[Breast cancer patient satisfaction with immediate two-stage implant-based breast reconstruction]. / Spokojenost onkologických pacientek s okamzitou dvoudobou aloplastickou rekonstrukcí prsu.

BACKGROUND: For most breast cancer patients in the Czech Republic, breast reconstruction is available only in a delayed manner. In the Masaryk Memorial Cancer Institute (MMCI), suitable candidates are offered immediate breast reconstruction using tissue expander with later exchange to a permanent silicone implant. The aim of this study was to assess patient satisfaction with this type of reconstruction. PATIENTS AND METHODS: Sixty-two women who had undergone surgery at the MMCI from 2007 through 2013 were sent a simple questionnaire developed by our working team. Fifty-seven patients completed the questionnaire. The data were evaluated by description methods and statistical tests. RESULTS: Patient response was 92%. The absolute majority of patients (56/57) would opt for this method again. The vast majority of patients (48/57) are generally satisfied with their reconstruction. Most women (8/14) younger than 50 years after the unilateral surgery would prefer synchronous contralateral prophylactic mastectomy and bilateral reconstruction if they could choose again. After bilateral surgery, reconstructed breasts are more often regarded as a part of the patients body. Dressed women rate their look substantially better than when they are undressed. As for self-esteem, these women are feeling excellent or good. Their psychosocial well-being in common situations is predominantly excellent. Their sexual well-being is significantly worse, and almost half of these women indicate occasional pain in their reconstructed breasts. The patients emphasize the need for appropriate information before the surgery. CONCLUSION: Immediate two-stage implant-based breast reconstruction is a suitable option for some breast cancer patients. With regard to the less natural cosmetic result and feeling of the implant-reconstructed breast, appropriate selection of women for this type of surgery is necessary and potential candidates must be thoroughly informed in the preoperative setting.

[Treatment of a ruptured extensor policis longus tendon by extensor carpi radialis longus transfer]. / Vliv slachového transferu extensor carpi radialis longus - extensor pollicis longus na funkci ruky.

PURPOSE OF THE STUDY: Two tendons, i.e., the extensor indicis proprius (EIP) and the extensor carpi radialis longus (ECRL), are commonly used to reconstruct the function of a ruptured extensor pollicis longus (EPL) tendon. We reviewed a group of patients with EPL ruptures treated by ECRL tendon transfer to the EPL tendon, which was the method of choice. The aim was to evaluate the results and to assess the effect of ECRL detachment on hand function. MATERIAL AND METHODS: Twenty patients were treated surgically for a subcutaneous rupture of the EPL tendon between 2003 and 2007. Each patient was examined at 2 years after surgery. The range of motion (ROM) of both the injured and the contralateral hand was recorded and evaluated with a modified Geldmacher scoring system; a response to the DASH questionnaire was obtained. The mean follow-up was 24 months (19-31 months). RESULTS: For the ROM of the operated hand, the mean Total Active Motion (TAM) of 98.75 degrees (60-140, SD 22.74) was calculated. The mean extension lag at the interphalangeal (IP) joint was 5.42 degrees (0-25, SD 8.77) and the mean IP flexion was 65.8 degrees (40-80, SD 13.2). In order to evaluate body side differences, the ROM of the contralateral thumb was recorded. The values were as follows: mean TAM, 141.3 degrees (115-190, SD 20.43); mean IP extension lag, 0 degrees (0-0, SD 0); mean IP flexion, 68.8 degrees (50-80, SD 9.6). DISCUSSION: The extension lag at the IP joint was detected in both the operated and the contralateral hands. The patients examined at a longer interval after surgery showed an increase in extension lag. This may have been caused by undesired adaptation of the donor muscle, the presence of adhesions or suture loosening. CONCLUSIONS: The results showed increased adaptation of thumb motion to the extension lag at the IP joint, which had a mild effect on the patient's hand function. The difference in wrist extension between the operated and the contralateral hand corresponded to the pre-operative condition.

