Reconstructive Plastic Surgery Research Articles

Accelerated Frostbite-Induced Acroosteolysis in Pediatric Insensate Hand: A Case Report and Literature Review.

In pediatric patients, frostbite is a well-documented cause of epiphyseal cartilage destruction and subsequent growth deformity of the affected phalanges. Cases of full acroosteolysis, also referred to as phalangeal osteolysis, of distal phalanges as soon as three months after cold exposure have yet to be reported. We describe a complicated case of frostbite-associated phalangeal osteolysis in the dominant hand of a nine-year-old patient, in the context of post-traumatic insensate hand after sustaining prior electrical burn injuries. This case demonstrates the unique sequela of pediatric frostbite injury involving early loss of the distal phalanx through resorption of the bone and parallel soft tissue retraction, rendering early plastic surgery reconstruction impractical. Reconstructive strategies for frostbite injury in pediatric patients will need to account for the individualized dynamic tissue changes that develop in the months after cold exposure.

Long-term functional results of reconstructive plastic surgery on the pelvic floor

Background. With all the variety of treatment methods for pelvic organ prolapse (POP), the criteria for cure are reduced to the absence of anatomical defects of the pelvic floor. At the same time, the complete restoration of the physical, psycho-emotional and social components of a woman’s life is practically not taken into account. Studying the quality of life, as well as the sexual function of patients with POP will help to clarify the effectiveness of the synergy of surgical treatment and hardware rehabilitation methods.The purpose of the study is to assess the quality of life and sexual function of women of reproductive age after reconstructive plastic surgery on the pelvic floor in combination with radiofrequency exposure.Material and methods. An open prospective longitudinal study was conducted on 60 patients of reproductive age with stage II-III genital prolapse according to the POP-Q classification. The women were divided into two groups: group 1 — patients who underwent vaginal plastic surgery with their own tissues (n=30); group 2 — patients who, after reconstructive plastic interventions, underwent postoperative rehabilitation using dynamic quadripolar radiofrequency (n=30). Before surgery, 1 month and 1 year after treatment, a survey was conducted to determine the quality of life using the Short Form-36 questionnaire and sexual function using the Female Sexual Function Index and Female Sexual Distress Scale.Research results. The combination of surgical correction of pelvic organ prolapse with subsequent radio wave therapy makes it possible to correct anatomical defects, and at the same time statistically significantly increases the index of quality of life and female sexual function, reducing a woman’s experiences associated with problems in her sexual life.Conclusion. The synergy of surgical methods of correction and postoperative rehabilitation with the use of DCRF contributes to the long-term preservation of the functional results of treatment of pelvic floor incompetence during reproductive age.

The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry.

Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools. This retrospective, double-blind study was conducted at Tekirdağ Namık Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques. Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality. The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of cellular versus acellular amnion in facial burns at burn center of Punjab: Our experience.

Objective: To compare the effectiveness of cellular versus acellular amnion in patients with superficial facial burns at tertiary care hospital burn center of Punjab. Study Design: Randomized Control Trial. Setting: Department of Burn and Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st September 2020 to 31st December 2021. Methods: A total of 60 patients who fulfilled the inclusion criteria were recruited after the informed consent and were randomly divided into two groups with 30 patients in Group A and 30 patients in Group B. Group A patients had acellular amnion application and Group B had cellular amnion application over the superficial facial burns. The data was noted on a predesigned proforma and analyzed by using IBM-SPSS.Version.25 and was compared in terms of outcome measures. Results: The mean age in Group A and B was 37.79.86 and 38.19.37(range20-70 years) respectively and mean pain score was 8.50.937 in group A and 8.70.897 in group B. Hypersensitivity reaction was seen in 13.33% in group A vs 26.67% patients in Group B, infection rate of 8.33% in Group A vs 25% in Group B, Healing in 31.67% vs 18.33% in Group A and B respectively while in Group A the need for skin graft was noted in 8.33% vs 20% in group B patients and the difference was significant statistically (p=0.045). Conclusion: Application of Acellular amnion is better choice than Cellular amnion over facial burns with less hypersensitivity reaction, infection rate, need of skin graft and with improved wound healing. Objective: To compare the effectiveness of cellular versus acellular amnion in patients with superficial facial burns at tertiary care hospital burn center of Punjab. Study Design: Randomized Control Trial. Setting: Department of Burn and Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st September 2020 to 31st December 2021. Methods: A total of 60 patients who fulfilled the inclusion criteria were recruited after the informed consent and were randomly divided into two groups with 30 patients in Group A and 30 patients in Group B. Group A patients had acellular amnion application and Group B had cellular amnion application over the superficial facial burns. The data was noted on a predesigned proforma and analyzed by using IBM-SPSS.Version.25 and was compared in terms of outcome measures. Results: The mean age in Group A and B was 37.79.86 and 38.19.37(range20-70 years) respectively and mean pain score was 8.50.937 in group A and 8.70.897 in group B. Hypersensitivity reaction was seen in 13.33% in group A vs 26.67% patients in Group B, infection rate of 8.33% in Group A vs 25% in Group B, Healing in 31.67% vs 18.33% in Group A and B respectively while in Group A the need for skin graft was noted in 8.33% vs 20% in group B patients and the difference was significant statistically (p=0.045). Conclusion: Application of Acellular amnion is better choice than Cellular amnion over facial burns with less hypersensitivity reaction, infection rate, need of skin graft and with improved wound healing.

