Acta Chirurgiae Plasticae

The purpose of the present study was to confirm the clinical expediency of using a particular type of biological skin substitute--porcine skin xenograft--in the treatment of partial-thickness scald burns. Over a period of three years (from the beginning of the 2005 to the end of the 2007) 109 admitted patients with partial-thickness scald burns were treated with skin xenografts. The mean age of the patients was 7.6 years (S.D.: 15.3), while mean TBSA was 13% (S.D.: 8.2). The number of patients healed by the 14th day postburn or sooner and their mean healing time, the mean healing time for all 109 patients, mean hospital stay and number of patients undergoing surgery were all evaluated. Of the 109 patients, 78 (71%) healed within 14 days with a mean time of 9.6 days (S.D.: 3.2). One sample t-test which compared mean healing times achieved within 14 days with the value of 14 days established a significant difference (p = 0.0001). For all 109 cases the mean healing time was 15.1 days (S.D.: 11.6), with no significant difference between mean healing times and the value of 14 days (p = 0.3). The mean hospital stay was up to 10 days (S.D.: 6.7). Four patients (3.6%) received split thickness skin grafts with an average extent of 4.5% TBSA. The data obtained were compared with similar studies and other treatment options for this indication and were discussed. This retrospective study proves the clinical efficiency of using skin xenografts for the treatment of partial-thickness scald burns. Skin xenografts showed good adherence on the wound surfaces, decreased the amount of exudate and reduced pain. In addition, the risk of hypertrophic scar formation was lower when wound healing was achieved within 14 days.
The Bratislava Burn Department was founded and started its activity 5 years ago. The department serves an area with 2.5 million of inhabitants with mixed both urban and rural population. We tried to analyze epidemiological data of 1119 acute burn injuries treated at the Department during a five-year period. All the data were compiled from statistical burn charts of in-patients. The average annual number of acute burn admissions including referrals was approximately 200 patients. We could see a distinct male predominance in almost all of the age groups with an average male to female ratio of 2.1:1. Children represented 38.1% of all the treated burn patients. The age group with the highest number of patients was in children 0-3 years with 237 patients (21.1%), and in adults 16-30 years with 197 patients (17.6%). The extent of burns varied between 1 and 99% of the BSA. The mean burn size was 15.7% of the BSA. The majority of the accidents were caused by hot liquids, followed closely by flame and/or explosion--they represented 43% and 36%, respectively. Concerning the place and/or cause of the accidents, the majority of burns occurred at homes, they represent 81.5% of the cases. Only 18.5% occurred at work, mostly in industry. Almost all of the injuries were caused by negligence. The rate of suicides by our patients was very low, less than 1%. 83 patients died, only 3 of them were children. The overall mortality rate was 7.3%. The mortality rate in children was as low as 0.7%. We compared our data with similar studies done in Kosice (Slovakia), Spain, and Brazil.(ABSTRACT TRUNCATED AT 250 WORDS)
A new system of classification, index of deep burn injuries (IDBI), was proposed in this paper. Using this system, we investigated 304 burn sites in 117 cases, of which 94.1% were repaired with the GCM with a satisfactory result. The IDBI of the 304 burn sites is in direct proportion to the severity and extent of burn injury and inverse ratio to the results. Analyses performed in this group suggested that the IDBI has many significances, which include: 1, making a correct diagnosis; 2, providing decided repair indications; 3, indicating the prognosis; 4, providing a reliable method for further investigation in the burn field. The standard of IV degree burn is equal to or more than 2 of IDBI.
Reduction mammaplasty, one of the most common plastic surgery procedures, has been shown to confer significant sustained health benefits for patients with symptomatic breast enlargement providing a remedy for back, neck, and shoulder pain. Unfortunately, operations of breast reduction may lead to patient dissatisfaction for poor aesthetic outcome due to complications. Complications, including infection, hematoma, seroma, dehiscence, fat necrosis, and skin loss, may occur in as many as 50% of patients. Unacceptable scarring has also been reported. Complication data revealed several significant features, although there isn't much objective evidence to support that. Over the period 2004-2008, 127 consecutive patients were admitted for breast reduction surgery, data have been analyzed retrospectively to determine whether any correlation could be found between complication rate and perioperative risk-factors using a multifactorial ANOVA F-test. Analysis of variables associated with complications showed that, after adjusting for age and smoking status, only BMI was associated with any complication (p < 0.05). By power analysis, based on a comparison of three proportions, a power of 92% with a significance level of 0.05 was found for the hypothesis that the outcomes of the procedures depends on BMI.
