Complicațiile în chirurgia estetică a feței și tratamentul acestora

Department of Orthopedics and Traumatology, Nicolae Testemitanu SUMPh, Institute of Emergency MedicineBackground. Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favourable safety profiles and consistent outcomes. Objective of the study. Această revizuire își propune să ofere o scurtă actualizare a abordărilor cele mai utilizate în zilele noastre în domeniul dermato-estetic, a indicațiilor acestora și a complicațiilor aferente. Material and Methods. The article provides information from International expert consensus on complications associated with the use of HA-based fillers, as well as data from many years of clinical experience of the authors of this article. Results. A group of experts in aesthetic treatments reviewed the main factors associated with the complications that arise when using dermal filler and BonTa.A searh of English, French and Russian language articles in PubMed was performed using the terms "complications". Conclusion. This consensus review provides key elements to help clinicians who are starting to use dermal fillers to employ standard procedures and to understand how best to prevent potential complications of the treatment.Introducere. Tratamentul estetic facial cu neuromodulatori injectabili și materiale de umplutură cu acid hialuronic este bine stabilit, cu profiluri de siguranță favorabile și rezultate considerabile. Scopul lucrării. În aceast studiu ne propunem să oferim o scurtă actualizare a abordărilor cele mai utilizate în domeniul dermato-estetic, a indicațiilor acestora și a complicațiilor aferente. Material și Metode. Articolul oferă informații în baza Acordului experților internaționali cu privire la complicațiile asociate cu utilizarea materialelor de umplere pe bază de HA, precum și date importante din experiența clinică a autorilor acestui articol. Rezultate. Un grup de experți în tratamente estetice a analizat principalii factori asociați cu complicațiile care apar atunci când se utilizează umplutură dermică și BonTa. O cercetare a articolelor în limba engleză, franceză și rusă din PubMed a fost efectuată folosind termenii : chirurgia estetică, față, complicații. Concluzii. Această revizuire oferă elemente cheie pentru a ajuta clinicienii care încep să utilizeze substanțe de umplere dermică să folosească proceduri standard și să înțeleagă cum să prevină cel mai bine posibilele complicații ale tratamentului

Aesthetical expression in the traumatized hand

Clinica Chirurgie Plastică, Estetică și Microchirurgie Reconstructivă, Catedra Ortopedie și Traumatologie, IMSP USMF „Nicolae Testemiţanu”, Chișinău, Republica Moldova, 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 dezvoltareIntroduction. 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. Purpose. 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. Conclusions. The attempt to preserve both the function and the aesthetic aspect in each group of pathologies requires a lot of effort, the higher HISS score, higher costs, and higher technique witch was used. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually

The biocompatibility of titanium in a buffer solution: compared effects of a thin film of TiO2 deposited by MOCVD and of collagen deposited from a gel

This study aims at evaluating the biocompatibility of titanium surfaces modified according two different ways: (i) deposition of a bio-inert, thin film of rutile TiO2 by chemical vapour deposition (MOCVD), and (ii) biochemical treatment with collagen gel, in order to obtain a bio-interactive coating. Behind the comparison is the idea that either the bio-inert or the bio-active coating has specific advantages when applied to implant treatment, such as the low price of the collagen treatment for instance. The stability in buffer solution was evaluated by open circuit potential (OCP) for medium time and cyclic voltametry. The OCP stabilized after 5104 min for all the specimens except the collagen treated sample which presented a stable OCP from the first minutes. MOCVD treated samples stabilized to more electropositive values. Numeric results were statistically analysed to obtain the regression equations for long time predictable evolution. The corrosion parameters determined from cyclic curves revealed that the MOCVD treatment is an efficient way to improve corrosion resistance. Human dermal fibroblasts were selected for cell culture tests, taking into account that these cells are present in all bio-interfaces, being the main cellular type of connective tissue. The cells grew on either type of surface without phenotype modification. From the reduction of yellow, water-soluble 3-(4,5-dimethyldiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT cytotoxicity test), MOCVD treated samples offer better viability than mechanically polished Ti and collagen treated samples as well. Cell spreading, as evaluated from microscope images processed by the program Sigma Scan, showed also enhancement upon surface modification. Depending on the experimental conditions, MOCVD deposited TiO2 exhibits different nanostructures that may influence biological behaviour. The results demonstrate the capacity of integration in simulated physiologic liquids for an implant pretreated by either method

Breast reconstruction on irradiated territory using tissue expander technique and latissimus dorsi flap: a case report

