ABSTRACT
Microsurgical reconstruction is currently considered a method of choice for the repair of soft tissue or bony defects in head and neck surgery. This technical note presents the use of a reverse flow technique in mandibular reconstruction with two segments of fibula free flap in a patient with bilateral pseudoarthrosis. In the standard procedure, both segments of the fibula are supplied by one donor vascular pedicle with normal antegrade blood flow. The approach presented here employs reverse flow in the distal segment of the fibula using a venous graft to create two vascular independent free fibula segments. Reverse flow in mandibular reconstruction represents an alternative option to support the success of microsurgical procedures in indicated cases.
Subject(s)
Free Tissue Flaps , Mandibular Reconstruction , Humans , Free Tissue Flaps/blood supply , Mandibular Reconstruction/methods , Fibula/transplantation , Microsurgery , Mandible/surgeryABSTRACT
Pressure ulcers (PUs), also known as pressure injuries, are chronic wounds that represent potential lifelong complications. Pressure ulcers of a deep category (III and IV) are often indicated for surgical treatment - debridement and surgical reconstruction. Sharp surgical debridement is widely used in the debridement of PUs; however, the Versajet® hydrosurgery system is becoming an increasingly popular tool for tangential excision in surgery due to its numerous advantages. This work focused on the expression of selected genes, especially those associated with oxidative stress, in PUs debrided by two approaches - sharp surgical debridement and debridement using Versajet® hydrosurgery system. Expression of following genes was evaluated: NFE2L2, ACTA2, NFKB1, VEGFA, MKI67, HMOX1, HMOX2, HIF1A, and SOD2. ACTB and PSMB were used as housekeeping genes. So far, five patients have been enrolled in the study. Preliminary results suggest no significant difference in gene expression with different pressure ulcer treatment approaches except NFE2L2, despite the macroscopic differences. However, the results revealed correlations between the expression of some genes, namely HIF1A and SOD2, VEGFA and SOD2 and VEGFA and HIF1A. These results may indicate a connection between hypoxia, oxidative stress, pressure ulcer healing processes and angiogenesis.
Subject(s)
Pressure Ulcer , Wound Healing , Humans , Wound Healing/genetics , Debridement/methods , Pressure Ulcer/genetics , Pressure Ulcer/surgery , Pilot Projects , Treatment Outcome , Gene Expression , SuppurationABSTRACT
Third degree burn trauma of the head and neck requires an interdisciplinary approach. After emergency care and hemodynamic stabilization of the patient the focus lies on the reconstruction of the damaged tissue. The options of reconstruction are influenced by the general condition of the patient and by the condition of the surrounding tissues. The deep defects of the head are dangerous for a high risk of wound infection and possible fatal complications. In particular cases the first methods of choice for closure of the defect may be ineffective and a free flap transfer should be considered. We present a case report of a 62-year-old woman who suffered third degree burn trauma of the head and neck leading to a deep defect of the forehead reaching behind the hairline. On the bottom there was an exposed bone with no healing tendency. Due to surrounding fragile scarred tissue we chose a free flap transfer using serratus anterior muscle as a method of closure. The flap was fully healed and provided good aesthetic and functional outcome.
Subject(s)
Burns/surgery , Facial Injuries/surgery , Free Tissue Flaps , Neck Injuries/surgery , Plastic Surgery Procedures/methods , Burns/complications , Facial Injuries/etiology , Female , Forehead/injuries , Forehead/surgery , Humans , Middle Aged , Neck Injuries/etiology , Treatment OutcomeABSTRACT
Electrical burns are not ranked among the most frequent type of injuries, but they have the most devastating potential of all thermal injuries and often cause lifelong stigmatization. Those primarily affected are young males: work injuries predominate. An electrical burn is a specific nosological unit that has multiple acute and chronic abnormal manifestations. In this study we describe the case of a young man who suffered an electrical injury after contact with a high-voltage line (22,000 volts) while paragliding. This contact was followed by a 10 m fall. In our work we present the need for multidisciplinary cooperation along with the opportunities, problems and risks that accompany the treatment of this type of injury.
