[Vascularised Fibula and Tendon Transfer in the Comprehensive Treatment of Forearm Fracture with Gas Gangrene Complication]. / Vaskularizovaná fibula a slachový transfer v komplexnej liecbe otvorenej zlomeniny predlaktia komplikovanej plynnou snetou.

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.

Adipose derived mesenchymal stem cells harvesting.

BACKGROUND: The lipografting is increasingly used in the field of plastic surgery. Widely used harvesting technique of fatderived stem-cells is lipoaspiration. There exist two big streams of fat harvesting for lipografting: mechanical liposuction and manual liposuction. METHODS: Two harvested specimens were compared in this prospective blind study in the means of stem-cells viability and their ability to grow in cell-cultures. Techniques to compare were: manual lipoaspiration with 50 ml syringe and WAL (water-jet assisted liposuction). RESULTS: Twenty specimens from ten patients were investigated in the tissue bank. There were no differences in the amount of live stem-cells between two groups. Also no differences were found between both harvesting techniques in the mean of cell ability to grow in cell-cultures. CONCLUSION: It can be concluded that there are no statistically significant differences in the number, vitality and viability of stem cells when comparing two ways of mesenchymal stem cell collection, both manual and machine sampling (WAL). When cultured in vitro, both samples collected from each patient also appeared to be able to multiply with no statistical differences (Tab. 2, Fig. 2, Ref. 18).

Primary reconstruction of pharyngo-oesophageal defects in oncologic patients.

OBJECTIVES: Majority of patients that undergo total or partial removal of the hypopharynx and cervical oesophagus are oncologic patients. Optimal management of head and neck malignancies requires multimodal therapy including surgical ablation, reconstruction, and adjuvant oncologic therapy. Despite aggressive surgical and adjuvant therapy, a five-year survival rate is achieved only in 25-35 %. METHODS: In the presented retrospective study, the choice of reconstructive method was influenced by type, length and extent of the defect, and condition of patient. The flap was indicated when the defect not allowed for primary suture of the hypopharynx and/or cervical oesophagus. Two-team approach was used. RESULTS: The study was based on the data of ten patients. Radial forearm flap was used in 8 cases; pectoralis major myocutaneous flap was used in 3 patients, and ALT perforator free flap in 1 case. A total of 12 flaps were used for 10 patients. Two patients developed free flap necrosis. These necrotic flaps were substituted with pedicled pectoralis major myocutaneous flaps. CONCLUSIONS: The primary reconstruction of the pharyngo-oesophageal defects could be the method of choice. For the partial defects, the best choice could be a radial forearm free flap. For circumferential defects, jejunal flap could be the best. The pectoralis major pedicled flap could be a safe procedure for elderly patients with multiple medical problems (Tab. 6, Fig. 2, Ref. 34).

Prevalence of cleft lip and palate in western Slovakia in the years 2001-2007.

OBJECTIVES: The aim of this study was to investigate the prevalence of orofacial clefts (OC) in live newborns from 2001 to 2007 in Western Slovakia and correlate their occurrence with a number of relevant seasonal and geographical factors and epidemiological trend of this condition. In this study we used retrospective active survey collecting clinical data of 220 children with OC registered and operated at the cleft centre in Bratislava. Our study group included 67 patients from Bratislava region and 151 patients from the remaining Western Slovakia (Nitra, Trnava, Trencín regions). Data of live births was obtained from Health Statistics of the Slovak Republic. RESULTS: Total incidence (TI) of 1.49/1000 live births (LB) in the region of Western Slovakia in 2001-2007 marked a decrease of prevalence compared to 1.64/1000 LB in the years 1985-2000. Bratislava region dominated in total prevalence of 1.82/1000 LB compared to the rest of Western Slovakia regions with 1.37/1000 LB. Most observed cleft type was the CP with 38.6 % frequency, followed by CLP with 35.5 % and CL with a frequency of 24.1 %. The frequency of AM with 1.82 % was the lowest. CONCLUSION: The results showed that the frequency risk rate of a birth of a child with OC was 1 to 671 LB in Western Slovakia. The data proved a higher prevalence of OC in Bratislava region with 1 child with this type of congenital anomaly to 549 LB compared with 1 child with OC to 730 LB in the rest of the Western Slovakia regions (Tab. 7, Ref. 16).

Interaction of human adipose tissue-derived mesenchymal stromal cells with breast cancer cells.

