Rotational Advancement in Cleft Nose Rhinoplasty - Buccal Mucosal Grafts Serve as a Powerful Tool.

OBJECTIVE: Our aim was to analyze our technique of a modified rotational advancement in conjunction with buccal mucosal grafts (BMGs) in a subgroup of severe cleft cases. DESIGN: A retrospective clinical and photographic evaluation was conducted. Columella angle (CA) and tip projection (TPR) served as instruments in a photometric analysis. SETTING: Academic university hospital and specialized craniofacial cleft center. PATIENTS: At the time of the secondary rhinoplasty, 61 cleft patients were included, all 17 years or older. INTERVENTIONS: Rotational advancement with usage of BMGs was performed in selected cases by a single surgeon. MAIN OUTCOME MEASURES: Nasal symmetry and aesthetic appearance. RESULTS: From 2003 to 2011, 29 unilateral severe cleft cases (group I) underwent a modified alar rotational advancement with BMGs. Group II, with 32 cases, represented patients without BMGs. Technique and management of BMGs were described in detail. The complication rate of donor and recipient site presented as very low. The CA was improved significantly in both groups. Also, TPR improved (not significantly) in group I. Using our technique, we considerably enhanced the aesthetic results and symmetry in secondary cleft rhinoplast. CONCLUSIONS: Rotating the vestibular skin makes it possible to eliminate the traction of this skin on the repositioned alar cartilage, therefore achieving a more pleasing and stable nasal symmetry in secondary cleft rhinoplasty. Versatile BMGs close this gap, thus making them a powerful tool in the arsenal of the reconstructive cleft surgeon.

The operative treatment of pressure sores in the pelvic region: A 10-year period overview.

CONTEXT: Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate. METHODS: A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire. RESULTS: We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%. CONCLUSION: The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.

[Methods and importance of volume measurement in reconstructive and aesthetic breast surgery]. / Az emlotérfogat-meghatározás jelentosége és módszerei a helyreállító és esztétikai emlosebészetben.

Volume measurement of the breast allows for better surgical planning and implant selection in breast reconstructive and symmetrization procedures. The safety and accuracy of tumor removal, in accordance with oncoplastic principles, may be improved by knowing the true breast- and breast tumor volume. The authors discuss the methods of volume measurement of the breast and describe the method based on magnetic resonance imaging digital volume measurement in details. The volume of the breast parenchyma and the tumor was determined by processing the diagnostic magnetic resonance scans, and the difference in the volume of the two breasts was measured. Surgery was planned and implant selection was made based on the measured volume details. The authors conclude that digital volume measurement proved to be a valuable tool in preoperative planning of volume reducing mammaplasty, replacement of unknown size implants and in cases when breast asymmetry is treated.

[Autologous fat transplantation in the modern reconstructive surgery of breast cancer]. / Autológ zsírátültetés az emlorák modern rekonstrukciós sebészetében.

Autologous fat transplantation is often used in aesthetic plastic surgery, and is recently becoming increasingly popular in the reconstruction of soft tissue defects following oncological surgery. A still not standardized technique of fat transplantation for breast cancer reconstruction is rapidly getting popular. The procedure is not a passive volume replacement, but transplantation of biologically active tissue bearing endocrine, paracrine, exocrine functions and containing fat-derived stem cells, which in the tumorous environment raises many questions in relation to the oncological safety and diagnostic follow-up. Although long-term results based on prospective, randomized studies are not yet available, published clinical experience is promising and reveals an effective and surgically safe procedure if used with appropriate indications and techniques. The authors conducted a broad review of the literature, presenting indications, technique, molecular interactions, and potential risks of the clinical results of autologous fat transplantation in the breast cancer reconstructive surgery. The authors initiated that breast and plastic surgeons should promote adequate long term follow-up of breast cancer patients who underwent breast reconstruction with autologous fat transplantation by the establishment of national registries.

[Modern breast surgery]. / Modern emlosebészet.

