Post traumatic and post surgical sciatic neuropathy

Department of Orthopaedics and Traumatology, Clinical aesthetic plastic surgery and reconstructive microsurgery, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Sciatic nerve neuropathy surgical related is an unpleasant event with repercussions on the patient and the surgical team. The precise localization and extension of the nerve lesion, thedetermination of nerve continuity, lesion severity, and fascicular lesion distribution are essential for assessing the potential of spontaneous recovery and thereby avoiding delayed or inappropriate therapy. The aim of this study is to identify and detail posttraumatic and postoperative neuropathies. Material and Methods:We identified 11 patients diagnosed with the posttraumatic sciatic nerve palsy, including postoperative one. We examined clinical data, trauma’s information, surgery, symptoms and medical records. Discussion results: From the group of patients involved in the study 9 patients were men. Patients’ age ranged from 21 to 63 years old. We determined that 5 cases were during trauma or after surgery, and in 6 cases – at distance. Our data find their confirmation in literature data published by the authors: Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Conclusion: Knowing the complications allows finding the preventive measures that are targeted towards monitoring the intraoperative neurophysiological complex depending on performed procedure

Artrodeza genunchiului cu lambou compozit fibular. Raport de caz clinic

Catedra de ortopedie şi traumatologie, Catedra de anatomie topografică şi chirurgie operatorie, USMF „Nicolae Testemiţanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareBackground. The free vascularized bone transfer has evolved to become an accepted and often the preferred reconstruction for critical size bone defects in both the axial and appendicular skeleton (Sparks et al., 2017). Objective of the study. To perform the clinical case rapport about the approach and evolution of the large bone defect, that occurred after ablation of the total knee prosthesis, septic complicated on oncology patient. Material and Methods. The clinical case's about the patient (31 yrs) diagnosed in 2009 with osteoclastoma of the distal femur. The tumor was ablated quickly, the total endoprotesation of the knee was made. That was complicated by a septic bone defect(2015). The approach: septic defect healing, prosthesis ablation were done. The next step: arthrodesis of the knee was done with a vascularized fibular composite flap. Results. The patient was periodically investigated postoperatively and 5 years (2020) later. No recurrences of the infectious or oncological process were determined. The satisfactory clinical and paraclinical indices were recorded. Conclusion. Our experience allows us to maintain that the utilization of an axially composite flap for reconstruction of the complicated septic process at the pelvic limb can be a solution without respecting the required period for the remission of the infection. Introducere. Transferul osos vascularizat liber a evoluat treptat pentru a deveni o reconstrucție acceptată și deseori preferată pentru defectele osoase de dimensiuni critice. (Sparks și colab., 2017) Scopul lucrării. De a efectua un raport de caz clinic despre abordarea și aprecierea evoluției la distanță, a unui defect osos vast, care a apărut după ablația protezei totale de genunchi, septic complicată la un pacient oncologic. Material și Metode. Caz clinic al pacientei (31 de ani) diagnosticată în 2009 cu Osteoclastom al 1/3 distale os femural. Se efectuează imediat ablația tumorii, endoprotezarea totală a articulației genunchiului. În 2015 se complică cu defect osos septic. Abordarea fiind stabilită în II etape. I: sanarea focarului și ablația protezei. II-a: artrodeza genunchiului drept cu un lambou compzit fibular vascularizat. Rezultate. Pacienta a fost investigată periodic postoperatoriu și la 5 ani (2020) distanță. Nu au fost determinate recidive ale procesului infecțios sau oncologic. Indicii clinici și paraclinici satisfăcători. Concluzii. Utilizarea unui lambou fibular compozit vascularizat poate fi soluția în reconstrucția unui defect vast osos septic la nivelul membrului pelvin, fără a respecta perioada necesară pentru remisia infecției

Advanced Polypropylene and Composites with Polypropylene with Applications in Modern Medicine

