92 research outputs found
Post traumatic and post surgical sciatic neuropathy
Department of Orthopaedics and Traumatology, Clinical aesthetic plastic surgery and reconstructive microsurgery, 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: Sciatic nerve neuropathy surgical related is an unpleasant event with repercussions
on the patient and the surgical team. The precise localization and extension of the nerve lesion, thedetermination of nerve continuity, lesion severity, and fascicular lesion distribution are essential for
assessing the potential of spontaneous recovery and thereby avoiding delayed or inappropriate therapy.
The aim of this study is to identify and detail posttraumatic and postoperative neuropathies.
Material and Methods:We identified 11 patients diagnosed with the posttraumatic sciatic nerve
palsy, including postoperative one. We examined clinical data, trauma’s information, surgery, symptoms
and medical records.
Discussion results: From the group of patients involved in the study 9 patients were men.
Patients’ age ranged from 21 to 63 years old. We determined that 5 cases were during trauma or after
surgery, and in 6 cases – at distance. Our data find their confirmation in literature data published by the
authors: Farrell CM, Springer BD, Haidukewych GJ, Morrey BF.
Conclusion: Knowing the complications allows finding the preventive measures that are targeted
towards monitoring the intraoperative neurophysiological complex depending on performed procedure
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
Advanced Polypropylene and Composites with Polypropylene with Applications in Modern Medicine
Synthetic polypropylene (PP) is used extensively in many fields of medicine. On the one hand, it is utilized in the manufacture of medical equipment: syringes, storage, transport, electric cables, etc. On the other hand, synthetic, nonabsorbable isotactic PP (iPP) is often used to perform meshes for hernia and pelvic organ repair operations, as well as in urinary incontinence. Products that release in time from meshes are depending on the conditions in which they are utilized, can produce undesirable reactions for the human body. For this reason, nonabsorbable synthetic PP was replaced in surgical sutures and meshes with bio polypropylene (bio PP). The chapter analyzes the specific characteristics of these polymers as well as their degradation due to the influence of different factors: humidity, perspiration, temperature, and presence of bacteria. Obtaining new composite materials with PP as matrix and metal powders as fillers is considered as a possibility of their use in vital problems such as cancer detection and treatment. These allow the emergence of new strategies in the design of biosensors that use nanocomposite materials with different fillers and polymeric films. The chapter analyzes the characteristics of new composite materials with PP matrix and metallic powders of iron (Fe)
MANAGEMENT OF LARGE BONE DEFECTS BY THE INDUCED MEMBRANE METHOD
Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Defectele osoase pot fi cauzate de traumatisme, tumori sau infecții (osteomielita). Reconstrucția chirurgicală a defectelor osoase prezinta o provocare semnificativă pentru chirurgul ortoped-traumatolog. Tehnica membranei induse este o metodă chirurgicală de referință pentru tratamentul defectelor complexe. Scopul lucrării. Prezentarea cazurilor clinice rezolvate prin aplicarea tehnicii membranei induse. Material și metode. Datele anamnestice, clinice și paraclinice au fost prelevate din fișele medicale a 14 pacienți (11 bărbați, 3 femei), (dimensiunea defectelor cuprinsa între 4-15 cm, 11 defecte osoase tibiale, 3 defecte osoase femurale). Pacienții au fost investigați clinico-radiologic preoperator, postoperator și în dinamică. A fost studiată literatura privind rezolvarea cazurile similare cu ajutorul tehnicii membranei induse. Rezultate. În studiu dat au fost incluși 14 pacienți cu vârsta cuprinsă între 27 și 69 de ani cărora li s-au efectuat intervențiile chirurgicale prin tehnica membranei induse, supranumită și Masquelet. 13 din 14 (93%) pacienți au demonstrat rezultate foarte bune in urma metodei aplicate, membranei induse, dând dovadă de formarea vascularizării satisfăcătoare, prevenirea fibrozei si migrării osoase după prima etapa și osteointegrarea reușita a grefei osoase după a 2-a etapa. La un bărbat cu vârsta de 60 de ani și comorbidități, DZ tip II, angiopolineuropatie diabetică nu s-a observat osteointegrare reușită. Concluzii. Metoda membranei induse asigura un proces intens de proliferare și diferențiere celulară cu secreția factorilor osteoinductivi, cu promovarea vascularizării și corticalizarea osului. Tehnica Masquelet este o metodă efectivă, care permite consolidarea osului în cadrul unei pierderi osoase de mărime critică.Background Bone defects can be caused by trauma, tumors or infections (osteomyelitis). Surgical reconstruction of bone defects presents a significant challenge for the trauma and orthopedic surgeon. The induced membrane technique is a reference surgical method for the treatment of complex defects. Objective of the study. Presentation of clinical cases solved by applying the induced membrane technique. Material and methods The anamnestic, clinical and paraclinical data were taken from the medical records of 14 patients (11 males, 3 females), (dimension of defects between 4-15cm, 11 tibial bone defects, 3 femoral bone defects). The patients were clinically and radiologically investigated preoperatively, postoperatively and follow-up. The literature on solving similar cases using the induced membrane technique was studied. Results. In this study, 14 patients aged between 27 and 69 were included, who underwent surgical interventions using the induced membrane technique, also known as Masquelet. 13 out of 14 (93%) patients showed very good results following the applied method, the induced membrane, proving the formation of satisfactory vascularization, the prevention of fibrosis and bone migration after the first stage and the successful osseointegration of the bone graft after the 2nd stage. In one man aged 60 and comorbidities, DZ type II, diabetic angiopolyneuropathy, no successful osseointegration was observed. Conclusion. The induced membrane method ensures an intense process of cell proliferation and differentiation with the secretion of osteoinductive factors, with the promotion of vascularization and bone corticalization. The Masquelet technique is an effective method that allows bone consolidation within a bone loss of critical size
