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

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

Preliminary results in the treatment of the diaphyseal bones defects of the lower limb using the method of the induced membrane

Plastic, Reconstructive and Microsurgery Clinic, State University of Medicine and Pharmacy ”Nicolae Testemițanu” Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Introduction: The management of segmental long-bone defects is a challenge. The literature has described many techniques, but each is fraught with specific difficulties. Masquelet’s technique of induced membrane is now a reference surgical procedure for the treatment of complex lesions requiring bone regeneration. The concept of induced membrane was introduced by Alain-Charles Masquelet in 1986. The method consists in formation of an induced membrane by a foreign body which has secretory properties, influencing positive on the regeneration and strengthening of the cancellous bone grafts. Aim: To investigate the morphological properties and characteristics of induced membrane which was modeled in an experimental group of rabbits in order to asses and to optimize the effectiveness of the Masquelet method in the clinic. Materials and methods: Experimental work was done using a group of rabbits (n=10) with the weight 5,5±0,5kg and the age – 5 months. The investigation had 3 steps. The first step of the study consisted in creating the bone defect, filling it up with an antibiotic-impregnated cement spacer and stabilizing it with a plate. The second step of the study was 21 days later, consisting in incision of the induced membrane, removing the spacer and filling up the space with cancellous bone chips collected from iliac crest. At this stage we sacrificed 5 rabbits in order to perform the histological and morphological examination. At the sixth week we switched to the third step – ablation of metal construction and the radiological control exam. At this stage we sacrificed 5 rabbits to study the morphological aspect of the healed bone. Results: The histo-morphological examination performed at the 21 days demonstrated the presence of an inflamator process characterized by neutrophilic, eosinophilic elements and regeneration’s elements – fibroblasts. Also, it was determined a pseudo-synovial metaplasia and a villous hyperplasia with formation of synovial epithelium on the internal face of the induced membrane. The histo-morphological exam performed at the 6 weeks has demonstrated the continuation of the neoformating process and of the bone modelation, the regeneration process prevailed over the inflammatory one. The morphological aspect was formed by agglomerations of fibroblasts, myoblasts and collagen and numerous vascular buds, that promotes a good neoangiogenesis and osteogenesis of the bone. Conclusion: The morphological study demonstrated an intense process of cell proliferation and differentiation, which highlights the biological role of induced membrane by foreign body with secretion of the osteoinductive factors, promoting the vascularization and corticalization of the bone. The Masquelet method is an effective method that allows getting the consolidation of the bone in case of critical size bone loss

Prophylaxis and treatment particularities in leg bone chronic osteitis

Catedra Traumatologie, ortopedie şi chirurgie de campanieIn this article, basis principles of prophylaxis of septic complications are exposed, as well as final satisfactory result in complex treatment of 978 patients with leg bone chronic osteitis, obtained in 91,3 % cases with a stable remission of the septic process. În articol sunt expuse principiile de bază a profilaxiei complicaţiilor septice şi rezultatul final satisfăcător în tratamentul complex a 978 bolnavi cu osteită cronică a oaselor gambei obţinut în 91,3% cazuri, cu o remisie stabilă a procesului septic

Lamboul corticoperiosteocutanat în tratamentul pseudartrozelor septice de tibie. Caz clinic

Background. In addition to the traditional methods for treatment of the septic pseudarthrosis, in the literature is described vascularized bone plasty for the treatment of this pathology. The priorities of this method are the re-vascularization of the septic focus with stimulation of osteogenesis. Objective of the study. Implementation of the vascularized plasty method with corticoperiosteal-skin flap in the treatment guide of septic pseudarthrosis of tibia bone. Clinical case presentation. Material and Methods. Clinical case: male, 45 y.o.. Diagnosed with septic pseudarthrosis of the tibia, distal third, with tibial bone defect and soft tissue defect of the ankle region. One year after open fracture of the calf, tipe III A Gustilo-Anderson. The case was resolved by using the corticoperiosteal-skin tibial posterior perforator flap for arthrodesis of the ankle and bone and soft tissue recovering. Results. The postoperative period evolved without complications of any kind, in accordance with the indications: bed regimen for the first 14 days, initiation of walking with moderate support on the limb at 3 months, control visit every 2 months. At 6 months after the surgery, we obtained the consolidation, at 1 year the metal plate was removed. At 1 year 5 months post op. the patient returned to work, the function of ankle was partially taken over by forefoot joint. Conclusion. Vascularized corticoperioteal-skin flap can be good method in the treatment of septic pseudarthrosis of tibia, ensuring the satisfactory vascularization necessary to consolidation. Introducere:.Pe lângă metodele tradiționale de tratament a pseudartrozelor septice, în literatura de specialitate este descrisă tratarea acestei patologii prin plastia osoasă vascularizată. Prioritățile acestor plastii sunt: revascularizarea focarului septic cu stimularea osteogenezei și inițierea consolidării. Scopul lucrării. Implementarea metodei de plastie vascularizată cu lambou corticoperiosteocutanat în ghidul de tratament al pseudartrozelor septice de os tibial. Prezentarea de caz clinic. Material și Metode. Caz clinic: bărbat, 45 de ani. Diagnosticul: pseudartroza septică tibiei, 1/3 distală, cu defect osos al tibiei și defect de țesuturi moi ale gleznei pe dreapta. Un an de la fractura deschisă de gamba timp III A GustiloAnderson. Cazul a fost rezolvat prin utilizarea lamboului perforant, corticoperiostecutanat pentru artrodeza tibio-talică și plastia defectului osos și de țesuturi moi. Rezultate. Perioada postoperatorie a evoluat fără complicații de orice gen, cu respectarea indicațiilor: regim la pat primele 14 zile, inițierea mersului cu sprijin moderat pe membru la 3 luni, control repetat la fiecare 2 luni. La 6 luni de la intervenția chirurgicala, am obținut consolidarea, la 1 an a fost înlăturată placa metalică. La 1 ani 5 luni, pacientul a revenit în câmpul muncii, funcția art. gleznei fiind parțial preluată de către art. antepiciorului. Concluzii. Lamboul vascularizat corticoperiosteocutanat, reprezintă o metodă bună în tratamentul pacienților cu pseudartroze septic de os tibial prin asigurarea vascularizării satisfăcătoare necesare pentru obținerea consolidării

