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

Reconstruction of the pinna after burn injury using a temporo-frontal island flap

Clinica de Chirurgie Plastică şi Microchirurgie Reconstructivă, USMF “Nicolae Testemițanu”, Centrul Republican de Leziuni Termice, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Majorarea numărului de leziuni ale urechilor în ultimii ani a determinat necesitatea unor soluții simple şi eficiente. Scopul studiului: Prezentarea cazurilor de reconstrucție a pavilionului auricular bilateral într-o singură etapă chirurgicală. Material şi metode: Experiența noastră constituie 2 cazuri clinice la care am utililizat lamboul insular temporo-frontal bilateral. Ambii pacienți au fost bărbați, cu vîrstele – 36 ani şi 47 ani. Ambii au suportat arsuri grave, inclusiv la nivelul capului. În perioada reconvalescentă, după externarea în stare satisfăcătoare din unitatea medicală bolnavii au fost consultați repetat în vederea ameliorării estetice. Utilizarea lamboului insular temporo-frontal a fost condiționată de starea precară a țesuturilor din jurul urechilor. În ambele cazuri intervenția chirurgicală reconstructivă a fost efectuată bilateral într-o etapă. Rezultate: Zona donatoare de lambou şi cea recipientă au regenerat primar. Principalele avantaje ale acestei metode de plastie sunt efectuarea lor într-o singură etapă, spre deosebire de metodele clasice şi posibilitatea de a le folosi în defecte infectate, mizând pe buna lor vascularizare. Concluzii: Lamboul temporo-frontal insular ridicat pe vasele temporale oferă țesuturi vascularizate colorate identic cu tegumentul pavilioanelor auriculare în cantități suficiente pentru plastii ale defectelor tegumentare din această regiune. Intervențiile chirurgicale reconstructive cu acest lambou la necesitate se vor efectua bilateral într-o etapă.Introduction: The growing number of ear trauma cases has brought about the need for simple and efficient solutions. The aim: To present two cases of bilateral reconstruction of pinna in one surgical step. Material and methods: Our experience counts 2 clinical cases. We have used island temporo-frontal flaps bilaterally. Both patients were males, with the ages of 36 and 47 years. Both have suffered serious burns, including head area. During recovery period, after discharge in satisfactory condition from medical unit, patients have been consulted repeatedly in order to improve aesthetic appearance. The use of flap was conditioned by poor status of the tissues around ears. In both cases reconstructive surgery was performed bilaterally, in one surgical session. Results: The flap’s donor area and recipient have primary regenerated. The main advantages of this plastic method are conducting them in one step as opposed to classical methods, and the ability to use them in infected defects relying on their good vascularization. Conclusions: The island temporo-frontal flap rised on temporal vessels offers perfused tissues identically colored as a skin of the pinna in sufficient quantities for the plasty of the tissues defects in this region. Reconstructive surgeries with this flap, if necessary, can be carried out bilaterally in one surgical session

Latissimus dorsi pedicle flap for trunk and upper limb defects: possibilities and limits