Early Detection of Vascular Obstruction in Microvascular Flaps using Thermographic Camera.

To evaluate the early detection of vascular obstruction in microvascular flaps using a thermographic camera. A cross-sectional study. Place and Duration of the Study: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan, from July to December 2023. Microvascular flaps with cutaneous islands were monitored postoperatively with a thermographic camera in addition to conventional clinical methods. The decision to re-explore was based on conventional methods, and confirmation was achieved through intraoperative findings of vascular obstruction during re-exploration. Thirty-one patients who underwent microvascular surgery were monitored postoperatively with a thermographic camera. There were 20 (64.5%) anterolateral thigh flaps, 4 (12.9%) radial forearm flaps, 3 (9.7%) scapular-parascapular flaps, 1 (3.2%) medial plantar flap, 1 (3.2%) myocutaneous gracilis flap, 1 (3.2%) latissimus dorsi (LD) flap, and 1 (3.2%) chimeric adductor longus and gracilis flap. Three (9.7%) flaps developed postoperative vascular obstruction. The thermographic camera detected complications two to four hours earlier than conventional methods, with a statistically significant difference (p >0.109). A thermographic camera is a valuable, non-invasive, and simple tool for monitoring microvascular flaps. It can detect complications several hours earlier and has the potential to be a practice-changing modality. Microvascular flaps, Thermographic camera, Vascular obstruction.

Update burn surgery: overview of current multidisciplinary treatment concepts

Abstract The treatment of severe burn injuries is an essential part of plastic-reconstructive surgery. Severe burned patients are treated in burn centers, which have highly specialized technical and personnel equipment. In addition to clear recommendations for prehospital management, intensive care therapy is usually required for extensive burn wounds. Shock therapy in burns primarily involves balanced fluid resuscitation according to hemodynamic monitoring, vasopressor support, pain management, temperature regulation, oxygen therapy, and comprehensive supportive care to stabilize the patient’s condition. Surgical treatment is still based on wound debridement and the gold standard of autologous split-thickness skin grafting. Besides skin transplantation, surgical management of burns may also involve the application of various topical therapies to promote wound healing, reduce pain, and prevent infection. These therapies may include antimicrobial dressings, skin substitutes, growth factors, or specialized wound care products. Once the acute treatment has been completed, multidisciplinary rehabilitation treatment takes place, which begins in the acute hospital and continues in the outpatient and inpatient rehabilitation areas. Surgical treatment of the secondary complications of burns and scars is also an important component of burn care. Comprehensive knowledge of the various components and players involved in the care of severely burned patients is, therefore, required in order to achieve the best possible outcome for the patient.

Unusual Multiple and Bilateral Combinations of Arterial and Neural Variations in the Axillae of Single Cadaver

Nerve During the dissection of the axillae and upper limbs of an 80-year-old male donor, multiple vascular and neural variations were encountered. On the right side, the thoracoacromial artery and the lateral thoracic artery were absent. On the left side the subscapular artery was absent, and the posterior cord of the brachial plexus gave branch to two upper subscapular nerves and then divided into radial nerve and a common stem that branched into thoracodorsal nerve, lower subscapular nerve, nerves to teres major and minor muscles and the axillary nerve. Additionally, in the left arm there was a variant communication between the musculocutaneous nerve and the median nerve. Although the existence of these variations is well documented in the literature as individual entities or few combinations, the occurrence of such multiple variations in a single cadaver in a limited area of the body involving vessel and nerves is not common. A multitude of variations in a small area of the body such as this can be a source of diagnostic and imaging interpretation errors. Unpredictable iatrogenic injuries can also occur during various procedures in the area such as during preparation of muscle flap, mastectomy with axillary lymph node dissection, reconstructive and aesthetic plastic surgery of the breast and other clinical procedures including shoulder arthroplasty.

