Acta chirurgiae plasticae最新文献

Introduction: Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are a known phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop a treatment algorithm for superficial and deep sternotomy wound infections.

Material and methods: Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections.

Results: Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up.

Conclusion: Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Introduction: Breast cancer is the leading cause of neoplasm mortality among women. Several prevention strategies have been implemented to early detect and prevent the cancer occurrence. The most effective protocol includes prevention mastectomy for the high-risk patients. In our study, we have compared the efficacy of subcutaneous mastectomy (SCM) and skin sparing mastectomy (SSM) in long-term follow up.

Methods: We have included 201 female patients who have been treated at our department over the course of 20 years between 2000 and 2019. All the patients were at high risk of developing breast cancer and therefore were indicated for the prophylactic mastectomy. The main indication was the presence of the mutation in the BRCA1 or BRCA2 cluster, however, even in the lack of such mutation, the family history was sufficient for the mastectomy indication. Patients underwent either SCM, SSM or areola sparing mastectomy (ASM), and were allocated to aforementioned groups, respectively. We have collected the data regarding the reconstruction method along with age, weight, height, body mass index (BMI) and presence of predisposing genetic mutations such as BRCA positivity.

Results: The patients who underwent SSM compared to those who underwent SCM were of higher age, with higher BMI and body mass. The patients in SSM group had statistically significantly higher BMI than in ASM. There was no difference in efficacy between patients who underwent SSM and SCM. The majority of patients (91.5%) were positive for BRCA1 or BRCA2 mutation. In our study, only four patients were tested negative for known breast cancer inducing mutation (three in SCM and one in SSM). The most common reconstruction method was an abdominal flap and breast implant.

Conclusions: Prophylactic mastectomy is a reliable strategy for significantly reducing the number of breast cancer incidence in high-risk patients regardless of the selected method of mastectomy. These operations allow for the subsequent reconstruction with the whole spectrum of reconstructive options.

Introduction: Surgery is the primary treatment modality for oral squamous cell carcinoma. The purpose of the surgical procedure is complete removal of the tumor with a sufficient margin of healthy tissue in its surroundings. Resection margins represent an important factor for planning further treatment and for estimation of the disease prognosis. Resection margins can be divided into negative, close and positive. Positive resection margins are considered a prognostically unfavorable factor. However, the prognostic significance of close resection margins is not entirely clear. The aim of this study was to evaluate the relationship between resection margins and disease recurrence, disease-free survival and overall survival.

Material and methods: The study included 98 patients who underwent surgery for oral squamous cell carcinoma. During histopathological examination, resection margins of each tumor were evaluated by a pathologist. The margins were divided into negative (> 5 mm), close (0-5 mm), and positive (0 mm). Disease recurrence, disease-free survival and overall survival were evaluated according to the individual resection margins.

Results: Disease recurrence occurred in 30.6% of patients with negative, 40.0% with close, and 63.6% with positive resection margins. Significantly shorter disease-free survival and shorter overall survival in patients with positive resection margins was proven. The five-year survival rate was 63.9% in patients with negative, 57.5% with close, and only 13.6 % with positive resection margins. The risk of death was 3.27times higher in patients with positive resection margins compared to patients with negative resection margins.

Discussion: Positive resection margins represent a negative prognostic factor, which was also confirmed in our study. There is no unequivocal consensus on the definition of close and negative resection margins and also on the prognostic significance of close resection margins. Factors that may contribute to inaccuracy in the evaluation of resection margins include tissue shrinkage after excision and after fixation of specimens before the histopathological examination.

Conclusion: Positive resection margins were associated with a significantly higher incidence of disease recurrence, shorter disease-free survival and shorter overall survival. When comparing the incidence of recurrence, disease-free survival, and overall survival between patients with close and negative resection margins, the differences were not statistically significant.

Background: Lower limb defects may be present due to various causes including infections, vascular diseases, tumor resections, and crush or avulsion injuries. Management of lower leg defects is a complex problem, especially when they are large with deep soft tissue loss. These wounds are difficult to be covered with local skin flaps, distant skin flaps or even conventional free flaps because of the compromised recipient vessels. In such cases, the vascular pedicle of the free flap could be anastomosed to the recipient vessels of the contralateral healthy leg temporarily and then divided after adequate neo-vascularization of the flap from the wound bed. The ideal time to divide such pedicles should be investigated and accurately assessed to have the maximum success rate possible for these challenging conditions and procedures.

Methods: Sixteen patients who did not have a suitable adjacent recipient vessel for free flap reconstruction had been operated with cross leg free latissimus dorsi flap between February 2017 and June 2021. The mean soft tissue defect dimension was 12 × 11 cm (the smallest 6 × 7 cm; the largest 20 × 14 cm). Gustilo type 3B tibial fractures were present in 12 patients, while no fractures were present in the other 4 patients. Preoperatively, arterial angiography was performed on all patients. After the fourth week post-operatively, non-crushing clamp was applied around the pedicle for 15 minutes. The clamping time was increased by 15 minutes on each consequent day (average 14 days). On the last 2 days, the pedicle was clamped for 2 hours, and bleeding was assessed by a needle prick test.

Results: Clamping time was assessed in each case to reach a scientific calculation of the adequate vascular perfusion time needed for full flap nourishment. All flaps survived completely except two cases of distal flaps necrosis.

Conclusion: Cross-leg free latissimus dorsi can provide a solution for large soft-tissue defects in lower extremities especially with absence of any suitable recipient vessels or when the use of vein grafts would not be feasible. However, ideal time before dividing the cross vascular pedicle should be identified to have the maximum success rate possible.

The formation of a seroma after abdominoplasty is one of the most common complications faced by plastic surgeons. A 59-year-old man underwent lipoabdominoplasty and developed a large subcutaneous seroma that persisted for 7 months. Percutaneous sclerosis with talc was performed. We present the first report of chronic seroma after lipoabdominoplasty successfully treated with talc sclerosis.

The authors present a novel modification of vastus lateralis muscle free flap based orbital reconstruction in a 41-year-old patient, with a secondary defect to an injury with technical oil under high pressure. The patient underwent multiple reconstructive procedures in different medical centers with poor functional and esthetic results including simple local plasty techniques. The patient underwent simultaneous reconstruction of the soft tissues of the orbit, and conjunctival sac based on a prelaminated vastus lateralis free flap. The two-stage reconstruction of these structures is beneficial both for the patient's psychical and mental condition and for health system finances. Therefore, whenever it's possible, we should try to decrease the number of required procedures. The authors believe that their technique can significantly improve the quality of life of patients after exenteration but simultaneously they emphasize the need to carry out more procedures in order to refine it.

Squamous cell carcinomas of the oral cavity represent the largest group of malignancies in this area. Currently, there are many prognostic histopathological factors, according to which the maxillofacial surgeon in collaboration with the oncologist is able to determine the prognosis and subsequently also set an appropriate therapy. Nowadays, the squamous cell carcinoma invasion pattern in the area of the "invasive tumor front" seems to be a very important prognostic factor. The invasion pattern is connected to metastatic potential (and to the presence of subclinical microscopic metastases) and may well be the answer to why even early-stage tumors do not respond to standard therapy. That is to say, based on varying invasion pattern, oral cavity squamous cell carcinomas with identical TNM manifest varying clinical behavior and growth tendencies and a varying metastatic potential.