Acta chirurgiae plasticae最新文献

Background: Eagle's syndrome (ES) is a term describing a group of symptoms associated with the elongation of the styloid process (SP) of the temporal bone or with ossification of the stylohyoid ligament. Clinically, it manifests through pain in the orofacial and pharyngeal regions, similar to that experienced by patients with temporomandibular joint disease. The presented paper aims to assess the evaluation of the success of surgical treatment and the complications associated with such treatment.

Methods: Our retrospective study includes nine patients with ES treated in our Department Oral and Maxillofacial Surgery in years 2019-2023 (median age of 47 years) - all patients affected with this disease out of 2,716 patients examined at our department due to a temporomandibular joint disease. Eight of these patients underwent a surgical resection of the SP. The success and complications in these patients are evaluated in this study.

Results: In seven patients, the problems disappeared or at least diminished, which is consistent with data from the literature. Postoperative complications such as deficit of the marginal branch of the facial nerve (n. VII), limited sticking the tongue out (n. XII), and velopharyngeal insufficiency (n. IX) occurred in three patients.

Conclusion: The wide spectrum of clinical manifestations makes ES a condition that should be considered in the differential diagnosis of temporomandibular joint disorders, post-traumatic conditions, or complicated eruption of wisdom teeth or their extraction. ES can be treated conservatively or (mostly) surgically. Surgical treatment can be relatively successful and effective, but it is necessary to respect the anatomical placement of the SP, which can be associated with the development of complications, especially in cases with extremely long SP.

Introduction: Electrical burns account for up to 10% of burns admissions worldwide and are a potentially serious mechanism of injury. The aim of this study is to describe the epidemiology, presentation, management and complications of electrical burn injuries in adults.

Material and methods: A retrospective study of all adult patients with electrical burns admitted to a tertiary burns centre.

Results: Eighty-two cases were identified. The mean age was 40 ± 2 years, 92.7% were males. The most common activities causing the injuries were work (39%) and do-it yourself activities (32%). A low voltage (< 1,000 W) power source was involved in 78% of cases. The mean total body surface area involved was 3 ± 0.3%. The head, hands, and other upper extremities were the body parts most frequently injured. The mean hospital stay was 2 ± 1days.

Conclusion: Electrical injury was an infrequent but potentially serious cause of injury in adults. Minor injuries were successfully managed non-operatively. Electrical burns in adults are mainly low voltage burns contracted by manual workers resulting in a flesh burn. Although rare, the loss of digits, neurological sequelae, cardiac arrhythmias and renal failure remain serious complications in a significant number of cases.

Abdominal wall defects encompass a broad spectrum of musculo-fasciocutaneous anomalies. We present case of a 42-year-old woman with a history of multimorbidity and bilateral subcostal scars. The patient underwent incisional ventral hernia repair and abdominoplasty performed by a general surgeon at another institution. However, she developed extensive necrosis of the cutaneous-fatty panniculus between the bilateral subcostal incisions and the abdominoplasty incision. The patient presented with a medial area of 50 × 60 cm with loss of soft tissue vitality and necrotic plaques. Tangential escharotomies were performed to remove devitalized tissue, and management of the open wound included hydrocolloid and alginate dressings. Finally, a defect of 45 × 40 cm was achieved. Three tissue expanders were used to reconstruct the abdominal wall, allowing sufficient adjacent autologous tissue to be harvested for definitive correction of the abdominal defect. An acceptable aesthetic result was observed 5 years after surgery. This report highlights the importance of adequate evaluation of the previously scarred abdominal wall prior to abdominoplasty.

Background: Vascularized lymph node transfer (VLNT) is a relatively well-established microsurgical treatment for lymphedema that is especially beneficial for advanced cases in which lymphovenous anastomosis is not indicated due to lymphatic vessel sclerosis. When VLNT is performed without a skin paddle, such as a buried flap, the possibilities for postoperative monitoring are limited. The aim of our study was to evaluate the use of ultra-high-frequency color Doppler ultrasound with 3D reconstruction in a pedicled axillary lymph node flap.

Methods: Flaps were elevated in 15 Wistar rats based on the lateral thoracic vessels. We preserved the axillary vessels to maintain the rats' mobility and comfort. The rats were divided into three groups as follows: Group A, arterial ischemia; group B, venous occlusion; and group C, healthy.

Results: Ultrasound and color Doppler scan images revealed clear information on flap morphology changes and pathology if it was present. Surprisingly, we detected venous flow in group A rats, supporting the pump theory and venous lymph node flap concept.

Conclusion: We conclude that 3D color Doppler ultrasound is an effective method for monitoring buried lymph node flaps. 3D reconstruction makes it easier to visualize the flap anatomy and detect pathology if it is present. Moreover, the learning curve for the technique is short. Our setup is user-friendly even in the inexperienced hands of a surgical resident, and images can be reevaluated at any time if necessary. The use of 3D reconstruction removes the complications associated with observer-dependent monitoring of VLNT.

We report two cases of the basal phalanx fractures of the thumb treated with absorbable mesh plates. In both cases, the mesh plates specifically tailored for each fracture were effective in obtaining bone union and healing. We conclude that absorbable mesh plates could be a practical option for phalangeal fractures, especially where proprietary pre-molded metallic plates do not neatly fit the reduced fracture area.

Many objective examinations can be used to evaluate the results of surgical care. In addition, a variety of specific questionnaires, so-called PROMs (Patient-reported Outcome Measures), can be used to assess a patient's subjective perception. In recent years, PROMs, which assess the main areas of patients' interest, have been considered an important element in the comprehensive measurement of treatment outcomes. Recently, this approach has also proven valuable for the possibility of evaluating the results of health care without the need for the physical presence of the patient in the medical facility. In the presented overview, a brief list of objective measurements in the area of the hand and wrist is provided. It then focuses on the most used PROMs, together with a summary of the basic theory of their use.

The periorbital plastic surgery, especially upper and lower blepharoplasty is a very common surgical procedure. Usually the preoperative finding is typical, the surgery routine without unexpected surprises and postoperative course is smooth, quick and without complications. However, periorbital area can also be the source of unexpected findings and peroperative surprises. In this article we present a rare case of a specific disorder - adult onset orbital xantogranuloma in a 37-year-old woman who was treated for recurrences of facial adult orbital xantogranuloma by surgical excisions at the Department of Plastic Surgery, University Hospital Bulovka.

Introduction: Lower extremity wounds have always been a challenge for the reconstructive surgeons. Free perforator flaps are considered to be the best option for this problem but require the complexity of microsurgery. So, pedicled perforator flaps have emerged as an alternative option.

Patients and methods: Prospective study was conducted in 40 patients with traumatic soft tissue defects in the leg and foot. The free flaps included the anterolateral thigh flap (ALT) and medial sural artery perforator flap (MSAP). In pedicled perforator flaps group, 10 cases were designed as propeller flaps while the other 10 flaps were designed as perforator plus flaps.

Results: Free flaps were mainly used for large-sized defects; we had one case of partial flap loss and one case of complete flap necrosis.  MSAP flap was the first option for coverage of large-sized defects on foot and ankle as it is a thin and pliable flap, while ALT flap was used for coverage of larger defects on the leg. Pedicled perforator flaps were used mainly for small to medium-sized defects, especially in the lower third of the leg; we had three cases of flap loss in propeller flap design while we had no cases of flap loss in perforator plus flap.

Conclusion: Perforator flaps have become a reasonable solution for soft tissue defects of the lower extremity. Careful assessment of the dimensions, location, patient comorbidities, availability of surrounding soft tissue and presence of adequate perforators are mandatory for proper perforator flap selection.