Evaluation of suture material characteristics in an in vitro experimental model.

BACKGROUND: The purpose of our study was to indentify the mechanical characteristics of various suture materials. We created an in-vitro experimental flexor tendon model. MATERIAL AND METHODS: Materials were divided into four groups: monofilament polypropylene non-absorbable material (group 1); monofilament long-term absorbable material (group 2); polyester multifilament non-absorbable coated material (group 3) and polyester multifilament non-absorbable uncoated material (group 4). We performed 135 tests. The mean maximal tensile strength was 62.92 N in group 1, 75.20 N in group 2, 36.38 N in group 3 and 72.4 N in group 4. Elasticity in millimetres was adjusted at the 35N level: group 1:2.01 mm, group 2:2.18 mm, group 3:2.14 and group 4:1.51 mm. DISCUSSION: With regard to its elasticity and favourable SD for tensile strength measurements, polyester multifilament non-absorbable uncoated material was considered to be the most suitable material.

A new type of plasma knife and its effect on biological issues--a pilot study.

BACKGROUND: Currently, several types of plasma discharge devices have become established for performing surgical procedures or superficial sterilization. Our goal is to introduce a brand new type of plasma discharge device with different characteristics, which we have used for two experiments involving thermal damage to biological tissues. MATERIAL AND METHODS: A plasma discharge device with the following characteristics was used for all incisions in plasma group: radio frequency barrier discharger at atmospheric pressure with a working frequency of 13.56 MHz. The working gas was Argon. We used a Cesar 136 generator with typical power 100-150W and with a working gas flow rate between 0.5 and 3 litres per minute. The inner diameter of the end of the nozzle was 0.4mm. A standard Martin electrotome was used for all comparative incisions in the electrotome group. We used two experimental fresh rat cadavers, employing their skin, tails, lungs, livers, kidneys and spleens to make a comparative study between incisions made with a plasma discharge knife and those made with a standard electrotome device. All samples underwent histological verification. DISCUSSION: Our experiment showed slight differences in the impact on incision edges made by the plasma knife and the electrotome. The most interesting effect is on the skin: the plasma knife does not damage hair bulbs, and it results in less thermal damage. The plasma discharge knife is a promising device for cutting various biological tissues. Its effect can be compared with a standard electrotome, while in some tissues it causes less harm then an electrotome. Moreover, we can adjust its therapeutic effect. However, we do not consider the plasma knife a better choice at present, because maneuvering it is unwieldy.

Evaluation of early dynamic splinting versus static splinting for patients with transposition of the extensor carpi radialis longus to the extensor pollicis longus.

We present a group of 20 patients who underwent transposition of the extensor carpi radialis longus to the extensor pollicis longus between April 2003 and September 2007. The group was divided into ten patients with an early dynamic splint and ten patients with a static plaster cast following the standard rehabilitation protocols. We compared these two rehabilitation protocols. The post-rehabilitation total range of motion was 87.5 degrees in the dynamic group and 58.75 degrees in the patients treated by the static protocol. The total time of rehabilitation was 10.2 weeks in the dynamic and 14.2 weeks in the static group. The overall mean follow-up was 12.2 weeks. We conclude that early dynamic splinting brings shorter recovery time, shorter time off work and significantly better movement of the thumb.

High inductive magnetic stimuli and their effects on mesenchymal stromal cells, dendritic cells, and fibroblasts.

