Biomedical subjects

J Kozarski

Publications and source records attributed to J Kozarski.

12 recordsLinked to original sources

PubMed2001

[Importance of adequate immobilization of the upper extremity in using the vascularized fibular graft].

The most complications in patients after the reconstruction of the bone defect of the upper extremities are the fractures of the bone graft and pseudoarthrosis on one of the graft suture with defects of humerus. These complications influence on the primary efficiency of the reconstruction and prolong the recovery period. We registered five fractures, four pseudoarthrosis and two graft angulations in the prospective study on 25 patients where the defect of humerus, radius and ulna was compensated by the vascularized fibular graft. The analysis showed four fractures on the distal part of the reconstructed humerus graft and three pseudoarthrosis on the proximal part of reconstructed ulna. All osteogenic complications, apart from angulations which did not require additional interventions were solved by spongyoplasty according to Phemisters and more efficient postoperative immobilization.

Female↗

PubMed2001

[Complications in the use of vascularized fibular grafts: classification and treatment].

The complications in the reconstruction of the diaphysed defects by the use of VFG or VOSKFG are not shown in the literature coherent so it is very difficult to compare and use showed results. For the compensation of the bone defects the specific complications could be differentiated according to the influence on the primary and overall efficiency of the reconstruction. The classification of the complications in the donors region and osteogenic and vascular complications in the recipients region was suggested in the analysis which encompassed all these divisions.

Bone Transplantation↗

PubMed2000

[Metastasis of malignant melanoma in the small intestine--case report].

Small bowel metastases of the malignant melanoma are usually discovered in 2-5% of the patients with malignant melanoma of the skin during the life. They are usually being diagnosed with a complication on the small bowel, such as occlusion, bleeding, anemia and perforation of the intestine. Authors show three patients with metastases of the malignant melanoma in the small bowel, which lead to invagination, subocclusion and anemia due to bleeding. In all the patients, resection of the small bowel was performed with termino-terminal anastomosis. One of them lived 7, the other 4 months after the surgery and is in pretty well condition, while third patient was not controlled at all.

Aged↗

PubMed1999

[Reconstruction of the long bones and mandible with vascularized fibular grafts].

In two prospective studies at the Clinic for Plastic Surgery and Burns and Clinic for Maxillofacial Surgery of the Military Medical Academy in the period from 1991 to 1996 we performed 47 transplantations of the vascularized fibular graft in order to compensate bone defects of the long bones and mandibular inflicted by war wounding. The importance of the length of the vascular pedicle preparation for the total success was pointed out as well as the immobilization of the elbow region for the compensation of the defects of the upper arm and forearm and total healing of the mandibular for the later functional rehabilitation. The realized primary efficiency of 70.2% and total successfulness of 93.6% indicated that at the compensation on of bone defects the etiology of war wound could be compared to the etiology of malignant tumors resection and trauma.

Adolescent↗

PubMedDate not supplied

[Evaluation of perfusion of transplanted microvascular flaps using radionuclide arteriography].

Microvascular flap by its autonomous circulation, following the transplantation in recipient region, provides the quantity of blood sufficient for nutritive needs of flap, but it also provides additional blood supply in the surrounding of recipient region. The evaluation of the relation of the tissues perfusion of transferred microvascular flaps and the tissues of surrounding recipient region was done in 33 patients, 15.24 months after the transplantation of microvascular flaps, by radionuclide angiography using Tc-99m in the form of MAA HAS or pertechnetate at the Clinic for Plastic Surgery and Burns of Military Medical Academy (MMA) and at the Institute for Nuclear Medicine of MMA. Cutaneous, myocutaneous and osteocutaneous microvascular flaps were transferred to the foot, lower leg and in the head region. The obtained results revealed that the perfusion of the tissue of transferred flaps was better than the perfusion of the recipient region surrounding (232%). Perfusion of myocutaneous flaps related to the type of microvascular flap was the highest and came to 244% of the perfusion of the recipient region surrounding. Accumulation of radiopharmaceuticals in the tissue of the flap was homogenous in 19 (57.57%) flaps.

Adult↗

PubMedDate not supplied

[Temperature of the skin in microvascular flaps].

