BACKGROUND: Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair. METHODS: Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI). The mean age was 63 ± 13 years, and 69% of the patients were male. Ascending aortic/root replacement was required in 62%. As a first step, ring annuloplasty was performed, and then leaflet repair included leaflet plication for prolapse, nodular unfolding, double pericardial patching of commissural defects or holes, complete pericardial leaflet replacement, leaflet extension, and Gore-Tex reinforcement. Leaflet techniques and causes of adverse outcomes were evaluated. RESULTS: The follow-up time was 2-years maximal and 0.9 years mean, with a survival of 97%. Eighty percent of patients required repair of leaflet defects: leaflet prolapse (52/65-80%), ruptured commissures (6/65-9%), leaflet holes (4/65-6%), and nodular retraction (6/65-9%). The average preoperative AI grade of 2.9 ± 0.8 fell to 0.7 ± 0.7 (p < 0.0001). Three patients (4.6%) required interval valve replacement because of (1) suture untying, (2) iatrogenic leaflet tear, or (3) diphtheroid endocarditis. Five other patients experienced grade 2 or grade 3 AI: probable suture untying in 1 patient, ineffective leaflet extensions in 2 patients, and unsuccessful Gore-Tex reinforcements in 2 patients. Two patients with single pericardial leaflet replacements and all those with double pericardial reconstructions did well. CONCLUSIONS: Leaflet defects are common in patients with moderate to severe AI. Leaflet plication, nodular unfolding, and double pericardial patching performed well. Gore-Tex and leaflet extension seemed less satisfactory. Standardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair.

• MeSH
• anuloplastika srdeční chlopně metody   MeSH
• aortální chlopeň chirurgie   MeSH
• aortální insuficience diagnostické zobrazování   chirurgie   MeSH
• časové faktory MeSH
• chirurgické laloky * MeSH
• dospělí MeSH
• echokardiografie transezofageální MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• perikard transplantace   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• šicí techniky MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

OBJECTIVE: To asses the viability of laparoscopic management of cervical agenesis. DESIGN: Case report. SETTING: II. Gynaecology and Obstetrics Dpt. at the University Hospital of F.D. Roosevelt, Banská Bystrica, Slovakia. METHODOLOGY: Diagnostic management and laparoscopic technique. RESULTS: Congenital agenesis of the cervix is a rare anomaly of the inner genital. It may be associated with vaginal aplasia and less frequently with other anomalies like an incomplete fusion of müllerian ducts. Hysterectomy was frequently used to resolve main symptoms with respect to frequent complications associated with reconstructive surgery. Recently we can see a comeback to reconstructive surgery as a result of new medical technologies (new antibiotics and antibacterial sutures). Laparoscopic surgery is considered to be the main approach. The treatment strategy is related to a detailed individual pre-surgery investigation. Success of the surgical treatment is measured by normal menstruation and restored fertility. In this article we report the laparoscopic approach in creating the uterovaginal anastomosis in 20-year old women with cervical agenesis and duplex uterine anomaly and review the treatment options. CONCLUSION: Laparoscopic treatment of cervical agenesis is eligible and might be considered as a first-line treatment option.

• MeSH
• cervix uteri abnormality   chirurgie   MeSH
• dospělí MeSH
• endometrióza komplikace   diagnóza   chirurgie   MeSH
• gynekologické chirurgické výkony metody   MeSH
• laparoskopie * MeSH
• lidé MeSH
• mladý dospělý MeSH
• nemoci ovaria komplikace   diagnóza   chirurgie   MeSH
• uterus abnormality   chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: This retrospective clinical study would like to objectively denote a quality of life of persons afflicted by an abdominal catastrophe and managed by an extensive surgery can be almost as well conformable as those of healthy people in a similar age group. METHODS: A set of eighteen patients who were successfully surgically treated and cured enjoyed a relatively good convalescence after their surgery and returned to a satisfactory standard of life from the point of view of organ function and psychosomatic state. Statistical analysis of the data collected over a period of 1 to 6 years after this complex therapy using special questionnaire for QOL assessment SF-36 was performed. RESULTS: Almost half of the patients evaluated their state similarly to the rest of the population of comparable age and general health status. The remainder of the patients declared significantly worse evaluations in the majority of the observed domains of the questionnaire. CONCLUSION: Therapy of these patients was and must be complex: it included preparation for surgery at a special metabolic internal site, careful diagnostics of the digestive tract state, suitable surgery and good quality care after the surgery.

