Miquel Quer Agustí

Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados

Introduccion La cirugia oncologica de cabeza y cuello ha ido avanzando a medida que se ha podido ofrecer una reconstruccion adaptada al acto quirurgico. En los ultimos 30 anos se han desarrollado 2 tecnicas fundamentales: el colgajo pediculado de pectoral mayor (CMPM) y los colgajos microanastomosados. El CMPM tuvo un papel preeminente en los anos ochenta, y con posterioridad su uso disminuyo de forma progresiva a favor de los colgajos microanastomosados. Material y metodo Se realizo una revision de 351 actos reconstructivos en 317 pacientes en los que se llevo a cabo 275 CMPM y 76 colgajos libres. Analizamos la edad, el sexo, el tipo de colgajo, la indicacion y el ano de la cirugia. Resultados De los colgajos revisados: el 34 % fueron de reconstruccion de hipofaringe; el 33 %, de orofaringe; el 21 %, de reparacion de partes blandas, y el 12 %, de reparacion de fistulas faringocutaneas. La incorporacion en el uso de colgajos libres a partir del ano 2001 ha supuesto en nuestro centro el incremento en el uso de procedimientos reconstructivos, asi como la sustitucion para una serie de indicaciones del CMPM por colgajos microanastomosados. Conclusiones En la era de los colgajos libres, creemos que el CMPM sigue manteniendo un lugar privilegiado para la reconstruccion de la hipofaringe y defectos de la region cervical. Sin embargo, actualmente, en determinadas localizaciones, como la cavidad oral y la orofaringe y en defectos de las partes blandas faciales, preferimos el uso de colgajos microanastomosados para la reconstruccion.

Pectoralis Major Flaps. Evolution of Their Use in the Age of Microvascularized Flaps

Abstract Introduction Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, 2 basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. Material and method A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. Results 34% of the revised flaps were used for reconstruction of the hypopharynx, 33% for the oropharynx, 21% for soft tissues, and 12% for the repair of pharyngealcutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. Conclusions In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft tissue reconstruction we prefer the use of microvascularized flaps.

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker

INTRODUCTION Zenkers diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years. MATERIAL AND METHOD A retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO(2) laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed. RESULTS The endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach. CONCLUSIONS The combined endoscopic approach offers good results in patients with symptomatic Zenkers diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.

Miositis fulminante del compartimento muscular cervical posterior. A proposito de un caso

An atypical case of deep neck infection is presented with muscular involvement as the main feature. Streptococcus pyogenes was the causal agent and abrupt haemodynamic impairment and severe systemic failure characterized its clinical course, requiring emergency surgical examination and subsequent admission to the critical care unit. After the diagnosis of streptococcal myositis was obtained and the antibiotic treatment adjusted, the patient progressively recovered completely.

La audición en la enfermedad ósea de Paget

INTRODUCTION AND OBJECTIVES Pagets disease of bone (PDB) may lead to hearing loss. The present study was conducted with the aim of measuring, characterizing and determining the risk factors for hearing loss in a group of subjects with PDB. METHODS An observational, transversal, case-control study was conducted, a cohort of 76 subjects diagnosed with PDB in the case group and a control group of 134 subjects were included. Clinical, demographic and audiometric data were analysed. RESULTS The comparative analysis between the subjects in the PDB group and the control group found that the case group showed higher hearing thresholds (39,51dB) compared with the control group (37.28dB) (P=.069) and presented a greater rate of conductive hearing loss (22.76%) than the control group (12.05%) (P=.0062). The study of risk factors for hearing loss found that skull involvement in bone scintigraphy, age and high blood pressure were risk factors for higher impairment in PDB. CONCLUSIONS The subjects with PDB showed more profound and a higher proportion of conductive hearing loss than the control group. The patients with PDB and skull involvement presented a more severe hearing loss compared with the subjects without skull involvement. Skull involvement and age were found to be risk factors for hearing loss.

Sudden myositis of the posterior cervical muscular compartment. Case report

Abstract An atypical case of deep neck infection is presented with muscular involvement as the main feature. Streptococcus pyogenes was the causal agent and abrupt haemodynamic impairment and severe systemic failure characterised its clinical course, requiring emergency surgical examination and subsequent admission to the critical care unit. After the diagnosis of Streptococcal Myositis was obtained and the antibiotic treatment adjusted, the patient progressively improved to complete recovery