Occurrence of contralateral breast cancer in a BRCA-positive breast cancer patient who underwent free TRAM flap reconstruction: a case report

This report presents a case of contralateral breast cancer in a BRCA mutation-positive patient who had previously undergone delayed free transverse rectus abdominis myocutaneous flap reconstruction for unilateral breast cancer. Having used up the available abdominal autologous tissue in the first reconstruction, a direct-to-implant procedure was employed for the reconstruction of the second, contralateral breast. Therefore, one breast was reconstructed using autologous tissue from the abdomen, while the other was asymmetrically reconstructed with an implant. If the risk of contralateral breast cancer had been anticipated initially, we might have opted for implant-based reconstruction from the start to facilitate a more symmetrical outcome in the event of subsequent contralateral reconstruction. This case underscores the importance of reviewing the risk of contralateral breast cancer in patients with unilateral breast cancer who also carry mutations in BRCA and other breast cancer susceptibility genes. Furthermore, it encourages consideration of how mutations in breast cancer susceptibility genes, including BRCA, influence the choice of plastic surgery reconstruction techniques. The findings from genetic testing for breast cancer susceptibility are now crucial to achieving aesthetic completeness in breast reconstruction.

Use of a controlled negative pressure system for the treatment of periprosthetic breast complications

Background. One of the most common methods of breast reconstruction after mastectomy for malignant tumors is reconstruction using an endoprosthesis. However, this technique is associated with the risk of developing periprosthetic complications. The classic solution to this problem is to remove the endoprosthesis, achieve complete remission of the infectious process and repeat the cycle of reconstructive measures. In this work we present a new approach to the treatment of periprosthetic complications.Aim. To evaluate the effectiveness of the controlled negative pressure system (CNP) in the treatment of periprosthetic breast complications.Materials and methods. From 2019 to 2023, the study included 23 patients who underwent combined/complex treatment for breast cancer, including reconstructive plastic surgery with the installation of endoprostheses, and 1 patient who underwent aesthetic surgery was included. All patients experienced various complications after the reconstructive stage: protrusion of the endoprosthesis, ischemia of the flap and/or local inflammation. To relieve the complications that arose, treatment was carried out using a flushing system and a CNP.Results. The duration of therapy with the sequential installation of a flushing system followed by replacement with a СNP averaged 15 days. In 7 cases out of 24, it was not possible to preserve or reinstall endoprostheses due to thinning of the musculocutaneous flap, resistance of the microflora to the treatment, or relapse of the infectious process. In 17 cases, no complications were recorded after re-installation of endoprostheses for 2 years. As a result of the work, in most cases, within one hospitalization, it was possible to preserve the skin sheath, achieve complete regression of complications and perform repeated reconstructive interventionConclusion. In most cases, the use of a CNP allows you to save the bed for the full installation of a new endoprosthesis. To do this, a number of conditions must be met: absence of microflora growth; presence of granulation after treatment; full thickness and integrity of the musculocutaneous flap. Systemic treatment and a history of radiation therapy are not a contraindication to retaining endoprostheses.

DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA: A CLINICAL EXAMPLE OF INTERDISCIPLINARY PATIENT MANAGEMENT

Differentiated vulvar intraepithelial neoplasia (dVIN) is an obligate precancer, develops during chronic vulvodermatoses, such as lichen sclerosus and lichen simplex chronicus. The epidemiological, clinical, pathomorphological, diagnostic, and prognostic features of dVIN are discusses. A clinical case of interdisciplinary management of a patient with dVIN, complicated by malignancy and urethral stricture, is presented. Early oncological alertness was demonstrated, microinvasive vulvar cancer in woman with of lichen sclerosus was diagnosed. It is actually, because there is high amount primary patients with advanced vulvar cancer. The joint work of oncologists, urologists, and gynecologists made it possible to successfully perform reconstructive plastic surgery for urethral stricture using a buccal graft for the first time in the Trans-Baikal Territory. Thanks to this the urinary function was restored and the quality of life improved.

