Gastroschisis - Biophysics of the Alexis Wound Separator as a SILO device скачать в хорошем качестве

Gastroschisis - Biophysics of the Alexis Wound Separator as a SILO device

In 2005, in Japan they used the Alexis wound retractor (SHA), as a tool for protection and reduction of intestinal loops in newborns with gastroschisis; experience that has been replicated in different parts of the world with good experiences, some advantages that are mentioned are that it is available, inexpensive and less often that the device "slipping" (slipping-off) or "jumping" (pop-off). come out of the abdominal defect. Kusafuka J, et al. Gastroschisis reduction using ‘‘ Applied Alexis ’’, a wound protector and retractor. Pediatr Surg Int 2005; 21: 925–927. In the first experience in Japan, the SHA was modified and was another model than those currently available. In France in 2014, they published their experience, WITHOUT MODIFICATION, and another SHA model with good results, mentioning the little or no frequency of "slipping-off or pop-off" and trying to explain with a physical formula tension on the abdominal wall (force over area), how it exerts its function and why it does not slide from the defect. In the analysis of the article, the French do not consider all the force vectors that are generated in the abdominal wall with the use of SHA and their biophysical explanation of the device seems incomplete. Gomes FC, et al. Staged gastroschisis closure using Alexis wound retractor: first experiences. Pediatr Surg Int 2014; 30: 305–311. There is no physical-mathematical formula that perfectly explains the BIOPHYSICS of the devices (SILOS) for the reduction of intestinal loops Likewise, I have not found in the literature publications that explain the BIOPHYSICS of the “SILO” since 1969, the name given to the device by Allen and Wren, in their publication. Allen RG, Wren EL. Silon as a Sac in the Treatment of Omphalocele and Gastroschisis. J Pediatr Surg 1969; 4: 3-8. The laws of physics that could be applied to the study of biophysics of SILOS is Poiseuille's Law and Bernoullie's Law, for those who like physics. These laws of the physics of tubes and fluids cannot be applied in a perfect way or 100%, because they are created to have control of all the elements, they are not fluids what we introduce, that is, the tubes are rigid (not have compliance, do not deform), the temperature, pressure, viscosity, are constant, the inlet and outlet area of ​​the tube are determined. In addition, that in our patient there are many variables that we cannot measure or control, such as the capacity of the abdominal cavity, the distension of the walls, the resistance pressure, etc. Trying to do so in search of a "magic number" could prove catastrophic. But some elements of the formula allow us to analyze and observe how the intestinal loops can behave in these tubes called SILOS, and infer the force vectors that are generated with gravity and / or plications. So we decided (a server and a group of biophysicists from the Autonomous University of Baja California), to study from the biophysical point of view how this device behaves, specifically in terms of the force vectors that are generated and deduced your behavior. We created this VIDEO-ANIMATION to explain in a practical way how the SHA (Alexis wound separator) works as a SILO device for gastroschisis. In the first part of the video, product of the review of clinical articles from 1953 to date, we define the objectives, physical characteristics of the SUITABLE SILO and the principles that must be met for the benefit of the newborn with gastroschisis (I appreciate the images provided by Dr. Alex Peñarrieta Daher of the Children's Hospital of Mexico). There are no "IDEAL SILOS" devices that meet all the objectives, characteristics and principles; Due to the fact that there are many elements that we do not control in the evolution of patients and SILOS devices will behave differently according to the conditions of each patient.