Effects of low-frequency electromagnetic fields (LF EMF) on the activation of different tissue recovery processes have already been fully understood. Preliminary recent data demonstrated that a special case of sinusoidal electromagnetic fields, known as amplitude-modulated currents (AMC) could have a potential to accelerate the cell metabolism or cell migration. An AMC generator was designed to generate sinusoidal induced electric currents with the amplitude modulation and the harmonic carrier frequency of 5,000 Hz was modulated by frequencies of 1 to 100 Hz. The magnetic field peak was 6 mT, electric field intensity 2 V/m and the current density of induced electrical currents was approximately 1 A/m(2). The coil of the generator was adapted to easy handling and safe integration into the shelf of the CO(2) incubator. The shelf with the coil was prepared for the introduction of cells in standard plastic in vitro chambers. The tests focused on cells with migratory capacity after injury or during immunological processes and thus, mesenchymal stromal cells (MSC), dendritic cells (DC), and fibroblasts were chosen. The tests involved exposures of the cells to LF EMF (180 min/day) every day, for a period of three days, before examining them for cell death, morphology changes, and CD markers. The samples were tested by using MTT assay and the effects on the intracellular concentration of reactive oxygen species were quantified. The cell migration was finally measured with the help of the transwell migration assay. None of the cell types showed any decrease in the cell viability after the LF EMF application and the cells displayed minimum changes in reactive oxygen species. Functional changes (acceleration of cell migration) after AMC exposure were statistically significant for the MSC samples only. The acceleration of MSCs is associated with the production of MMP by these cells. The EMF has a potential to be a safe, clinically applicable selective activator of MSC homing, MSC paracrine production, and subsequent regeneration processes.

Neo-phalloplasty with re-innervated latissimus dorsi free flap: a functional study of a novel technique.

Twenty two patients with gender dysphoria underwent neo-phalloplasties using a novel technique. Latissimus dorsi musculocutaneus re-innervated free flap was used to allow voluntary rigidity of the neo-penis. From the first 22 patients, 18 have obtained motoric function of reconstructed penis; the "paradox erection" was obtained. 14 patients came for examination after a follow-up period of mean 26.4 months. We evaluated the motility and shape changes of neo-phallus measuring its different size and dimension during relax and muscle contraction. The range of neo-phallus length in relaxed position was between 7 and 17 cm (mean 12.2 cm), its circumference in the same position had a range between 13 and 20 cm (mean 13.7 cm). All patients were able to contract the muscle with an average length reduction of 3.08 cm and an average circumference enlargement of 4 cm. In this study, the dimensions and motility were quantified demonstrating the neo-phallus function and size changes during sexual intercourse.

[Treatment of congenital pseudarthrosis of tibia by vascularized fibular graft]. / Lécba vrozeného pakloubu bérce vaskularizovaným kostním stepem.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the results in a group of patients with congenital pseudarthrosis of the tibia treated by transfer of a vascularized fibular graft from the contralateral extremity. MATERIAL: The group included three boys and two girls aged 2 to 8 years at the time of surgery. In two patients, the vascularized graft transfer was preceded by other operations. All patients but one had Crawford type IV pseudarthrosis. The signs of peripheral neurofibromatosis were found in four of the five patients. METHODS: The operation was carried out by two surgical teams, i. e., orthopedic and microsurgery (plastic surgery) specialists. Deep dissection of the pseudarthrosis was performed down to healthy, well vascularized tissue; a vascularized pedicle bone graft was harvested from the contralateral fibula. The graft was inserted and anchored intramedullarily in both tibial fragments, and stability was provided with a K-wire introduced through the calcaneus. Subsequently, the vascular pedicle of the fibular graft was joined to the surrounding vessels (anterior tibial artery and anterior tibial vein). The extremity was immobilized in plaster cast and later a KAFO brace was applied. RESULTS: Graft union partially failed in the proximal end of the graft due to bone resorption of both the graft and the proximal tibial fragment in two patients. This was successfully treated by additional spongioplasty. In all patients bony union was achieved at an average time of 9.8 months (range, 6 to 21 months). An increase by more than 100 % in the diameter of the transplanted fibula was recorded in four patients. The increase, which was of course related to follow-up time, was a clear proof of primary graft vascularization. DISCUSSION: The use of vascularized fibular graft harvested from the contralateral extremity showed high effectiveness in comparison with other methods. This was in agreement with the relevant literature reports. CONCLUSIONS: This method can be used regardless of patients' age and our experience showed that, even in small children, union can be achieved and can thus allow for early weight-bearing and prevention of crus atrophy.

