Cíl: Úraz elektrickým proudem z vysokého napětí je jedním z nejzávažnějších úrazů, se kterými se můžeme v moderní medicíně setkat. Často bývá spojený s více následky a vysokou náchylností k infekčním komplikacím. Tito pacienti jsou přijímáni do specializovaných popáleninových center a vyžadují rozsáhlou multidisciplinární spolupráci. V této studii se snažíme odhalit prevalenci, typy a charakteristiky mikrobiálních infekcí, které se vyvíjejí po vysokonapěťovém elektrotraumatu, a identifikovat rizikové faktory, které mohou přispívat k náchylnosti pacientů k infekcím. Materiál a metodika: Pro účely této publikace byla zpracována data všech 37 pacientů hospitalizovaných na jednotce intenzivní péče Kliniky popálenin a plastické chirurgie FN Brno s diagnózou úraz elektrickým proudem vysokým napětím v letech 2006–2016. Otisky a stěry z exfoliovaných oblastí byly opakovaně odebírány k mikrobiální analýze spolu s tracheobronchiálním aspirátem, sputem nebo bronchoalveolární laváží, močí a periferní krví. Získaná data byla zpětně analyzována. Výsledky: Mezi 37 pacienty byl medián věku 31,9 s průměrnou dobou hospitalizace 44,3 dne a úmrtností 8,1 %. Na umělé plicní ventilaci bylo závislých celkem 28 osob. Výskyt infekčních komplikací se v průběhu hospitalizace liší podle místa kultivace odběru a doby strávené v nemocnici. U 97,3 % pacientů se vyvinula infekce alespoň v jednom tělesném kompartmentu. V 88,8 % případů byla multipatogenní a ve 41,6 % se rozvinul septický stav. V naší studijní kohortě dominovaly G+ nad G-kmeny. Nejčastějšími zástupci z G+ spektra byli koaguláza negativní stafylokoky (97 %), Staphylococcus aureus (57 %), Enterococcus fecalis et faecium (51 %). V G-spektru bylo pořadí následující: Klebsiella pneumoniae (46 %), Pseudomonas aeruginosa (41 %), Escherichia coli (35 %) a Acinetobacter baumannii (18,9 %). Nejčastější pozorovanou infekcí byla infekce popálenin (BWI), následovaná infekcemi krevního řečiště (BSI), infekcemi dolních cest dýchacích (LRTI) a infekcemi močových cest (UTI), primárně způsobené G+ patogeny. Je pozoruhodné, že delší doba hospitalizace byla spojena s rostoucí prevalencí G-patogenů, zejména K. pneumoniae, P. aeruginosa a A. baumannii, které vykazovaly vysoký stupeň antimikrobiální rezistence. Závěr: Tato studie poskytuje podrobný pohled na výskyt a následky úrazů elektrickým proudem s vysokým napětím na Moravě v průběhu desetiletí. Faktory významně ovlivňující přežití a závažnost výsledků zahrnovaly celkovou plochu popálenin, popáleniny v celé tloušťce, inhalační poranění a potřebu tracheostomie. Studie je však limitována relativně malou velikostí vzorku, dlouhou dobou sběru dat s potenciálními změnami v klinické praxi a jednocentrovým designem, což může ovlivnit zobecnění nálezů. K ověření těchto výsledků a zpřesnění strategií prevence infekcí u této populace pacientů jsou zapotřebí další multicentrické studie.

