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The combination of posterior femoral head dislocation with ipsilateral intertrochanteric fracture is an extremely rare occurrence, therefore, few reports exist. In this paper, we describe a particular case of a middle-aged patient who sustained a high energy trauma which led amongst other to this lesion. We performed the reduction and fixation of the fracture-dislocation on a traction table with a Dynamic Hip Screw-plate (DHS-plate). Primary objectives of the treatment were to obtain a stable limb, to reduce blood loss in a polytraumatized patient and allow early mobilization. Follow-up after three months was good. [ABSTRACT FROM AUTHOR]

The thumb is responsible for 40% of the hand function. Therefore, when resurfacing of the thumb is required, cross-finger flap may prove very useful. In this paper, we reported three cases where cross-finger flaps were used successfully in order to cover soft tissue defects of the thumb's distal phalanx. No major complications were encountered. All patients were satisfied with the cosmetic aspect of the reconstruction procedure (9 on VAS). All the fingers were fully functional, with a mean TAM score of 266° for the donor fingers and a mean DASH score of 2.16 after 1 year from injury. Using this technique, we obtain good quality soft and bulky tissue to restore the original form of the thumb in order to prevent function loss by reducing length and primary suture of the finger. Therefore, we consider this method very effective in covering vital structures with almost no morbidity related to the donor site. Alongside other previous papers describing this technique, we concluded that the cross-finger flap is a versatile reconstruction procedure. [ABSTRACT FROM AUTHOR]

Rhinophyma is a benign tumor characterized by a progressive hypertrophy of the nasal soft tissue and it is believed to be the end stage of severe acne rosacea. It is more common in Caucasian men. The main differential diagnosis is the basal cell carcinoma. Non-surgical treatment proved insufficient in reversing this disease, while surgery remains the golden standard, even if a spontaneous regression may be observed in extremely rare cases. We presented a case of a severe rhinophyma associated with a giant nodule successfully treated with surgical removal of the suspicious tissues with safety margin and grafting of the excised area. The postoperative outcome was satisfactory for the patient. [ABSTRACT FROM AUTHOR]

The Lisfranc fracture-dislocation of the foot is uncommon and many cases are misdiagnosed. A neglected or untreated injury of the Lisfranc joint can lead to secondary arthritis and significant morbidity with disability. In this paper we described pacient's recent medical history that led to Lisfranc lesion and our means of diagnosis and treatment. The chosen implant was a limited contact plate 3.5 mm (LCP) with screws and screw fixation, and temporary Kirschner (K) wire fixation (6 weeks). The main objectives of the treatment consists in anatomical reduction associated with an early mobilization in order to avoid mineral bone loss and to keep the patient as close as possible to the fullest of its function prior to the event that has led to his static and kinematic disorder. After three months the follow-up was excellent. [ABSTRACT FROM AUTHOR]

The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. [ABSTRACT FROM AUTHOR]

The hand is both a motor and sensory organ, and in terms of society, it is an organ of defense, of creation and an organ of expression. This is why hand surgery is very important and studies regarding the functional results of different treatments in order to treat injuries are necessary. In this paper, we presented the results of a retrospective clinical study in order to compare osteosynthesis using plates and screws (n=36) versus fixation using Kirschner wires (n=32) in order to treat metacarpal fractures of 68 patients. The functional outcomes where assessed using the DASH and the TAM score measured at two and twelve months from surgery.The DASH scores were lower (showing better results) in the PS group compared to the KW group, with a mean difference of 20.53 after two months and 6.41 after twelve months, while the TAM scores were higher (235° at two and 261° at twelve months in the PS group compared with 218° at two and 257° at twelve months in the KW group). Therefore, we concluded that osteosynthesis using plates and screws leads to better functional recovery than osteoynthesis using Kirschner wire. [ABSTRACT FROM AUTHOR]

