Modern Reconstructive Surgery Research Articles

Autologous Tissue Repair and Total Face Restoration

Total face restoration remains a challenge in modern reconstructive surgery. After 17 years of experiments and preliminary clinical studies, a new concept of face prefabrication was developed for face restoration with autologous tissue. To evaluate the long-term results of face restoration with autologous tissue and report a finalized and standardized approach of face prefabrication. In this single-center long-term retrospective study, 32 patients who underwent total face restoration between 2005 and 2022 were reviewed. These patients underwent total facial reconstruction, which included flap prefabrication, 3-dimensional printing, tissue expansion, and flap transfer with aid of indocyanine green angiography (IGA). The flap first undergoes prefabrication by transferring vascularized fascia under the skin of the selected chest. A tissue expander is then placed under the fascia to create a large, thin, reliable skin flap after expansion. Once completed, the flap is transferred to the face during the second stage of the reconstruction. Intraoperative IGA is performed to guide the design of subsequent openings for facial fissures. Data were analyzed from July to September 2023. Flap healing, reconstructive outcome, and patient recovery were assessed during follow-up. Three questionnaires, including the 36-Item Short Form Health Survey (SF-36), Aesthetic and Functional Status Score of Facial Soft-Tissue Deformities/Defects, and the EuroQoL Health-Related Quality of Life (EQ-5D-5L), were used to evaluate the quality of life and satisfaction with facial aesthetic and functional status. Of 24 included patients, 14 (58%) were male, and the mean (range) age was 32.9 (8-62) years. The mean (range) follow-up was 5.6 (2-12) years. All patients reported a significant improvement in quality of life (SF-36), especially in mean (SD) social functioning (preoperative score, 53.65 [34.51]; postoperative score, 80.73 [19.10]) and emotional stability (preoperative score, 56.67 [25.55]; postoperative score, 71.17 [18.51]). A total of 22 patients (92%) went back to work. Mean (SD) facial aesthetic status (preoperative score, 4.96 [3.26]; postoperative score, 11.52 [3.49]; P < .001) and functional status (preoperative score, 11.09 [3.51]; postoperative score, 15.78 [3.26]; P < .001) also improved. In addition, there was a significant increase in overall satisfaction and self-reported health status (preoperative score, 8.13 [1.52]; postoperative score, 3.58 [2.31]). In this study, 5-year follow-up results suggested that this innovative approach to total face restoration offered a safe and valid option for indicated patients, with acceptable reconstructive and cosmetic outcomes.

Microbiological challenges in the treatment of war injuries

The treatment of war injuries represents a continuing and recurrent challenge in modern reconstructive surgery. Previously, tumor resections and sepsis-related resections were mainly responsible for lengthy bone defects in Germany. In recent years another picture has increasingly emerged, particularly caused by the medical support of Ukraine. Aspects of military surgery are also becoming more important in civil hospitals, especially in the treatment of gunshot and explosion injuries. In Germany, war injuries are currently secondarily treated, as the distribution of patients is carried out according to the cloverleaf principle, weeks or months after the occurrence of the primary injury. In addition to complex bone and soft tissue defects of the extremities following such injuries, which often affect neural and vascular structures, reconstruction is often complicated by an increasing spectrum of multidrug-resistant pathogens. The definition of microbiological terms, such as contamination, colonization, critical colonization, local and systemic infections are important in the clinical routine in order to initiate a targeted treatment, especially in treatment with antibiotics. Wound swabs for determination of the spectrum of pathogens and the optimal testing of resistance are important for selecting the appropriate antibiotic agents. The concept of antibiotic stewardship (ABS) is established in many hospitals to improve the quality of antibiotic treatment and to minimize the formation of resistance. The selection of the method of reconstruction depends on the condition of the patient, the overall clinical constellation and the function to be expected after completion of treatment. The treatment of injuries due to violence and terrorism necessitates clear concepts and an interdisciplinary approach, especially with respect to microbiological challenges and increasing resistance situations.

