Advantages of simultaneous radial nerve and tendon reconstruction - a case report.

Transection of the radial nerve is frequently associated with humeral shaft fractures that are part of a very complex upper extremity injury. In the presented case, a 19-year-old man with a 10-cm radial nerve defect with a need for nerve grafting to recover complete sensory and motor deficit of the radial nerve. In our case, at the same time we provided the tendon transfer of musculus (m.) pronator teres to m. extensor carpi radialis brevis, m. flexor carpi ulnaris to m. extensor digitorum communis, m. palmaris longus to m. extensor pollicis longus, and long sural nerve graft because of an extensive zone of the injury. The assumption was that if these two procedures are performed in one surgery, it will accelerate overall recovery, restore the functionality of the upper limb more quickly, and thus enable a faster recovery.

SKIN SUBSTITUTES IN RECONSTRUCTION SURGERY: THE PRESENT AND FUTURE PERSPECTIVES.

The progress in critical and intensive care burn management in the 21st century has significantly reduced mortality in patients with critical burn injuries. This progress has moved the focus of burns care from simple survival to the quality of life after the burn trauma, in particular to healing of defects caused by full-thickness burns, subsequent maturation, characteristics and appearance of the scars. The benefits of the application of skin substitutes include elimination of excessive scarring, hypertrophic and keloid scar formation and subsequent contracture development. The authors of this article present the strategy of use, application and development of dermal scaffolds as well as the current trends in the use of dermal scaffolds in the treatment of full-thickness burns.

USE OF MEDIAL FEMORAL CONDYLE FLAP AND ANTEROLATERAL THIGH FREE FLAP IN PROXIMAL TIBIAL POSTTRAUMATIC NON-UNION WITH MULTIPLE ANASTOMOSIS - CASE REPORT.

Fractures of the proximal tibia are high energy fractures. According to available literature, 3-4% of all fractures heal problematically with non-union or osteomyelitis. Usage of locking compression plating system as well as usage of hybrid fixator is associated with the risk of compartment syndrome, local infection and subsequent malunion, osteomyelitis or non-union. We present a case of 30-year-old male suffering from posttraumatic non-union. The medial femoral condyle flap was selected due to its favourable properties providing a highly vascularised osteogenic tissue in combination with anterolateral thigh flap and Corlett loop. Our case report describes a reconstruction of a long weight-bearing bone. Despite the amount of anastomoses and usage of vein graft, the selected method of reconstruction seems to be safe and with a long-lasting benefit for the patient.

Fatal progression of multifocal infection of Aspergillus sp. and multi-resistant Pseudomonas aeruginosa in a patient with toxic epidermal necrolysis and renal cancer.

Toxic epidermal necrolysis is an autoimmune disease expressed predominantly on the skin and mucous membranes. It is a serious bullous disease manifesting itself by induction of apoptosis in the dermo-epidermal junction. In most cases,it is attributable to the use of some drug. The basic approach to stopping progression of the disease is immunosuppression. Unfortunately, patients with such extensive loss of epidermis and defective mucosa are confronted by a variety of opportunistic, potentially pathogenic microorganisms. Unsurprisingly, infectious complications are today a predominant cause of death in patients thusly affected. Despite thorough review of the literature, we found no comprehensive case report concerning the development of multifocal Aspergillus infection in patients with this disease.

[The past and present of thumb reconstruction]. / Historie a soucasnost rekonstrukce palce ruky.

The thumb is the most important digit for hand function. Its role is not only functional, but also aesthetic, the hand being a very exposed part of the body. Loss of the thumb can lead to life-long physical and mental stigma. With regard to this experience, early reconstruction of the thumb in order to return patients to normal life as soon as possible is clearly preferred. When using early thumb reconstruction, the patient does not gain wrong stereotypes in hand-grip manoeuvres. The paper presents an overview of current options for non-microsurgical and microsurgical thumb reconstruction techniques.

