Treatment of the defect in the occipital region with the myocutaneous trapezius island flap. Clinical case

IMSP Institute of Emergency Medicine, Plastic Surgery and Reconstructive Microsurgery Clinic, USMF “Nicolae Testemiţanu” Chişinău, Republic of 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 There are three distinct musculocutaneous flaps that can be harvested from the trapezius muscle, making it unique among the regional muscle flaps that are used in head and neck reconstruction. It is divided into 3 parts according to function and the direction of the muscle fibers: superior (descending), middle (transverse), inferior (ascending). Purpose Covering the massive defect in the occipital region with the trapezius inferior myocutaneous flap, avoiding cancer recurrence and forming an aesthetic appearance Material and methods Patient A65-year-old woman who was diagnosed with cornified pluristrative squamos cancer with bone destruction and invasion to confluence sinus and left transverse venous sinus. We cover the defect 10 by 18 cm, that was produced by excision of the occipital extraintracranial tumor removal, thus requiring a more complex approach. We decide to cover the defect with the trapezius inferior myocutaneous flap. Results The defect was completely covered, the donor region being closed in one stage. More than 2 months after the intervention, there was a good integration of the flap, without a recurrence of the cancer. Conclusions The decision of the reconstructive technique should be taken into account with regarding to its consequences on the affected anatomical structures, the personal pathological antecedents and pre-existing lesions at the level of the donor area

Utilizarea terapiei cu presiune negativă în tratamentul defectelor infectate

Background. Negative pressure wound therapy (NPWT) is a non-invasive treatment of surgical treatment of traumatic wounds, both acute and chronic, as a possibility to accelerate the healing process, bringing numerous benefits in morbidity, mortality as well as aesthetic benefits. Objective of the study. To evaluate the results and benefits obtained from the topical use of negative pressure wound therapy in patients with infected wounds. Material and Methods. This was a retrospective study of 63 patients with infected wounds treated using NPWT. The infected wounds were caused by trauma. The treatment system used was applied to the wound in continuous mode from 50 to 150mmHg, according to wound’s sizes and state. The negative pressure wound system was changed every 48-72 hours with modus adjustment and pressure corrections according to wound’s state. Results. In all 63 cases (47 male and 16 females, mean age 42 years) was successfully used negative pressure therapy with granulation formation. Full wound’s closure was achieved in 43 cases, secondary skin graftining was used in 20 cases. The use of negative pressure wound therapy varied according to wound’s state between 6 days and 1month. No complication directly caused by negative pressure wound therapy was observed. Conclusion. Negative pressure wound therapy stimulates infection-free scar tissue formation in a short time, and is a quick and comfortable alternative to conventional infected wounds treatment methods. Introducere. Terapia cu presiune negativă reprezintă o metodă minim invazivă în tratarea plăgilor/defectelor septice acute și cronice, având posibilitatea de a accelera procesul de vindecare, astfel aducând numeroase beneficii ce ține de morbiditate, mortalitate și aspecte estetice. Scopul lucrării. A evalua rezultatele și beneficiile obținute în urma utilizării topice a terapiei cu presiune negativă la pacienții cu defecte/plăgi infectate. Material și Metode. A fost un studiu retrospectiv la 63 de pacienți cu defecte/plăgi infectate, tratate prin utilizarea terapiei cu presiune negativă. Plăgile infectate au fost cauzate de traume. Sistemul de tratament utilizat a fost aplicat pe plagă în mod continuu, de la 50 la 150mmHg. Sistemul a fost schimbat la fiecare 48-72 de ore cu reglarea regimului și a presiunii în funcție de starea plăgii/defectelor. Rezultate. În toate cele 63 de cazuri (47 de bărbați și 16 femei, vârsta medie 42 de ani) a fost utilizată cu succes terapia cu presiune negativă cu formarea granulației. Închiderea completă a plăgii a fost realizată în 43 de cazuri, grefarea secundară a pielii a fost utilizată în 20 de cazuri. Utilizarea terapiei cu presiune negativă a variat în funcție de starea plăgii între 6 zile și 1 lună. Nu a fost observată nici o complicație cauzată de terapia cu presiune negativă. Concluzii. Terapia cu presiune negativă stimulează formarea de țesuturi cicatriciale într-un timp scurt și este o alternativă rapidă și comodă în comparație cu alte metode convenționale de tratare a plăgilor/defectelor infectate

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

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