Stromal-cellular remodeling of breast tissue after silicone implant damage

One of the current vectors of modern reconstructive and cosmetic surgery is augmentation mammoplasty - an operation to enlarge the mammary glands. The breast implant is well tolerated by the body, as the immunogenicity of its material is extremely low. At the same time, the silicone gel of the implant is a foreign object and the surrounding breast tissues give a stereotypical response in the form of growth of the connective tissue stroma with the formation of a capsule around the implant and the appearance of focal cellular infiltrates. Modern breast implants, unlike implants of previous decades, are more sophisticated in their structure, and the level of protection against damage is much higher. A complication associated with the long-term use (up to 20 years) of implants, where low-quality silicone or industrial silicone was used as a filler, is the penetration of low-molecular-weight particles of the implant through its shell to the surrounding tissues with the subsequent formation of silicone granules. In the vast majority, such changes develop after mechanical traumatization of the implant. The purpose of the study is to establish the morphological criteria of the reaction of breast tissue after silicone implant damage. The material for research was histological micropreparations of breast tissue from the archive of the "Grace Clinic" (Kyiv), with the mutual consent of patients who applied for repeated mammoplasty. The duration of the implants in the breast gland was from 6 to 20 years. The age range of the women was from 36 to 53 years. On preparations stained with hematoxylin and eosin, tissue biopsies of the glands of 9 patients with a diagnosis of deformation of silicone implants and violation of the integrity of their wall were presented. The micropreparations were visualized using a UlabXSP-137TLED light microscope at various magnifications and photographed with an XCAM 1080P camera. The study of histological preparations of soft tissues of the breast glands, from which silicone implants were removed, established changes in stromal-cellular elements, namely: decorated fibrous structures accumulated in the form of dense capsules with elements of local contractures; from the side of cellular elements, the most demonstrative were cellular infiltrates, which included macrophages, lymphocytes, and plasma cells, which indicated a high probability of a chronic inflammatory process. A large number of giant multinucleated cells of foreign bodies were present in practically all examined sections, which indicated the impossibility of macrophages to complete phagocytosis with lysis of the phagocytosed material, which by its chemical composition is the silicone of the implant. All the described phenomena can be interpreted as a natural reaction of the tissues to the implant, the contents of which got into the soft tissues of the breast. Thus, the presence of numerous giant multinucleated cells of foreign bodies, dense capsules with elements of local contractures, and a significant predominance of macrophages, lymphocytes, and plasma cells in cellular infiltrates over other cellular elements can be considered a morphological criterion for the reaction of breast tissue to silicone implant damage.

Long-Term Treatment Outcome of a Patient with Extensive Circular Soft Tissue Defect of the Distal Third of the Lower Extremity: A Case Report

Background. Open fractures of the lower leg bones associated with extensive soft tissue defects are among the most challenging in trauma surgery.&#x0D; Aim of the study is to demonstrate the possibilities of modern reconstructive surgery in the treatment of severe polystructural trauma of the lower limb using a unique clinical example.&#x0D; Case description. An 18-year-old patient sustained a polytrauma which included head and extremities injuries as a result of a fall under a moving train. Due to the signs of uncompensated ischemia of the left lower limb at the first stage of treatment the patient underwent emergency left tibial artery thrombectomy, repeated debridement of the left lower leg wound, remounting of the external fixator, and lumbar sympathectomy. The second stage of surgical treatment included free transplantation of a vascularized anterolateral flap of the right thigh. The third stage included staged necrectomies; replacement of the soft tissue defect of the posteromedial surface of the distal lower leg with a sural fasciocutaneous vascularized flap on the distal vascular pedicle from the contralateral tibia; the fourth stage included cutting off the fasciocutaneous cross flap. At the follow-up, 2 years after the end of the treatment the patient complained of persisting swelling of the foot, which occurred during prolonged standing in the upright position and required elastic compression of the ankle joint. The cause of the swelling was impaired lymphatic outflow due to the damage to all venous collaterals in the injury area. She walks with full load on the injured limb without additional support. There is no pain syndrome, foot sensitivity is fully preserved.&#x0D; Conclusion. Presented clinical case demonstrates the possibility of successful replacement of an extensive circular defect of the distal lower leg using sequentially free and non-free vascularized tissue complexes.

