A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds.

Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes.

The squamous cell carcinoma at the level of the cephalic extremity: epidemiological, clinical and histopathological aspects.

Malignant tumors represent one of the most important medical problems, due to the increased mortality rate, life quality alteration, and the lack of a curable treatment. Skin neoplasm ranks first most frequent top primary tumor, summing a higher percentage than any other neoplastic location. It is also known, the fact that, in our country, gastric adenocarcinoma represents the most encountered tumor of the digestive tube. Our case, male, 49-year-old, comes from a rural area, was diagnosed with and surgically treated, within one year, for gastric adenocarcinoma (intestinal type gastric carcinoma) and squamous cell carcinoma (at the level of the lower lip). A high number of etiologic agents are associated with different risks in developing a carcinoma with squamous cells at the level of the head and the neck, and a gastric carcinoma (our patient is known to suffer from gastric ulcer and Helicobacter pylori, for more than 20 years, and he is a chronic consumer of alcohol and nicotine).

Anatomo-clinical aspects of the basal cell carcinoma at the level of the cephalic end.

More than one third of all diagnosed cancer cases from all over the world are skin cancers, and the majorities are basal cell carcinomas. The incidence of skin tumors around the world is growing, the main concern being the increased frequency of skin tumors among young persons. Therefore, an early detection is required, starting with the general practitioner, dermatologist, oncologist, plastic surgeon and not least, the pathologist. We studied a sample consisting of 149 patients diagnosed with basal cell carcinoma at the level of the cephalic end and neck, all of them undergoing surgery--surgery individualized for each case. Some cellular and molecular modifications also resulted from infecting the cells with high carcinogenic risk HPV, considered by some scientists as responsible for the developing and progression of some neoplasias, including melanocytes and non-melanocytes skin tumors.

The synergy between lasers and adipose tissues surgery in cervicofacial rejuvenation: histopathological aspects.

BACKGROUND AND AIMS: Nowadays patients want a long-lasting youthful appearance but through a less invasive approach. Our unique approach, "AdipoLASER reJuvenation (ALJ)", involves a variety of less invasive techniques based on simultaneous laser resurfacing, and lipolysis together with adipose tissue graft and redistribution. Recently, we added to this platelet-rich plasma therapy. We conducted a study aiming to emphasize the histopathological changes occurred following these procedures. PATIENTS AND METHODS: Between 2011-2012, we included 50 patients that were preparing for abdominoplasty (tummy tuck) in which we applied ALJ procedures, in two comparative zones of inferior abdomen. Histological examination varied from 10 days to four months, according to the time of the abdominoplasty. RESULTS: There was a notable histological difference between stimulated and non-stimulated fat graft regarding adipose cells structure and number, neocollagenesis, and dermal matrix remodeling. CONCLUSIONS: The low level laser therapy effect (LLLT) of the fractional CO2 laser combined with the effect of the growth factors derived from activated platelets (PRP) prolonged the life and improved the take of the facial fat graft, increase collagen formation and lead to a better remodeling of the dermal matrix. This unique surgical combination of all four approaches in our ALJ with additional PRP offers a real less invasive but strongly visible - yet natural result - as an alternative to the classic facelift.

Correlations between morphological appearance and psychosocial difficulties in patients with extensive burns who received allotransplant.

Extensive burns are devastating traumatic events, with significant potential for development of complex psychosocial problems. The aim of the study was to identify and quantify these difficulties among extensive burns patients. This study was conducted at Clinical Emergency Hospital for Plastic, Reconstructive and Burns Surgery and "Bagdasar-Arseni" Emergency Hospital, in Bucharest, on 43 extensive burn patients. For each patient we developed a statistic sheet with demographic data and medical information. For data collection, subjects completed the following instruments: Hamilton Depression Scale (HAMD) and Satisfaction With Appearance Scale (SWAP). The impact variables evaluated in this study were demographic characteristic of patients, burn injury characteristics, abnormal scarring and visible scars, body image dissatisfaction and depression symptoms. Although performed on a small sample, the results of this pilot study could be a valuable starting point for future larger studies, to achieve more generalizable results on extensive burns survivor's quality of life.

Psychological impact of burn scars on quality of life in patients with extensive burns who received allotransplant.

With the remarkable progress in the field of burns treatment, the outcome of extensive burns improved significantly. The increased likelihood of survival of a burn victim heightens concerns for potential psychological morbidity for the survivors. Hypertrophic scarring is devastating and can result in disfigurement that affects quality of life. To assess the impact of burn scars on the quality of life of the survivors, we used two scales: the WHOQOL-BREF questionnaire to evaluate the quality of life and the POSAS scale for the subjective evaluation of the post-burn scars in 26 patients who suffered extensive burns and received allotransplant. A significant correlation was observed between the WHOQOL-BREF score and POSAS scale (r=-0.93, p<0.001). In conclusion, burn scar visibility and severity did have a strong relationship with the quality of life in the survivors of a major burn who received allotransplant. Therefore, more effort must be placed into developing psychosocial interventions that help survivors to accept scars, reduce depression and build a strong supportive system.

