[About Clinical Applicatoin of Local Rotation Plasty].

Introduction: Local rotation plasty is a well-known and well-accepted plastic surgery tool for the body surface defects treatment. Because of some new theoretical streams in the literature, authors performed their own researches among oncological, non-oncological cases in which the method was performed as a part of surgical treatment. Aim: The aim of this study is a clinical analysis of local plasty application in different anatomical regions of the human body. Material and Methods: A retrospective study was performed among 54 consecutives local plasty surgical cases. Results and discussion: Between 01.2010 and 01.2015 54 consecutive patients were treated with local plasty surgical approach. 39 of them were man and 15 - women. The median age of the participants was 62,5 years for the man and 57.5 years for the women. In the 24,07 % of all cases the rotation angle chosen was 90°, and in the other 75,93% of all cases this one was lower 90°. Postoperative complication were established in 9,26 % ±4,25 % mainly in the greater angle rotation group. All of them were conservatively managed without reconstructive failure. We discuss our results with those obtained in the literature focused on some new streams in the local plasty applications.

Tissue expansion used as a method of reconstructive surgery in childhood.

Tissue expansion has developed as an important routine procedure in plastic and reconstructive surgery in the past two decades. It is used progressively in cases of reconstruction treatment for children and adults who do not have enough adjacent tissue for reconstruction of the skin surface that is defective as a result of a trauma, burns, or congenital deformation. When applied to children, the method of tissue expansion enabled us to achieve aesthetic and functional results that had not been obtained before with traditional procedures of reconstructive surgery. This paper presents the results of tissue expansion in 62 children in the period 2000-2006 treated in the Burns and Plastic Surgery Centre in Sofia, Bulgaria. Seventy expanders with different forms and different volumes varying from 50-1000 ml were used as treatment according to the specific goals for reconstruction. The indications for using tissue expanders for children were the following: skin and soft-tissue defects after deep burns and injuries, traumatic defects, and pigmented stains. The children in this study of tissue expansion were 39 boys and 23 girls. The higher percentage (64%) of injured boys was due to the higher occurrence of traumatism among boys. The anatomical areas subjected to tissue expansion in relation to the reconstruction of the primary tissue defects were as follows: scalp, face, neck, mental area, breast area, sacral area, back, and upper and lower extremity. More than one tissue expander was placed in the same area in five children during a single operational phase. We observed functional recovery and excellent aesthetic results in 85% of the patients who underwent the tissue expansion treatment. The lowest percentage of complications was reported in the group of children aged 4-7 yr, i.e. 3.22%.

Effect of early nutritional support on clinical course and septic complications in patients with severe burns.

Retrospective and prospective analyses of methods for nutritional support were carried out to assess their efficiency in covering the calculated caloric and protein needs of patients with severe burns. The energy and protein needs of the patients in Group 1 (study group) with nutritional support started 24 h after the thermal trauma were determined by the Toronto formula or by means of indirect calorimetry. Nutritional support of patients in Group 2 (control group) were initiated on day 4 post-trauma. The patients in the two groups were similar in respect to age, gender, body surface area burned, and injury severity score. We found statistically significant differences in the metabolic response of both groups as measured by nitrogen balance, serum proteins, and absolute lymphocyte count. Significant differences were also registered in body weight loss, number of positive haemocultures, and the complications rate.

Comparison of four drugs for local treatment of burn wounds.

Effective local treatment is very important in preventing wound infection and its generalization and ensuring successful skin grafting. The aim of our study is to compare the activity of four topical agents [deflamol (20 patients), polyvidone-iodine (21 patients), flammazine (silver sulphadiazine--SSD) (28 patients) and flammacerium (SSD with cerium nitrate) (five patients)] for treatment of patients with burns by confirming our clinical observations of their efficacy with comparative bacteriological investigations. The final estimation of our results showed the undoubted priority of flammazine and flammacerium over deflamol and polyvidone-iodine, as the treatment of all the patients with these two drugs gave very good and good results, respectively. In contrast, the results in 70% of the patients from the deflamol group and in 52.4% of those from the polyvidone-iodine group were unsatisfactory. At this stage we cannot find any significant differences in the antibacterial activity between flammazine and flammacerium. However, the excision of the firm eschars formed by flammacerium is easier and it gives the opportunity to postpone operation for a month or more. In conclusion we found suitable indications for preference of each of the topical agents included in our study.

First aid and transportation of burned patients during mass disasters.

Twenty-eight mass burn disasters in Bulgaria with 381 injuries in the last 27 years (1968-1994) were reviewed. Mass burn disasters were classified as follows: industrial accidents, 23, with 273 injured and 103 dead; traffic accidents, 2, with 97 injured and 30 dead; domestic accidents, 2, with 11 injured and 6 dead. Organization of first aid at the disaster site and in the regional hospitals is described, as well as the time of transport of the patients to major hospitals near the site of the accident. As a priority, the injured were transported early to the biggest center for burns and plastic surgery in the capital.

Suicide by self-inflicted burns.

Eighty-nine patients who had made an attempt on their life by self-burning were reviewed. For 12 years (1983-94) these patients were treated at the Institute of Emergency Medicine 'Pirogov', Sofia (Bulgaria). The gender distribution was almost equal (48 males: 41 females); the most vulnerable age was 20-40 years (57 patients) (64.05 per cent). Flame was the preferred thermal agent of attempted suicide (chosen by 72 patients), followed by electricity (11 patients). Thirty-one of the injured persons died (34.8 per cent). Forty-six of those who survived were operated on (116 surgical interventions: an average of 2.52 operations per patient) the mean length of treatment was 56.3 days. Eleven of the operated patients died subsequently (average stay in the hospital 8.20 days). There were some difficulties in collecting data about this method of self-harming. Twenty-three of the patients had recognized psychic disorders, in 43 of the patients the accident was preceeded by an agitated depression; in 15 by severe alcoholism. Emphasis is placed on the role of joint teams of physicians, psychologists and sociologists, for the treatment of these difficult patients.

Staphylococcal infections in the Sofia Burn Centre, Bulgaria.

This study analysed staphylococcal infections in the Sofia Burns Centre in order to estimate their frequency, features and role in burns. For an 8-year period (1987-94) the bacterial aetiology of wound infections and bacteraemia in burned patients was studied. The prevalence of staphylococci in both wound exudation (31.4 per cent) and in blood cultures (60.7 per cent) was established. During the last year of the study there was a significant increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) from 19.4 per cent in 1993 to 28.0 per cent in 1994 (P < 0.001). This raised serious therapeutic problems. MRSA were found more frequently in the ICU than in the wards and in wounds and blood cultures compared with other species/strains. MRSA caused infections in 18.8 percent of patients. Over 70 per cent of the MRSA strains were resistant to gentamicin, erythromycin and tetracycline and about one-third to lincomycin, co-trimoxazole, chloramphenicol and ciprofloxacin. All the MRSA strains were sensitive to vancomycin and 71.1 per cent to rifampicin. These findings show the necessity of urgent measures for restriction of the further distribution of MRSA infections in our burns centre.