[The role of capsuloligamentotaxis and minimally invasive percutaneous osteosynthesis with rigid and dynamic unilateral external fixation of the intra-articular pilon fracture]. / Die Rolle der Kapsel-Ligamentotaxis und der minimalen perkutanen Osteosynthese mit starrer und dynamischer einseitiger externer Fixierung bei der intraartikulären Pilonfraktur.

Fractures of the tibial pilon are severe injuries which can be accompanied by articular impaction, comminution and soft tissue injury. Soft tissue injury with already existing skin damage can further complicate the method of treatment. In these cases, the method of unilateral or circular external fixation can be used as an alternative method of treatment. Minimally invasive percutaneous osteosynthesis with spanning rigid and dynamic unilateral external fixation as a one-stage method has been used for the treatment of intra-articular pilon fractures. We report a case of a patient with an intra-articular pilon fracture with chronic venous insufficiency and venous ulcer, who was injured after falling from a height and who had emergency surgery based on capsuloligamentotaxis and percutaneous osteosynthesis with a spanning unilateral external fixator. The patient was mobilized postoperatively for walking without weight bearing on the injured leg. The initial rigid spanning external fixation was transformed into dynamic fixation to enable ankle joint movements 8 weeks after surgery. The external fixator was removed 4.5 months after surgery and the Kirschner wire and screws were removed 7 months after surgery. The final functional result 1 year after the injury was good and motion of upper ankle joint was moderately restricted without pain. Swelling occurred after walking for longer distances.

Distributions of Platelet-Derived Growth Factor Receptor-α Positive Cells and Interstitial Cells of Cajal in the Colon of Rats with Diabetes Mellitus Type 2.

Background and Objectives: Diabetic gastroenteropathy (DG) is a common complication of diabetes mellitus type 2. Interstitial cells are non-neural cells of mesenchymal origin inserted between nerve elements and smooth muscle cells, necessary for normal function and peristaltic contractions in the gastrointestinal (GI) tract. There are at least two types of interstitial cells within the GI muscle layer-interstitial cells of Cajal (ICC) and interstitial platelet-derived growth factor receptor α-positive cells (IPC). The mechanism of diabetic gastroenteropathy is unclear, and interstitial cells disorders caused by metabolic changes in diabetes mellitus (DM) could explain the symptoms of DG (slow intestinal transit, constipation, fecal incontinence). The aim of this study was to identify PDGFRα and c-kit immunoreactive cells in the colon of rats with streptozotocin-nicotinamide-induced diabetes mellitus type 2, as well as to determine their distribution in relation to smooth muscle cells and enteric nerve structures. Materials and Methods: Male Wistar rats were used, and diabetes type 2 was induced by an intraperitoneal injection of streptozotocin, immediately after intraperitoneal application of nicotinamide. The colon specimens were exposed to PDGFRα and anti-c-kit antibodies to investigate interstitial cells; enteric neurons and smooth muscle cells were immunohistochemically labeled with NF-M and desmin antibodies. Results: Significant loss of the intramuscular ICC, myenteric ICC, and loss of their connection in intramuscular linear arrays and around the ganglion of the myenteric plexus were observed with no changes in nerve fiber distribution in the colon of rats with diabetes mellitus type 2. IPC were rarely present within the colon muscle layer with densely distributed PDGFRα+ cells in the colon mucosa and submucosa of both experimental groups. In summary, a decrease in intramuscular ICC, discontinuities and breakdown of contacts between myenteric ICC without changes in IPC and nerve fibers distribution were observed in the colon of streptozotocin/nicotinamide-induced diabetes type 2 rats.

Head and neck cutaneous melanoma: 5-year survival analysis in a Serbian university center.

BACKGROUND: Head and neck melanoma (HNM) is specific from the anatomical and etiopathogenetic aspects. In addition to morphopathological parameters, rich vascularization and lymphatic drainage of the head and neck affect the occurrence of lymphogenic and hematogenous metastases, as well as the metastases on both sides of the neck. METHODS: A retrospective cross-sectional study included cutaneous melanoma patients who underwent surgery at a clinical center over a 10-year period. The clinical follow-up was at least 60 months. The Kaplan-Meier method was used for the survival analysis. The predictor effect of certain independent variables on a given dichotomous dependent variable (survival) was measured by the Cox regression analysis. RESULTS: The analysis of demographic and clinical characteristics of 116 patients with HNM revealed that there was no statistically significant difference in age and gender in the total sample. Thirty-three (28.45%) patients were already in stage III or IV of the disease at the first examination, which affected the overall survival rate. The overall 5-year survival was 30.2%. No statistically significant difference in 5-year survival was found in relation to age and location. The period without melanoma progression decreased progressively in the advanced stage. Forty-nine patients (42%) underwent surgery for lymphogenic metastases in the parotid region and/or neck during the follow-up. CONCLUSIONS: Patients with HNM included in this study frequently presented an advanced stage of the disease at the first examination, which is reflected in a low rate of 5-year survival. Early diagnosis and adequate primary treatment can ensure longer survival.

The effect of bilberries on diabetes-related alterations of interstitial cells of Cajal in the lower oesophageal sphincter in rats.

Diabetic gastroenteropathy involves not only the parasympathetic and sympathetic autonomic nerves, but also enteric neurons, smooth muscle cells and interstitial cells of Cajal (ICC). ICC are the cells of mesenchymal origin that occur within and around the muscle layers in the gastrointestinal tract. The objective of the present study was to investigate the alterations of ICC in the lower oesophageal sphincter (LOS) of streptozotocin-nicotinamide non-insulin-dependent diabetes rats. Moreover, we investigated possible ICC in rats with the same type of diabetes, treated with bilberry fruit extract, bearing in mind that its hypoglycemic effect had been already proven. Male Wistar rats (10 weeks old) were used, and diabetes was induced by an intraperitoneal injection of streptozotocin, immediately after intraperitoneal application of nicotinamide. The specimens were exposed to anti-c-kit antibodies to investigate the distribution of ICC, and the smooth muscle cells were immunohistochemically labelled using anti-desmin antibodies. Intramuscular ICC were very abundant in the LOS of rats. They were spindle-shaped, with two long processes connecting them into long linear sequences. In the LOS of diabetic rats, intramuscular ICC were rarely present and linear cell-cell connections between these cells were completely missing. In groups treated with bilberry, the number and distribution of ICC were exactly the same as in the above described rats with induced diabetes. In summary, a decrease of intramuscular ICC, discontinuities and breakdown of contacts between ICC were observed in streptozotocin-nicotinamide induced diabetes rats and in groups treated with bilberry. Bilberry fruit extract was shown to have hypoglycemic activity, but without any protective effects on ICC in the LOS of diabetic rats.

Tensor fascia lata flap is a workhorse for defects after inguinal lymph node block dissection.

Introduction: Enlarged inguinal lymph nodes very often present a site of metastatic disease. Inguinal lymph node block dissection is a demanding procedure, which usually requires at least one of reconstructive modalities. Among different reconstruction options we selected the tensor fascia lata (TFL) musculocutaneous flap. Objective: The paper aims at presenting a series of inguinal block dissections, followed by immediate reconstruction, using the TFL flap, and evaluation of tumor type, flap dimension, complication rate and the duration of hospital stay. Methods: We present a consecutive case series of 25 conducted block dissections. The defects were reconstructed using TFL flap, because of the extent and site of the tissue defects, reliability of the flap, and potentially primarily infected exulcerated tumors. Results: The reconstruction was successful in all cases, the incidence of surgical complications was 16%, no further complications, such as lymphedema or gait disturbances, were noted. Primary skin tumors were predominant (13 cases), followed by genitalia tumors (four cases). The male sex was more frequently affected (14 vs. 11 cases). Conclusion: Having in mind that TFL presents as a flap of adjustable size, length, shape, and volume, with negligible donor site morbidity, and after comparing of our results to those of other authors, we advise broader use of TFL flap. As a reliable flap, not too difficult to harvest, with a low complication rate, it must be taken into consideration regarding the benefits for the patient, and, on the other hand, the surgery cost and duration.

