Use of a new cone shaped flap to cover skin defects. Experience in 108 patients Background: A new type of fasciocutaneous flap with the shape of an ice cream cone that is formed by locally rotated and V-Y advance flaps joined together, that can be used to cover complex defects, was developed. Previously, the irrigation of these flaps was ascertained in the legs of ten corpses. Aim: To report the results with the use of this type of ice cream cone shaped flap. Material and Methods: Retrospective analysis of 108 patients aged 20 to 52 years (99 males) in whom an ice cream cone shaped flap was used. Results: The defects covered were located in the leg in 27%, in the ankle in 10%, in the sole in 9%, in the heel in 8% and in other locations in the rest of patients. Eighty flaps (74%) had a good evolution, 11 (10%) had a major dehiscence, 13 (12%) had a minor dehiscence and 4 flaps (4%) had necrosis. Conclusions: This ice cream cone shaped flap is easy to use, safe and devoid of complications in most cases.

Treatment of trochanteric pressure sores with V-Y and tensor fasciae latae flapsBackground: Trochanter pressure sores can be treated with random, myocutaneous, fasciocutaneous or free flaps. Aim: To report the use of V-Y and tensor fasciae latae flaps for the treatment of trochanteric pressure sores. Material and Methods: Prospective study of 14 males and two females aged 24 to 64 years, with 17 sores. The surgical technique consisted in the design of a V shaped flap with irrigation in its superior base and lower vertex with one of its extremes in contact with the sore. A resection is made until a vital base is obtained, excising the prominent bone until a plane in which healthy tissue is seen. The flap is raised and rotated, covering the defect. A V-Y primary closure without tension is performed, leaving drainages that are withdrawn ten days later. Results: The complications recorded were three seromas, which were treated using a closed system with external and internal negative pressure. Two wound dehiscence episodes and two hematomas required a surgical correction. Conclusions: This type of flap is other therapeutic alternative for pressure trochanteric sores.

Axillary burn contracture treated with Integra ® Introduction: Severe axillary burn is an unusual accident that frequently evolves to contracture generating important cosmetic and functional defi ciencies. Contracture scars in this region are diffi cult to treat because of the anatomic characteristics of the area that has multiple power vectors. Functional restoration has to be one of the main goals in the management of burns in the axilla and fl aps have shown high rate of morbidity. Integra ® provides satisfactory elasticity and dermal resistance which results in positive functional results. Objective: Analyze the results of the use of Integra ® in axillary burn contracture scars at a specialized Burns Center. Materials and Methods: There were 4 patients who underwent reconstructive surgery using Integra ® for axillary burn contractures between january 2002 and march 2006. Follow-up was divided into perioperative and late. Early follow-up checked general post-operative evolution and late follow-up was focused on functionality and patient independence evaluated using Barthel's index of daily living activities. Results: There were 3 males and 1 female, average age 27 (18-41) with a minimum follow up of 9 months. There were no perioperative complications and good or very good range of motion results. Conclusions: Our results are similar to artifi cial skin substitutes used in other anatomical regions.

Critical appraisal of clinical guidelineObjective: Critical appraisal of the clinical practice guideline (CPG) "Gran Quemado-Extensive Burn Patients"(2007 issue) corresponding to "Garantías Explícitas en Salud-Explicit Health Guarantees" (GES). Material and Methods: The CPG was evaluated using the previously validated AGREE instrument. This instrument evaluates a series of items organized in 6 domains, that capture different dimensions of the guidelines quality comparing the scores obtained with a maximum theoretical score. The CPG was evaluated by three independent and masked authors applying the AGREE instrument. Results: Stratifi ed by domain, in the "scope and purpose" domain there was an 88.9% of compliance; in "stakeholder involvement" 47.9%; in the "rigour of development" 47.6%; in "clarity and presentation" 79.2%; in "applicability" 30.6% and 75% in the "editorial independence" domain; reaching a 44.9% fi nal score of compliance. Conclusions: The score obtained was below 50% of the optimum for a CPG. The detailed analysis by domain makes evident the areas that may be subject of improvement, so as to optimize the applicability of the CPG and therefore guarantee better health care and treatment results for all burn patients benefi ting from the "Explicit Health Guarantees".Key words: Critical appraisal, practice guidelines, quality assessment, evidence based medicine, AGREE, burn. ResumenObjetivo: Evaluar críticamente la guía de práctica clínica (GPC) de Gran Quemado correspondiente a las Garantías Explícitas en Salud (GES) versión 2007. Material y Método: La evaluación se realizó con el instrumento AGREE el cual ha sido previamente validado. El instrumento AGREE evalúa una serie de ítems en 6 dominios entregando un puntaje específi co que se compara con un máximo teórico. Tres autores Rev.