Posters
1. Right radial nerve compression syndrome I. Lascar, Angelica Banu R. Crutescu, D. Zamfirescu, D. Totir, I. Dragoicea 2. A critical assess over own experience in flexor tendon surgery Irina Visa, Sorin Velicu, Dan Grigorescu 3. Hand tumors corect evaluation between radical excizion and a conservative surgery for prezerving hand function I.Lascar, F. Juravle, S. A. Popescu, Ruxandra Andrei, Ruxandra Sinescu, C. Mitache 4. Prominent ears - retrospective study of Mustarde technique I. Bordeianu, M. Thalathini, B. Caraban 5. Breast augumentation I. Bordeianu, C. Panchici, B. Caraban ,M. Thalathini 6. Ito syndrome – case report B. Caraban, M. Thalathini, I. Bordeianu 7. Penile and urethral reconstruction – original procedure. Case presentation. I. Lascar, Rodica Crutescu., Dana Vasilescu., D. Zamfirescu., Ioana Dragoicea., Anca Breahna 8. Giant von Recklinghausen tumor (68 kg) removal – case report I. Lascar, MK McKinnon, R. Crutescu, C.S. Hariga, S.A. Popescu, O. Vermesan, C. Munteanu, L. Cojocaru, D. Zamfirescu 9. Learning curve in experimental and clinical microsurgery during the residency training period in Plastic Surgery Lascar I, Zamfirescu D 10. Evaluation of distant sentinel skin allografts for monitoring of rejection of limb transplants Zamfirescu DG, Owen E, Lascar I, Molitor M, McCaughan G, Bishop GA, Lauer CA, Wright B, Lanzetta M 11. Composite tissue allografts models on the rat Zamfirescu D, Owen ER, Lanzatta M, Lascar I 12. Superior digestive hemorhage at a child with extensive burns D. M. Enescu 13. Burn and Plastic Surgery Center Clinical Emergency for Children Hospital „Grigore Alexandrescu" D. M. Enescu 14. Therapeutic Strategies in child burns D. M. Enescu 15. Pediatric Plastic Surgery, past, present, future D. M. Enescu
1. Right radial nerve compression syndrome I. Lascar, Angelica Banu R. Crutescu, D. Zamfirescu, D. Totir, I. Dragoicea Plastic Surgery and Reconstructive Microsurgery Clinic Clinical Emergency Hospital Bucharest Compression of the posterior interosseous nerve was recognized in 1905 by Guillain. Mulholland (1966), Spinner (1968), Nielsen (1976) have described the clinical and electrophysiologic sequence of this syndrome. The etiophatogeny of the radial nerve compression syndrome has a traumatic cause in 60% cases. The severity of the lesions is a result of the magnitude as well as the duration of the compressive trauma. The functional disorder may vary from motor weakness to muscle paralysis. We present the case of a 62 years old female who presents in our clinic for posterior interosseous nerve compression syndrome. The clinical course was good, with functional satisfactory results. . 2. A critical assess over own experience in flexor tendon surgery Irina Visa, Sorin Velicu, Dan Grigorescu Plastic Surgery Department, County Hospital Brasov Contact e-mai: irinav@rdslink.ro Introduction. Same findings can be the motivation of the paper: the high incidence after fractures in the traumatic injuries traditional interest of our department for the surgery of flexor tendon; socio-economic reasons in relations with flexor’s injuries. Material. We realized an overview for 500flexor tendons operated in a period of 3 yrs. at 266 patients. Method. Our surgical strategy was: primary tenorraphy, followed by early mobilization for the injuries located in a II-III-IV anatomical zone. For the injuries located in the I and V zone this protocol was inconstant used. Early motion started in a first day of surgery, keeping the hand in a permanent splint for 30 days; a program of controlled rehabilitation is continue for a 30-40 days. For a complex neuro - tendinous injuries the recovery period can be longer, till 90 days after surgery. Our surgical technique was: modified Kessler core suture with running peripheral suture, monophilament material; usually the A2 and A4 pulleys are preserved and also the FDS, every time when his suture is without tension or poolley blockade, otherwise it is resected. Always the associated Nerves injuries are reparated in the same time. Results. We obtain a very good recovery in almost 85%cases. We reduced very much the indication of tenolysis, reserved mostly for the cases with nerves injuries associated. Like bad results: contracture of PIP joint, with lack of extension, in 20% cases, tendon rupture in 1% and suppurative wound evolution in 2% cases. Conclusion. Post operative early motion represent the Key point for flexor rehabilitation. An a traumatic but strong primary suture offer the support of the motion. Surgical strategy have to be adapted for each case .The rehabilitation program after surgery have to by controlled both by the hand surgeon and the kinesytherapeut.