Plexiform neurofibromas (PN) are one of the most common and severe types of neurofibroma that occur in neurofibromatosis type I. These tumours affect long portions of nerves, infiltrating the nerve and surrounding tissue thus causing significant pain, deformity and functional problems in the affected part of the body. Treatment of this variant of neurofibromas is currently surgical. The aim of this study was to analyze the surgical treatment of plexiform neurofibromas in the lower and upper extremities. The clinical pathological features of 29 neurofibromas, 12 in the upper extremities and 17 in the lower extremities, as diagnosed at the Department of Plastic and Reconstructive Surgery of University "La Sapienza" in Rome from 2000 to 2007, were reviewed. We established that subtotal and total resection without functional destruction is often possible for superficial PN.
The investigation is based on a longitudinal cephalometric investigation of lateral teleroentgenographic pictures of male patients with a complete unilateral cleft of the lip and palate. Using cluster analysis the authors investigated the relationship of 75 craniofacial characteristics of size, shape and position during the time interval from 10 to 18 years of age. The main objective of the work was to characterize the development of intracranial relations during the pubertal spurt and compare the final condition in adulthood with a control group. The angle of the cranial base and its effect on the position of the mandibular joint did not change during the investigation period. The relationship between the rotation of the mandible and the inclination of the upper alveolar process with the protrusion of different parts of the skeletal profile also remained constant. Up to adulthood, the rotation of the mandible developed independently of the sagittal intermaxillary relations. The relationship between the sagittal intermaxillary relations and other parts of the face did, however, change. Before the onset of puberty it was influenced most by the reduced length of the maxilla. The inadequacy of maxillary growth was balanced during this period by a change in the shape and position of the mandible. Its adaptative capacities could not compensate later for this uneven development of the jaws potentiated by the pubertal growth spurt. Due to this the intermaxillary relations deteriorated at the end of development in the majority of patients. The association of the restricted vertical maxillary growth with its retroposition was manifested only in adulthood. Intracranial relations of the control group differed from those in the group with clefts. Sagittal intermaxillary and dental relations were not associated in healthy men. As individual probands were not linked by any restriction of growth or development, no close relationship developed between the shape characteristics of the lower jaw, which is the main compensatory adaptative mechanism.
The development of surface measurements of the palpebral fissures and age-related changes in the quality of the relationships between the individual measurements were followed in 1552 healthy Caucasians between ages 2 and 18. At age 2, the height of the palpebral fissure and the biocular width (ex-ex) were the most developed features (93.3% and 86%) and the least developed was the intercanthal width (77.6% to 82.9%). The measurements reached adult size between ages 8 (intercanthal width in girls) and 16 (palpebral fissure inclination in boys). The rate of growth in the orbital measurements was usually moderate, seldom above-average and fast only in intercanthal width between ages 3 and 4. The study determined the periods with minimal growth (approximately ages 5 to 7 and 9 to 10) for each of the measurements. After maturation, the changes in measurements were minimal. A knowledge of the developmental levels of the measurements at an early age, their changes with age and their maturation times are of great importance in timing early or final corrective surgical procedures.
