[Perineal hernia - hernia repair using rectus abdominis muscle flap]. / Perineální hernie - plastika pomocí laloku prímého brisního svalu.

UNLABELLED: Perineal hernia is defined as a protrusion of intra-abdominal viscera through a defect in the pelvic floor. Primary hernias are extremely rare; secondary (postoperative) hernias following pelvic surgery, especially abdominoperineal resection or pelvic exenteration, are more common. Impaired perineal wound healing and neoadjuvant chemoradiotherapy in cancer patients are defined as main risk factors. A growing incidence of this complication is expected in connection with an increasing use of laparoscopic approaches and ELAPE. Despite the considerable time since the first described secondary perineal hernia in literature, patient series, prospective studies and treatment guidelines are still missing. The authors present a case of a 66-year-old man with secondary perineal hernia following a previous laparoscopic abdominoperineal resection for rectal cancer undergoing a surgical intervention. This was performed through an abdominal approach using a rectus abdominis muscle flap to repair the pelvic floor defect. KEY WORDS: perineal hernia - hedrocele - RAM - abdominoperineal resection.

[Pressure ulcers in spinal cord injury]. / Dekubity u paraplegiku.

INTRODUCTION: Pressure ulcers in spinal cord injury represent a challenging problem that often leads to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. METHODS: Review article. RESULTS: The paper presents possible types of reconstructive surgery of ischial, sacral and trochanteric pressure ulcers and our own experience with procedures of such pressure ulcers done in three years. CONCLUSION: We emphasize the versatility and reliability of gluteus maximus musculocutaneus flaps and the importance of preoperative preparation and postoperative care.

[Pilonidal sinus - diagnosis at the intersection of general and plastic surgery]. / Pilonidální sinus - diagnóza na pomezí vseobecné a plastické chirurgie.

INTRODUCTION: Pilonidal sinus predominantly affects young patients. Improper treatment results in long-term restrictions in everyday life and incapacity for work. The aim of the study was to find out what the results and current treatment options of pilonidal sinus are. MATERIAL AND METHODS: This is a retrospective analysis of 67 patients treated at the Department of Surgery of the Second Medical Faculty of Charles University and Motol Hospital in the period 20102013. We evaluated the type of surgery and infectious complications in the wound, as well as age, sex, BMI, smoking, employment of the patients, duration of wound drainage, length of hospital stay, time required to complete healing of the surgical wound, the surgeons erudition and disease recurrence. RESULTS: 50 (75%) patients underwent primary closure in the midline, Limberg flap was used in 15 (22%) patients. In 2 (3%) patients, the wound was left without suture. In the group of patients who had not undergone flap reconstruction, secondary wound healing occurred in 20 (40%) patients. In the group of patients where flap reconstruction was used, secondary healing occurred in 3 patients (20%). Relapse of the disease within one year occurred in the group of patients with primary suture in the midline in 4 (8%) patients; other patients had no recurrence. CONCLUSION: According to our experience as well as literary data, the treatment of choice is the extirpation of the sinus with primary suture beyond the midline using a flap reconstruction technique.