Negative Pressure Wound Therapy in Postbariatric Lower Body Lift-A Method of Decreasing Postoperative Complications.

BACKGROUND: Lower body lift procedure is one of the most common procedures in postbariatric surgery, which can be followed by postoperative complications that delay the healing time. The purpose of this study was to analyse whether the use of negative pressure wound therapy (NPWT) as a replacement for the classical drainage method would provide better postoperative results with fewer complications. METHODS: The authors reviewed their experience with 46 consecutive patients that underwent lower body lift surgery from 2018 to 2021. They were divided into two groups: 23 of them received NPWT as drainage method and another 23 received classical active drains. We assessed the complication rates and types between the two groups to demonstrate the efficiency of NPWT as a support in the surgical protocol. RESULTS: Forty-six patients were included in this study. Two equal groups formed by 23 patients were analysed for age, sex, type of weight loss, type of circumferential lower body lift, type of drainage, quantity of drainage, time of drain usance, postoperative complications, operation time, hospital stay and frequency of hospital visits. The group that received NPWT had a 26.08% rate of complications as compared with the drain group that had a 47.8% complication rate. CONCLUSIONS: This study is performed as a comparison between negative pressure wound therapy and classical drainage method in lower body lift surgery, as a new method of reducing the postoperative complications. By achieving faster closure of large, undermining areas, it concludes in a lower risk of seroma or hematoma formation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Basal Cell Carcinoma-A Retrospective Descriptive Study Integrated in Current Literature.

Basal cell carcinoma (BCC) is considered to be the most common cancer in humans. It has a slow growth rhythm, and for this reason, metastases are rare. For our retrospective study, we selected 180 patients from those who underwent surgery for a variety of skin tumours between January 2019 and August 2022 and whose histopathological examination revealed basal cell carcinoma. All surgeries were performed by plastic surgeons at the "St. John" hospital in Bucharest. The aim of this article is to provide observational data regarding BCC-in terms of histopathology and diagnostic and therapeutic management and to integrate these data into the current knowledge of this pathology.

Spectro-Electrochemical Properties of A New Non-Enzymatic Modified Working Electrode Used for Histamine Assessment in the Diagnosis of Food Poisoning.

We successfully prepared a non-enzymatic sensor based on a graphene-thiophene composite for histamine detection. The self-assembling properties of the thiophene onto Au support and the high electrical conductivity of graphene encouraged the choice of this type of composite. The composite was deposited via electrochemical polymerization onto the Au layer of a screen-printed microelectrode. The electropolymerization and electrochemical detection of histamine were both achieved by cyclic voltammetry. Two types of electrolytes were used for the electrochemical detection: (a) phosphate buffer solution (PBS), which showed low-intensity redox peaks for histamine; and (b) trichloroacetic acid (TCA) 0.01 M, which showed improved results over PBS and did not damage the microelectrode. For the concentration range of 100-200 mg/kg, the sensor shows a linear regression pattern for the oxidation peak fitted on the equation Ipa = 123.412 + 0.49933 ×x, with R2 = 0.94178. The lowest limit of detection was calculated to be 13.8 mg/kg and the limit of quantification was calculated at 46 mg/kg. These results are important since by monitoring the amount of histamine in a food product, early onset of spoilage can be easily detected, thus reducing foodborne poisoning and food waste (by recycling products that are still edible).

Graphene-Based Sensor for the Detection of Cortisol for Stress Level Monitoring and Diagnostics.

In this work, we study the sensing properties of multi-layer graphene combined with pyrrole in order to elaborate low-cost, high-sensitive material for cortisol detection. Graphene nanoplatelets and pyrrole were dispersed in a solution containing 1M HNO3 by using a powerful ultrasound probe for 10 min, then centrifuged for 30 min at 4000 rpm; polymerization was performed by cyclic voltammetry. The graphene-pyrrole composite was tested to ultra-low levels of cortisol in artificial saliva, consistent to the levels excreted in human salivary samples. The composite was further investigated by Raman spectroscopy and we modeled the interaction between the sensitive layer and cortisol using MarvinBeans software. It shows a good sensitivity for salivary values of cortisol cyclic voltammetry being able to detect a level down to 0.5 ng/mL cortisol.

Complications related to breast reconstruction after mastectomy using multiple surgical techniques - a national and international comparative analysis.

