Producción Científica UPeU

URI permanente para esta comunidadhttps://cris.upeu.edu.pe/handle/123456789/1

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Autor/a: search.filters.author.Rossell Perry, Percy EduardoFecha de inicio: 1961

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    Experiencia con el colgajo de Kirschbaum en secuelas de quemaduras cérvico-faciales
    (2014-01-01)
    ;
    P. Paredes-Leandro
    intro_obj: Presentamos nuestra experiencia con el colgajo de Kirschbaum (colgajo en charretera) en la corrección de retracciones cicatriciales de la región cervical anterior y del tercio inferior de la cara. Llevamos a cabo un estudio retrospectivo sobre una serie de 63 pacientes con retracciones cicatriciales de la región cervical anterior y del tercio inferior facial, operados por el primer autor entre los años 1996 y 2012 dentro del marco de las campañas quirúrgicas desarrolladas a lo largo del país (Perú) en las áreas geográficas con mayor necesidad de atención especializada. En todos los casos empleamos el colgajo en charretera tomado de la región lateral del cuello y de la región deltoidea. Evaluamos a los pacientes mediante el examen físico y la documentación fotográfica obtenida en los periodos pre y postoperatorio. Obtuvimos mejoría en diferentes grados de la limitación funcional de la región cervical y facial en todos los casos operados, con viabilidad total del colgajo en 59 casos (93,65%) y parcial en 4 casos (6,34%). No hubo ningún caso de pérdida total. Las complicaciones recogidas fueron pocas, principalmente hematomas, 6 casos (9,52%) e infección, 2 casos (3,17%). Las zonas donantes evolucionaron con cicatriz hipertrófica en 22 de los casos (34,92%). En conclusión, nuestra experiencia con el uso de esta técnica quirúrgica ha demostrado ser de utilidad en el tratamiento de las secuelas de quemadura con retracción cicatricial cervical y facial, por lo que consideramos que el colgajo de Kirschbaum es seguro y tiene pocas complicaciones.
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    Commentary on Anthropometric Effect of Mucoperiosteal Nostril Floor Reconstruction in Complete Cleft Lip
    (2015-12-24)
    From the Faculty of Medicine, San Martin de Porres University, Lima, Peru. Address correspondence and reprint requests to Percy Rossell-Perry, PhD, FACS, Post Graduate Studies Faculty of Medicine, San Martin de Porres University, Lima Peru, 120 Schell St Apt, 1503 Miraflores, Lima 18, Perú; E-mail: [email protected] Received 28 July, 2015 Accepted 24 October, 2015 The author reports no conflicts of interest.
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    The effects of individually tailored rTMS on hand function in chronic stroke: a protocol for an adaptive, phase II, randomized, sham-controlled clinical trial
    (2016-03-15)
    Ali Jannati
    ;
    Teixeira PEP
    ;
    Guilherme Santoro‐Lopes
    ;
    Mohamed H. Babiker-Mohamed
    ;
    Rodrigo Huerta
    Stroke is a leading cause of disability among adults. Existing rehabilitation programs haven’t been able to accomplish full motor recovery partially due to the pathologic plasticity exerted from the unaffected hemisphere to the affected one. This inhibition can be disrupted using non-invasive brain stimulation (NIBS). Transcranial magnetic stimulation (TMS) is a NIBS technique that has the capacity of depolarizing or hyperpolarizing neurons depending on the frequency of the pulses. Although several trials have been conducted to find the efficacy of low frequency rTMS for motor recovery after stroke, their results have been heterogeneous. One of the main variables that determine the response to rTMS is the dose, corresponding to the number of pulses delivered to the patients. However, due to the localization and the extension of the stroke, each patient responds differently to certain dose. Therefore, using the SPIRIT statement, we designed a protocol for an adaptive, phase II, randomized, sham-controlled clinical trial. The study proposed will include 75 patients between 45 and 80 years old, with hand function impairment after 1 to 3 years of stroke; it will exclude patients with severe cognitive or neuropsychiatric comorbilities, any previous stroke episode, Fugl Meyer (Upper limb) < 20, inability to understand the task or contraindications for rTMS. The study will have 3 arms: individually tailored (adaptive dosing) low frequency (1Hz) rTMS plus standard of care rehabilitation (physical therapy) compared to sham and fixed rTMS plus standard of care rehabilitation. The intervention will be applied during 6 weeks after which the main analysis will be performed. Subjects will be followed-up during 3 months and the results from this analysis will be exploratory. This protocol will use the results from the Pegboard test as a primary outcome and SF-36 questionnaire, hand strength, and responder´s rate as secondary outcomes.
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    A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique
    (2016-09-01)
    BACKGROUND: This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair. MATERIALS AND METHODS: This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3-6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded. RESULTS: There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty. CONCLUSIONS: We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.
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    Effect of Relaxing Incisions on the Maxillary Growth after Primary Unilateral Cleft Palate Repair in Mild and Moderate Cases: A Randomized Clinical Trial
    (2017-01-01)
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    Omar Cotrina‐Rabanal
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    Olga Figallo-Hudtwalcker
    ;
    Alicia Gonzalez-Vereau
