Acta chirurgiae plasticae最新文献

Complex injuries to the posterior trunk can still pose a significant challenge to the reconstructive surgeon. Due to the lack of skin laxity, dependent anatomical location and the importance of the deeper structures, a systematic approach tailored to the individual defect should be considered for these types of reconstructions. In our case report, we present a reconstructive solution of a chronic defect of the back caused by resection of an ulceration. What was previously considered to be a relapse of a malignant melanoma turned out to be a chronic osteomyelitis of the spinous processes of the thoracic vertebrae. The defect after the resection of the ulceration and infected spinous processes of the thoracic vertebrae with exposed dorsal lamina was covered with pedicled myocutaneous flap. Reconstruction yielded well-vascularized tissue that provided sufficient volume and tissue quality. Even in the light of modern perforator flaps, local or locoregional muscle and myocutaneous flaps remain the first choice for the treatment of deep back defects. Considering all the factors in the given case, plastic surgeons are able to tailor the reconstructive technique to every individual case to match the desired reconstruction goal.

Introduction: Smoking poses a risk to flap viability, with nicotine being a major contributor to the formation of free radicals. Allopurinol, known for its antioxidant properties, has been shown to enhance tissue survival in ischemic conditions by reducing the production of reactive oxygen species (ROS). This study aims to assess the impact of allopurinol on the viability and success of skin flaps in Wistar rats exposed to nicotine.

Methods: This study examined skin flap survival in nicotine-exposed rats treated with allopurinol. Twenty-eight rats were separated into two groups. During 1 month of nicotine exposure, the treatment group received systemic allopurinol 7 days before and 2 days after the flap procedure, while the control group received no allopurinol. Pro-angiogenic factors, proinflammatory factors, anti-inflammatory factors, and oxidative markers were assessed on the 7th day after the flap procedure using enzyme-linked immunosorbent assay method. Macroscopic flap viability was evaluated on the 7th day using Image J photos.

Results: As an oxidative marker, malondialdehyde levels were significantly lower in rats given allopurinol than in controls (P < 0.001). The levels of interleukin 6 and tumor necrosis factor α, as markers of inflammatory factors, were significantly lower in the group of rats given allopurinol compared to controls (P < 0.001). The level of angiogenesis in rats given allopurinol, measured by vascular endothelial growth factor levels, was also higher in the treatment group compared to controls (P < 0.001). Macroscopically, the percentage of distal flap necrosis in Wistar rats given allopurinol was lower and statistically significant compared to controls (P < 0.001).

Conclusions: Xanthine oxidoreductase is part of a group of enzymes involved in reactions that produce ROS. Allopurinol, as an effective inhibitor of the xanthine oxidase enzyme, can reduce oxidative stress by decreasing the formation of ROS. This reduction in oxidative stress mitigates the risk of ischemic-reperfusion injury effects and significantly increases the viability of Wistar rat flaps exposed to nicotine.

Nail bed reconstruction is crucial after fingertip trauma, impacting both function and aesthetics. In this article, the authors describe a case of partial distal phalanx amputation of the index finger with laceration of the nail bed's remaining part. A traumatically elevated skin-fat flap covered the exposed bone on the fingertip, preserving finger length and sensitivity on the radial side. A full-thickness skin graft from the forearm closed a secondary defect on the finger pulp. Nail bed suturing prevented scarring and nail deformity, and a temporary artificial plastic nail replacement maintained the nail bed's shape. Temporary artificial nail replacements protect the regenerating fingertip bed, promote healing, and prevent nail deformities. Proper adaptation of lacerated nail bed edges, supported by either the patient's own nail or a temporary artificial nail, is crucial for optimal fingertip restoration, including proper nail shape.

Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.

Nowadays, median nerve entrapment is a frequent issue. Many physicians are familiar with the most common median entrapment, which is the carpal tunnel syndrome (CTS). By contrast, less frequent entrapments, historically called "pronator syndrome" are still misdiagnosed as overuse syndrome, flexor tendinitis or other conditions. This article is meant to introduce proximal median nerve entrapments, followed by a case report of the rarest example - anterior interosseous nerve syndrome (AIN syndrome).

