Varia Amputation by mikesanye

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									Varia

        1. The actual stage of Plastic Surgery in Romania – past, present and future
        D.Enescu, M.Enescu, S.Giuvelea, D.Ionita, G.Constantinescu
        2. Plastic Surgery in solving the politrauma cases admitted in the Eme rgency
Hospital Bucharest
        I.lascar, F.Juravle, S.A.Popescu, Ruxandra Sinescu, Ruxandra Andrei
        3. Chronic Wound Management
        I.lascar, Anca Breahna, D.Zamfirescu, S.A.Popescu, Ioana Sebe, Ioana Dragoicea,
Maya Corbolokovici
        4. Scars topic the rapy with Cimeosil products: indications, adva ntages,
results, pers pectives.
        S. Marinescu, I.P. Florescu, Noela Elena Ionescu, Andreea Proca, Carmen
Giuglea, Ioana Apostolescu, Anca Oporanu
        5. Ligasano PUR foam, a revolutionary dressing for difficult wounds
        A. Botan, Alina Cozma
        6. Local treatment of leg ulcers by Ligasano PUR foam
        A. Botan, Alina Cozma
        7. Early cove ring of soft tissues defect in the treatment of extensive gangrene
        Urda Ioan, Alshaeir Ala Alden, Clepce Corina, Bulbul Khaled
        8. Extensive inte rstitial calcinosis ( Tessier) complicated
        Sorin Bratila
        9. The versatility of the gluteal flap in covering sacral decubitus ulcers
        A.R. Budurca, T. Stamate
        10. Diabetic foot examination
        D.M.Stana, Luminita Dobrescu,Raluca Maxim
        11. General manage ment considerations of pacient with diabetic foot
        I. Lascar, L. Cojocaru, D.M. Stana, Ruxandra Andrei, D. Ionescu
        12. The diabetic foot. Decompression of periphe ral nerves for preventing
and/or treatment of diabetic neuropathy complications
        D.M.Stana, Luminita Dobrescu, Ruxandra Andrei, M. Popescu
        13. Radical resection of a giant upper limb lymphe dema after mastectomy
        D. Dorobantu, Al. Botianu, Carmen Munteanu, Georgeta Liliana Cif, Adela
Malos
        14. Pathologic flora in bite wounds and the subsequent antibiotic treatment
        I.Lascar, S.A.Popescu, Ruxandra Andrei, Manuela Andrei, Liviu Cojocaru,
Khaled al Falah
       1. The actual stage of Plastic Surgery in Romania – past, present and future
       D.Enescu, M.Enescu, S.Giuvelea, D.Ionita, G.Constantinescu
       Plastic Surgery Reconstructive Microsurgery Department
       Clinical Emergency Hospital for Children "Grigore Alexandrescu"

         The complexity of plastic surgery is briefly emphasized through its goals and
backgrounds as well as through the historical moments with significance in Romania.
         The development of this branch occurred over the years, treating a wide range of
pathological features, burns representing a great challenge of the field.
         The recently founded clinic at Grigore Alexandrescu hospital is depicted through
its performance as shown by clear parameters. Decreasing the mortality rate of severe
burns stands as a reward for the team treating these difficult cases.
         So do the good results upon approaching treatment of cleft lip and palate,
hemangiomas and microtia.
         Post burn reconstruction and rehabilitation requires a wide range of methods
aimed at improving the quality of life for those who suffered burns and who not rarely
prove to be complex in the therapeutic approach.
         Strong and well-organized teams should cope with the difficult tasks plastic
surgery presents.


     2. Plastic Surgery in solving the politrauma cases admitted in the Clinical
Emergency Hospital Bucharest
     I. Lascar, F.Juravle, S.A.Popescu, Ruxandra Sinescu, Ruxandra Andrei
     U.M.Ph. „Carol Davila”
     Plastic surgery and reconstructive Miccrosurgery Clinic
     Clinical Emergency Hospital Bucharest
     Contact e- mail: juravle@yahoo.com

