. Material and Methods: The linguistic validation guidelines of the MAPI/TRUST Research institute were used and the survey was applied to six patients aged 29 ± 6 years with 14 ± 2 years of studies. The internal stability of the test was assessed using Cronbach alpha. Results: The mean body mass index of the patients was 25 ± 1 kg/m 2 . The internal stability of the scale was 97%. The scores of the test in the preoperative period ranged from 74 to 125 points. Conclusions: The Breast Q Re-

Evolución del cáncer gástrico en 30 años 1975-2005

SUMMARY Background: Gastric cancer is the first cause of cancer death in Chile. Aim: To study the changes in epidemiological and pathological features of gastric cancer that occurred between 1975 and 2005. Material and methods: Analysis of 1193 pathological samples derived from total and subtotal gastrectomies for gastric cancer, performed at a Clinical Hospital between 1975 and 2005. The variables obtained from the reports were age, gender, pathological type, location and depth. Results: The pathological samples came from 803 males and 308 females. There was an increase in the frequency of diffuse type of carcinoma since 1985. In the last decade, 40% of carcinomas were of this pathological type. Among patients operated in the first decade of the study period, 60% of lesions were located in the inferior 2/3 of the stomach. However in the last decade 45% of lesions were in the upper third of the stomach. Conclusions: Gastric cancer predominates in males. The diffuse type became the main pathological type in the last decade. In the same period, almost half of the lesions were located in the upper third of the stomach.

Reconstrucción con colgajos libres: una experiencia de 33 años*

Microvascular free tissue transfer Background: Microvascular free tissue transfer has gained world-wide acceptance as a means of reconstructive plastic surgery. Since1979, the authors have introduced this microsurgical procedure in our country and a total of 317 free flaps have been carried out during a period of 33 years. Aim: To present the consecutive free flaps performed at Hospital Clinico Universidad de Chile and Hospital Mutual de Seguridad between 1979-2011. Patients and Methods: Retrospective analysis of 293 patients underwent 317 microsur- gical flaps. Results: 293 patients. Median age 43 years old (range 12-81). The lower limb has been the most common site (181 cases), followed by head and neck, upper limb and trunk. The most frequently used flap was the gracilis flap. A survival rate of 95% has been achieved. Follow-up range from 6 months to 9 years. Conclusion: This pioneering series in Chile using microsurgical flaps, shows a satisfactory solution in an one-stage procedure. The authors believe that free flap would be part of the armamentarium of modern plastic surgeons, frequently as a first choice.

Medición de los resultados desde la perspectiva del paciente en cirugía de contorno corporal: creación del instrumento Body-QoL

Development of an instrument to evaluate the results of plastic surgery from the perspective of the patient Background: Body remodeling surgical procedures requires an assessment from the clients point of view in terms of esthetic satisfaction. Aim: To develop an instrument of assess body remodeling surgical results from the point of view of the patient. Material and Methods: A literature search for assessment methods was carried out. Posteriorly, in depth interviews and focus groups with plastic surgeons and patients subjected to plastic surgery procedures were performed. With this information, a conceptual framework was established to devise the instrument. Results: Sixteen patients and five plastic surgeons participated in the interviews and focus groups. The domains included in the conceptual framework were outfit and body image, affective and sexual life, self-image and esteem, social relationships and physical symptoms. Conclusions: The conceptual framework for the instrument is ready and the psychometric evaluation is the next step in its development.

MEDICIÓN DE LOS RESULTADOS ESTÉTICOS Y FUNCIONALES DESDE LA PERSPECTIVA DEL PACIENTE EN RINOPLASTÍA: CREACIÓN DEL INSTRUMENTO NOSE-QoL

Development of a new patient-reported outcome measure for rhinoplasty suergery: the Nose-QoL Background: Instruments that assess the results of plastic surgery from patient’s perspective allow a multidimensional evaluation of surgical results. Aim: To develop a new instrument to assess the functional and esthetic results of rhinoplasty from the point of view of the patient. Material and Methods: A conceptual framework about important results for nasal image was developed using information from in depth interviews to patients, focal groups with experts and interviews to esthetic surgeons and patients subjected to rhinoplasty. Results: Four patients and four plastic surgeons were interviewed. The three sub scales identified for the con ceptual framework were quality of life, postoperative disability and pain and surgeon’s objective evaluation scale. Five domains for quality of life were identified including nose size and form, self-image and esteem, third party perceptions and social relationships, nasal function and segmental nasal analysis. Conclusions: After completion of the psychometric assessment, the Nose-QoL instrument will become a valuable instrument to measure the impact and effectiveness of rhinoplasty from the patient’s perspective.

