Patricio Andrades C

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-

Rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios nasales

Introduccion: El objetivo del presente trabajo fue conocer el rendimiento de la evaluacion clinica en el diagnostico de fractura de huesos propios en pacientes con trauma nasal. Material y Metodo: Revision retrospectiva de fichas clinicas de 220 pacientes con trauma nasal atendidos en el Servicio de Cirugia Maxilofacial del Hospital del Trabajador de Santiago. Ocho criterios clinicos fueron evaluados: epistaxis, equimosis, inflamacion, herida nasal, obstruccion de via aerea, laterorrinia, dorso nasal irregular, y lesion aguda del tabique nasal. El estandar de oro para el diagnostico de fractura nasal fue el estudio radiologico. La sensibilidad, especificidad, y positivo/valor predictivo negativo (VPP/VPN) se calcularon para cada criterio clinico por separado (8), para todas las combinaciones posibles de 2 criterios clinicos (28) y 3 criterios clinicos (56). Resultados: Para cualquiera de los 8 criterios, el promedio de sensibilidad y valor predictivo negativo para la fractura nasal fue muy baja ( 90%) y aumento, respectivamente, cuando al menos un criterio estuvo presente (92% y 94%, respectivamente), cuando 2 criterios clinicos estaban presentes (98% y 96%, respectivamente), y cuando al menos 3 criterios clinicos estaban presentes (100% para ambos). Conclusiones: La presentacion de los criterios clinicos puede ser un metodo valioso para el diagnostico de fractura nasal, sin embargo, cuando estos criterios clinicos estan ausentes, la posibilidad de la fractura nasal no se puede descartar, aunque la posibilidad es remota.

INFLUENCIA DE LA APARIENCIA DE LAS MAMAS EN LA CALIDAD DE VIDA. DIFERENCIAS ENTRE POBLACIÓN PREOPERATORIA DE MAMOPLASTÍA DE REDUCCIÓN Y POBLACIÓN CONTROL

Criterion validity of a questionnaire to assess quality of life associated to the appearance of breasts in women Background: The Breast QoL Reduction and Mastopexy Module assesses quality of life associated to breast appearance from the point of view of the patient. Its Spanish version was recently validated in Chile. Aim: To assess the criterion validity of the instrument applying it in different populations of women and in the pre and post-operative periods. Material and Methods: The questionnaire was applied to six women subjected to reduction mammoplasty in the pre and post-operative period. It was also applied to 20 women hospitalized for other causes and 20 female medical students. Results: There were significant differences between operated women and their non-operated counterparts in the domains body self-image, social performance and physical symptoms. No differences in sexuality were found. However this last question was answered only by four operated patients, since two declared not to have sex life. Conclusions: The questionnaire is useful to assess quality of life associated to the appearance of breasts.

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 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

Rinoplastía: resultados desde la perspectiva del paciente. Validación lingüística y psicométrica del Rhinoplasty Outcome Evaluation Instrument*

Validation of the spanish version of the Rhinoplasty Outcome Evaluation Background: The Rhinoplasty Outcome Evaluation is a questionnaire that assesses, form the point of view of the patient, the functional and cosmetic outcome of rhinoplasty. It has six items for esthetic and functional domains, using Likert type questions with five alternatives. The scale ranges from 6 that is the worst outcome to 30, the best. Aim: To translate and validate the Rhinoplasty Outcome Evaluation, to be used in Chile. Material and Methods: The linguistic validation guidelines of the MAPI/TRUST Research Institute were used. The instrument was translated from English to Spanish, counter translated and applied to a pilot sample of five patients. The internal stability was assessed using Cronbach alpha. Results: The five female patients in whom the questionnaire was applied were aged 22 ± 4 years, had 15 ± 2 years of studies and their body mass index was 23 ± 4 kg/m 2 . Cronbach alpha was 84%. The scale changed from 10 points in the preoperative period to 17 points in the postoperative period. Conclusions: The Rhinoplasty Outcome Evaluation is a valid and reliable questionnaire to evaluate the results of rhinoplasty

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.

LAS MUJERES SOMETIDAS A REDUCCIÓN MAMARIA MEJORAN SU APARIENCIA ESTÉTICA, AUTOESTIMA, SÍNTOMAS FÍSICOS Y VIDA SEXUAL

effects of breast reduction surgery on the quality life background: The results of breast reduction surgery are usually reported in terms of anthropome tric assessments. However the impact of surgery in quality of life is seldom informed. aim: To assess the effects of breast reduction surgery on the quality of life of patients. material and methods: The “Breast-Q Reduction and Mastopexy Module” was prospectively applied to all women subjected to breast reduction surgery in a University Hospital during one year. results: Twenty women answered the survey in the preoperative period and 20 in the postoperative period. The most commonly cutaneous pattern employed that the inverted T in 10 women, followed by the Wise pattern in six patients. The most commonly used pedicles were superior in 10 patients, followed by superomedial in seven patients. Mean excision weight was 923 g (range 150-2850). Mean Breast Q score improved from 45 to 65%. Satisfaction with breast appearance improved from 31 to 83%, self-esteem from 39 to 80%, sexuality from 50 to 81% and physical symptoms decreased from 48 to 16%. There was a significant association between the magnitude of ex cision and improvement in physical symptoms. conclusions: Quality of life improves notably in women after breast reduction surgery.

RECONSTRUCCIÓN MICROQUIRÚRGICA EN EL TRAUMA PEDIÁTRICO

Introduccion: Se presenta una serie de casos clinicos en la cual se realiza transferencia libre de tejidos para solucionar defectos de cobertura de origen traumatico en 4 pacientes pediatricos (5 colgajos libres). Se analiza cada caso clinico, la indicacion de colgajo libre, complicaciones y resultados. Casos clinicos: Se realizaron 2 colgajos musculares (dorsal ancho y recto abdominal) y 3 colgajos fasciocutaneos (anterolateral de muslo). Solo un caso requirio revision quirurgica, no tuvimos perdidas de colgajos y hasta la fecha los pacientes se encuentran en fase de rehabilitacion, tras un seguimiento medio de 12 meses. Esta serie es la primera comunicacion nacional de reconstruccion microquirurgica en pacientes pediatricos traumaticos.