Platelet-Rich Plasma: Characteristics and Current Review of its Use in Surgery.

Platelet-rich plasma (PRP) is presently employed across various medical disciplines, including surgical specialties. It is primarily used in the healing of chronic wounds, burn medicine, tissue regeneration support, and scar correction as well as in other surgical and orthopedic indications. Wounds, in general, possess a pro-inflammatory biochemical environment characterized by high protease activity that diminishes the effective concentration of growth factors. In contrast, PRP serves as a source of growth factors and exhibits mitogenic, angiogenic, and chemotactic properties. PRP is a biological product defined as a portion of the autologous blood's plasma fraction with a higher than physiological platelet concentration. PRP is obtained through the centrifugation of blood samples collected from patients. The insights into the biology, mechanism of action, and classification of PRP presented in this review can assist medical professionals in orienting themselves and comprehending the possibilities of the clinical application of this therapy, which remains a subject of investigation and validation. This review summarizes up-to-date information regarding the use of PRP, primarily in burn and reconstructive surgery, plastic surgery, traumatology, and general surgery.

Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis.

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.

Effectiveness of 3D visualization technologies in planning and performing reconstructive plastic surgeries in patients with elbow contractures caused by ossification

Background. Open reconstructive plastic surgeries are the most radical method of treating patients with elbow contractures caused by ossification. However, these surgeries pose a serious problem due to the large number of unsatisfactory results. The aim of the study is a comparative assessment of the effectiveness between standard techniques and 3D visualization technologies in the surgical treatment of patients with elbow contractures caused by ossification. Methods. Using random number generation, all patients (n = 71) were randomized into two groups. The first group included 34 patients with elbow contractures caused by ossification that underwent surgical intervention using 3D technologies to assess the ossification process. The second group enrolled 37 patients with a similar nosology that underwent standard examination and surgical treatment. The results were evaluated intraoperatively and 180 days after the surgery. The data were obtained from primary medical records and further survey. Results. The application of new planning technology and tactics for onstructive plastic surgeries made it possible to reduce the surgery time by 1.2 times (p0.05), reduce blood loss by 1.3 times (p0.05) and increase the relative number of patients with sufficient movement volume by 10.6% (p0.05). The assessment of various performance parameters (range of motion, pain syndrome, quality of life etc.) showed that after 6 months in the main group, the relative number of patients with problems related to the operated joint was significantly lower than in the control group: 20.5% vs 84.7% (p0.05). Conclusions. The data obtained indicate that the use of the new technique for planning and performing reconstructive plastic surgery in patients with elbow contractures caused by ossification contributes to a less invasive intervention and achievement of better intraoperative and medium-term treatment results.

Trends in Gender, Ethnicity and Less-Than-Full-Time Training among Reconstructive Plastic Surgery Registrars and Consultants between 2009 and 2020

ObjectiveThis study aimed to examine the trends in gender, ethnicity and less-than-full-time (LTFT) training in reconstructive plastic surgery from 2009 to 2020 in the UK by comparing them to overall surgical specialties. MethodsWe analysed NHS Digital workforce data from 2009 to 2020 by examining trends in gender, ethnicity and LTFT working among reconstructive plastic surgery consultants and registrars and comparing them to overall surgical specialties. Data were analysed using linear regression models. ResultsThe percentage of female reconstructive plastic surgery consultants and registrars increased significantly over the period, with reconstructive plastic surgery groups having higher percentages of females than overall surgical specialties. LTFT working trends varied, with declining trends among consultants and increasing trends among registrars. Ethnicity trends were complex, varying between different ethnic categories and between consultants and registrars, but showing an increase in diversity within the workforce. ConclusionThe demographics of reconstructive plastic surgeons in the UK became more diverse from 2009 to 2020 with trends indicating that this will continue in the future. However, there were significant variations among the different groups and levels of seniority, suggesting the need for targeted interventions to promote diversity and inclusivity in surgical specialties.

Prevalence and characteristics of paediatric burns at the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana

IntroductionBurn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care. Study objectiveTo establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center. MethodologyA retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed. Data analytical methodsDescriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome. ResultsThe period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p < 0.001). ConclusionThis study found a high prevalence of paediatric burns with hot water and foods being the predominant causes. Higher TBSA predicted lower chances of survival. The findings have scientific value in informing prevention strategies, allocating resources, and improving the quality of care.