Frequency of associated non-hand anomalies 
Tubiana's classification of Dupuytren's desease 
Objective: To evaluate the incidence, therapy results and complications of operatively treated congenital disorders of the hand in a large state hospital during a 14-year period. Method: The institutional database was retrospectively analysed for patients with congenital disorders of the hand during a 14-year period (1998-2012). Disorders were classified according to the modified Swanson classification. For each entity, the incidence, the patients age at the time of the operation and operation techniques were evaluated. Results: A total of 191 patients was treated operatively for the congenital disorders of the hand with syndactyly being present in 87, polydactyly in 66, constriction ring syndrome in 7, clinodactyly in 5, macrodactyly in 10, camptodactyly in 8, cleft hand in 5 and thumb hypoplasia in 3 cases. Patients age at the time of the operation was 5.2 as a mean value. Conclusion: Congenital hand deformities were seen 1.5 times in male patients compared with female patients. In complex cases where bone deformities seem to disrupt the soft tissue envelope development, surgery is indicated at a preschool age.
The use of local anaesthetic infiltration with adrenaline is now considered safe in reduction mammaplasty. However, the technique of infiltration by those who support its use is often unclear. Any technique must take account of the neurovascular anatomy of the breast if it is to be effective. We propose the use of a large volume of dilute local anaesthetic (20 ml of 1% lignocaine and 1 mg of adrenaline made up to 400 ml with 0.9% saline) which is placed judiciously in the retroglandular space 15 minutes prior to surgery. The results in 96 consecutive patients (192 breasts) who had an inferior pedicle technique were analysed. The breast complication rate was 9.36% and the patient complication rate 19.79%. Postoperative blood loss ranged from 0 to 305 ml with a mean of 56.03 ml and a median of 50 ml. The described method could be considered a variation of the tumescent technique used in liposuction. The results is an almost bloodless dissection with minimal postoperative blood loss. It should be possible to dispense with the use of drains in most cases.
Our Burn Specific Health Scale was initially developed in 1978. Using a number of existing health scales, including the sickness impact profile, a depression scale, and the activities of daily living scale, and a large number of burn specific items derived from staff and patients, we eventually developed an 80 item instrument. This instrument was divided into four domains each containing 20 items of equal weight. The instrument was validated sequentially with intrarater, interrater and global validation systems, and subsequently compared with a number of other health and mental scales during which it performed very well. We now have longitudinal data which link this measurement system of quality of life to pre-injury educational level, to post-injury, stress disorder and predictability of return to work. The results indicate that total burn size has little to do with quality of life after recovery, and that a number of other factors play a bigger role, which will be presented.
Over 132,783 newborns from 1981-1995 have been analysed revealing 267 infants with cleft lip and/or palate resulting in a mean frequency of clefts at 2:1000. Additionally, the forms and sides of clefts, and sex of the children with clefts have been defined. The comparison of the studies in Lodz from 1951-65 and 1981-95 indicates a slight increase in the occurrence of clefts.
Between 1983 and 1997 a total of 2029 children with CL/P (cleft lip, cleft lip and palate or cleft palate), who were born in the Bohemian districts of the Czech Republic and who underwent surgery and treatment at the Clinic of Plastic Surgery in Prague, were analysed. One possibility for decreasing the risk of delivery of a child with CL/P is to decrease or eliminate its prenatal exposure to embryotoxic factors. Detection of the embryotoxic factors acting at the individual level (e.g. elevated temperature, drug consumption, x-ray examination or infection) is easier than the detection of embryotoxic factors operating at the population level (e.g. water contamination, air pollution). When searching for the latter factors, we first have to reveal regional differences in CL/P incidence. The aim of the present paper was to determine significant differences in the mean incidence of newborns with CL/P in Bohemian districts during a 15 year period. The correlation between the incidence of CL/P and the birth rate in the different districts was also examined. The mean incidence of CL/P in all Bohemian districts was 1.86 per 1000 newborns (1.86/1000). Districts were divided into three groups, according to significant differences in the incidence of CL/P using a confidence interval. The lowest mean incidence of CL/P was detected in the Svitavy district (0.72/1000) and Louny (1.05/1000). The highest mean incidence was found in the Beroun district (2.86/1000). Besides Beroun, a high mean incidence of CL/P (more than 1.96/1000) was also found in Klatovy, Mĕlník, Tábor, Kolín, Semily, Ceská Lípa, Pardubice, Teplice, Ceský Krumlov, Sokolov, Chomutov, Praha-západ, Jicín, Rakovník, Kladno, Prachatice, Rokycany, Tachov, Liberec, Pelhrimov. Paradoxically, the districts with a higher or lower birth rate exhibited a lower (1.62/1000) or higher (1.92/1000) incidence of CL/P, respectively. Future studies should elucidate whether the significant regional differences in the incidence of CL/P can be related to differing exposure of pregnant women to harmful environmental embryotoxic factors.