Background and Aim: High voltage electrotrauma is one of the most serious injuries we can encounter in modern medicine, often associated with multiple disabilities and high susceptibility to infectious complications. These patients are admitted to specialized burn centers and require extensive multidisciplinary collaboration. In this study, we aim to uncover the prevalence, types and characteristics of microbial infections that develop in the aftermath of high voltage electrotrauma and to identify risk factors that may contribute to patients’ susceptibility to infections. Material and Methods: For the purposes of this publication, data of all 37 patients hospitalized in the intensive care unit of the Department of Burns and Plastic Surgery of the University Hospital in Brno with a diagnosis of high-voltage electrical injury between 2006–2016 were processed. Imprints and swaps from exfoliated areas were repeatedly taken for microbial analysis, together with tracheobronchial aspirate fluid, sputum, or bronchoalveolar lavage, urine and peripheral blood. The obtained data were analysed retrospectively. Results: Among the 37 patients, the median age was 31.9, with an average hospital stay of 44.3 days and a mortality rate of 8.1%. A total of 28 individuals were dependent on artificial lung ventilation. The incidence of infectious complications varies during the hospitalization period according to the location of sampling cultivation and time spent at the hospital. 97.3% of patients developed infection in at least one body compartment. In 88.8% of cases, it was multipathogenic and in 41.6% a septic condition developed. In our study cohort, G+ dominated over Gstrains. Most common representatives from G+ spectrum were Coagulase negative Staphylococci (97%), Staphylococcus aureus (57%), Enterococcus fecalis et faecium (51%). In Gspectrum, the order was as followed: Klebsiella pneumoniae (46%), Pseudomonas aeruginosa (41%), Escherichia coli (35%) and Acinetobacter baumannii (18.9%). The most common infection observed was burn wound infection (BWI), followed by bloodstream infections (BSI), lower respiratory tract infections (LRTI), and urinary tract infections (UTI), primarily caused by G+ pathogens. Notably, an increased hospital stay duration was associated with a rising prevalence of Gpathogens, particularly K. pneumoniae P. aeruginosa and A. baumannii which exhibited a high degree of antimicrobial resistance. Conclusion: This study provides a detailed insight into the occurrence and consequences of high-voltage electrical injuries in Moravia over a decade. Factors significantly impacting survival and severity of outcomes included total burn surface area, full-thickness burns, inhalation injury, and the need for tracheostomy. However, the study is limited by its relatively small sample size, long data collection period with potential changes in clinical practice, and single-center design, which may affect the generalizability of the findings. Further multicentric studies are needed to validate these results and refine infection prevention strategies in this patient population.

Multidisciplinární lékařský tým z několika českých nemocnic se zúčastnil v rámci projektu MEDEVAC mise do nemocnice v ukrajinském městě Vynnyky. Civilním pacientům byla poskytnuta specializovaná chirurgické péče ve spolupráci s plastickými chirurgy u úrazů v souvislosti s bojovými operacemi i bez ní. Krátce je popsán případ komplexní otevřené zlomeniny předloketních kostí s rozsáhlým defektem měkkých tkání i skeletu u 32letého civilního pacienta.

A multidisciplinary medical team from several Czech hospitals participated in a mission to a hospital in the Ukrainian town of Vynnyky as part of the MEDEVAC project. Civilian patients were provided with specialized surgical care in cooperation with plastic surgeons for injuries related to combat operations and without it. A case of a complex open fracture of the forearm bones with extensive defect of soft tissues and skeleton in a 32-year-old civilian patient is briefly described.

BACKGROUND: Large femoral defects after trauma, femoral non-unions, fractures complicated by osteomyelitis or defects after bone tumour resection present high burden and increased morbidity for patient and are challenging for reconstructive surgeons. Defects larger than 6 cm and smaller defects after failed spongioplasty are suitable for reconstruction using a free, eventually a pedicled vascularised bone flap. The free fibular flap is preferred but an iliac crest free flap or a pedicled medial femoral condyle flap can be also used. These vascularised flaps are ideal for bridging defects of long bones and can be also used as osteocutaneous or osteomuscular flaps for coverage of soft tissue defect if present. The patients and their families were informed that data will be submitted for publication and they gave their written informed consent prior to the submission. The study was approved by the institutional ethic committee. METHODS: We analysed a group of eight patients with large diaphyseal or distal metaphyseal femoral defects. A free fibular flap was used in six patients, a pedicled medial ipsilateral femoral condyle flap was used in two patients and a defect in one patient was reconstructed using an iliac crest free flap. RESULTS: All flaps healed completely in all patients and no fracture of the flap was detected during the study period. In one patient, a locking plate broke and was replaced by a compression plate. At the last check-up all patients were able to step on the reconstructed limb with full weight. DISCUSSION: Although our study comprises a heterogeneous group of cases, they all have been successfully treated by a similar technique, adapted in each case specifically to the needs of the patient. A major limitation parameter of reconstruction by a free vascularised flap is the size of bone defect needed to be reconstructed. In case of a bone defect longer than 6 cm and a concomitant soft tissue disruption, a vascularised double-barrel fibula is the preferred. CONCLUSION: Large femoral defects can be successfully reconstructed with good long-term results using suitable free or pedicled vascularised bone flaps, especially preferring the free fibular flap.

