Showing papers in "Acta chirurgiae plasticae in 1998"

Environmental pollution and the occurrence of congenital defects in a 15-year period in a south moravian district

Abstract: We have made a simple 15-year retrospective epidemiological study of a part of South Moravia, district Breclav, on the basis of genetic documentation of 245 congenital defects and 28 spontaneous abortions. The whole area was worked up by computer-geographical methods, and the occurrence of congenital defects was compared both in areas of severe chronic air pollution and in less contamined areas. There were three municipal areas, Mikulov, Breclav-Postorna, Velke Bilovice and their surroundings, in which an increased number of congenital defects was recorded. In the municipal area of Breclav-Postorna there was also a greater occurrence of organic solvents and phosphoric acid and a significantly higher occurrence of spontaneous abortions and at the same time a higher occurrence of heart defects.

Prophylactic antibiotics administration head and neck cancer surgery with major flap reconstruction: 1-day cefoperazone versus 5-day cefotaxime.

Abstract: Patients who undergo surgery of the head and neck cancer with major flap reconstruction, benefit from perioperative antibiotic prophylaxis. Head and neck surgery, especially ablative cancer surgery with major flap reconstruction is potentially contaminated iatrogenic wound, and the use of preoperative, perioperative and post operative chemoprophylaxis for infection is mandatory. This study is being done to determine if shorter course of antibiotic administration (Cefoperazone) would be more effective than conventional 5-day antibiotic administration (Cefotaxime). Patients who are identified as requiring major flap reconstruction after extensive ablative surgery for head and neck cancer, are considered as potential candidates for this study. The choice of ideal antibiotics and duration period are still under discussion. Patients were assigned randomly to receive Cefoperazone sodium for either 24 hr. (study group) or Cefotaxime sodium for 120 hr. (control group). A total of fifty patients were studied. The incidence of wound infection, flap death and major complications are evaluated. Out of the fifty patients studied, twenty-eight were assigned to 1-day prophylaxis. Incidence of failure of prophylaxis (F. P.) was 7.1% in this group. Twenty-two patients were assigned to 5-day prophylaxis, in whom F. P. rate was 9.8%. This study suggests that, there is no beneficial effect from administration of antibiotics for more than 24 hr. postoperatively in patients two undergo major flap reconstruction for head and neck cancer after extensive radical ablation surgery.

The tissue adhesive indermil and its use in surgery.

Abstract: Indermil, in relation to the tissue adhesives described remains the state of the art with regard to function and clinical outcome. The advantage of an inventory sterile tissue adhesive that is to say one that is in the clinic or operating theatre ready for immediate use on demand is the requirement of modern surgical practice. Cost factors are also an important consideration in today's environment. A research study by the Department of Health Economics at the University of York found the cost of the Indermil tissue adhesive system equivalent to absorbable sutures and produced projected savings per patient in relation to conventional sutures with respect to theatre time and return patients' visits (6). In parallel a survey of patients showed 90% would prefer wound closure by an adhesive in relation to traditional sutures. There are few areas of surgical practice which cannot find some application for tissue adhesives. The growing international interest in adhesives and their application would confirm their importance and potential in surgery.

Our experience with the use of cerium sulphadiazine in the treatment of extensive burns.

Abstract: The development of the burn disease with infection as the most important complication represents still a major problem in burn patients. With the introduction of the method of early surgical excision of the Af1p4r with immediate grafting in major burns, improved survival has been achieved, particularly in children. However, especially in adults, early massive excisions did not prove to be of much benefit for survival. In these cases, more-or-less sequential staged excisional procedures have been introduced by many renown burn surgeons. In 1976 Monafo et al. presented the cerium nitrate-silver sulphadiazine cream (CSD) combination for topical therapy. The addition of 2.2% of the rare earth metal cerium salt to silversulphadiazine causes the formation of a relatively hard, yellow, leather-like eschar with excellent resistance to infection and good long-term adherence to the burn wound. This allows the surgeon to perform late tangential excision and immediate autografting thus decreasing the open wound size and the rate of severe infections originating in the burn wound itself. We report our experience with the treatment of 20 patients with deep burns exceeding 20% of the BSA with cerium nitrate-silver sulphadiazine cream compared with a similar group of burn patients treated by silver sulphadiazine cream alone. CSD proved to be safe and effective in the treatment of deep and extensive burns. Its advantages include easy and painless application and removal, turning the necrotic skin to yellow, and a leathery crust with good resistance to infection, thus enabling later, or staged, sequential excisions in cases where early massive excisions are not possible.