Orofacial clefts are common congenital anomalies. The aim of this study was to assess the incidence in Western Slovakia. The study material were the case records of infants from the Bratislava and Western Slovakia regions, born between 1985 and 2000, and operated on in the Department of Plastic Surgery, Faculty of Medicine, Commenius University, General Hospital Ruzinov, in Bratislava. Of 409,205 live births in this period, 670 children were born with OC (orofacial clefts) and operated in the above-mentioned department. This study found a total incidence of 1.64/1000 live births. Compared to the Western Slovakia region, the incidence was higher in Bratislava. Of the different types of OC, CLP was the commonest, with a male preponderance of OC at the rate of 1.16:1. The available data showed significant differences of clefts in some of the studied districts, which could be a base for an intensive follow-up of endemic (genetic and exogenous) factors.
The authors analyze the epidemiology and trend of thermal injuries in Slovakia since 1990. The article includes statistics from both of the burn injury workplaces in Bratislava and Kosice. The article contains conclusions and proposals for preventive measures which have contributed to the decrease of thermal injuries in Slovakia since 2000.
The authors evaluate the mortality of severely burned children hospitalized in the Intensive Care Unit, Prague Burns Centre from 1994 till 1997. There were hospitalized 345 children (aged 3 months-15 years, 1%-88% TBSA, mixed superficial and deep burns). No child died from burn shock during the early postburn period. Five children who died suffered deep burns greater than 50% of TBSA and at necropsy there were identified signs of multiple organ system failure which was related to infection.
During the period from 1994-1999, 226 patients were treated, incl. 91 replantations and 135 revascularizations. The group included 199 men and 27 women. The success rate of microsurgical reconstruction operations in replantations was 78%, in revascularizations 93%. As compared with the period 1984-1993, the success rate in replantations improved by 4%, while the indication pattern was preserved.
There are many possibilities for breast reconstruction after mastectomy. The use of abdominal advancement flap in combination with silicone implant is among the less commonly used methods, although it is simple, fast and leads to excellent results. We started to use this technique at our department eight years ago. Since then we have performed 207 breast reconstructions using abdominal advancement flap in combination with silicone implants. We performed follow-up checks on the patients for between one and six years. Key words: breast reconstruction, abdominal advancement flap.
Enzymatic debridement by the use of a proteolytic enzyme complex derived, isolated and purified from pineapple stems proves to be an innovative, rapid, effective, selective and safe method of postburn necrotic skin removal. The major advantages of the procedure include minimal invasivity, rapidity, effectiveness, possibility to perform the debridement at the bedside, minimal or no loss of blood and minimal interference with natural wound healing processes. Our preliminary experience with this treatment method showed that in most of the cases treated the debridement was excellent, safe and rapid. The average duration of the debridement was less than 4 hours. The debridement was accompanied by minor to moderate pain which could be treated by analgetic medications. No serious adverse events or reactions have been observed during the study. The time for healing was comparable with the standard of care methods. The second randomized multicenter study is still in progress and has not yet been finished.
Background: Preoperative evaluation of the anatomical features of the region around the breast is strongly recommended in order to choose the most appropriate technique of reductive mammaplasty. Normally breast hypertrophy presents itself as a bilateral clinical picture, but no study in the literature refers to the incidence of volumetric asymmetry. Aims: This study aims to analyze weight differences between the right and left breast on a selected sample of patients who underwent reductive mammaplasty or mastopexy over the last five years at our Plastic Surgery Unit and have maintained a good postoperative symmetry for at least 1 year subsequently. Patients and method: 344 consecutive cases treated between January 2005 and April 2010 were considered for this study. Patients were classified according to the degree of hypertrophy and age. Breast asymmetry was scored, according to the senior author's original classification, on the weight difference of glandular resection. Results and conclusion: In 20% of the patients a difference greater than 200 g was found. The statistical analysis showed no significant differences in the predominant side (left or right). Breast hypertrophy is confirmed as a substantially bilateral pathology, but in 1 out of 5 patients a difference of more than one quadrant can be present: thus a careful evaluation is essential in order to decide the correct surgical strategy.
