Acta chirurgiae plasticae最新文献

Infratemporal fossa (ITF) tumors represent a group of tumors with complicated approach, due to specific anatomy of the space. The incidence is rare, but they always represent a challenge for choosing a treatment for each patient. We would like to present a few cases of ITF tumors treated in cooperation with our department to provide multiple views on this topic. In the presented cases, we used the open transmandibular approach, the endoscopic approach and the conservative approach in terms of patient observation.

Background: Trigger finger causes pain, catching, and locking of the finger, with corticosteroid injection being the first-line treatment. Injections with local anaesthetic may reduce immediate pain, but it has been suggested that added volume worsens pain. This systematic review aimed to evaluate studies investigating pain following corticosteroid injection for trigger finger, with or without local anaesthetic. Evaluation of the topic: We performed a prospectively registered systematic review (PROSPERO ID: CRD42024502361) following PRISMA guidelines. We searched PubMed, Cochrane Library, and Embase database for randomised trials or prospective cohort studies investigating pain following injection with corticosteroid with or without local anaesthetic. Patient demographic data, injection details and outcomes including visual analogue scale (VAS) pain scores were collected and summarised. Two articles including 98 patients (135 injections) were included. One article compared steroid injection with local anaesthetic and adrenaline to steroid injection with placebo (0.9% saline), and found that omitting local anaesthetic had a lower immediate VAS pain score (2.0 vs. 3.5; P < 0.01) however all injections contained the same volume. The second study measured VAS pain scores at multiple time points, and a recollection score for patients injected with either corticosteroid alone (1mL), corticosteroid and 1% xylocaine (2 mL), or corticosteroid and 0.9% saline (2 mL). VAS pain scores were similar in the steroid alone and steroid and local anaesthetic group at 1 minute post-injection and highest in the steroid and saline group. The local anaesthetic group had the lowest pain score 10 minutes post-injection. Meta-analysis of outcomes in these heterogeneously reported studies was not possible.

Conclusion: Corticosteroid injection for trigger finger varies considerably and outcomes are reported inconsistently. The evidence suggests that the addition of local anaesthetic may increase immediate pain due to volume effect or lowered pH but reduce early post-injection pain. Further well-designed randomised studies are needed to guide treatment decisions.

Background: Orofacial clefts (OFC) are common congenital anomalies with complex genetic and environmental etiologies. Although multiple risk factors have been suggested, their role in cleft type and severity remains unclear.

Objective: This study aimed to assess the relationship between environmental and maternal health factors (body mass index - BMI, parental age, infection, stress, prenatal vitamin supplementation) and the occurrence and severity of cleft types in the Czech population, as well as the effectiveness of prenatal diagnosis by ultrasound.

Methods: A total of 96 parents of children with nonsyndromic OFC born between 2017 and 2024 in the Czech Republic were surveyed using a custom online questionnaire (RoRis). The data were analyzed using Fisher's exact test (a = 0.05).

Results: The distribution of cleft types in this Czech sample was consistent with international data. Prenatal diagnosis by ultrasound was established in 55% of cases. The highest detection rates were observed for bilateral cleft lip and palate, with 100% of cases diagnosed prenatally, and for unilateral cleft lip and palate, with a 93% detection rate. In contrast, cleft palate only (CPO) was the most frequently missed, with 88% of cases undetected. No significant associations were found neither between the cleft type nor the severity of clefts and parental age, maternal BMI, medication use, infection with fever, or stress during pregnancy. Most mothers had a normal BMI (51%), and 85% reported prenatal supplement use. COVID-19 infection during pregnancy was reported in 13 cases, but no clear link with cleft severity was found.

Conclusion: While several exogenous factors were studied, no significant associations neither with cleft type nor severity were found. The study highlights the limitations of prenatal screening diagnosis by ultrasound, particularly for CPO, and supports the need for further research into modifiable risk factors.

Background: Brachymetacarpia is a rare deformity characterized by shortening of one or more metacarpals, most commonly the fourth. This study aimed to evaluate the outcomes of surgical treatment for brachymetacarpia using an internal mini distractor and to compare its advantages over external fixators and other surgical techniques.

Materials and methods: We retrospectively analyzed 9 patients treated between 2011 and 2021 using gradual distraction osteogenesis with an internal mini distractor. Evaluated parameters included pre- and postoperative metacarpal lengths, deviation from ideal length, complications, treatment duration, and patient satisfaction.

