Тактические аспекты лечения инфекций в длинных трубчатых костях конечностей

Despite recent advances in medicine, particularly in the field of antibiotics and reconstructive surgery, the treatment of osteomyelitis remains complex and expensive. The standard treatment is antibiotic therapy and surgical treatment, which includes sanitation, removing the dead space, restoring the blood supply, adequate coverage of the soft tissues, stabilization and reconstruction. In this article is described the general classification of osteomyelitis by Cierny-Mader, as well as performed volume of treatment depending on the type of osteomyelitis in 223 patients.Несмотря на последние достижения в медицине, особенно в области антибиотиков и реконструктивной хирургии, лечение остеомиелитов остаётся сложным и дорогостоящим. Стандартное лечение осуществляется антибиотикотерапией и оперативным лечением, которое включает санацию, устранение мёртвого пространства, воcстановление кровоснабжения, адекватное покрытие мягких тканей, стабилизацию и реконструкцию. В статье описаны общие принципы классификации остеомиелитов по Cierny-Mader, а также выполненный объём лечения в зависимости от типа остеомиелита у 223 пациентов

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

Complicațiile în chirurgia estetică a feței și tratamentul acestora

Department of Orthopedics and Traumatology, Nicolae Testemitanu SUMPh, Institute of Emergency MedicineBackground. Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favourable safety profiles and consistent outcomes. Objective of the study. Această revizuire își propune să ofere o scurtă actualizare a abordărilor cele mai utilizate în zilele noastre în domeniul dermato-estetic, a indicațiilor acestora și a complicațiilor aferente. Material and Methods. The article provides information from International expert consensus on complications associated with the use of HA-based fillers, as well as data from many years of clinical experience of the authors of this article. Results. A group of experts in aesthetic treatments reviewed the main factors associated with the complications that arise when using dermal filler and BonTa.A searh of English, French and Russian language articles in PubMed was performed using the terms "complications". Conclusion. This consensus review provides key elements to help clinicians who are starting to use dermal fillers to employ standard procedures and to understand how best to prevent potential complications of the treatment.Introducere. Tratamentul estetic facial cu neuromodulatori injectabili și materiale de umplutură cu acid hialuronic este bine stabilit, cu profiluri de siguranță favorabile și rezultate considerabile. Scopul lucrării. În aceast studiu ne propunem să oferim o scurtă actualizare a abordărilor cele mai utilizate în domeniul dermato-estetic, a indicațiilor acestora și a complicațiilor aferente. Material și Metode. Articolul oferă informații în baza Acordului experților internaționali cu privire la complicațiile asociate cu utilizarea materialelor de umplere pe bază de HA, precum și date importante din experiența clinică a autorilor acestui articol. Rezultate. Un grup de experți în tratamente estetice a analizat principalii factori asociați cu complicațiile care apar atunci când se utilizează umplutură dermică și BonTa. O cercetare a articolelor în limba engleză, franceză și rusă din PubMed a fost efectuată folosind termenii : chirurgia estetică, față, complicații. Concluzii. Această revizuire oferă elemente cheie pentru a ajuta clinicienii care încep să utilizeze substanțe de umplere dermică să folosească proceduri standard și să înțeleagă cum să prevină cel mai bine posibilele complicații ale tratamentului

Resolving a case with septic complication after total knee prothesasion at an oncological patient

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 first data about the importance of the vascularization of bone graft transplant appear in 1905 (Huntington T.W.) As the authors mentioned, this helps callus formation in ordinary terms. In 1975 found the first data about successful transfer human vascularized fibula (Taylor G.I.) two years later, the same authors describe the first migration of the proximal fibula, for the replacement of the distal femoral defect. The purpose of the work: Presenting a solved case of bone defect, that occurred after ablation of the total knee prosthesis complicated septic in an oncology patient. Materials and Methods: This work presents the clinical case of a woman of 30 years, who was diagnosed in 2009 with osteoclastoma in1/3of the distal femur operated in the same year in the Oncology Institute, was removed the tumor and was done total knee joint prothesation, at the end of 2015 at our clinic addressed with an septic area at pelvic right limb. After performing preoperative planning, I decided to solve in 2 surgery stage. At the first stage we performed ablation of the protthesis. In another step we made the right knee joint arthrodesis with a vascularized fibular flap. Bone transplantation with a length of 20 cm with a pedicle of 10 cm that was migrated through rollover technic, that in his structure enetered a muscular sleeve and skin island for future monitoring. At the final, the leg was stabilized in an external extrafocar device. After 4 months later, at a follow-up visit, the patient moves independently, using crutches and moderate support on the foot. Conclusions: Using a composite musculoskeletal cutaneous vascular defect axially allow reconstruction complicated septic at pelvic limb without following the required period

