Background Hyaluronic acid fillers are the second-most commonly performed nonsurgical procedure. Arterial thrombosis is their most devastating complication. Recent research shows that along hyaluronic acid thrombi, a platelet/fibrin thrombus forms in the site of injection. This is not addressed by current management protocols, which focus on perivascular hyaluronidase plus adjuvant strategies to increase blood flow. We experimented with an animal model utilizing both hyaluronidase and a thrombolytic agent for treatment of occlusion. Objectives The authors sought to evaluate the efficacy of a combined treatment of hyaluronidase with a thrombolytic agent applied perivascularly to an artery occluded with hyaluronic acid. Methods After direct intravascular injection into the femoral artery, rats were randomized to receive one of the following perivascular solutions: saline, hyaluronidase, alteplase, or hyaluronidase + alteplase. Reperfusion, distal bleeding, and microscopic findings were evaluated 4 hours after intervention. Results None of the subjects in the control group showed signs of reperfusion. In the hyaluronidase group, 60% reperfused, 10% completely, the rest only partially. In the alteplase group, 50% reperfused partially. In the hyaluronidase + alteplase group, 50% had partial and 50% complete prepermeabilization. Kruskal-Wallis test showed a P < 0.0001 favoring hyaluronidase + alteplase. Microscopic findings were compatible with bleeding rates. Conclusions Both hyaluronic acid and red thrombi play a role in the occluded vessel. Perivascular application of hyaluronidase with a thrombolytic agent seems to achieve greater reperfusion rates than either one alone. If proven safe in humans, this strategy could make treatment more effective while still being suitable for an outpatient setting.

Options for breast reconstruction after oncologic treatment include the use of prosthetic materials, autologous tissues, as well as a combination of both. Worldwide, autologous breast reconstruction remains the gold standard, and Transverse Rectus Abdominis Muscle flap (TRAM flap), one of the most frequent choices. The present study determines the frequency of complications after breast reconstruction with pedicled TRAM flap at the Plastic and Reconstructive Department of the Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos in Mexico City (México). A period of 7 years was reviewed. In addition, risk factors that influenced the occurrence of such complications were analyzed. We designed an observational, descriptive and retrospective study that included 71 patients. Overall, 59.15% patients presented at least one complication. Most of these were considered minor (54.9%) and only 3 patients had a major complication (4.2%). The most common donor site complication was abdominal hernia (9.86%). The most frequent flap complication was partial fat necrosis (23.94%). The only 2 systemic complications were atelectasis and pulmonary embolism, with 1 case each. Bivariate analysis showed that smoking elevated 40% the risk for a flap complication (p=0.041). Patients with radiation therapy had a 30% increase in total complications (p=0.021). Thirty-two of the patients that received chemotherapy presented with fat necrosis while only 10% of the patients that did not receive chemotherapy had that problem (p=0.047). The use of pedicled TRAM flap remains so far the gold standard in breast reconstruction in our practice and as a major procedure, some complications may be expected, mostly minor. The results in our hospital are consistent with reports in the international literature.

BACKGROUND Carpal tunnel syndrome is the most common peripheral neuropathy affecting patients at productive age and has an important economical impact on those who suffer it. This study assessed the diagnostic performance of carpal tunnel syndrome´s signs and described the epidemiology at a tertiary care center in Mexico City. METHODS All patients diagnosed with carpal tunnel syndrome during a fiveyear period were included. Demographic data, electromyography results, positive clinical signs and the severity score according to the Italian scale were recorded. Diagnostic accuracy of Tinel and Phalen´s signs were calculated via odds ratio. RESULTS Totally, 650 patients were diagnosed and treated during a fiveyear period, 84% were female and 16% male, and the mean age was 55.8 years. The associated comorbidities were trigger finger (36.1%), thyroid disease (25.6%) and diabetes (20%). Diagnosis yielded for Phalen and Tinel signs were variable in each of the study groups (males and females) and showed to be beneficial in diagnosis of the disease. CONCLUSION Carpal tunnel syndrome is a complex disease in which clinical signs remain the cornerstone of diagnosis. Extension studies are useful to assess the severity of the disease.

Introduction: The nostril sill is defined as the “facial subunit composed of fibro-adipose soft tissue whose topographic delimitation is given by four anatomical limits: the medial crura of the columella on its medial limit, the nasal wing on its lateral limit, the nasal vestibule in its upper limit, and the upper lip on the lower limit.” It represents an essential element in the appearance, balance, and function of the nose. The study and classification of the nostril sill in the healthy Mexican pediatric population are the necessary tools for facial reconstruction since it is generally affected in patients with cleft lip and palate and craniofacial malformations. Objective: The objective of the study is to describe the nostril sill in the Mexican pediatric population using standardized photographs taken in frontal and basal projections and classifying according to Oh et al. and to study if there is a significant relationship between nostril sill with age and gender. Materials and Methods: An observational cross-sectional study was carried out in a sample size of 83 healthy children aged between 3 and 12 years, simple randomly chosen. The classification was performed with facial photographs in frontal and basal projections. The data analysis was performed with descriptive statistics, kappa concordance coefficient was used between observers, and bivariate analysis was used to evaluate the association of the nostril sill classification with age and gender. Results: Of the 83 volunteers, 51.8% (n = 43) were female and 48.2% (n = 40) male, with a mean age of 7.38 years. The 74.6% (n = 62) were classified as a nostril sill Type I, 14.4% (n = 12) as Type III, and 10.8% (n = 9) as Type II, with a Cohen's kappa coefficient between observers of 0.92 (almost perfect agreement). In the bivariate analysis with Chi-square test, no statistically significant association was found between age (P = 0.420) and sex (P = 0.524). Conclusion: The nostril sill of the nostril represents a fundamental nasal subunit that every reconstructive surgeon must recognize and locate. It is crucial to describe and classify the nostril sill according to ethnic and racial characteristics, in the Mexican pediatric population, the most frequent corresponds to Type I, followed by Type III and finally the least frequent Type II, and that gender and age are not associated with a specific type.