A short report describing the unique experience of visiting the famous Brooke Army Medical Center (BAMC) in San Antonio, Texas, USA and its Burn Center and Plastic Surgery Department in the period between June 27 and August 26, 2016. Read More
Care for burn patients is defined in most developed countries as an independent multidisciplinary specialty (burn medicine) and it is concentrated to specialized units, which are sufficiently staffed with appropriate space area and equipment. Since the 50s of the previous century in the former Czechoslovakia, there were five such units, three of which were in the Czech Republic (Prague, Ostrava, Brno). The specialty successfully developed and achieved prestige also abroad, mainly due to uninterrupted contacts with the foreign units. Read More
Introduction: Microneedling (percutaneous collagen induction therapy) is a new promising miniinvasive therapeutic method for the treatment of skin alterations of different aetiology, including burn scars. Since 2016, it is also available at our department. The microtraumatization of scars with the Dermaroller® leads to an activation of the healing cascade, activation of growth factors, which activate cell proliferation in the wound, increased synthesis and deposit of collagen - elastin complex with successive transformation of collagen III to collagen I, to neoangiogenesis and thus to accelerated scar remodelling. Read More
Goal: Determination of basic epidemiological parameters of burn patients with micromycetes infection. Identification of the most important micromycetes in burn patients.
Material And Methods: Monocentre retrospective study enrolling all adult burn patients who were hospitalized between 2007 and 2015 and in whom micromycetes were isolated during hospitalization. Read More
Introduction: Integra® dermal replacement has a wide spectrum of use both in burn medicine as well as in reconstructive plastic surgery and traumatology. Since 2002, it has been a part of surgical treatment of patients at Prague Burns Centre of the Královské Vinohrady Teaching Hospital.
Study Group: Integra® was used in 47 patients in total between years 2002 and 2016. Read More
Introduction: Chemical necrectomy of deep burns using 40% benzoic acid has been used extensively by the Department of Burns and Reconstructive Surgery at the University Hospital since its establishment in 1982. In spite of definite advantages for the patient and medical staff, hard data concerning benzoic acid absorption through skin necrosis and patient safety was missing.
Material And Methods: We examined 22 burn patients in collaboration with the University Hospital Brno, Department of Clinical Biochemistry. Read More
Background: Early necrectomy and skin autotransplantation are prerequisites for successful treatment of extensive burns. Insufficient autograft donor site availability is a limiting factor. The Meek micrografting technique, published by C. Read More
The reconstruction of complex craniofacial and orbital defects should satisfactorily restore functional and aesthetic integrity. Autologous reconstruction of nasal, periorbital and auricular facial subunits as a whole using a locoregional or a free flap is very challenging and the results are not sometimes ideal. With advanced technologies that are currently available it is possible to plan and produce authentic facial prosthesis that can satisfactory substitute these facial subunits. Read More
A variety of surgical techniques has been used to correct hypoplastic breast malformations and deformities, including tissue expanders, breast implants, custom chest wall implants, mammary gland remodelling, as well as locoregional or free flap. Case series of successful breast reconstruction using lipomodelling technique in one patient with severe Polands syndrome and two patients with tuberous breasts are reported together with literature review. No surgical complications were observed and ultrasound examination did not reveal any pathology in breast tissue other than oil pseudocysts postoperatively. Read More
Background: The preoperative perforator mapping is an important step in autologous breast reconstruction, making the flap raising safer, more predictable and time-saving. Although the Doppler exam has proven to be less accurate in locating perforators compared with colour duplex sonography and CTA, it will probably remain of importance in clinical practice. The aim of this paper is to share some advices on how to perform a Doppler exam in preoperative evaluation of a DIEAp flap, increasing its reliability in location of the perforators. Read More
In case of an upper eyelid injury with loss of tissue, it is very important to perform reconstruction to restore protection of the cornea and bulbus. Depending on the size and location of the defect the most suitable reconstructive technique is chosen. This case report presents a patient with a partial loss of the upper eyelid. Read More
Onychomatricoma is a rare benign fibroepithelial tumour that originates from the nail matrix and can affect the nail bed of fingers and toes. Onychomatricoma may represent a premalignant lesion and although the etiology is still not fully understood, a previous finger trauma is considered the main predisposing factor. Unlike previous scientific articles we report a case of a "non traumatic" onychomatricoma in a 60 years old woman underlining the clinical and histological features to distinguish this uncommon lesion from other lesions originating from the nail apparatus. Read More
Post-traumatic deformity of frontal sinus anterior table can be treated in various ways. Usage of a certain type of an implant is a common method. We performed an osteotomy and subsequent reduction of the fragments to reconstruct their anatomical position. Read More
Pulmonary embolism is a potentially lethal complication in plastic surgery patients. About 34% of the members of American Society of Plastic Surgery have diagnosed pulmonary embolism in their patients, and 7% had experienced at least 1 death due to this complication. The American Society of Plastic Surgeons Executive Committee approved the Venous Thromboembolism Task Force Report. Read More
Non-malignant and malignant obstruction of the tracheal airway causes significant morbidity and mortality. With increased use of artificial airways, benign and iatrogenic complications are increasing. A tracheal stenosis that is less than 5 cm in length can be resected with end-to-end anastomosis. Read More
Transplantation in reconstructive surgery has been performed for more than 20 years, although the official beginning of these procedures is considered the first successful transplantation of the hand in 1998. The original name "Composite Tissue Transplantation" has been used less frequently; more common is the term "Vascularized Composite Allotransplant", which better describes the basis of the procedure. There have been so far approximately 180 transplantations performed, the exact number is difficult to find. Read More
Background: The treatment of breast cancer has developed a lot during the last decade, nevertheless it still remains a considerable social and economical problem all over the world. The choice of the surgical procedure depends on a patients protocol and the surgeons preferences. The aim of this study is to evaluate the stress on the scar after breast reconstruction. Read More
Background: The authors present their experience with endoscopy assisted open reduction and internal fixation of condylar fractures of the mandible. Their results are presented in a retrospective study of 33 patients with unilateral subcondylar fracture, who underwent a surgical procedure between 2010 and 2015. Reduction and fixation, stability of occlusion 12 months after the operation and also presence of complications were evaluated. Read More
Osseous reconstruction of the thumb following traumatic bone loss can be approached through a variety of techniques. The use of a silicone spacer with secondary bone grafting is a valid therapeutic option. In case of combined injuries, simultaneous immediate reconstruction of missing soft tissues over the spacer by well-vascularised skin cover is essential. Read More
The deep inferior epigastric artery perforator (DIEAp) flap is becoming a widely used method of autologous breast reconstruction. Despite the huge use of the DIEAp flap in reconstructive field, an evidenced based approach in perforator selection has not yet been developed. Unfortunately there is no clear evidence about the relation between the number and dimension of the perforator vessel and the prediction of flap survival in a living model. Read More
Non-compliance with the production process and use of non-certified materials du- ring production of PIP implants opened an extensive debate regarding regulation and control mechanisms during their production, but the question of health safety of breast implants in general was also reopened. Production of breast implants is subject to various control mechanisms in each country and it is necessary to unify and coordinate such mechanisms. PIP implants were on the market for more than 15 years and in this period the production process and used materials were being changed purposely and without control, which resulted in production of implants with poor quality capsule filled with non-certified silicon gel. Read More
Background: Replantation is a complicated procedure in avulsion injuries in majority of the cases. When replantation of an avulsed thumb is not feasible, it is mandatory to find an appropriate reconstruction choice as soon as possible due to the importance of the thumb function in the dynamics of the handgrip.
Materials And Methods: Three patients with skin avulsion injury underwent immediate reconstruction by twisted lateral arm flap in our department since 2004. Read More
The rat's femoral artery is definitely the most frequently used model in microsurgical training for its easy dissection. Our model, consisting in the creation of several anastomoses in a row, helps the novice surgeon to assess his microsurgical level and to improve his capacity. Indeed, this leads to an amplification of the trainee surgeon's mistakes, which add up to each other as the anastomoses are performed. Read More
Background: The effect of magnesium sulphate on mechanically provoked vasospasm of the flap pedicle on porcine model was not studied yet. Positive effect of magnesium sulphate on vasospasm was proved in previous studies on rat.
Methods: The bilateral pedicled flaps based on the caudal superficial epigastric arteries were raised on 8 pigs. Read More
Replantation of amputated fingertip is a technical challenge to the microsurgeons. The success rate depends directly on the availability and the size of preserved vessels and on the degree of their damage. In distal digital amputations, veins are usually not easily recovered or even absent, and thus high number of replantation procedures fails because of the venous congestion. Read More
The authors present a case report of a patient with anophthalmia in whom retroauriculo-temporal flap (Washio flap) was used for reconstruction of eyelids. This flap, which is mostly used for reconstructions of nasal defects, was not used in this way according to available literature. Read More
Breast implants are medical devices used for augmentation of the breast, to reconstruct the breast after mastectomy and to correct breast asymmetry. The breast prostheses are likely the most frequently used medical implants. The evolution of modern silicone breast implants was not straightforward and is characterised with a lot of medical, forensic and public attention. Read More
Background: An experimental model for testing vasodilating drugs on vasospasm caused by standardized traumatisation of a pedicle has not been described yet. The aim of this study was to develop such model and to compare the effects of different types of surgical manipulations that can provoke vasospasm during flap dissection.