Loco-regional flap in treatment of actinic skin defect

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: Plasty techniques currently used in the treatment of the defects are largely standardized. But in clinical practice, quite often we are faced with patients who were undergoing radiation therapy. In this patients category, reconstructive plastic surgery requires a series of questions determined by major changes produced by ionizing radiation to tissues after underwenting radiotherapy. Clinical case: This work reflects a clinical case of a man of 61 years old, that was submit to radiation therapy after tumoral excision, manifested at the level of the third upper part of the large intestine, rectum. At a distance of 2 years after radiotherapy, in the treated actinic sacral region, there was an area of necrosis of about 20x20 cm. The area that was actinic changed, was divided in 3 fields, the limit between them being visually. During surgery, it have been included all 3 fields, that created a defect in the sacral region, of about 20x20 cm. According to the pre surgery plan, it has been done defect’s plasty 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 of the viable area. Conclusions: 1. Target area for histological examination is the No.2 area, where examination is indicative in the damage of the skin and soft tissue. 2. The integration of the tissues and organ transplant from another area in the case of actinic defect, may take place after exceeding the second field, histological appreciated with regenerative potential. 3. A preoperative histopathology of actinic area determines the edge of the viable tissue, in some significant cases-areas with important tissu

Aesthetical expression in the traumatized hand

Clinica Chirurgie Plastică, Estetică și Microchirurgie Reconstructivă, Catedra Ortopedie și Traumatologie, IMSP USMF „Nicolae Testemiţanu”, Chișinău, Republica 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. 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. Purpose. 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. Conclusions. The attempt to preserve both the function and the aesthetic aspect in each group of pathologies requires a lot of effort, the higher HISS score, higher costs, and higher technique witch was used. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually

Secondary reconstruction of the back after oncological excision of a massive squamos carcinoma

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: Plastic surgical techniques can be used to cover defects results from tumor resections, practically at any level of the human body’s surface. Purpose: elucidation of a case of plasty with axial vascularized flap of a huge back’s defect. Material and methods: the study includes a clinical case of a woman of 56 years, which having a burn at the age of 3 years, now develops a skin squamous keratinized carcinoma of the back. After being treated at the Institute of Oncology and defect’s primary closure has failed, she addressed to our department with a huge soft tissues defect of the back. We decided to cover the defect using a LD flap, and we partially extended flap’s fascio-cutaneous component on abdomen’s antero-intern surface. Secondary surgical debridement was performed in one step with flap’s harvesting with dimensions of 30 x 25 cm, donor site being closed in the same stage. After a period of 21 days was determined recovery of the patient. Conclusions: Postoperative defects of oncological patients are a challenge for plastic surgeons and using flaps on a safe vascular pedicle, to ensure an adequate blood supply, represents a solution

