Thirty-five years of the Department of Plastic Surgery and Burns Treatment at the University Hospital in Hradec Králové.

BACKGROUND: The Department of Plastic Surgery and Burns Treatment was established as a part of the newly created 2nd Department of Surgery of Charles University, Medical Faculty and the University Hospital in Hradec Králové in 1985. Through modest beginnings, activities of the Department expanded up to full coverage of specialized care in plastic surgery within the region with almost one million inhabitants. AIM: In this article, the most important events of several historical phases related to almost four decades are described. The aspects of medical personnel, technological and space equipment are especially emphasized. The Department has always been working on the principles of interdisciplinary co-operation within the department itself and other departments within the hospital as well. Over the past 35 years, the Department of Plastic Surgery and Burns Treatment has been firmly entrenched in the spectrum of specialized activities of the University Hospital in Hradec Králové.

Impact of Antibiotics Associated with the Development of Toxic Epidermal Necrolysis on Early and Late-Onset Infectious Complications.

Toxic epidermal necrolysis (TEN) is a rare disease, which predominantly manifests as damage to the skin and mucosa. Antibiotics count among the most common triggers of this hypersensitive reaction. Patients with TEN are highly susceptible to infectious complications due to the loss of protective barriers and immunosuppressant therapy. The aim of this study was to investigate the potential relationship between antibiotics used before the development of TEN and early and late-onset infectious complications in TEN patients. In this European multicentric retrospective study (Central European Lyell syndrome: therapeutic evaluation (CELESTE)), records showed that 18 patients with TEN used antibiotics (mostly aminopenicillins) before the disease development (group 1), while in 21 patients, TEN was triggered by another factor (group 2). The incidence of late-onset infectious complications (5 or more days after the transfer to the hospital) caused by Gram-positive bacteria (especially by Enterococcus faecalis/faecium) was significantly higher in group 1 than in group 2 (82.4% vs. 35.0%, p = 0.007/p corr = 0.014) while no statistically significant difference was observed between groups of patients with infection caused by Gram-negative bacteria, yeasts, and filamentous fungi (p > 0.05). Patients with post-antibiotic development of TEN are critically predisposed to late-onset infectious complications caused by Gram-positive bacteria, which may result from the dissemination of these bacteria from the primary focus.

Human allogeneic keratinocytes cultured on acellular xenodermis: the use in healing of burns and other skin defects.

The tissue engineered skin should be composed of both dermal and epidermal layers. We combined cultured human allogeneic keratinocytes with acellular xenodermis prepared from pig xenografts. The resulting composite skin was termed recombined human/pig skin (RHPS), and could be cultured in both, undifferentiated and differentiated phenotype. The undifferentiated RHPS was grown submerged and formed 1-2 layers of keratinocytes. The differentiated phenotype (D-RHPS) was grown at the air-liquid interface and formed 5-20 cell layers similar to the normal epidermis, including the granular and horny layers. Undifferentiated RHPS has skin-like consistency and has been successfully used for treatment of burns and skin defects using "upside-down" application. Donor sites and deep dermal burn wounds prepared by tangential excision or deep dermabrasion grafted with RHPS healed in the course of about one week after keratinocyte transplantation. Simple acellular xenodermis without keratinocytes can also be used as temporary cover for donor sites, small to medium leg ulcers and other skin defects. Xenodermis can be fully sterilized and stored at the room temperature.

Objective evaluation of the effect of autologous platelet concentrate on post-operative scarring in deep burns.

INTRODUCTION: The healing of grafted areas after surgical treatment of deep burns frequently generates mutilating scars, and rises the risk of subsequent scar hypertrophy. Scar assessment based on clinical evaluation is inherently subjective, which stimulates search for objective means of evaluation. OBJECTIVE: The aim of this study was to objectively evaluate the effect of using autologous platelet concentrate (APC) in combination with split thickness skin grafting (STSG) on scarring processes following surgery of deep burns as compared with application of STSG alone. METHOD: Selected viscoelastic properties of 38 scars on 23 patients in total were examined using the Cutometer MPA 580 under controlled conditions for long-term outcomes 1, 3, 6 and 12 months after surgery following deep burns. RESULTS: The findings of this study suggest that the STSG+APC combination reduces the time of scar viscoelastic properties recovery as compared with application of STSG alone. This was statistically significant for viscoelastic parameters R2 and Q1. CONCLUSION: APC has been advocated to enhance scarring after surgery of deep dermal and full thickness burns. We objectively demonstrated that the viscoelastic properties of scars treated with STSG+APC combination return more rapidly to the plateau state than areas treated with STSG only.

Suture-free anastomosis of the colon. Experimental comparison of two cyanoacrylate adhesives.

BACKGROUND: We explored the potential of two cyanoacrylate tissue adhesives for constructing colonic anastomoses. METHOD: The study involved 12 female domestic pigs. The animals were divided into two equal groups. In both groups, the sigmoid colon was transected. An intestinal anastomosis was constructed with a modified circular stapler (all staples were withdrawn) and cyanoacrylate tissue adhesives. Glubran 2 was used in group A and Dermabond was applied in group B. Fourteen days after the first operation, a follow-up surgery was performed in both groups. The glued section of the colon was resected, processed with the standard paraffin technique and stained with haematoxylin-eosin. The finished specimens were examined under light microscopy. Assessments were made for the presence of fibroblasts, neutrophils, giant polynuclear cells, neovascularisation and collagen deposits. Adhesions, anastomotic dehiscence, peri-anastomotic inflammation and intestinal healing were assessed peri-operatively. RESULTS: All anastomoses in group A healed with no signs of pathology. In group B, fibrotic adhesions and stenoses tended to occur in areas surrounding the anastomoses. Histological examinations confirmed increased fibrosis. CONCLUSION: The tissue adhesive Glubran 2 appears to be (under experimental conditions) a promising synthetic adhesive for colonic anastomosis construction; conversely, the tissue adhesive Dermabond was unsuitable for suture-free anastomosis construction.