Material And Methods: The pedicled groin flap was dissected in 185 male Wistar rats under standardised conditions. Read More
Closure of a nasal tip defect has specific characteristics with regards to the shape, colour, thickness and texture of skin. During the reconstruction it is necessary to observe aesthetic and functional characteristics to achieve an optimal result. There are several methods for closure of a defect in this area. Read More
Background: The aim of this paper is to ascertain the number of patients with a burn injury sustained during an epileptic seizure treated in our facility, to identify the characteristics of these types of injuries and to suggest preventive measures, which could reduce the frequency and morbidity of such injuries.
Patients And Methods: We performed a retrospective study, identifying all patients admitted with burns sustained during an epileptic seizure within a period of six years.
Results: Totally 7 women with an average age of 45 years were enrolled in this retrospective study. Read More
Background: Nasal tip is one of the most frequent areas affected by basocellular carcinoma. The treatment must avoid any postsurgical deformity, as the nasal tip is the main part of the facial triangle. Most of these patients are elderly and polymorbid. Read More
Based on long-term experiences, the authors consider lipomodelling to be a major advance in plastic, reconstructive and aesthetic surgery of the breast. The technique is now well established and the complication rate is very low. The risk of focal fat necrosis is around 3%. Read More
Background: Complications resulting from enlargement of the penis by applications of unknown types of silicone and mineral oils are well described. Surgical removal of the tissue altered by inflammation leads to the development of defects of various sizes, often circular from the glans penis to the scrotum. The options of subsequent surgical treatment described in literature are not very extensive. Read More
Macrodystrophia lipomatosa (MDL) is a rare, congenital, developmental anomaly causing localized overgrowth of a digit(s) or extremity. Trigger wrist is a relatively rare entity, which may be caused by a mass originating from a tendon, an anomalous muscle or intracarpal pathologies. A 42-year-old male patient presented with triggering during active motion of the fingers and intractable pain and numbness in fingers to our emergency department. Read More
The authors present their experience in treating 23 fingers on 20 patients affected by Dupuytrens Disease in stages III and IV of the Tubiana classification with their personal technique that involves the percutaneous needle fasciotomy followed 40 days after by a selective open aponeurectomy on the previously treated cord, by making a small cutaneous incision. The treatment requires careful selection of the patients. In fact, patients suffering from the disease for more than 5 years and all the cases with a suspicion of joint rigidity are excluded from the study. Read More
Background: The rhinophyma is an important soft-tissue hypertrophy of the nose. In literature a wide range of surgical approaches to rhinophyma has been described such as dermoabrasion, scalpel shave, cryosurgery, electrocautery, near total excision with skin grafting, and laser excision.
Patients And Methods: The authors describe their experience with CO(2) ultrapulsed laser in 14 elderly male patients, using their personal approach, the Downward steps technique. Read More
Objective: To evaluate the incidence, therapy results and complications of operatively treated congenital disorders of the hand in a large state hospital during a 14-year period.
Method: The institutional database was retrospectively analysed for patients with congenital disorders of the hand during a 14-year period (1998-2012). Disorders were classified according to the modified Swanson classification. Read More
Background: The flap selection criteria in lower extremity reconstruction are based on the wound characteristics and donor site morbidity. We hypothesized that the decision-making could be influenced by integrating Duplex Ultrasound (DU) in the preoperative design.
Methods: We retrospectively reviewed data on patients who underwent lower-extremity microvascular soft-tissue reconstruction at our institution by the same surgeon. Read More
We report on a 9-year-old girl who sustained an injury to her left middle finger with a piece of metal 2 months before she presented to our clinic. In the acute trauma phase she applied ice to her hand and did not consult a medical practitioner about the pain and swelling on her finger. Two months after the injury she came to us with a palpable mass on the volar side of middle phalanx. Read More
Amputation of an ear is a rare injury. Subsequent replantation is a challenging and very difficult task for an experienced micro-surgeon. Every well described successful replantation of an ear is a valuable lesson for a micro-surgeon mainly because securing the venous drainage of the replanted ear is very difficult. Read More