[Options for correction of post-traumatic length discrepancies in forearm bones in children (case reports)]. / Moznosti korekce posttraumatických délkových diskrepancí predloketních kostí u detí (kazuistika).

Correction of radius length after a premature complete or partial closure of the distal epiphyseal plate is important for both the correction of radial deviation of the hand and the restoration of normal function of the radiocarpal articulation. This study comprised four patients. Two children with complete closure of the epiphyseal plate of the distal radius underwent callotaxis. One patient was treated for atrophic pseudoarthrosis of the distal radial metaphysis by external fixation and subsequent spongioplasty. One patient with partial closure of the epiphyseal plate was treated by physeal distraction. In each patient an Ilizarov's external fixator was applied. The full correction of radius length was achieved in all cases. No complications were recorded with the exception of tissue irritation around Kirchner's wires, which occurred mainly on the volar side. In the therapy of injuries suffered during adolescent growth acceleration, it is necessary to perform a certain overdistraction of the radius. An alternative method includes epiphyseodesis of the distal ulna. Key words: post-traumatic closure of the epiphyseal plate, callotaxis, physeal distraction, chondrodiatasis.

[Injuries of the fingernail area in childhood]. / Poranení nehtové oblasti prstu ruky v detském veku.

The authors submit a summary of the most recent findings on the damage of the nail area of the fingers of the hand (nail matrix, surrounding soft tissues, skeleton excluding avulsion fractures and epiphyseolyses.). The reason is the fact that almost 50% of all finger injuries in children under 5 years include also damage of this complex. Although the incidence of this injury is relatively high there is no uniform therapeutic procedure and unfortunately very frequently therapeutic procedures do not lead to favourable results. This apparently trivial injury can however, in particular in relation to occupation, lead not only to cosmetic but also functional disorders and therefore it is necessary to pay adequate attention to it. The authors supplement data from the literature by their own experience with the treatment of this comprehensive injury. The objective of the work is therefore to summarize available therapeutic findings on the classification and diagnostic procedures of these apparently light injury from the layman's aspect and unfortunately also from the aspect of some professionals, these injuries being overlooked and underrated (Innis, 1995). Particular attention is however devoted to adequate treatment which must lead to restoration of the injured fingers to full function which subsequently will restore the comprehensive role of the whole hand.

Plasma discharge and time-dependence of its effect to bacteria.

Several types of plasma discharge have been proven to have a capacity for sterilization. Our goal is to introduce new nonthermal plasma pencil. We used it to sterilize different microbial populations with differing ages. We used a plasma discharge of the following characteristics: radio frequency barrier discharger at atmospheric pressure with a working frequency of 13.56 MHz, and the working gas used was argon. We performed 110 tests with the following microbial populations: Pseudomonas aeruginosa, Staphylococcus aureus, Proteus species, and Klebsiella pneumoniae. All populations were inoculated on the previous day and also on the day of our experiment. We made our evaluations the following day and also after 5 days, with all our microbial populations. Eradication of microbial populations is dependent on the plasma discharge exposure time in all cases. With regard to freshly inoculated microbes, we were able to sterilize agar with intensive exposure lasting for 10 s of colonies Pseudomonas, Proteus, and Klebsiella. The most resistant microbe seems to be S. aureus, which survives 5 s of coherent exposure in half of the cases. Using the lightest plasma discharge exposure, we achieved a maximum of 10(4)-10(5) CFU/mL (colony-forming unit - CFU). Regarding older microbial populations inoculated the day before the experiment, we can only decrease population growth to 10(5) CFU/mL approximately, but never completely sterilize. The plasma discharge with our characteristics could be used for the sterilization of the aforementioned superficially growing microbes, but does not sufficiently affect deeper layers and thus seems to be a limitation for eradication of the already erupted colonies.