Free tissue transfer in hand surgery--essential step in hand transplantation.

INTRODUCTION: The development of microsurgery allowed huge advancements in the reconstructive surgery of the upper limb. The use of free digital transfer started a true revolution for the reconstruction of the mutilated, functionally compromised hand, with multiple amputations. Slowly, surgeons started using free tissue transfers in other reconstructive procedures of the hand, forearm and arm. This way they avoided amputating a limb and they realized quality reconstructions in a single surgical step in cases in which classical methods did not apply. We shouldn't neglect to mention that free tissue transfers, along with hand replantation, represent an important step for microsurgery centers in preparing the hand transplant. MATERIAL AND METHODS: There have been 48 cases of free tissue transfers of the upper limb in the Plastic Surgery Department of the "Bagdasar-Arseni" Emergency Hospital between 2000 and 2010, of which 18 free digital transfers, 11 free tissue transfers of the hand, 15 transfers of the forearm and 4 of the arm. RESULTS AND DISCUSSION: Of the total 48 cases we studied, 4 have been total failures and 6 cases presented partial necrosis of the transferred tissue, all of which have been managed with ulterior corrective procedures. We used free tissue transfer in cases where there was no other surgical option and also in cases where other methods applied, but free tissue transfer provided a superior quality solution.

Surgical management of extensive burns treatment using allografts.

Patients with extensive burns (TBSA over 45%) can benefit from treatment with split thickness skin allotransplants (skin bank or honorific donors). In this study, we present our protocols for the surgical treatment by using allografts. We emphasize the criteria for the staging of the procedures, the prioritisation of the areas that need to be grafted and the postoperative management. The treatment includes a serial excision grafting with simple grafts or the sandwich method, which implies the covering of the wound with a widely meshed autograft (6:1). This layer is covered by a 1,5:1 or 3:1 expanded mesh allograft.

Surgical options in extensive burns management.

Background - hypothesis and objective: In the past decades, extensive burn care has improved to the extent that burn victims can now frequently survive. Current treatment of a severe burned patient extends beyond the preservation of life and function; the ultimate goal is the return of survivors, as full participants, back to their families, work field and communities. Methods: This paper is based on our experience in treating patients with extensive burns. We had two panels as follows: 148 subjects with extensive burns in one original retrospective study (2002-2009) and other 47 new patients with extensive burns enrolled in other original prospective study (2010-2011). We selected the subjects with extensive burns who received allotransplant (n = 59). Our study aimed to identify and quantify the main psychosocial difficulties in patients with extensive burns who received allotransplant, also taking into account the surgical procedures applied in each case. Results: One of the major problems a surgeon faces is the nature of the decision he has to make regarding a treatment (conservative versus operative), based on the exact determination of burn wound depth. In case of early excision, deep lesions and suitable grafting represent the chosen surgical treatment in our center. The benefits of skin allografts are well known due to their contribution to burn management. Conclusions & discussion: This paper is designed as a guideline and instruction manual to help those with less experience through particular situations in surgical burn care. Early excision and immediate coverage of the burn wounds represent nowadays the standard care for extensive burned patients. For patients with massive thermal injury, temporary coverage with allografts is essential. The use of allograft has multiple benefits because it plays both as physiologic and mechanical barriers.

In vitro biocompatibility testing of some synthetic polymers used for the achievement of nervous conduits.

Biocompatible synthetic polymers are largely used in the bio-medical domain, tissue engineering and in controlled release of medicines. Polymers can be used in the achievement of cardiac and vascular devices, mammary implants, eye lenses, surgical threads, nervous conduits, adhesives, blood substitutes, etc. Our study was axed on the development of cytotoxicity tests for 3 synthetic polymers, namely polyvinyl alcohol, polyethylene glycol and polyvinyl chloride. These tests targeted to determine the viability and morphology of cells (fibroblasts) that were in indirect contact with the studied polymers. Cell viability achieved for all the studied synthetic polymers allowed their frame in biocompatible material category. Cell morphology did not significantly change, thus accomplishing a new biocompatibility criterion. The degree of biocompatibility of the studied polymers varied. Polyvinyl alcohol presented the highest grade of biocompatibility and polyvinyl chloride placed itself at the lowest limit of biocompatibility. The results achieved allowed the selection of those polymers that (by enhancing their degrees of biocompatibility due to the association with various biopolymers) will be used in the development of new biocompatible materials, useful in nervous conduits manufacture.

