Acta chirurgiae plasticae最新文献

Introduction: Venous thrombosis is a common cause of flap failure. Performing a second vein anastomosis provides a backup channel for draining. However, this may not be useful in circumstances of vessel kinking and compression. When a flap is compromised, there is a decrease in glucose levels and an increase in anabolic metabolites like lactate. In our study, we measured the ratio of flap/peripheral sugar levels (glucose index - GI) as a metabolic indicator and assessed flap perfusion after the second vein anastomosis.

Materials and methods: This was a single-centre prospective cohort study. Based on the inclusion criteria, eligible patients reconstructed with a free flap (anterolateral thigh flap / radial forearm flap / fibula flap) were included in the study.

Results: In our series, the mean flap sugar levels after the first and the second vein anastomoses were 116.60 mg/dL and 131.5 mg/dL, respectively. There was an increase in the flap sugar level after the second vein anastomosis. This increase was found statistically significant (P = 0.009), suggestive of better perfusion. In this study, the flap/peripheral glucose level (GI) ratios after the first and the second vein anastomoses were 0.90 and 0.99, respectively. The increase in this ratio after the second vein anastomosis indicated better flap perfusion after a double vein anastomosis.

Conclusion: The study concluded that there is a better perfusion after a double vein anastomosis.

Although complications from gel injection breast augmentation were documented over 20 years ago, they are still encountered today. This case report involves a 46-year-old patient who first had breast implants in 2004, with replacements in 2019. In April 2022, the implants were swapped for smaller ones. In December 2022, the patient underwent a gel injection boost augmentation. We first saw the patient in June 2023 when she was admitted to our emergency room in septic condition. Initial treatment included lavage and drainage, followed by intensive care unit admission. Once stabilized, a significant amount of gel was removed from the breast tissue. However, the procedure had to be repeated months later and hemostatic net sutures were added for 2 days. No more relapses occurred following this treatment. We strongly advise against using gel injections for breast augmentation, as they can lead to severe complications and unsatisfactory cosmetic outcomes.

Introduction: A wound is defined as damage or loss of continuity to the skin or body tissue which can cause disruption to the body's anatomical structure. Wounds can be caused by several things, such as post-operative wounds, trauma, contact with heat sources, chemicals, and accidents. One of the potential complications from wounds and maxillofacial surgery is dehiscence. The combination of guava leaf ethanol extract (Psidium guajava Linn) and polyvinylpyrrolidone (PVP) hydrogel is expected to help the healing process of traumatic wounds on the oral mucosa by increasing the number of fibroblasts, epithelialization, vascular endothelial growth factor (VEGF) levels, and decreasing interleukin-16 (IL-16) levels.

Methods: This research was an experimental test, using 28 rabbits as experimental animals. A traumatic wound is an incision made 2 cm laterally from the left central incisor and along the curve of the tooth. The wound reaches the gum line from the incision on the facial aspect to the midline of the papilla. The animals were divided into four treatment groups.: group 1 - the intervention group with wounds healed and given a combination gel; group 2 - the intervention group with wounds not healed and given a combination gel; group 3 - the observed group with wound healed and given placebo gel; group 4 - the observed group with wounds not healed and given placebo gel. There was an increase in the number of fibroblasts, epithelialization, VEGF levels, and a decrease in IL-16 levels between the treatment and control groups.

Results: This study showed an increase in fibroblast levels in the treatment group (64.50 ± 4.43) which was higher than the control group (55.67 ± 4.04), with P = 0.041 as well as an increase in epithelialization in the treatment group. The results of the analysis in this study support the superiority of this gel combination in accelerating wound healing through a positive influence on VEGF levels and angiogenesis. In this study, IL-6 levels on day 3 showed a decrease of 25% in the treatment group.

Conclusion: The combination of guava leaf ethanol gel and PVP hydrogel is an innovative therapy with high potential to accelerate wound healing, especially in chronic or difficult-to-heal wounds, with minimal risk of excessive inflammation and scar tissue formation.

Cosmetic/aesthetic surgery has increased in popularity, reflecting the increased consumer demand. Modern women feel compelled to meet near-impossible standards of beauty. Most of those who undergo cosmetic/aesthetic surgery are (middle-aged) women. Women are often under pressure to meet near-impossible standards of beauty. This study examined cosmetic/aesthetic surgery attitudes and perceptions among 516 Czech middle-aged women. It assessed the perception and attitudes towards cosmetic/aesthetic procedures of middle-aged Czech women and determined the possible factors influencing their level of acceptance through a quantitative survey. The research findings are based on an online questionnaire survey. Based on our analyses, we revealed that acceptance and attitudes towards cosmetic/aesthetic surgery among women can be influenced by the variables such as marital status, place of living, fear of ageing, the importance of physical appearance, occupational status, and partner's influence. This study provided a first general look at the situation around cosmetic/aesthetic surgery in the context of the Czech Republic. However, to gain a more comprehensive understanding of the acceptance and attitudes towards cosmetic/aesthetic surgery in the Czech Republic, further research should be conducted across the country to assess the attitudes of the wider population (for example, different age groups).

