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
Introduction: The aim of this study was to assess the long-term impact and potential effectiveness of our specialized acellular dermal matrix (ADM) in a two-stage breast reconstruction process. Objective: Opinions regarding the use of ADMs are currently divided. While their positive contribution to reconstructive breast surgery is evident, the results of studies vary depending on specific procedures, patient selection, and techniques employed. Material and methods: In a retrospective study conducted between January 2015 and October 2023, it was examined a cohort of patients who underwent delayed two-stage breast reconstruction with the addition of ADM prepared by Central Tissue Bank (CTB) the Burn and Reconstructive Surgery Department University Hospital Ružinov. Our primary focus was on the occurrence of significant postoperative complications during both the initial and subsequent reconstruction periods, taking into account patients’ medical history, comorbidities, and adjuvant therapy. Results: We examined a total of 46 patients (49 breasts) who underwent two-stage breast reconstruction. The average age of the patients was 46 and the average BMI was 23.1. The average length of outpatient follow-up for female patients was 32 months. We observed a total of 4 cases of capsular contracture, ranging from grade I to grade III, with 2 cases requiring surgical revision through capsulotomy and implant exchange. Postoperative complications, such as infection and dehiscence leading to expander/implant loss, occurred in one case. The occurrence of seroma was noted in 3 cases. Complications were more frequently observed in the group of patients with post-radiation chest changes and comorbidities such as diabetes or hypertension, and in patients with a lower BMI than the group’s average (23.1). In the group of patients who were smokers, we did not observe an increased rate of complications, with the exception of wound dehiscence in cases where there was no expander exposure. Conclusion: In experienced hands, ADM prepared by CTB and used in delayed two-stage breast reconstruction, can be beneficial as an adjunct to prosthetic breast reconstruction while also reducing costs.
The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.
- Klíčová slova
- Cold River,
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- mladý dospělý MeSH
- pacienti psychologie MeSH
- popálení * ošetřování psychologie terapie MeSH
- postoj zdravotnického personálu MeSH
- senioři MeSH
- terapie pomocí virtuální reality * metody přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
Objective: Limberg flap, is a rotational rhomboid flap. A procedure done for people who have either complex or recurrent pilonidal disease. This study has been performed to determine effects of the Limberg flap for sacrococcygeal pilonidal sinus, regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients’ satisfaction. Methods: A total of 10 patients were operated from January 2022 to March 2023. Patients were selected according to the disease complexity and recurrence, so that the patients selected were classified as complex and at least of a second recurrence of the disease. Results: Patients successfully underwent surgery, with mild to moderate postoperative pain, stayed in hospital for 3 days in average, returned to work after 6 weeks, with 5 patients having flap oedema, 1 patient had wound infection, no one had flap necrosis, and there were no recurrences so far for an average follow-up time of about 3 months. Patients with flap oedema took 2–3 weeks to heal with regular dressing only. Patient satisfaction and final cosmetic result were well accepted. Limberg flap for sacrococcygeal pilonidal sinus was found very useful in terms of recurrences. Conclusion: Better patients’ acceptance and satisfaction despite the increased risk in postoperative pain, infection rates, and longer return to work in comparison to the open procedures.
- Klíčová slova
- Limbergův lalok,
- MeSH
- chirurgické laloky * chirurgie škodlivé účinky MeSH
- dermatochirurgické výkony metody škodlivé účinky MeSH
- dospělí MeSH
- edém etiologie MeSH
- lidé MeSH
- pilonidální sinus * chirurgie MeSH
- sakrokokcygeální krajina chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
Complex injuries to the posterior trunk can still pose a significant challenge to the reconstructive surgeon. Due to the lack of skin laxity, dependent anatomical location and the importance of the deeper structures, a systematic approach tailored to the individual defect should be considered for these types of reconstructions. In our case report, we present a reconstructive solution of a chronic defect of the back caused by resection of an ulceration. What was previously considered to be a relapse of a malignant melanoma turned out to be a chronic osteomyelitis of the spinous processes of the thoracic vertebrae. The defect after the resection of the ulceration and infected spinous processes of the thoracic vertebrae with exposed dorsal lamina was covered with pedicled myocutaneous flap. Reconstruction yielded well-vascularized tissue that provided sufficient volume and tissue quality. Even in the light of modern perforator flaps, local or locoregional muscle and myocutaneous flaps remain the first choice for the treatment of deep back defects. Considering all the factors in the given case, plastic surgeons are able to tailor the reconstructive technique to every individual case to match the desired reconstruction goal.
- MeSH
- chirurgické laloky * chirurgie MeSH
- dermatochirurgické výkony metody MeSH
- hrudní obratle chirurgie patologie MeSH
- lidé MeSH
- maligní melanom kůže komplikace MeSH
- osteomyelitida * chirurgie MeSH
- pooperační péče metody MeSH
- senioři MeSH
- stafylokokové infekce komplikace MeSH
- vřed chirurgie komplikace patologie MeSH
- záda chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
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
- amputace MeSH
- dospělí MeSH
- infekce * chirurgie terapie MeSH
- lidé MeSH
- nekróza chirurgie terapie MeSH
- pokus o sebevraždu MeSH
- popálení elektrickým proudem * chirurgie komplikace MeSH
- poranění ruky chirurgie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- 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
- MeSH
- lidé MeSH
- management bolesti ekonomika metody MeSH
- popálení * ošetřování terapie MeSH
- terapie pomocí virtuální reality * ekonomika metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