Within the framework of a research project concerning hard palate morphometry in facial clefts, optical non-contact 3D profilometry based on the Fourier transform method was applied. The article discusses the principle of Fourier transform profilometry, the procedure for image acquisition and processing, as well as the merits of this method in the study of palate morphology.
The effect of FC-43 perfluorocarbon emulsion and alpha-tocopherol on lipid peroxidative damage and deformability of erythrocytes was evaluated in rats (full skin thickness burns over 15-20% of total body surface) at third hour after burns. The animals were divided into five groups: (1) non-burnt non-treated (controls); (2) burnt non-treated; (3) burnt but treated with alpha-tocopherol ("Serva", Germany, 20 mg/kg b.m. i.p.) (4) burnt treated with FC-43 emulsion ("Green Cross Corp.," Japan, 5 ml/kg, i.v.); (5) burnt treated with combination of alpha-tocopherol (20 mg/kg) and FC-43 perfluorocarbon emulsion (5 ml/kg). In the burnt non-treated group the concentration of alpha-tocopherol decreased by 38% (p < 0.05), the levels of malonyl dialdehyde (MDA) and fluorescent damaged products raised by 32% (p < 0.001) and by 52% (p < 0.001) of the controls, respectively, whereas the deformability of red blood cells diminished by 34% (p < 0.001). Both the accumulation of MDA and fluorescent lipid peroxidation products and the decrease in deformability of affected cells were suppressed significantly by alpha-tocopherol treatment which also prevented the decrease in erythrocyte alpha-tocopherol content. FC-43 emulsion lowered the level of MDA but did not restrain the reduction in erythrocyte deformability significantly. The combined application of alpha-tocopherol and FC-43 emulsion immediately after thermal skin injury decreases peroxidative membrane damage and improved erythrocyte deformability more significantly than alpha-tocopherol at the third hour after thermal skin injury.
The author presents a brief analysis of burns sustained by patients over 60 years of age in order to point out the problems and pitfalls of therapy, and to propose measures designed with a view to improving the prognosis of thermal injury in this particular age category.
The objectives of this open-perspective clinical study were to test the effect of a new type of anaesthesia using sevofluran during surgical treatment of patients with burns, and to compare it with that of ketamin, at present the most frequently used anaesthetic. The study, conceived as a pilot study, was performed on 10 paediatric and 8 adult patients with 2nd degree burns covering between 7% and 35% of body surface. Owing to highly significant differences in parameters in favour of sevofluran, it was recommended by our ethical committee not to increase the number of patients. The parameters considered were ease of induction, undesirable effects, span of time before oral administration of liquids. Daily uptake of energy was measured for both types of anaesthetics in another group of 10 patients. In adult patients the two anaesthetics, ketamin versus sevofluran, differed in terms of incidence of unrest during surgery (ketamin 50% vs. sevofluran 0%, p < 0.05), time between end of surgery and return to full consciousness (11.3 min. vs. 2.7 min. p < 0.001), post-surgical inhibition (75% vs. 0%, p < 0.01) psychomimetic reactions after surgery (50% vs. 0%, p < 0.05), time until first intake of liquids (86.7 min. vs. 8.5 min, p < 0.001), and mobilisation (110.8 min. vs. 17 min., p < 0.001). In paedriatic patients, differences in speed of onset of anaesthesia (216 sec. vs. 66 sec., p < 0.001) and time until first uptake of liquids (75 min. vs. 22 min., p < 0.001) were statistically significant. Apart from problems associated with anesthesia, another considerable advantage of the new anaesthetic sevofluran was a significantly increased uptake of calories after use than was the case after ketamin (1645 kJ higher on the average, p < 0.05). Based on these results, sevofluran was introduced to burns surgery as a routine anaesthetic.
