V této kazuistice prezentujeme léčbu pacienta s fulminantním průběhem Fournierovy gangrény zevního genitálu v septickém stavu s rozvojem multiorgánového selhání a nutností hospitalizace na anesteziologicko-resuscitačním oddělení. Včasné zahájení léčby a mezioborová spolupráce vedla ke zvládnutí kritického stavu pacienta. Rozsáhlý kožní defekt penisu se zdařilo kompletně zahojit užitím kožního štěpu v plné tloušťce s dobrým funkčním i estetickým výsledkem a tím zachovat dobrou kvalitu života pacienta.
In this case report, we present the management of a patient with fulminant Fournier ́s gangrene of the external genitalia in a septic state with the development of multiple organ failure and the need for admission to the anaesthesiology and intensive care unit. Early initiation of treatment and interdisciplinary cooperation led to the management of the patient ́s critical condition. The extensive penile skin defect was successfully completely healed with a full-thickness skin graft with good functional and aesthetic results, thus preserving the patient ́s good quality of life.
- MeSH
- debridement MeSH
- Fournierova gangréna * diagnóza terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- penis chirurgie patologie MeSH
- sepse diagnóza terapie MeSH
- skrotum chirurgie patologie MeSH
- transplantace kůže MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.
- MeSH
- bércové vředy patologie terapie MeSH
- elastin terapeutické užití MeSH
- kolagen terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění dolní končetiny * patologie terapie MeSH
- průzkumy zdravotní péče metody statistika a číselné údaje MeSH
- transplantace kůže * metody MeSH
- vředy dolních končetin patologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
Ztrátová poranění ruky jsou častým úrazem, se kterým se potýkají v první linii především ambulantní chirurgové. Cílem tohoto článku je systematicky popsat zevrubné vyšetření ruky a jednotlivé možnosti rekonstrukce ztrátových poranění ruky, a tím vytvořit praktický přehled využitelný v praxi. Článek se zaměřuje na metody od prostého hojení per secundam intentionem až po základní techniky lalokové rekonstrukce. Popisuje krytí defektů různými druhy kožních štěpů, které jsou častým a efektivním řešením v mnoha případech. Dále se článek věnuje využití místních laloků, jež poskytují spolehlivou alternativu tam, kde jednoduché kožní štěpy nejsou vhodné. Rovněž se dotýká otázky vzdálených axiálních laloků a laloků volných, které umožňují rekonstrukci rozsáhlejších a komplikovanějších defektů. Nakonec je probrána problematika replantací, která, i přes svou náročnost a komplikovanost, může v některých případech nabídnout nejlepší řešení pro záchranu a obnovení funkce ruky. Cílem článku je poskytnout přehledný a praktický návod, který může ambulantním chirurgům usnadnit rozhodování a zlepšit výsledky léčby ztrátových poranění ruky.
Loss injuries of the hand are a common trauma primarily encountered by outpatient surgeons on the front lines. The aim of this article is to systematically describe a thorough examination of the hand and the various options for reconstructing loss injuries of the hand, thereby creating an overview that can be utilized in practice. The article focuses on methods ranging from simple healing by secondary intention to basic techniques of flap reconstruction. It describes the coverage of defects with various types of skin grafts, which are a common and effective solution in many cases. Furthermore, the article addresses the use of local flaps, which provide a reliable alternative where simple skin grafts are not suitable. The article also describes the use of axial, distant flaps, and free flaps, which allow the reconstruction of larger and more complicated defects. Finally, the issue of replantation is discussed, which, despite its difficulty and complexity, can offer the best solution for the preservation and restoration of hand function in certain cases. The goal of the article is to provide a clear and practical guide that can facilitate decision-making for outpatient surgeons and improve treatment outcomes for loss of hand injuries.
Nail bed reconstruction is crucial after fingertip trauma, impacting both function and aesthetics. In this article, the authors describe a case of partial distal phalanx amputation of the index finger with laceration of the nail bed’s remaining part. A traumatically elevated skin-fat flap covered the exposed bone on the fingertip, preserving finger length and sensitivity on the radial side. A full-thickness skin graft from the forearm closed a secondary defect on the finger pulp. Nail bed suturing prevented scarring and nail deformity, and a temporary artificial plastic nail replacement maintained the nail bed’s shape. Temporary artificial nail replacements protect the regenerating fingertip bed, promote healing, and prevent nail deformities. Proper adaptation of lacerated nail bed edges, supported by either the patient’s own nail or a temporary artificial nail, is crucial for optimal fingertip restoration, including proper nail shape.
Full-thickness skin grafts are essential tools for reconstructive surgery. Rectangular or square secondary defect usually occurs after performing a cross-finger flap or homodigital island flap. With the traditional fusiform ellipse design, trimming out excess graft tissue is necessary. Double right triangular shape full-thickness skin grafts are designed to correct the problem.