Primary reconstruction of mandible in head and neck cancer with silastic implant : a review of 69 cases

Abstract: Different methods of primary mandibular reconstruction carried out at the Tata Memorial Cancer Hospital range from the pectoralis major myocutaneous or osteomyocutaneous composite flap, which is the most frequently performed procedure, to a free vascularised composite tissue transfer with microvascular anastomosis, including, iliac crest free vascularised bone grafts or radial artery forearm flap free vascularised radius bone grafts, free vascularised fibular bone grafts and silastic mandibular implants. The clinical results of immediate mandibular reconstruction with a silastic mandibular implant (SMI) in 69 patients is presented. Out of the 69 cases, 2 patients died in the early post-operative period. Twenty (30%) SMI were retained for a period of 1 year to 5 years. Forty seven (70%) SMI were retained for a period of less than 1 year. These implants have been used in a variety of cases, with or without major flap reconstruction, where a skeletal support was indicated, especially after mandibular arch resection. The results of this series indicates the importance of these implants as a short term spacer, even in advanced, fungating lesions of head and neck cancer where the risk of infection, haematoma and salivary leak is very high. Bone replacements were undertaken at a later date in suitable cases. The effects of preoperative chemotherapy and radiotherapy on the retention of these implants has also been studied.

Bacteriological monitoring in the Prague Burns Center.

Abstract: The microbiological aspect of the prevention of nosocomial infections at the Burn Center consists primarily in the surveillance of bacterial flora and its antibiotical resistance. The Prague Burn Center is regularly monitoring the microbial flora. Patients are examined not only by the conventional methods of taking swabs of burned sites, but also by printing method, which allows a semiquantitative assessment of the colonization of burned areas. Simultaneously, investigation of bacterial contamination in the external environment of the department is carried out and the colonization of nursing staff is investigated. In all isolated strains the sensitivity to antibiotics is examined; this is significant from the point of view of current knowledge about therapeutic possibilities and for the antibiotic policy. The typing of bacterial strains makes possible to determine their epidemiological markers, and thus to investigate their spread within the department. The most frequent isolate is S. aureus and the prevalence of MRSA is relatively high. Among gramnegative rods the strains of P. aeruginosa, K. pneumoniae and E. cloacae are most often isolated. Various typing methods revealed endemic spread of particular strains of rarely isolated species (E. agglomerans, S. marcescens, A. baumannii, etc.).

Craniofacial abnormalities in sleep apnoea syndrome.

Abstract: One hundred and four men with the suspected diagnosis of sleep apnoea syndrome (SAS) not suffering from neuromuscular diseases or acromegaly were examined by X-ray cephalometry. Subjects suffering from bronchial obstruction, laryngeal carcinoma, suspected Treacher Collins syndrome as well as subjects in whom SAS was not verified were excluded. The remaining 81 men were divided into two groups depending upon disease severity as expressed by the mean index of oxygen desaturations per hour (less than 30-group A; more than 30-group B). In group B, the following parameters were significantly altered as compared with group A: dorsocaudal rotation of the mandible, elongation of the soft palate, and an increase of the saddle angle, increase of the angle of the cranial base, the lower gonion angle and the angle of the inclination of the mandible. Differences in the size of the soft palate, the rotation of the mandible and the size of the lower gonion angle can be found not only between healthy and subjects with SAS but also between subjects with mild and severe apnoea.

Some thoughts and observations concerning the prevention of neuroma.

Abstract: Reliable prevention of neuroma is a problem the solution of which is still outstanding. Compared to earlier methods, which mostly consisted in attempts to stop axonal proliferation abruptly, it is now coming to be generally accepted that the regenerative potential of the axons needs to be reduced gradually. The methods most in accord with this view--centro-central anastomosis and capping of nerve ends with a nerve or vein graft--are considered, adding personal observations. A new variant that has shown special promise in animal experiments involves using a nerve and a vein graft in combination. The method still requires clinical verification.

Mortality in pediatric burns in the Prague Burns Centre (1994-1997).

