Esophago-diaphragmatic plastic surgery in cardiostenosis

When performing plasty of cardiostenosis the author proposes to dissect the muscular ring of the esophageal opening along the anterio-lateral border in order to avoid a disturbance of the His angle. The resulting anterior and posterior flaps of the diaphragm are mobilized. The stenosed part of the esophagus is dissected longitudinally up to the submucous layer on its anterio-lateral surface. Plastic reconstruction of the muscular defect of the cardia is performed by the anterior flap of the muscular ring of the esophageal opening of the diaphragm having rich blood supply. The posterior flap of the diaphragm is sutured to the lower border of the anterior flap.     

Choice of the method of plasty in hiatal hernia]

Results of operative treatment of patients with esophageal hernias of the diaphragm can be substantially improved in cases of differential approach to choice of the plasty method. Choice of the method of plasty depends on the hernia type, topographic-anatomical structure of the esophageal opening of the diaphragm, concomitant diseases and age of the patient. Preference should be given to methods of non-complete fundoplication performed from the transabdominal access.     

Accelerated plastic surgery using inguinal flap on temporary feeding pedicle

The method of accelerated plasty with an inguinal flap was used for treatment of 13 patients with electric burns and frostbites of the IV degree. The 2nd step of the non-free skin plasty was performed 5 days (120 hours) after the first operation which was possible following a special training--a periodical, with increasing duration of the compression of the flap feeding pedicle which was started next day after the first step of the plasty.     

Autodermal plasty in postoperative ventral hernias

The method of autodermal plasty was used in 299 patients with postoperative ventral hernias. Among them great and giant hernias made up 62,8%. The autodermal method of plasty results in less amount of complications in the wound which can be explained by an increased concentrations of humoral non-specific defense factors in the operation field due to the effect of the skin flap. Remote results were followed in 84% of the patients during 2-6 years. Recurrences were detected in 3,2%.     

Use of a radial flap of the forearm in plastic and reconstructive surgery of the extremities

A detailed characteristic of the ways of using fascio-cutaneous, osteo-cutaneous and muscular-cutaneous flaps disposed in the basin of the radial vascular bundle is given on the basis of an experience with 18 operations. Non-free plasty by an island flap on a peripheral vascular pedicle was used in 13 patients. Free plasty with microvascular anastomoses was used in 4 patients. In 16 of the 17 patients a complete take of the flap took place.     

The use of muscle flaps in the surgical treatment of infected vascular prosthesis

The solutions for graft infection and its complications in vascular surgery are well known. However, publications dealing with this topic do not, or just occasionally mention muscular flap plast, which is already quite widely used in other fields of surgery. The authors first used pedicled muscular flap plasty in 1996, to cover grafts that had been exposed as a result of infection. Later, this method was also applied in covering subinguinal suturelines and anastomoses respectively, to ward off impending haemorrhage. Between 1996 and 1999, 32 patients presenting with septic complications after vascular surgery were treated. Muscular flap plasty was performed in 12 of these cases. In 7 patients the exposed graftsere covered, while in 5 patients the subinguinal suture-lines and anastomoses were covered respectively with muscle flaps, 5 of the graft covering procedures were successful. In two cases of superinfection and septic progression respectively the graft had to be removed without amputation of the extremity. 3 successful operations were recorded in the cases where the covering of the subinguinal suturelines and anastomoses were the aim. 2 patients presented with erosive haemorrhage, which led to ligation of the femoral artery and consequent amputation, in view of the absence of further possibilities for reconstruction.     

Use of external brachial cutaneo-fascial flap for plastic microsurgery of defects of functionally important areas of the hand and foot

On the basis of morphological investigations on 20 non-fixed cadavers, the microsurgical anatomy of the external fasciocutaneous brachial flap was detailed . A flap was successfully used for plasty of the tissue defects of the foot, forearm and hand in 14 patients. The recommendations concerning the technique of flap elevation and transplantation are given.     

Hernioplasty with a dermal autograft in recurrent and postoperative hernias

Long-term results of treatment of ventral recurrent and postoperative hernias by Yanov's method from 1988 till 2000 in 160 patients aged from 19 to 65 years were studied. Depending on the type of hernia the autodermal strip, flap or their combination were used for plasty of hernial ring. Recurrence was in 6.2% patients, wound suppuration--in 4.3%. One elderly patient died of postoperative pneumonia.     

Treatment of wide scar contracture of antecubital fossa with bipedicle flap from scar tissue

Many surgical techniques exist for reconstruction of burn scar contracture of the antecubital fossa, such as Z plasty, VY plasty, lateral arm flap, and medial arm flap. Another option is direct release of the scar contracture and skin graft of the defect area, which requires prolonged splinting and risk of graft failure. Additionally, in the areas with exposed tendons or vessels, we cannot use grafts. Recurrence of contracture remains another drawback of this treatment, in this article we present a new, simple alternative method for treatment of these cases. In this clinical trial we introduce a new technique of bipedicle flap from scar tissue for coverage of the antecubital fossa with skin grafting of the proximal and distal parts of this bipedicle flap. From July 2002 to July 2005 we used this flap in 12 patients and efficacy and versatility of this flap was studied. Seven patients were female and 5 were male with mean age of 23.7 years. The mean time between burn and our reconstructive operation was 3.2 years. The mean surface area of antecubital burn scar tissue was 77.5%. Mean extension lag before operation was 66.5 degrees , mean extension lag during operation was 4.5 degrees and after operation was 5.4 degrees . Minor complication was observed in two cases with necrosis of the flap margin. Mean follow-up period was 17 months and the appearance of operated site in antecubital fossa was acceptable in all patients. The advantage of this bipedicle flap is its simple surgical technique. The risk of flap necrosis is negligible and it is a reliable flap. Splinting time is short and the risk of recurrence of contracture with this technique is minimal.     

Morpho-functional study of electrostimulated latissimus dorsi muscle flap for diaphragm substitution

Based on practical applications of the muscle latissimus dorsi (MLD) as much in reconstruction thoracic-abdominal defects as functionally in cardiomyoplasty, and in our experience in the electrostimulation with diaphragm pacing, we elaborated the primary objective of this work consisting of the creation of functional muscle plasty of MLD for substitution of the diaphragm. In two groups of cats formed by 6 animals each one, with section of the corresponding phrenic nerve, MLD plasty has been done to replace hemidiaphragm, conserving the thoracodorsal pedicle, by thoracic route in a group (intrathoracic plasty), and in the other by abdominal route (intraabdominal plasty). In a second intervention the stimulador electrode is implanted on thoracodorsal pedicle and the rest of components of the diaphragmatic pacing in a subcutaneous pocket. During a month progressive electroestimulation of MLD plasty is made, carrying out radiological and spirometric evaluation, that compares with evaluation control made before making plasty. After the sacrifice of the animals planimetric and histologic evaluation of the extirpated diaphragm were performed. Morphologic and functional results obtained allow us to affirm that functional plasty of MLD is an effective diaphragmatic substitute, although with a smaller degree of function than the original diaphragm, and functionally intraabdominal plasty has been superior to intratorácica plasty.     

Plastic repair of ulcers of the plantar surface of the foot with local tissues

The experience with the treatment of 8 patients enabled the authors to conclude that sole ulcers can be effectively treated by plasty with a bilobed skin-fat flap of healthy tissues from non-supporting part of the sole with the fascia included. For profound ulcers in the heel area a combined plasty by a muscle and bi-lobed skin-fat flap is indicated. Other kinds of reconstruction are indicated only for extended wounds on the heel and absence of healthy tissue in the sole fornix.     

皮瓣结合重睑术修复上睑皮肤缺损的临床应用

目的：探讨较大的上睑皮肤肿物切除后的修复方法。方法：针对不同年龄的患者,采用推进皮瓣或旋转皮瓣结合不同的重睑术式一次性修复较大的上睑皮肤肿物切除后的皮肤缺损。结果：上睑皮肤肿物切除后的皮肤缺损完全修复,无睑外翻、眉下垂发生,双上睑形成对称的重睑线。结论：根据患者上睑皮肤肿物的部位、大小以及上睑皮肤的松弛程度采用不同的皮瓣并结合不同的重睑术式可有效的修复肿物切除后形成的皮肤缺损,既避免术后睑外翻、眉下垂的发生,又最大程度的维持了双上睑形态的对称性,且增加眼部的美感。     

Diaphragmatic reconstruction using a latissimus dorsi muscle flap following wide resection of the diaphragm combined with esophago-gastrectomy for cardial cancer

In three patients with cardial cancer invading the esophagus and the diaphragm, wide resection of the left diaphragm and its reconstruction using a latissimus dorsi muscle flap were performed during radical esophago-gastrectomy. More than two thirds of the diaphragm could be resected because the muscle flap was large enough to be brought into the thoracic cavity without difficulty, to repair the diaphragmatic defect. The postoperative respiratory function of these patients was adequately maintained. A technique for diaphragmatic reconstruction by means of the latissimus dorsi muscle flap is described in this report.     

Z皮瓣成形术矫正内眦赘皮的临床效果

目的 探讨Z皮瓣成形术矫正内眦赘皮的临床效果。方法 选取我院2022年1月-12月收治的56例 内眦赘皮患者，随机分为对照组和观察组，各28例。两组均实施重睑术，同期分别联合不同的皮瓣成 形术，对照组行Y-V皮瓣成形术，观察组行Z皮瓣成形术，比较两组临床效果、切口瘢痕增生情况、患 者满意度。结果 观察组手术优良率为100.00%，高于对照组的71.43%（P＜0.05）；观察组术后1、3个月 OSAS、PSAS、VSS评分均低于对照组（P＜0.05）；观察组患者满意度为100.00%，高于对照组的67.86% （P＜0.05）。结论 Z皮瓣成形术矫正内眦赘皮的效果确切，特别是针对重度内眦赘皮患者而言疗效更为 理想，且术后内眦瘢痕较为轻微，患者满意度较高，可作为临床重睑术可选的有效、可靠、安全方法。     

Surgical Treatment and Prognosis of Rectovaginal Fistulae According to their Origin

Introduction: The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis. Material and Methods: Between 1 /?2000 and 1 /?2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data. Results: In a timespan of ten years 36?patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n?= 21) and earlier surgical measures (n?= 6). Moreover tumour-associated fistulas (n?= 5) and fistulas with unknown genesis (n?= 4) were seen. As surgical techniques anterior resection (n?= 21), transrectal flap plasty (n?= 7), subtotal colectomy (n?= 3), pelvine exenteration (n?= 2) and rectal exstirpation (n?= 1) were used. The closure of the vaginal lesion was performed by single suture (n?= 25), flap plasty (n?= 6), transvaginal omental plasty (n?= 2) and posterior vaginal plasty (n?= 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12?months (6 - 36). Within this timespan 6?patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n?= 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence). Conclusion: The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.     

Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty.

A total of 45 patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. We reviewed 35 of them. Out of these, 31 patients had unilateral cleft lip nasal deformities and four patients had bilateral cleft lip nasal deformities. The age range of the patients was from 3 years to 56 years. A reverse-U incision with V-Y plasty was used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. A bilateral reverse-U incision and a trans-columellar incision were used in the four patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were used to ensure firm contact between the nasal skin and the redraped reverse-U flap. A composite graft for columellar lengthening was used in six cases of severe unilateral cleft lip nasal deformity and the four cases of bilateral cleft lip nasal deformity. Ancillary procedures included correction of a lateral displacement of the alar base, lip scar revision, a cartilage graft for tip augmentation, iliac bone grafting for correction of hypoplasia of the maxilla or for an alveolar cleft and corrective rhinoplasty. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 months to 26 months, with an average of 18 months. The final results were evaluated based on the degree of symmetry of the nostrils, the redraping of the alar-columellar web and the exposure of the nostrils. Good results were obtained in 29 patients where alar-columellar web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was achieved. Four patients had fair results and two patients had poor results. In conclusion, we suggest that the reverse-U incision with V-Y plasty is a useful method for achieving symmetry of the nostrils in cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.     

