Publications by authors named "Beatriz Berenguer"

17 Publications

  • Page 1 of 1

Surgical treatment of pressure injuries in children: A multicentre experience.

Wound Repair Regen 2021 Sep 2. Epub 2021 Sep 2.

Pediatric Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1-17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
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http://dx.doi.org/10.1111/wrr.12964DOI Listing
September 2021

Aesthetic forehead reduction in female patients: Surgical details and analysis of outcome.

J Plast Reconstr Aesthet Surg 2021 Jun 18. Epub 2021 Jun 18.

Unit of Plastic Surgery, Hospital la Luz, Madrid, Spain.

Introduction: Primary aesthetic hairline lowering, also known as forehead reduction, is a relatively unexplored procedure, and the perceived satisfaction with outcome has not been previously discussed in scientific literature. The objectives of this study were to review the surgical technique and to analyze outcome assessing objective reduction, improvement of facial balance, patient satisfaction, and complications.

Patients And Methods: This was a prospective cohort study of patients seeking aesthetic forehead reduction since 2010. Inclusion criteria were as follows: women with a high but stable hairline. We excluded smokers, those seeking combined surgery, and those who had history of scalp surgery or hair loss. All patients were operated following the same protocol. Forehead reduction was measured comparing the pre- and postoperative distance from the glabella to the trichion. Improvement in facial balance was assessed comparing the pre- and postoperative quotient between the upper and middle thirds of the face. The forehead FACE-Q tool and the Vancouver Scar Scale were used to assess patient satisfaction. All complications were registered with a minimum follow-up of 6 months.

Results: Twenty-six women aged 16 to 56 years were included. The average reduction was 2.03 cm. The facial balance quotient improved from 1:1.44 preoperatively to 1:1.05 postoperatively (p < 0.01). Both the forehead FACE-Q and the Vancouver Scar Scale showed significantly positive results. Complications included transient scalp numbness in 23 subjects, small areas of scar widening in 3 patients, and minor seroma in 1 patient.

Conclusion: With meticulous execution, aesthetic forehead reduction in female patients is effective and safe, resulting in high patient satisfaction. The FACE-Q is owned by the Memorial Sloan Kettering Cancer Center (MSKCC) and was used with permission for this research.
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http://dx.doi.org/10.1016/j.bjps.2021.06.002DOI Listing
June 2021

Neonatal Fournier's Gangrene: Avoiding Extensive Debridement.

Pediatr Infect Dis J 2021 Oct;40(10):e384-e387

From the Division of Plastic Pediatric Surgery, Pediatric Surgery Department.

Fournier's gangrene is a necrotizing fasciitis of the scrotal and inguinal region, associating high mortality and complication rates. It is extremely rare in the neonatal period and may be life threatening. We present an exceptional case of a 24-day-old boy who consulted to the emergency department for fever (39 °C) and an indurated, fluctuating and painful erythema in both groins, left hemiscrotum, left anterior femoral region and perineum for the last 6 hours. Blood analysis showed increased acute phase reactants without leukocytosis. Ultrasound revealed significant soft-tissue involvement. Due to high clinical suspicion and hemodynamic instability (tachycardia and prolonged capillary filling), urgent fasciotomy, placement of Penrose drains and intensive irrigation was performed. Wound care with irrigations was performed 3 times a day. During the 12 days neonatal intensive care unit admission, he required hemodynamic support and orotracheal intubation and sedation for pain control. Broad-spectrum antibiotic therapy (with cefotaxime, clindamycin and cloxacillin) was administered for 2 weeks. Ampicillin-sensitive Streptococcus pyogenes (Group A) was isolated in blood culture at 4th day of admission allowing antibiotic de-escalation. He was discharged on postoperative day 24. He has minimal, inconspicuous scars and no functional sequelae. Fever in neonates requires close observation considering the use of empirical broad-spectrum antibiotics and hospitalization. Early diagnosis, prompt surgical management and broad-spectrum antibiotic therapy are essential to prevent complication. Early fasciotomy with intensive irrigation and close survey may avoid extensive skin debridement.
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http://dx.doi.org/10.1097/INF.0000000000003224DOI Listing
October 2021

Life-Threatening Acute Angioedema, a Rare Complication After Secondary Blepharoplasty.