• Klíčová slova
• intestinal fistulas, quality of life, questionnaire SF-36, reconstructive bowel surgery,
• MeSH
• chirurgie trávicího traktu metody   MeSH
• dospělí MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• střevní píštěle chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH

Malignant head and neck tumors belong among common diseases and their incidence constantly rises. In the Czech Republic, the proportional representation of orofacial tumors ranges around 2% of the total number of malignancies. Rational treatment of these tumors is complex and long. In the course of therapeutic planning, you have to consider the age of the patient and the stage of the disease including the presence of distant metastases. Removal of the tumor with a sufficient safety margin and an eventual treatment of the relevant lymphatic system according to the type of the tumor is an important prerequisite for the success of the surgical therapy. Reconstructive procedures in maxillofacial oncosurgery presume good interdisciplinary cooperation and a high professional preparedness of the surgical and nursing team. Selection of the right patient is also very important with regard to the risks of both local and systemic postoperative complications. Use of the free flap techniques is currently the gold standard, but it is also necessary to master pedicled flap techniques, whose advantages lie in simpler technique and often better aesthetic results. At the same time, we have to realize that even traditional, classical reconstructive procedures using prosthetic replacements can still represent the ideal solution in many cases.

• Klíčová slova
• flap, free flap, head and neck surgery, pedicled flap,
• MeSH
• chirurgické laloky MeSH
• lidé MeSH
• nádory hlavy a krku MeSH
• stomatochirurgie * MeSH
• zákroky plastické chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• lidé MeSH
• metody MeSH
• nosní přepážka chirurgie   MeSH
• plastická chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes. A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures. Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %). Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.

• Klíčová slova
• Avn, Femoral head, Fracture, Pipkin, Surgical approach,
• MeSH
• fraktury kyčle chirurgie   MeSH
• hlavice femuru zranění   chirurgie   MeSH
• lidé MeSH
• luxace kyčle chirurgie   MeSH
• náhrada kyčelního kloubu metody   MeSH
• pooperační komplikace epidemiologie   MeSH
• vnitřní fixace fraktury * metody   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Nipple reconstruction often gives the highest satisfaction to the patient despite being just a minor procedure. During the last 50 years, many techniques have been described in order to improve the cosmetic appearance. Star and skate flaps are two of the most frequently reported procedures. The aim of this study was to compare the personal experience of two plastic surgery departments that have been using these two different methods. Thirty patients have been included in this study. Nipple projection and cosmetic appearance have been evaluated by both patients and surgeons. Follow-up ranged between 1 and 5 years. Results have been compared. Both techniques proved to be versatile and valid. The skate flap seemed to keep projection for a longer time, while the star technique gave a better cosmetic appearance.

• MeSH
• chirurgické laloky * MeSH
• estetika MeSH
• lidé MeSH
• prsní bradavky chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

A new hypothesis of "symbiosis" in reconstructive surgery is introduced, which has been used for single stage reconstruction of a metacarpal hand. The concept, technique and its use, along with it's merits are detailed.

• MeSH
• chirurgické laloky metody   MeSH
• dítě MeSH
• lidé MeSH
• plastická chirurgie metody   MeSH
• poranění prstů ruky chirurgie   MeSH
• traumatická amputace chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• dospělí MeSH
• hemiatrofie obličeje chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipodystrofie chirurgie   MeSH
• mladiství MeSH
• obličej chirurgie   MeSH
• plastická chirurgie * MeSH
• protézy a implantáty * MeSH
• silikonové elastomery * MeSH
• techniky in vitro MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• silikonové elastomery * MeSH

BACKGROUND: Primary soft tissue reconstruction in complex leg injuries is mandatory in order to protect exposed tissues; however, it may be precluded by the patient's clinical status or by local wound conditions. This retrospective study aims to evaluate the use of negative pressure as an adjunct to delayed soft tissue reconstruction in patients with complex lower limb trauma. MATERIAL AND METHODS: Forty-two patients with 49 complex lower limb injuries were treated with Vacuum assisted closure (VAC) 48 hours after bone fixation, vascular repair and surgical debridement. Wound swab cultures were obtained before and after every VAC application. Duration of therapy, wound flora, final reconstructive technique required, outcome and follow-up period were retrieved from medical records. RESULTS: Twenty-four male and eighteen female patients were recruited, with a mean age of 47 years. All were treated with VAC therapy for 15-42 days. Reconstruction was delayed due to the patients' critical condition, advanced age, medical co-morbidities, heavily exuding wounds and questionable viability of soft tissues. Patients were followed up for 90-895 days. Two wounds healed spontaneously, 6 were managed with delayed direct suture, 31 with split thickness skin grafts and 9 required local cutaneous, fasciocutaneous or muscular flaps. One patient died due to fat embolism. Wound bacterial flora progressively decreased in all but one patient. Scar formation was aesthetically acceptable by the patients while function depended on the initial injury. CONCLUSIONS: Negative pressure is a safe and effective adjunct to delayed soft tissue reconstruction in high-risk patients with severe lower extremity injuries, minimizing reconstructive requirements and therefore postoperative morbidity.

• MeSH
• dolní končetina zranění   MeSH
• dospělí MeSH
• fraktury tibie chirurgie   MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• polytrauma chirurgie   MeSH
• poranění měkkých tkání chirurgie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• terapie ran pomocí řízeného podtlaku * MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH