Acta chirurgiae plasticae最新文献

The Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital in Brno, and Faculty of Medicine of Masaryk University, Brno, has a long history of surgical treatment of lymphedema and elephantiasis, which started in 1970s. There were many types of surgeries described and performed at our department - starting with prof. Bařinka's radical operation of elephantiasis, then lower limb end-to-side lymphovenous anastomosis pulled through the wall to the great saphenous vein, and genital lymphedema reduction. We call this era "the first period" of surgical lymphedema treatment. "The second period" started in 2016 by using free flaps with lymph nodes or vascularized lymph nodes and using microsurgical techniques of end-to-end, end-to-side and side-to-end lymphovenous anastomoses to the subcutaneous veins of a small calibre, which then drain the lymph into the blood stream. "The third period" started 2 years ago after the visit of prof. Yang from Taiwan - we started to use the method of single stitch end-to-side anastomosis to big subcutaneous veins like the great saphenous vein or the cephalic vein.

Introduction: The aim of this study was to assess the long-term impact and potential effectiveness of our specialized acellular dermal matrix (ADM) in a two-stage breast reconstruction process.

Objective: Opinions regarding the use of ADMs are currently divided. While their positive contribution to reconstructive breast surgery is evident, the results of studies vary depending on specific procedures, patient selection, and techniques employed.

Material and methods: In a retrospective study conducted between January 2015 and October 2023, it was examined a cohort of patients who underwent delayed two-stage breast reconstruction with the addition of ADM prepared by Central Tissue Bank (CTB) the Burn and Reconstructive Surgery Department University Hospital Ružinov. Our primary focus was on the occurrence of significant postoperative complications during both the initial and subsequent reconstruction periods, taking into account patients' medical history, comorbidities, and adjuvant therapy.

Results: We examined a total of 46 patients (49 breasts) who underwent two-stage breast reconstruction. The average age of the patients was 46 and the average BMI was 23.1. The average length of outpatient follow-up for female patients was 32 months. We observed a total of 4 cases of capsular contracture, ranging from grade I to grade III, with 2 cases requiring surgical revision through capsulotomy and implant exchange. Postoperative complications, such as infection and dehiscence leading to expander/implant loss, occurred in one case. The occurrence of seroma was noted in 3 cases. Complications were more frequently observed in the group of patients with post-radiation chest changes and comorbidities such as diabetes or hypertension, and in patients with a lower BMI than the group's average (23.1). In the group of patients who were smokers, we did not observe an increased rate of complications, with the exception of wound dehiscence in cases where there was no expander exposure.

Conclusion: In experienced hands, ADM prepared by CTB and used in delayed two-stage breast reconstruction, can be beneficial as an adjunct to prosthetic breast reconstruction while also reducing costs.

In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.

Introduction: The deep inferior epigastric perforator (DIEP) flap is widely considered as the gold standard in breast reconstruction. The inset technique of the DIEP flap is crucial in determining the overall aesthetic outcome; however, to date no systematic review is available that comprehensively assesses the various techniques. Evaluation of topic: A systematic review was performed according to the PRISMA guidelines. The methodology is outlined within our published protocol (Prospero CRD42023449477). Included articles met a minimal criterion compromising of the intervention (DIEP free flap for breast reconstruction) and outcomes (aesthetic and clinical outcomes). Six articles were included in this review, with a total of 346 patients and a follow-up ranging from 6 months to 4 years. Four articles were of a prospective case series study design, one article was a randomized controlled trial, and one article was a case-control study. The risk of bias was assessed to be high in the case series, but low and moderate in the randomized controlled trial and case-control study respectively.

Conclusion: Although limited by the quality of the evidence, the single aesthetic unit principle, dual-plane inset, elimination of the need for a skin paddle, appropriate flap positioning and rotation, and algorithmic in-setting may all improve the aesthetic outcome of DIEP free flaps.

Introduction: Skin malignancy is one of the most common reasons for seeking out a plastic surgery clinic. This article presents an overview of the therapeutic results at Department of Plastic and Aesthetic Surgery Brno and includes an algorithm according to which we proceed in the treatment of patients with skin malignancy.

Material and methods: Retrospective analysis of data for the year 2022, including a set of 791 patients with a total of 1,117 procedures to remove skin malignancy. The representation of cutaneous malignancy was as fol-lows - basalioma (51%), squamous cell carcinoma (14%), and other malignancies including precancerous lesions were represented in 35%. Age, sex, a character and a number of procedures (excision, re-excision, controlled excision), and the histological results of resected specimens (with a sufficient margin or ingrowth) were evaluated. Based on the analysis of the patient cohort, an algorithm is presented to guide the surgical management of the patient.

Results: Patients' age ranged from 26 to 102 years. There was a discrete male predominance in the cohort (51%). Tumour localization was most frequently on the skin of the face, cleavage, and extremities. Regarding the spectrum of procedures, excision accounted for the largest proportion (83%). Re-excision accounted for the rest of the procedures (10%), controlled excision was performed in 6% and excisional bio-psy accounted for 1%. Primary sanative excision with a histologically sufficient margin was performed in 96%. In the group of controlled excisions, 59% were sanative. Overall, 73% of patients in our cohort underwent a single operation only to remove a cutaneous malignancy.

Conclusion: The results of the therapy and the algorithm of the care for patients with skin malignancy can be evaluated as successful based on the analysis performed. The determination of the surgical strategy according to the algorithm appears to be effective. The authors recommend its use in practice, especially with the current trend of the increasing incidence of skin malignancies and the desire to improve the effectiveness of surgical interventions.

Introduction: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist.

Case: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient's condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6 cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength.

Conclusion: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.

The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.