Continuous negative pressure wound therapy in the treatment of a gigantic trophic leg ulcer.

AIM: to present a therapeutic algorithm for chronic venous insufficiency complicated with ulceration, using etiologic treatment combined with local treatment by negative pressure wound therapy (NPWT) before and after skin grafting. MATERIAL AND METHOD: we are discussing a 59 years-old patient with a lower leg gigantic, circumferential trophic lesion. The aetiology was combined, post-traumatic and chronic venous insufficiency, with 30 years of evolution. RESULTS: the treatment was applied in two surgical steps. Initially the pathological refluxes were interrupted; secondarily a skin graft was applied, preceded and followed by NPWT until graft intake. The wound healed completely; patient developed secondary foot lymphoedema. CONCLUSIONS: 1. Case treatment particularity consists in using a combination of etiologic and local treatment, combined with adjuvant NPWT. 2. Secondary lymphoedema developed due to circumferential location of the lesion. 3. Continuous NPWT has proven its efficiency in chronic ulcer before and after skin grafting, reducing costs and duration of treatment.

Retrospective study regarding objectives and results of upper limb transplant.

INTRODUCTION: Upper limb amputation causes a severe permanent disability. Upper limb transplantation is subject to treatment to prevent rejection and influenced by organizational, socioeconomic, psychological, ethical factors. Analysis of the results creates the potential for continuing this work in specific conditions in our country. MATERIAL AND METHODS: We retrospectively analyzed data from the literature. Upon completion of documentation (May 2011) there were 74 transplants in 53 patients worldwide. We have studied the available information on the surgical interventions and their results. RESULTS: Upper limb allograft has a complex structure comprising tissue with variable antigenicity. Surgery is performed by a large multidisciplinary team, whose increased experience leads to a shorter length of the operation. The postoperative follow-up and rehabilitation program are standardized, and patients' compliance is essential. The greatest advances have occurred in immunosuppression protocols. CONCLUSION: The upper limb transplantation was performed in 20 centers of 12 countries so far. The specification of the indications and contraindications, the proper selection of patients, the increasing experience and new immunosuppression protocols provide a higher success rate and quality of functional outcome. By applying these conceptual acquisitions we will be able to create conditions for the integration of our country in this globally convergent scientific effort.

Breast reconstruction with autologous tissue--our clinical experience.

INTRODUCTION: Breast reconstruction after mastectomy gained new grounds since the introduction of autologous tissue and oncoplastic surgery techniques. Nowadays large postoperative breast defects can be treated with high quality tissues obtained by autogenous flap surgery, to achieve the best functional and physical results. OBJECTIVES: The purpose of this study is to analyze our results in breast reconstruction using autologous tissue and to emphasize the importance of a multidisciplinary team. MATERIAL AND METHODS: During a five year period (2005-2009) we performed 28 breast reconstructions after cancer surgery, 15 in delayed and 13 in primary reconstruction, using three types of flaps: latissiumus dorsi flap, transverse rectus abdominis myocutaneous flap and deep inferior epigastric artery perforator flap. RESULTS: Functional and cosmetic results were very good, only minor complications such as seroma and hematoma of the donor site and partial/marginal flap necrosis occurred after the surgical procedure. There were no major complications like total flap loss. CONCLUSIONS: Breast reconstruction with autologous tissue is a safe, well proved, although not easy procedure that confers best functional and cosmetic results and is at the same time oncologically safe.

Severe saddle nose deformity reconstructed with rib cartilage.

Augmenting the nasal dorsum is often a difficult task, because of the irregularities that might be visible under the thin dorsal nasal skin. Saddle noses are especially difficult to correct because of the need to provide strong structural support to the nose while at the same time achieving an aesthetic dorsum. Stable reconstruction of the cartilaginous septum is the critical challenge in the operative treatment of such deformities with both functional and morphological implications. Treatment depends on the degree of saddling. Autologous cartilage is widely recognized to be the standard against which other materials must be judged. It is the most acceptable and reliable long-term graft. We present a case of unusually severe posttraumatic saddle nose resolved with a single rather large costal cartilaginous graft and a columellar strut. Classic extended spreader grafts could not be used due to the lack of bony and cartilaginous support of the nasal pyramid and, thus, no possibility of stabilization. A normal nasal dorsum, as well as breathing improvement, were achieved and the patient was extremely satisfied with the result. We had no complications except a slight asymmetry of the nostrils. Graft resorbtion or displacement was not observed on the 14-months follow-up.

An alternative for local treatment of superficial burns.

There is a wide variety of local therapeutical methods for partial superficial burns. Burns require meticulous local treatment as part of the complex therapeutic protocol. Local treatment for burns is essential, influencing the patient's evolution and future. All local burn treatment methods are adapted in relation to the particular aspects of the burn lesion (patient's age, aetiology, localization, associated pathologies). Immerci H3 was clinically tested for partial superficial burns treatment and the results were favourable. Healing was more rapid and there was a decrease in mean hospital stay and treatment costs.