[The value of radial shock wave therapy in the management of extended crural ulceration. Case report]. / A radiális lökéshullám-kezelés szerepe a nagyméretu ulcus cruris gyógyításában.

The authors present the history of a 36-year-old woman who had crural ulceration in the ventral side of the left lower limb due to venous circulatory failure for 5 years. In addition to the application of dressing adapted to the actual status of the wound, the authors applied an extracorporal shock wave therapy two times per week. After this treatment the size of the ulcer significantly decreased and it became suitable for mesh-graft cover. The patient is currently asymptomatic. The authors draw attention to the fact that the number of patients having crural ulcer is increasing in developed countries including Hungary. Lower limb ulcers occur in 1-5% of the adult population. Predisposing factors include older age and civilization hazards such as obesity, diabetes and sedentary lifestyle. The main cause of the disease is circulatory failure; venous insufficiency occurs in about two-thirds of the patients, arterial ischemia in 15% and diabetic angiopathy in 15% of the cases. Infections, metabolic diseases and immunological disorders may be also an underlying cause in a small number of patients. In several patients the causative factors occur simultaneously making difficult to find and effective treatment. Despite the use of numerous preventive and therapeutic protocols, treatment is usually long and does not always match expectations of the patients.

[The use of Integra dermal regeneration matrix in the surgical treatment of a recurrent, extensive, malignant skin lesion in the temporal region]. / Integra irharegenerációs mátrix alkalmazása recidív, kiterjedt, halántéktáji bordaganat sebészi kezelésében.

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull.

[The role of Integra dermal regeneration matrix in skin replacement on the upper extremity]. / Integra irharegenerációs mátrix szerepe a felso végtag borhiányainak pótlásában.

Authors report the application of Integra dermal regeneration matrix in 10 patients in 12 indications (ages 25-74 years, 6 female and 4 male patients). The smallest reconstructed area was 6 cm2, the largest was 500 cm2. Skin coverage was needed on the lower arm in two patients, on the lower arm and the hand in two patients and on the hand in six patients. Skin grafting onto the neodermis was made on days 19-25. The take rate of Integra was equal or higher than 97%, and the take rate of the skin graft was equal or higher than 90%. Integra dermal regeneration template proved to be suitable for the management of complex wounds on the hands and upper extremities.

[Use of Integra in a case of extensive upper extremity avulsion]. / Kiterjedt felso végtagi nyúzásos sérülés kezelése Integra mesterséges borrel.

Authors performed successful skin replacement with Integra, a dermal regeneration template, on a patient with circumferential avulsion injury including the elbow region and the dorsum of the hand. The take rate of Integra was 97%, followed by a 98% take rate of the split thickness mesh graft used for final wound coverage. Treatment modality provided excellent aesthetic and functional results, underlining the role of Integra in cases of extensive traumatic skin and soft tissue deficit, such as the treatment of avulsion injury.

[Mandibular reconstruction with free osteocutaneous fibula flap using the occipital artery as recipient vessel]. / Mandibularekonstrukció arteria occipitalisra varrt szabad osteocutan fibulalebennyel.

Authors performed reconstructive surgery for extensive skin and mandibular bone defect following gunshot injury to the left side of the face. The soft tissue and bone defect was reconstructed with the free osteocutaneous fibula flap harvested from the left lower leg, as suitable local reconstructive flap was not available. The bony continuity was reestablished with a 7 cm long fibula segment. Microvascular anastomoses were performed to the left occipital artery and the left internal jugular vein. The occipital artery was chosen as the external carotid system was completely missing on the right side and was missing several branches on the left side due to the trauma. The fibular segment became fully incorporated and 95% of the flap healed by primary intention.

[Posterior circumflex humeral artery perforator flap (PCHAP-flap) in axillary scar release]. / Arteria circumflexa humeri posterior perforátor (PCHAP) lebeny alkalmazása axillaris hegkorrekcióban égési sérülés után.

Scar contracture after burn injury is frequent in the axillary region. If conservative treatment of scars limiting the range of motion of the shoulder joint fails, surgical correction is needed. The authors performed an early reconstruction in a case with unstable scar formation and limited range of motion after burn injury to the axillary region, using the posterior circumflex humeral artery perforator flap. In their opinion, the flap (beside its conventional use as a free flap) may be useful as an island flap in the reconstruction of the axillary region, e. g. for axillary scar release.

[The use of Integra "artificial skin, dermal regeneration template" and the reverse radial forearm fasciocutaneous flap in the primary reconstruction of a septic hand injury]. / Integra "mesterséges bor, irha-újraképzodési minta" és reverz radiális lebeny alkalmazása szeptikus kézsérülés elsodleges rekonstrukciójában.

Reconstruction was performed on the back of a hand following a poorly managed septic hand injury leading to skin and extensor apparatus necrosis using a reverse radial forearm fasciocutaneous flap and a bilayer artificial skin substitute. CASE DEMONSTRATION: Authors report on the first Hungarian case using Integra dermal regeneration template. Integra was placed on the back of the hand on an area left uncovered by the reverse radial forearm fasciocutaneous flap as well as on the flap harvest area. After biointegration of the regeneration template, the outer silicon layer was removed and a split thickness skin graft was applied. CONCLUSION: The take-rate on the donor area was 100% for Integra and 99% for the skin graft, and 90% for both Integra and the skin graft on the back of the hand, providing a good functional and aesthetic result.

[Skin replacement with biological and biosynthetic materials following burn injury]. / Bôrpótlási lehetôségek biológiai és bioszintetikus anyagokkal kiterjedt égési sérülésben.

Autotransplantation is currently regarded as the optimal skin replacement method, sufficient donor site, however, is often not available in extensively burned patients. Intensive research and development of skin replacement products is conducted worldwide in order to decrease the size of the required donor site. Short- and long-term wound coverage is made possible by temporary synthetic and non-synthetic skin substitutes. Autografts and cultured epithelial autografts are used for permanent skin substitution. Until this is possible, the barrier function of the skin is provided by bio-engineered temporary skin substitutes. Some products and methods are currently available in Hungary, while others are still in the introductory phase. In order to provide an overview, authors summarize the skin replacement methods and compare the different skin replacement products used worldwide from the perspective of the burn surgeon. The use of new methods to be introduced in the near future needs to be rationalized due to financial considerations.