Primary reconstruction of neck defect after excision of metastatic melanoma of unknown primary site with regional pectoral myocutaneous flap.

Introduction: Metastatic melanoma of unknown primary (MMUP) is already a well described oncologic phenomenon in the literature, whereas tissue defects' reconstructions on the neck region always present a challenge for the reconstructive surgeon. Two cases of giant metastatic, skin infiltrative neck tumor masses are presented. In both cases MMUP was diagnosed. Both intraoperative tissue defects were reconstructed using pectoralis major (PM) regional flap. Outline of cases: The first patient was admitted with giant tumor mass on the right side of the neck. The fast growing mass appeared two months prior to the admission. Thorough examination showed no signs of primary tumor. Removal surgery was performed and the defect was reconstructed using the PM musculocutaneous flap. The second patient was admitted with large tumor mass on the left side of the neck. Thorough examination displayed no signs of any primary tumor. After the excision, the tumor mass and subsequent neck dissection, reconstruction followed, using the pedicled PM muscle flap and partial thickness skin transplants. There were no major complications in either case. The histopathological examinations presented metastatic melanoma diagnoses. Conclusion: Clinical outcome of MMUP described in literature is rather variable. Different studies have shown that prognosis in patients with MMUP is better than that in patients with diagnosed primary melanoma with metastatic disease. Therefore, the best initial course of action in those cases would be surgery, according to oncological principles, if possible. Neck defects' reconstructions should fulfill both functional and esthetic demands. Due to the reliability and low cost of the procedure, PM regional flap presents a very good and trustworthy reconstruction modality.

Reconstruction of full thickness abdominal wall defect following tumor resection: a case report.

INTRODUCTION: Reconstruction of a full thickness abdominal wall defect is a demanding procedure for general and also for plastic surgeons, requiring vigorous planning and reconstruction of three layers. CASE OUTLINE: We present a case of a 70-year-old patient with a huge abdominal wall tumor with 40 years evolution. Surgery was performed under general anesthesia. Full thickness abdominal defect appeared after the tumor resection. Reconstruction followed in the same act. The defect was reconstructed using a combination of techniques, including omental flap, fascia lata graft, local skin flaps and skin grafts. After surgery no major complications were noted, only a partial skin flap loss, which was repaired using partial thickness skin grafts. The final result was described by the patient as very good, without hernia formation. CONCLUSION: Omenthoplasty, abdominal wall reconstruction in combination with free fascia lata graft and skin grafts can be one of good options for the reconstruction of full thickness abdominal wall defects.

Second look procedure for large burn defect by banana peel pericranial flap based on one artery.

INTRODUCTION: Scalp and calvarial defects may result from trauma, thermal or electrical burns, resection of benign or malignant tumors, infections or radionecrosis. Reconstruction of large scalp defects is a demanding procedure. The reconstructive "ladder" are applicable to scalp and calvarial defects reconstruction. CASE OUTLINE: A 68-year-old female was admitted to our clinic due to the nine-day old scalp burn wound, incurred under unclear circumstances. Third degree burn wound affected the left frontal-parietal, temporal and part of the occipital region with carbonification of the whole left ear lobe.The treatment was carried out in two stages. Radical full thickness necrectomy of the scalp was performed, the defect margins were curetted to the active bleeding, and the ear lobe was amputated.The defect sized 23 x 15 cm was reconstructed using the"banana peel"transposition galea-cutaneous flap from the remainder of the scalp, which was based only on the right occipital artery.Two months after the surgery the appearance was satisfactory, and all wounds were healed. CONCLUSION: Designing of large-scale flaps is very hazardous, especially in elderly people. Scalp reconstruction based on one artery has to be planned in detail and performed when the possibility of complication is reduced to minimum. Our case report underlines possible reconstruction as delayed procedure even with the exposed bone (second look procedure), as well as the reconstruction of half scalp with the local flap based on one pericranial artery.