[Plastic surgery options for the treatment of chronic foot ulcers]. / Plastische Deckungsmöglichkeiten chronischer Ulzera am Fuß

BACKGROUND: A large number of possibilities to cover chronic ulcers are available. The special aspects of the diabetic foot need to be considered when selecting a flap design for coverage. OBJECTIVES: The purpose of this work is to discuss which plastic surgery techniques are preferred when treating chronic ulcers of the diabetic foot. MATERIALS AND METHODS: Analysis of our own cases and discussion of basic literature. RESULTS: Muscle flaps generally have better perfusion and increased angiogenic activity than skin flaps and, therefore, have better results in the treatment of chronic wounds. Especially important when choosing a procedure for the treatment of the diabetic foot is the situation of vessels and perfusion. CONCLUSIONS: An interdisciplinary approach with internal, orthopedic, and radiological specialists from the beginning of the treatment is the basis for success. The pedicled myocutaneous instep flap with inclusion of the abductor hallucis muscle allows stable coverage in the weight bearing area to be obtained. Free flaps like the anterolateral thigh flap should be raised including a muscle (part of vastus lateralis muscle) to achieve multilayer coverage. Postoperative wound care and training of the flap by the patient are also important for successful treatment and need to be guaranteed in advance.

High voltage electrical injury: an 11-year single center epidemiological study.

The aim of our study was to retrospectively evaluate the epidemiological characteristics of patients with high voltage electrical injury from 1999 to 2009. The Clinic of Burns and Reconstructive Surgery, Faculty Hospital Brno is located in a region of 2,505,000 inhabitants. In total 13,911 patients (including both children and adults, and outpatients as well as hospitalized patients) were treated at our burn center during the period of study. Of these patients, 1,030 were hospitalized for burns treatment. For the purposes of this study, we have included only patients with high voltage electrical trauma, of which there were 58, 2 of whom were female. Basic epidemiological indicators were gathered on these patients, including age, gender, place of accident, extent of trauma, mortality and whether the injury was occupational or non-occupational. Electrical burns (caused by both low-voltage and high-voltage electric current) made up 1.10% of all burns treated in our burn center and high voltage electrical injuries represented 0.42% of all burn injuries. The average incidence of high voltage electrical trauma was 0.21 cases/100,000 inhabitants. The average age of the patients was 28.59 years. Nine patients died and the mortality was fixed at 15.52%. The average length of hospitalization was 53.43 days. The average extent of burnt area was 35.01% TBSA. In our study, we were able to define the basic epidemiological parameters in 58 patients with high voltage electrical trauma. We also have to highlight the still disappointingly high number of non-occupational electrical injuries affecting those in the lower age groups, especially children. However, preventive programmes for educating specific risk groups have shown positive results.

Le but de notre étude était d'évaluer rétrospectivement les caractéristiques épidémiologiques des patients présentant les lésions électriques causées par la haute tension de 1999 à 2009. La Clinique de « Burns and Reconstructive Surgery ¼, Faculty Hospital Brno, est située dans une région de 2.505.000 habitants. Au total, 13 911 patients (y compris les enfants et les adultes, et ambulatoires ainsi que les patients hospitalisés) ont été traités dans notre centre pendant la période d'étude. Parmi ces patients, 1.030 ont été hospitalisés pour le traitement des brûlures. Aux fins de cette étude, nous avons inclus seulement les patients avec un traumatisme électrique à haute tension, il y en avait 58, dont 2 étaient des femmes. Des indicateurs épidémiologiques de base ont été recueillies sur ces patients, dont l'âge, le sexe, le lieu de l'accident, l'ampleur du traumatisme, de la mortalité et si la blessure était liée ou non au travail. Les brûlures électriques (causée par une basse tension et le courant électrique à haute tension) représentaient 1,10% de toutes les brûlures traitées dans notre centre, et des blessures électriques à haute tension représenté 0,42% de toutes les brûlures. L'incidence moyenne de traumatisme électrique à haute tension est de 0,21 cas pour 100,000 habitants. L'âge moyen des patients était de 28,59 années. Neuf patients sont décédés et la mortalité a été fixée à 15,52%. La durée moyenne d'hospitalisation était de 53,43 jours. La moyenne surface corporelle brûlée était 35.01% de la SCT. Dans notre étude, nous avons pu définir les paramètres épidémiologiques de base chez 58 patients atteints de traumatismes électrique à haute tension. Nous devons également mettre en évidence le nombre toujours élevé de blessures électriques non-professionnelles affectant ceux dans les groupes d'âge inférieures, surtout les enfants. Toutefois, les programmes de prévention pour sensibiliser les groupes à risque spécifiques ont montré des résultats positifs.

An unusual solution after bilateral lower extremity amputation.

The authors present a case of a 40-year-old male with devastating amputation trauma of both lower extremities. Reconstruction of the right lower extremity was solved by the unusual use of inserted vascularized bone-skin graft from the left crus with a simultaneous replantation of the right foot. The result after 3.5 years is preservation of one extremity with full knee mobility. The other lower extremity was fitted for thigh prosthesis.