Retrospective Study of a Patient with Multiple de Novo Skin Tumor Formations.

In Romania, the incidence of malignant melanocytic tumors is continuously increasing. According to the World Health Organization, the incidence of melanocytic and non-melanocytic skin neoplasms has increased considerably and globally, in the last decade. We present the case of a 49-year-old patient who, over the course of 7 years, came in the Plastic Surgery Clinic of the Emergency County Hospital of Craiova for the excision of a number of 25 skin tumor formations, located on the face, cervical region, trunk and upper limbs. Treatment included complete microsurgical excision and supervision. In the end, the patient's treatment compliance decreased significantly.

Treatment of skin defects with PRP enriched with hyaluronic acid - histological aspects in rat model.

Tissue healing is a complex, dynamic process, characterized by the replacement of devitalized and absent cell and tissue structures. This can be obtained by different methods, these being found in the "reconstructive scale", which although it is very rich does not offer a universally valid solution for closing skin wounds. In plastic surgery, platelet-rich plasma (PRP) has proven effective in the treatment of skin graft donor areas, burn wounds, skin grafts, tendons, or varicose ulcers. Also, hyaluronic acid (HA) has found its utility in different areas of medicine, other than the esthetics field, with satisfactory results after its use in various lesions. The aim of our study was to find a method of healing wounds with skin defect that shortens the time of complete epithelialization compared to native healing, which is accessible to any patient both by its simplicity and by the lowest possible costs. So, we decided to test a preparation consisting of PRP and granular HA in this type of wounds on a group of 30 Wistar rats. Corroborating the macroscopic data with the microscopic ones, an important similarity can be observed between the healing of the adjuvant-treated lesion at 14 days postoperatively and the healing of the lesion left to natural healing at 21 days, thus shortening the healing period by seven days.

Study on the Application of PRP Enriched with Hyaluronic Acid to Skin Wounds-Macroscopic Result.

Tissue healing is a complex process of replacing damaged tissue structures, being a dynamic process with spatial and temporal involvement. In practice, there are three types of healing: primary, secondary and tertiary. Since even tertiary healing can cause different problems depending on the individual patient, the medical world has always strived for new, easier, more effective, faster, and low cost-effective methods to cover skin wounds. This experiment aims to find a method that is as efficient and fast as possible, with minimal costs, of native healing of skin wounds and the development of a protocol that is as reliable and safe as possible for the patient. The experiment was carried out within the animal facility of the University of Medicine and Pharmacy of Craiova, with the agreement of our institutional Ethics Committee. The experimental group consisted of 30 individuals (Wistar laboratory rats), clinically healthy, male and female, being divided into 3 sublots of 10 individuals each. Each sublot was sacrificed at different time intervals: 7, 14 and 21 days, respectively. The local evolution of each individual was monitored during the experimental days, as well as their general state of health. Before slaughter, the lesions were examined macroscopically, following their size, whether or not the infection was present and the presence of other self-inflicted lesions later. Macroscopically, a faster wound healing was found where PRP enriched with hyaluronic acid was applied from the 7th day, so we can say that at first glance the "free" healing period in the case of enhanced epithelialization was about 7 days shorten. This fact will be confirmed or refuted following histopathological examinations and immunohistochemistry.

Retrospective Study Over the Hypospadias Surgery in a Single Tertiary Center.

Hypospadias surgery is a common activity in every department for pediatric surgery, increased incidence of this condition contributing this aspect. For this purpose permanent review of the data of cases is probably necessary, in order to promptly evaluate short and long term results. MATERIAL AND METHODS: The authors are presenting this retrospective clinical and statistical study, enrolling 149 patients, hospitalized and operated in the Department of Pediatric Surgery and Orthopedics, between 2009 and 2018. several parameters were taken into consideration: moment of conception, type of hypospadias, associated malformations, use of meatoplasty, age at meatoplasty, age at urethroplasty, type of urethroplasty, postoperative incidents and complications. RESULTS: Most of the patients included in the study were classified as anterior type of hypospadias, associated malformations were present in 20,13% of the patients, and 80% of the associated malformations belonged to the urogenital system. Over 60% of the cases underwent meatoplasty as a tactical procedure. Mathieu was the most appreciated procedure (74,5%) for urethroplasty and over a half of the patients were operated after the age of 3 years. Early and late postoperative fistula formation was noted in 18,12% of cases. CONCLUSIONS: Better parameters to assess the exact type of hypospadias are needed to be introduced. Also, clear protocols for preoperative work-up in detection of other abnormalities, especially genito-urinary. Meatoplasty as a tactical procedure is having unclear influence for urethroplasty. Decreasing the age at urethroplasty should be the next goal. Some surgeons should really get overspecialized for this type of surgery.

