Acta chirurgiae plasticae
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Microneedling (percutaneous collagen induction therapy) is a new promising miniinvasive therapeutic method for the treatment of skin alterations of different aetiology, including burn scars. Since 2016, it is also available at our department. The microtraumatization of scars with the Dermaroller® leads to an activation of the healing cascade, activation of growth factors, which activate cell proliferation in the wound, increased synthesis and deposit of collagen - elastin complex with successive transformation of collagen III to collagen I, to neoangiogenesis and thus to accelerated scar remodelling. ⋯ Our first clinical experience show that microneedling appears to be a suitable microinvasive method for the improvement of scar quality after burn trauma.
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Early necrectomy and skin autotransplantation are prerequisites for successful treatment of extensive burns. Insufficient autograft donor site availability is a limiting factor. The Meek micrografting technique, published by C. P. Meek in 1958, appears to be a potential solution. Skin grafts are cut into micrografts and expanded at a ratio of 1:3, 1:4, 1:6 or 1:9. Thus, even in cases with limited donor site availability, it is possible to cover large areas after necrectomy. ⋯ Meek micrografting is effective in the surgical management of deep burns in extensive thermal injuries with limited donor site availability...
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Even though reconstructive surgery of the nerves underwent significant progress due to experimental and clinical research over the past 40 years, injuries to the peripheral nerves still remain a great challenge for microsurgery. Literature results of these procedures are often evaluated as very good but the final result is often characterized by an achievement of only a useful and not full function, which is rather rare. It is not only a simple suture; the success is also based on functional regeneration and interconnection of the nerve fibres. ⋯ Apart from standard neurolysis and epi- or perineural suture with or without nerve grafts, distal nerve transfers (in case of proximal injuries) and end-to-side neurorrhaphy (mainly in trauma of sensitive nerves) have recently been frequently used. The future is however based on influence of nerve regeneration at the cellular level using substances with growth potential. The main prerequisite of successful surgery is however early indication of surgical revision in a specialized centre.
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Acta chirurgiae plasticae · Jan 2020
SKIN SUBSTITUTES IN RECONSTRUCTION SURGERY: THE PRESENT AND FUTURE PERSPECTIVES.
The progress in critical and intensive care burn management in the 21st century has significantly reduced mortality in patients with critical burn injuries. This progress has moved the focus of burns care from simple survival to the quality of life after the burn trauma, in particular to healing of defects caused by full-thickness burns, subsequent maturation, characteristics and appearance of the scars. The benefits of the application of skin substitutes include elimination of excessive scarring, hypertrophic and keloid scar formation and subsequent contracture development. The authors of this article present the strategy of use, application and development of dermal scaffolds as well as the current trends in the use of dermal scaffolds in the treatment of full-thickness burns.
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Acta chirurgiae plasticae · Jan 2013
Review Case ReportsCombined triggering at the wrist and fingers and severe carpal tunnel syndrome caused by macrodystrophia lipomatosa. Case report and review of literature.
Macrodystrophia lipomatosa (MDL) is a rare, congenital, developmental anomaly causing localized overgrowth of a digit(s) or extremity. Trigger wrist is a relatively rare entity, which may be caused by a mass originating from a tendon, an anomalous muscle or intracarpal pathologies. A 42-year-old male patient presented with triggering during active motion of the fingers and intractable pain and numbness in fingers to our emergency department. ⋯ The index finger was bigger than the other fingers and thenar eminence area of the hand looked like a large mass. Resection of hypertrophic carpal bone and debulking of large soft tissue mass removed the carpal tunnel symptoms and limited the range of motion of the wrist and fingers. This is a case report of triggering at the wrist and severe carpal tunnel syndrome due to carpal bone enlargement and lipofibromatous hamartoma (LH) of the median nerve in a patient with MDL.