MICROANASTOMOSIS VENOSA MECÁNICA COUPLER ® . UN IMPORTANTE APORTE TECNOLÓGICO A LA MICROCIRUGÍA VASCULAR*

Coupler ® venous mechanic microanastomosis. An important technological contribution to microvascular surgery

Colgajo radial: experiencia del equipo de Cirugía Plástica de la Universidad de Chile

El colgajo radial, es un colgajo fasciocutaneo tipo II segun Mathes y Nahai, de gran versatilidad gracias a su irrigacion principal por la arteria radial y a sus pediculos menores, ofrece una amplia variedad de alternativas frente a la reconstruccion no solo de defectos proximales o distales del brazo, sino que tambien es posible utilizarlo como colgajo libre en defectos de cabeza y cuello, porcion posterior del tronco, extremidad inferior y reconstruccion de esofago y pene. Permite incorporar hueso, tendones, nervio y musculo para reparacion de lesiones complejas, pudiendose utilizar con flujo directo o flujo retrogrado. En el presente articulo, mostramos la experiencia adquirida por el equipo de Cirugia Plastica y Reconstructiva del Hospital Clinico de la Universidad de Chile en la utilizacion del colgajo radial, como alternativa de cobertura frente a diversos tipos de defectos. En nuestros resultados, el 100% de los pacientes evoluciono favorablemente, sin perdidas parciales ni totales del colgajo; solo algunos debieron recibir injertos dermo-epidermicos (IDE) complementarios en un segundo tiempo, sin ningun otro procedimiento quirurgico posterior al alta.

ANGIO TC EN LA IDENTIFICACIÓN PREOPERATORIA DE VASOS PERFORANTES

Introduction: Perforator flaps have become a coverage option validated and increasingly used in reconstructive surgery. These flaps require preoperative identification and intraoperative dissection of the perforator vessels. The aim of this study was to evaluate the use of Angio CT in the preoperative assessment of perforating vessels and its correlation with intraoperative findings. Material and Methods: We retrospec-tively reviewed all perforator flaps performed at the Division of Plastic Surgery, University of Chile Clinical Hospital between June 2009 and June 2012. All patients were asked for an Angio CT according to the protocol of the University of Gent (Belgium). Data points were used and a specific coordinate system to locate the point at which the perforator vessel fenestrate the deep fascia. The information provided in the Angio CT was compared with surgical findings. Results: A total of 41 patients underwent perforator flap planning during the study period. 40 underwent surgery: 18 women and 22 men, with a mean age of 46.6 ± 5.7 years. Flaps were performed as follows: anterolateral thigh (ALT) = 14, inferior epigastric (DIEP) = 18, superior gluteal (SGAP) = 5, posterior tibial (PTAP) = 4 and thoracodorsal (TDAP) = 2. In all cases the Angio CT identified one or more perforator vessel with a 100% concordance with intraoperative findings. Conclusions: CT Angio is a test with high performance in preoperative characterization of perforator vessels. It is a helpful tool that must be considered whenever planning this type of flaps.Key words: Perforator vessels, flaps, Angio CT, reconstructive surgery.ResumenIntroduccion: Los colgajos de perforantes se han convertido en una opcion de cobertura valida cada vez mas utilizada en cirugia reconstructiva. Se caracterizan porque requieren de la identificacion preoperatoria y diseccion intraoperatoria del vaso perforante. El objetivo del presente trabajo fue evaluar el Angio TC en el estudio preoperatorio de los vasos perforantes y su correlacion con los hallazgos intraoperatorios. Material

DIFERENCIAS EN CALIDAD DE VIDA ASOCIADO A LA APARIENCIA NASAL EN PACIENTES OPERADOS DE RINOPLASTIA COMPARADO CON GRUPO CONTROL: VALIDEZ DEL INSTRUMENTO RHINOPLASTY OUTCOME EVALUATION

Evaluation of the Rhinoplasty Outcome Evaluation among Chilean participants Background: The Rhinoplasty Outcome Evaluation (ROE) is an instrument to assess the cosmetic and functional aspects of the nose from the patient’s perspective. Its construct validity in Chilean subjects has been published previously. Aim: To compare the ROE scores in different groups of participants. Material and Methods: The questionnaire was applied to patients waiting for a rhinoplasty, patients hospitalized for other causes and medical students. Results: The overall reliability of the scale was 84.8%. Significant diffe rences between groups in the total scores of four out of six items were observed. Conclusions: The Spanish version of the ROE is adequate to evaluate the satisfaction with nasal appearance and function among Chilean individuals.