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 2016Scop. Evidențierea variantelor posibile de migrare la nivelul membrului toracic și trunchiului a lamboului latissimus dorsi pediculat (LDp) și a limitelor permisive pentru obținerea rezultatelor optime reconstructive. Material și metode. LDp a fost utilizat in 8 cazuri pentru tratamentul defectelor tegumentare, fiind utilizat in varianta miocutanată. A fost utilizat in 5(62,5%) cazuri pentru acoperirea a 3 regiuni ale membrului toracic: brațului–2(25%) cazuri, articulația cotului – 3(37,5%), 1/3 proximală antebraț–3(37,5%). In 3(37,5%) cazuri s-a folosit pentru acoperirea defectelor la nivelul toracelui: 1(12,5%) caz–sânul postmastectomie, 2 (25%)– regiunea parascapulară. LDp a fost recoltat după metoda clasică pe pediculul toracodorsal. Dimensiunile maxime ale defectelor tegumentare au constituit 40 x 20 cm. Rezultate. In studio au fost recoltate 8 lambouri, nici unul fiind pierdut. 6(75%) lambouri au supraviețuit complet, iar in 2(25%) cazuri au ajuns la 10-15 cm distal față de olecran, fără alungire semnificativă a pediculului. In 2(25%) cazuri s-a determinat necroza marginal distal de aproximativ 5 cm, fiind efectuată necrectomie și grefare cutanată. In 6(75%) cazuri calea de migrare a fost suturată in prima etapă, iar in 2(25%)– in etapa a 2-a,cu grefare. Complicații la nivelul zonei donatoare nu s-au înregistrat. Concluzii. LDp poate fi utilizat pentru acoperirea defectelor tegumentare vaste cu localizare la nivelul toracelui și membrului thoracic până la nivelul 1/3 medii a antebrațului. S-a constatat că pentru acoperirea defectelor poate fi utilizată până la 60% din suprafața LDp, fără compromiterea funcțională a umărului. Migrarea distal de olecran nu este mereu sigură fiind însoțită de către complicații, precum necroza marginală.Purpose. Highlighting possible migration variants of pedicle latissimus dorsi (pLD) flap at thoracic limb and trunk level and the permissive limits for achievement of the best reconstructive results. Material and methods. pLD flap was performed in 8 cases for tissues defects treatment, being used myocutaneous type. pLD flap was used in 5(62.5%) cases to cover 3 regions of limb: arm-2(25%) cases, elbow joint-3(37.5%), proximal third of forearm-3(37.5%). In 3(37.5%) cases was used to cover defects of the chest: 1(12.5%) case-breast postmastectomy, 2(25%) – parascapular region. The flaps were harvested in classical way on their thoracodorsal pedicle. The maximum dimensions of tissues defects were 40 x 20 cm. Results. In the study were harvested 8 flaps, none being lost. 6(75%) flaps survived completely, and in 2(25%) cases had reached to a point 10 cm up to 15 cm distal to olecranon without significant elongation of the pedicle. 2(25%) cases developed marginal distal necrosis of about 5 cm, being carried out necrectomy and skin grafting. In 6(75%) cases migration paths were sutured during first surgical stage and in 2(25%) – at second surgical stage, using skingrafts. No complications at donor site were reported. Conclusions. pLD flap can be used to cover large skin defects localized on trunk and thoracic limb down to the proximal third of the forearm. It can be used up to 60% of the LD to cover the defects, without compromising the function of the shoulder. Migration distal to olecranon is not always safe, being accompanied by complications such as marginal necrosis

Invited Article: Filamentary deposition of laser energy in glasses with Bessel beams

We investigate the nonlinear absorption of laser energy in the bulk of transparent dielectrics for femtosecond and picosecond laser pulses focused by a conical lens. We highlight the influence of the pulse duration, laser pulse energy, and cone angle on laser energy absorption in transparent dielectrics. We provide a semi-analytical model allowing the calculation of maps for the density of nonlinear absorption of energy in BK7 and in SiO2 as a function of the pulse duration and peak fluence in the focal region. The comparison of the density of nonlinear absorption of energy with the available energy density determines optimal pulse durations and Bessel beam cone angles compatible with uniform laser energy deposition in the Bessel zone. The results reproduce quantitatively the transmission measurements for experiments in BK7 with picosecond pulses and suggest that the loss of propagation invariance and uniform laser energy deposition is responsible for a previously reported transition between different types of damage morphology in SiO2 [M. K. Bhuyan et al., Appl. Phys. Lett. 104, 021107 (2014)].We investigate the nonlinear absorption of laser energy in the bulk of transparent dielectrics for femtosecond and picosecond laser pulses focused by a conical lens. We highlight the influence of the pulse duration, laser pulse energy, and cone angle on laser energy absorption in transparent dielectrics. We provide a semi-analytical model allowing the calculation of maps for the density of nonlinear absorption of energy in BK7 and in SiO2 as a function of the pulse duration and peak fluence in the focal region. The comparison of the density of nonlinear absorption of energy with the available energy density determines optimal pulse durations and Bessel beam cone angles compatible with uniform laser energy deposition in the Bessel zone. The results reproduce quantitatively the transmission measurements for experiments in BK7 with picosecond pulses and suggest that the loss of propagation invariance and uniform laser energy deposition is responsible for a previously reported transition between different typ..

