[Importance of adequate immobilization of the upper extremity in using the vascularized fibular graft]. / Znacaj adekvatne imobilizacije gornjeg ekstremiteta kod primene vaskularizovanog fibularnog grafta.

The most complications in patients after the reconstruction of the bone defect of the upper extremities are the fractures of the bone graft and pseudoarthrosis on one of the graft suture with defects of humerus. These complications influence on the primary efficiency of the reconstruction and prolong the recovery period. We registered five fractures, four pseudoarthrosis and two graft angulations in the prospective study on 25 patients where the defect of humerus, radius and ulna was compensated by the vascularized fibular graft. The analysis showed four fractures on the distal part of the reconstructed humerus graft and three pseudoarthrosis on the proximal part of reconstructed ulna. All osteogenic complications, apart from angulations which did not require additional interventions were solved by spongyoplasty according to Phemisters and more efficient postoperative immobilization.

[Complications in the use of vascularized fibular grafts: classification and treatment]. / Komplikacije u primeni vaskularizovanog fibularnog grafta: klasifikacija i resavanje.

The complications in the reconstruction of the diaphysed defects by the use of VFG or VOSKFG are not shown in the literature coherent so it is very difficult to compare and use showed results. For the compensation of the bone defects the specific complications could be differentiated according to the influence on the primary and overall efficiency of the reconstruction. The classification of the complications in the donors region and osteogenic and vascular complications in the recipients region was suggested in the analysis which encompassed all these divisions.

[Reconstruction of the long bones and mandible with vascularized fibular grafts]. / Nadoknada defekata dugih kostiju i mandibule vaskularizovanim fibularnim graftom.

In two prospective studies at the Clinic for Plastic Surgery and Burns and Clinic for Maxillofacial Surgery of the Military Medical Academy in the period from 1991 to 1996 we performed 47 transplantations of the vascularized fibular graft in order to compensate bone defects of the long bones and mandibular inflicted by war wounding. The importance of the length of the vascular pedicle preparation for the total success was pointed out as well as the immobilization of the elbow region for the compensation of the defects of the upper arm and forearm and total healing of the mandibular for the later functional rehabilitation. The realized primary efficiency of 70.2% and total successfulness of 93.6% indicated that at the compensation on of bone defects the etiology of war wound could be compared to the etiology of malignant tumors resection and trauma.

[Pigmented villonodular synovitis--analysis of 50 patients]. / Pigmentni vilonodularni sinovitis--analiza 50 bolesnika.

Fifty patients with pigmented villonodular synovitis (PVNS) were examined and treated in the Military Medical Academy in twenty-year period (1977-1996). Among them, 32 were male and 18 female (2:1), of average age from 6 to 72 years. Articular disease localization was 2.5 times more frequent compared to the non-articular. The rate of circumscribed in relation to diffuse form was 1.5:1. The ankle joint was most frequently involved (94%). In one patient, PVNS was proved in both ankle joints. The disease was clinically expressed as chronic, and 4 times more frequently as chronic recurrent synovitis. The data of previous injury were known in 14 patients. Associated rheumatic disease or injury was found in more than a half patients (53%). For the disease diagnosis there were used: physical examination, standard laboratory tests, radiography, ultrasonographic and magnet resonance examination and histopathologic examination of synovia obtained by open or arthroscopic biopsy. Surgical methods, such as total or partial synovectomy were applied in the therapy. Chemical synovectomy was performed in one patient, 6 months after the diagnostic arthroscopy due to disease recurrence. Therapeutic effect was estimated in 22 patients, from 3 months to 11 years after the surgery on the basis of disease recurrence. Except for the cited one patient, none other had the disease recurrence. It was concluded that timely diagnosis of PVNS offered more adequate treatment and conditions for complete recovery. In the disease limited just in the ankle joint, arthroscopic synovectomy would be the therapy of choice. In advanced diffuse form, total synovectomy should be performed for all the disease localizations.

[Histopathologic changes in the skin of transplanted microvascular flaps]. / Histopatoloske promene u kozi transplantiranih mikrovaskularnih reznjeva.

During the microvascular transfer, the free flaps tissue is exposed to series of pathophysiological changes (tissue anoxia, tissue acidosis, anaerobic metabolism, wound healing and cicatrisation, degeneration of nerves fibers in the free flaps tissue, etc.) In 1993-1998 period, at the Clinic for Plastic Surgery and Burns at the Military Medical Academy, we analyzed histopathologic changes in the skin taken from the transferred flaps and from the recipient region surroundings of 31 patients with microvascular tissue transfer. The bioptic materials were taken between 6 and 36 months following the free tissue transfer--average 23.6 months. By light microscopy we analyzed histopathologic changes of the epidermis, collagen's fibers, skin adnexa, blood vessels and nerve fibers. The data obtained showed considerable difference in the histopathology test results of the epidermis, collagen's fibers, the skin adnex and the nerve fibers in the transferred free flaps compared to the results obtained from testing recipient region surroundings. The histopathologic tests of the blood vessels did not show considerable comparative difference.