Today, as a result of the complex and coordinated medical treatment of breast malignancies the long-term survival rate reaches 80%. Modern breast surgery plays a prominent role in the multidisciplinary treatment of breast tumors. Breast surgery in the 21st century simultaneously performs medical and aesthetic procedures on the same organ. Modern day breast surgery is founded on a complex view of breast malignancies, multidisciplinary cooperation, oncoplastic practice, and selecting the optimal surgery techniques, based on state of the art tools and a detailed treatment plan. Authors present the evolution of modern breast surgery; discuss the procedures such as mastectomy, breast conservation surgery, axillary lymph node removal, prophylactic mastectomy, as well as possible versions of immediate or delayed breast reconstruction.

[The place of skin-sparing mastectomy in oncoplastic breast surgery]. / A bõrtakarékos mastectomia helye a modern onkoplasztikus emlõsebészetben.

Despite its ever increasing popularity, there is no evidence-based confirmation so far on the results of skin-sparing mastectomy, introduced 20 years ago. However, the results of countless published retrospective, long-term trials seem to underpin the ability of the precisely implemeted procedure in early stage invasive and in situ breast cancers to yield the oncological results of modified radical mastectomy. As a result of the procedure involving special surgical techniques, the skin not affected by cancer can be preserved, which facilitates immediate reconstruction and improves cosmetic outcome. The effect of postmastectomy radiotherapy on the reconstruction needs to be considered at the time of the multidisciplinary design of the surgical procedure. The authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language.

[Special considerations in breast cancer treatment of an augmented breast]. / Emlonagyobbító mutét után kialakult emlorákok ellátásának speciális megfontolásai.

Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.

[Use of Integra in a case of extensive upper extremity avulsion]. / Kiterjedt felso végtagi nyúzásos sérülés kezelése Integra mesterséges borrel.

Authors performed successful skin replacement with Integra, a dermal regeneration template, on a patient with circumferential avulsion injury including the elbow region and the dorsum of the hand. The take rate of Integra was 97%, followed by a 98% take rate of the split thickness mesh graft used for final wound coverage. Treatment modality provided excellent aesthetic and functional results, underlining the role of Integra in cases of extensive traumatic skin and soft tissue deficit, such as the treatment of avulsion injury.

[Role of nipple sparing mastectomy in modern breast surgery]. / Az emlobimbó-megtartó mastectomia lehetséges helye a modern emlosebészetben.

Recently an increasing number of reports of clinical experience have been published on nipple-sparing mastectomy. By the preservation of uninvolved skin and the nipple areola complex, this surgical technique greatly facilitates immediate reconstruction and optimal aesthetic outcome. However, the procedure raises serious oncologic concerns regarding the risk of an occult or a newly formed primary tumor due to parenchyma left behind in the nipple and the retroareola. Despite the ever increasing popularity of the method, there is still no evidence based confirmation to it. According to data from scientific literature on nipple-sparing mastectomy, there is no straightforward consequence to be drawn on oncologic safety; therefore the procedure is not generally considered to be alternative to standard mastectomy. In the indication of risk reduction, justification of the intervention seems to be well supported, and is expected to foster a greater rate of acceptance of surgical prophylaxis in patients with higher risk diseases. The procedure should be carried out possibly in the framework of clinical trials, in well selected patients with suitable preoperative and postoperative examinations, applying precise techniques and adequate patient education, according to international guidelines. Further long-term results are needed to form a substantive expert opinion. Authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language.

[Challenges in oncologic plastic surgery of the breast]. / A modern emlosebészet onkoplasztikai kihívásai.

Breast screening programs along with advances in diagnostic methods and oncologic treatment have resulted in full recovery for a decisive number of patients diagnosed with early-stage breast cancer. The results of the ultra-radical-, followed by the breast conserving era pose new opportunities and challenges for the oncologic breast surgeon. The focus of oncoplastic surgery is not only on the tumor, but also on the female patient, allowing for individualized immediate breast reconstruction with acceptable esthetic result following radical tumor exstirpation. Modern procedures differ both in concept and technique from that of traditional breast surgery. This paper provides a comprehensive and detailed overview of reconstructive and oncoplastic breast surgery.

