Breast implant rupture: A sports trauma report.

OBJECTIVE: Breast augmentation is one of the most commonly performed plastic surgery procedures worldwide. Because of the quality of the implant material, implant rupture may first occur about 10 years after implantation. Ruptured breast implants caused by competitive sport events are rare but should be considered in women athletes as a potential risk factor. The authors report a noteworthy case of this kind. DESIGN: Literature overview and case report. SETTING: Department of Plastic and Obstetrics and Gynaecology 1st faculty of Charls University, Bulovka hospital, Prague. METHODS: Evaluation of the literature and an observational study. CONCLUSION: Breast implant ruptures are generally at high risk in competitive contact sports. We do not recommend the use of breast implants in women competing in contact sports such as boxing.

Hemimandibulectomy and therapeutic neck dissection with radiotherapy in the treatment of oral squamous cell carcinoma involving mandible: a critical review of treatment protocol in the years 1994-2004.

This retrospective non-randomized 10-year follow-up study compared 147 patients with squamous cell carcinoma (SCC) of the oral cavity requiring hemimandibulectomy, treated by surgical resection, therapeutic neck dissection and radiotherapy. The 5-year survival rates were compared related to localization, size of the tumour, infiltration of locoregional lymph nodes, distant metastases, histopathological grading, radicality of surgery, and invasion of tumour into the mandible. Occurrence of tumour relapse and its localization was studied. The mean 5-year survival rate was 26%. Patients with SCC of the mandibular alveolar process had higher rates; the lowest rates occurred in SCC of the buccal mucosa. Survival rate was significantly lower with insufficient resection of the tumour (85% relapse). An important number of patients with radical resection died within 3 months of surgery. In almost 55% of the mandibles tumour was not present. In 5% of infiltrated mandibles, dissemination into inferior alveolar nerve was proven. Decreasing survival rate was seen with increasing size of tumour and higher histological grade. Therapeutic neck dissection significantly reduces survival rate and increases the percentage of lymph node relapse. Elective neck dissection should be performed in SCC requiring hemimandibulectomy. Primary reconstruction should reverse the high percentage of postoperative complication arising from increased radicality.

The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep.

The impact of orthognathic surgery for class III malocclusion on ventilation during sleep was examined using a comparison of pre- and post-surgical respiratory parameters. 21 patients with both maxillary hypoplasia and mandibular excess underwent Le Fort I osteotomy and advancement together with bilateral sagittal split osteotomy (BSSO) setback. Respiratory parameters, ECG and position of the body were monitored before surgery and postoperatively after the fixation removal (mean 8.5 months). Average Le Fort I advancement was 4.44 mm, BSSO setback was 4.96 mm. Generally, the orthognathic procedure worsened breathing function during sleep, as reflected in significant increase of index of flow limitations and decrease in oxygen saturation. The posterior airways space decreased to 75% of its original volume, the distance between mandibular plane and hyoid bone increased to 133%. The results indicate that bimaxillary surgery for class III malocclusion increased upper airway resistance. A young person would probably be able to balance such a decline in respiratory function using different adaptive mechanisms, but the potential impact of orthognathic surgery on the upper airways should be incorporated in a treatment plan.

Clinical anatomy of the dorsal venous network in fingers with regard to replantation.

The arterial system of fingers is anatomically well described, and so, usually no difficulties arise during its preparation and the making of anastomoses in replantation surgery. Difficulties may occur, however, during manipulation in the dorsal vascular bed of fingers, known only as a random venous network. There are minimal references to its existence and the location of its valvular apparatus. Using a microscopic preparation, a contrast staining, and a histological assessment, topographic relations and the course of veins of the dorsal venous network, as well as the existence and location of their valvular apparatus, was investigated on 72 three-phalanx fingers. The specimens were either harvested from fresh cadavers or traumatically amputated. We found that veins of rather significant caliber predominantly run along the dorsal aspect of the finger on both the radial and ulnar sides above the proximal phalanx of three-phalanx fingers. Proximally, venous systems of respective neighboring fingers connect in the interdigital space. The valvular apparatus was found at all levels ranging from metacarpophalangeal joints to the distal phalanx. The valves were always located distally from the confluence of two veins. Aside from this confluence, the existence of valves was not observed. The exact description of architecture of this venous system, in practice, contributes to faster orientation, better preparation, and the creation of safer anastomoses of these structures, and thus, to an increased success of replantation.

