Serbian Journal of Experimental and Clinical Research, 2021
Radial forearm flap is an axial flap that has become an important technique in reconstructive sur... more Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), f...
The significance of war injuries of the hand is the direct consequence of the incidence of these ... more The significance of war injuries of the hand is the direct consequence of the incidence of these wounds and the resulting disability. According to the World War II data, the incidence of hand injuries was approximately 7% of all war injuries. Inadequate management and surgical treatment produce severe disability. Due to highly specialized anatomic structure characterized by a high ratio of skin surface and the volume of deeper tissue structures and complex functional mechanisms it possesses, the hand is an organ which injury requires specific diagnostic and surgical measures. Since war injuries of the hand are mostly complex and associated with tissue (cutaneous) defects, it is essential that a surgeon has good knowledge of the reconstruction methods in wound closure in the reparatory phase, as well as of appropriate atraumatic technique in the reconstruction of tendons, nerves, bones in the reconstruction phase. This paper aims to presenting surgical management of war injuries of t...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
War wounds caused by modern infantry weapons or explosive devices are very often associated with ... more War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defect...
At the Clinic for plastic surgery and burns of the MMA, we examined 33 patients with transferred ... more At the Clinic for plastic surgery and burns of the MMA, we examined 33 patients with transferred 5 cutaneous, 18 miocutaneous, and 10 osteocutaneous free flaps out of which 10 were done on foot, 13 on the lower leg, and 10 on the face. We analyzed the blood circulation (patency of arterial microanastomosis and perfusion) of transferred free flaps, recovery of sensitivity, functioning of the sebaceous and sweat glands as well as histomorphologic changes in the skin of the transferred free flaps during the period of 6 up to 36 months after the free flap transfer and compared with the same characteristics of the skin and tissue of the surrounding area of the recipient region.
At the Clinic for Plastic Surgery and Burns of the MMA, we examined 33 patients with transferred ... more At the Clinic for Plastic Surgery and Burns of the MMA, we examined 33 patients with transferred 5 cutaneous, 18 miocutaneous and 10 osteocutaneous free flaps of which 10 were on the foot, 13 on the lower leg and 10 on the face. We analyzed blood circulation (patency of arterial microanastomosis and perfusion) of transferred free flaps (1-3), sensitivity recovery, function of the sebaceous and sweat glands, as well as histomorphologic changes in the skin of the transferred free flaps during the period of 6 up to 36 months after the free flap transfer and compared with the same characteristics of the skin and tissue of the surrounding recipient region.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Acade... more In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Academy, 18 patients. 12 male and 6 female, with hereditary dystrophic epidermolysis bullosa (HDEB) and hand deformities were surgically treated, to achieve the complete separation of fingers, correction of the thumb adduction contracture and flexion or extension contracture of finger joints. The period of wound healing on flat surfaces after surgery, and the period between two operations was estimated. The most common deformity was the flexion contractures of metacarpophalangeal (MP) joints (45%) and one or both interphalangeal (IP) joints (types A1, A2). In 20% of the hands MP joint was stretched with the flexion contracture in distal interphalangeal (DIP) or both IP joints (types B1, B2). In 35% of hands MP joint was in hyperextension with folded proximal interphalangeal (PIP) or both IP joints (C1 i C2). The adduction deformity of the thumb type 1, without the possibility of abduction, wa...
Congenital absence of vagina is known from ancient times of Greek. According to the literature da... more Congenital absence of vagina is known from ancient times of Greek. According to the literature data, incidence is 1/4 000 to 1/20 000. Treatment of this anomaly includes non-operative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to establish anatomic and histological characteristics of vagina reconstructed by McIndoe method in Mayer Küster-Rockitansky Hauser (MKRH) syndrome and compare them with normal vagina. The study included 21 patients of 18 and more years with congenital anomaly known as aplasio vaginae within the Mayer Küster-Rockitansky Hauser syndrome. The patients were operated on by the plastic surgeon using the McIndoe method. The study was a retrospective review of the data from the history of the disease, objective and gynecological examination and cytological analysis of native preparations of vaginal stain (Papanicolau). Comparatively, 21 females of 18 and more years with normal vaginas were also studed. All the subjects were divided into the groups R (reconstructed) and C (control) and the subgroups according to age up to 30 years (1 R, 1C), from 30 to 50 (2R, 2C), and over 50 (3R, 3C). Statistical data processing was performed by using the Student's t-test and Mann-Writney U-test. A value of p < 0.05 was considered statistically significant. The results show that there are differences in the depth and the wideness of reconstructed vagina, but the obtained values are still in the range of normal ones. Cytological differences between a reconstructed and the normal vagina were found. A reconstructed vagina is smaller than the normal one regarding depth and width, but within the range of normal values. A split skin graft used in the reconstruction, keeps its own cytological, i.e. histological and, so, biological characteristics.