- MeSH
- lidé MeSH
- palec ruky * chirurgie zranění MeSH
- senioři MeSH
- transplantace kůže * metody škodlivé účinky MeSH
- traumatická amputace chirurgie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
Juvenile xanthogranuloma (JXG) is a rare, benign non-Langerhans cell histiocytosis that primarily affects the skin, with infrequent extracutaneous manifestations. Lesions typically emerge during early childhood and often resolve spontaneously, obviating the need for treatment. This paper details the case of a child diagnosed with a solitary JXG on the sole, necessitating surgical excision due to its functional impairment, specifically a delay in walking and weight bearing.
- MeSH
- abnormality lymfatického systému chirurgie patologie MeSH
- dermatochirurgické výkony metody MeSH
- juvenilní xantogranulom * chirurgie patologie MeSH
- kojenec MeSH
- lidé MeSH
- transplantace kůže MeSH
- vrozené deformity nohy (od hlezna dolů) chirurgie patologie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Hidradenitis suppurativa (HS) je ťažko diagnostikovateľné ochorenie, ktoré často nereaguje na konvenčnú liečbu, čo spôsobuje, že terapia a manažment sú pre lekárov veľmi náročné. Možnosti liečby sa môžu líšiť v závislosti od štádia ochorenia. U každého pacienta sa doporučuje správna edukácia zahrňujúca možnosti konzervatívnej liečby, psychosociálnu podporu, možnosti tlmenia bolesti a ošetrenie supurujúcich prejavov s aplikáciou vhodného krytia. Zhľadiska minimalizácie recidív má svoje nezastupiteľné miesto chirurgická terapia a to v každom štádiu ochorenia. Multidisciplinárny prístup zahŕňajúci najmä dermatológa a plastického chirurga je kľúčom k rýchlej optimálnej kontrole ochorenia.
Hidradenitis suppurativa (HS) is difficult to diagnose and often refractory to conventional treatment which make its treatment and management very challenging for clinicians. The treatment option can vary according to the stage of the disease. For each patient, proper education is recommended, including options for conservative treatment, psychosocial support, options for pain relief, and treatment of suppurative manifestations with the application of appropriate wound coverage. To achieve minimal recurrence, surgical therapy has its place at every stage of the disease. A multidisciplinary approach including mainly dermatologist and plastic surgeon is key to prompt optimal disease control.
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
- MeSH
- hojení ran MeSH
- jizva etiologie prevence a kontrola chirurgie MeSH
- kůže patologie MeSH
- lidé MeSH
- popálení * chirurgie patologie MeSH
- transplantace kůže metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Prezentujeme kazuistiku 40letého pacienta s lézí na glans penis, primárně histologicky potvrzena jako penilní intraepiteliální neoplazie (PeIN). V první linii na sektorovém dermatovenerologickém pracovišti byla zvolena lokální terapie 5‐fluorouracilem. Následná opakovaná biopsie glandu histologicky prokazuje perzistenci PeIN. U pacienta byla provedena cirkumcize a parciální resurfacing glandu s použitím bukálního štěpu s dosažením příznivého kosmetického i funkčního efektu.
We present a case report of a 40 year old patient presenting with lession on glans penis. First biopsy histologically confirmed penile intraepithelial neoplasia (PeIN) associated with HPV p16. Local treatment with 5-fluorouracil provided by dermatologist was ineffective and another biopsy of glans penis again confirmed persistence of PeIN. The patient underwent a circumcision and partial glans resufacing using a buccal graft with favourable aesthetical and functional outcome.
- Klíčová slova
- resurfacing glandu,
- MeSH
- dospělí MeSH
- fluoruracil terapeutické užití MeSH
- infekce papilomavirem diagnóza terapie MeSH
- lidé MeSH
- lidský papilomavirus 16 patogenita MeSH
- nádory penisu * chirurgie diagnóza MeSH
- protinádorové antimetabolity MeSH
- transplantace kůže MeSH
- urologické chirurgické výkony u mužů MeSH
- zákroky plastické chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
While fasciotomy is the only urgent treatment option for compartment syndrome, the resulting open wound leaves room for complications. Closure of the wound can be done by different techniques, including split-thickness skin grafts, negative pressure therapy, an absorbable barbed suture system and a cable ties system. The aim of this paper is to demonstrate how a combined application of these methods can reduce their respective individual disadvantages. Our combined method was tried in two patients, one with an open tibial fracture and the other who underwent ulnar nerve reparation. Both patients started exhibiting signs of compartment syndrome within 3 hrs after surgery. Firstly, absorbable barbed suture systems were positioned with the running intradermal technique. Following this the cable ties were inserted and the limb in question was placed in an elevated position. Complete closure of the patient’s wounds was achieved within 2 weeks without complications. This result is a testament to the added benefit of a combination of these methods in comparison with the results they produce individually.
- MeSH
- dospělí MeSH
- fasciotomie metody MeSH
- kompartment syndrom * chirurgie MeSH
- lidé MeSH
- šicí techniky MeSH
- sutura MeSH
- transplantace kůže MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
