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      Quemaduras del pabellón auricular: membrana amniótica frente a cura oclusiva para prevención de condritis Translated title: Burns of the auricular pavillion: amniotic membrane versus occlusive cure for chondritis prevention

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          Abstract

          Resumen Introducción y objetivo. Prevenir la condritis es un pilar importante en el tratamiento de las quemaduras del pabellón auricular teniendo en cuenta que, en la actualidad, no existe un protocolo de manejo frente a esta patología y sus posteriores complicaciones. El presente estudio pretende analizar la literatura disponible acerca del manejo de las quemaduras auriculares y comparar el uso de membrana amniótica frente a la cura oclusiva en un grupo de pacientes con quemadura en pabellón auricular para prevenir la deformidad de oreja en coliflor como secuela. Material y método. Revisión de la literatura sobre las diversas formas de tratamiento de las quemaduras auriculares y estudio en un grupo de pacientes de la Unidad de Quemados de la Subred Integrada de Servicios en Salud Norte E.S.E. UHMES Simón Bolívar de Bogotá, D.C., Colombia, con quemaduras en pabellones auriculares a los que se les aplicó membrana amniótica para cubrir las lesiones con el fin de disminuir el riesgo de condritis y la consecuente deformidad en coliflor, entre otras complicaciones. Resultados. De la revisión de la literatura obtenemos una comparativa del uso de tratamientos conservadores frente a quirúrgicos y en el estudio sobre pacientes tratados con membrana amniótica observamos una importante disminución en la respuesta inflamatoria local, dolor, frecuencia de curaciones y por lo tanto, menor estancia hospitalaria. Conclusiones. Nuestro trabajo aporta revisión bibliográfica y experiencia propia comparativa de interés para la prevención de la condritis postquemadura auricular y contribuye a protocolizar el tratamiento de este tipo de lesiones a fin de evitar sus secuelas. Nivel de evidencia científica 4c Terapéutico

          Translated abstract

          Abstract Background and objective. Preventing chondritis is an important pillar in the treatment of burns of the auricular pavilion because, currently, there is no management protocol for this pathology and its subsequent complications. The present study aims to analyze the available literature on the management of auricular burns, and to compare the use of amniotic membrane versus occlusive treatment in a group of patients with burns in the auricular pavilion to prevent cauliflower ear. Methods. Literature review of the different ways of treatment for ear burns and study in a group of patients from the Burn Unit of the Integrated Subred of Health Services North E.S.E. Simón Bolívar (UHMES) from Bogotá D.C Colombia, with burns on the auricular pavilion to which amniotic membrane was applied to cover up the injuries in order to reduce the risk of chondritis and the consequent cauliflower deformity, among other complications. Results. From the literature review, we obtain a comparison between the use of conservative treatments versus surgical procedures and, in the study of patients treated with amniotic membrane, we observed a significant decrease in the local inflammatory response, pain, frequency of wound healing, and therefore, shorter hospital stay. Conclusions. Our study provides a bibliographic review and our own comparative experience, both of interest for the prevention of post-auricular burn chondritis and contributes to create protocols for treatment of this type of injury in order to avoid its sequelae. Level of evidence 4c Terapeutic

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          Most cited references23

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          The clinical applications of human amnion in plastic surgery.

          Since the early 1900s, human amnion has been applied to a wide variety of clinical scenarios including burns, chronic ulcers, dural defects, intra-abdominal adhesions, peritoneal reconstruction, genital reconstruction, hip arthroplasty, tendon repair, nerve repair, microvascular reconstruction, corneal repair, intra-oral reconstruction and reconstruction of the nasal lining and tympanic membrane. Amnion epithelial and mesenchymal cells have been shown to contain a variety of regulatory mediators that result in the promotion of cellular proliferation, differentiation and epithelialisation and the inhibition of fibrosis, immune rejection, inflammation and bacterial invasion. The full repertoire of biological factors that these cells synthesise, store and release and the mechanisms by which these factors exert their beneficial effects are only now being fully appreciated. Although many commercially available biological and synthetic alternatives to amnion exist, ethical, religious, and financial constraints may limit the widespread utilisation of these products. Amnion is widely available, economical and is easy to manipulate, process and store. Although many clinical applications are of historical interest only, amnion offers an alternative source of multi-potent or pluripotent stem cells and therefore may yet have a great deal to offer the plastic surgery and regenerative medicine community. It is the purpose of this article to review the clinical applications of human amnion relevant to plastic surgery.
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            The burned ear; possibilities and challenges in framework reconstruction and coverage.

            Ear reconstruction remains a challenging procedure, especially in burn victims. The ear is particularly vulnerable to thermal injury because of its location and the thin integument. The thermal injury could subsequently include skin and the deeper located auricular cartilage framework. This type of injury could have long lasting mutilating effect not only because the ear's morphology is mainly related to this framework but also because it will not recover or regenerate once injured. Grafts of costal cartilage or synthetic materials might replace missing cartilage. However, the poor quality of the adjacent skin and subcutaneous tissues makes the reconstruction of a burned ear an even more daunting procedure than congenital or many oncologic indications. As such, regeneration of the skin will be the next step in reconstruction of the burned ear. There is still much development and research to be done, but encouraging results have been shown in tissue engineering of skin and cartilage. Furthermore, 3D (bio)printing of cartilage to facilitate reproduction of the ear's complex shape certainly has potential and might find an interesting role in ear reconstruction. In this review, different clinical challenges and options for ear reconstruction in burn patients are described. Subsequently, although still far from large scale clinical application, state of the art developments in the field of tissue engineering and 3D (bio)printing are also discussed.
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              MANAGEMENT OF THE INJURED EAR.

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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2023
                : 49
                : 3
                : 301-308
                Affiliations
                [2] Bogotá orgnameHospital Simón Bolívar Subred Norte orgdiv1Unidad de Quemados Colombia
                [3] Bogotá Bogotá orgnameUniversidad El Bosque Colombia
                [1] Bogotá orgnameHospital Simón Bolívar Subred Norte orgdiv1Unidad de Quemados Colombia
                Article
                S0376-78922023000300013 S0376-7892(23)04900300013
                10.4321/s0376-78922023000300013
                b7b33a08-ef3f-4ea7-af52-78d836b5a91a

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 01 September 2023
                : 13 April 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 8
                Product

                SciELO Spain

                Categories
                Quemados

                Cauliflower ear,Quemadura,Amnios,Condritis,Quemadura pabellón auricular,Oreja en coliflor,Chondritis,Burns,Auricular pavilion burns

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