• MeSH
• chirurgické laloky * MeSH
• dospělí MeSH
• femur * chirurgie   transplantace   MeSH
• fibula transplantace   chirurgie   zranění   MeSH
• fraktury femuru chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• retrospektivní studie MeSH
• senioři MeSH
• transplantace kostí * metody   MeSH
• volné tkáňové laloky transplantace   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Pseudomonas aeruginosa poses a significant threat to both immunocompetent and immunocompromised individuals, often resulting in life-threatening infections. With increasing antimicrobial resistance, novel therapeutic strategies are urgently needed. Although animal models are crucial for preclinical studies, limited data are available for porcine models, more specifically for P. aeruginosa complicated skin and soft tissue infections (cSSTIs). This study presents a novel porcine model inducing and sustaining cSSTI for 14 days. Six pigs (120 wounds) were used for the development of infections, and within this group, two pigs (40 wounds) were used to evaluate the progression of the cSSTI infection. The model demonstrated bacterial loads of more than 107 CFU/gram of tissue or higher. The cSSTI fully developed within three days and remained well above these levels until day 14 post-infection. Due to the immunocompetence of this model, all the immunological processes associated with the response to the presence of infection and the wound healing process are preserved.

BACKGROUND: The purpose of dermal substitutes is to mimic the basic properties of the extracellular matrix of human skin. The application of dermal substitutes to the defect reduces the formation of hypertrophic scars and improves the scar quality. This study aims to develop an original dermal substitute enriched with stable fibroblast growth factor 2 (FGF2-STAB®) and test it in an animal model. METHODS: Dermal substitutes based on collagen/chitosan scaffolds or collagen/chitosan scaffolds with nanofibrous layer were prepared and enriched with FGF2-STAB® at concentrations of 0, 0.1, 1.0, and 10.0 μg ‧ cm-2. The performance of these dermal substitutes was tested in vivo on artificially formed skin defects in female swine. The outcomes were evaluated using cutometry at 3 and 6 months. In addition, visual appearance was assessed based on photos of the scars at 1-month, 3-month and 6-month follow-ups using Yeong scale and Visual Analog Scale. RESULTS: The dermal substitute was fully integrated into all defects and all wounds healed successfully. FGF2-STAB®-enriched matrices yielded better results in cutometry compared to scaffolds without FGF2. Visual evaluation at 1, 3, and 6 months follow-ups detected no significant differences among groups. The FGF2-STAB® effectiveness in improving the elasticity of scar tissues was confirmed in the swine model. This effect was independently observed in the scaffolds with nanofibres as well as in the scaffolds without nanofibres. CONCLUSION: The formation of scars with the best elasticity was exhibited by addition 1.0 μg ‧ cm-2of FGF2-STAB® into the scaffolds, although it had no significant effect on visual appearance at longer follow-ups. This study creates the basis for further translational studies of the developed product and its progression into the clinical phase of the research.

• MeSH
• chitosan * MeSH
• fibroblastový růstový faktor 2 * MeSH
• hojení ran účinky léků   MeSH
• jizva hypertrofická MeSH
• kolagen MeSH
• kůže MeSH
• modely nemocí na zvířatech MeSH
• nanovlákna terapeutické užití   MeSH
• popálení MeSH
• prasata MeSH
• pružnost * MeSH
• tkáňové podpůrné struktury MeSH
• umělá kůže * MeSH
• viskozita MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

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.

• MeSH
• autologní transplantace metody   MeSH
• fraktury humeru chirurgie   terapie   MeSH
• horní končetina chirurgie   diagnostické zobrazování   patologie   zranění   MeSH
• kosterní svaly chirurgie   transplantace   MeSH
• lidé MeSH
• mladý dospělý MeSH
• nervus radialis * chirurgie   patologie   transplantace   MeSH
• nervus suralis chirurgie   transplantace   MeSH
• neurochirurgické výkony metody   MeSH
• přenos šlachy metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

UNLABELLED: Previous surgical procedures in the abdomen are no longer contra-indications for free flap breast reconstruction using the deep inferior epigastric artery perforator flap. Nonetheless, a possible consequence of previous surgical procedures may be trauma to the deep inferior epigastric (DIE) pedicle, leading to interruption. In these cases, a modification in operative strategy may be required. METHODS: A study was performed across two centers, during a 10-year period between January 1, 2010 and December 2019. Patient and outcome data were collected from the patient file and operation notes. RESULTS: Four cases with clear evidence of DIE pedicle interruption were found, with an average age of 54 years and an average body mass index of 28.9. Three patients had a preoperative diagnosis of DIE pedicle interruption on CT angiography, whereas in one case this was found peroperatively. For three cases, unilateral reconstruction was performed, and for one, bilateral reconstruction. Four flaps (in three cases) were unipedicled; the contralateral DIE pedicle was used in three, and the superficial system was used in one. For the bipedicled case, two hemiflaps were used, with the interrupted DIE pedicle anastomosed to a branch of the contralateral DIE pedicle. CONCLUSIONS: Interrupted DIE vessels remain a challenge for free flap breast reconstruction. The four cases demonstrated in this article highlight different surgical strategies, with an emphasis on detailed preoperative planning, including CT angiography. We present an algorithm to aid the reader in approaching cases with an interrupted DIE pedicle.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