... Vitalnost ironsplantovanog mikrovaskulaniog rei^nja posle kom-pletiranja mikrovaskulame anast... more ... Vitalnost ironsplantovanog mikrovaskulaniog rei^nja posle kom-pletiranja mikrovaskulame anastomoze je kontrollsana; Actando-vim lesiom prulaznosti anasiomoze, krvarenjem iz ivica slobod-nog reinja ... StoSic S, Novakovic M, Jovic N, Mirkovic Z. Bogeski T. Londarevic S. et al ...
... mclanomom lokalizo-vanim na stopalu kod 4 su bila nn prstirna, od toga 1 subun-gvalni (tabela... more ... mclanomom lokalizo-vanim na stopalu kod 4 su bila nn prstirna, od toga 1 subun-gvalni (tabela I). U pogledu kliniekog lira melanoma do ... prcdnjoj strani potko-lenice, dorzu mu stopala, poglavini i za pokriva-njc sckundamog dcfckta pri rrunspoziciji velikog rcznja sa poglavine. ...
Reconstruction of the amputated breast in female patients after surgical management of breast car... more Reconstruction of the amputated breast in female patients after surgical management of breast carcinoma is possible with the use of autologous tissue, synthetic implants, or by combining autologous tissue and synthetic materials. Autologous tissue provides soft and sufficiently elastic tissue, which is usable for breast reconstruction and eventually obtains original characteristics of the surrounding tissue on the chest wall. The use of the TRAM flap for breast reconstruction was introduced in 1982 by Hartrampf, Scheflan, and Black. The amount of the TRAM flap tissue allows breast reconstruction in the shape most adequate to the remaining breast. The possibilities of using the TRAM flap as pedicled myocutaneous flap or as free TRAM flap make this flap a superior choice for breast reconstruction in comparison with other flaps.
Using vacuum in medicine has been known from long ago, however, it has not been used for the trea... more Using vacuum in medicine has been known from long ago, however, it has not been used for the treatment of wounds. The first experiments in this field were performed by Wagner Fleischmann, University of Ulm, Ulm, West Germany, in 1993. The aim of this study was to present our clinical experience with the treatment of surgical wounds complications in vascular patients by the use of controled vacuum. In a period October 2006 - December 2009 a total of 18 patients with infection and surgical wound dehiscence were treated by the use of vacuum. Vacuum was applied to wounds by placing a polyurethane sponge on them and by fixing a polyurethane foil and a sponge to the surrounding healthy skin so to completely airtight wounds. Over a foil vacuum of--150 mmHg was applied for a 5-day period, and on the day 6 a foil and a sponge were removed. In all the 18 wounds treated by the use of vacuum secondary wound closing was achieved with no complications and with a significantly shortened time period treatment. Wound infections were healed using this method and only in 2 patients antibiotics were used at the same time. The use of vacuum in the treatment of operative wounds complications is an easy and reliable method contributing significantly to wounds better healing.
Vascularized osteoseptocutaneous radial flap is commonly used in the reconstruction of composite ... more Vascularized osteoseptocutaneous radial flap is commonly used in the reconstruction of composite bony and soft tissue defects of the lower third of the face due to the outstanding quality of its cutaneous component. The aim was to evaluate the primary and overall success in the reconstruction of mandibular defects, following war injuries, with vascularized osteoseptocutaneous radial flap. At the Department of Maxillofacial Surgery of the Military Medical Academy Belgrade, there were eight patients with this kind of defect following war injury, and the mandible was reconstructed with a vascularized osteoseptocutaneous radial flap. Bony compartment of the graft was harvested as up to 11 cm long segment of radial circumference. The localization and structure of the defect, features of a harvested compound graft, the procedure of the reestablishment of the mandibular continuity was presented as well as immediate and late complications during the consolidation period, and the primary successful reconstruction in 87.5% of the patients. The primary and overall success in the mandibular defects reconstruction with a vascularized osteoseptocutaneous radial flap was equal or even better than those presented in the literature on the reconstruction of the similar defects after tumor resections.