Results: The mean lengthening was 1.2 cm (range 0.7-1.5 cm), with minimal deviation from the ideal metacarpal length (+0.3 cm on average). The average distraction period was 68 days. Minor complications occurred in 3 patients, including synovitis and delayed consolidation, all managed successfully. Functional outcomes and patient satisfaction were uniformly excellent.

Conclusion: The internal distraction system provides a reliable, safe, and patient-friendly method for metacarpal lengthening. Compared to external fixators, it offers superior stability, reduced the risk of infection, and improved aesthetic and functional outcomes in selected cases.

A 62-year-old female patient with no relevant medical history presented with elevated vitamin B12 levels, which were incidentally detected during a routine examination. Comprehensive evaluations excluded oncohematological disorders, liver diseases, pulmonary conditions, viral infections, autoimmune disorders, and cardiovascular causes, as well as paradoxical increases in vitamin B12 levels. It was hypothesized that the elevated vitamin B12 levels were related to a chronic inflammatory process, potentially exacerbated by the presence of biopolymers. Given the improvement in symptoms and the risks associated with implant removal, it was decided to proceed with semi-annual clinical monitoring, with surgical intervention considered only if clinical abnormalities or significant changes in imaging were observed.

Background: Complex nasal defects most often arise due to oncological resection or severe trauma. Traditional methods of two-stage nose reconstruction using a forehead flap with a skin graft have often resulted in collapse and deformity of the nose with a very compromised outcome over time. These techniques were gradually replaced by new procedures consistently reconstructing the intranasal lining, most often with flaps from the nasal septum. These methods reconstruct the cartilaginous and bony support of the nose as well, while the skin cover of the nose is, nowadays, in large defects, reconstructed in three stages. Evaluation of the topic: The options for intranasal lining reconstruction are as follows: a composite graft, a turnover flap covered with a local flap, advancement of the residual lining (bipedicle vestibular mucosa flap), a folded forehead flap, a prelaminated forehead flap, the use of another local flap (a forehead, nasolabial, facial artery myomucosal flap), a hinged turnover flap, a septal mucoperichondrial hinged flap, a composite septal chondromucosal pivot flap, a turbinate flap and microvascular free flaps (a radial forearm flap, a helix free flap, a kite flap, a dorsalis pedis free flap, a temporoparietal free flap, a postauricular free flap). Thanks to the abundant vascular supply of the face, the risk of ischemia and infection is mitigated, allowing most complex nasal defects to be reconstructed by using local flaps to restore all layers of the nose. Local tissues retain ideal quality, coloration, and texture, are reliable, and usually result in esthetically acceptable morbidity of the donor area. If the inner lining defect is extensive, it must be reconstructed by free microvascular tissue transfer. If other than intranasal flaps are used in the reconstruction of the internal lining, it is preferable to postpone the reconstruction of the supporting framework until the second stage while thinning the flaps used; otherwise, there is a high risk of obturation of the nasal airways.

Conclusion: The results of modern reconstruction dramatically improved after the introduction of three-stage nasal reconstruction and emphasizing the reconstruction of all layers of the nose. Therefore, a quality inner lining is the basis for the construction of the new nose.

Background: The surgical procedure of feminizing genitoplasty aims at restoration of normal anatomy and function in various cases of disorders of sexual development with ambiguous genitalia.

Material and methods: Between April 2021 and May 2023, 23 patients underwent a single stage feminizing genitoplasty procedure at the department of plastic and reconstructive surgery. All the patients underwent clitoroplasty with partial glans preservation, omega flap vaginoplasty and labioplasty. Cases with only clitoroplasty were excluded from the study. Of these 23 patients, 17 had congenital adrenal hyperplasia and the rest 6 had varying degrees of androgen insensitivity syndrome. The age of the patients ranged from 4 to 23 years and all were raised as females. The mean operating time was around 120 to 150 minutes and average hospitalization period was 7 to 8 days. At follow-up evaluation, no major complications were observed. In all cases the vaginal introitus was located in the physiological position and was of varying size and elastic.

Conclusion: This procedure of single stage feminizing genitoplasty enables reconstruction with good cosmetic and functional results not only in children but also in adults presenting with ambiguous genitalia.