PRP Enriched with Hyaluronic Acid -PRP from Rat Protocol and Method of Preparation.

Observing the positive effects of PRP (platelet-rich plasma) used in various pathologies, both in traumatology, orthopedics, sports medicine, and in plastic and reconstructive surgery, we decided to develop an improved product, using granular hyaluronic acid. The paper aims at establishing a protocol for obtaining PRP enriched with hyaluronic acid, which can be used in the current practice of treatment of skin defects, safely, with minimal side effects and limited possible, but to provide a shorter healing period as compared to native, "free" healing. The experiment aims to find an effective and rapid method of healing wounds with skin defects, by using a local adjuvant (PRP enriched with hyaluronic acid), which is available to any plastic surgeon. Following the combination of PRP with granular hyaluronic acid, we obtained a product that macroscopically has a gelatinous, viscous consistency, with a good adhesion to the tissues. The potential benefits of this experiment could be the basis for the development of treatment protocols for various pathologies, which result in wounds with skin defects, the most important aspect being the shortening of the classic healing period.

Basal Cell Carcinoma and its Impact on Different Anatomical Regions.

Basal cell carcinoma (BCC) is the most common skin cancer. We conducted a retrospective study over a period of two years (2018-2019), on 214 patients from the Plastic Surgery clinic in order to identify the clinical and histopathological aspects of the disease: the case distribution according to sex, living environment, age, histopathological subtype, location. Results. The F/M ratio was of 1.03 in favour of women. The incidence was higher for patients from rural areas (55.14%). The most affected group age was between 70-80 years old, with 76 patients (35.51%). The most frequent histological type was nodular basal cell carcinoma (65.42%), followed by micronodular subtype (17.29%). We observed the association of basal cell carcinoma with a number of other conditions such as: high blood pressure (92 cases), diabetes (19 cases), chronic kidney disease (2 cases), liver disease (5 cases), epilepsy (2 cases). Correlating the histopathological subtype and the invasion of the edges of the surgical excision specimen, we noticed that edge invasion was present: in the case of nodular basal cell carcinoma (15.71%), micronodular subtype (43.24%), superficial subtype (50%), morpheaform subtype (40%). Dividing the cases by location, we highlighted the risk areas: nasal region (29.44%), cheek (10.75%), orbital region (13.55%), scalp (10.75%), auricular region (7.48%), forehead (8.41%), etc. Thus, 89.72% of cases were located on photo-exposed areas (head and neck). Patients from rural areas registered a higher number of cases both in photo-exposed and non-exposed areas.

Extracorporeal Septoplasty-A Well Proven Technique for Treatment of Crooked Noses.

Crooked noses (noses with complex septal and pyramidal deviations) are an important challenge for both plastic surgeons and otolaryngologists. Extracorporeal septoplasty, described by Gubisch constitutes an effective solution to this problem. The article describes a series of 7 cases (5 males and 2 females) in which this method was used during open rhinoseptoplasty. The technique we used is described in detail. All the patients showed improvement of the nose appearance and good nasal air flow. Hypertrophy of the right inferior turbinate complicated one case, but was resolved with electro cauterization. Although the learning curve is slow and it claims the surgeon's imagination, the method is sometimes the only solution in complex cases of septal deviation. Our short series demonstrates that good indication and careful dissection are prerequisites for success in difficult cases.

Histological aspects of full-thickness skin grafts augmented with platelet-rich fibrin in rat model.