Beyond Borders: A Global Microsurgery Training and Case Exposure Survey.

Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical interventions. Despite anecdotal evidence of varying quality of microsurgery training globally, no empirical studies have investigated this. We conducted a global survey to investigate microsurgical training and clinical case exposure among plastic surgery trainees worldwide. An online survey was conducted using a secure platform to gather information on microsurgical case exposure and training among plastic surgery trainees between August 2020 and April 2021. Participants provided consent and completed a 37-question survey across four themes: clinical caseload, surgical exposure to microsurgery, microsurgical simulation training exposure, and barriers and opportunities. A total of 202 responses were received, with most respondents in formal training programs (86.7%). The data highlighted regional variation in microsurgery case indications and flap types, with North America and Europe exhibiting the highest activity levels in microsurgery. Trainees in Asia have the highest cumulative practical exposure in microsurgery, followed by Australia and Oceania, and North America. Only 39.6% of respondents reported formal microsurgical simulation training, and almost one-third (29.7%) received no simulation training. Trainee access to practical experience is limited by several factors, including insufficient time and procedure complexity. Notably, practical experience was most commonly denied without reason being given. Our study highlights significant disparities in microsurgical training and exposure among plastic surgery trainees globally. Further research is needed to identify strategies for addressing these issues, given the growing demand for complex reconstructive microsurgery and its impact on health care inequalities.

Interdisciplinary aspects of abdominal and plastic surgery- what does the (abdominal) surgeon need to know?

The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. - Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or"tensor-fascia-lata"(TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber).-Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps.-Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight.-Abdominoperineal rectum extirpation (APE): Holm's procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty.-Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension.-Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty.-Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time-plastic surgery expertise has to be included into interdisciplinary tumor concepts.-Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose.-Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer).-Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e.,surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve.-Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed byplastic surgery coveragecan prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life. The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice. An interdisciplinary approach of abdominal and plastic surgery is characterized bya highly developed cooperationin common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.

Modern reconstructive surgery of the maxillo-facial region

The article is devoted to modern methods of reconstructive surgery of the upper, middle and lower zones of the face in the elimination of defects and deformities that are accompanied by significant violations of the proportions of the face and arise as a result of injuries and the elimination of extensive neoplasms, as well as in connection with congenital anomalies in the development of the facial skeleton.

Результаты реконструктивно-восстановительной хирургии после тяжелой сочетанной травмы глаза, век и глазницы

Purpose. Presentation of the clinical result of complex surgical rehabilitation in a patient with combined traumatic injury of the eye, its adnexa and orbit. Material and methods. A clinical case is presented. Described step by step: surgical reconstruction of orbital walls with «Ekoflon» material (Russia), of lacrimal duct by Taumi method, of medial palpebral ligament, of upper eyelid coloboma with free skin graft, evisceration with plastic surgery of the musculoskeletal stump and ocular prosthetics. Results. Evaluation of the results of the surgical treatment performed at the final examination 14 months after the injury showed that the dimensions of the patient’s palpebral fissure had no obvious differences from the healthy side, the mobility of the upper eyelid was restored, and the lacrimal drainage function was preserved. There was a normal position and good mobility of the ocular prosthesis. Conclusion. Complex specialized rehabilitation of patients after a severe concomitant injury of the organ of vision using the achievements of modern reconstructive ophthalmic surgery makes it possible to restore the anatomy and function of the adnexal apparatus of the eye as much as possible, to carry out cosmetic prosthetics with a satisfactory aesthetic outcome. Key words: combined ocular injury, reconstructive and cosmetic eyelid surgery, lacrimal duct reconstruction; periorbital reconstruction; eye prosthesis