The thumb is responsible for 40% of the hand function. Therefore, when resurfacing of the thumb is required, cross-fi nger flap may prove very useful. In this paper, we reported three cases where cross-fi nger flaps were used successfully in order to cover soft tissue defects of the thumb`s distal phalanx. No major complications were encountered. All patients were satisfi ed with the cosmetic aspect of the reconstruction procedure (9 on VAS). All the fi ngers were fully functional, with a mean TAM score of 266° for the donor fi ngers and a mean DASH score of 2.16 after 1 year from injury. Using this technique, we obtain good quality soft and bulky tissue to restore the original form of the thumb in order to prevent function loss by reducing length and primary suture of the fi nger. Therefore, we consider this method very effective in covering vital structures with almost no morbidity related to the donor site. Alongside other previous papers describing this technique, we concluded that the cross-fi nger flap is a versatile reconstruction procedure. [ABSTRACT FROM AUTHOR]

The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. [ABSTRACT FROM AUTHOR]

The hand is both a motor and sensory organ, and in terms of society, it is an organ of defense, of creation and an organ of expression. This is why hand surgery is very important and studies regarding the functional results of different treatments in order to treat injuries are necessary. In this paper, we presented the results of a retrospective clinical study in order to compare osteosynthesis using plates and screws (n=36) versus fi xation using Kirschner wires (n=32) in order to treat metacarpal fractures of 68 patients. The functional outcomes where assessed using the DASH and the TAM score measured at two and twelve months from surgery.The DASH scores were lower (showing better results) in the PS group compared to the KW group, with a mean difference of 20.53 after two months and 6.41 after twelve months, while the TAM scores were higher (235° at two and 261° at twelve months in the PS group compared with 218° at two and 257° at twelve months in the KW group). Therefore, we concluded that osteosynthesis using plates and screws leads to better functional recovery than osteoynthesis using Kirschner wire. [ABSTRACT FROM AUTHOR]

Purpose of review: The aim of this paper is to provide the clinician an overview about the link between iron homeostasis and erythropoiesis and how we can promote this relationship in order to improve surgical patients’ outcome. Key elements: Iron is essential for various cellular processes, like cell signalling, oxygen transport, erythrocyte and heme synthesis, mitochondrial respiration, host defence, nucleic acid replication. Erythropoietin and iron are the main erythropoiesis regulators. Under iron-restricted conditions, the erythrocytes production is impaired, leading to microcytic hypochromic anemia appearance. Iron-restricted condition enables patient capacity to recover from post-surgery anemia. Long-term consequences of chronic anemia affect patient’s quality of life. Therefore, parenteral iron supplementation, in patients with anemia secondary to blood loss, can lead to a fivefold increase in erythropoietic response, therefore enhancing recovery. Summary: Under normal circumstances, the link between iron and erythropoiesis is maintained especially through regulatory feedback mechanisms, with minimal external support. In face of important blood loss, with secondary acquired iron-restricted anemia, parenteral iron supplementation improves the bone marrow erythroid response and helps correcting haemoglobin levels. [ABSTRACT FROM AUTHOR]

Severe burn injuries represent a major challenge to the entire healthcare system in developing countries and even for states with a high standard of care. A clear understanding of the physiopathology of burn injuries is essential for providing an adequate prompt treatment to ensure an optimal patient outcome. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. Specific treatment must be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance. A diagnostic and therapeutic algorithm is presented, centered on infectious source prevention and control with early surgical excision and skin grafting together with culture-guided antimicrobial therapy. It is a known fact that, indifferent of the involved germ, the best intervention for both prophylaxis and treatment of infections in the burn patient is the early excision of the devitalized tissue and subsequent closure of burn wounds with skin grafts, measures that diminish local and systemic mediator releasing effects in burnt tissue, attenuating the progressive inflammatory chain. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hypokalemia in psychiatric population is very high with eating disorders and laxative abuse being the main incriminated factors. Case presentation: We report a case of a 34-year-old woman with history of sleeve gastrectomy and breast implant, who presented for fatigue, severe myalgia, generalized hypotonia and palpitations. Laboratory exams revealed severe hypokalemia and rhabdomyolysis. The electrocardiography showed prolonged QT interval and ST segment depression with second-degree atrioventricular block. She received intravenous potassium supplementation with consecutive hydration. When potassium level was within safety limits, the patients received loop diuretics in order to decrease rhabdomyolysis and avoid kidney injury. The underlying cause was a pathological behavior, with frequent self-provoked episodes of nausea and vomiting after eating and chronic consumption of laxatives. She started psychotherapy. Conclusion: Psychiatric behaviour can lead to life-threatening conditions, therefore it should be discovered and managed promptly. [ABSTRACT FROM AUTHOR]

Introduction: Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment. [ABSTRACT FROM AUTHOR]

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years. [ABSTRACT FROM AUTHOR]

Introduction: Severe burn injuries still are a major challenge for the entire healthcare system. Multiple predictive factors may influence the prognosis of burn patients and a careful management of those parameters will decrease the morbidity and mortality and will determine an improvement in patient's final functional outcome. Material and Methods: We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. A detailed analysis was performed on those 210 critical patients in order to determine the parameters that aggravate the prognosis of burn injuries. A large data panel was taken into consideration regarding burn severity, mechanism of injury, patient characteristics, associated illnesses, promptitude in hospitalizing the patient in our burn center; ABSI score was used to evaluate the mortality risk, burn injury-associated complications were noted and analyzed. Results and discussion: We highlighted a series of parameters regarding therapeutic management that influence the outcome of the patient after severe burn injury: an adequate hydro-electrolytic resuscitation in the acute phase, further support of vital functions, early excision and grafting of deep burn injuries, comorbidities treatment and adherence to rehabilitation and follow-up program. ABSI Score is an important tool in the assessment of mortality in burn patients. Multiple complications were encountered in our patients: infections, pulmonary, cardiac, renal, thrombo-embolic, hematologic, digestive and neurologic disorders. Conclusion: A detailed analysis of the physiopathology of burn injuries and their complications is essential for providing an adequate prompt treatment for decreasing morbidity and mortality. Mortality still represents the primary outcome evaluation for burn care, therefore scoring systems aim to use the most predictive patient and injury-related parameters to appreciate an expected mortality for a given patient. Early excision of the devitalized tissue and subsequent grafting reduce the local and systemic effects of the mediators released from the burned tissue with cessation of the progressive inflammatory chain. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. [ABSTRACT FROM AUTHOR]

Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety efficiency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion. [ABSTRACT FROM AUTHOR]

Introduction: The more and more frequent use of radiotherapy has hindered the approach manner of breast reconstruction. Applied before, during or after breast reconstruction, the radiotherapy compromises the esthetical results. Material and Method: The team's study included a number of 68 patients admitted to the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu" Plastic and Reconstructive Surgery, within the period May 2013 - June 2017 for breast reconstruction after radical modified mastectomy with adjuvant treatment, chemotherapy / radiotherapy, or for subcutaneous mastectomy and immediate reconstruction with oncological indication. Among the followed objectives, we can list: the comparative assessment of the various reconstructive techniques with the premises of the presence of an adjuvant treatment of the curative mastectomy; the influence exercised by the medical history of the patient on the final result of the reconstruction and the susceptibility to complications or the need for a surgical re-intervention based on the used reconstructive procedure. Results: A careful and detailed pre-operatory assessment of the expectations of the patient and the selection of the adequate reconstructive procedure represent a necessity for a satisfying result. The breast reconstruction with implant during the associated therapy leads to the possibility of development of capsular contracture. Also, the additional use of a flap does not always offer protection against this complication. Conclusion: The radiotherapy improves the survival rate in the case of the patients with breast cancer in advanced stages, but makes difficult the selection of a reconstructive procedure. [ABSTRACT FROM AUTHOR]

We present a case of a 40 years old female who was admitted in our hospital after a road accident with thoracolombar, right fibula and tibia trauma injuries. Physical examination relevant for kidney injury was only represented by macroscopic hematuria. Findings on computed tomography (CT) imaging were defining to put the diagnosis of posttraumatic right renal artery thrombosis. She underwent classical total nephrectomy do to the prolonged renal ischemia time (>48 hours after the accident). [ABSTRACT FROM AUTHOR]

