Reconstruction of nasal defect with the composite expanded forehead flap.

Nasal tip and septal perforations may lead to significant upper airway problems as well as disturbing esthetic changes in the external contour of the nose. Nasal defects impede normal social contact and create great self-identity problems for the patients. We report the case of a 37-year-old woman, taking drugs for 10 years, who had sepsis and nasal abscess with necrosis of the nasal tip and septum. Using a composite expanded forehead flap for reconstruction of the nose, good esthetic and functional results were achieved.

An Analysis of the Effectiveness of Skin Grafting to Treat Chronic Venous Leg Ulcers.

AIM: This study assessed the effectiveness of skin autografting at 6 months post treatment. MATERIALS AND METHODS: A prospective analysis of the disease course and treatment of 2 groups of patients (group S contained patients who have been treated by performing the surgery of skin autografting, group C contained patients who have been treated only by nonoperative means of treatment) after 6 months who were treated from January 2001 to June 2005 at the Department of Plastic Surgery and Burns and at the Clinic of Skin and Venereal Diseases of Kaunas Medical University Hospital was performed. The analysis evaluated the influence on the speed of epithelization (healing) of ulcers by performing surgical skin autografting and conservative treatment. The speed of epithelization (the decrement of an area of an ulcer within 6 months) for the treatment of large chronic leg ulcers after the first 6-month period was also analyzed. RESULTS: Seventy-one patients (group S, n = 40; group C, n = 31) participated in the 6-month study period. Ulcers did not heal completely in any patients in group C (100%)-ulcer size increased in 17 patients and decreased in 14 patients. The average area of ulcers for group C was 171.12 cm2 (range = 8 cm2-720 cm2). Compared to the area before treatment (m = 182.29 cm2), the reduction in average area was not significant (P > 0.5). The contamination of ulcers did not change much in either group over the course of the study. Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly found pathogens. In group S, the skin epithelized completely in 27 cases (67.5%) and did not epithelize in 13 cases (32.5%). The average ulcer area was 16 cm2 (range = 6 cm2-52 cm2). In comparison with the previous area (m = 279 cm2), the current area was rather small and did not (or was insignificant) influence patient quality of life. CONCLUSION: According to the data from all factors that were analyzed, age was the only influence on the origination of large chronic venous leg ulcers (CVLUs, P < 0.05). Large CVLUs (> 50 cm2) of 67.5% of elderly patients (> 60 years) were healed within 2-3 weeks by skin grafting compared to the conservatively treated group and maintained closure up to 6 months (ie, if the subjects were studied up to 6 months).

Staphylococcus aureus infection in the surgery of burns.

S. aureus causative agent is relatively pathogenic to humans and is found on the skin and mucosa of up to 40% of all population. Burn injuries are infected with S. aureus in 30% of cases; however, in many cases the injuries heal without the antibiotic therapy, solely by applying dressing with antiseptic solutions, early removal of necrotic masses and covering the injury with a skin graft. In 2000, in the Division of Plastic Surgery and Burns of our institution, the frequency of S. aureus infection among patients with burns was 47%, of which methicillin-resistant S. aureus - 45%. The study included 100 patients who had S. aureus grown in the samples of their injuries. The article compares the severity of the trauma and the results of treatment in groups of patients with methicillin-resistant S. aureus and methicillin-sensitive S. aureus.