Publications by authors named "Carlos Giugliano"

6 Publications

  • Page 1 of 1

Protocol for outpatient management in cleft lip and palate repair.

Int J Pediatr Otorhinolaryngol 2021 Mar 11;142:110592. Epub 2021 Jan 11.

Fundación Gantz Hospital Del Niño con Fisuras, Santiago, Chile; Plastic Surgery Unit, Surgery Department, Clínica Alemana, Santiago, Chile.

Cleft lip is a common malformation in Chile. The standard care for cleft lip and palate repair is inpatient admission; this is mainly to observe complications and administer intravenous fluids, antibiotics, and analgesics. In our center, however, a strict selection of patients undergo ambulatory surgeries. In this paper, we illustrate our experience managing outpatient cleft lip and palate repair and show that it is possible to carry out a successful ambulatory surgery with few to no complications in children and adults with cleft lip and palate.
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March 2021

Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education.

Cleft Palate Craniofac J 2020 10 30;57(10):1238-1246. Epub 2020 Jul 30.

The Hansjörg Department of Plastic Surgery, New York University Langone Health, New York City, NY, USA.

Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact.

Design: Cross-sectional survey-based evaluation.

Setting: Simulation-based comprehensive cleft care workshop.

Participants: Total of 180 participants.

Interventions: Three-day simulation-based comprehensive cleft care workshop.

Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice.

Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices.

Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.
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October 2020

Persistent Nasal Infantile Hemangioma: A Surgical Treatment Algorithm.

J Craniofac Surg 2018 Sep;29(6):1509-1513

Servicio de Dermatología, Clínica Alemana.

Treatment of infantile hemangioma is usually medical. The nose is one of the most important aesthetic and functional units of the face; therefore, surgical management is preferred in persistent lesions (fibro-fatty tissue component) that do not respond to medical treatment. Herein, the authors analyze the results of surgical nasal hemangioma treatment in their center, a literature review and propose an algorithm for surgical management. A retrospective analysis of 23 persistent nasal hemangioma operated between 1996 and 2014 at our institution was made. The authors recollected the following demographic and clinical data: hemangioma subtype, phase of evolution, affected aesthetic nasal subunit, previous treatment, surgery type, complications and follow-up period. The Strasser scale was chosen for assessment of postoperative photographic results. Surgical treatment was performed. Age average was 6.8 years old (range 2-19). Mixed hemangioma was the most common subtype (83%). Surgery was mainly performed in the involution phase (87%). The most affected aesthetic subunit was nasal tip (44%). All lesions received previous medical treatment. The most common surgical technique was open rhinoplasty approach. Follow-up was an average of 26.6 months. Aesthetic results according to the Strasser method included: 3 excellent scores, 15 good, 5 regular, and none poor. Surgery was performed on patients in order to correct nasal persistent hemangiomas sequel. The nose has serious psychosocial impact and mixed infantile hemangiomas appear to have a higher rate of persistent hemangioma requiring surgery, but further studies are needed. Aesthetic outcome with surgical procedures chosen were acceptable and no complications were reported.
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September 2018

Pilomatrixomas presenting as vascular tumors on color Doppler ultrasound.

J Pediatr Surg 2010 Oct;45(10):2094-8

Department of Radiology, Clinica Servet, Faculty of Medicine, Universidad de Chile, Santiago, Chile.

Diagnosis of pilomatrixomas may be difficult because they can mimic other clinical conditions. Color Doppler ultrasound had been proven useful in the study of localized lesions of the skin and can both define lesion morphology and determine blood flow changes in real time, and may thus help differentiate primary from secondary vascular skin lesions. We present 3 cases of pilomatrixomas that mimic vascular lesions of the skin on physical examination. Clinical, sonographic, intraoperative, and histologic images are provided to highlight the nature of these challenging cases.
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October 2010

Liposuction and lipoinjection treatment for congenital and acquired lipodystrophies in children.

Plast Reconstr Surg 2009 Jul;124(1):134-143

Santiago, Chile From the Plastic Surgery Division, Department of Surgery, Roberto del Rio Hospital, Clinica Alemana and University of Chile Clinical Hospital School of Medicine.

Background: The purpose of this clinical study was to establish liposuction and lipoinjection as a noncosmetic procedure in children to correct lipodystrophies.

Methods: Liposuction, fat injection, or a combination of both was performed on 30 patients between 1994 and 2006 at Roberto del Rio Hospital or Clinica Alemana, Santiago, Chile. Liposuction was indicated in patients with excessive amounts of fatty tissue or tumor-like swelling. Combined liposuction and lipoinjection was performed on patients with deficit and excess in soft tissues. Lipoinjection was used for patients with soft-tissue insufficiencies. Samples of fat obtained by liposuction were submitted to histopathologic examination. Traditional tumescent technique was used for liposuction. The supernatant obtained by simple filtration was used for fat injection. Short- and long-term postoperative follow-up included registration of complications and assessment of aesthetic and functional outcome. The kappa test was used for statistical analysis.

Results: Thirty patients, nine boys and 21 girls, were operated on, with an average age of 11 years (range, 4 to 17 years). A total of 43 procedures were performed: 27 liposuctions, 10 lipoinjections, and six combined procedures. Average hospital stay was 1.1 days. Of a total 20 patients who underwent liposuction, six required revision. Histopathologic study showed 19 lipomatoses and one lipoblastomatosis. Cosmetic outcomes based on Strasser scale were as follows: six excellent, 19 good, four mediocre, and one poor.

Conclusions: Liposuction and lipoinjection as sole or combined procedures are safe methods for the pediatric population. They are well tolerated, with a low rate of complications and satisfactory aesthetic results.
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July 2009

Nasal reconstruction with a forehead flap in children younger than 10 years of age.

Plast Reconstr Surg 2004 Aug;114(2):316-25; discussion 326-8

Plastic Surgery Unit, Pediatric Surgery Department, Dr. Roberto del Rio Clinical Hospital for Children, University of Chile, School of Medicine, Santiago.

Nasal reconstruction has been analyzed extensively in adults but not in children. The purpose of this article is to review the authors' experience with the forehead flap for nasal reconstruction in 10 children under the age of 10 during a 10-year period. Outcomes were assessed by an objective grading system for cosmetic surgical results. Subjective criteria were also applied by an assistant surgeon and by the patients' relatives. Appropriate results were obtained by the following principles: (1) A modified approach that considers three subunits consisting of the dorsum, tip, and ala was used; (2) a forehead flap is the best option for an entire subunit or a full-thickness defect repair; (3) the forehead flap design should be paramedian, oblique, and opposite to the major defect to avoid the hairline and allow better caudal advancement; (4) ear or costal cartilages are good options for structural support (the septum is a nasal growth center that should not be touched); (5) infundibular undermining of vestibular mucosa, turnover flaps, and skin grafts are good options for internal lining; (6) reconstruction is a three-stage procedure (an intermediate operation is added to thin the flap and perform secondary revisions for lining and support); (7) reconstruction should be completed before the child is school aged, to achieve good aesthetic results immediately and avoid psychosocial repercussions; and (8) the reconstructed nose, with skin, lining, and support, will grow with the child (no final surgery should be planned at the age of 18, other than revisions of late complications).
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August 2004