NEW WAYS TO SOLUTION PROSTHETICS FOR EXTENSIVE DEFECTS OF THE JOINTS AND BONES OF THE HAND (LITERATURE REVIEW)

The human hand is an organ of labor, self-service, touch. According to Kaplan E.V. the hand is an extension of our brain in the environment around us. However, being one of the most functionally loaded systems, the hand and its bone segments are damaged quite often. The purpose of this work is to analyze a literary review of modern prostheses in the treatment of diseases of the bones and joints of the hand. Material and methods. We systematically searched the literature and selected sources from MEDLINE, Cochrane databases, Google Scholar, PubMed, as well as research papers and online educational publications in English and Russian. Forty papers that met the inclusion criteria were included. Results. The review article presents methods of treating patients with defects and injuries of the bones and joints of the hand, the causes of the development of this pathological condition. Conclusion. Thus, the existing types of prostheses currently do not fully meet the needs of patients and do not have a 100% positive effect from their use in modern reconstructive surgery. The number of unsatisfactory results of reconstructive operations and disability rates remain high.

First Femoropopliteal Bypass for a Critical Limb Ischemia

First Femoropopliteal Bypass for a Critical Limb Ischemia

The Role of Split Anterolateral Thigh Free Flaps in Reconstructive Surgery: a Systematic Review and Case Report

Radical tumor ablation or severe trauma can result in challenging tissue defects. The split anterolateral thigh free flap has been promoted as an ideal option for complex defects. We aimed to evaluate whether this flap could be performed without major morbidity. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to assess this hypothesis. An illustrative case about pharyngeal reconstruction is discussed, and the role of free split anterolateral thigh free flaps in modern reconstructive surgery is evaluated. The systematic search of literature yielded 221 studies with 7 articles about free anterolateral thigh flaps fully split in two separate flaps based on one pedicle. Favorable outcomes in a total of 31 patients were described. Tissue defects were mainly located at extremities, chest wall, lip, and cheek. A low complication incidence was reported in all studies, in terms of flap loss, donor site morbidity, and general wound healing problems. The flap was utilized for pharyngeal reconstruction and simultaneous neck resurfacing, which allowed a more convenient way of flap monitoring in the present case. Being technically a rather demanding flap variant, splitting the anterolateral thigh free flap has still become an accepted technique among microsurgeons. Currently, literature suggests that it can be performed without major complications for reconstructing extremities and the head and neck area. Rearrangement of the flap units in pharyngeal reconstruction increases the flap’s versatility as it allows neck resurfacing and external monitoring of buried inaccessible flaps.

Utilization of Leech Therapy after Rhinoplasty.

The use of medicinal leeches in modern reconstructive surgery is well-described. Leech therapy after rhinoplasty has not been previously well-characterized. The medical records of all patients who underwent open rhinoplasty by a single surgeon over a 4-year period were reviewed. Patient demographics, including age, sex, medical comorbidities, number of previous rhinoplasty surgeries, time to utilization of leech therapy, adjunct therapies used, resolution of skin changes, and smoking status, were recorded. Operative reports were reviewed for pertinent information, including number of tip grafts used, graft materials used, and placement of septal extension grafts or "unicorn" grafts. Between April of 2016 and March of 2020, 545 patients underwent rhinoplasty performed by the senior author (P.S.N.). Of these patients, 39 (7.2 percent) underwent leech therapy postoperatively. The mean age of included patients was 47.4 years. Of the patients who required leech therapy, 34 (87.2 percent) had undergone revision rhinoplasty. The mean number of previous rhinoplasties was 3.4. The mean number of tip grafts used was 2.6. Thirty-three patients (84.6 percent) had either a traditional septal extension graft or unicorn graft placed. Nine patients (23.1 percent) were former smokers. Complete resolution of skin color changes was seen in 38 patients (97.4 percent). There were no major complications after leech therapy. Leech therapy is a useful tool for the rhinoplasty surgeon, particularly in the setting of complex revision rhinoplasty, in patients who have undergone multiple previous nasal surgical procedures, or in patients who require significant cartilage grafting to reconstruct the nasal tip or lengthen the nose. Therapeutic, IV.

In vivo experimental study of the arterial supply of the rabbit posterior limb

Background: The use of bone graft has been a successful step in the treatment of a large number of diseases of the osteoarticular system. But a massive bone defect remains a dilemma for modern reconstructive surgery. Present methods used have a high level of morbidity and complication. Literature indicates the absence of an optimal solution in massive bone defects healing. The aim of this study: to perform an in vivo preliminary study of vascularization of the hind limb in the rabbit model, for obtaining a graft able for further inclusion in the host blood circulation, without immunosuppression by decellularization. Material and methods: The study was performed on the 12 laboratory rabbits. After euthanasia of the rabbit, the femoral and tibiofibular bone was collected without soft tissue, only with the vascular pedicle, and keeping the passage through the vessels. In the abdominal aorta was injected contrast material, with the subsequent preparation of the arterial vessels, succeeded by anatomical, morphological, radiography, and microangiography study of this vascularized bone segment. Results: The principal nutrient artery of the rabbit femur springs from the lateral circumflex femoral artery. The optimal segment for vascularized allografting (the rabbit model) was determined the upper third of the femur with the up to the level of the internal iliac artery. So, it could be used as a bone graft for further conservation and decellularization. Conclusions: The vascularized allogeneic bone without immunosuppression would be a perfect alternative in the treatment of the massive bone defects.

Morphological and radiological characteristics of experimental bone tissue regeneration

Objective.To study the dynamics of reparative bone tissue regeneration in experimental animals using a native transplantation autosmix (NTA).Materials and methods.Male Wistar rats weighing 180–200 g and aged 6–7 months were used. Bone tissue defects were modelled using a cutter with a diameter of 2 mm (experimental group). A similar defect of the middle third of the right tibia was formed in the control group animals without flling the defects with bone tissue. The animals were removed from the experiment on days 3, 7, 14, 30 and 60 of the experiment (per 6 animals for each observation period). The indicators of defect occupancy, necrosis, the area of bone trabeculae, the area of granulation tissue were determined in the histological sections. All the indicators were presented as percentage of the tested area. Osteoblasts, osteocytes, and osteoclasts were calculated in absolute values on the tested area.Results.The study has showed a higher rate of bone tissue formation in the bone defects in the experimental animals after autotransplantation of the bone mixture. Bone recovery in the experimental group had a higher rate, which was manifested by faster flling of the bone tissue defect, a low percentage of the necrosis area, a higher area of bone trabeculae, its rapid transformation into lamellar bone tissue.Conclusion.Osteogenesis had practically completed by day 30 of the experiment. At the same time, in the control group it had completed by day 60. The results obtained are a theoretical precondition for further research in the feld of bone autoplasty. Advanced development of surgical and minimally invasive technologies of bone mixture application will increase the effciency of modern reconstructive surgery of bones and joints.