Synthetic polypropylene (PP) is used extensively in many fields of medicine. On the one hand, it is utilized in the manufacture of medical equipment: syringes, storage, transport, electric cables, etc. On the other hand, synthetic, nonabsorbable isotactic PP (iPP) is often used to perform meshes for hernia and pelvic organ repair operations, as well as in urinary incontinence. Products that release in time from meshes are depending on the conditions in which they are utilized, can produce undesirable reactions for the human body. For this reason, nonabsorbable synthetic PP was replaced in surgical sutures and meshes with bio polypropylene (bio PP). The chapter analyzes the specific characteristics of these polymers as well as their degradation due to the influence of different factors: humidity, perspiration, temperature, and presence of bacteria. Obtaining new composite materials with PP as matrix and metal powders as fillers is considered as a possibility of their use in vital problems such as cancer detection and treatment. These allow the emergence of new strategies in the design of biosensors that use nanocomposite materials with different fillers and polymeric films. The chapter analyzes the characteristics of new composite materials with PP matrix and metallic powders of iron (Fe)

MANAGEMENT OF LARGE BONE DEFECTS BY THE INDUCED MEMBRANE METHOD

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Defectele osoase pot fi cauzate de traumatisme, tumori sau infecții (osteomielita). Reconstrucția chirurgicală a defectelor osoase prezinta o provocare semnificativă pentru chirurgul ortoped-traumatolog. Tehnica membranei induse este o metodă chirurgicală de referință pentru tratamentul defectelor complexe. Scopul lucrării. Prezentarea cazurilor clinice rezolvate prin aplicarea tehnicii membranei induse. Material și metode. Datele anamnestice, clinice și paraclinice au fost prelevate din fișele medicale a 14 pacienți (11 bărbați, 3 femei), (dimensiunea defectelor cuprinsa între 4-15 cm, 11 defecte osoase tibiale, 3 defecte osoase femurale). Pacienții au fost investigați clinico-radiologic preoperator, postoperator și în dinamică. A fost studiată literatura privind rezolvarea cazurile similare cu ajutorul tehnicii membranei induse. Rezultate. În studiu dat au fost incluși 14 pacienți cu vârsta cuprinsă între 27 și 69 de ani cărora li s-au efectuat intervențiile chirurgicale prin tehnica membranei induse, supranumită și Masquelet. 13 din 14 (93%) pacienți au demonstrat rezultate foarte bune in urma metodei aplicate, membranei induse, dând dovadă de formarea vascularizării satisfăcătoare, prevenirea fibrozei si migrării osoase după prima etapa și osteointegrarea reușita a grefei osoase după a 2-a etapa. La un bărbat cu vârsta de 60 de ani și comorbidități, DZ tip II, angiopolineuropatie diabetică nu s-a observat osteointegrare reușită. Concluzii. Metoda membranei induse asigura un proces intens de proliferare și diferențiere celulară cu secreția factorilor osteoinductivi, cu promovarea vascularizării și corticalizarea osului. Tehnica Masquelet este o metodă efectivă, care permite consolidarea osului în cadrul unei pierderi osoase de mărime critică.Background Bone defects can be caused by trauma, tumors or infections (osteomyelitis). Surgical reconstruction of bone defects presents a significant challenge for the trauma and orthopedic surgeon. The induced membrane technique is a reference surgical method for the treatment of complex defects. Objective of the study. Presentation of clinical cases solved by applying the induced membrane technique. Material and methods The anamnestic, clinical and paraclinical data were taken from the medical records of 14 patients (11 males, 3 females), (dimension of defects between 4-15cm, 11 tibial bone defects, 3 femoral bone defects). The patients were clinically and radiologically investigated preoperatively, postoperatively and follow-up. The literature on solving similar cases using the induced membrane technique was studied. Results. In this study, 14 patients aged between 27 and 69 were included, who underwent surgical interventions using the induced membrane technique, also known as Masquelet. 13 out of 14 (93%) patients showed very good results following the applied method, the induced membrane, proving the formation of satisfactory vascularization, the prevention of fibrosis and bone migration after the first stage and the successful osseointegration of the bone graft after the 2nd stage. In one man aged 60 and comorbidities, DZ type II, diabetic angiopolyneuropathy, no successful osseointegration was observed. Conclusion. The induced membrane method ensures an intense process of cell proliferation and differentiation with the secretion of osteoinductive factors, with the promotion of vascularization and bone corticalization. The Masquelet technique is an effective method that allows bone consolidation within a bone loss of critical size

Reconstruction of the scalp defect with the trapezius muscle flap (clinical case)

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaBackground. Many patients with complex scalp and skull defects can benefit from scalp reconstruction using the trapezoid flap, reducing the morbidity of the donor site. The trapezius flap was first reported by Nakajima and Fujino in 1984. It was originally described as a myocutaneous or muscle flap, and it has also been used as a free flap. The blood that supply the trapezium muscle and the skin is mainly from the superficial and descending branches of the transverse cervical artery as well as the occipital artery

Treatment of actinic skin defect using locoregional island flap

Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: plasty techniques currently used in the treatment of the defects are largely standarldized, but in clinical practice, quite often we are faced with patients who were undergoing radiation therapy for the treatment of certain lesion (malignant or benign ). In this category require reconstructive plastic surgery, patients, with major changes that produce ionizing radiation to tissues undergo radiotherapy. Clinical case: This work reflect a clinical case of a man 61 years, that was submit to radiation therapy after tumoral excision, manifests itself at the level of the third upper part of the large intestine, rectum. At a distance of 2 years after radiotherapy, equivalent in the amount of 60 Gy in the sacral region treated actinic, there was an area of necrosis, about 20x20cm.The area that was actinic changed, was divided in 3 filed, the limit between them being visualy determined by the intensity of the dystrophic changes, so the field 1 included the central area with the highest degree of necrosis, and the field 3 with marginal erythema. During surgery, have been included all the 3 field, that created a defect in sacral region, about 20x20cm. According to the presurgery plan, it has been done plasty defect with gluteal flap on the both parts, the donor place being closed by direct suture at the same stage. After surgery, the demarcated area were separated and studied histological for determination the viable area. Conclusion: target area for histological examination is the area nr.II where examination is indicative in the damage of the skin and soft tissue. The integration of the tissues and organ transplant from another area in the case of actinic defect, may take place after exceeding the field II, histological appreciated with regenerative potential. A preoperative histopathology of actinic area determines the edge of the viable tissue, in some significant cases areas with important tissue

The vascularized allotransplant– successful alternative for massive bone defects

Department of Traumatology and Orthopedics, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The massive bone defects after trauma, in congenital anomaly, tumors, infections or nonunions is a real dilemma for reconstructive surgery of the locomotor system. Contemporary methods that are usually used for reconstruction of the bone structure are: bone transplant, cryopreserved allografts, autograft or prosthesis, having high levels of morbidity and complication rates. Their common features are bad blood circulation and unviability, resulting in mechanical instability and poor bone consolidation (periprosthetic fractures, stress fractures, pseudoarthrosis, sepsis). Aim of the study. To determine what are the different methods used in reconstruction of massive bone defects. Materials and methods. Scientific papers and research results regarding bone defects reconstruction methods were reviewed. Review. A vascularized bone graft, reclosed microsurgicaly in the circuit, has a good potential for regeneration, plasticity, and a post-graft mechanical stiffness. The vascular bone autograft, with all biological and mechanical characteristics is considered the "gold standard" in the treatment of small bone defects. However, it becomes insufficient in size, shape and cellular repair capacities in the case of massive bone defects due to the increased circulatory needs of the injured segment. Maintaining the osteoplastic properties of the vascularized autograft and combining them with the orthotopic characteristics of an allogene bone or bone segment would be a successful alternative for the reconstructive surgery of the locomotor. The dilemma imposed by vascularized composite allotransplantation (VCA), is immunosuppression (IS) and immunomodulation for life, which is not justified in case of vital organs (heart, liver, kidneys) transplants, because of adverse effects risk (systemic complications, sepsis, neoplasms). Without an IS, the immune cascade will cause vascular endothelial cell lysis, compromise microcirculation with necrosis of the graft. The last studies, describe the surgical neoangiogenesis typical of the host in VCA with a short-term IS - 14 days, as an effective one, with results that allow consolidation and mechanical stability. Studies are performed preclinically on rats, rabbits and pigs. Other studies present decelularization methods of the vassel while preserving vascular stiffness. Conclusions. A perfect alternative in treatment of the massive bone defects is using a vascular allograft, without associated immunosuppression

