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Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas.We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes.We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients.Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio.Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales.Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes.El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

IntroductionDonor sites of split-thickness skin grafts (STSGs) are painful and limit patient rehabilitation. We conducted this study to assess the efficacy of a non-adherent polyurethane dressing in reducing pain and its effect on the epithelialization rate of donor sites of STSGs.MethodsFifteen patients requiring an STSG were included. In 10 patients the donor sites were randomly divided into two halves and covered with either a non-adherent polyurethane dressing or a standard non-adherent gauze. In five patients with bilateral donor sites, one side was covered with the non-adherent polyurethane dressing and the other with non-adherent gauze. The pain was assessed with a visual analog scale and epithelialization was also assessed, calculating non-epithelialized areas with image software by a blinded surgeon. Epithelialization of the wounds covered with the non-adherent polyurethane dressing was assessed at day 8 and 10 and those with non-adherent gauze at day 10.ResultsPostoperative pain significantly decreased with the non-adherent polyurethane dressing during the length of the study (6.07±1.46 vs. 1.72±1.6) and at each time point (p

Background With some frequency, in mestizo rhinoplasty, we focus much of our attention on the nasal tip. This work also highlights the importance of obtaining a proper balance of the columella, achieving a pleasing visual effect of the vector lines that make up the nasal profile (columella and nasal tip vectors). Methods We performed a complete medical history in all patients and developed a surgical plan after nasal anatomy analysis. Pre- and postoperative photographs were obtained for medium and long term control. Results We treated 112 patients with this surgical technique, 77 with an open approach and 35 with a closed approach. The results were documented in the short and long term with a range of 6 months to 5 years. Conclusions We feel that the use of an angulated extended columellar graft is highly polyfunctional, providing length, definition and support to nasal tip grafts. Because of the graft design, it is possible to predetermine the new columella length/tip, thus visualizing the columella and nasal tip vectors of the nasal profile. The angulated extension prevents cephalic–lateral–caudal displacements of the tip graft, and to some degree it is possible to increase or decrease nasal length depending on the angularity of the extension.