Reconstrucción articular con tallado tridimensional de cartílago costal autólogo en pacientes con microtia, Hospital del Niño Dr. Francisco de Ycaza Bustamante 2009 - 2012
Fecha
2014
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
INTRODUCCIÓN
La microtia es una patología congénita, aislada o en asociación con síndromes que
puede representar más que problemas estéticos, psicológicos, y auditivos. Una adecuada
y definitiva reconstrucción puede prevenir estos desenlaces. El objetivo de este estudio
fue determinar la prevalencia de complicaciones en la reconstrucción auricular con
tallado tridimensional de cartílago costal autólogo.
METODOLOGÍA
Estudio de corte transversal, que determina la prevalencia de complicaciones en la
reconstrucción de microtia tipo III, a partir del tallado de cartílago autólogo costal, en
niños de 6 a 14 años en el Hospital Francisco Ycaza Bustamante, desde el 2009 al 2012.
RESULTADOS
Se reclutaron 61 sujetos (63 orejas). El 57% eran niños, la edad media de la primera
intervención fue 8.6 años (DE ±2.2; IC 95% 7-10), en el 67.2% (IC 95% 54 - 78.7) de
los casos el defecto era derecho, y el 16,4% (IC 95% 8.2- 28.1) se presentó asociado a
síndromes. La prevalencia de complicaciones con esta técnica es del 24,6% (IC 95%
14.4 – 37.3); la complicación más frecuente fue la reabsorción parcial del cartílago
costal.
CONCLUSIONES
El tallado del marco auricular a partir de cartílago es un desafío para el cirujano, el cual
debe ser muy habilidoso y estar altamente entrenado para desarrollar esta técnica. La
prevalencia de complicaciones encontrada en este estudio fue del 24.5%, sin embargo la
prevalencia reportada con prótesis auricular es del 11.4%, esta diferencia puede deberse
al bajo poder de los estudios publicados. La elección de la técnica dependerá de las
habilidades del cirujano, de las características clínicas del paciente, y de las preferencias
y posibilidades económicas de los padres del niño.
Microtia is a congenital disorder that may coexist with other congenital syndromes, or more frequent, may be present alone. It may lead to psychological and hearing problems, in addition to aesthetical discomfort. A prompt and definitive reconstruction may prevent these outcomes. The objective of this study was to determine the prevalence of complications in ear repair with autologous cartilage framework. METHODS Cross sectional retrospective study, determining the prevalence of complications in ear reconstruction with autologous costal cartilage in patients presenting with type III microtia, in children ranging 6 to 14 years old, at Francisco Ycaza Bustamante Hospital, from 2009 – 2012. RESULTS 61 subjects (63 ears) were recruited. 57% were males, mean age of first surgery was 8.6 years (SD ±2.2; IC 95% 7-10), in 67.2% (IC 95% 54 - 78.7) defect was right-sided, and 16,4% (IC 95% 8.2- 28.1) was presented as part of a congenital syndrome. Prevalence of complications using this technique was 24,6% (IC 95% 14.4 – 37.3); the most frequent complication was partial reabsorption of cartilage framework. CONCLUSIONS Performing the cartilage framework requires high training and skills. Prevalence of complications with cartilage technique was 24.5%, although published studies report a prevalence rate of 11.4% with prosthesis technique, this difference, may be due to lower power of these studies. The choice of technique used to repair the ear remains in the training and skills of surgeon, clinical features of patient, and willing and economical possibilities of care givers.
Microtia is a congenital disorder that may coexist with other congenital syndromes, or more frequent, may be present alone. It may lead to psychological and hearing problems, in addition to aesthetical discomfort. A prompt and definitive reconstruction may prevent these outcomes. The objective of this study was to determine the prevalence of complications in ear repair with autologous cartilage framework. METHODS Cross sectional retrospective study, determining the prevalence of complications in ear reconstruction with autologous costal cartilage in patients presenting with type III microtia, in children ranging 6 to 14 years old, at Francisco Ycaza Bustamante Hospital, from 2009 – 2012. RESULTS 61 subjects (63 ears) were recruited. 57% were males, mean age of first surgery was 8.6 years (SD ±2.2; IC 95% 7-10), in 67.2% (IC 95% 54 - 78.7) defect was right-sided, and 16,4% (IC 95% 8.2- 28.1) was presented as part of a congenital syndrome. Prevalence of complications using this technique was 24,6% (IC 95% 14.4 – 37.3); the most frequent complication was partial reabsorption of cartilage framework. CONCLUSIONS Performing the cartilage framework requires high training and skills. Prevalence of complications with cartilage technique was 24.5%, although published studies report a prevalence rate of 11.4% with prosthesis technique, this difference, may be due to lower power of these studies. The choice of technique used to repair the ear remains in the training and skills of surgeon, clinical features of patient, and willing and economical possibilities of care givers.
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Palabras clave
Microtia, Complicaciones, Cartílago costal autólogo, Reconstrucción auricular, Procedimientos quirúrgicos reconstructivos, Hospital del Niño Francisco de Icaza Bustamante, Cantón Guayaquil, Ecuador