Adenocarcinoma of the pancreatic tail remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. Surgery remains the goldstandard of treatment for pancreatic ductal adenocarcinoma and complete removal of the cancer confers a definite survival advantage. We report the case of a 48 year old male patient with imagistic findings (CT scan, MRI) that reveal a pancreatic tail tumor with advanced loco-regional invasion and liver metastasis. Multivisceral resection with liver metastasectomy was performed, with postoperative outcome complicated by Clostridium difficile infection (CDI). No signs of local recurrence or distant metastasis were present at three months follow-up. Chemotherapy was delayed due to pulmonary thromboembolism 5 weeks after surgery and a severe recurrence of the CDI was diagnosed 9 weeks postoperatively. We consider that a multidisciplinary meeting is mandatory to optimize the outcome in these type of patients. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing postmastectomy breast reconstruction, with a history of prior radiation therapy, present a particular clinical scenario. This is because of their well-documented higher complication rates, secondary to deleterious effects of irradiation on the soft tissue envelope of the remaining breast. Case presentation: This article presents the case of a breast reconstruction in a 53-year old woman with two subsequent breast reconstruction procedures after being treated with chemotherapy and radiotherapy. The first procedure was placing an expander under the mastectomy skin flaps, but it was followed by complications requiring the removal of the expander. One year later the second procedure was performed with latissimus dorsi flap and implant with satisfactory results. But after two years from the latest procedure, the patient turned to our clinic for improvement of the cosmetic outcome. Taking into account the medical and surgical history of the patient and after a complete clinical evaluation, the decision was to perform the right breast reconstruction with contralateral unipedicle musculocutaneous TRAM flap. Conclusions: The aesthetic results of standard delayed breast reconstruction after radiation therapy in patients with locally advanced breast cancer are satisfactory at best, even in the hands of experienced surgeons. The result quality that can be obtained in a patient with previous radiotherapy is therefore less optimal than the one achieved in a nonirradiated patient. [ABSTRACT FROM AUTHOR]

Background: The reconstruction of the breast with latissimus dorsi muscle-cutaneous flap and implant continues to be a reliable and easy to perform method, both by the experienced surgeons and also for the beginners. Case presentation: This article describes the case of a 38-year old woman who underwent breast reconstruction after 5 months from the mastectomy. After the clinical and paraclinical evaluation, all reconstruction options were presented to her, with advantages and disadvantages. Following the detailed pre-operatory evaluation and observing, as much as possible, the desires of the patient - to have a bigger breast compared to the amputated one and, at the same time, with an as natural as possible aspect, observing the integrity of the abdominal wall and the possibility to hide the scar of the donor area at the back - the surgical team together with the patient decided the reconstruction of the right breast with latissimus dorsi muscle - cutaneous flap and silicone implant (295cc). Even if the specialty literature presents this technique with some disadvantages in the final results and functionality of the ipsilateral shoulder, in this case the latissimus dorsi muscle-cutaneous flap offered a good coverage with satisfactory cosmetic outcome and proper functionality of the shoulder. Conclusions: Through the approach of a standardized protocol and adjusted to the requirements and anatomic possibilities of the patient, the breast reconstruction with LD and implant remains one of the most versatile techniques of reconstruction and which local complications are comparable to the ones in the esthetic mammary augmentation. [ABSTRACT FROM AUTHOR]

Work-related accidents have a great spread worldwide. The incidence of crush syndrome is 2-15% in all trauma patients and in many cases may lead to trauma related amputation. This type of patients are at risk of developing cardio-vascular instability, renal failure, other organ failure and metabolic abnormalities. The treatment is complex and should prevent and treat all the complications. In the present paper we reported a case of work related injury which lead to the above-knee amputation, followed by severe complication and difficult social rehabilitation. In this particularly cases, when you think that the fight is almost over, a new organ failure may occur and threaten the life of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Skin flaps are often use for reconstructing cutaneous defects. Based on their blood supply these are classified in random and axial flaps, the success of their survival being adequate perfusion. Infrared thermographic camera measures the skin temperature, influenced by vessel distribution. The objectives of the study: The purpose of this paper is to evaluate the skin vascularization using the thermographic camera in order to design viable facial flaps. Used methodology: We present the cases of three patients with facial defects reconstructed using local and regional flaps whose vascularization was monitored pre and postoperatively using a thermal camera. No local complications occurred and aesthetic and functional outcome was good. Conclusions: Infrared thermographic camera might represent a new method of evaluating flap vascularization that could help in minimizing ischemic complications in flap surgery. [ABSTRACT FROM AUTHOR]

Introduction: Severe burn injuries still are a major challenge for the entire healthcare system. Multiple predictive factors may influence the prognosis of burn patients and a careful management of those parameters will decrease the morbidity and mortality and will determine an improvement in patient's final functional outcome. Material and Methods: We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. A detailed analysis was performed on those 210 critical patients in order to determine the parameters that aggravate the prognosis of burn injuries. A large data panel was taken into consideration regarding burn severity, mechanism of injury, patient characteristics, associated illnesses, promptitude in hospitalizing the patient in our burn center; ABSI score was used to evaluate the mortality risk, burn injury-associated complications were noted and analyzed. Results and discussion: We highlighted a series of parameters regarding therapeutic management that influence the outcome of the patient after severe burn injury: an adequate hydro-electrolytic resuscitation in the acute phase, further support of vital functions, early excision and grafting of deep burn injuries, comorbidities treatment and adherence to rehabilitation and follow-up program. ABSI Score is an important tool in the assessment of mortality in burn patients. Multiple complications were encountered in our patients: infections, pulmonary, cardiac, renal, thrombo-embolic, hematologic, digestive and neurologic disorders. Conclusion: A detailed analysis of the physiopathology of burn injuries and their complications is essential for providing an adequate prompt treatment for decreasing morbidity and mortality. Mortality still represents the primary outcome evaluation for burn care, therefore scoring systems aim to use the most predictive patient and injury-related parameters to appreciate an expected mortality for a given patient. Early excision of the devitalized tissue and subsequent grafting reduce the local and systemic effects of the mediators released from the burned tissue with cessation of the progressive inflammatory chain. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. [ABSTRACT FROM AUTHOR]

Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety effi ciency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion. [ABSTRACT FROM AUTHOR]

We present a case of a 40 years old female who was admitted in our hospital after a road accident with thoracolombar, right fi bula and tibia trauma injuries. Physical examination relevant for kidney injury was only represented by macroscopic hematuria. Findings on computed tomography (CT) imaging were defi ning to put the diagnosis of posttraumatic right renal artery thrombosis. She underwent classical total nephrectomy do to the prolonged renal ischemia time (>48 hours after the accident). [ABSTRACT FROM AUTHOR]

Work-related accidents have a great spread worldwide. The incidence of crush syndrome is 2-15% in all trauma patients and in many cases may lead to trauma related amputation. This type of patients are at risk of developing cardio-vascular instability, renal failure, other organ failure and metabolic abnormalities. The treatment is complex and should prevent and treat all the complications. In the present paper we reported a case of work related injury which lead to the above-knee amputation, followed by severe complication and diffi cult social rehabilitation. In this particularly cases, when you think that the fi ght is almost over, a new organ failure may occur and threaten the life of the patient. [ABSTRACT FROM AUTHOR]

Background: The reconstruction of the breast with latissimus dorsi muscle-cutaneous flap and implant continues to be a reliable and easy to perform method, both by the experienced surgeons and also for the beginners. Case presentation: This article describes the case of a 38-year old woman who underwent breast reconstruction after 5 months from the mastectomy. After the clinical and paraclinical evaluation, all reconstruction options were presented to her, with advantages and disadvantages. Following the detailed pre-operatory evaluation and observing, as much as possible, the desires of the patient - to have a bigger breast compared to the amputated one and, at the same time, with an as natural as possible aspect, observing the integrity of the abdominal wall and the possibility to hide the scar of the donor area at the back - the surgical team together with the patient decided the reconstruction of the right breast with latissimus dorsi muscle - cutaneous flap and silicone implant (295cc). Even if the specialty literature presents this technique with some disadvantages in the fi nal results and functionality of the ipsilateral shoulder, in this case the latissimus dorsi muscle-cutaneous flap offered a good coverage with satisfactory cosmetic outcome and proper functionality of the shoulder. Conclusions: Through the approach of a standardized protocol and adjusted to the requirements and anatomic possibilities of the patient, the breast reconstruction with LD and implant remains one of the most versatile techniques of reconstruction and which local complications are comparable to the ones in the esthetic mammary augmentation. [ABSTRACT FROM AUTHOR]