Nowadays, techniques and the use of patient specific implants seem to be the recent high technology standard in reconstructive surgery. Surgery planning is as old as the surgery procedures themselves. Any good surgeon, before entering the operating theatre, has a plan for how to proceed. It is based on knowledge and experience in combination of evaluation of all case relevant information. In fact, virtual surgery planning and CAD/CAM reflects the technological "state of the art" into the medical daily practice. Recently, 3D printing technologies became easy and accessible for everyone. Virtual 3D images substituted the plaster models, the film profile analysis switched to digital, 3D printed bone models of the case helped to understand the morphology of the deformity and prepare the osteotomies with "hands on the bone". The authors' own 20 years of experience on surgical planning, the development of digital technologies in oral and maxillofacial surgery is traced and comments on case examples are presented.

Background: Scalp arteriovenous malformations (SAVM) are extremely uncommon vascular malformations, with only ~200 cases published in the English language in the past years. The objective of the present study was to describe the experience of a single reference service in neurosurgery.

Methods: This is a descriptive and retrospective study conducted at our institution, which included cases of SAVM treated between 2001 and 2022. All information were extracted from the medical records of our institution. Patient confidentiality was preserved. Furthermore, an illustrative case has been described in detail.

Results: Seven patients were included. The male-to-female ratio was 2.5: 1 and the mean age was 23.3 (3-42) years. Most cases (56.4%) were spontaneous and the lesions were located in the frontal (28.7%) and parietal (28.7%) regions. All lesions were supplied by more than one feeder, with the superficial temporal and occipital arteries being the most commonly involved (71.5%). Six patients underwent preoperative embolization, and 56.4% patients had scalp necrosis. Five patients underwent surgical resection, all without recurrence and with good postoperative evolution.

Conclusions: More than one artery was involved in all cases, and the properties of the involved vessel influences the approach strategy. Surgical treatment is curative, and preoperative embolization helps reduce bleeding during the surgery. Complete resection of the lesions prevents associated complications, such as bleeding or recurrence. Scalp necrosis is a frequent complication in the treatment of these lesions, and a multidisciplinary approach involving reconstructive plastic surgery should always be considered.

Ischemic limb necrosis due to high dose of norepinephrine (NE) in a patient with septic shock is uncommon. Unfortunately, amputation of necrotic parts is the only available treatment. Reconstruction with skin autografts for defects resulting from the amputation of the lower limbs is challenging. Herein we report a case of digit necrosis in the upper and lower limbs after administration of a high dose of NE > 1 μcg/kg/min in a patient with septic shock. The source of infection that led to septic shock was not detected. Surgical amputation was performed as it was impossible to repair impaired vasculature and patients' life was endangered. Large defects were covered with skin autografts from the patient's thighs. The included figures demonstrate the extremities' appearance before, after amputation, during and after skin graft transplantation.

Lymph node transfer has recently become one of the popular techniques for surgical treatment of lymphedema. We aimed to evaluate postoperative donor site numbness and other complications in patients who underwent supraclavicular lymph node flap transfer to treat lymphedema with preservation of the supraclavicular nerve. From 2004 to 2020, 44 cases of supraclavicular lymph node flap were reviewed retrospectively. In the donor area, sensorial evaluation was clinically done with the postoperative controls. Among them 26 had no numbness at all, 13 had short-term numbness, two had numbness for > 1 year and three had numbness for > 2 years. We suggest that careful preservation of the supraclavicular nerve branches can avoid the major complication of numbness around the clavicle.

Introduction: It is often questioned whether to perform replantation or revision amputation for amputation injuries in elderly patients and smokers. According to the current indication criteria, neither old age nor smoking in the absence of other risk factors are considered to be risk factors for replantation failure. However, many microsurgeons still may make the decision not to perform digital replantation based solely on these factors.

Material and methods: In order to evaluate the influence of both factors, we provided univariate and multivariate analyses of patients who underwent replantation at our centre during a 10-year period. We divided patients in two groups according to age (< and ≥ 60 years) and smoking status.

Results: In the univariate analysis, there were no differences in immediate results between the two age groups. In the multivariate analysis, no statistical difference was found in neither long-term nor short-term results between the two age groups and between smokers and non-smokers.

Conclusion: Smoking and age should not be considered the only risk factors when deciding whether to perform digital replantation.