3. Hand tumors corect evaluation between radical excizion and a conservative surgery for prezerving hand function I.Lascar, F. Juravle, S. A. Popescu, Ruxandra Andrei, Ruxandra Sinescu, C. Mitache Plastic Surgery and Reconstructive Microsurgery Clinic Clinical Emergency Hospital Bucharest If we consider the excision of a malignant tumor at the hand level we must careful evaluate the balance between a "large" radical excision and a radical "conservative" excision having in mind both the radical oncology treatment and the preservation of the hand function as much as possible. To do a good surgery planning we have to do a complete preoperative exploration (imagistic, biochemical) so that the presumptive diagnose should be as close as possible from the histopathology certain diagnose. A histopathology result during the surgery is also very helpful, as well as having a flexible "reserve" strategy. 4. Prominent ears - retrospective study of Mustarde technique I. Bordeianu1, M. Thalathini2, B. Caraban1 1 – Plastic Surgery Clinic, Universiy „Ovidius" Constanta, 2 – Plastic Surgery Clinic, Clinical Emergency County Hpspital Constanta Contact e-mail: i_bordeianu@hotmail.com Prominent ears is a condition that cause extreme Psychological distress in young people. This cosmetic deformity can be corrected by Otoplasty, which is a surgical procedure that is done to set prominent ears back closer to the head or to reduce the size of large ears. For the most part, the operation is done on children between the ages of 4 and 14.Ears are almost fully grown by age four, and the earlier the surgery ,the less teasing and ridicule the child will have to endure .Ear surgery on adults is also possible, and there are generally associated with high rate of patient satisfaction. In our plastic and reconstructive microsurgery clinic ,Constanta county hospital, we perform otoplasty using Mustarde technique and adapting the technique depending on the patient case.26 cases were performed in our clinic in the last 8 years,patients between the ages of 8 and 32 with very satisfaction results for the patients. 5. Breast augumentation I. Bordeianu1, C. Panchici2, B. Caraban1, M. Thalathini2 1 – Plastic Surgery Clinic, Universiy „Ovidius" Constanta, 2 – Plastic Surgery Clinic, Clinical Emergency County Hpspital Constanta Contact e-mail: i_bordeianu@hotmail.com
The breast is the universal symbol of femininity, nurturing, love, and sexuality. It is not surprising that breast augmentation is one of the more common aesthetic plastic surgery procedures performed. Most women presenting for breast augmentation or enlargement are charming, attractive and outgoing individuals. They are insecure regarding their small breast size and have been since their teenage years. The overwhelming majority of women who undergo breast augmentation are very satisfied with their result. In fact, most patients benefit psychologically and experience an improvement in body image. In fact, studies show that many women have less anxiety, depression, and shyness after breast augmentation. In our clinic we perform submammary breast augmentation using silicone gelfilled implants through inframammary incision. 160 cases were performed in the last 3 years with very good results except a case of single fistula complication in which we had to remove the implant ,perform capsulectomy and to insert the implant back again. 6. Ito syndrome – case report B. Caraban1, M. Thalathini2, I. Bordeianu1 1 – Plastic Surgery Clinic, Universiy „Ovidius" Constanta, 2 – Plastic Surgery Clinic, Clinical Emergency County Hpspital Constanta Contact e-mail: i_bordeianu@hotmail.com Ito syndrome is the presence of whirled hypochromic skin lesions often associated with systemic manifestations, introduced in 1951 by Ito. Chromosomal mosaicism and sporadic mutations are the causes, but the identity of a specific gene has not been confirmed. A karyotype analysis survey was performed by Ruiz-Maldonado in 1992 on 115 patients and revealed chromosomal anomalies in 52 of cases(60%). The common finding in all these patients is the pigmentary changes and the associations with neurologic(mental retardation,[IQ] <70) skeletal, and other congenital abnormalities. We present a 14 year old female with hypochromic skin lesions and mental retardation but with normal karyotype. 7. Penile and urethral reconstruction – original procedure. Case presentation. I. Lascar, Rodica Crutescu., Dana Vasilescu., D. Zamfirescu., Ioana Dragoicea., Anca Breahna Plastic Surgery and Reconstructive Microsurgery Clinic Clinical Emergency Hospital Bucharest We present a penile and urethral reconstruction to a young patient with accidentaly penile amputation. We made penile reconstruction with fasciocutaneous resensitive microsurgical free flap and urethral reconstruction using a scrotal flap to avoid urethral fistula complication.