Reconstruction of soft tissue defect secondary to open fracture of calf – case report

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. Fracturile asociate cu defecte tisulare sunt considerate urgenţe,necesitând un management sofisticat şi un sistem de gradare pentru obţinerea unei vindecări necomplicate cu o restabilire funcţională completă. Scopul. Raportarea unui caz clinic de fractură deschisă ale oaselor gambei asociată cu defect tisular tratat ortoplastic şi analiza rezultatului final în dependenţă de timpul consolidării şi complicaţii. Caz clinic. Lucrarea prezintă un caz clinic a unui bărbat de 35 ani,fumător,internat in DU cu diagnosticul de Fractură deschisă in 1/3 medio-distală a ambelor oase ale gambei drepte Gustilo-Anderson 3A, fractura pilonului tibial pe dreapta şi defect de ţesuturi moi AOIO2. Primar s-a efectuat debridarea,osteosinteza în aparat extern şi plastia defectului cu lambou tibial posterior perforant. Calea de migrare a lamboului a fost închisă în etapa II-a prin autodermoplastie.La 4 zi s-a efectuat reducerea deschisă şi osteosinteza pilonului tibial cu şuruburi. Lamboul a fost monitorizat fiece oră primele 24h,fiece 4h următoarele 48h şi fiece 8h următoarele 72h.La 7 zi p/o s-a determinat infectarea grefei cu pierderea parţială,fiind efectuată debridarea şi re-autodermoplastie. După perioada de imobilizare de 2 săptămâni, urmată de 1 săptămână de descărcare,pacientul a început să meargă utilizând dispozitiv de mers,fiind externat. La 2 luni p/o s-a determinat osteita tibiei,forma fistulară şi edemul lamboului,fiind efectuată fistulosechestrnecrectomie asociată tratamentului conservator complex. La 5 luni p/o s-a constatat consolidarea primară acceptabilă a fracturii şi integrarea satisfăcătoare a lamboului. Concluzii. Fracturile deschise care necesită plastie cu lambouri trebuie tratate prioritar prin debridare precoce,radicală,fixare rigidă şi plastie precoce cu lambouri. Majoritatea leziunilor date pot fi reconstruite satisfăcător cu lambouri locale sau regionale.Introduction. Fractures with soft-tissue injury must be considered as surgical emergencies. They need a sophisticated management protocol and an excellent grading system to achieve uncomplicated healing with complete restitution of function.Purpose. To report a clinical case of leg’s open fracture with tissues defect treated ortho-plastic and analyze final outcome with regards to time taken for union and complications. Clinical case. This paper reflects a clinical case of a 35 years man, smoker, admitted in ED with Gustilo Andreson type 3A open fracture in medio-distal 3rd of right calf ’s both bones, pilon fracture and soft tissues damage AOIO2.In acute stage was performed debridement, fracture fixation in external fixator and reconstruction with posterior tibial artery distal perforator flap. Donor area was covered in 2nd stage with a split thickness skin graft. Within 4days was performed open reduction and pilon’s internal fixation with screws. Flap was monitored hourly during first 24h,every 4h-next 48h,every 8h-next 72h.At 7days p/o was determined graft’s infection with its partial loss, being performed debridement and re-grafting. After 2weeks of immobilization, followed 1 week offloading, patient started to walk using a boot, being discharged. After 5th month, patient started a full weight bearing status without any assistant devices. At 2months follow-up was determined fistular tibial osteitis, flap’s oedema, being underwent sequester-necrectomy and complex conservative treatment. At 5months follow-up was determined acceptable primary union and satisfactory flap’s integration. Conclusion. Open fracture which needs flap coverage should be treated with high priority of radical early debridement, rigid fixation and early flap coverage. A majority of these wounds can be satisfactorily covered with local or regional flaps