Magnifying Endoscopy and Chromoendoscopy in Upper Gastrointestinal Tract - Clinical Applications
Reconstruction of the scalp defect with the trapezius muscle flap (clinical case)
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaBackground. Many patients with complex scalp and skull defects can benefit from scalp
reconstruction using the trapezoid flap, reducing the morbidity of the donor site. The trapezius
flap was first reported by Nakajima and Fujino in 1984. It was originally described as a
myocutaneous or muscle flap, and it has also been used as a free flap. The blood that supply the
trapezium muscle and the skin is mainly from the superficial and descending branches of the
transverse cervical artery as well as the occipital artery
Treatment of actinic skin defect using locoregional island flap
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: plasty techniques currently used in the treatment of the defects are largely
standarldized, but in clinical practice, quite often we are faced with patients who were undergoing
radiation therapy for the treatment of certain lesion (malignant or benign ). In this category require
reconstructive plastic surgery, patients, with major changes that produce ionizing radiation to tissues
undergo radiotherapy.
Clinical case: This work reflect a clinical case of a man 61 years, that was submit to radiation
therapy after tumoral excision, manifests itself at the level of the third upper part of the large intestine,
rectum. At a distance of 2 years after radiotherapy, equivalent in the amount of 60 Gy in the sacral region
treated actinic, there was an area of necrosis, about 20x20cm.The area that was actinic changed, was
divided in 3 filed, the limit between them being visualy determined by the intensity of the dystrophic
changes, so the field 1 included the central area with the highest degree of necrosis, and the field 3 with
marginal erythema. During surgery, have been included all the 3 field, that created a defect in sacral
region, about 20x20cm. According to the presurgery plan, it has been done plasty defect with gluteal
flap on the both parts, the donor place being closed by direct suture at the same stage. After surgery, the
demarcated area were separated and studied histological for determination the viable area.
Conclusion: target area for histological examination is the area nr.II where examination is
indicative in the damage of the skin and soft tissue. The integration of the tissues and organ transplant
from another area in the case of actinic defect, may take place after exceeding the field II, histological
appreciated with regenerative potential. A preoperative histopathology of actinic area determines the
edge of the viable tissue, in some significant cases areas with important tissue
The vascularized allotransplant– successful alternative for massive bone defects
Department of Traumatology and
Orthopedics,
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The massive bone defects after trauma, in congenital anomaly, tumors, infections
or nonunions is a real dilemma for reconstructive surgery of the locomotor system.
Contemporary methods that are usually used for reconstruction of the bone structure are: bone
transplant, cryopreserved allografts, autograft or prosthesis, having high levels of morbidity and
complication rates. Their common features are bad blood circulation and unviability, resulting in
mechanical instability and poor bone consolidation (periprosthetic fractures, stress fractures,
pseudoarthrosis, sepsis).
Aim of the study. To determine what are the different methods used in reconstruction of massive
bone defects.
Materials and methods. Scientific papers and research results regarding bone defects
reconstruction methods were reviewed.
Review. A vascularized bone graft, reclosed microsurgicaly in the circuit, has a good potential
for regeneration, plasticity, and a post-graft mechanical stiffness. The vascular bone autograft,
with all biological and mechanical characteristics is considered the "gold standard" in the
treatment of small bone defects. However, it becomes insufficient in size, shape and cellular
repair capacities in the case of massive bone defects due to the increased circulatory needs of the
injured segment. Maintaining the osteoplastic properties of the vascularized autograft and
combining them with the orthotopic characteristics of an allogene bone or bone segment would
be a successful alternative for the reconstructive surgery of the locomotor. The dilemma imposed
by vascularized composite allotransplantation (VCA), is immunosuppression (IS) and
immunomodulation for life, which is not justified in case of vital organs (heart, liver, kidneys)
transplants, because of adverse effects risk (systemic complications, sepsis, neoplasms). Without
an IS, the immune cascade will cause vascular endothelial cell lysis, compromise
microcirculation with necrosis of the graft. The last studies, describe the surgical
neoangiogenesis typical of the host in VCA with a short-term IS - 14 days, as an effective one,
with results that allow consolidation and mechanical stability. Studies are performed
preclinically on rats, rabbits and pigs. Other studies present decelularization methods of the
vassel while preserving vascular stiffness.
Conclusions. A perfect alternative in treatment of the massive bone defects is using a vascular
allograft, without associated immunosuppression
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
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