        Clinical Emergency Hospital Bucharest has for specific activity from its very
beginning to solve severe politrauma cases. In the last decade many of these cases
benefited also from plastic surgery procedures. Regardless the etiology of the
politraumatism plastic surgeons were able to solve face wounds, upper limb and hand
lesions, nerve impairments at upper and lower limb, defects of soft tissue at any level,
revascularization of limbs sometimes in association with vascular surgeons for 251
patients in a period of 3 years. To particularize such situations we mention that the
patients were admitted by the general surgeon or orthopedist, the plastic surgery
procedures were restricted by the time that could be afforded for severe vital prognostic
patients, nerves were microsurgical repaired under operative microscope when possible
or loupes in other cases, on site when a revascularization was made or in delayed
emergency when conditions permitted. Some open fractures were later solved by free
transfers.
        In the last years there was a progressive growth of the incidence of cases in which
plastic surgeons were involved for solving politrauma pathology.
       3. Chronic Wound Management
       I.Lascar, Anca Breahna, D.Zamfirescu, S.A.Popescu, Ioana Sebe, Ioana
Dragoicea, Maya Corbolokovici
       U.M.Ph. „Carol Davila”
       Plastic surgery and reconstructive Miccrosurgery Clinic
       Clinical Emergency Hospital Bucharest

        Aim: The morbidity and mortality from chronic wounds of varying etiology
represent a significant health care problem. In one year period (march 2004- march 2005)
we examined the moist wound healing in 80 patients whose systemic disease produced
multiple local disturbances and impaired healing. Our goal was to evaluate the benefit of
using this large variety of modern wound dressings .
        Methods: Between march 2004-march 2005 we examined 80 patients.
Approximately 75% were female and 25% were male. The average age was 64.This
patients presented the following pathology:
        1. Venous insufficiency-80%
        2. Peripheral arterial disease-5%
        3. Mixed : arteriovenous-10%
        4. Other causes-10%
                 • Neuropathy
                 • Radionecrosis
                 • Trauma
                 • Infectious
                 • Foot condition related
        We used the following protocol: history, complete physical examination, general
biological profile, Doppler ultrasound, oscilometry, CT-scan.
        Our indicators were:
        1. necessary time to obtain granulation tissue
        2. quality of the granulation tissue
        3. number of dressings applied per week
        4. total time necessary for complete wound closure
        5. total time of hospitalization
        6. recurrences of lesions in the same area
        Results: 30 patients from the total of 80 needed surgical debridement. 50 patients
needed mechanical and chemical debridement using topical dressings( superabsorbant
polyacrilate, silver-coated charcoal, calcium alginate, argentic sulfadiazine).
        Once the wound is clean of fibrotic an necrotic tissue we promote granulation
tissue formation using foam dressings, calcium alginates, polyurethane foam, hyaluronic
acid.
        In 8 cases we obtained total spontaneous reepithelialization using collagen and
hyaluronic acid.70 cases were grafted and in 2 cases we used local flaps to cover the
wound.
        The donor sites for skin grafts reepithelialization was promoted using tull in 65
cases and collagen in 15 cases.
       Discussion: Appropriate selection and use of dressings that optimize the local
wound environment are part of the overall treatment plan of the patient with a chronic
wound. This permitted us the obtain complete wound closure in all cases studied, with
functional and aesthetically satisfactory scars, to manipulate less traumatic and less
frequently the wounds ,to shorten the time till grafting and the time of hospitalization and
to lower the costs of wound care.


        4. Scars topic the rapy with Cimeosil products: indications, advantages,
results, pers pectives.
        S. Marinescu, I.P. Florescu, Noela Elena Ionescu, Andreea Proca, Carmen
Giuglea, Ioana Apostolescu, Anca Oporanu
        Plastic, Reconstructive Aesthetic Surgery Department
        Clinical Emergensy Hospital „Bagdasar Arseni”, Bucharest


       Terapia topica a cicatricilor cu produse Cimeosil: indicatii, avantaje, resultate,
perspective
       S. Marinescu, I.P. Florescu, Noela Elena Ionescu, Andreea Proca, Carmen
Giuglea, Ioana Apostolescu, Anca Oporanu
       Sec]ia Chirurgie Plastica, Microchirurgie Reconstructiva [i Chirurgie Estetica
       Spitalul Clinic de Urgenta „Bagdasar Arseni”, Bucuresti


       5. Ligasano PUR foam, a revolutionary dressing for difficult wounds
       A. Botan*, Alina Cozma**
       *Burn Centre &Plastic Surgery Dept.County Emergency Hospital Targu Mures
       **Maxillo-Facial Surgery Dept. County Emergency Hospital Targu Mures
       Contact e- mail: adrian.botan@rdslink.ro
                               czmaalina@yahoo.com