Úvod: Traumatická ztráta palce ruky je vážné zranění ovlivňující schopnost pacienta pracovat a účastnit se každodenních činností. Hlavním cílem plastického chirurga je obnovit úchop ruky, často mikrochirurgickými metodami. Pacienti by však měli být informováni o všech následcích odběru tkáně. Cílem studie bylo posoudit dopad na došlap donorské nohy a na chůzi u pacientů, kteří podstoupili rekonstrukci palce ruky technikou twisted-toe modifikovanou Kempným. Materiál a metody: Studie se zúčastnilo 12 pacientů: všichni utrpěli ztrátu palce ruky mezi lety 2003 a 2011 a pro rekonstrukci byla použita technika twisted-toe. Byly hodnoceny změny v rozložení tlaku na chodidla a zatížení kloubů dolních končetin. Výsledky: Rozdíly mezi celkovým maximálním plantárním tlakem, integrálem tlakového času, kontaktní plochou a maximální silou mezi postiženou a nepostiženou končetinou; byly však zjištěny statisticky významné rozdíly v kinetických parametrech a momenteh předního kotníků a kolene. Závěr: Funkčnost donorské končetiny a anatomické postižení byly hodnoceny pomocí pedobarografických systémů a 3D analýzy chůze. Nejvýznamnější nálezy byly zaznamenány v rozdílné distribuci plantárního tlaku (zvýšený tlak v I., IV. a V. metatarzální oblasti) a přetížení mediálního kompartmentu kolenního kloubu. Proto by pro pacienty po rekonstrukci palce technikou twisted-toe mohlo být jako prevence osteoartrózy prospěšné nošení individuálně přizpůsobených vložek do bot.

Background: Traumatic thumb loss is a serious injury affecting patient´s ability to work and participate in activities of daily life. The main goal for a plastic surgeon is to restore hand grip, often by microsurgical methods. However, patients should be informed of all effects associated with tissue harvesting. The aim of the study was to assess the impact on donor foot and gait cycle in patients who have undergone thumb reconstruction using twisted-toe technique modified by Kempný. Material and methods: Twelve patients participated in the study: all suffered a thumb loss between the years 2003 and 2011 and the twisted-toe technique for thumb reconstruction was utilized. The changes in foot pressure distribution and lower extremity joint loading were evaluated. Results: The differences in total maximal plantar pressure, pressure time integral, contact area, and maximum force between the affected and non-affected foot were statistically significant (P ≤ 0.1). No significant differences of temporal gait parameters between the affected and non-affected extremity were observed; however, statistically significant differences in kinetics parameters, frontal ankle and knee moments were detected. Conclusion: Donor limb functionality and anatomical disability were assessed using pedobarography systems and 3D-gait analysis. The recorded differences in plantar pressure distribution (increased pressure in I., IV. and V. metatarsal areas) and overload of the medial compartment of the knee joint were the most significant findings. Therefore, wearing individually adapted shoe insoles as prevention of osteoarthrosis might be beneficial for patients after thumb reconstruction by a twisted-toe technique.

• Klíčová slova
• pedobarografie,
• MeSH
• analýza chůze přístrojové vybavení   MeSH
• lidé MeSH
• palec nohy * transplantace   MeSH
• palec ruky * transplantace   MeSH
• pooperační komplikace MeSH
• pooperační období MeSH
• posturální rovnováha MeSH
• traumatická amputace chirurgie   MeSH
• zákroky plastické chirurgie MeSH
• zatížení muskuloskeletálního systému MeSH
• zobrazování trojrozměrné metody   MeSH
• Check Tag
• lidé MeSH

Infectious complications are responsible for the majority of mortalities and morbidities of patients with critical burns. Although bacteria are the predominant etiological agents in such patients, yeasts and fungi have become relatively common causes of infections over the last decade. Here, we report a case of a young man with critical burns on 88% TBSA (total body surface area) arising as a part of polytrauma. The patient's history of orthotopic liver transplantation associated with the patient's need to use combined immunosuppressant therapy was an additional complication. Due to deep burns in the forearm region, we have (after a suitable wound bed preparation) applied a new bi-layered dermal substitute. The patient, however, developed a combined fungal infection in the region of this dermal substitute caused by Trichoderma longibrachiatum and Aspergillus fischeri (the first case ever reported). The infection caused the loss of the split-thickness skin grafts (STSGs); we had to perform repeated hydrosurgical and mechanical debridement and a systemic antifungal treatment prior to re-application of the STSGs. The subsequent skin transplant was successful.

• Publikační typ
• kazuistiky MeSH