BACKGROUND AND OBJECTIVES: The restoration of the damaged tissue commences very early with a regulated sequence of biochemical events set into motion to repair the damage. While the understanding of this entire process is still incomplete, it has been established that platelets play a decisive role not only in hemostasis, but also in the wound healing process, through an abundance of growth factors and other signaling cytokines modulating the inflammatory response. To this end, we attempted to evaluate the effect of a platelet-rich biomaterial - platelet-rich fibrin (PRF) - in the augmentation of full-thickness skin grafts (FTSGs). MATERIALS AND METHODS: Skin defects were performed on the rats' dorsum and covered with FTSGs. The test group wound bed was treated with PRF before the suture of the graft. Skin graft specimens were obtained from the control and test group rats for histological and immunohistochemical examination on the 21st postsurgical day. Our study included 40 male Wistar rats. Average thickness of epidermal cell layers was recorded for each wound site. The average fibroblast count was compared between the control and test (PRF-augmented FTSG) groups. Blood vessel count and vascular density - the blood vessels were identified under low-power microscopy. The prominent vascular areas were then scanned in higher-power fields; individual vessels were marked and counted by hand. Vascular density was calculated. Mean vascular count for each graft was then calculated. RESULTS: The mean thickness of the epidermal layer was significantly higher and closer to the physiological epidermal thickness, in the test group than in the control group. The average fibroblast and fibrocyte count in the dermal layer in FTSGs augmented with PRF was higher than in the control group. We discovered a statistically insignificant increase in the blood vessel count and vascular density of the test group, compared to the control group. CONCLUSIONS: Our limited data supports the theory that the addition of PRF to FTSG recipient wound beds has the potential to improve graft take and regulate the proliferation of a thicker and more uniform epidermis, while decreasing healing time and dermal necrosis rates.

Histological findings from rat calvaria defect augmented with platelet-rich fibrin by using two consecutive periosteal incisions.

BACKGROUND AND OBJECTIVES: Platelet-rich fibrin (PRF) is a new generation of biomaterial that proved to be an effective tool in numerous clinical uses. This study aims at expanding the range effectiveness of PRF in promoting bone healing by histological evaluation. MATERIALS AND METHODS: We performed a pair of two calvaria defects on 35 Wistar rats. The left defect was left empty as a control and the right defect was augmented with PRF. After 45 days, the experiment was terminated and the calvaria were collected and underwent morphological and histological analysis. RESULTS: New bone formations have been shown to be prevalent in the PRF augmented defect. CONCLUSIONS: PRF increases the body's natural ability to heal and regenerate bone.

Platelet-Rich Fibrin and its Emerging Therapeutic Benefits for Musculoskeletal Injury Treatment.

New therapies that accelerate musculoskeletal tissue recovery are highly desirable. Platelet-rich fibrin (PRF) is a leukocyte- and platelet-rich fibrin biomaterial that acts as a binding site for both platelets and growth factors. Through increasing the local concentration of growth factors at specific tissues, PRF promotes tissue regeneration. PRF has been frequently used in combination with bone graft materials to reduce healing times and promote bone regeneration during maxillofacial surgery. However, its benefits during muscle repair and recovery are less well-documented. Here, we perform a narrative review on PRF therapies and muscle injuries to ascertain its beneficial effects. We reviewed the factors that contribute to the biological activity of PRF and the published pre-clinical and clinical evidence to support its emerging use in musculoskeletal therapy. We include in vitro studies, in vivo animal studies and clinical articles highlighting both the success and failures of PRF treatment. PRF can promote the healing process when used in a range of orthopaedic and sports-related injuries. These include cartilage repair, rotator cuff surgery and anterior cruciate ligament surgery. However, conflicting data for these benefits have been reported, most likely due to inconsistencies in both PRF preparation protocols and dosing regimens. Despite this, the literature generally supports the use of PRF as a beneficial adjuvant for a range of chronic muscle, tendon, bone or other soft tissue injuries. Further clinical trials to confirm these benefits require consistency in PRF preparation and the classification of a successful clinical outcome to fully harness its potential.