Tissue transplantation in face reconstruction.

INTRODUCTION: At face level, tissue transplantation is one of the main methods in reconstructive surgery, generally used when local and locoregional reserves are outworked. To reconstruct different face units after trauma or oncologic resection we use different methods, according to dimensions, nature and site of the defect. In cases with extensive defects or mutilating sequelas, face transplantation can be a reconstructive option that should be taken in account, despite its desavantages. MATERIAL AND METHOD: In this paper we present a retrospective study of the cases we operated during 2004-2010, in our Plastic and Reconstructive Surgery Clinic of Clinical Emergency Hospital "Bagdasar-Arseni" which needed reconstructions with different tissue transplantation methods. RESULTS: Case evaluation showed that postoperative results were good and very good. For this evaluation, we took in account both case gravity and operative risks, for each reconstructive method. CONCLUSIONS: Tissue transplantation for face reconstruction represents the latest milestone in face reconstruction, as well as a preliminary stage for face transplantation, when there is right indication.

[Risks and difficulties in the treatment of malignant tumors of the lower face]. / Riscuri si dificultati în tratamentul neoplasmelor de etaj facial inferior.

The extensive malignant tumors of the face impose numerous problems regarding the surgical treatment due to, on one hand to their extension and on the other hand, to the aggressivity of the histological entity. The histopathology and the grading of these tumors are very helpful in orientating the specialist to choose the best therapeutic protocol in each case.

[Surgical methods of covering head soft tissues defects]. / Modalitati chirurgicale de acoperire a defectelor de parti moi la nivelul capului.

Posttraumatic and post-excisional head soft tissue defects represent a challenge for the plastic surgeon due to the functional and esthetic impact of this body area. Choosing the simplest way of covering a defect is many times the most efficient way, but it must deliver a good tissue cover and their aspect and function must simulate the characteristics of that area. This article is proposing to be a brief description of all these procedures, informing and being necessary for every general surgeon. The methods of covering head soft tissues defects specific to plastic surgery will be presented in a ladder way from simple to complex, that means from the simple skin graft to island flaps and the tissues transfers. Choosing a right procedure refers to the etiopathogeny, and the length and width of the defect. We shall present advantages and disadvantages of each procedure, indications and their limits, giving specific clinical cases. We shall present the results for each type of procedure also, giving specific arguments for our option. We'll insist on the functional reconstruction of the lids, nose and cheek, as single defects and on the surgical limits which come upon very large soft tissue defects. Due to the complexity of the head structures, either single or complex, and to the functional and esthetic impact of these soft tissue defects, we consider this paper to be a real benefit. It is very important to choose the right procedure, considering all the factors who are implicated (sex, age, general condition, etiopathogeny, the length and width of the defect, previous treatments, patient wish, etc).

[Comparative electronmicroscopic research on normal palmar aponeurosis and adulterated palmar aponeurosis in Dupuytren disease]. / Studiu comparativ electronomicroscopic al aponevrozei palmare normale si modificate in maladia Dupuytren.

This article represents a comparative research between the normal palmar aponeurosis seen with the electron microscope and adulterated palmar aponeurosis in Dupuytren disease. For that reason, we harvested normal palmar aponeurosis from 5 patients hospitalised in emergency in our department with different posttraumatic hand lesions, and adulterated palmar aponeurosis from 15 patients with Dupuytren disease. The samples were prepared to obtain sections visualised with the electron microscope. Comparative research of these sections lead to the conclusion that in the normal palmar aponeurosis the fibroblast is visualised in its resting functional form (fibrocytes), and in the adulterated palmar aponeurosis in Dupuytren disease the fibroblast is visualised in its active, secretory, form. In Dupuytren disease we found an increased, anarchic, collagen production, clinically demonstrated by nodules and fibrous strips. This paper is just a preliminary stage of a research looking for alternative, noninvasive, therapeutical methods in Dupuytren disease (ex. : effects of electromagnetic field made by millimeter waves on the adulterated palmar aponeurosis cell structure).

[Therapeutic solutions in post-excision defects for plantar verrucous carcinoma]. / Modalitati de acoperire într-un caz de carcinom verucos plantar (Epithelioma cuniculatum).

Carcinoma verrucous--anatomoclinical entity histological high rate of differentiation of the spinocellular epithelioma, clinically associated with 3 types of lesion. We present the therapeutical solution of a plantar carcinoma verrucous case, a large post-excisional defect-free flap transfer of latissimus dorsi muscle using microsurgical techniques.