Corticoperiosteal-skin flap in the treatment of septic pseudarthrosis of the calf. Clinical case

State University of Medicine and Pharmacy “Nicolae Testemitanu”, Department of Orthopaedics and Traumatology, Chisinau, Emergency Medicine Institute, Chisinau, 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 Vascularized bone plasty, is described in literature like a good method in treatment of nonunion. The priviledges of this method, is stimulation of osteogenesis through blood supply and initiation of consolidation where is was imposible earlier. Purpose Implimentation of the vascularized plasty method with corticoperiostealskin flap in treatment guide of septic pseudarthrosis of tibia bone. Clinical case presentation. Material and methods Clinical case: 45 y.o. male. One year after open fracture of the calf, tipe III A GustiloAnderson. Hospitalization diagnosis: pseudarthrosis of the tibia, distal third, with tibial bone defect and soft tissue defect of the ankle region. Results The case was solved using the corticoperiosteal-skin tibial perforator flap for arthrodesis of the ankle and for bone and soft tissue recovering. At 6 months after the surgery, we obtained the consolidation, at 1 year the metal plate was removed. At 1 year 5 months post op. the patient returned to work, the function of ankle was partially taken over by forefoot joint. Conclusions Vascularized corticoperiosteal-skin flap, can be a good method in treatment of septic pseudarthrosis of the tibia

Locoregional flaps in treatment of ankle and foot defects after oncological exercises

Plastic Surgery and Reconstructive Microsurgery Clinic, Department of Orthopedic and Traumatology, USMF ,,Nicolae Testemițanu’’ Chișinău, 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. At the current stage the defects of ankle and foot resulting from oncological exercises require a reconstructive plastic approach for preserve the function and aesthetic part of the lower limb. Purpose. Treatment of lower limb defects generated by oncological excision with locoregional flaps. Material and methods. Group of 15 patients monitored according to the following parameters: integration of the flap in the recipient bed healing of the donor area presence / absence of recurrences remote monitoring of the affected areahealing of the donor area presence / absence of recurrences remote monitoring of the affected area Results. The plasty of defects of 15 patients was performed with the following types of flaps: posterior tibial perforator(4) , fibular perforator(6), supramaleolar(5). After dynamic monitoring, the following results were established: secondary healing (2 cases), a case of recurrence in adjacent area of the flap, a repeated surgery for cosmetic remodeling of the flap. Conclusions. Oncological excision is performed with reserves outside the pathologically modified tissue exposing atmospheric bone tissue or other "noble" structures. The use of properly vascularized flaps in the vicinity of defects or remotely facilitates the restoration of affected areas while maintaining their function

Combined decelularization of vascularized bone allograft. In vivo experimental study stage

State University of Medicine and Pharmacy "Nicolae Testemitanu“, Laboratory of Tissue Engineering and Cellular Culture, 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 •Massive bone defects is an actual real dilemma for reconstructive surgery to the locomotor system. • The vascularized bone allograft would be a successful alternative, with his osteoplastic properties of the vascularized autograft and the orthotopic characteristics of the allogenic bone. •Decellularization of organs, including bone, gives an acellular biological graft, which keeps their extracellular 3D structure. Objective of the study: To extract the cellular component from the vascularized bone allograft by the combined method, according to the algorithm, without injuring the extracellular structure and matrix. Material and methods: The study was performing on New Zealand White Rabbit. The femur was taken with the internal iliac artery(I), located between the upper part of the great trochanter and the distal 1/3 of the femoral shaft, respecting the vascular continuity. The grafts were stored at -84.1C for 14 days, subsequently disengaged by the gradual method. The graft was examined histologically (A. internal iliac art.B. proximal femur) The graft was connected to the closed-circuit peristaltic pump (II). After that was processed, gradually, with a series of solutions (during 7 days): 1. sol. NaCl 0,9%-100ml+sol. Heparin 500Me/ml-5 ml 2. 0,1g EDTA + sol. PBS 100ml 3. 0,1g EDTA + 150 ml sol. TRIS tampon 10 millimolar 4. 0,5g SDS + 100ml sol. TRIS tampon 10 millimolar 5. 1ml sol. TRITON-X 100 + 100ml ml sol. TRIS tampon 10 millimolar 1. 1mg ARNaze + 100ml dist. Water 2. 0,153 ml sol. PenicillinStreptomycin (10,000un.- 10 mg/mL) + 100 ml PBS. Conclusions: The combined process of decellularizing of vascularized bone tissue can generate bone grafts devoid of immunological agents. The decellularized of vessels need additional studies to evaluate the processes for keep its resistance, an imperative factor in subsequent grafting

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