[Mandibular reconstruction with free osteocutaneous fibula flap using the occipital artery as recipient vessel]. / Mandibularekonstrukció arteria occipitalisra varrt szabad osteocutan fibulalebennyel.

Authors performed reconstructive surgery for extensive skin and mandibular bone defect following gunshot injury to the left side of the face. The soft tissue and bone defect was reconstructed with the free osteocutaneous fibula flap harvested from the left lower leg, as suitable local reconstructive flap was not available. The bony continuity was reestablished with a 7 cm long fibula segment. Microvascular anastomoses were performed to the left occipital artery and the left internal jugular vein. The occipital artery was chosen as the external carotid system was completely missing on the right side and was missing several branches on the left side due to the trauma. The fibular segment became fully incorporated and 95% of the flap healed by primary intention.

[Breast conserving oncoplastic surgery in the treatment of centrally located malignant breast tumors]. / Emlomegtartásos onkoplasztikai sebészi lehetoségek centrális elhelyezkedésu malignus emlotumorok kezelésében.

Central breast neoplasms account for 5 to 20% of breast cancer cases. For decades, they have been traditionally treated with mastectomy. The high incidence of involvement associated with these tumors necessitates nipple and areola resection. Oncoplastic surgical techniques, in well selected cases, enable the achievement of adequate cosmetic results following a radical central quadrantectomy along with the Nipple-Areola Complex. The present paper summarizes the indications, techniques and results of breast conserving surgeries of central breast tumors.

[Posterior circumflex humeral artery perforator flap (PCHAP-flap) in axillary scar release]. / Arteria circumflexa humeri posterior perforátor (PCHAP) lebeny alkalmazása axillaris hegkorrekcióban égési sérülés után.

Scar contracture after burn injury is frequent in the axillary region. If conservative treatment of scars limiting the range of motion of the shoulder joint fails, surgical correction is needed. The authors performed an early reconstruction in a case with unstable scar formation and limited range of motion after burn injury to the axillary region, using the posterior circumflex humeral artery perforator flap. In their opinion, the flap (beside its conventional use as a free flap) may be useful as an island flap in the reconstruction of the axillary region, e. g. for axillary scar release.

[The use of Integra "artificial skin, dermal regeneration template" and the reverse radial forearm fasciocutaneous flap in the primary reconstruction of a septic hand injury]. / Integra "mesterséges bor, irha-újraképzodési minta" és reverz radiális lebeny alkalmazása szeptikus kézsérülés elsodleges rekonstrukciójában.

Reconstruction was performed on the back of a hand following a poorly managed septic hand injury leading to skin and extensor apparatus necrosis using a reverse radial forearm fasciocutaneous flap and a bilayer artificial skin substitute. CASE DEMONSTRATION: Authors report on the first Hungarian case using Integra dermal regeneration template. Integra was placed on the back of the hand on an area left uncovered by the reverse radial forearm fasciocutaneous flap as well as on the flap harvest area. After biointegration of the regeneration template, the outer silicon layer was removed and a split thickness skin graft was applied. CONCLUSION: The take-rate on the donor area was 100% for Integra and 99% for the skin graft, and 90% for both Integra and the skin graft on the back of the hand, providing a good functional and aesthetic result.

[Skin replacement with biological and biosynthetic materials following burn injury]. / Bôrpótlási lehetôségek biológiai és bioszintetikus anyagokkal kiterjedt égési sérülésben.

Autotransplantation is currently regarded as the optimal skin replacement method, sufficient donor site, however, is often not available in extensively burned patients. Intensive research and development of skin replacement products is conducted worldwide in order to decrease the size of the required donor site. Short- and long-term wound coverage is made possible by temporary synthetic and non-synthetic skin substitutes. Autografts and cultured epithelial autografts are used for permanent skin substitution. Until this is possible, the barrier function of the skin is provided by bio-engineered temporary skin substitutes. Some products and methods are currently available in Hungary, while others are still in the introductory phase. In order to provide an overview, authors summarize the skin replacement methods and compare the different skin replacement products used worldwide from the perspective of the burn surgeon. The use of new methods to be introduced in the near future needs to be rationalized due to financial considerations.