Importanța estetică a mâinii operate

Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Introducere. Traumatismele mâinii reprezintă una dintre cele mai mari suferințe. Reconstrucțiile chirurgicale sunt critice și necesită iscusința chirurgului pentru păstrarea structurii anatomice, funcției și importanța esteticului. Scopul lucrării. Studiul a fost conceput pentru a marca importanța estetică în practica chirurgiei reconstructive asupra mâinii operate din prisma corelației dintre gravitatea leziunilor și rezultatului estetic postoperator. Material și Metode. Studiu de tip observațional s-a desfășurat în Clinica de Chirurgie Plastică în Institutul de Medicină Urgentă. Eșantionul a cuprins 175 pacienți cu tramatisme mutilante. Bărbați 107, femei 68, cu vârsta de la 15-60 ani. Leziunile au fost pe falange în 115 cazuri, în regiunea metacarpiană 32, la nivelul carpului 23 și în 5 cazuri pe întreaga suprafață a mâinii. Rezultate. Studiul s-a exat pe examinarea relației dintre severitatea traumei la mâina operată și modificarea calității vieții pacientului prin prisma esteticului corelat cu impactul funcțional și psihologic. Studiul a demonstrat legătura atât dintre satisfacția imaginii, cât și a funcției mâinii operate, corelate cu indicatorul mic al injuriei. Concluzii. Încercarea de a păstra atât funcția, cât și aspectul estetic în fiecare grup de patologii necesită mult efort. Valoarea înaltă a scorului HISS solicită timp, costuri majore și tehnică de performanță. Sporirea calității vieții, integrării în societate și dorința de recuperare cresc gradual

Lamboul interosos posterior antebrahial

Background. The posterior interosseous forearm flap appeared as an option for upper limb reconstruction with priority on the hand. Being vascularized by the posterior interosseous vessels of the forearm, this flap can be used even when the ulnar or radial vessels are damaged. Objective of the study. To improve the results of the treatment of tissue defects in the hand by using the posterior antebrachial island flap. Material and Methods. In 12 patients treated using this flap, we studied the following items: age, sex, morphological component, size, direction of migration, location of defects and functional outcomes. Results. Using the posterior interosseous forearm flap, a complete regeneration was obtained, total recovery of the function of the forearm and the hand with the movements in a complete volume. Depending on the sex, we had 8 men and 4 women, aged between 28-71 years. The flaps covered defects with an average area of about 35 cm2 and were migrated on the forearm from one patient to the remaining 11 patients in the hand regions. In all cases they were harvested in the fasciocutaneous composition. The registered complications were manifested by transient local infections in 3 patients. Conclusion. The posterior interosseous flap can be migrated with fasciocutaneous components to different parts of the forearm and hand to cover soft tissue defects, with satisfactory surgical and functional outcome and minimal complications. Introducere. Lamboul interosos posterior antebrahial a apărut drept o opțiune pentru reconstrucția membrului superior cu prioritate la nivelul mâinii. Fiind vascularizat de vasele interosoase posterioare ale antebrațului, acest lambou poate fi utilizat chiar când vasele ulnare sau radiale sunt lezate. Scopul lucrării. Îmbunătățirea rezultatelor tratamentului defectelor tisulare la nivelul mâinii prin utilizarea lamboului insular antebrahial posterior. Material și Metode. La 12 pacienți tratați prin utilizarea acestui lambou am studiat următorii itimi: vârsta, sexul, componenta morfologică, dimensiunile, direcția de migrare, localizarea defectelor și rezultatele funcționale. Rezultate. Utilizând lamboul interosos posterior antebrahial, s-a obținut o regenerare completă, recuperare totală a funcției antebrațului și a mâinii cu mișcările într-un volum complet. În funcție de sexe am avut 8 bărbați și 4 femei, cu vârste între 28-71 ani. Lambourile au acoperit defecte cu o suprafață medie de cca 35 cm2 și au fost migrate pe antebraț la un pacient, la restul 11 pacienți pe regiunile mâinii. În toate cazurile au fost recoltate în componența fasciocutanată. Complicațiile înregistrate s-au manifestat prin infecții locale tranzitorii la 3 pacienți. Concluzii. Lamboul interosos posterior antebrahial poate fi migrat cu componente fasciocutanate, în diferite părți ale antebrațului și mâinii pentru acoperirea defectelor țesuturilor moi, cu rezultat chirurgical și funcțional satisfăcător și complicații minime