8. Giant von Recklinghausen tumor (68 kg) removal – case report I. Lascar1, MK McKinnon2, R. Crutescu1, C.S. Hariga1, S.A. Popescu1, O. Vermesan1, C. Munteanu1, L. Cojocaru1, D. Zamfirescu1 1 Bucharest University of Medicine, Plastic Surgery and Reconstructive Microsurgery Department, Bucharest Emergency Hospital 2 University of Chicago, Chicago Memorial Hospital The aim of this paper is to present the very complex medical management of a 47 years old women with a giant von Recklinghausen tumor (68 kg after surgical excision) that severe alterated the general biologic status: severe secondary anemia, class II-III NYHA cardiac insufficiency, severe malnutrition and hipoanabolic syndrome, primitive pulmonary hypertension, functional tricuspidian insufficiency, ascetic syndrome, lithiasic cholecystitis, hydrostatic leg vein varicosities class 4, lumbar discopathy. The patient was complete investigate from biologic and imagistic point of view. The global management of this case was very complex because of the unique ratio between tumor and total body weight (almost 2/3), and because of secondary multiple system insufficiencies. An excellent collaboration between two international surgical and anesthesiological teams was the success key of the entire procedure of giant tumor excision. The procedure had a very high anesthetic risk because of the possibility of bleeding or multiorgan failure on this poor general condition patient, but the anesthesiological management permit a normal 8 hours surgical procedure.The 20% of body surface defect remained after surgical removal of the tumor was covered progressively in 3 stages. The functional and esthetical local results after one year postoperatively are very good and the general biologic status recovered progressively to a normal level during the first 6 mounts. 9. Learning curve in experimental and clinical microsurgery during the residency training period in Plastic Surgery Lascar I, Zamfirescu D Bucharest Carol Davila Medical University, Plastic Surgery and Reconstructive Microsurgery Department, Emergency Hospital Bucharest, Romania This paper presents a personal learning curve in experimental and clinical microsurgery during the 6 years training period in Plastic Surgery in Bucharest Emergency Hospital and during 1 year research fellowship in Microsearch Foundation of Australia. After the constant following of Plastic Surgery and Reconstructive Microsurgery Department training program in microsurgery in the first 2 years of residency, the patency of microvascular anastomosis in animal models increase from 50% to more than 90%. Reaching this value of patency allow to start the clinical microsurgical practice (especially replantations). In the first 3 years of training the vascular success in replantations was 66.67% (10 from 15 cases) and in the last 3 years was 97% (33 from 34 cases). In a series of 77 consecutive limb transplants in rats the success rate increased from 33.33% in the first 24 cases, to 98% in the last 53 cases (100% in the last 46 consecutives cases). A good program of training and a constant effort to work in experimental laboratory is an essential condition to obtain good result in microsurgery. With the microsurgical basic and advanced techniques practiced, there
will be more ease, confidence and success when doing tissue transplantations or replantation in humans, even in infants. 10. Evaluation of distant sentinel skin allografts for monitoring of rejection of limb transplants Zamfirescu DG1,2, Owen E1, Lascar I2, Molitor M3, McCaughan G4, Bishop GA4, Lauer CA5, Wright B1, Lanzetta M1 1 Microsearch Foundation of Australia, Sydney, NSW, Australia 2 Bucharest Emergency Hospital, Bucharest, Romania 3 St. Anne’s University Hospital, Brno, Czech Republic 4 Centenary Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia 5 Missenden Medical Center, Lauer Pathology, Sydney Previous studies have demonstrated that composite tissue transplants such as limbs reject more slowly than skin transplants. This has led to the hypothesis that a simultaneous skin graft may act as an effective marker of limb rejection. The aim of this study was to test the predictive value of a sentinel skin graft as a marker of rejection, using a hind limb transplantation model in rats. Lewis rat recipients received a hind limb transplants alone from Brown Norway donor (control, n=15) or combined with a full thickness 15 cm2 sentinel skin graft (n=45). All animals received drug therapy (FK506, MMF and Prednisone) for 6 weeks, then treatment was ceased entirely. Rejection of the skin graft and limb skin, was assessed by both visual and histologic grading system. Detectable rejection (grade 1) was observed 1.35 ± 1.5 days earlier in the sentinel skin graft than in the limb skin (p < 0.0005) and clearest rejection (grade 2) appeared 0.91 ± 1.58 days earlier in the sentinel skin graft (p < 0.005). The average histologic grade for early rejection of the skin graft was 1.46 and 1.08 for the limb skin (p < 0.05). These findings confirm a visual and histological delay in rejection of the limb skin compared to a distant sentinel skin graft. Skin grafts transplanted simultaneously with hind limbs can be a useful marker of early rejection 11. Composite tissue allografts models on the rat Zamfirescu D1,2, Owen ER2, Lanzatta M2, Lascar I1 1 Emergency Hospital Bucharest, Romania 2 Microsearch Foundation of Australia, Sydney, Australia The aim of this work was primary to familiarize with some experimental animal models used in the research field of Composite Tissue Allografts (CTAs) and secondary to develop advanced microsurgical skills. All these animal models are vascularized allotransplants from Brown Norway to Lewis rats. A total 97 procedures were done: orthotopic (n = 60) and heterotopic (n = 5) limb transplantation, femur transplantation (n = 5), limb and contralateral femur transplantation (n = 5), knee transplantation (n = 5), tail transplantation (n = 5), sternum transplantation (n = 2), face transplantation (n=5), and toe–to-thumb allotransplant (n = 5). All animals received drug therapy (FK506, MMF and Prednisone) for 8 weeks, then treatment was ceased entirely. The average
success rate of transplantation was 84.57%. This study demonstrated that the composite tissue transplantation could be a reliable new method to solve the difficult problem of Plastic Surgery – the reconstruction of extensive soft tissue defects or mutilations. In the same time we improved our rate of success performing anastomoses of vessels of less than 0.8 - 0.5 mm in diameter. Clinically such anastomoses are necessary for replantation of the distal digits in adults and whole digits in children, and for the new direction of perforators’ free flaps. With this techniques practiced, there will be more ease, confidence and success when doing small tissue transplantations or replantation in humans, even in infants.