Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

• MeSH
• bércové vředy chirurgie   etiologie   patologie   terapie   MeSH
• dospělí MeSH
• imunosupresiva škodlivé účinky   MeSH
• komorbidita MeSH
• lidé MeSH
• poranění dolní končetiny chirurgie   komplikace   patologie   terapie   MeSH
• terapie neúspěšná MeSH
• tibie * chirurgie   patologie   zranění   MeSH
• záchrana končetiny metody   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• anastomóza chirurgická metody   MeSH
• chirurgické laloky * MeSH
• CT angiografie MeSH
• lidé MeSH
• mikrochirurgie metody   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy 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.

• MeSH
• chirurgické laloky MeSH
• lidé MeSH
• poranění prstů ruky chirurgie   diagnóza   MeSH
• poranění ruky * chirurgie   diagnóza   MeSH
• transplantace kůže MeSH
• traumatická amputace chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

INTRODUCTION: Postoperative constipation (PC) in patients with imperforate anus and perineal fistula (PF) has been reported in up to 60%. Histological studies of PF revealed innervation anomalies which seem to be one of the reasons for PC. Perioperative histologically controlled fistula resection (PHCFR) allows appropriate resection of PF and pull-down normoganglionic rectum at the time of posterior sagittal anorectoplasty (PSARP). MATERIALS AND METHODS: A total of 665 patients with anorectal malformations underwent surgery between 1991 and 2021. Of these, 364 presented PF; 92 out of them (41 F) were studied. Patients with sacral and spinal cord anomalies, neurological disorders, and cut-back anoplasty were excluded. PSARP was done on all patients. Hematoxylin-eosin staining and NADH Tetrazolium-reductase histochemical method were used. Four and more ganglion cells in the myenteric plexus represented a sufficient length of the resection. The continence was scored according to the modified Krickenbeck scoring system. Final scores ranged from 1 to 7 points. Values are given as median. RESULTS: A total of 65 (70.7%) patients presented an aganglionic segment in PF, and 27 patients presented hypoganglionosis. The median length of the resected fistula was 25 mm (interquartile range [IQR]: 20-30). The median total continence score was 7 (IQR: 6-7). Post-op constipation was observed in 6/92 (6.5%) patients. CONCLUSION: PHCFR diminished PC to 6.5% of patients.

• MeSH
• anální atrézie * chirurgie   MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• perineum chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• předškolní dítě MeSH
• rektální píštěl * chirurgie   MeSH
• rektum chirurgie   abnormality   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• zácpa etiologie   chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

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

Moderní technologie nacházejí stále větší využití i v medicíně a zkracuje se čas, za který se etablují jako její plnohodnotné součásti. Je to vidět právě na 3D tisku, kdy za poměrně krátkou dobu od přihlášení patentu je již nedílnou komponentou celé řady lékařských oborů, včetně ORL, maxilofaciální a plastické chirurgie. Jejímu rozšíření výrazně napomáhá pokles pořizovacích nákladů tiskáren a používaných materiálů, včetně dostupnosti software. Další výhodou je zvyšující se počet absolventů oboru biomedicínský inženýr, kteří pomáhají lékařům s vlastní přípravou modelů a následně s jejich tiskem. Dne 17. 6. 2023 přijala Česká lékařská společnost J. E. Purkyně nově vzniklou „Českou společnost pro 3D tisk v medicíně“ jako svou organizační složku. Jejím cílem je napomáhat rozvoji 3D tisku v medicíně, nastavit standardy využití a garantovat jejich dodržování. Přehledový článek uvádí praktické příklady využití 3D tisku v otorinolaryngologii, maxilofaciální a plastické chirurgii.