Establishing a Collaborative Orthoplastic Approach for the Management of Primary Musculoskeletal Neoplasms: An 8-year Case Series.

Orthoplastic surgery is a multidisciplinary approach that is well-studied for extremity trauma, but not for musculoskeletal oncologic reconstruction. Here, the authors describe the application of a collaborative orthoplastic approach for the management of primary musculoskeletal neoplasms and evaluate its impact. The collaboration protocol, implemented in July 2019, comprises specific checkpoints of interdisciplinary co-management, which span the pre-, intra-, and postoperative treatment period. This involves direct communication between attending surgeons and their respective clinical teams. Patients who underwent resection of a primary musculoskeletal neoplasm between March 2014 and April 2022 were retrospectively categorized into conventional or collaboration groups. Of the 136 total patients, there were 63.2% (n = 86) conventional and 36.8% (n = 50) collaboration; 31.6% (n = 43) had reconstruction and 68.4% (n = 93) did not. Compared with the conventional group, the collaboration group had significantly higher rates of diabetes (18% versus 7%, P = 0.048) and radiation treatment (68% versus 43%, P = 0.005). The collaboration group was significantly more likely to have plastic surgery involvement in their care than the conventional group (38% versus 14%, P = 0.001), and to undergo reconstruction (42% versus 26%, P = 0.047). The groups showed no difference in rates of hematoma, seroma, delayed healing, infection, 30- or 90-day reoperation, or partial or complete flap/graft failure. The collaborative approach described here is feasible and associated with increased plastic surgery involvement and reconstructive surgery. Complications were equivalent despite evidence suggesting increased case complexity in the collaboration group. These early results are promising and could inspire wider adoption of structured orthoplastic protocols for care of these patients.

The role of reconstructive plastic surgery in the treatment of victims of the 2023 Kahramanmaraş earthquake

Objective: As a result of the 2023 Kahramanmaraş earthquake, medical institutions experienced a large influx of patients requiring acute multidisciplinary surgical and medical care. This study aimed to evaluate the patient demographics and treatment management of survivors admitted to our reconstructive plastic surgery department. Materials and Methods: We retrospectively analyzed the age, sex, time under the wreckage, time of admission, types and locations of injuries, treatment modalities, receipt of hyperbaric oxygen therapy, and receipt of vacuum-assisted closure therapy of the earthquake victims referred to our department. Results: The definitive management of all 42 earthquake survivors admitted to our department was reviewed. This included five free flaps, four regional flaps, 18 split-thickness skin grafts, and one maxillofacial fracture repair. Eight patients were treated conservatively including two with non-displaced maxillofacial fractures. Of the 26 patients treated for lower extremity injuries, four were already amputees. Among the remaining 22 patients with such injuries, one underwent Charcot amputation plus free flap reconstruction to preserve extremity length and one underwent below-the-knee amputation. Of the 16 upper extremity injuries, two patients referred with extensive forearm necrosis underwent forearm amputation. To preserve extremity length and ensure the limbs were suitable for biomechanical orthoses, free transverse upper gracilis musculocutaneous flaps and free chimeric Anterolateral- Vastus Lateralis musculocutaneous flaps were performed. Conclusion: This study illustrates the value of multi-modal reconstructive plastic surgery in the treatment of disaster survivors, particularly in the management of multi-trauma.