280 one-opposition near-Earth asteroids recovered by the EURONEAR with the <i>Isaac Newton</i> Telescope

Context. One-opposition near-Earth asteroids (NEAs) are growing in number, and they must be recovered to prevent loss and mismatch risk, and to improve their orbits, as they are likely to be too faint for detection in shallow surveys at future apparitions. Aims. We aimed to recover more than half of the one-opposition NEAs recommended for observations by the Minor Planet Center (MPC) using the Isaac Newton Telescope (INT) in soft-override mode and some fractions of available D-nights. During about 130 h in total between 2013 and 2016, we targeted 368 NEAs, among which 56 potentially hazardous asteroids (PHAs), observing 437 INT Wide Field Camera (WFC) fields and recovering 280 NEAs (76% of all targets). Methods. Engaging a core team of about ten students and amateurs, we used the THELI, Astrometrica, and the Find_Orb software to identify all moving objects using the blink and track-and-stack method for the faintest targets and plotting the positional uncertainty ellipse from NEODyS. Results. Most targets and recovered objects had apparent magnitudes centered around V ~ 22.8 mag, with some becoming as faint as V ~ 24 mag. One hundred and three objects (representing 28% of all targets) were recovered by EURONEAR alone by Aug. 2017. Orbital arcs were prolonged typically from a few weeks to a few years; our oldest recoveries reach 16 years. The O−C residuals for our 1854 NEA astrometric positions show that most measurements cluster closely around the origin. In addition to the recovered NEAs, 22 000 positions of about 3500 known minor planets and another 10 000 observations of about 1500 unknown objects (mostly main-belt objects) were promptly reported to the MPC by our team. Four new NEAs were discovered serendipitously in the analyzed fields and were promptly secured with the INT and other telescopes, while two more NEAs were lost due to extremely fast motion and lack of rapid follow-up time. They increase the counting to nine NEAs discovered by the EURONEAR in 2014 and 2015. Conclusions. Targeted projects to recover one-opposition NEAs are efficient in override access, especially using at least two-meter class and preferably larger field telescopes located in good sites, which appear even more efficient than the existing surveys

A large topographic feature on the surface of the trans-Neptunian object (307261) 2002 MS4_4 measured from stellar occultations

This work aims at constraining the size, shape, and geometric albedo of the dwarf planet candidate 2002 MS4 through the analysis of nine stellar occultation events. Using multichord detection, we also studied the object's topography by analyzing the obtained limb and the residuals between observed chords and the best-fitted ellipse. We predicted and organized the observational campaigns of nine stellar occultations by 2002 MS4 between 2019 and 2022, resulting in two single-chord events, four double-chord detections, and three events with three to up to sixty-one positive chords. Using 13 selected chords from the 8 August 2020 event, we determined the global elliptical limb of 2002 MS4. The best-fitted ellipse, combined with the object's rotational information from the literature, constrains the object's size, shape, and albedo. Additionally, we developed a new method to characterize topography features on the object's limb. The global limb has a semi-major axis of 412 $\pm$ 10 km, a semi-minor axis of 385 $\pm$ 17 km, and the position angle of the minor axis is 121 $^\circ$ $\pm$ 16$^\circ$. From this instantaneous limb, we obtained 2002 MS4's geometric albedo and the projected area-equivalent diameter. Significant deviations from the fitted ellipse in the northernmost limb are detected from multiple sites highlighting three distinct topographic features: one 11 km depth depression followed by a 25$^{+4}_{-5}$ km height elevation next to a crater-like depression with an extension of 322 $\pm$ 39 km and 45.1 $\pm$ 1.5 km deep. Our results present an object that is $\approx$138 km smaller in diameter than derived from thermal data, possibly indicating the presence of a so-far unknown satellite. However, within the error bars, the geometric albedo in the V-band agrees with the results published in the literature, even with the radiometric-derived albedo