The present paper describes and analyzes complications related to alloplastic breast reconstruction, as well as those associated with surgical techniques involving myocutaneous flaps. The article also contains a comparative analysis of the results obtained with the data in the international specialized literature. The statistical analysis is primary based on data obtained from patients included in the National Breast Reconstruction Program developed within the "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania, between 2015 and 2019. In order to highlight and present a thorough comparison between the possible long-term complications associated with multiple reconstructive techniques, the paper also includes data related to patients who have undergone such surgical interventions in the aforementioned Health Unit, but which were not included in the national program, resulting a total of 73 reconstructive surgical interventions. The research results show that the overall rate of complications was 43.83%, skin necrosis, superficial infection and seroma being in this order the main complications that were identified. In the authors' opinion, risks of complications are moderated in relation with breast reconstruction surgery. However, the complication rate significantly varies depending on the chosen technique. The lowest risk levels registered in this study were associated with the breast reconstruction using the two-stage expander-implant technique. The analysis compares the achieved results with data provided by international studies, the main differences being caused by the status of the medical infrastructure, as well as the moment of hospital admission that is primarily determined by the level of medical education.

Correlations between clinics, dermoscopy and histopathology in a female with two dermatofibromas - a case report.

Dermatofibromas are benign fibrohistiocytic tumors that involve the dermis. They have often a polymorphous clinical aspect, being frequently confused with other lesions varying from vascular tumors to melanoma. An important tool in diagnosis is represented by dermoscopy, which facilitates the recognition of dermatofibromas' characteristic structures such as central white patch and peripheral pigment network. Although dermatofibromas are often solitary lesions, we report the case of a woman who presented two fibrohistiocytary masses, involving the calf and the thigh, the last one with an atypical aspect leading to the confusion with a malignant tumor. Furthermore, the lesions were different at both dermoscopic and histopathological examinations, needing a second histopathological opinion. The aim of our study is to emphasize the role of histopathology, which represents the diagnostic golden standard in suspicious cases and the possible connections between dermatoscopy and histology. Sometimes, even histopathology may be very difficult, needing repeated sections and even special stains.

[Surgical methods of covering head soft tissues defects]. / Modalitati chirurgicale de acoperire a defectelor de parti moi la nivelul capului.

Posttraumatic and post-excisional head soft tissue defects represent a challenge for the plastic surgeon due to the functional and esthetic impact of this body area. Choosing the simplest way of covering a defect is many times the most efficient way, but it must deliver a good tissue cover and their aspect and function must simulate the characteristics of that area. This article is proposing to be a brief description of all these procedures, informing and being necessary for every general surgeon. The methods of covering head soft tissues defects specific to plastic surgery will be presented in a ladder way from simple to complex, that means from the simple skin graft to island flaps and the tissues transfers. Choosing a right procedure refers to the etiopathogeny, and the length and width of the defect. We shall present advantages and disadvantages of each procedure, indications and their limits, giving specific clinical cases. We shall present the results for each type of procedure also, giving specific arguments for our option. We'll insist on the functional reconstruction of the lids, nose and cheek, as single defects and on the surgical limits which come upon very large soft tissue defects. Due to the complexity of the head structures, either single or complex, and to the functional and esthetic impact of these soft tissue defects, we consider this paper to be a real benefit. It is very important to choose the right procedure, considering all the factors who are implicated (sex, age, general condition, etiopathogeny, the length and width of the defect, previous treatments, patient wish, etc).

An animal model of peripheral nerve regeneration after the application of a collagen-polyvinyl alcohol scaffold and mesenchymal stem cells.

Extensive nerve injuries often leading to nerve gaps can benefit, besides the gold standard represented by autologous nerve grafts, by the inciting field of tissue engineering. To enhance the role of biomaterials in nerve regeneration, the nerve conduits are associated with Schwann or Schwann-like cells. In this study, we evaluated rat sciatic nerve regeneration, by using a biodegradable nerve guide composed of Collagen (COL) and Polyvinyl Alcohol (PVA), associated with mesenchymal stem cells (MSC). After the exposure of the rat sciatic nerve, a nerve gap was created by excising 1 cm of the nerve. Three experimental groups were used for nerve gap bridging: autografts, nerve conduits filled with medium culture and nerve conduits filled with MSC. The methods of sensory and motor assessment consisted of the functional evaluation of sciatic nerve recovery - toe-spread, pinprick tests and gastrocnemius muscle index (GMI). The histological and immunocytochemical analysis of the probes that were harvested from the repair site was performed at 12 weeks. Successful nerve regeneration was noted in all three groups at the end of the 12th week. The functional and immunocytochemical results suggested that COL-PVA tubes supported with mesenchymal stem cells could be considered similar to autologous nerve grafts in peripheral nerve regeneration, without the drawbacks of the last ones. The functional results were better for the autografts and the ultrastructural data were better for the nerve conduits, but there were not noticed any statistical differences.

