[Vascularised osteocutaneous scapular flap in the reconstruction of mandibular defects after war wounding].

Vascularized osteocutaneous scapular flaps belong into the most convenient ones in reconstruction of mandibular defects followed by massive loss of adjacent skin and mucous membrane due to its vascular supply, bulkiness, suitability and mobility of cutaneous component of the flap. In seven wounded patients such defects of the mandible and adjacent soft tissues after war wounding have been reconstructed at the Clinic for Maxillofacial Surgery of the Military Medical Academy - Belgrade during the six years period with vascularized osteocutaneous scapular grafts. Here we present localization and structure of the defect, features of harvested compound graft, the procedure of reestablishment of mandibular continuity, immediate and late complications during the consolidation period, as well as the analysis of the success rate.

[Reconstructive methods in the treatment of soft tissue defects below the knee]. / Reconstruktivne metode u zbrinjavanjudefekata mekih tkiva potkolenice.

The specificity of the lower leg is in sparse collateral blood flow of the skin cover in the middle and distal part, reduced subcutaneous tissue and the prominence of the front side of tibia immediately under the skin. These characteristics of the lower leg make the application of the standard plastic reconstructive principles, which have been applied in the other regions of the body to a certain degree impossible. The progress of anatomical knowledge in relation to vascularization of the tissue territories--angiosoma, and the anatomy of the vascular skin system of the lower leg, along with the technological progress represented by the application of the surgical microscope, new surgical instruments and suture materials, provides the reconstructive surgeon, not only with classic but also with the modern surgical methods in this region: microvascular transplantation of the tissue and the application of the fasciocutaneous reversible flaps. The aim of this study was to show the available reconstructive methods in the treatment of the lower leg soft tissue and to analyze its application in the management of war wounds in the injured from the civil war in the former Yugoslavia. On the basis of our experiences in the management of war wounds, especially of the lower leg with the tissue defects, we would like to point on the existence of the clear indications for the application of certain reconstructive methods depending on the size, localization and tissue defect structure, as well as the advantages and disadvantages of the available reconstructive procedures.

[Vascularized fibular grafts in the reconstruction of bone defects caused by war injuries]. / Vaskularizovani fibularni graft u rekonstrukciji kostanih defekata nastalih ratnim ranjevanjem.

The efficiency of the vascularized fibular graft application in the reconstruction of diaphyseal defects of the long bone of extremities caused by war injuries was prospectively investigated in the group of 33 patients in the period 1991-1996, during the war in the former Yugoslavia. The preoperative, intraoperative and postoperative procedures were systematized. Early and late complications in donor and recipient regions were shown. The primary success was 63.6% and the total one was 93.9%. The efficiency of the vascularized fibular graft in the treatment of bone defects caused by war injuries could be compared with bone defects caused by trauma or by resection of malignant tumors.

[Sebaceous gland function in transplanted microvascular flaps]. / Funkcija lojnih zlezda transplantovanih mikrovaskularnih resnjeva.

Sebaceous glands produce sebum that contains: triglycerides, esters of cholesterol, and sometimes even pure cholesterol, squalene and esters of wax. Microvascular transplantation exposed the tissue of free flaps to the temporary ischemia and anaerobic metabolism, inflammatory, denervative and reinnervative processes. The sebaceous glands of the free flaps were also exposed to the action of physiopathologic processes during the micro vascular transfer. Because of that, the function of the sebaceous glands of the transplanted free flaps was estimated compared to the function of the sebaceous glands of the recipients and donor's region environment. The investigation of the sebaceous glands of free flaps function has been performed in 32 wounded patients at the Clinic for Plastic Surgery and Burns, and Institute for Medical Biochemistry of the Military Medical Academy. All the wounded have undergone the microvascular transplantation of the cutaneous, myocutaneous and osteocutaneous flaps. Dry residue in either of the soluble substances was measured in the period from six to thirty six months after the transplantation. The obtained results indicated that the function of the sebaceous glands of the transferred flaps 25.36 months after the transplantation was weaker than the function of the sebaceous glands of the recipients and donor's region's environment and amounted to 98% of the function of the sebaceous glands of the recipient is region's environment.

[Temperature of the skin in microvascular flaps]. / Temperatura koze mikrovaskularnih reznjeva.

Transferred free flaps by their defined vascular net improve the perfusion of the recipient region. Skin temperature depends on the skin perfusion, temperature conduction of the visceral organs, muscles and blood vessels, as well as on the heat loss by the evaporation and air convection in the environment. At the Clinic for Plastic Surgery and Burns and at the Institute of Hygiene of the Military Medical Academy, skin temperature of the transferred free flaps and the recipient region surrounding were analyzed and measured in controlled microclimate conditions. The analysis was performed in 31 subjects, 20.23 months after the free tissue transfer. The aim of the study was to determine the differences between the skin temperature of the transferred free flaps and the recipient region surrounding, as wall as of the donor's region surrounding. The results of the investigation revealed that skin temperature of the transferred free flaps was lower in 28 (90.3%) patients than the temperature of the donor's region surrounding. Skin temperature of the transferred free flaps was higher in 25 subjects (80.6%) than the temperature of the recipient region surrounding. Skin temperature of free flaps transferred to the foot and the lower leg was higher than the skin temperature of the recipient region surrounding but was also lower in the flaps transferred on the head. The temperature of the recipient region surrounding influenced the skin temperature of the transferred free flaps, besides the flap tissue perfusion.