[The radial forearm free flap in oro-maxillo-facial reconstruction. Experience of a multidisciplinary team approach--maxillofacial and plastic surgery]. / Lamboul radial în reconstructia pierderilor de substanta în teritoriul oro-maxilo-facial. Experienta unei abordari în echipa mixta--chirurgie maxilofaciala, chirurgie plastica.

The treatment of extended oro-maxillofacial lesions is a difficult task. Free flaps are the optimal reconstruction method in well defined situations. Though not improving survival, they have lead to a lower morbidity and to the improvement of the patient's life quality. A great step forward was represented by the radial forearm flap. This paper reflects the experience of a team approach (oro-maxillofacial and plastic surgery). The radial forearm free flap was considered as the optimal solution for 22 patients with defects concerning the tongue and/or mouth floor (8), the lower lip (7), or other facial regions (5). The defects were due to the resection of malignant tumors spinocellular (18) or basocellular carcinoma (2), benign tumors (1) or posttraumatic (1). Flap's characteristics allow wide area coverage and high plasticity. Thus, in case of malignant tumors, surgeons may perform resections within the oncological limits, while post-resectional defects can be covered with very good functional and aesthetic results. The morbidity of the donor region is within acceptable limits. Team approach in head and neck reconstruction (oromaxillofacial surgeon-plastic surgeon) leads to superior quality results, allowing each specialist to focus on the aspects he/she is most familiar.

Integra--a therapeutic alternative in reconstructive surgery. Our first experience.

Coverage is one of the most important issues in plastic surgery. The both acute and reconstructive surgery can often face with limited donor site availability requiring additional therapeutic options. One of the research direction developed in the last 30 years is the quest for the "artificial skin". Integra is a permanent skin substitute used in acute full thickness burns, after injuries and also in reconstructive surgery. We used it with very good results in three cases: in two patients for replacement of facial and neck burn scars and in one case for penis coverage in a traumatic degloving avulsion of perineal skin. Even the anatomic regions were demanding (cervical area, frontal area and penis) we had no Integra displacement. The skin graft take was 100% in all the cases. We had no hematoma, no infection. Follow up period is 3-8 months. A meticulous surgical technique with a good hemostasis and continuous wound care during first and second stage are mandatory for optimal esthetic and functional results. This is the first use of Integra in Romania. Experience is important for further steps are needed in coverage of patients with severe burn trauma.

Assessment of the microsurgical skills: 30 minutes versus 2 weeks patency.

The aim of this study is to evaluate the amount of training needed by a trainee, with no background in microsurgery, in order to achieve proper skills for microvascular anastomosis. A protocol based on the rat femoral artery was established to provide a quantitative representation. Five inexperienced subjects started performing microvascular anastomosis. Patency was assessed at 30 min. The final assessment was performed at 2 weeks when rats were reoperated and the patency below the anastomosis was checked. The experiment was discontinued for one subject when he/she succeeded to have two series of four anastomosis with 100% patency at 2 weeks. The results were: 47.5% patency rate at 30 min and 7.5% at 2 weeks (series 1-2); 67.5 and 32.5% (3-4); 82.5 and 35% (5-6); 100 and 70% (7-8); 100 and 87.5% (9-10). Two trainees obtained 100% patency at 2 weeks after series 9-10. Other three needed two more series. There is a significant statistic difference (P < 0.01) between the results at 30 min and 2 weeks for the series (1-2, 3-4, 5-6, 7-8). The patency rate at 2 weeks reflects in a better way the microsurgical skills of a trainee. For long term functioning anastomosis, the training period needs an extension beyond that necessary for 100% patency at 30 min.