Pressure sores--a constant problem for plegic patients and a permanent challenge for plastic surgery.

Pressure sores can be defined as lesions caused by unrelieved pressure resulting in damage of the underlying tissue. They represent a common problem in the pathology of plegic patients and, plastic surgery has a significant role in their treatment. Pressure sores occur over bony prominences and so, they are most commonly seen at the sacrum and trochanters in paralyzed patients and at ischium for the patients who sit in a wheelchair for a long time. For these patients, surgical treatment is very important because on one hand, it stops the loss of nutrients and proteins at the site of the pressure sore, and on the other hand, it permits the initiation of neuromuscular recuperation treatment much faster.

Forequarter amputation (upper limb and shoulder girdle) in a synovial sarcoma case--case report.

We are often confronted with severe cases - patients with very aggressive tumours that suppose a complex and in the same time radical approach--in our medical practice. The correct approach and management of such cases ensure both the surgical success and the patient survival. In this paper, we present the case of a young woman, who has been admitted in our clinic with a giant, irradiated tumour involving left axilla, shoulder and scapula. Due to the vast size of the tumour and to the fact that surgical biopsy revealed a poorly differentiated sarcoma; other clinics considered that the case above belongs to surgical therapy. After the clinical examination, blood tests and diagnostic imaging, which allowed the correct evaluation of the case--tumour sizes and neighbouring tissue reports--we decided to perform tumour radical excision, respectively forequarter amputation, when the patient presented a satisfactory metabolic status. The presented case supports the idea that radical excision which might involve even mutilating amputations for extensive cancers can give patients a chance, even in desperate cases.

Surgical treatment of a case of recurrent irradiated basal cell carcinoma of the head with a large soft tissue and bone defect.

Taking into account the great number of skin malignances that occur in the head and neck regions, problems related to their surgical treatment represent a constant concern for plastic surgeons. They have to deal with the difficulties of radical excision and also with reconstructive possibilities. More than 2/3 of these malignances are basal cell carcinomas, which, if left untreated might become very invasive, surgical treatment being more difficult in such cases. Recurrent carcinomas combined with radiation injuries represent a serious challenge even for experienced surgeons regarding the size of the defect and anatomical structures involved. In this paper we present a case of a patient with basal cell carcinoma of the parietal region and the reconstructive treatment involving neurosurgery and plastic surgery team approach, using microsurgery techniques. We also present the difficulties of the case as well as the final outcome that we consider the best option for the patient. The neurosurgical stage consisted in fongus removal, excluding all brain tissue located outside the dural limits, craniectomy, duraplasty and cranioplasty. Because of the large size of the defect and also because the local resources were exhausted we chose as a covering solution the free tissue transfer consisting in a latissimus dorsi musculocutaneous flap. The difficulties of these cases consist both in the aim of radical excision and the limited reconstructive options. In this case, our collaboration with the neurosurgery team proved to be crucial, permitting us to solve this case in a single operative time, with deep excision, reconstruction of the dura mater and cranioplasty, and reconstruction of the soft tissues with microsurgical free transfer.

[Risks and difficulties in the treatment of malignant tumors of the lower face]. / Riscuri si dificultati în tratamentul neoplasmelor de etaj facial inferior.

The extensive malignant tumors of the face impose numerous problems regarding the surgical treatment due to, on one hand to their extension and on the other hand, to the aggressivity of the histological entity. The histopathology and the grading of these tumors are very helpful in orientating the specialist to choose the best therapeutic protocol in each case.

[Therapeutic solutions in post-excision defects for plantar verrucous carcinoma]. / Modalitati de acoperire într-un caz de carcinom verucos plantar (Epithelioma cuniculatum).

Carcinoma verrucous--anatomoclinical entity histological high rate of differentiation of the spinocellular epithelioma, clinically associated with 3 types of lesion. We present the therapeutical solution of a plantar carcinoma verrucous case, a large post-excisional defect-free flap transfer of latissimus dorsi muscle using microsurgical techniques.