SURGICAL METHODS OF PREVENTION OF POST-MASTECTOMY SYNDROME: A LITERATURE REVIEW

Relevance: Despite improvements in early diagnosis, breast cancer continues to be one of the most common types of malignant tumors in the Republic of Kazakhstan, affecting about 5,000 women annually. Surgery remains the main method of treatment for breast cancer. Rapid development and improvement of various methods and devices for reconstructive plastic surgery plays an important role in the medical, psychological, and social rehabilitation of patients with breast cancer, allowing to achieve better aesthetic and functional results. Postmastectomy syndrome (PMPS) is a complex complication of surgical tumor resection and affects almost half of women who have undergone this intervention. The study aimed to analyze surgical methods for the prevention of postmastectomy syndrome to improve the outcomes, the course of the postoperative period and the quality of life of patients. Methods: Data from MEDLINE, Embase, Scopus, PubMed, and Cochrane Central Register of Controlled Trials were analyzed to select and analyze relevant information over the past 10 years using the keywords: “postmastectomy syndrome,” “mastectomy,” “lymphedema,” “brachioplexitis.” Results: The literature analysis showed that treating PMS requires a comprehensive approach, since the manifestations of PMS may vary depending on individual characteristics, the extent of surgical intervention, and other individual factors. The effectiveness of the interventions varied, with some showing promising results in reducing pain intensity, while others demonstrated improvements in functional outcomes and quality of life. Thus, it was found that ultrasound dissection is superior to electrocoagulation in terms of intraoperative blood loss, amount of lymphorrhea, and average hospital stay. Lymphatic-venous anastomoses are difficult to reproduce, but have been reported to be 95% effective in preventing lymphedema. Autologous fat tissue transplantation solves several problems, including reducing chronic pain syndrome (&gt;6 months) by 3.1 points. Brachioplexitis and associated complications can be prevented during surgery. Conclusions: Given the variability of PMS complications, it is advisable to prevent the burden and financial costs of rehabilitation in the postoperative period. Surgical methods of prevention discussed in this literature review can be used intraoperatively to significantly reduce the risk of PMS.

Human Acellular Collagen Matrices-Clinical Opportunities in Tissue Replacement.

The field of regenerative medicine is increasingly in need of effective and biocompatible materials for tissue engineering. Human acellular dermal matrix (hADM)-derived collagen matrices stand out as a particularly promising candidate. Their ability to preserve structural integrity, coupled with exceptional biocompatibility, positions them as a viable choice for tissue replacement. However, their clinical application has been largely confined to serving as scaffolds. This study aims to expand the horizon of clinical uses for collagen sheets by exploring the diverse cutting-edge clinical demands. This review illustrates the clinical utilizations of collagen sheets beyond traditional roles, such as covering skin defects or acting solely as scaffolds. In particular, the potential of Epiflex®, a commercially available and immediately clinically usable allogeneic membrane, will be evaluated. Collagen sheets have demonstrated efficacy in bone reconstruction, where they can substitute the induced Masquelet membrane in a single-stage procedure, proving to be clinically effective and safe. The application of these membranes allow the reconstruction of substantial tissue defects, without requiring extensive plastic reconstructive surgery. Additionally, they are found to be apt for addressing osteochondritis dissecans lesions and for ligament reconstruction in the carpus. The compelling clinical examples showcased in this study affirm that the applications of human ADM extend significantly beyond its initial use for skin defect treatments. hADM has proven to be highly successful and well-tolerated in managing various etiologies of bone and soft tissue defects, enhancing patient care outcomes. In particular, the application from the shelf reduces the need for additional surgery or donor site defects.

Еffect of Radiation Therapy on Breast Reconstruction in Breast Cancer Patients

Background. The surgical stage remains the main one in the combined and complex treatment of breast cancer. Radical mastectomy and reconstructive plastic surgery are the main option for surgical treatment of vast majority patients. Radiation therapy can lead to the development of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause technical difficulties for the radiologist to properly adjust the required dose of irradiation. Aim — to choose the optimal method of breast reconstruction using various implants, as well as endoprostheses to minimize post-radiation complications and maintain a high level of quality of life for patients after breast cancer treatment. Methods. The retrospective study was conducted in the department of oncology and reconstructive plastic surgery of the breast and skin in the P.A. Herzen Moscow Research Oncology Institute from June 2013 to November 2017. There were performed 132 operations: 111 subcutaneous mastectomy with one-stage reconstruction with an endoprothesis and 21 mastectomy with a one-stage reconstruction with an endoprothesis. The distribution by stages: I — 57, IIA — 39, IIB — 17, IIIA — 13, IIIC 4; 2 cases of breast sarcoma. Prophylactic mastectomy of the contralateral gland was performed in 22 patients, mastopexy in 8, augmentation in 20. Polyurethane implants were applied in 82 cases (62%). Radiation therapy was performed in 47 patients with total dose 45 Gy. Bilateral reconstruction was performed in 22 patients. Results. The mean follow-up period was 28.44 ± 14.66 months (from 6 to 48 months). The most frequent complication in the postoperative period was the development of capsular contracture: seroma — 20 patients, hematoma — 2, edge necrosis — 6, protrusion — 6, infection — 2 patients. The most common capsular contracture by Baker was III degree, n = 18. The average period of development of capsular contracture was 7.6 ± 11.65 months. Conclusion. Despite the greater number of complications during the one-stage reconstruction, the implants remain in advantage in choosing a method of treating breast cancer by both the patient and the surgeon.