1/37. Experience with banked skin in the Prague Burn Center.Despite progress in materials science, the use of human allografts and xenografts of pig origin is in the Prague Burn Center among the preferred means of temporary burn wound cover since 1973. True closure is achieved only with living autografts or isografts (identical twins). The method for preparing fresh porcine grafts was introduced in Prague 25 years ago: dermoepidermal sheets are retrieved in strips, are treated with a lavage of chemotherapeutics and antibiotics, are spread onto sterile wet gauze and stored in Petri dishes at 4 degrees centigrade in a refrigerator. Cellular viability is maintained for 10-14 days when transferred to patients. The Prague skin Bank commenced its activity in 1986. The Protocol for the cryopreservation of skin was established: the pretreated skin is kept in aluminium vessels in containers with vapours of liquid nitrogen. Cryoprotective Medium is used with 15% glycerol. The skin viability has been verified by investigation of glucose metabolism. The production of fresh and long-term stored viable skin grafts has been increasing continuously and at present, the production represents 2 million square centimeters per year. About 15% of the harvest is distributed to other surgical and trauma departments. Any burn wound dressing may fail due to a failure to use them properly-lack of attention to the details in burn wound care can lead to disappointment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/37. Resurfacing deep wound of upper extremities with pedicled groin flaps.A total of 29 axial pedicled groin skin flaps were applied clinically with satisfactory result excepting for one flap which tailed on transplantation. These cases included severe scar contracture of the dorsum of hands in 20 patients, deeply burned wounds with infection and exposure of deep structure in upper extremities in nine patients, such as electrical burns and hot-crushing injuries. The flap is supplied by two groups of nutrient vessels with abundant vascularization and located in a hidden area. Therefore, the pedicled groin skin flap is still valuable due to its advantages as safe, easy operation and strong antiinfective ability although the free groin flap is more widely used today.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/37. Microsurgical reconstruction of the thermally injured upper extremity.The use of free flaps for coverage of the deeply burned hand has advantages that include the salvage of the exposed vessels, nerves, tendons, joints, and bone; a single operation to obtain wound closure, minimizing the risk of infection; and earlier physical therapy. This article focuses on the choice of suitable free flaps for the coverage of the deeply burned hand; and it also presents some case reports.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/37. Reconstruction of a full-thickness defect of the chest wall caused by friction burn using a combined myocutaneous flap of teres major and latissimus dorsi muscles.This report describes the therapeutic course of a case of deep burns caused by friction heat generated over a long contact time by a rotating tractor wheel. The burn was accompanied by a full-thickness defect of the chest wall, which we treated with a combined myocutaneous flap of teres major and latissimus dorsi muscles with a large skin flap. Our therapeutic concept of this case is discussed. Based on the postoperative course of this case, we think a combined myocutaneous flap of teres major and latissimus dorsi muscles with two nourishing vessels as an alternative is a very useful, safe, and secure method for the treatment of cases with axillary damages which require one-stage and stable reconstruction, like our patient.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/37. Free lateral supramalleolar flap transfer as a small, thin flap.Lateral supramalleolar flaps were elevated as free flaps and transferred with microvascular anastomoses in 3 patients. The peroneal vessels were used for the vascular anastomosis. In all patients, the flaps survived completely. The free lateral supramalleolar flap is thinner than the peroneal flap and is as thin as the radial forearm flap. This flap is useful when thin, small flaps are required, and may be a valuable alternative to the radial forearm flap because it necessitates less donor site morbidity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/37. An anatomical and clinical study of the dorsal intercostal cutaneous perforators, and application to free microvascular augmented subdermal vascular network (ma-SVN) flaps.We report a two-part anatomical and clinical study whose aim was to map the dominant dorsal intercostal cutaneous perforators (DICPs), which are useful for microvascular augmentation of flaps raised from the skin of the back called subdermal vascular network (SVN) flaps, and to test their reliability in the clinical setting. In the anatomical arm of the study, using preserved cadavers, we macroscopically confirmed the location of DICPs, and performed micro-angiography of the dorsal skin to find each dominant DICP. In the clinical arm of the study, we confirmed the location of the dominant DICP during microvascular augmented SVN flap transfer. Postoperatively, posteroanterior radiographs of the chest were taken to locate vessel clips used to ligate the DICPs. The combined study results showed that the dominant DICP is the sixth or seventh in most instances, but there are some anatomical variations. If no dominant DICP is found in the sixth or seventh spaces, at least one DICP that is of sufficient calibre for microvascular augmentation can usually be found in the general vicinity, such as the fifth, eighth or ninth spaces. The clinical application of microvascular augmented SVN flaps, both pedicled and free, is presented.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/37. The microvascular augmented subdermal vascular network (ma-SVN) flap: its variations and recent development in using intercostal perforators.In 1994 we reported the use of the microvascular augmented occipito-cervico-dorsal 'super-thin' flap for reconstruction of the cervical region in three cases. Since this preliminary report, we have performed a further 17 flaps, and the usefulness of the flap in the treatment of anterior cervical scar contractures in extensively burned patients has become apparent. Moreover, we have devised flaps with not only a narrow skin pedicle but also myocutaneous or island vascular pedicles. Various augmentation vessels, including myocutaneous perforators of the intercostal spaces in the back and chest, have also been used successfully. Here, we describe the microvascular augmented subdermal vascular network flaps that we have devised.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/37. Local perforator flap for reconstruction of deep tissue defects in the elbow area.Limited deep tissue defects in the elbow area can occur after burns, advanced bursitis, and inflammatory processes, to name a few. Reconstruction is complicated because sufficient tissue with adequate elasticity and strength has to be transferred. Often major surgical procedures such as free tissue transfer are considered. A novel method for reconstruction of deep tissue defects in the elbow area, based on a single perforator artery and vein, is described. Perforator vessels are identified preoperatively using color Doppler ultrasonography, and a flap from the upper arm is rotated 180 degrees. The authors describe the successful treatment of two patients. The surgical technique is comparatively simple and can be performed with regional anesthesia. Postoperative recovery is short and skin sensibility is retained. The authors suggest that local, single perforator flaps can be considered as a first alternative in treatment of limited, deep tissue defects in the elbow area, especially for elderly or severely ill patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/37. Prefabricated galeal flap based on superficial temporal and posterior auricular vessels.scalp layers are widely used in reconstructive procedures. The authors used prefabricated galeal flaps based on the superficial temporal or postauricular vessels for ear, cheek, mandible, and cranium reconstructions in three cases. In case 1, synchronous beard and ear reconstructions were accomplished by using the temporoparietal and retroauricular flaps. In case 2, a buccomandibular defect was reconstructed by transposing the supra-auricular and retroauricular galea with prefabricated bone and skin. In case 3, an epidural hematoma in the left frontoparietal area was evacuated after a circular craniectomy. The harvested bone was not put back on the defect area but buried between the periosteal and galeal layers because of brain edema. These layers were raised as an osteogaleoperiosteal flap and transposed onto the defect area after 7 weeks. When used with a prefabrication method, scalp layers offer versatile options for repairing composite defects of the head region. A galeal flap based on the posterior auricular vessels is practical and reliable in reconstructive procedures. The authors suggest that this flap is an option in cases in which the temporoparietal fascia artery or the superficial temporal artery is not available. Prefabrication of the harvested cranial bone inside the adjacent tissues offers several advantages in that a viable bone is provided at the end of the procedure, intervention at a distant area is avoided, the graft is placed on osteogenic tissue (periosteum) that is also transposed onto the defect, and sophisticated procedures such as microsurgical techniques are not needed.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
10/37. hair growth following scalp microvascular flap transfer for baldness due to burn injury.A female patient, 8 years of age, presented with baldness of the right scalp following deep scalds from boiling soup landing on the head, neck, and chest. The depth of the burn was severe enough to cause baldness. She was primarily advised to wear a wig to address the problem of baldness on one side. Surgery was planned to use uninjured scalp skin to offer hairy skin coverage of the bald site. A left scalp skin flap (2.5 by 7 cm) based on the superficial temporal artery and vein was transferred to the bald area, with microvascular anastomosis to the superficial temporal vessels on the right side. There was complete survival of the flap with uneventful recovery and satisfactory growth of hair. hair growth from the flap was comparatively thicker than from the rest of the scalp. This microvascular flap has produced sufficient hair to cover the entire area of the baldness and the patient does not need to wear a wig.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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