There is a natural asymmetry in normal female brests. When the difference in the shape, size or p... more There is a natural asymmetry in normal female brests. When the difference in the shape, size or position of the breast and nipple-areola complex is visible, surgical correction is the only treatment option and presents one of the greatest challenges for a plastic surgeon. Based on the Nahai classification presented in details, the aim of the study was to present the possibilities of plastic surgery to correct primary (congenital), secondary (developmental) and tertiary (acquired) brest asymmetries. We conducted a retrospective analysis of female breast asymmetry surgeries performed in the Clinic for Plastic Surgery and Burns, Military Medical Academy (MMA), Belgrade over the last seven years (January 2002 - January 2009). During the above mentioned period, 82 female patients, 18 - 65 years of age, underwent surgery for breast asymmetry. The most frequent asymmetries were developmental, "pubertal" (n = 43); acquired asymmetries as a consequence of tumor surgery were found in the other 22 patients, while 7 patients were diagnosed with primary asymmetries such as congenital chest-wall asymmetry (Sy. Poland), accessory and tuberous breasts. All patients underwent preoperative ultrasound examination, while hormone status was determined in those with developmental, "pubertal" asymmetries. The selection of surgical procedure for correction of breast asymmetry depended upon clinical examination findings and patient's wish relating to the shape and size of the breasts. The most of breast asymmetries were corrected by a combination of surgical procedures including primary and secondary reconstruction, reduction, suspension or augmentation mammoplasty. Having combined different surgical procedures, we managed to achive satisfactory results. The hypertrophic scar formation after reduction mamoplasty was seen in some cases, however, they caused no significant patient's discomfort. Application of plastic, reconstructive and aesthetic surgical principles can considerably contribute to achieving excellent results in corrective surgery for breast asymmetries. In addition to most suitable breast asymmetry surgical procedures choice, motivation of a patient is also very important for achieving satisfactory results.
Vascular anomalies in the hand do not occur frequently. Their presence in the metacarpal region c... more Vascular anomalies in the hand do not occur frequently. Their presence in the metacarpal region can cause different functional disorders. The extent of such disorders directly depends on the localization and size of vascular anomalies, duration and the nature of the anomaly growth as well as on eventual secondary complications such as ulceration or bleeding. The aim of this case report was to show the specifics in the clinical picture, pathogenesis and evolution of such anomalies, applied diagnostic procedures (radiography, ultrasound, magnetic resonance, electromyography) and surgical treatment as well as postoperative functional results. In the Clinic for Plastic Surgery and Burns, Military Medical Academy Belgrade, two patients were treated surgically for vascular anomalies of the middle palmar region of the hand. The first patient, a 36-year-old male, a former active sportsman (professional handball player) was treated for acute increase in the vascular anomaly of hand in the metacarpal region and proximal phalange of III and IV fingers of his right hand. The anomaly was detected 6 months prior to his hospitalization while two weeks before the hospitalization there was a sudden growth and increase in the change. The second case, a 15-year-old male patient actively pursuing a career in professional basketball was treated for a tumor localized in the metacarpal zone of his left hand. According to the information provided by his parents, the anomaly had been present since his birth. Initially, the anomaly manifested itself as a discoloration of the skin with a marked capillary drawing, gradually increasing throughout the last five years to the present dimension. The growth of the malformation was noticed to coincide in both patients with more active pursuit of their professional sports career. The clinical picture of hand vascular anomalies is dominated by the symptoms of compression of neurovascular structures (paresthesia, intense hand pain, swollen fingers). If it is a chronic progressive process, signs of ischemic intrinsic muscle fibrosis with corresponding functional deficit, as well as tissue defect (usura) of bone and joint structures represent the basic pathological findings. Acute increase is accompanied by compartment syndrome symptoms and ischemic fibrosis of intrinsic hand musculature and development of irreversible dysfunction of the hand. In the presented cases rapid response implies accurate diagnostic methods followed by surgical extirpation in order to treat compartment syndrome.