Modern technologies are increasingly finding their place in medicine, rapidly establishing as invaluable assets. This is evident in 3D printing, which in a relatively short time, has become an integral part of numerous medical fields including ENT, Maxillofacial and Plastic surgery. Its expansion is substantially facilitated by the decrease in the acquisition costs of printers and used materials, including software availability. Another advantage is the increasing number of graduated biomedical engineers who assist doctors in preparing and printing their models. On June 17, 2023, the Czech Medical Society of J. E. Purkyně accepted the newly established „Czech Society for 3D Printing in Medicine“ as its organizational component. Its objective is to help the development of 3D printing in medicine, and to set standards of use and adherence. This article presents practical examples of the use of 3D printing in Otorhinolaryngology, Maxillofacial and Plastic surgery.

• MeSH
• 3D tisk * klasifikace   MeSH
• hlava * chirurgie   diagnostické zobrazování   MeSH
• krk * chirurgie   diagnostické zobrazování   MeSH
• lidé MeSH
• ortognátní chirurgické výkony klasifikace   metody   MeSH
• zákroky plastické chirurgie klasifikace   metody   MeSH
• zobrazování trojrozměrné klasifikace   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Surgical site infection (SSI) is the most consistently reported complication of cranioplasty. No material showed a categorical superiority in the incidence of infection. Porous polyethylene (PE) is considered a low risk material regarding SSI. However, the literature data are very limited. Thus, our objective was to verify the assumed low incidence of SSI after PE cranioplasty in patients at high risk of SSI. The primary objective was the infection rate, while secondary objectives were implant exposure, revision and cosmetic results. METHOD: Patients who underwent three-dimensional (3D) personalized PE cranioplasty in the period 2014-2023 were evaluated prospectively. Only patients with an increased risk of SSI, and a satisfactory clinical conditions were included in the study. RESULTS: Thirty procedures were performed in 30 patients. Cranioplasty was performed 23 times after hemispheric decompressive craniectomy, five times after limited size craniotomy and two times after bifrontal decompressive craniectomy. Risk factors for the development of infection were 18 previous SSIs, 16 previous repeated revision surgeries, four intraoperatively opened frontal sinuses and two times radiotherapy. Neither infection nor implant exposure was detected in any patient. All patients were satisfied with the aesthetic result. In two cases, a revision was performed due to postoperative epidural hematoma. CONCLUSIONS: Three-dimensional personalized PE cranioplasty is associated with an extremely low incidence of SSI even in high-risk patients. However, our conclusions can only be confirmed in larger studies.

• MeSH
• dekompresní kraniektomie škodlivé účinky   metody   MeSH
• dospělí MeSH
• infekce chirurgické rány * epidemiologie   etiologie   MeSH
• kraniotomie škodlivé účinky   metody   MeSH
• lebka chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polyethylen MeSH
• poréznost MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• zákroky plastické chirurgie * metody   škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Objective: To study the efficacy of autologous fat transplantation after preservation at -2 to -18°C in a domestic refrigerator.Patients and methods: This study was conducted in a private clinic from December 2017 to December 2021. A total of 973 female patients were included. Under a full aseptic technique, fat was harvested using a 4 mm suction blunt cannula with three longitudinal slits. Three 50 mL syringes of fat were obtained before transferring it to 10 mL syringes; then, the fat was centrifuged at 3500 rpm for 1 min and injected through an 18 gauge blunt cannula. In addition, 50 mL of fat without centrifugation was stored in a domestic refrigerator for 3 weeks to be reinjected after fast thawing for 20 min, and then centrifuged to be ready for the second session. All participants had follow-up visits at 3 weeks, 6 months, and 1 year.Results: Participants ranged in age from 18 to 65 years. The abdomen was the fat donor site in 63.3% of the patients, while round-face style augmentation was performed in 48.3% of the patients. An assessment at 3 weeks revealed that 84.1% of patients required a second session. After 6 months, on an assessment using a 10-point scale, patients who received a single session and a second session scored 6.05 and 7.46, respectively. At 1 year, the assessment scores were 5.65 and 7.12 for those with a single and second session, respectively, and 60% of patients were fully satisfied.Conclusion: Autologous fat preserved in a domestic refrigerator for 3 weeks is a safe, cheap, and tolerated filler for facial augmentation.

• MeSH
• autologní transplantace * metody   přístrojové vybavení   MeSH
• dospělí MeSH
• kryoprezervace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• obličej chirurgie   MeSH
• statistika jako téma MeSH
• tuková tkáň * chirurgie   transplantace   MeSH
• zákroky plastické chirurgie metody   přístrojové vybavení   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH

The Department of Plastic and Aesthetic Surgery, St. Anne‘s University Hospital in Brno, and Faculty of Medicine of Masaryk University, Brno, has a long history of surgical treatment of lymphedema and elephantiasis, which started in 1970s. There were many types of surgeries described and performed at our department – starting with prof. Bařinka‘s radical operation of elephantiasis, then lower limb end-to-side lymphovenous anastomosis pulled through the wall to the great saphenous vein, and genital lymphedema reduction. We call this era “the first period” of surgical lymphedema treatment. “The second period” started in 2016 by using free flaps with lymph nodes or vascularized lymph nodes and using microsurgical techniques of end-to-end, end-to-side and side-to-end lymphovenous anastomoses to the subcutaneous veins of a small calibre, which then drain the lymph into the blood stream. “The third period” started 2 years ago after the visit of prof. Yang from Taiwan – we started to use the method of single stitch end-to-side anastomosis to big subcutaneous veins like the great saphenous vein or the cephalic vein.

• Klíčová slova
• Bařinkova operace,
• MeSH
• anastomóza chirurgická klasifikace   metody   MeSH
• dějiny 20. století MeSH
• dějiny 21. století MeSH
• elefantiáza chirurgie   diagnóza   terapie   MeSH
• lidé MeSH
• lymfedém * chirurgie   diagnóza   terapie   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie * dějiny   klasifikace   metody   MeSH
• Check Tag
• dějiny 20. století MeSH
• dějiny 21. století MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

Introduction: Skin malignancy is one of the most common reasons for seeking out a plastic surgery clinic. This article presents an overview of the therapeutic results at Department of Plastic and Aesthetic Surgery Brno and includes an algorithm according to which we proceed in the treatment of patients with skin malignancy. Material and methods: Retrospective analysis of data for the year 2022, including a set of 791 patients with a total of 1,117 procedures to remove skin malignancy. The representation of cutaneous malignancy was as follows – basalioma (51%), squamous cell carcinoma (14%), and other malignancies including precancerous lesions were represented in 35%. Age, sex, a character and a number of procedures (excision, re-excision, controlled excision), and the histological results of resected specimens (with a sufficient margin or ingrowth) were evaluated. Based on the analysis of the patient cohort, an algorithm is presented to guide the surgical management of the patient. Results: Patients’ age ranged from 26 to 102 years. There was a discrete male predominance in the cohort (51%). Tumour localization was most frequently on the skin of the face, cleavage, and extremities. Regarding the spectrum of procedures, excision accounted for the largest proportion (83%). Re-excision accounted for the rest of the procedures (10%), controlled excision was performed in 6% and excisional biopsy accounted for 1%. Primary sanative excision with a histologically sufficient margin was performed in 96%. In the group of controlled excisions, 59% were sanative. Overall, 73% of patients in our cohort underwent a single operation only to remove a cutaneous malignancy. Conclusion: The results of the therapy and the algorithm of the care for patients with skin malignancy can be evaluated as successful based on the analysis performed. The determination of the surgical strategy according to the algorithm appears to be effective. The authors recommend its use in practice, especially with the current trend of the increasing incidence of skin malignancies and the desire to improve the effectiveness of surgical interventions.

• MeSH
• bazocelulární karcinom chirurgie   patologie   terapie   MeSH
• lidé MeSH
• management nemoci MeSH
• nádory kůže * chirurgie   patologie   terapie   MeSH
• retrospektivní studie MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• spinocelulární karcinom chirurgie   patologie   terapie   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH