ResumenEl objetivo de la presente revisión sistemática es determinar si los lipoinjertos enriquecidos con células madre derivadas del tejido adiposo son superiores a los injertos de tejido graso convencionales en el tratamiento de la lipoatrofia facial.Realizamos una búsqueda sistemática de publicaciones en las bases de datos: MEDLINE, SCOPUS, OVID SP, SCIELO y EMBASE y posteriormente, una valoración basada en criterios actuales de medicina basada en la evidencia de las publicaciones encontradas por dos revisores independientes; las discrepancias en el análisis se resolvieron por acuerdo. Los criterios de inclusión fueron: ensayos clínicos aleatorizados, series clínicas y reportes de casos en humanos, excluyendo los ensayos en animales.Encontramos 6 publicaciones que cumplían con los criterios previamente mencionados. Entre éstas se incluyeron 2 ensayos clínicos aleatorizados controlados que recogían la superioridad de los lipoinjertos enriquecidos con células madre derivadas del tejido adiposo en el tratamiento de la lipoatrofia facial en términos de resistencia a la reabsorción (preservación del volumen) y menor necesidad de nuevos lipoinjertos, en comparación con los lipoinjertos convencionales.Concluimos diciendo que existen publicaciones con buenos niveles de evidencia que sugieren que los lipoinjertos enriquecidos con células madre derivadas del tejido adiposo son superiores a los lipoinjertos convencionales en el tratamiento de la lipoatrofia facial. No obstante, son estudios de reciente publicación y aún es necesario tener seguimientos a más largo plazo y con mayor número de pacientes para mejorar los ya buenos niveles de evidencia disponibles.Palabras clave Atrofia facial, Lipoatrofia facial, Hemiatrofia facial, Lipoinjertos, Células madre, Lipoinjertos enriquecidos, Evidencia científica. Nivel de evidencia científica II AbstractThe objective of this systematic review is to determine if the lipografts enriched with stem cells derived from adipose tissue are superior to the conventional fatty tissue grafts in the treatment of facial lipoatrophy.A systematic search was performed for publications in the databases: MEDLINE, SCOPUS, OVID SP, SCIELO and EMBASE. An evaluation was subsequently conducted based on current criteria of evidence-based medicine of the publications found by two independent reviewers and discrepancies in the analysis were resolved by agreement. The inclusion criteria were: randomized clinical trials, clinical series and case reports in humans; the reports in animals were excluded.We found 6 publications that meet the criteria previously mentioned. Between these, 2 randomized controlled clinical trials reported the superiority of the lipografts enriched with stem cells derived from adipose tissue in the treatment of facial lipoatrophy in terms of resistance to the reabsorption (volume preservation) and less need for new lipografts when compared with the conventional lipografts.We conclude that there are publications with good levels of evidence to suggest that the lipografts enriched wi...
Palabras clave Sobremordida horizontal, Micrognatia, Crecimiento mandibular. Nivel de evidencia científica 4
There is no universal technique for reconstructing the different types of labial defects. The etiology, the size and location, the layers compromised and the depth of the defect are the main determinants of the technique to be chosen. The aesthetic form and the function recovery must be the main objective of the therapeutic process. Scarce studies concentrate into the pediatric population and the operational resolution of complex, full-depth defects. The oral contingence, articulation and facial expression (mimicking) are amongst the most important functions of the lower third of the face, and, in terms of reconstruction, they represent a difficult task for the plastic surgeon. In our case, the experience has taught us about new tools, useful and potentially replicable to guide the reconstruction of our infantile population. The authors present different techniques from five different cases, using loco-regional options that spare microsurgical solutions.
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