The delay method is a surgical, pharmacological and combined method that includes two or more tim... more The delay method is a surgical, pharmacological and combined method that includes two or more time separated phases, which gives bigger flap surface. In our research we explored the possibility of flap surface enlargement in a new arterialised venous flap (AVF) on an experimental rabbit ear model by the delay surgical method. The aim of this research was to establish vitality surface of our AVF and to maintain the difference in flap vital surface between AVF flaps, with or without performing the delay surgery method. We used both ears of "Big Chinchilla" rabbits in 10 experimental male animals, divided into two groups, average weight 3-3.5 kg, and average age 8-10 months. In the first (experimental) group, a venous flap was arterialised by our method. In the second (control) group, the venous flap was arterialised 14 days after the delay surgical method. AVF surface was measured on the 1 and 14 days by the method of trapezoid rule. Vital surface on our AVF experimental model was bigger than 87% of elevated flap surface after the delay surgical method. Vital surface on AVF without delay on our experimental model was bigger than 30% of elevated flap surface (p < 0.001). Analysis of previous experimental models on the rabbit ear, non-delayed and delayed (to enlarge flap surface) led us to conclusion that previously created experimental models of non-delayed AVF are hemodynamically negative. Our experimental non-delay AVF model is hemodynamically more positive than previously created models of non-delay AVF and provides better conditions for AVF survival and enlargement of vital flap surface of elevated flap. On the other hand, surgical delay method significantly enlarges vital surface of AFF.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
The retrospective analysis of 1,514 cases treated at the Clinic for Plastic Surgery and Burns of ... more The retrospective analysis of 1,514 cases treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy in the period between 1991 and 1995, established that the percentage of the injuries caused by gunshots and those caused by explosives during the conflict in former Yugoslavia, was more or less the same. The injuries caused by gunshot more often occurred on the head, neck, arms and trunk. The injuries of the legs caused by the explosives were more frequent, and they occurred in 83% of the cases. All the plastic surgeons who took part in the treatment of patients and in preparing the surgeons of other specialties for the treatment applied the original classification of the war injuries according to the structure of the defects that had occurred, to standardize the approach to the planning of treatment and the treatment itself of the wounded. In the delayed primary or secondary treatment of the injuries with the tissue defects all known plastic and reconstructi...
Serbian Journal of Experimental and Clinical Research, 2021
Radial forearm flap is an axial flap that has become an important technique in reconstructive sur... more Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), f...
The significance of war injuries of the hand is the direct consequence of the incidence of these ... more The significance of war injuries of the hand is the direct consequence of the incidence of these wounds and the resulting disability. According to the World War II data, the incidence of hand injuries was approximately 7% of all war injuries. Inadequate management and surgical treatment produce severe disability. Due to highly specialized anatomic structure characterized by a high ratio of skin surface and the volume of deeper tissue structures and complex functional mechanisms it possesses, the hand is an organ which injury requires specific diagnostic and surgical measures. Since war injuries of the hand are mostly complex and associated with tissue (cutaneous) defects, it is essential that a surgeon has good knowledge of the reconstruction methods in wound closure in the reparatory phase, as well as of appropriate atraumatic technique in the reconstruction of tendons, nerves, bones in the reconstruction phase. This paper aims to presenting surgical management of war injuries of t...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
War wounds caused by modern infantry weapons or explosive devices are very often associated with ... more War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defect...
At the Clinic for plastic surgery and burns of the MMA, we examined 33 patients with transferred ... more At the Clinic for plastic surgery and burns of the MMA, we examined 33 patients with transferred 5 cutaneous, 18 miocutaneous, and 10 osteocutaneous free flaps out of which 10 were done on foot, 13 on the lower leg, and 10 on the face. We analyzed the blood circulation (patency of arterial microanastomosis and perfusion) of transferred free flaps, recovery of sensitivity, functioning of the sebaceous and sweat glands as well as histomorphologic changes in the skin of the transferred free flaps during the period of 6 up to 36 months after the free flap transfer and compared with the same characteristics of the skin and tissue of the surrounding area of the recipient region.