Abstract: The authors evaluate the mortality of severely burned children hospitalized in the Intensive Care Unit, Prague Burns Centre from 1994 till 1997. There were hospitalized 345 children (aged 3 months-15 years, 1%-88% TBSA, mixed superficial and deep burns). No child died from burn shock during the early postburn period. Five children who died suffered deep burns greater than 50% of TBSA and at necropsy there were identified signs of multiple organ system failure which was related to infection. Language: en

Body structure of female-to-male transsexuals.

Abstract: 31 female-to-male transsexuals treated in the Department of Plastic Surgery, Medical University of Lodź, were examined. Anthropometric measurements were carried out according to Martin's technique. 23 measured characteristics of the examined transsexuals were studied; they were compared with identical characteristics in males and females of the control group. The results indicate that the somatic characteristics in transsexual women are between the values typical for man and women.

Penile replantation--a case report.

Abstract: The authors submit a successful case of penile replantation. They discuss the course of the procedure and document the immediate and long-term result of this procedure.

Reconstruction of paralyzed biceps brachii muscle by transposition of pedicled latissimus dorsi muscle: report of two cases.

Abstract: The biceps brachii muscle was reconstructed in two patients with inveterate injuries of the brachial plexus. The latissimus dorsi muscle was transferred on the thoracodorsal neurovascular bundle into the regio brachii anterior and sutured to the long head of the m. biceps brachii. The distal part of the latissimus dorsi muscle was sutured above the tuberositas radii along with the insertion tendon of the biceps brachii muscle. Both patients achieved very satisfactory restoration of flexion in the elbow joint 12 and 16 months after surgery.

Surgical treatment of ankyloses of the temporomandibular joint in children.

Abstract: Ankylosis of the temporomandibular joint leads in children to serious disorders such as loss of dentition, growth retardation of the lower jaw, facial asymmetry etc. During the period from 1993 till 1997 we treated 12 children incl. eight who had unilateral and four bilateral ankylosis. In six patients, after elimination of the ankylosis, reconstruction of the head was made with a total of nine costochondral grafts. In entire all patients the temporal muscle or a silicone plate was interposed between the skull base and mandible. Postoperative complications were minimal. Surgical treatment, which is only half of the issue of treatment, must be followed by long-term careful rehabilitation. The results which were achieved contributed in a significant way to a more favourable further development of the children.

A further application of buried chip skin grafting.

Abstract: Buried chip skin grafting used to close a granulation wound, that cannot be kept at rest, or else is in some way irritated, is described. This requires an extremely small amount of skin. Although it takes a month to heal, irritation or contamination of the grafted area does not affect or have any influence on the take of graft survival. Therefore, the patient need not be kept at rest after surgery, and can continue with daily living or rehabilitation exercises.

Inveterate lesions of the collateral ligaments of the thumb joints.

Abstract: Inveterate lesions 2-18 months following injury to the collateral ligaments of the metacarpophalangeal (MP) joint of the thumb and pollicised proximal interphalangeal (PIP) joint were replaced by a tendinous transplant from the palmaris longus muscle. The group comprised three patients, 34-46 years old, with a post-traumatic injury of the ulnar collateral ligament of the MP joint of the thumb and a seven-year-old child with an congenital defect of the radial collateral ligament. Lateral 30-degree instability indicates injury of the collateral ligament. On examination the range of instability in the investigated group was between 45 and 90 degrees. The authors recommend comparison with the contralateral thumb.

Roentgencephalometric analysis of the skulls of the Luxemburgs, the second Bohemian Royal Dynasty.

