Anatomical Prediction for Surgical Positioning of the Umbilicus in a Croatian Population.

AIM: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. METHODS: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body mass (BM), body height (BH), BMI, WC and HC, and waist-hip ratios (WHR). All collected data were subjected to standard statistical analyses. RESULTS: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM × 0.5799 + BH × -0.5051 + BMI × -1.8230 + WHR × -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age × 0.2033 + BM × 0.6445 + BH × -0.5692 + BMI × -2.2802 + WC × -0.0911 + 101.9408. METHODS: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected.

Possible target for preventing fibrotic scar formation following acute myocardial infarction.

Bone morphogenetic protein 1 (BMP1) was originally isolated from bone with other BMPs due to its affinity for heparin. While all other BMPs are members of the Transforming Growth Factor ß (TGFß) superfamily of growth factors, BMP1 is not an authentic member of the BMP protein family. Together with mammalian Tolloid Like protein 1 (mTLL-1) and mTLL-2, BMP1 comprise a small group of zinc- and calcium-dependent proteinases. Acute myocardial infarction (AMI) is the leading cause of death in developed countries which accounts for 13% of deaths worldwide. It was recently shown that inhibition of BMP1-3 reduces progression of fibrosis in chronic kidney disease and suggested that BMP1-3 is an important molecule for fibrogenesis. We hypothesize that inhibition of BMP1-3 represents future of therapeutic interventions in the heart tissue fibrosis following AMI. This novel approach aims to acquire the first candidate specific treatment for recuperating the heart function in patients with AMI.

Reconstruction of a soft tissue defect of the back after myelomeningocele closure with modified V-Y plasty.

Myelomeningocele is a congenital defect in vertebral arches with cystic dilatation of meninges and structural or functional abnormality of spinal cord or cauda equina. It is a form of spinal dysraphisam with overlying skin defect (spina bifida aperta). That condition is related to other clinical complications such as infection that can produce furthermore complications. To prevent rate of complications surgical treatment in first 24 h is strongly suggested. In this case report we describe a patient (infant) with congenital myelomeningocele who's defect was treated surgically by the neurosurgeon. In operative procedure plastic surgeon was involved to cover the skin defect remaining after neurosurgical closure of spinal canal. Bilateral advancement local skin flaps were used in soft tissue defect closure. Review of the literature that refers to advancement local skin flaps was carried out.

Endoscopically assisted latissimus dorsi flap harvesting and breast reconstruction in young female with Poland syndrome.

We will describe a second phase of breast reconstruction on a young girl suffering from Poland syndrome. She has the breast, pectoralis major and minor muscle aplasia on the right side. She has no other deformities. The best result is achieved by combining latissimus dorsi flap and a silicone implant, and even better aesthetic result is accomplished with endoscopically assisted latissimus dorsi harvesting. Purpose of this operation is to correct the chest asymmetry and to accomplish good aesthetic result.

Combined vacuum-assisted closure treatment with laparoscopic mobilization of an omental flap and meshed skin grafts for reconstruction of infected sternotomy wounds: two cases.

In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thickens skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds.