Breast reconstruction on actinic affected territory by using of the latissimus dorsi flap plasty and dermotension (Case report)

Clinica de Chirurgie Plastică și Microchirurgie Reconstructivă, USMF “Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Caz clinic: Lucrarea reflectă cazul clinic al unei femei de 33 ani supusă amputației totale de sîn pe motiv oncologic. Postoperator a urmat 3 cure de radioterapie. La 6 luni de la intervenția chirurgicală primară a susținut un examen complex după care a primit acordul medical la refacerea plastică a sânului. La momentul examinării în Clinica de chirurgie plastică prezenta dureri în regiunea cicatricei rămase după amputația sânului. La prima etapă de tratament s-a decis înlăturarea cicatricelor aderate agresiv de hemitorace și plastia defectului rămas cu un lambou insular din latissimus dorsi. Etapa a doua a urmat după obținerea regenerării primei etape – implantarea unui expander tisular cu un volum maximal de 500 ml. Etapa a treia a avut loc după umplerea balonului expandat. Sub surplusul tegumentar în schimbul expanderului am plasat o proteză mamară. Cunoscând că un component al tratamentului a fost iradierea actinică, temerea pentru înlaturarea cicatricei și plastia defectului cu țesuturi locale era argumentată. Astfel motivați am decis să folosim lamboul insular latissimus dorsi din regiunea sănătoasă. Dimensiunile lui maxime au permis expandarea, care a rezultat cu refacerea sânului prin punerea unui implant mamar. Concluzii: Utilizarea metodelor de chirurgie plastică-reconstructivă și estetică într-o consecutivitate corectă permit refacerea sânului după amputații oncologice, chiar dacă regiunea marcată este tratată actinic.Clinical case: We present a clinical case of 33 years old female, which was subjected to total breast amputation. After surgery she followed 3 cycles of radiation therapy. At 6 months after primary surgery she underwent a comprehensive examination after which has received medical agreement for plastic restoring of the breast. At the moment of the examination she has been complaining on pain in the region of the scar. In the first stage of the treatment it was decided to remove the aggressive adhered on hemithorax scars and to do the plasty of the defect with a free latissimus dorsi flap. The second stage was constituted of implanting a tissue expander. The third stage: under the tissue’s excess instead of expander we have placed a mammary prosthesis. Knowing that one of the treatment factors was actinic radiation, the fear for the removal of the scar and the plasty of the defect with local tissues was substantiated. Thus, we decided to use latissimus dorsi flap from the healthy region. Its maximal dimensions have allowed expanding resulting with restoration of the breast by placing a mammary implant. Conclusion: Using the methods of plastic-reconstructive and aesthetic surgery in a correct order allows the rebuilding of the breast after oncological amputations, even if the region was exposed to actinic treatment

The first rays joint fractures and treatment modalities

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Incidenţa crescută a traumatismelor mâinii ocupa primul loc in traumatismele corpului uman. Aceasta stimulează în permanenţă ingeniozitatea chirurgilor în a găsi noi metode reconstructive tot mai performante. Deși, ei se confruntă pe de o parte, cu anatomia complexă a mâinii, iar pe de altă parte cu obligativitatea de a păstra integritatea sistemului nervos, vascular şi tendinos totuși, este reala posibilitatea unei reconstrucţii complexe cu ţesuturi similare fără a crea defecte secundare importante.Scopul. Eșalonarea incidenței lezionale a policelui în complexul de traumatisme ale mâinii si separarea itimilor depistați în funcție de suprafață și pe nivele razei digitale. Material si metode. În lucrare am inclus un lot de 460 de pacienți pe perioada anului 2015. Limitele de vârsta au fost între 19-70 ani, divizați pe categorii a câte 10 ani. Repartizarea pe sexe dintre cei 79 de pacienți cu traumatisme a policelui a constituit: 69 (87.34%) bărbați si 10 (12.66%) femei. Frecvența traumatismelor înregistrate la membrul stâng 40 (50.34%) a fost mai mare decât la membrul drept 39 (49.67%). 79 (17.17%) pacienți din lotul total au suferit traumatisme ale policelui, dintre care: separat al policelui 46 (58.22%) și în complex cu alte degete 33 (41.78%). În traumatismele policelui pe segmente au fost incluși pacienții tratați in staționar. Falanga proximală s-a dovedit a fi cel mai des traumată 39 (49.36%) de cazuri, apoi urmează falanga distală 37 (46.83%) de cazuri și doar în 3 (3.79%) cazuri au avut de suferit ambele falange. Rezultate. Incidența traumatismului policelui separat se întâlnesc la 46(58.22%) de pacienți și in complex cu alte degete la 33 (41.78%) de pacienți. Ceia ce constituie din ansamblu de traumatisme ale mâinii 17.17%. Prelucrarea materialului obținut denota prevalenta incidentei pentru falanga distală a policelui dar nu si ca gravitate care se manifesta mai accentuat pe măsura avansării spre baza lui. Aceasta a dictat managementul tratamentului si complexitatea intervențiilor chirurgicale efectuate. Concluzie. Leziunile policelui in complexul traumatismelor mâinii se întâlnesc mai des ca fiind un traumatism separat decât in asociere cu celelalte degete ale mâinii, prevalând la bărbați, iar membrul superior stâng fiind afectat intr-o incidenta ușor mai sporită.Introduction. The increased incidence of hand trauma injuries ranks first in the human body. This continually stimulates surgeons ingenuity to find new performant ways in reconstructive methods. Although, they are facing, on the one hand, with complex hand’s anatomy complex and, on the other hand, with the obligation to preserve the integrity of the nervous, vascular and tendon system, however, it is real the possibility of a complex reconstruction with similar tissues without creating significant defects. Purpose. Distribution of thumb’s lesional incidence in hand’s trauma complex and items separation detected depending on the surface and levels of digital beam. Material and methods. In this paper we included a group of 460 patients treated during the 2015 year. The age limits were between 19-70 years, divided into categories of 10 years. The sex ratio of the 79 patients with thumb injury was: 69 (87.34%) men and 10 (12.66%) women. Frequency of trauma registered in left member - 40 (50.34%), was higher than in the right one - 39 (49.67%). 79 (17.17%) patients from total group have suffered thumb’s trauma, including: separate thumb - 46 (58.22%) and in complex with other fingers - 33 (41.78%). In thumb’s trauma, according to segments, were included patients treated in hospital. Proximal phalanx was found to be most traumatized - 39 (49.36%) cases, followed by the distal phalanx - 37 (46.83%) cases and only in 3 (3.79%) cases have suffered both phalanges. Results. Incidents of separate thumb’s trauma are met at 46 (58.22%) patients and in complex with other fingers in 33 (41.78%) patients, which constitutes in the ensemble of hand’s trauma 17.17%. Processing of obtained material denotes prevalence of incidence of thumb’s distal phalanx, but not the severity that manifests more pronounced as it progresses toward its base. This dictated the treatment’s management and complexity of performed surgery. Conclusion. Thumb’s injuries in complex of hand’s trauma are more often met as a separate trauma than in association with other fingers of the hand, with prevalence in men, and left upper limb is affected with a slightly increased incidence

Methodology for assessing the social effectiveness of exhibition activity

Improving the exhibition activity efficiency is a rather complex and multi-purpose task that requires taking into account many factors and using various methods and tools. To achieve success in this field, it is necessary to apply an integrated approach, considering the relationship between the economic and social effectiveness of exhibition activity, as well as to use innovative technologies and the latest research methods. The article presents the methodology developed by the authors for the quantitative assessment of social efficiency, which is complex and also includes the calculation of the selected elements’ sensitivity of social efficiency to different changes. The indicators’ calculation of the exhibition social significance the makes it possible to assess its impact on society and determine how much it contributes to the development of culture, coverage of topical issues and familiarization of the general population with cultural and scientific achievements. The quantitative assessment methodology of the exhibition activity effectiveness based on the calculation of the social efficiency integral indicator can be supplemented with methods of organizational support of the exhibition process, meta-planning and risk assessment

Importance of thermometry in monitoring of the flaps

Department of Orthopaedics and Traumatology, 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: Complications highlighted in the postoperative period remains to be one of the current problems of reconstructive surgery, which has a relatively increased incidence (5-17%). Aim: evaluation of diagnostic value of local thermometry of flaps for early detection of complications. Material and methods: The study group was 36 patients treated in the period 2014-2015 within the IEM, women - 10 (27.8%), men - 26 (72.2%). The limits of age were 16-70 years, with mean age 44.7 years. The thermometry was performed with an electronic thermometer with an accuracy of 0.1 0C and the data were recorded in the form of thermal curves. The temperature of the receiving areas were considered baseline values that were compared to the thermometric values of the flaps. Duration of monitoring was from 1 postoperative day to 1 year, at 2-3 months range. Data were statistically analyzed using the "step by step regression" with truthful coefficients. Results: In the study group were 30(83.3%) island flaps, free – 6 (16.7%) cases. Thermometric differences in the postoperative period ZR/ZD >20C were found in 6 (16.7%) cases: island flaps – 4 (13.3%) cases, free – 2 (33.3%) cases. If the island complications occurred in 8( 26.7%) cases, free – two (33.3%) cases. Free flap complications: venous insufficiency due to anastomosis’s thrombosis (n=1), marginal necrosis (n=1) and insufficiency of anastomosis due to adjacent tissue’s edema (n=1). Complications of island flaps were: marginal necrosis (n=4), vascular insufficiency due to edema (n=3) and loss of the flap (n=1). Conclusions: In the early postoperative period thermometric difference >20C indicates a flap’s vascular suffering that requires urgent actions. In the case of island flaps the thermometry has a sensitivity of approximately 85%, while in the case of free - 95%, the specificity is 98% in both

Porous structure of nano-dimensional boraso-graphenic powders

The structural features of surface of the nano-dimensional bor-azo-graphenic powders (t-BNg) after previous washing in boiling water were researched. The results showed that after process of purifier (washing) the powder’s surface of t-BNg characterized as slit-like micro-, mesoporous (monodispersed) structure with a narrow porous distribution in the range of 3.82 - 4.17 nm. The outer surface specific area of the powders of t-BNg according to “t - method” is 28.3 m²/g. The inner specific surface area of the mesopores is 141 m²/g (BJH method). The residues of boron oxonitride in the form of a purified sublimate, a white powder, extracted from a washed and dried sample of t-BNg at a temperature of 540 K and a pressure of ≤ 1.0 Pa. The sublimate, according to chemical analysis and infrared spectroscopy, was identified on the assumption of the cyclic dimer of di-hydro-di-hydroxo-di-bor-ox-azole of the composition of H(OH)[(BON)₂](OH)H. The model of carbamide synthesis of boron nitride, as a sequence of chemical transformations of borate-carbamide precursors in a freely radical boron-pair (> B - N В - N В – N <)

Thermometry need in monitoring flaps

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Complicațiile evidențiate în perioada post-operatorie rămân a fi una din problemele actuale ale chirurgiei reconstructive, acestea având o incidență relativ mărită (5-17%). Scopul. Evaluarea valorii diagnostice a termometriei locale a lambourilor în depistarea precoce a complicațiilor. Material și metode. Lotul de studiu a constituit 36 de pacienți, tratați în perioada 2014-2115 în cadrul IMU,repartizarea fiind: femei - 10 (27,8%), bărbați - 26 (72,2%). Limitele de vârstă - 16-70 ani, vârsta medie fiind de 44,7 ani. Termometria s-a efectuat cu un termometru electronic cu precizie de 0,1 0C, datele fiind înregistrate sub forma de curbe termice. Valorile termice ale zonelor receptoare au fost considerate valori de referință cu care s-au comparat valorile termice ale lambourilor. Durata de monitorizare: din 1 zi postoperator până la 1 an, cu interval de 2-3 luni. Datele obținute au fost prelucrate statistic prin metoda “regresiei pas cu pas” cu coeficienți veridici. Rezultate. În lotul de studiu au fost lambouri insulare 30 (83,3%) cazuri, libere – 6 (16,7%) cazuri. În perioada postoperatorie diferențele termometrice ZR/ZD > 2 0C au fost evidențiate în 6 (16,7%) cazuri: lambouri insulare – 4 (13,3%) cazuri, libere – 2 (33,3%) cazuri). În cazul celor insulare complicații au survenit în 8 (26,7%) cazuri, în libere - 2 (33,3%) cazuri. Concluzii. În perioada postoperatorie precoce diferența termometrică >20C indică asupra unei suferințe vasculare a lamboului necesitând măsuri urgente de resuscitare. În cazul lambourilor insulare termometria posedă o sensibilitate de aproximativ 85%, iar în cazul celor libere - 95 %, specificitatea fiind de 98% în ambele tipuri.Introduction. Complications highlighted in the postoperative period remains to be one of the current problems of reconstructive surgery, which has a relatively increased incidence (5-17%). Purpose. Evaluation of diagnostic value of local thermometry of flaps for early detection of complications. Material and methods. The study group was 36 patients treated in the period 2014-2115 within the IEM, women - 10 (27.8%), men - 26 (72.2%). The limits of age were 16-70 years, with mean age 44.7 years. The thermometry was performed with an electronic thermometer with an accuracy of 0.1 0C and the data were recorded in the form of thermal curves. The temperature of the receiving areas was considered baseline values that were compared to the thermometric values of the flaps. Duration of monitoring was from 1 postoperative day to 1 year, at 2-3 months range. Data were statistically analyzed using the "step by step regression" with truthful coefficients. Results. In the study group were 30(83.3%) island flaps, free - 6(16.7%) cases. Thermometric differences in the postoperative period ZR / ZD> 20C were found in 6(16.7%) cases: island flaps - 4(13.3%) cases, free - 2(33.3%) cases). If the island complications occurred in 8(26.7%) cases, free - two(33.3%) cases. Conclusions. In the early postoperative period thermometric difference > 20C indicates a flap’s vascular suffering that requires urgent actions. In the case of island flaps the thermometry has a sensitivity of approximately 85%, while in the case of free - 95%, the specificity is 98% in both

Planning flaps in the calf according to availability physiology

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Acest studiu a fost efectuat pentru a determina lățimea optima disponibila a zonei donatoare de lambou care nu va prejudicia închiderea primara a plăgii donore, fiind suturata primar plan cu plan.Scop. Evaluarea disponibilității tegumentare fiziologice a fiecărei regiuni donatoare de la nivelul gambei. Material și metode. Studiul a fost efectuat pe un lot de 30 de voluntari, pe membrele sănătoase. Limitele de vârsta in lot au fost de 20 - 60 de ani, divizate pe categorii a câte 10 ani, fiecare subcategorie incluzând minim 5 voluntari. Disponibilitatea fiziologica s-a calculat pentru lambourile: safen, sural, peronier superficial, suprameleolar, fibular, tibial posterior si tibial anterior. Tegumentul s-a plicaturat in centrul teritoriului donator (cetripet), pana când părtile plicaturate contactau formând duplicatura (Ld). Grosimea duplicaturii s-a măsurat, fiind trecuta pe linia milimetrica. Ulterior, plica cutanata era desfăcuta la parametrii normali ai tegumentului cu extensia acelorași puncte in exterior (centrifug), fixându-se lungimea in milimetri (Le). Disponibilitatea tegumentara fiziologica (Dt) s-a calculat după formula: Dt =Le – Ld. Rezultate. Cea mai mare disponibilitate fiziologica la nivelul gambei s-a determinat in regiunea lamboului safen (5.05±0.29 cm; n=30; p=0.033), urmata de regiunea lamboului sural (4.83±0.25 cm; n=30; p=0.028) si regiunea lamboului tibial anterior (4.28±0.20 cm; n=30; p=0.03). Cea mai mica disponibilitate fiziologica s-a determinat în regiunea lamboului supramaleolar (3.04±0.21 cm; n=30; p=0.018). Concluzii. În urma studiului efectuat am constatat ca ridicarea unui lambou cu lățimea disponibila fiziologica a regiunilor donatoare la gamba nu va produce probleme de închidere a plăgii donore, fiind suturata primar plan cu plan.Introduction. This study was conducted to determine the optimal, available width of the flap’s donor site that will not harm the primary closure of donor wound. Purpose. To assess the skin physiological availability of each donor region of the calf. Material and methods. The study was conducted on a group of 30 volunteers, assessing healthy limbs. Age limits in group were 20-60 years, divided into categories of 10 years, including at least 5 volunteers each category. Physiological availability was calculated for flaps: saphenous, sural, superficial peroneal, suprameleolar, fibular, posterior and anterior tibial. The skin was fold in the center of donor territory (centripetal) until the folded parts was contacting, forming a folding (Ld). Folding’s thickness was measured, being passed on millimeter line. Subsequently, skin fold was unfolded to normal skin with the extension of the same points outside (centrifugal), attaching the length in millimeters (Le). Skin physiological availability (Dt) was calculated using the formula: Dt = Le - Ld. Results. Highest physiological availability was determined in region of saphenous flap (5.05±0.29 cm; n = 30; p = 0.033), followed by the sural flap (4.83±0.25 cm; n=30; p= 0.028) and region of anterior tibial flap (4.28±0.20 cm, n=30; p=0.03). The smallest physiological availability was determined in the region of supramalleolar flap (3.04±0.21 cm, n = 30; p = 0.018). Conclusions. From this study we found that raising a flap with physiological available width of donor regions of calf will not cause problems in donor wound’s closure, this being sutured primary

Management of Activities of the Rospotrebnadzor Institutions in the Khabarovsk Territory with the View to Sanitary-Epidemiological Welfare Provision for the Population in the Period of High Water

In order to enhance the surveillance over sanitary-epidemiological situation in the period of flood, 2013 Rospotrebnadzor institutions in the Khabarovsk Territory took anti-epidemic team augmentation, affiliated to Irkutsk Research Anti-Plague Institute. Moreover, forged have been 30 mobile units for investigation of sanitary conditions in the residential areas of the region, water supply and water-consuming facilities, quality of nutrition among the population, living and sanitary conditions in the temporal accommodation sites; 11 mobile groups for sample collecting from ambient environment objects. Carried out has been operational deployment of two laboratory sub-units with the following membership: 5 microbiological, 5 sanitary-chemical, 2 radiological and 1 virusological facilities. By efforts of Rospotrebnadzor institutions performed has been a complex of key sanitary-hygienic, anti-epidemic and prophylactic measures aimed at prevention and control over distribution of mass infectious diseases, at the provision of sanitary-epidemiological welfare of the population in the Khabarovsk Territory, and the relief of social tension during the period of rainfall floods in August-September, 2013

НОВЫЙ РЕАГЕНТ ДЛЯ МЕЧЕНИЯ БЕЛКОВ ИОНАМИ РЕДКОЗЕМЕЛЬНЫХ МЕТАЛЛОВ

Activated ester of a carboxylic derivative of europium diethylenetriaminetetraacetate has been synthesized by the interaction of europium salt of diethylenetriaminepentaacetic acid aminoethylamide with di-N-succinimidyl-p-phthalate. This reagent was applied to introduce rare earth metal ions in animal immunoglobulins (monoclonal antibodies). The proteins labelled with Eu3+ provide the required characteristics of fluorescence intensity, background, sensitivity and selectivity in diagnostic systems of lanthanide immunofluorometric assay.Взаимодействием европиевой соли 2-аминоэтиламида диэтилентриаминпентауксусной кислоты с ди-N-сукцинимидным эфиром n-фталевой кислоты получен активированный эфир карбоксипроизводного диэтилентриаминтетраацетата европия. Этот реагент использован для введения ионов редкоземельного металла в структуру молекул моноклональных антител. Белки, меченные Eu3 +, обеспечивали необходимые характеристики интенсивности флуоресценции, фона, чувствительности и специфичности в медицинских диагностических наборах лантанидного иммунофлуориметрического анализа