At the Clinic for Plastic Surgery and Burns of the MMA, we examined 33 patients with transferred ... more At the Clinic for Plastic Surgery and Burns of the MMA, we examined 33 patients with transferred 5 cutaneous, 18 miocutaneous and 10 osteocutaneous free flaps of which 10 were on the foot, 13 on the lower leg and 10 on the face. We analyzed blood circulation (patency of arterial microanastomosis and perfusion) of transferred free flaps (1-3), sensitivity recovery, function of the sebaceous and sweat glands, as well as histomorphologic changes in the skin of the transferred free flaps during the period of 6 up to 36 months after the free flap transfer and compared with the same characteristics of the skin and tissue of the surrounding recipient region.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Acade... more In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Academy, 18 patients. 12 male and 6 female, with hereditary dystrophic epidermolysis bullosa (HDEB) and hand deformities were surgically treated, to achieve the complete separation of fingers, correction of the thumb adduction contracture and flexion or extension contracture of finger joints. The period of wound healing on flat surfaces after surgery, and the period between two operations was estimated. The most common deformity was the flexion contractures of metacarpophalangeal (MP) joints (45%) and one or both interphalangeal (IP) joints (types A1, A2). In 20% of the hands MP joint was stretched with the flexion contracture in distal interphalangeal (DIP) or both IP joints (types B1, B2). In 35% of hands MP joint was in hyperextension with folded proximal interphalangeal (PIP) or both IP joints (C1 i C2). The adduction deformity of the thumb type 1, without the possibility of abduction, wa...
Congenital absence of vagina is known from ancient times of Greek. According to the literature da... more Congenital absence of vagina is known from ancient times of Greek. According to the literature data, incidence is 1/4 000 to 1/20 000. Treatment of this anomaly includes non-operative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to establish anatomic and histological characteristics of vagina reconstructed by McIndoe method in Mayer Küster-Rockitansky Hauser (MKRH) syndrome and compare them with normal vagina. The study included 21 patients of 18 and more years with congenital anomaly known as aplasio vaginae within the Mayer Küster-Rockitansky Hauser syndrome. The patients were operated on by the plastic surgeon using the McIndoe method. The study was a retrospective review of the data from the history of the disease, objective and gynecological examination and cytological analysis of native preparations of vaginal stain (Papanicolau). Comparatively, 21 females of 18 and more years with normal vaginas were also studed. All the subjects were divided into the groups R (reconstructed) and C (control) and the subgroups according to age up to 30 years (1 R, 1C), from 30 to 50 (2R, 2C), and over 50 (3R, 3C). Statistical data processing was performed by using the Student's t-test and Mann-Writney U-test. A value of p < 0.05 was considered statistically significant. The results show that there are differences in the depth and the wideness of reconstructed vagina, but the obtained values are still in the range of normal ones. Cytological differences between a reconstructed and the normal vagina were found. A reconstructed vagina is smaller than the normal one regarding depth and width, but within the range of normal values. A split skin graft used in the reconstruction, keeps its own cytological, i.e. histological and, so, biological characteristics.
... Vitalnost ironsplantovanog mikrovaskulaniog rei^nja posle kom-pletiranja mikrovaskulame anast... more ... Vitalnost ironsplantovanog mikrovaskulaniog rei^nja posle kom-pletiranja mikrovaskulame anastomoze je kontrollsana; Actando-vim lesiom prulaznosti anasiomoze, krvarenjem iz ivica slobod-nog reinja ... StoSic S, Novakovic M, Jovic N, Mirkovic Z. Bogeski T. Londarevic S. et al ...
... mclanomom lokalizo-vanim na stopalu kod 4 su bila nn prstirna, od toga 1 subun-gvalni (tabela... more ... mclanomom lokalizo-vanim na stopalu kod 4 su bila nn prstirna, od toga 1 subun-gvalni (tabela I). U pogledu kliniekog lira melanoma do ... prcdnjoj strani potko-lenice, dorzu mu stopala, poglavini i za pokriva-njc sckundamog dcfckta pri rrunspoziciji velikog rcznja sa poglavine. ...
Reconstruction of the amputated breast in female patients after surgical management of breast car... more Reconstruction of the amputated breast in female patients after surgical management of breast carcinoma is possible with the use of autologous tissue, synthetic implants, or by combining autologous tissue and synthetic materials. Autologous tissue provides soft and sufficiently elastic tissue, which is usable for breast reconstruction and eventually obtains original characteristics of the surrounding tissue on the chest wall. The use of the TRAM flap for breast reconstruction was introduced in 1982 by Hartrampf, Scheflan, and Black. The amount of the TRAM flap tissue allows breast reconstruction in the shape most adequate to the remaining breast. The possibilities of using the TRAM flap as pedicled myocutaneous flap or as free TRAM flap make this flap a superior choice for breast reconstruction in comparison with other flaps.