Variants of plastic surgery using the flaps in the area of the Achilles tendon

Operations were performed on 10 patients with persistent ulcers of the scars in the zone of Achilles tendon. Plasty with L-shaped whole thickness flap raised from the area of the external surface of the foot, ankle and lower third of the shin with a proximal pedicle was fulfilled in 9 patients after a radical dissection of ulcerated scars. In one patient plasty was fulfilled by translocation of a two-pedicle flap. Different variants of operations and results of treatment are described. A conclusion is made that scarry-trophic ulcers in the zone of Achilles tendon can be successfully treated by plasty with a whole thickness flap raised in the area of the lower third of the shin, external ankle and the lateral surface of the foot.     

移行皮瓣成形术治疗结肠造口狭窄

目的探讨手术治疗结肠造口狭窄的新方法并初步评价其效果。方法采用移行皮瓣成形术治疗10例结肠造口狭窄病人。结果10例病人均解除梗阻症状,造口恢复正常排便功能,随访1~2年无狭窄再发生。结论移行皮瓣成形术治疗结肠造口狭窄方法简单,效果良好。     

Full‐Endoscopic Approach Forchronic Low Back Pain from Baastrup's Disease: Interspinous Plasty

The objective was to introduce a new endoscopic technique‐interspinous plasty for low back pain from Baastrup''s disease; based on clinical manifestations, imaging findings and diagnostic test, to discuss a detailed diagnostic procedure for Baastrup''s disease; and to explore the mechanism of interspinous plasty in pain relief. To our knowledge, there is no report about the results of endoscopic lumbar technique for Baastrup''s disease. This study described the successful full‐endoscopic surgical treatment for Baastrup''s disease, providing a brand‐new therapeutic method for patients. Clinical manifestations, imaging findings, including X‐ray, computed tomography (CT) and magnetic resonance imaging, and a “positive” diagnostic test with local anesthetic were used to confirm Baastrup''s disease in the three included patients. The interspinous plasty procedure, which aimed to recover a physiological gap between the adjacent spinous processes, was performed by full‐endoscopic resection of marginal osteophytes. The removal of local inflamed tissue and reducing inflammation via intraoperative saline irrigation also lead to pain relief. Clinical outcomes included visual analog scale (VAS) for low back pain and the Oswestry Disability Index (ODI). The distance between the adjacent spinous processes was measured from the preoperative and postoperative CT scan. We calculated and recorded the difference between preoperative and postoperative measurements. Technical procedures and advantages of interspinous plasty are introduced. The three patients showed improvement in terms of the postoperative VAS of low back pain (from 8 to 2, from 7 to 1 and from 8 to 2) and ODI (from 68.9% to 33.3%, from 77.8% to 28.9% and from 71.1% to 28.9%, respectively) at the 12‐month follow‐up. Compared postoperative ODI index, the ODI index increased from 26.7% to 33.3% and from 24.4% to 28.9% in two of the cases at the 12‐month follow‐up. At 1 week, CT confirmed an obvious reduction in the marginal osteophytes between the adjacent spinous processes. Compared with those on preoperative CT images, the distance between adjacent spinous processes on postoperative CT was enlarged from 1 to 4 mm, and a repeated CT scan 3 months later reconfirmed little recrudescent osteoproliferation. In selected cases, full‐endoscopic surgical treatment for chronic mechanical back pain as part of the phenomena of Baastrup''s disease may be beneficial. The operations in this study were performed under local anesthesia, with satisfactory early clinical outcomes and a low incidence of complications or adverse events. This may be a feasible therapeutic method or an alternative option for patients who cannot tolerate general anesthesia surgery.     

Correction of a deformity of the upper lip after primary plastic surgery of bilateral cleft lip

The author describes a method of reparative operation intended for bringing down the prolabium as a skin-muscle flap on two feeding vascularized pedicles with simultaneous plasty of the defect of the lining of the intermaxilla with a flap of the mucosa from the prolabium. The posterior wall of the upper lip and entrance to the mouth were formed by shifting the lateral fragments of the lip to the center. The red border defect was also eliminated at the expense of the same tissues. In order to avoid complications it is necessary not to make thinner the skin of the nose septum which was used for the elongation of prolabium and to suture the edges of the orbicular muscle of the mouth with tension. The method was used in 438 patients and gave good results.