Different methods of primary mandibular reconstruction carried out at the Tata Memorial Cancer Hospital range from the pectoralis major myocutaneous or osteomyocutaneous composite flap, which is the most frequently performed procedure, to a free vascularised composite tissue transfer with microvascular anastomosis, including, iliac crest free vascularised bone grafts or radial artery forearm flap free vascularised radius bone grafts, free vascularised fibular bone grafts and silastic mandibular implants. The clinical results of immediate mandibular reconstruction with a silastic mandibular implant (SMI) in 69 patients is presented. Out of the 69 cases, 2 patients died in the early post-operative period. Twenty (30%) SMI were retained for a period of 1 year to 5 years. Forty seven (70%) SMI were retained for a period of less than 1 year. These implants have been used in a variety of cases, with or without major flap reconstruction, where a skeletal support was indicated, especially after mandibular arch resection. The results of this series indicates the importance of these implants as a short term spacer, even in advanced, fungating lesions of head and neck cancer where the risk of infection, haematoma and salivary leak is very high. Bone replacements were undertaken at a later date in suitable cases. The effects of preoperative chemotherapy and radiotherapy on the retention of these implants has also been studied.
Both in experiments and on patients, calf rib cartilage, conserved by deep freezing and in 70% alcohol, was used for transplantation. Two series of experiments on 55 rabbits with intervals of observation ranging from 4 days to 3 yr were carried out. The results showed that the grafts, after implantation into soft tissues, were sufficiently resistant to absorption. Superficial absorption and replacement by connective tissue was observed in parts of the grafts which had no perichondrium. Perichondrium prevents absorption of cartilage. Conserved heterologous cartilage was transplanted to 168 patients during a total of 188 operations carried out for various defects and deformations in the face. The late results were checked up after 1 to 10 yr in 110 patients. Good results were found in 78, satisfactory in 13 and poor in 19 patients. It was established that the results of chondroplasty are independent of the mode of conservation and the site of implantation. Large size implants show a better resistance to absorption than diced cartilage. Cracks and foci of ossification in the cartilage facilitate absorption. The good results permit one to recommend heterologous cartilage for reconstructive operations in the face as full value plastic material.
This is a retrospective analysis of a group of 67 senior citizens over 75 years of age who had been hospitalized at the Burn Center of the FNsP Hospital in Ostrava--Poruba in the years 1999 - 2003. We have studied a group of males and females, noting their average age, most common causes of burn injuries, mechanisms of burn injuries, average extent of burn injuries, and most commonly burned body parts. We have also reviewed the seriousness of burn injury in senior citizens, factors that complicated the course of treatment as well as its impact on the final therapeutic effect. The importance of specific approach and individual therapeutic strategy is emphasized. We would also like to emphasize the need for complex therapy approach due to secondary diseases that are very common in this age group. The treatment of burn patients in this age group is very challenging from a personal and economic point of view. The goals of therapy are a full recovery and the return of the patient to normal life. However, goals and therapeutic results are determined and limited by the above-mentioned factors. Nevertheless, every therapeutic success, although partial, should be perceived as positive. For the patient, every success from the point of view of the ability to take care of himself or herself and the overall quality of life is fundamental.
The authors describe successful healing of a burn injury covering 100% of TBSA with 96% full-thickness skin loss and inhalation injury. The patient was admitted to the burn department of our hospital on September the 4th 1987. He smoothly overcame the shock stage with help of fluid replacement and application of alkaline drugs in large quantities. Early escharectomy and repeated micrografting were performed. The treatment is discussed.
Top-cited authors
Miroslav Tvrdek
  • Fakultní nemocnice Královské Vinohrady
J. Veselý
  • St. Ann's University Hospital Brno
Mehdi Farahani
  • The Iran Banking Institute
Miroslav Peterka
  • Kralovske Vinohrady University Hospital in Prague
Günter Germann
  • Universität Heidelberg