Poststernotomy wound management by debridement and pedicle flaps reconstruction.

BACKGROUND: Sternal wound infection and sternal dehiscence are very serious, sometimes life-threatening complications of cardiac surgery, which require immediate attention. The mortality rate can reach 50%. During the past 30 years,various flaps for coverage of sternal wounds have been described. OBJECTIVE: The authors objective was to evaluate their 7-year experience with flaps used for coverage of poststernotomy wounds, with an emphasis on flap selection and post repair complications. RESULTS: The records of 15 patients were reviewed. The most common coverage techniques were pectoralis major flap (n=5)and rectus abdominis flap (n=4). Four patients had both of these flaps. One patient had a latissimus dorsi flap, and another one had an omental flap. Eight of the 15 patients experienced a local complication; these included seroma(n=2), hematoma (n = 1), infection requiring debridement and antibiotics (n = 2), partial flap necrosis (n = 2) and abdominal hernia (n=1). The perioperative mortality rate was 13.3% (n = 2), and all deaths were attributable to multiple organ deficiency due to sepsis. CONCLUSIONS: Early debridement and coverage of the remained defects with flaps are the two main principles in the management of poststernotomy infected wounds, especially insituations where rapid wound healing and recovery are extremely important. Individual approach to each patient and proper selection of the method of reconstruction significantly reduces the postoperative morbidity and mortality rate.

Gastro-omental free flap in oro/hypopharyngeal reconstruction after enlarged ablative surgery for advanced stage cancer.

UNLABELLED: Reconstruction of complex mucocutaneous defects after ablative surgery for advanced cancer of the oropharynx, hypopharynx and larynx (Stages III and IV of disease according to TNM classification) with previous radiotherapy is a challenging problem for the plastic surgeon. The gastroomental free flap provides in these cases both a reliable mucosal lining of the digestive tract and soft tissue coverage in the neck. One-stage surgical excision and reconstruction improves the quality of life by reducing the hospitalization and providing recovery of the swallowing function. BACKGROUND: The method of reconstruction of the complex mucocutaneous defects that usually occur after extensive ablative surgery associated with radiotherapy for advanced malignant lesions of the oropharynx, hypopharynx and larynx should provide both digestive tract reconstruction and soft tissue coverage of the neck. The purpose of the article is to report our experience with the use of the gastroomental free flap for the reconstruction of such complex defects of the oro-and hypopharynx. METHOD: Gastro-omental free flap was used for one-stage reconstruction of complex defects of the oropharynx in four cases and hypopharynx in eleven cases between December 1990 and December 2008 after extensive ablative surgery for cancer. All fifteen patients had received previous irradiation. In all cases the tumor ablation was associated with neck dissection. RESULTS: There was one flap failure in this series (6.67%). Complications included: two cases of gastric outlet obstructions, one case of mild superficial bleeding of the transplanted gastric mucosa and three fistulas formed. Thirteen patients had adequate swallowing function after reconstruction of the digestive tract. CONCLUSION: Gastro-omental free flap represents a reliable and valuable solution in covering of extended and complex defects in the oral and cervical area following advanced cancer ablation.

Human adipose-derived stem cells: definition, isolation, tissue-engineering applications.

Recent researches have demonstrated that the most effective repair system of the body is represented by stem cells - unspecialized cells, capable of self-renewal through successive mitoses, which have also the ability to transform into different cell types through differentiation. The discovery of adult stem cells represented an important step in regenerative medicine because they no longer raises ethical or legal issues and are more accessible. Only in 2002, stem cells isolated from adipose tissue were described as multipotent stem cells. Adipose tissue stem cells benefits in tissue engineering and regenerative medicine are numerous. Development of adipose tissue engineering techniques offers a great potential in surpassing the existing limits faced by the classical approaches used in plastic and reconstructive surgery. Adipose tissue engineering clinical applications are wide and varied, including reconstructive, corrective and cosmetic procedures. Nowadays, adipose tissue engineering is a fast developing field, both in terms of fundamental researches and medical applications, addressing issues related to current clinical pathology or trauma management of soft tissue injuries in different body locations.

[Options for flap coverage in pressure sores]. / Optiuni de acoperire cu lambouri in escarele de decubit.

Despite improvements in reconstructive techniques for pressure sores, recurrences are still seen frequently, and success rate remains variable. During 2003 - 2007, at the Emergency Hospital for Plastic Surgery and Burns in Bucharest, 27 patients underwent surgical repair of 45 pressure sores located at sacral (22 ulcers), ischial (12 ulcers) and trochanteric (11 ulcers) regions. The mean patient age was 57, 1 years (range 26 to 82 years). Mean postoperative follow-up was 6 months (range 2 months - 2 years). There were 18 complications for the 45 sores (40%). At 6 months postoperatively, recurrence was noted in 12 ulcers (27%). Details regarding indications, contraindications, advantages and disadvantages for different coverage options are outlined. The authors advocate the importance of surgical coverage in reducing morbidity, mortality and treatment costs.