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

Aplicabilitatea lamboului plantar medial

Department of Orthopedics and Traumatology, Nicolae Testemitanu SUMPh, Institute of Emergency MedicineBackground. Reconstructive coverage of foot defects, especially those of the calcaneus region, is a unique technical challenge for the surgeon due to the high degree of specialization of the tissues involved and the relative immobility of the proximal tissues. Objective of the study. The objective of this study is to present a series of cases involving patients with traumatic lesions of the foot, who underwent surgical reconstruction with the medial plantar flap and gone out succesfully. Material and Methods. The study was designed to mark our experience with the application of the plantar medial flap to cover tissue defects in the foot, especially in traumatic tissue loss. Our clinical cases were included 4 different indication of reconstruction, performed in the Clinic of Plastic, Aesthetic Surgery and Reconstructive Microsurgery, Chisinau, Republic of Moldova. Results. The indications were traumatic tissue loss of the plantar fat pad, in the region of the calcaneal and of the dorsum of the foot. All flaps were elevated as fasciocutaneous pedicle flaps based on the medial plantar artery. All the flaps healed without major complications, except one case that involved partial loss. The donor area was covered with a partial skin graft and there was one case of partial graft loss. The flap displayed a slightly lower protective sensitivity than the normal side. Conclusion. According to our results, the applicability of the plantar medial flap is an optimal method of reconstruction of tissue defects in the back of the foot. The integrity of the skin with similar texture and protective sensitivity gives the flap a major advantage over other flaps.Introducere. Reconstrucția defectelor piciorului, în special a celor din regiunea calcaneului, este o provocare tehnică unică pentru chirurg datorită gradului ridicat de complexitate și specificitate a țesuturilor implicate și a imobilității relative a țesuturilor proximale. Scopul lucrării. Obiectivul acestui studiu este de a prezenta o serie de cazuri care implică pacienții care au suferit de leziuni traumatice ale piciorului și s-au rezolvat prin aplicarea lamboului medial plantar. Material și Metode. Prezentul studiu ilustrează experiența noastră în utilizarea lamboului pe baza arterei plantare mediale pentru a acoperi defectele tisulare la nivelul piciorului, în special în regiunea calcaniană, plantară și inframaleolară. Au fost incluse 4 cazuri clinice, aplicate în Clinica de Chirurgie Plastică, Estetică și Microchirurgie Reconstructivă, Chișinău, Republica Moldova. Rezultate. Indicațiile de reconstrucție la nivelul piciorului prin utilizarea lamboul plantar medial au fost: pierderea traumatică a țesutului din regiunea plantei, regiunii calcaneului și a dorsului piciorului. Toate lambourile au fost ridicate sub formă de lambouri pediculare fasciocutane pe baza arterei plantare mediale. Toate cazurile s-au vindecat fără complicații majore. Zona donatoare de lambou a fost acoperită cu o grefă liberă despicată a pielii. Lamboul plantar medial a demostrat o aplicabilitate înaltă și diversă, care poate rezolva 3 cauze majore de defecte din regiunea piciorului. Concluzii. Conform rezultatelor, aplicabilitatea lamboului medial plantar este o metodă optimă de reconstruție a defectelor tisulare din reriunea piciorului. Integritatea pielii cu textură similară și sensibilitate protectivă conferă lamboului un avantaj major față de alte lambouri

Management of lower limb fractures in patients with diabetes

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 2016Purpose: Analysis of the posttraumatic damage coupled with diabetic polyneuropathy of the pelvic limb and possibilities of healing the defects. Material and methods: A retrospective study was carried out over a period of two years (2014-2016) and included 15 patients with diabetic polyneuropathy. The patients were treated at the Clinic of Plastic Surgery and Reconstructive Microsurgery. The selection criteria included: - Diagnosis of diabetes with skin and soft tissue ulceration. - Non-healing traumatic or surgical wounds, with no tendency of healing in diabetic patients. The 15 patients were divided in 4 subgroups according to the type of surgical procedure performed: split skin grafts, the neighboring flaps, distant flaps, amputation at different levels. The descriptive parameters included: age, gender, the presence of type I or type II diabetes, the location. Additionally, the post-surgery complications were monitored. Results: 15 patients included in this study, out of which 4 women and 11 men were divided into four subgroups based on type of performed surgeries: the neighboring flaps - 4, distant flaps - 2, split skin grafts - 7, amputation in 2 cases. 12 patients had diabetes of type II, and the remaining 3 patients were insulin dependent. The 6 patients who had reconstruction through flaps, had distal defects (foot or ankle), whereas the patients who suffered per primam amputation had lesions at the ankle which were skin and soft tissue necrosis, with bone disease and osteitis, with signs of severe vascular disease. The majority of patients who had benefited from split skin grafts, suffered from skin lesion at the ankle level. Conclusions: Posttraumatic defects in patients with diabetic polyneuropathy of the pelvic limb can be treated through flaps or split skin grafts, so the amputation rate decreases significantly