Aesthet Surg J 2021 Aug;41(9):NP1244-NP1246

Plastic Surgery Unit, Hospital Universitario La Luz, Madrid, Spain.

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http://dx.doi.org/10.1093/asj/sjab093DOI Listing
August 2021

An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions.

J Plast Reconstr Aesthet Surg 2021 Sep 5;74(9):2341-2348. Epub 2021 Feb 5.

Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK. Electronic address:

Background: There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective.

Methods: Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties.

Results: Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X(80) = 90.9, p = 0.19) and Adverse Effects (X(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales.

Interpretation: The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.
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http://dx.doi.org/10.1016/j.bjps.2021.01.014DOI Listing
September 2021

Corrigendum to: "Use of innovative negative pressure therapy for cartilage exposure in microtia reconstruction" [Journal of Plastic, Reconstructive & Aesthetic Surgery 72(2) 2019 e3-e4].

J Plast Reconstr Aesthet Surg 2020 Apr 22;73(4):809. Epub 2020 Feb 22.

Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain.

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http://dx.doi.org/10.1016/j.bjps.2020.02.001DOI Listing
April 2020

Management of congenital midline nasofrontal dermoid cysts in two identical twins: Case report.

Pediatr Dermatol 2019 Sep 29;36(5):745-746. Epub 2019 Jul 29.

Pediatric Plastic Surgery Department, Hospital General Universitario "Gregorio Marañon", Madrid, Spain.

Midline dermoid cysts are uncommon lesions that can lead to severe complications when an intracranial extension exists. We report the cases of two twin sisters referred to surgery for removal of the masses and the intracranial extension. They represent an additional example of familial nasal dermoid cysts, providing further support for a genetic basis for the disorder.
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http://dx.doi.org/10.1111/pde.13940DOI Listing
September 2019

Use of innovative negative pressure therapy for cartilage exposure in microtia reconstruction.

J Plast Reconstr Aesthet Surg 2019 Feb 14;72(2):e3-e4. Epub 2018 Nov 14.

Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain.

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http://dx.doi.org/10.1016/j.bjps.2018.10.044DOI Listing
February 2019

Bleomycin-induced flagellate erythema after venous malformation sclerosis-Case report and brief review.

Pediatr Dermatol 2018 Jan 21;35(1):e5-e8. Epub 2017 Nov 21.

Pediatric Plastic Surgery Section, Hospital General Universitario Gregorio Marañon, Madrid, Spain.

Bleomycin-induced flagellate erythema is a rare but typical skin toxicity of bleomycin. We report the case of a boy with a left foot venous malformation who developed this skin rash after two sessions of bleomycin intralesional injection. We discuss the mechanism and characteristics of this reaction to bleomycin, which is usually benign and self-limited. We conclude that, although rare, flagellate pigmentation can occur when bleomycin is used as a sclerosant in children.
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http://dx.doi.org/10.1111/pde.13297DOI Listing
January 2018

Maxillary growth in a congenital cleft palate canine model for surgical research.

J Craniomaxillofac Surg 2014 Jan 21;42(1):13-21. Epub 2013 Feb 21.

Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain. Electronic address:

We have recently presented the Old Spanish Pointer dog, with a 15-20% spontaneous congenital cleft palate rate, as a unique experimental model of this disease. This study aimed to describe the cleft palate of these dogs for surgical research purposes and to determine whether congenital cleft palate influences maxillofacial growth. Seven newborn Old Spanish Pointer dogs of both sexes, comprising a cleft palate group (n = 4) and a normal palate group (n = 3), were fed using the same technique. Macroscopic photographs and plaster casts from the palate, lateral radiographs and computer tomograms of the skull were taken sequentially over 41 weeks, starting at week 5. The cleft morphology, the size and the tissue characteristics in these dogs resembled the human cleft better than current available animal models. During growth, the cleft width varies. Most of the transverse and longitudinal measures of the palate were statistically lower in the cleft palate group. The cleft palate group showed hypoplasia of the naso-maxillary complex. This model of congenital cleft palate seems suitable for surgical research purposes. A reduced maxillofacial pre- and post-natal development is associated to the congenital cleft palate in the Old Spanish Pointer dog.
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http://dx.doi.org/10.1016/j.jcms.2013.01.032DOI Listing
January 2014

Osteoinduction in the palatal submucosa by injecting BMP-2 on 2 different carriers.

J Craniofac Surg 2012 Mar;23(2):594-8

Servicio Aragonés de Salud, Atención Primaria, Sector Zaragoza III, Tarazona, Spain.

In this work, we investigated the ability of injected recombinant human bone morphogenetic protein 2 (rhBMP-2) on brushite cement (a β-tricalcium phosphate-based biomaterial) and collagen gel as carriers to induce osteogenic differentiation in the palatal submucosa of 10-day-old rats. This was part of a broader study aiming to create bone in the palatal submucosa at cleft palate edges in the search for a minimally invasive treatment. Thirteen treated animals, 7 with rhBMP-2/brushite cement and 6 with rhBMP-2/collagen gel, were injected with 5 to 10 μL of each biomaterial in the right palatal submucosa at the level between the second and third rugae. The contralateral site was uninjected and served as the control. Six weeks after injection, both brushite cement and collagen gel were histologically unrecognizable in all treated animals. New bone structures such as ossicles of woven bone were not detected. However, an augmentation in the thickness of the palatal fibromucosa was observed at the injection site of all palates. In addition, immunolabeling for osteopontin, proliferating cell nuclear antigen, and TUNEL revealed intense osteogenic induction at the injection site with both constructs, which was negative in the control site from the same specimens; no differences regarding cell proliferation and death were observed. The present study confirms the feasibility of generating osteogenic cells in the palatal submucosa by injecting low doses of rhBMP-2 in these 2 biomaterials, together with their inability to form bone.
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http://dx.doi.org/10.1097/SCS.0b013e31824cd6c7DOI Listing
March 2012

Breast implant in complex lymphatic malformation.

Plast Reconstr Surg 2009 Nov;124(5):262e-263e

Department of Plastic Surgery; Clínica la Luz; Madrid, Spain (Berenguer, de la Cruz, Rodríguez-Urcelay, González Meli) Antoni van Leeuvenhoek Hospital; Amsterdam, The Netherlands (Hage).

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http://dx.doi.org/10.1097/PRS.0b013e3181b98dd5DOI Listing
November 2009

Correction of nasojugal groove with tunnelled fat graft.

Aesthet Surg J 2009 May-Jun;29(3):194-8

Background: Pronounced nasojugal sulcus (tear trough deformity) is a frequent and distressing symptom in aesthetic palpebral surgery. The sliding fat technique using the transcutaneous or transconjunctival approach has proven to be considerably useful in patients with clinically evident fat bags. In the absence of fat bags, commonly used techniques can lead to unpredictable (and frequently less than optimal) results.

Objective: The authors report their experience with correcting the nasojugal groove in the absence of palpebral fat bags by use of a one-piece, free fat graft as an alternative to autologous fat injections or the placement of alloplastic materials.

Methods: The authors conducted a retrospective study of a consecutive series of 34 patients (33 women and one man) between 42 and 57 years of age. In all cases, small, free fat grafts harvested from the medial fat compartment of the upper eyelid were placed precisely under the depression through two stab incisions in the suborbicularis plane, filling in the groove.

Results: Results were considered excellent in 24 out of the 34 patients. Results in the remaining 10 patients were rated as good, in most cases because of mild undercorrection. All patients expressed a high degree of satisfaction. Recovery time was very short and no eye or eyelid complications were observed.