Using vacuum in medicine has been known from long ago, however, it has not been used for the trea... more Using vacuum in medicine has been known from long ago, however, it has not been used for the treatment of wounds. The first experiments in this field were performed by Wagner Fleischmann, University of Ulm, Ulm, West Germany, in 1993. The aim of this study was to present our clinical experience with the treatment of surgical wounds complications in vascular patients by the use of controled vacuum. In a period October 2006 - December 2009 a total of 18 patients with infection and surgical wound dehiscence were treated by the use of vacuum. Vacuum was applied to wounds by placing a polyurethane sponge on them and by fixing a polyurethane foil and a sponge to the surrounding healthy skin so to completely airtight wounds. Over a foil vacuum of--150 mmHg was applied for a 5-day period, and on the day 6 a foil and a sponge were removed. In all the 18 wounds treated by the use of vacuum secondary wound closing was achieved with no complications and with a significantly shortened time period treatment. Wound infections were healed using this method and only in 2 patients antibiotics were used at the same time. The use of vacuum in the treatment of operative wounds complications is an easy and reliable method contributing significantly to wounds better healing.
Vascularized osteoseptocutaneous radial flap is commonly used in the reconstruction of composite ... more Vascularized osteoseptocutaneous radial flap is commonly used in the reconstruction of composite bony and soft tissue defects of the lower third of the face due to the outstanding quality of its cutaneous component. The aim was to evaluate the primary and overall success in the reconstruction of mandibular defects, following war injuries, with vascularized osteoseptocutaneous radial flap. At the Department of Maxillofacial Surgery of the Military Medical Academy Belgrade, there were eight patients with this kind of defect following war injury, and the mandible was reconstructed with a vascularized osteoseptocutaneous radial flap. Bony compartment of the graft was harvested as up to 11 cm long segment of radial circumference. The localization and structure of the defect, features of a harvested compound graft, the procedure of the reestablishment of the mandibular continuity was presented as well as immediate and late complications during the consolidation period, and the primary successful reconstruction in 87.5% of the patients. The primary and overall success in the mandibular defects reconstruction with a vascularized osteoseptocutaneous radial flap was equal or even better than those presented in the literature on the reconstruction of the similar defects after tumor resections.
There is a natural asymmetry in normal female brests. When the difference in the shape, size or p... more There is a natural asymmetry in normal female brests. When the difference in the shape, size or position of the breast and nipple-areola complex is visible, surgical correction is the only treatment option and presents one of the greatest challenges for a plastic surgeon. Based on the Nahai classification presented in details, the aim of the study was to present the possibilities of plastic surgery to correct primary (congenital), secondary (developmental) and tertiary (acquired) brest asymmetries. We conducted a retrospective analysis of female breast asymmetry surgeries performed in the Clinic for Plastic Surgery and Burns, Military Medical Academy (MMA), Belgrade over the last seven years (January 2002 - January 2009). During the above mentioned period, 82 female patients, 18 - 65 years of age, underwent surgery for breast asymmetry. The most frequent asymmetries were developmental, "pubertal" (n = 43); acquired asymmetries as a consequence of tumor surgery were found in the other 22 patients, while 7 patients were diagnosed with primary asymmetries such as congenital chest-wall asymmetry (Sy. Poland), accessory and tuberous breasts. All patients underwent preoperative ultrasound examination, while hormone status was determined in those with developmental, "pubertal" asymmetries. The selection of surgical procedure for correction of breast asymmetry depended upon clinical examination findings and patient's wish relating to the shape and size of the breasts. The most of breast asymmetries were corrected by a combination of surgical procedures including primary and secondary reconstruction, reduction, suspension or augmentation mammoplasty. Having combined different surgical procedures, we managed to achive satisfactory results. The hypertrophic scar formation after reduction mamoplasty was seen in some cases, however, they caused no significant patient's discomfort. Application of plastic, reconstructive and aesthetic surgical principles can considerably contribute to achieving excellent results in corrective surgery for breast asymmetries. In addition to most suitable breast asymmetry surgical procedures choice, motivation of a patient is also very important for achieving satisfactory results.