Department of Orthopedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Postmastectomy radiation therapy is a well-established risk factor for complications before and after breast reconstruction.The reconstruction of a large variety of breast cancer surgery defects, especially on a pathologically modified field can be challenging for plastic surgeons, autologous tissue transfer being often indicated to achieve improved tissue quality during breast reconstruction after radiotherapy. The aim was to discuss the approach in a modified irradiated territory for breast reconstruction and analyze satisfaction with aesthetic outcome between patient and plastic surgeons. Case report. A 33 years old female after a total unilateral breast mastectomy due to breast cancer. After surgery she followed 3 cycles of radiatio-therapy. At 6 months after primary surgery she undergone a comprehensive multilateral examination after which has received medical agreement for breast reconstruction of the amputated breast. During examination at admission in Plastic surgery clinic, she has been complaining on pain in the region of the scar left after mastectomy which were exacerbated during thoracal inspiration. In the first stage of the treatment it was decided to remove the aggressive adhered on hemithorax scars and to reconstruct the remained defect after scars’ removal with a pedicled latissimus dorsi flap. The second stage - implanting a tissue expander with a maximum volume of 500 ml, followed after recovering from the first stage. The third stage took place after filling the expandable balloon. Under the tissue’s excess instead of expander we have placed a mammary prothesis. Conclusions. Among the plethora of breast reconstruction techniques, the LDF is a versatile, reliable means for soft tissue coverage, providing form and function with acceptable perioperative and long-term morbidities, especially in patients with previous radiation. Using plastic, reconstructive andaestheticsurgerymethods in a correct order allows to rebuild the breast after oncological amputations even if the region was actinically treated

Aplicabilitatea lamboului plantar medial

Department of Orthopedics and Traumatology, Nicolae Testemitanu SUMPh, Institute of Emergency MedicineBackground. Reconstructive coverage of foot defects, especially those of the calcaneus region, is a unique technical challenge for the surgeon due to the high degree of specialization of the tissues involved and the relative immobility of the proximal tissues. Objective of the study. The objective of this study is to present a series of cases involving patients with traumatic lesions of the foot, who underwent surgical reconstruction with the medial plantar flap and gone out succesfully. Material and Methods. The study was designed to mark our experience with the application of the plantar medial flap to cover tissue defects in the foot, especially in traumatic tissue loss. Our clinical cases were included 4 different indication of reconstruction, performed in the Clinic of Plastic, Aesthetic Surgery and Reconstructive Microsurgery, Chisinau, Republic of Moldova. Results. The indications were traumatic tissue loss of the plantar fat pad, in the region of the calcaneal and of the dorsum of the foot. All flaps were elevated as fasciocutaneous pedicle flaps based on the medial plantar artery. All the flaps healed without major complications, except one case that involved partial loss. The donor area was covered with a partial skin graft and there was one case of partial graft loss. The flap displayed a slightly lower protective sensitivity than the normal side. Conclusion. According to our results, the applicability of the plantar medial flap is an optimal method of reconstruction of tissue defects in the back of the foot. The integrity of the skin with similar texture and protective sensitivity gives the flap a major advantage over other flaps.Introducere. Reconstrucția defectelor piciorului, în special a celor din regiunea calcaneului, este o provocare tehnică unică pentru chirurg datorită gradului ridicat de complexitate și specificitate a țesuturilor implicate și a imobilității relative a țesuturilor proximale. Scopul lucrării. Obiectivul acestui studiu este de a prezenta o serie de cazuri care implică pacienții care au suferit de leziuni traumatice ale piciorului și s-au rezolvat prin aplicarea lamboului medial plantar. Material și Metode. Prezentul studiu ilustrează experiența noastră în utilizarea lamboului pe baza arterei plantare mediale pentru a acoperi defectele tisulare la nivelul piciorului, în special în regiunea calcaniană, plantară și inframaleolară. Au fost incluse 4 cazuri clinice, aplicate în Clinica de Chirurgie Plastică, Estetică și Microchirurgie Reconstructivă, Chișinău, Republica Moldova. Rezultate. Indicațiile de reconstrucție la nivelul piciorului prin utilizarea lamboul plantar medial au fost: pierderea traumatică a țesutului din regiunea plantei, regiunii calcaneului și a dorsului piciorului. Toate lambourile au fost ridicate sub formă de lambouri pediculare fasciocutane pe baza arterei plantare mediale. Toate cazurile s-au vindecat fără complicații majore. Zona donatoare de lambou a fost acoperită cu o grefă liberă despicată a pielii. Lamboul plantar medial a demostrat o aplicabilitate înaltă și diversă, care poate rezolva 3 cauze majore de defecte din regiunea piciorului. Concluzii. Conform rezultatelor, aplicabilitatea lamboului medial plantar este o metodă optimă de reconstruție a defectelor tisulare din reriunea piciorului. Integritatea pielii cu textură similară și sensibilitate protectivă conferă lamboului un avantaj major față de alte lambouri

Pedicled groin flap for soft tissue coverage

Department of Orthopedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Head of the Plastic, Aesthetic and Reconstructive Microsurgery Clinic, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. It is regularly used by many reconstructive surgeons to cover soft tissue defects of the abdomen, hand, arm and forearm. The groin flap has several advantages including adequate skin thickness and minimal donor site morbidity, making it the most usable free flap for soft tissue coverage. The disadvantages of the flap include a rather short pedicle and the small artery size. The groin flap was the first successful skin and soft tissue free flap, described by McGregor and Jackson in 1972. It provides a large amount of skin coverage with an easily restored donor site. Groin flap is a viable option for patients who are not candidates for free tissue transfer because of comorbidities and when the utility of microvascular technique is not feasible. We present a case report outlining the effectiveness and usefulness of this type of pedicled flap. Case report. A 68-year-old woman sustained a cholecystectomy in the surgery department, which was complicated postoperatively with ventral hernia of the abdominal wall. It was made an attempt to resolve it with the surgical treatment, but 12 days after the surgery, the patient presented a soft tissue defect, a surgical mesh on the abdomen wall being visualized. It was decided to perform surgical treatment of the abdominal defect and plastic surgery with vascularized groin flap. Necrosis of the cutaneous flap component occurred postoperatively. But fascia which remained viable was sufficient to cover the surgical mesh and served as a vascular bed for free split skin graft. Conclusions. We believe that the pedicled groin flap can be used safely and effectively in the soft tissue coverage. At the same time, it can preserve the aesthetic and functional properties of tissues. The technique is quick, facile, and reliable, with few complications. Despite the fact that this type of flap is used less, it represents the optimal solution in the case of lack of skin tissue and soft tissue. This case report demonstrates the versatility of the groin flap in closing complex soft tissue defects of the abdomen wall

Percutaneous needle aponeurotomy

Department of Orthopedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Dupuytren‘s disease is a bening, slowly progressive disorder, which affects the palmar fascia, that become tight and shortened and conduct to irreversible flexion posture of the fingers, that leads to hand deformity and impaired hand function. It can affect any of the fingers, but it most commonly affects the little finger and ring finger. It can occur in only one hand or in both hands at the same time. The most used treatment approachis surgical resection of the fibrous tissue by limited fasciectomy, but it carries a long recovery period and significant rate of complications. Percutaneous needle aponeurotomy is minimally invasive needle technique, for mild to moderate Dupuytren contractures, with perfect short term results and fast recovery period, with no loss of function and with few complications Aim of the study. To present our experience with a minimally invasive technique of percutaneous needle aponeurotomy and making recommendations about the safety and efficacy of this interventional procedure. Materials and methods. Our experience in percutaneous needle aponeurotomy was performed in the Plastic, Aesthetic Surgery and Reconstructive Microsurgery Clinic of the Emergency Medicine Institute. We treated 21 cases with Dupuytren contracture using this procedure, from 2016 to 2019 year. This treatment tend to restore hand function with minimally invasive intervention and to prevent progression, with minimum complications. Results. Men are more likely to be affected than women, and the symptoms of disease are more severe in older men. The goal of the surgery was to reduce the contracture and improve motion of the affected fingers. After percutaneous needle fasciotomy, pacients quiqly recovered hand function, returning to daily activities. In some cases, to avoid recurences, that acording to different authors are between 12%-73% and also depend on the severity of the disease, percutaneous needle fasciotomy may need to be repeated. Also is important to do regular hand exercises, in obtaining the best results. Conclusions. Percutaneous needle fasciotomy is a minimally invasive treatment option for mild to moderate Dupuytren contractures in the metacarpophalangeal and proximal interphalangeal joints, and the procedure requires limited resources. Multiple contractures can be treated during the same session and the treatment is considerably easier for the pacient and requires a minimum of rehabilitation, compared with open fasciectomy. Pacients report a greater aesthetical and moral satisfaction