The primary use of venous grafts in thumb replantation.

The authors describe modified thumb replantation technique. With this technique it is possible to avoid extensive mobilization of the digital arteries as well as incisions, particularly at the distal thumb phalanx, and therefore reduce further damage of the amputated part. Prior to the osteosynthesis a venous graft is harvested from the distal forearm or from the thenar area. Anastomosis between the venous graft and radial digital artery on the amputated part of the thumb is completed. Osteosynthesis of the bones with Kirchner wires follows. The venous graft is further anastomosed to the dorsal venous system of the stump. The arterial system is reconstructed with an anastomosis of the ulnar digital artery with a superficially positioned volar vein of the amputated part. The replantation technique described has proved effective in all cases when it was used.

[Primary surgical treatment of amputated fingers and indications for digital replantation]. / Primární chirurgické osetrení amputací prstu a jejich indikace k replantaci.

The amputation of a single finger, or its part, or more fingers results in functional and esthetic changes in the patient's life. Until 1965 when the first thumb ever was replanted, the treatment of amputated digits had been limited by technical facilities of the medical science. Since 1970s, the development of fine suture materials, microsurgical instruments and the operating microscope has made it possible that replantations have become routine procedures in hand surgery. Both surgical procedures and indication schemes have also evolved. The primary surgical treatment has been standardized to involve the wrapping of amputated parts in dressing material saturated with isotonic solution and cooling at 4 to 10 degrees C during transport. The first enthusiasm for replantation of everything that had been amputated was replaced, owing to long-term post-operative results, by a more selective approach. Even an absolute indication for digital replantation, such as amputation of a thumb, two or more fingers, amputation in the palm and all amputations in children, must be put aside when life-threatening injuries or serious diseases are present. The benefit of replantation should always outweigh the trauma of any operative procedure because this must not harm the patient.

History of upper extremity replantation in the Czech Republic and worldwide.

Replantation surgery is a specialization in plastic surgery which, in comparison with other disciplines, has a relatively short history of only forty years. Replantation surgery developed due to experience with macrovascular anastomosis and to the evolution of the operative microscope, special micro-instruments and ultra delicate suturing material. Due to these advances, it is possible to implement anastomosis of blood vessels with a diameter smaller than 1-2 mm. Each of the three pillars of microvascular surgery has its own history. This work outlines their use and the contribution of each to the development of microsurgery. Finally, it compares the development of replantation surgery in the Czech Republic and worldwide within a specific time frame.

Evaluation of results of replantations at the Department of Plastic Surgery, University Hospital Královské Vinohrady, during the period 1994-1999.

During the period from 1994-1999, 226 patients were treated, incl. 91 replantations and 135 revascularizations. The group included 199 men and 27 women. The success rate of microsurgical reconstruction operations in replantations was 78%, in revascularizations 93%. As compared with the period 1984-1993, the success rate in replantations improved by 4%, while the indication pattern was preserved.

Treatment of chronic osteomyelitis of the lower extremity using free flap transfer.

Between 1987 and 1995, 25 patients with chronic osteomyelitis of the lower extremity were treated by transfer of muscle or musculocutaneous flap. The subsequent follow-up extended over more than three years. Five patients developed a recurrence. Two were reoperated on and healed completely; in two an amputation had to be performed; and in one the infection persists. Recurrence occurred mainly in patients in whom the bone cavity could not be filled completely with muscle.

Suction lipectomy.

Suction lipectomy is a very effective and safe method, if performed by an experienced plastic surgeon. The authors demonstrate using a group of 284 patients operated on at the University Clinic of Plastic Surgery in Prague between 1994-1998, indications, the method and complications.