    Background: The purpose of this study was to evaluate the association between the use of relaxing incisions and maxillary growth disturbance after primary palatoplasty in patients with unilateral cleft lip and palate. Methods: This is a prospective, randomized, double-blind controlled trial study with ethical committee approval between 2 groups of patients with unilateral cleft lip and palate who were operated on using the two-flap and one-flap techniques from 2008 to 2011. Two groups of patients with unilateral cleft lip and palate were operated on using the mentioned techniques by the Outreach Surgical Center Program Lima since 2008. Data collection was accomplished by evaluation of maxillary arch dimensions and dental arch relationships (scored using the 5-year-olds’ index). Results: The mean score for the 5-year-olds’ index was 2.57 for two-flap technique and 2.80 for one-flap technique without statistical significant differences ( P = 0.71). Our comparative study did not find statistically significant differences in maxillary arch dimensions between the studied techniques for unilateral cleft palate repair. Good levels of agreement were observed according to the κ statistics. Conclusions: The results arising from this clinical trial do not provide statistical evidence that one technique let us obtain better maxillary development than the other at 5 years. The use of relaxing incisions was not associated with maxillary growth impairment. A technique with limited relaxing incisions does not has better maxillary growth. Additional longer term study is necessary to confirm this preliminary report.
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    Risk factors leading to mucoperiosteal flap necrosis after primary palatoplasty in patents with cleft palate
    (2017-01-13)
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    Olga Figallo-Hudtwalcker
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    Roberto Vargas-Chanduvi
    ;
    Yvette Calderon-Ayvar
    ;
    Carolina Romero-Narváez
    BACKGROUND: Few studies have been published reporting risk factors for flap necrosis after primary palatoplasty in patients with cleft palate. This complication is rare, and the event is a disaster for both the patient and the surgeon. This study was performed to explore the associations between different risk factors and the development of flap necrosis after primary palatoplasty in patients with cleft palate. METHODS: This is a case-control study. A 20 years retrospective analysis (1994-2015) of patients with nonsyndromic cleft palate was identified from medical records and screening day registries). Demographical and risk factor data were collected using a patient´s report, including information about age at surgery, gender, cleft palate type, and degree of severity. Odds ratios and 95% confident intervals were derived from logistic regression analysis. RESULTS: All cases with diagnoses of flap necrosis after primary palatoplasty were included in the study (48 patients) and 156 controls were considered. In multivariate analysis, female sex, age (older than 15 years), cleft type (bilateral and incomplete), and severe cleft palate index were associated with significantly increased risk for flap necrosis. CONCLUSIONS: The findings suggest that female sex, older age, cleft type (bilateral and incomplete), and severe cleft palatal index may be associated with the development of flap necrosis after primary palatoplasty in patients with cleft palate.
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  • Publicacion
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    Mucoperiosteal Flap Necrosis after Primary Palatoplasty in Patients with Cleft Palate
    (2017-05-01)
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    Omar Cotrina‐Rabanal
    ;
    Luis Barrenechea-Tarazona
    ;
    Roberto Vargas-Chanduvi
    ;
    Luis Paredes-Aponte
    BACKGROUND: The prevalence of flap necrosis after palatoplasty in patients with cleft palate. The prevalence of mucoperiosteal flap necrosis after palatoplasty remains unknown, and this complication is rare. This event is highly undesirable for both the patient and the surgeon. We present here a new scale to evaluate the degree of hypoplasia of the palate and identify patients with cleft palate at high risk for the development of this complication. METHODS: In this case series, a 20-year retrospective analysis (1994-2014) identified patients from our records (medical records and screening day registries) with nonsyndromic cleft palate who underwent operations at 3 centers. All of these patients underwent operations using 2-flap palatoplasty and also underwent a physical examination with photographs and documentation of the presence of palatal flap necrosis after primary palatoplasty. RESULTS: Palatal flap necrosis was observed in 4 cases out of 1,174 palatoplasties performed at these centers. The observed prevalence of palatal flap necrosis in these groups was 0.34%. CONCLUSIONS: The prevalence of flap necrosis can be reduced by careful preoperative planning, and prevention is possible. The scale proposed here may help to prevent this complication; however, further studies are necessary to validate its utility.
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    Primary unilateral cleft lip nasal deformity repair using V-Y-Z plasty: An anthropometric study
    (2017-05-01)
    BACKGROUND: Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities. METHODS: A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively. RESULTS: Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively. CONCLUSIONS: The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip.
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    A New Horizon for Craniofacial Research in Latin America
    (2018-06-19)
    Post Graduate Studies, Faculty of Medicine, San Martin de Porres University, Edgardo Rebagliatti Hospital ESSALUD, Lima, Peru, Outreach Surgical Center Program Lima, Resurge International, Sunnyvale, CA. Address correspondence and reprint requests to Percy Rossell-Perry, PhD, FACS, Schell St No 120 Apartment 1503 Miraflores, Lima 18, Peru; E-mail: [email protected], [email protected] Received 30 December, 2017 Accepted 2 May, 2018 The author reports no conflicts of interest.
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