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.

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.

Transplantation of composite tissue allograft: scientific bases and clinical applications.

Plastic surgery is by excellence a surgery in permanent search for new reconstructive options. In the last 50 years researches in the field of allotransplantation led to obtaining promising results for solving difficult cases when autologous tissues are not available for reconstruction, despite all the bioethical issues of this subject. This field of composite tissue transplantation evolved constantly, the top of it being total face transplantation, successfully accomplished while being based on the knowledge accumulated. There are many clinical applications of CTA, hand transplantation or only flexor tendon apparatus, lower limb, partial or complete face transplantations represent the most important part for us, plastic surgeons for obtaining the best reconstruction possible.

Integrative emphases on intimate, intrinsic propensity/pathological processes--causes of self recovery limits and also, subtle related targets for neuroprotectionl pleiotropicity/multimodal actions, by accessible therapeutic approaches--in spinal cord injuries.

BACKGROUND: The last two decades have come up with some important progresses in the genetic, immune, histochemical and bio (nano)-technological domains, that have provided new insight into cellular/molecular mechanisms, occurring in the central nervous system (CNS)--including in spinal cord-injuries. METHODS: In previous works, emerging from our theoretical and practical endeavors in the field, we have thoroughly described the principal intimate propensity and the pathophysiological processes--representing intrinsic limitations for self-recovery after SCI, and, at the same time, subtle targets for neuroprotection/recovery--and reviewed the main related worldwide-published reports. The aim of this paper is to emphasize the connections between such main aspects and some feasible integrative solutions, including the ones for clinical practice. RESULTS: Consequently, we stress upon some therapeutic suggestions regarding this subject matter by systematizing the most up to date and efficient ones--obviously, within major limits, according to the very low capacities of CNS/ spinal cord (SC) to post-injury self preserve and recover. Moreover, we also talk about accessible drugs, respectively those being already in clinical use (but at present, mainly used to treat other conditions, including the neurological ones) and hence, with relatively well known, determined effects and/or respectively, restrictions. DISCUSSIONS: The recent advances in the knowledge on the basic components of the afore mentioned CNS/ SC propensity for self destroying and inefficient endogenous repair mechanisms in the actual new context, will hopefully be, from now on, more effectively correlated with revolutionary--mostly still experimental--treatments, especially by using stem cells within tissue engineering, including, if needed, more advanced/courageous approaches, based on somatic cell nuclear transfer (SCNT). CONCLUSIONS: This paper contains the scientific motivated highlighting of some already available drugs, "neuroprotective" (and not only) properties too, which enable practitioners with (although not yet capable to cure--but anyway) more efficient therapeutic means, to approach the extremely difficult and still painfully disappointing domain, of spinal cord injury (SCI).

Incidence and significance of precipitating antibodies in occupational and non-occupational extrinsic non-atopic (type III) asthma (bronchial asthma with precipitins).

Precipitating antibodies against different organic enviromental dusts were studied in 37 patients with suggestive symptoms of nonatopic bronchial asthma, comparatively with a group of 4 patients with atopic asthma and with a group of asymptomatic subjects, exposed to the same organic dusts as the majority of patients. Precipitins were found present in over 75% of the sera from patients with infectious type non-atopic asthma and were associated with positive semidelayed type skin tests as well as with positive bronchial provocation tests a few hours after antigen inhalation. No precipitins were found in the sera from patients with atopic asthma. Precipitating antibodies were also found but in lower percentages (30%) and at lower titers, in clinically asymptomatic subjects who were occupationally exposed to the respective antigens. It was demonstrated that the presence of precipitins in the sera of patients with bronchial asthma is a valuable diagnostic element which confirms the clinical and anamnestic data. The pathogenic role of precipitins is not yet clear. It might be related to the amount of these precipitins in the serum.