Conclusions: Correction of the nasojugal groove with a tunnelled fat graft causes minimal tissue trauma and allows exact placement of the graft. The upper palpebral fat has unique characteristics that render it an ideal graft material for correction of the nasojugal groove in patients with no concomitant lower fat bags. This procedure offers more predictable results and a lower incidence of adverse effects than more commonly used techniques.
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http://dx.doi.org/10.1016/j.asj.2009.02.015DOI Listing
October 2009

Basal cell carcinoma in childhood after radiation therapy: case report and review.

Ann Plast Surg 2004 Dec;53(6):593-5

Department of Plastic Surgery, Children's Hospital Niño Jesus, Madrid, Spain.

We describe 2 patients who received ionizing radiation as part of a curative regimen for childhood malignancy which later developed basal cell carcinoma at an early age. They do not occur within the context of well-defined syndromes, such like basal cell nevus syndrome, albinism, or xeroderma pigmentosum. Basal cell carcinomas appears on radiated areas in older individuals, less often in younger patients, in which the period of latency between exposure to radiation and the appearance of basal cell carcinomas is shorter than in older patients. Our 2 cases presented a period of latency of 11 and 10 years. Radiated skin areas must be explored as part of the follow-up in children who received radiotherapy and should probably be maintained for life. The basal cell carcinoma in childhood is best treated by excision.
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http://dx.doi.org/10.1097/01.sap.0000136972.23991.07DOI Listing
December 2004

Rapidly involuting congenital hemangioma: clinical and histopathologic features.

Pediatr Dev Pathol 2003 Nov-Dec;6(6):495-510

Division of Plastic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

We define the histopathologic findings and review the clinical and radiologic characteristics of rapidly involuting congenital hemangioma (RICH). The features of RICH are compared to the equally uncommon noninvoluting congenital hemangioma (NICH) and common infantile hemangioma. RICH and NICH had many similarities, such as appearance, location, size, and sex distribution. The obvious differences in behavior served to differentiate RICH, NICH, and common infantile hemangioma. Magnetic resonance imaging (MRI) of the three tumors is quite similar, but some RICH also had areas of inhomogeneity and larger flow voids on MRI and arterial aneurysms on angiography. The histologic appearance of RICH differed from NICH and common infantile hemangioma, but some overlap was noted among the three lesions. RICH was composed of small-to-large lobules of capillaries with moderately plump endothelial cells and pericytes; the lobules were surrounded by abundant fibrous tissue. One-half of the specimens had a central involuting zone(s) characterized by lobular loss, fibrous tissue, and draining channels that were often large and abnormal. Ancillary features commonly found were hemosiderin, thrombosis, cyst formation, focal calcification, and extramedullary hematopoiesis. With one exception, endothelial cells in RICH (as in NICH) did not express glucose transporter-1 protein, as does common infantile hemangioma. One RICH exhibited 50% postnatal involution during the 1st year, stopped regressing, was resected at 18 months, and was histologically indistinguishable from NICH. In addition, several RICH, resected in early infancy, also had some histologic features suggestive of NICH. Furthermore, NICH removed early (2-4 years), showed some histologic findings of RICH or were indistinguishable from RICH. We conclude that RICH, NICH, and common infantile hemangioma have overlapping clinical and pathologic features. These observations support the hypothesis that these vascular tumors may be variations of a single entity ab initio. It is unknown whether the progenitor cell for these uncommon congenital vascular tumors is the same as for common infantile hemangioma.
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http://dx.doi.org/10.1007/s10024-003-2134-6DOI Listing
August 2004

Large involuted facial hemangioma treated with syringe liposuction.

Plast Reconstr Surg 2003 Jan;111(1):314-8

Division of Plastic Surgery and the Department of Dermatology, Hospital Niño Jesús, Madrid, Spain.

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http://dx.doi.org/10.1097/01.PRS.0000035780.55330.61DOI Listing
January 2003
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