        We used Ligasano dressing since 1999, in the BURN CENTRE & PLASTIC
SURGERY DEPT., for the local treatment of difficult wounds such as very deep old
neglected burns, extensive soft tissue infections, pressure sores, legulcers and so
on.Ligasano foam is made from polyurethane with a honey comb special structure giving
a remarkable local vascular "mechanical stimulus" combined with an amazing and
singular suction power which cleans all wounds by a so called "passive debridement",
keeping in the same time a moist environment and thus facilitating the natural healing
process. We used Ligasano White which is supplied in sheets of 50/50 cm and 0,5 1 and
2cm thick. All 3 thickness are very reliable for dressing the difficult wounds listed above,
in a single layer or better multilayered in different combinations. The firs lyer has to
outline the size and shape of the wound and is covered by other 1-2 layers of foam which
usually overlapp by 1-2 cm the previous layer. Even though the supplier are to change
this kind of dressing after a maximum of 3 days, we managed to keep the dressing in
place for about 5-7 days (and sometimes even 2 weeks in less exudating wounds) with
neither side effects nor modifications of the healing process, thus obtaining a very good
cost /efficiency ratio. There is also a real decrease of the hospitalization duration and
costs because the healing process seems to be significantly shorter.
        Conclusions: Ligasano dressing is very useful for a great number of difficult
wounds both in the office and in the hospital due to the following amazing qualities :
stimulates blood circulation in the wound bed and the surrounding tissues; gives a very
good elastic mechanical protection of the wound and surrounding area; has an amazing
suction which cleans the wound of all debris, necrotic tissues, pus and exudate due to the
so called "passive debridement"; has a very good cost/efficiency ratio due to the rare
need to change the dressing, the decrease of the hospitalization duration and the great
number of cases treated in the office (thus keeping all social and professional connection
for these patients and having a real benefit for the active people especially).



        6. Local treatment of leg ulcers by Ligasano PUR foam
        A. Botan*, Alina Cozma**
        *Burn Centre &Plastic Surgery Dept.County Emergency Hospital Targu Mures
        **Maxillo-Facial Surgery Dept. County Emergency Hospital Targu Mures
        Contact e- mail: adrian.botan@rdslink.ro
                                czmaalina@yahoo.com

         We began to use PUR foam since 1999 for a great number of patients with
"difficult wounds", leg ulcers representing about 60% among all these cases. Ligasano is
made from Pur foam with a "honey comb" special structure which gives it a remarkable
"vascular mechanical stimulus effect", combined with a singular "suction power",
cleaning all wounds by a "passive debridement", and thus facilitating the natural healing
process.
Ligasano white is supplied in 0,5 1 and 2 cm thick sheets, all three thickness being
reliable for the local treatment of leg ulcers in a single layer or better multilayered in
different combinations. The first layer has to outline the size and shape of the wound and
may be covered by other 1-2 layers which usually overlap with 1-2 cm the previous layer;
this foam dressing is then tighten by regular crepe and elastic bandage. There are two
categories of patients with leg ulcers treated by this method: a) patients treated in the
office, with leg ulcers under 7-8 cm diameter, and average healing in about 12 weeks
(there are also patients with leg ulcers larger than 7-8 cm refusing to go to hospital for
different personal reasons); b) patients with very large leg ulcers, first treated in the office
for about 6-8 weeks (during this period all lesions clean, decrease in size and obtain a
good granulation tissue), who are then admitted in the hospital in order to be split skin
grafted.
         Conclusions: the office treatment is very reliable for the most part of patients who
can maintain in this way, all their social and professional connections; there is a real
decrease of the hospitalization period, because the most part of the pre-operative
treatment to obtain a good granulation bed for the graft is done in the office, and thus the
healing process is shorter and less expensive. For all these reasons we consider that this
dressing has a very good cost/efficiency ratio, due to rare dressing changes, allowing the
patients to keep a good social and even professional connections, which has a great
benefit for the active people especially. That is why we recommend this dressing to all
surgeons dealing with leg ulcers.



       7. Early cove ring of soft tissues defect in the treatment of extensive gangrene
       Urda Ioan, Alshaeir Ala Alden, Clepce Corina, Bulbul Khaled
       Plastic and Reconstructive C linic
       Clinical County Hospital Oradea
       Contact e- mail: aladden@dr.com

        Aim: early cover of soft tissues defects has the aim to reduce the fluid,
electrolytes and protein loss, also to reduce post operative wound infection.
        Materials and methods: we have included 66 patients in our study; in 46% cases
we used early cover of post operative wounds.
        Results and conclusion: large defects resulting after excisions in treatment of
extensive gangrene can be covered early after 48-72 hr post excision or later after wounds
granulation. The advantages of early cover of soft tissues defects in order to avoid fluid
and protein lost, reestablish electrolytes balance, reduction in treatment coast and
hospitalization time. Postoperative wound is an open gate for fluid and electrolytes loss;
closing this gate with early skin graft won’t be possible without a correct excision of the
necrotic tissue along with a complex medical treatment.