Abstract: X-ray films of the skull of the king and emperor Charles IV and his four wives and two sons were made under standard conditions with the mandibles fixed in a centric occlusion. The results of roentgenocephalometric analysis were compared with norms valid for the contemporary Czech population. Consistent with the somatic condition of Charles IV, the findings indicate an above-average large face with the usual anteriorotational developmental type. The facial skeleton is structurally harmonious, but the sagittal intermaxillary relations belong into skeletal class II with a relatively retruded lower jaw in relation to the upper one. This is associated with a greater maxillary overjet of the upper incisors. The disharmony was caused by a fracture of the mandibular condyles. Reconstruction of the condition before the injury revealed an originally normal anteroposterior relationship of the jaws (skeletal class I) and occlusion of the incisors. As to the shape of the cranium, Charles IV's wives differ in basic features. In two, for different reasons, we find skeletal class II (retrogenia), in one skeletal class III (progenia) and only in Elizabeth of Pomerania, with marked flattening of the cranial base and posteriorotation of the face are the anteroposterior relations of the two jaws normal (skeletal class I). Wenceslas IV differs from his parents Charles IV and Anne of Svidnic by a flat cranial base which pushes the lower jaw backwards, however, it does not cause its posteriorotation; we find, similarly as in the father and mother, an anteriorotational growth type of the face. In the other basic parameters of the cranium there are no marked differences between son and parents. In evaluating the similarity of the facial structure of John of Gorlitz to that of his parents, disagreement is caused by the flat cranial base of the mother Elizabeth of Pomerania associated with posteriorotation of the face. In the son we find, conversely, an even more marked anteriorotation than in the father and also other parameters of the facial configuration indicating plausible agreement with the findings in Charles IV. The curving of the cranial base has an impact on the shape of the whole cranium, but the results indicate that the heritability of the rotational growth type of face and the degree of cranial base curvature probably is not very marked.

Congenital contracture of the superficial flexor of the hand.

Abstract: The authors describe a case of an inborn contracture of the superficial flexors of the three-phalangeal fingers in a 15-year-old girl and treatment of the condition. For clinical purposes a classification on congenital deformities in the proximal part of the flexor complex was proposed in which the described case is included. The classification was derived from the ontogenetic development of flexor tendons. There are three types of deformities: S1--the muscular belly of the superficial flexor of the fingers is only in the palm; S2--the muscle is attached to the area between the wrist and medial epicondyle; S3--the palmaris longus of the fingers is on the medial epicondyle, however the m. palmaris longus is lacking; Pl-1 the superficial flexor exists only in the form of a proximal muscular belly of varying length; Pl-2--the palmaris longus is on the wrist and the insertion tendon may be thinner than on the contralateral side. The described contracture deformity was classified as type S2.

Is there a borderline between reconstructive and aesthetic surgery

Abstract: Plastic and reconstructive surgery is frequently mistaken for aesthetic and cosmetic surgery. At present, plastic surgery is a very broad discipline in which aesthetic surgery is an integral part. The majority of reconstructive operations, in particular on the body surface, include an aesthetic component. Their purpose is not only the restoration of function but also the achievement of optimal aesthetic results. The authors demonstrate examples on the vague borderline between functional and aesthetic reconstruction and present their views on the medical indication for these operations.

Combined application of alpha-tocopherol and fc- 43 perfluorocarbon emulsion supresses early postburn lipid peroxidation and improves deformability of erythrocytes

Abstract: The effect of FC-43 perfluorocarbon emulsion and alpha-tocopherol on lipid peroxidative damage and deformability of erythrocytes was evaluated in rats (full skin thickness burns over 15-20% of total body surface) at third hour after burns. The animals were divided into five groups: (1) non-burnt non-treated (controls); (2) burnt non-treated; (3) burnt but treated with alpha-tocopherol ("Serva", Germany, 20 mg/kg b.m. i.p.) (4) burnt treated with FC-43 emulsion ("Green Cross Corp.," Japan, 5 ml/kg, i.v.); (5) burnt treated with combination of alpha-tocopherol (20 mg/kg) and FC-43 perfluorocarbon emulsion (5 ml/kg). In the burnt non-treated group the concentration of alpha-tocopherol decreased by 38% (p < 0.05), the levels of malonyl dialdehyde (MDA) and fluorescent damaged products raised by 32% (p < 0.001) and by 52% (p < 0.001) of the controls, respectively, whereas the deformability of red blood cells diminished by 34% (p < 0.001). Both the accumulation of MDA and fluorescent lipid peroxidation products and the decrease in deformability of affected cells were suppressed significantly by alpha-tocopherol treatment which also prevented the decrease in erythrocyte alpha-tocopherol content. FC-43 emulsion lowered the level of MDA but did not restrain the reduction in erythrocyte deformability significantly. The combined application of alpha-tocopherol and FC-43 emulsion immediately after thermal skin injury decreases peroxidative membrane damage and improved erythrocyte deformability more significantly than alpha-tocopherol at the third hour after thermal skin injury.