Vascular anomalies in the hand do not occur frequently. Their presence in the metacarpal region c... more Vascular anomalies in the hand do not occur frequently. Their presence in the metacarpal region can cause different functional disorders. The extent of such disorders directly depends on the localization and size of vascular anomalies, duration and the nature of the anomaly growth as well as on eventual secondary complications such as ulceration or bleeding. The aim of this case report was to show the specifics in the clinical picture, pathogenesis and evolution of such anomalies, applied diagnostic procedures (radiography, ultrasound, magnetic resonance, electromyography) and surgical treatment as well as postoperative functional results. In the Clinic for Plastic Surgery and Burns, Military Medical Academy Belgrade, two patients were treated surgically for vascular anomalies of the middle palmar region of the hand. The first patient, a 36-year-old male, a former active sportsman (professional handball player) was treated for acute increase in the vascular anomaly of hand in the metacarpal region and proximal phalange of III and IV fingers of his right hand. The anomaly was detected 6 months prior to his hospitalization while two weeks before the hospitalization there was a sudden growth and increase in the change. The second case, a 15-year-old male patient actively pursuing a career in professional basketball was treated for a tumor localized in the metacarpal zone of his left hand. According to the information provided by his parents, the anomaly had been present since his birth. Initially, the anomaly manifested itself as a discoloration of the skin with a marked capillary drawing, gradually increasing throughout the last five years to the present dimension. The growth of the malformation was noticed to coincide in both patients with more active pursuit of their professional sports career. The clinical picture of hand vascular anomalies is dominated by the symptoms of compression of neurovascular structures (paresthesia, intense hand pain, swollen fingers). If it is a chronic progressive process, signs of ischemic intrinsic muscle fibrosis with corresponding functional deficit, as well as tissue defect (usura) of bone and joint structures represent the basic pathological findings. Acute increase is accompanied by compartment syndrome symptoms and ischemic fibrosis of intrinsic hand musculature and development of irreversible dysfunction of the hand. In the presented cases rapid response implies accurate diagnostic methods followed by surgical extirpation in order to treat compartment syndrome.
The delay method is a surgical, pharmacological and combined method that includes two or more tim... more The delay method is a surgical, pharmacological and combined method that includes two or more time separated phases, which gives bigger flap surface. In our research we explored the possibility of flap surface enlargement in a new arterialised venous flap (AVF) on an experimental rabbit ear model by the delay surgical method. The aim of this research was to establish vitality surface of our AVF and to maintain the difference in flap vital surface between AVF flaps, with or without performing the delay surgery method. We used both ears of "Big Chinchilla" rabbits in 10 experimental male animals, divided into two groups, average weight 3-3.5 kg, and average age 8-10 months. In the first (experimental) group, a venous flap was arterialised by our method. In the second (control) group, the venous flap was arterialised 14 days after the delay surgical method. AVF surface was measured on the 1 and 14 days by the method of trapezoid rule. Vital surface on our AVF experimental model was bigger than 87% of elevated flap surface after the delay surgical method. Vital surface on AVF without delay on our experimental model was bigger than 30% of elevated flap surface (p < 0.001). Analysis of previous experimental models on the rabbit ear, non-delayed and delayed (to enlarge flap surface) led us to conclusion that previously created experimental models of non-delayed AVF are hemodynamically negative. Our experimental non-delay AVF model is hemodynamically more positive than previously created models of non-delay AVF and provides better conditions for AVF survival and enlargement of vital flap surface of elevated flap. On the other hand, surgical delay method significantly enlarges vital surface of AFF.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
The retrospective analysis of 1,514 cases treated at the Clinic for Plastic Surgery and Burns of ... more The retrospective analysis of 1,514 cases treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy in the period between 1991 and 1995, established that the percentage of the injuries caused by gunshots and those caused by explosives during the conflict in former Yugoslavia, was more or less the same. The injuries caused by gunshot more often occurred on the head, neck, arms and trunk. The injuries of the legs caused by the explosives were more frequent, and they occurred in 83% of the cases. All the plastic surgeons who took part in the treatment of patients and in preparing the surgeons of other specialties for the treatment applied the original classification of the war injuries according to the structure of the defects that had occurred, to standardize the approach to the planning of treatment and the treatment itself of the wounded. In the delayed primary or secondary treatment of the injuries with the tissue defects all known plastic and reconstructi...
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Papers by Jefta Kozarski