In recent years, the number of medical litigations is increasing and defensive medicine becomes a widespread approach among physicians all over the world. Defensive behavior of physicians is more common in scheduled, elective, compared to emergency medical services. The immediate direct consequences of this defensive behavior are found in the increase of costs (additional investigations) and the increase of waiting time for certain procedures and interventions (repeated postponements). Diffi cult and uncomfortable to admit that it exists, but defensive behavior is a reality. It raises numerous and complex ethical issues, and the goal of health policies should be to reduce this phenomenon. [ABSTRACT FROM AUTHOR]

When a surgical team is dealing with an after-hours colorectal surgery, they are actually confronting with a chain of elements and events, some linked to the patient and severity of the surgical case, others related to the medical team ability to cooperate, from nurses to surgeon and anesthetist. There is a series of differences between elective and emergency performed surgeries, two of them and most important elements are the patient (disease type, age, preoperative condition) and the operating team (experience, technical performance after-hours, especially at night). [ABSTRACT FROM AUTHOR]

Background: Patients undergoing postmastectomy breast reconstruction, with a history of prior radiation therapy, present a particular clinical scenario. This is because of their well-documented higher complication rates, secondary to deleterious effects of irradiation on the soft tissue envelope of the remaining breast. Case presentation: This article presents the case of a breast reconstruction in a 53-year old woman with two subsequent breast reconstruction procedures after being treated with chemotherapy and radiotherapy. The fi rst procedure was placing an expander under the mastectomy skin flaps, but it was followed by complications requiring the removal of the expander. One year later the second procedure was performed with latissimus dorsi flap and implant with satisfactory results. But after two years from the latest procedure, the patient turned to our clinic for improvement of the cosmetic outcome. Taking into account the medical and surgical history of the patient and after a complete clinical evaluation, the decision was to perform the right breast reconstruction with contralateral unipedicle musculocutaneous TRAM flap. Conclusions: The aesthetic results of standard delayed breast reconstruction after radiation therapy in patients with locally advanced breast cancer are satisfactory at best, even in the hands of experienced surgeons. The result quality that can be obtained in a patient with previous radiotherapy is therefore less optimal than the one achieved in a nonirradiated patient [ABSTRACT FROM AUTHOR]

Adenocarcinoma of the pancreatic tail remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. Surgery remains the goldstandard of treatment for pancreatic ductal adenocarcinoma and complete removal of the cancer confers a defi nite survival advantage. We report the case of a 48 year old male patient with imagistic fi ndings (CT scan, MRI) that reveal a pancreatic tail tumor with advanced loco-regional invasion and liver metastasis. Multivisceral resection with liver metastasectomy was performed, with postoperative outcome complicated by Clostridium diffi cile infection (CDI). No signs of local recurrence or distant metastasis were present at three months follow-up. Chemotherapy was delayed due to pulmonary thromboembolism 5 weeks after surgery and a severe recurrence of the CDI was diagnosed 9 weeks postoperatively. We consider that a multidisciplinary meeting is mandatory to optimize the outcome in these type of patients. [ABSTRACT FROM AUTHOR]

Introduction: Skin flaps are often use for reconstructing cutaneous defects. Based on their blood supply these are classifi ed in random and axial flaps, the success of their survival being adequate perfusion. Infrared thermographic camera measures the skin temperature, influenced by vessel distribution. The objectives of the study: The purpose of this paper is to evaluate the skin vascularization using the thermographic camera in order to design viable facial flaps. Used methodology: We present the cases of three patients with facial defects reconstructed using local and regional flaps whose vascularization was monitored pre and postoperatively using a thermal camera. No local complications occurred and aesthetic and functional outcome was good. Conclusions: Infrared thermographic camera might represent a new method of evaluating flap vascularization that could help in minimizing ischemic complications in flap surgery. [ABSTRACT FROM AUTHOR]