Human adipose tissue was shown to be a very attractive source of mesenchymal stromal cells that have a wide scale of potential applications in reconstructive plastic surgery and regenerative medicine. However, these cells were described to have profound effects on biological behaviour of tumour cells. The aim of this study was to analyze the influence of adipose tissue-derived human mesenchymal stromal cells (AT-MSC) on the proliferation of breast cancer cells. We have tested proliferation of three different human breast cancer cell lines under the influence of AT-MSC derived soluble factors as well as in the direct cocultures. These data were supplemented with the expression analysis of cytokines and their cognate receptors on the target cells. We have observed stimulation of proliferation in breast cancer cells MDA-MB-361, T47D and EGFP-MCF7. AT-MSC were found to secrete wide scale of cytokines, chemokines and growth factors, thus we concluded that this pro-proliferative effect was a result of their synergistic action. These data bring out a need to evaluate whether primary breast tumour derived human cells would respond to these type of stimuli in a similar manner in order to exclude any potential clinical risk related to the application of human mesenchymal stromal cells under the context of patient with history of breast cancer malignancy.

Vascularized free fibular graft in the treatment of congenital pseudarthrosis of tibia.

UNLABELLED: Aim of the study was to evaluate the results of the patients with "congenital pseudartrosis of tibia" treated by vascularized fibular graft transferred from the contralateral calf. MATERIAL AND METHODS: The cohort consist of four patients (2 boys and 2 girls) aged 5.75 y (range 4-8 years) in the time of the transfer of vascularized fibular graft from the contralateral calf into the resected tibia suffered from pseudarthrosis Crawford type II, III and IV. Patients were operated on between 1999-2007. RESULTS: A total graft union was achieved in three patients in one-year follow-up period. In one girl, treatment failed due to infection and was treated later with intramedullar Rush nail fixation and additional spongioplasty with an unsatisfactory result. CONCLUSION: Authors believe that after an accurate preoperative planning in cooperation with the microsurgeon, the treatment of congenital pseudarthrosis of the tibia by vascullarized fibular graft should be considered as a very effective, accurate and relatively safe method (Tab. 2, Fig. 4, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Reconstruction of a circular defect of the hypopharynx and cervical part of esophagus by a free jejunal flap (case report).

Patients with impaired continuity of the upper gastrointestinal tract are dependent on gastrostomy or jejunostomy tube feeds, which significantly reduce their quality of life. Reconstruction of the hypopharynx and esophagus is desirable in cases of congenital deformities, corrosive injuries, or defects after tumor resections. Free flap allows for easier reconstruction of head and neck defects. In this article, the authors present a case of complete hypopharynx closure in an oncology patient with a larynx carcinoma. The patient is a 60-year-old male diagnosed in 2002 with epidermoid carcinoma of larynx. The patient underwent laser resection of the tumor followed by radiotherapy and chemotherapy. In 2003 the patient underwent pharyngo - laryngectomy for relapse of the larynx carcinoma. Postoperatively the patient developed pharyngo - cutaneous fistula, which was reconstructed at the otorhinolaryngology department by a muscle - cutaneous flap from the pectoralis major muscle. During the course of healing the patient developed complete hypopharynx and cervical esophagus closure. Free flap of jejunum was recommended. The surgery team used a 10 cm long section of jejunum; the recipient blood vessels were arteria transversa colli and internal jugular vein. On the second day after the surgery patient developed salivary fistula in the wound. The fistula healed spontaneously in five weeks. Pharyngoscopy revealed that the transplanted jejunum was fully vital. Free flap of the jejunum allowed for upper gastrointestinal tract reconstruction and allowed the patient to restart peroral intake.

Restoration of upper extremity function after peripheral nerve injuries.

These days injuries to the peripheral nerves of the upper extremity that necessitate total or partial lesion are very common in the household and working environment. With regard to the majority of these injuries, not only plastic surgeons or neurosurgeons must have knowledge of their correct treatment, but general surgeons as well. The principles of reconstruction of the peripheral nerves of the upper extremity are described. The authors refer to immediate and delayed nerve repair, free nerve grafting, free vascularised nerve grafting, tendon transfer for a paralyzed hand, pedicled muscle transfer, functioning free muscle transplantation and neurotization.

[Tendon transfer of the extensor carpi radialis longus muscle in tendon rupture of the extensor pollicis muscle]. / Skúsenosti s transpozíciou slachy m. extensor carpi radialis longus po ruptúre slachy m. extensor pollicis longus.

The most common ruptures of all of the tendons of the hand are those of the extensor pollicis longus tendon (EPL). As to its etiology, the rupture of EPL can spontaneously occur tendosynovitis in rheumatic patients or rarely in result of conservative treatment of distal forearm fractures. During the last 18 months, 4 cases of EPL ruptures following the conservative treatment of distal forearm fractures have been diagnosed in our clinical material. All patients underwent the transfer of extensor carpi radialis longus (ECRL) tendon due to. We present our indications of the technique, and the clinical results. (Fig. 3, Ref. 8.)