To Check the Validity of Neoclassical Canon in Western Maharashtra- An Anthropometric Study

Introduction: In ancient days, it was believed that attractive and harmonious faces were having certain fixed proportions known as neoclassical canons. These canons were used extensively by Leonardo Da Vinci, Durer in their art during renaissance. They served as guidelines for artists as well as for aesthetic surgeons for centuries and proved to be helpful till now. From ancient days to modern era, the exact formula of beauty is not yet calculated. The norms of beauty changes from country to country and race to race. A face is beautiful and shows harmonious features if the individual components are proportional, this is what is referred as facial balance. In ancient Greece, they calculated the formula for creation of art and these formulae are called as neoclassical canons. The classical Greek canons of facial balance are still foundation of modern reconstructive and aesthetic surgery. Aim: To check the validity of neoclassical canon in Western Maharashtrian population. Materials and Methods: This was an observational type of study carried out from March 2018 to January 2020. The validity of Naso-oral canon was checked in Western Maharashtrian population. According to this canon ideal mouth width (ch-ch) (mouth width (distance between right and left corners of mouth called chelion)) is 1.5 times of Nose width/alar width (al-al) (alar width (distance between right and left ala of nose)). Mouth width=1.5 times of Nose width. However, the mouth width can be less than 1.5 times of nose width or mouth width can be greater than 1.5 times of nose width. This study was carried out in the five cities Sangli, Kolhapur, Islampur, Karad and Satara of Western Maharashtra, India. Total 1500 male and female students, 300 from each city, between the age group of 18-20 years were selected. Measurements were taken with the help of digital Vernier caliper. The methodology adopted for the measurements was taken from the guidelines given by Farkas LG in his book- “Anthropometric facial proportions in Medicine”. Results: In present study, total 68.33% subjects including males and females were having mouth width (ch-ch) lesser than one and half times of nose width/alar width (al-al) i.e., ch-ch &lt;1.5 (al-al). Remaining 31.67% subjects were having mouth width greater than one and half times of nose width/alar width i.e., ch-ch &gt;1.5 (al-al). Conclusion: Naso-oral neoclassical canon was not found valid in Western Maharashtrian young adults. In 78.32% male and 62.80% female population of Western Maharashtra, mouth width was found lesser than one and half times of nose width.

Surgical Treatment of Patient with Advanced Kienböck’s Disease: A Case Report

Relevance. For more than a century, many methods of treating Kienböck’s disease have been developed, although none of them could achieve consistently good results. The transposition of the pisiform into the lunate location after removal of the latter, as well as the combination of this operation with a shortening osteotomy of the radius, is considered as one of the promising methods of this disease treatment. The purpose of this publication was to demonstrate the options of the modern reconstructive surgery for the treatment the stage IIIb Kienböck’s disease. Case presentation. A clinical case of a successful non-free transplant of a blood-supplied pisiform in aseptic necrosis of the lunate is described. A patient was a 21 year old military serviceman with stage IIIb Kienböck’s disease complicated by persistent pain syndrome and severe dysfunction of the left wrist. He underwent removing the fragmented lunate with replacing it with a pisiform on the tendon feeding pedicle and performing simultaneous shortening osteotomy of the radius. The displaced bone was fixed with an anchor to the dorsal surface of the distal radial metaepiphysis. In 12 months after the surgery, an improvement of the wrist function was achieved in the form of an increase in the range of motion compared with the preoperative period and a significant decrease in the level of pain syndrome. The radiological examination at the same time showed the preservation of the shape, size and intraarticular localization of the bone autograft. Conclusion. The use of transposition of the blood-supplied pisiform on a permanent tendon feeding pedicle into the region of the removed lunate demonstrated, in our opinion, the favorable possibilities of successful surgical treatment of the late stages of Kienböck’s disease. A favorable outcome of such treatment is possible only in a specialized hospital, where there are trained specialists in the field of hand surgery, and there are also opportunities for employment a modern rehabilitation complex aimed at restoring movements in the hand joints, taking into account the strength and coordination parameters of its anatomical structures.

To Serve Those Who Served: Advances in Plastic and Reconstructive Surgery During War and Peace.

