Acta chirurgiae plasticae最新文献

Hibernomas are soft tissue tumors derived from remnants of brown fat. They are rare masses that can have variable presentations ranging from incidental asymptomatic masses to pain due to nerve compression. We present the case of a 52-year-old male presenting with an atypical lipomatous mass on ultrasound and magnetic resonance imaging. The mass was excised and sent for pathology with the result being a hibernoma. We should be vigilant in the treatment of such tumor presentations as they may be a low grade liposarcoma in disguise. Surgical biopsy or excision is the best treatment for achieving a definite diagnosis.

Introduction: The problem of the replacement after manubrial resection can be solved standardly through a pedicled pectoralis major muscle flap (PMMF) defect coverage, harvested thought an accessory incision. We recently established an alternative and easier harvesting technique, also in critical cases (patients with recurrent tumor and after radio-chemotherapy), that improves aesthetic outcome and allows harvesting an adequate muscle flap for an optimal chest wall coverage.

Material and methods: A single center retrospective analysis between 2017 and 2020 was performed. Flap harvest was performed subcutaneously using the same incision resections line, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle.

Results: Fifteen patients with recurrent tumors after radio-chemotherapy and involving the upper thoracic inlet underwent manubrial resection with associated extended upper mediastinal dissection and replacement using a pectoralis major island flap following our harvesting technique. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity. Four (26%) patients had major complications that required surgical revision. All patients had early postoperative shoulder mobilization without functional deficit or aesthetic deformity.

Conclusions: Pedicled pectoralis major muscle flap (modified harvesting) provides an adequate replacement of the upper thoracic inlet, with excellent aesthetic and functional results, also in high risk patients.

Skin and soft tissue infections (SSTIs) are a large group of diseases with a wide range of clinically different conditions, some of which can be immediately life-threatening. A number of bacteria play an important role in the etiology of SSTIs, especially gram-positive cocci Staphylococcus aureus and Streptococcus pyogenes. In this case report, a young woman with skin defects after a fasciotomy was treated using a dermal substitute application. Multiple infectious complications in the skin and soft tissues with a high risk of development of phlebitis and with significant intolerance to a variety of antimicrobials were observed. The dramatic SSTI was treated using intravenous administration of dalbavancin, a very potent bactericidal antibiotic representing a rational option in the treatment of SSTIs caused by gram-positive bacteria.

Perilunate fracture-dislocation is rare. We report a case of a 17-year-old patient with an atypical dorsal perilunate dislocation with no scapholunate ligament injury and an associated contralateral radiocarpal fracture-dislocation. When the initial diagnostic is uncertain, in order not to delay the treatment, computed tomography scan is strongly recommended. The fractures should be anatomically reduced and require a double surgical approach that allows for screw or K-wires insertion and carpal ligaments repair. This pattern of carpal derangement is described in detail. After 12 months the patient is asymptomatic with a total recovery of activities of daily living.

Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently discovered malignancy of T-cell type, correlated with the use of silicone breast implants. It has been theorized that the etiology may be linked to bacterial growth and long-term inflammation. The afflicted patient usually presents with breast swelling due to peri-implant fluid accumulation. Currently, the diagnosis is achieved by ultrasound, biopsy and testing for certain biomarkers. Following this, the treatment is achieved by complete surgical excision, or by capsulectomy and exchange with smoother surfaced implants. The aim of this study was to identify and report 50 most cited articles related to the field of BIA--ALCL.

Methods: The Web of Science Citation Index was used to identify 325 articles pertaining to BIA-ALCL. The 50 most cited articles among these were included in this study. The title, author name, journal and year of publication, country and institute of origin, level of evidence (LoE), type of study (clinical or basic), and topic of study (pathophysiology, oncologic management, diagnosis, case report and case series) were recorded.

Results: This study includes articles from the period 1997-2018 with an average citation rate of 65.5. The majority of the top cited articles (36%; N = 18) were found to be case reports, followed by case series (18%; N = 9), systemic reviews (12%; N = 6) and studies focused on the pathophysiology (16%; N = 8), oncologic management (6%; N = 3), databases (6%; N = 3), diagnostics (4%; N = 2) and informed consent (2%; N = 1). The articles were published across 30 journals and originated from 35 institutes. The United States was found to be the country of origin of most of the studies. While none of the articles achieved LoE 1, many were found to have LoE 4 (N = 11) or 5 (N = 19). Most of the articles (N = 42), were clinical research studies.

Conclusion: According to this citation analysis, a large fraction of the existing high impact literature on BIA-ALCL is focused on disease monitoring. Through this study, we hope to present a simple educational tool to better appreciate the research in this relatively young field.

Nasal basal cell carcinomas are the most common malignant tumors of the facial skin, which predilectively affect areas exposed to sunlight, including the nasal area. After their radical removal, there is a variable complex defect of the affected area (defect of all 3 layers of the nose) or even a composite defect (it also occupies the adjacent soft tissues around the nose), which are usually used to reconstruct this area. A 73-year-old female patient with recurrent infiltrative basal cell carcinoma of the left nasal ala underwent four re-excisions before histologically verified free margins without the presence of the tumor. The result was a composite defect that occupied the top of the dome of the right nostril, the entire left half of the soft nose, including the base of the wing, part of the upper lip, and a defect of the adjacent face area of 9 × 5cm. In the first phase, the left cheek and upper lip were reconstructed by advancement French plasty and coverage of the two residual skin defects with full-thickness skin graft. One month later, during the second phase of reconstruction, the flap was re-elevated, shifted and rotated, and a three-stage nasal reconstruction was started using a composite septal pivotal flap and left turbinate flap for inner lining reconstruction, and the nasal skeleton was reconstructed with a cartilaginous L-graft from the 6th rib, septal and conchal cartilages. The skin cover of the nose was reconstructed with the left paramedian forehead flap, which was thinned during the second stage with the simultaneous widening of the bottom of the left nostril by the transposition flap, during the third stage the flap pedicle was removed. In the reconstruction of a complex defect of the nose and its surroundings, it is first necessary to create a stable platform on which the reconstruction of the nose itself will be performed. To achieve an excellent functional and aesthetic result of nose reconstruction, it is appropriate to use a three-stage forehead flap. In this paper, we describe a unique method of nasal reconstruction - a combination of a septal pivotal flap with a turbinate flap to reconstruct the inner lining in conjunction with an L-graft to ensure a stable nasal skeleton and forehead flap to reconstruct the skin cover.

Background: Flaps are the essence of reconstructive surgery. The ability to successfully design, execute and manage the flaps makes plastic surgery an outstanding speciality. The choice of flap is mainly guided by the type of the defect. However, certain factors like technique feasibility, duration of the surgery and patient factors do have a role in decision making. The primary type of free flap (whether a muscle or a fasciocutaneous flap) is dictated by the defect or the wound characteristics. However, the choice of flap depends on various factors like the component of flap, pedicle length required, the ease of harvest and donor site morbidity. Tensor fascia lata (TFL) is one myocutaneous flap, which has well developed components other than a muscle.

Materials and methods: The patients admitted to a tertiary care hospital with the diagnosis of composite tissue defect in any region of the body were enrolled for this study from November 2016 to November 2018. Patients undergoing free TFL flap reconstruction are studied. The duration of flap harvest, the anatomical site of pedicle, flap outcome and the need of secondary surgery were analysed.

Results: Totally 14 patients were reconstructed with a free TFL flap. The anatomic location of the defect was more frequent on lower limbs - 8 cases (58%), followed by the upper limb and the head and neck area (3 cases, each 21%). The mean flap harvest time was -62.07 (45-80) min. The mean size of pedicle entry was 8.7 cm from the anterior superior iliac spine. Out of the 14 flaps, there were 10 (71%) flaps successful completely and 4 (29%) of them had partial loss.

Conclusion: A free TFL flap harvest time is very short compared to any other flaps and hence makes it the flap of choice in patients who are critical and cannot withstand long operating time.

Background: The ablative surgical resection has a critical importance for achieving better oncological outcomes for patients with head and neck cancer. However, radical surgical resections reveal the reconstruction requirement of complex anatomical structures. Microvascular free flaps have been recommended as a gold standard treatment choice for head and neck reconstruction following definitive oncological surgery. The supraclavicular artery island flap (SCAIF) is a thin and reliable fasciocutaneous pedicled flap that is simple and quick to harvest.

Material and methods: A total of 19 patients who underwent head and neck reconstruction with SCAIF were included in this study. The SCAIF was used for the reconstruction of oncological defects in 17 patients while it was used for the reconstruction of a skin defect on the lower face following radiotherapy in 1 patient and for cervical open wound (blast injury) closure in 1 patient.

Results: There were neither intraoperative nor postoperative major complications in any patient. The SCAIF has been used successfully in 18 of 19 patients for head and neck reconstructive surgery. Partial necrosis of the skin was detected in 1 patient (5.3%) only, while a total flap failure has not occurred in any patient. The partial skin necrosis was seen in an area of 1.5 cm of the distal end of the flap and was managed conservatively with local wound care. Wound dehiscence has not appeared in the flap donor area in any patient.

Conclusion: The SCAIF constitutes a good alternative to free flaps, providing almost equivalent functional results and requiring less operative time and surgical effort.

An anterior open bite (AOB) is an occlusal disorder that causes the patient both an aesthetic and functional handicap. The lower third of the face is disproportionately larger. Patients are unable to properly occlude with the anterior part of dental arch and occlusion only happens in the premolar and/or molar regions. An anterior open bite may be the result of anatomical anomalies. Long term stability as well as an immediate outcome of the surgery depends on the choice of a suitable treatment strategy. In this article, we review options of AOB treatment, from classical orthodontic treatment to current combined orthodontic and surgical approach with a benefit of an anchor system.

Introduction: Hypertrophic scars are an unwanted and mutilating consequence of deep burns, and are further exacerbated by extensive burn injuries. Fractional CO2 laser therapy is one of the methods for complex treatment of hypertrophic scars, it has been used since 2007 [1]. Although its effectiveness has been objectively proven in clinical practice, the optimal settings parameters have not been determined. To evaluate the effect of laser therapy, previously designed evaluation tools are used, which evaluate the quality of scars well, but fail to capture specific changes for the performed laser therapy.

Material and methods: Fractional CO2 laser therapy of hypertrophic scars is performed at the Department of Plastic and Esthetic Surgery, University Hospital Olomouc, since 2017 and the systematic study took place in 2019-2020. In common, 25 hypertrophic scars were treated in 13 patients; each scar was treated by fractional CO2 laser therapy more than once.

Results: Statistical analysis detected statistically significant improvement of the texture of the scars and the improvement of overall functional and esthetic result. We found significant reduction of the height under 2 mm (62,5% of scars) in scars with the height > 2 mm before the initiation of laser therapy. Correlation analysis detected a statistically significant positive correlation between the energy of laser beam and the reduction volume of the scar protruding above the niveau of healthy surrounding tissue. Fractional CO2 laser therapy showed statistically significant efficacy in the reduction of the risks associated with full-format CO2 laser-therapy. Fractional treatment was very well tolerated by the patients. Topical 5% lidocaine gel was effective in 24 out of 25 patients. Further healing was without complications in all patients.

Conclusion: Fractional CO2 laser therapy has achieved statistically significant improvement of the texture and reduction of hypertrophic scars and overall improvement of functional and esthetic result in our study.