       8. Extensive inte rstitial calcinosis (Tessier) complicated
       Sorin Bratila
       Plastic sugery departament
       Emmergency Hospital Petrosani

        The extensive interstitial calcinosis (Tessier) is an auto extensive disease as a
result of calcium metabolism disorder typified by settlement of hidroxiapatita to collagen
fibers, who are crocked.
        This theme is a case report, whereat diagnosis was confirmed during operation,
based on existence to body skin-deep various tumor forms with" metastasis" character.
        Severely local and general semeiology resolved as paraclinic investigations unreel
concomitantly with therapy.
        The varieties of diseases which conduct to settlement of calcium in skin and under
skin bring really problems for differential diagnostic.
        Treatment is strictly surgical on exclusively lesion; corthicotherapy or
immunosuppressant medications are aimless to limit lesion extension.


       9. The versatility of the gluteal flap in covering sacral decubitus ulcers
       A.R. Budurca, T. Stamate
       U.M. „Gr.T. Popa" Iasi
       Plastic Surgery and Reconstructive Microsurgery Clinic
       Contact e- mail: rbudurca@yahoo.com
       Clinical Emergency Hospital Iasi

        The variety in size and shape of the sacral decubitus ulcers is compensated by the
multiple choices in tailoring and raising of the gluteal flap (GF) as a fascio-cutaneous or
musculo-cutaneous flap. The authors have a 75 patients experience with 95 GF, in 20
cases the flap being raised on both sides. The types of the flaps used were rotational in 40
cases, V-Y advancement in 37 and transposition for 18. As anatomical types, we used 58
musculo-cutaneous and 37 fascio-cutaneous flaps. Two fascio-cutaneous flaps had a
minor marginal necrosis, the rest of the flaps having no survival problems. Sepsis
complicated the postoperative course in 16 patients, leading to wound dehiscence which
healed spontaneously in 7 cases and by resuturing of the flap in 9, raising the hospital
stay up to 30 days.
        The keys to success are the complete excision of the necrotic ad infected tissues,
correct biological rehabilitation pre- and postoperatively, broad spectrum antibiotherapy
and spasticity control. The multidisciplinary approach (psychologist, nutritionist,
anesthesiologist, kinesiologist, microbiologist, plastic surgeon) is essential for those
costly patients.


       10. Diabetic foot examination
       D. M. Stana, Luminita Dobrescu, Raluca Maxim
       Plastic Surgery and Reconstructive Microsurgery Clinic
       Clinical Emergency Hospital Bucharest

        Attentive physical examination, monofilament test for neuropathy and
noninvasive tests for renal insufficiency can identify the risk patients for developing feet
ulcers, and adequate patients with ulcers or other diabetes complication at foot level.
        Enforcing a systematic protocol for diagnoses and classification may improve the
communication between family physicians and the diabetes specialists a nd can facilitate
the complications treatment. This treatment is made by a medical team which finally aims
to reduce the major lower limb pathology due to diabetes.


       11. General manage ment considerations of pacient with diabetic foot
       I. Lascar, L. Cojocaru, D.M. Stana, Ruxandra Andrei, D. Ionescu
       Plastic Surgery and Reconstructive Microsurgery Clinic
       Clinical Emergency Hospital Bucharest

         Every 1000 people with diabetes mellitus, 10 are experiencing leg amputation, the
level of amputation rate increasing with age and illness persistency.
         Diabetes mellitus infection is the main reason for treatments of patients suffering
of this illness, statistically accounting of 25% of the cases. One of five patients is
suffering at least an amputation.
         There are estimations concluding that being aware of risk factors and adequate
treatments, established by an interdisciplinary medical team, the amputation rate could be
reduced. In addition, aggressive approach of diabetic foot complications is considerably
important as health expenses reduction.
        Medical techniques for prevention and treatment of leg amputation in case of
diabetic patients includes from primary leg examination to advanced procedures of
vascular and reconstructive surgery.
        Initial identification of risk factors, periodically and carefully examination and
aggressive treatment procedures established by the interdisciplinary medical team usually
prevents leg amputation in most cases of infections / diabetic leg ulcerations
        Adequate treatment of ulcerations consist of minimizing leg solicitation, infection
eradication, ischemia corrections and preserve a warm, clean and moist environment in
order to increase the healing of wounds.
        The success of these efforts maintains the life quality of patients with diabetes
mellitus and also reduces the social insurance system expenditures.

								
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