Ambiguous genitalia, a cluster of varied presentations classified as disorders of sexual development (DSD), involves a spectrum of manifestations affecting both internal and external genital organs. Diagnosing and treating these disorders is complex and requires a multidisciplinary approach. This article aims to explore the complexities and challenges of diagnosing and managing DSD. These cases highlight the importance of genetic, phenotypic, and biochemical evaluations in achieving accurate diagnosis and treatment plans, which may include surgical interventions and psychological support. The cases presented include individuals with 46,XY and 46,XX DSD, highlighting conditions such as MRKH syndrome, recto-vaginal fistula, and persistent urogenital sinus, androgen insensitivity syndrome each with unique clinical presentations and treatment challenges. Treatment options, such as McIndoe vaginoplasty, and considerations regarding psychological counselling and legal gender assignment further complicate the management of DSD, emphasizing the need for a comprehensive, individualized care approach.

Sarcomas affecting weight-bearing areas of the foot are a rare disease and represent a reconstructive challenge. The medial plantar artery (MPA) flap offers an optimal "like with like" reconstructive option for the sole. However, it has certain limitations such as the limited reach of the vascular pedicle, vascular impairment associated with retrograde flow flap or the morbidity of using contralateral foot as a free flap donor site. We present a case of a 30-year-old male with left sole forefoot defect after sarcoma excision. Because of the previous excision surgery along with the wish to avoid morbidity in the contralateral foot, reverse flow MPA flap and contralateral free MPA flap were ruled out. Reconstruction using an ipsilateral anterograde flow MPA flap with pedicle extension using a grater saphenous vein loop to advance the flap and reach the defect was proposed. After 9 months of reconstruction, the patient achieved full weight-bearing and ambulated normally without any complications. We propose this method of elongating the pedicle of the MPA flap as an optimal procedure, capable of encompassing mid-size defects in the entire sole of the foot. This approach reduces the morbidity associated with using the contralateral foot and avoids sacrificing other vascular axis in the affected foot for use as a recipient vessel. Although complications of the harvesting site are known, we believe that MPA flap is still the best option for reconstructing the weight bearing area.

Background: Brachioplasty in the post-bariatric patient deserves special attention since a not negligible number of wound complications is reported in the literature. In this study, the authors present unique risk factors for wound dehiscence and delayed wound healing based on retrospective data in post-bariatric patients who underwent brachioplasty alone or with other procedures.

Methods: A total 31 patients who underwent brachioplasty alone or combined with other procedures between 2017-2022 were included. Data analyzed encompassed demographic information, biometric data, type of brachioplasty if performed alone or in combination with other procedures, days to epithelization/closure, and its management.

Results: A total of 15 patients (48.38%) experienced surgical wound dehiscence, the majority (66%) being minor wound dehiscence. Subjects who underwent concomitant arm liposuction with brachioplasty showed a higher degree of dehiscence (P = 0.021) and more days to epithelialization/closure (P = 0.10). Fifty-seven percent of patients who underwent a combined procedure showed some degree of dehiscence, as well as more days to epithelialization/closure (41 vs 15.75 days). Brachioplasty and mastopexy as combined procedures demonstrated more days to epithelialization/closure (P = 0.05).

Conclusions: Brachioplasty in the post-bariatric population is deemed safe and effective; nevertheless, it carries an increased risk of wound dehiscence and delayed wound healing when combined with liposuction and other procedures. The plastic surgeon needs to become familiar with variables that increase the risk of this complication, all of which can be anticipated in preoperative planning.

Introduction: Breast reconstruction using a silicone implant after mastectomy is a common part of the comprehensive treatment of breast cancer patients. One of the most serious complications is implant infection, which can significantly affect the surgical outcome as well as the patient's quality of life. The aim of this study was to analyse the incidence of infectious complications following breast reconstruction with a silicone implant. The study also sought to identify major risk factors, assess possible preventive measures, and compare the findings with data available in the scientific literature. Special attention was paid to immediate versus delayed reconstruction following mastectomy.

Methods: A retrospective analysis was conducted on data from 17 patients who had surgery at Na Františku Hospital in Prague in 2024. Both clinical and surgical variables were evaluated, including the timing of reconstruction (immediate or delayed), incidence of infection, and microbiological findings in relation to the presence of risk factors (smoking, diabetes mellitus, radiotherapy, coagulopathy), reoperation, fat transfer prior to surgery, and length of hospitalization. The distal end of the Redon drain was sent for microbiological examination.

Results: Infection occurred in 7 out of 17 patients, with a higher incidence observed in cases of immediate reconstruction. The most common pathogens identified were Staphylococcus epidermidis and Staphylococcus capitis. The average length of hospitalization was 9.8 days (a median of 8 days). The most frequent complicating factors were immediate reconstruction, smoking (including IQOS), radiotherapy, and diabetes mellitus. A positive impact on reconstruction outcomes was observed in patients who had fat transfer prior to implant placement, which appeared to have a protective effect. Reoperation was required in 5 patients, and in 3 of these cases, implant removal was ultimately necessary.

Conclusion: The importance of identifying risk factors for planning reconstruction and preventing complications was confirmed. Smoking, diabetes mellitus, and radiotherapy are significant risk factors for implant-related infections. Fat transfer prior to implant-based reconstruction may serve as a protective factor.