The industrialization of modern warfare dating back to WWI led to an increase in combat-related injuries with unprecedented levels of severity. The necessity of addressing the clinical challenges that ensued led to the emergence of modern reconstructive surgery and subsequently a robust healthcare initiative for veterans in the form of the Department of Veterans Affairs. In the following article, a literature review was conducted to examine the interplay between combat injuries, veterans' care, and reconstructive surgery. We found that the relationship between military trauma and reconstructive surgery has led to an increase in survival rates and advances in mass casualty response while allowing the survivors to maintain a high quality of life. The relationship between the Veterans Affairs hospitals and plastic surgery has only strengthened over time as these hospitals play a major role in training the next generation of plastic surgeons throughout the nation. It is imperative to maintain this cooperative relationship to ensure a high level of care for our veterans and a comprehensive training experience for plastic surgery residents.

Fasciocutaneous Flap Side-to-Side V-Y: Fish Flap.

The use of fasciocutaneous flaps remain as first election of reconstructive method after remotion of tumors, benign lesions and sequel of traumas.A new designed fasciocutaneous flap according to mechanism V-Y like island flap is described. It has 2 different portions: 1. Superior and 2. Inferior or triangular.Resected area is reconstructed by means of the active or superior part, recruiting perilesional unaffected tissues; safe vascular supply is maintained by means of random pedicle from its inferior or triangular portion.Between 2012 and 2015 were operated in the Division Plastic Surgery at Argerich Hospital of Buenos Aires, 180 patients with benign and maligns lesions and trauma sequels in different body areas; reconstructive surgery was carried out using the flap described in this article.All flaps survived, except 2 which developed partial flap necrosis finally treated by advancement flap coverage. All donor sites were closed primarily with no secondary skin grafting; in the early postoperative period, any flaps showed signs of excessive tension of its margins and failures of arterial vascularization. All flaps achieve adequate reconstruction with excellent aesthetic results; all patients were satisfied with the surgical outcome. All the flaps reached objectives purposed obtaining an acceptable functional and aesthetic restoration.Fasciocutaneous flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscles and close skin. The advantages of "fish" flap included shorter operative time, lesser pedicle trauma, similar color-match and same texture, ample recruitment of both skin and soft tissues around of principal flap and finally it allowed an adequate closure of donor and reconstructed areas.

Pilot study on microvascular anastomosis: performance and future educational prospects.

SUMMARYThe introduction of microvascular free flaps has revolutionised modern reconstructive surgery. Unfortunately, access to training opportunities at standardised training courses is limited and expensive. We designed a pilot study on microvascular anastomoses with the aim of verifying if a short course, easily reproducible, could transmit microvascular skills to participants; if the chosen pre-test was predictive of final performance; and if age could influence the outcome. A total of 30 participants (10 students, 10 residents and 10 surgeons) without any previous microvascular experience were instructed and tested during a single 3 to 5 hour course. The two microanastomoses evaluated were the first ever performed by each participant. More than the half of the cohort was able to produce both patent microanastomoses in less than 2 hours; two-thirds of the attempted microanastomoses were patent. The pretest predicted decent scores from poor performances with a sensitivity of 61.5%, specificity of 100%, positive predictive value of 100% and negative predictive value of 40%. Students and residents obtained significantly higher scores than surgeons. Since our course model is short, cost-effective and highly reproducible, it could be introduced and implemented anywhere as an educational prospect for preselecting young residents showing talent and natural predisposition and having ambitions towards microvascular reconstructive surgery.

Modern possibilities of reconstructive plastic surgery of breast cancer

SUMMARY&#x0D; The surgical stage of treatment remains the main one in the complex therapy of breast cancer. The review of modern reconstructive plastic surgery, performed by single-step and delayed after radical mastectomy. Against the background of a huge number of existing methods of breast reconstruction, three main types have become the most popular among surgeons to date: the use of own tissues, silicone endoprostheses and their combination. The final choice of the option of breast reconstruction depends on the volume of cancer surgery, plastic tissue, somatic condition of the patient and her desire. Reconstructive plastic surgery for breast cancer does not affect the course of the disease and are not an obstacle to chemotherapy.