Transferred free flaps by their defined vascular net improve the perfusion of the recipient region. Skin temperature depends on the skin perfusion, temperature conduction of the visceral organs, muscles and blood vessels, as well as on the heat loss by the evaporation and air convection in the environment. At the Clinic for Plastic Surgery and Burns and at the Institute of Hygiene of the Military Medical Academy, skin temperature of the transferred free flaps and the recipient region surrounding were analyzed and measured in controlled microclimate conditions. The analysis was performed in 31 subjects, 20.23 months after the free tissue transfer. The aim of the study was to determine the differences between the skin temperature of the transferred free flaps and the recipient region surrounding, as wall as of the donor's region surrounding. The results of the investigation revealed that skin temperature of the transferred free flaps was lower in 28 (90.3%) patients than the temperature of the donor's region surrounding. Skin temperature of the transferred free flaps was higher in 25 subjects (80.6%) than the temperature of the recipient region surrounding. Skin temperature of free flaps transferred to the foot and the lower leg was higher than the skin temperature of the recipient region surrounding but was also lower in the flaps transferred on the head. The temperature of the recipient region surrounding influenced the skin temperature of the transferred free flaps, besides the flap tissue perfusion.

Adult↗

PubMedDate not supplied

[Use of Bernard's diadynamic current in evaluating recovery of pain sensitivity in transplanted microvascular flaps].

The application of microvascular transfer of tissues provides a single act transplantation of free flaps to any part of the body. Following the operation, free flaps are nerveless. By spreading out of nerves from the recipient region surrounding into the flap tissue, transplanted free flaps become reinervated. The sensitivity of the transferred free flaps is very important in feet, palms, breasts, genitals, face etc. The aim of our research was to use Bernard's diadynamic currents in establishing the time needed for recovery of the transferred flap's pain sensitivity in comparison with the recipient region's surrounding. At the Clinic for Plastic Surgery and Burns and Clinic for Physical Medicine and Rehabilitation of the Military Medical Academy, we used Bernard's-diadynamic current to analyze the recovery of the pain sensitivity in 33 patients with transferred free flaps. The first tests were performed six moths after the free flap transfer and were repeated in the intervals of 6 to 36 months. The pain recovery was tested in 5 cutaneous, 18 myocutaneous and 10 osteocutaneous flaps transplanted to foot-10, lower leg-13 and head-10. Pain sensitivity in the transferred flaps was detected 6 months after the free flaps transfer and was definitely ascertained 12 months after the operation. Current of 10.11 mA was required to reach the pain sensitivity threshold after the first six months and 8.52 mA after 36 months. It is obvious that the pain sensitivity threshold is significantly higher in the transferred free flaps (p < 0.001) than in the donor or recipient regions' surroundings.

Electrodiagnosis↗

PubMedDate not supplied

[Frequency, etiology, localization and surgical treatment of war injuries with tissue defects].

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 reconstructive methods were applied. In the cases requiring the covering of the the tissue defect with the full thickness skin, local skin, fasciocutaneous, fascioadipose or muscle flap was chosen. Distant pedicled direct flaps were used in cases when it was not possible to use a more suitable reconstructive method. Free skin, myocutaneous or complex microvascular flaps were applied in cases of more extensive defects or if a more suitable solution could not be found. Our experience in surgical treatment of war injuries with skin defects during the civil war in former Yugoslavia has shown that over 50% of all the injured patients required the treatment of a plastic surgeon in a definite surgical treatment of a war injury. A multidisciplinary approach is necessary in the majority of the injured, and the surgical team is composed according to the affected area and the extent of the injury.

Adolescent↗

PubMedDate not supplied

[Sebaceous gland function in transplanted microvascular flaps].

Sebaceous glands produce sebum that contains: triglycerides, esters of cholesterol, and sometimes even pure cholesterol, squalene and esters of wax. Microvascular transplantation exposed the tissue of free flaps to the temporary ischemia and anaerobic metabolism, inflammatory, denervative and reinnervative processes. The sebaceous glands of the free flaps were also exposed to the action of physiopathologic processes during the micro vascular transfer. Because of that, the function of the sebaceous glands of the transplanted free flaps was estimated compared to the function of the sebaceous glands of the recipients and donor's region environment. The investigation of the sebaceous glands of free flaps function has been performed in 32 wounded patients at the Clinic for Plastic Surgery and Burns, and Institute for Medical Biochemistry of the Military Medical Academy. All the wounded have undergone the microvascular transplantation of the cutaneous, myocutaneous and osteocutaneous flaps. Dry residue in either of the soluble substances was measured in the period from six to thirty six months after the transplantation. The obtained results indicated that the function of the sebaceous glands of the transferred flaps 25.36 months after the transplantation was weaker than the function of the sebaceous glands of the recipients and donor's region's environment and amounted to 98% of the function of the sebaceous glands of the recipient is region's environment.

Adult↗

PubMedDate not supplied

[Vascularized fibular grafts in the reconstruction of bone defects caused by war injuries].

The efficiency of the vascularized fibular graft application in the reconstruction of diaphyseal defects of the long bone of extremities caused by war injuries was prospectively investigated in the group of 33 patients in the period 1991-1996, during the war in the former Yugoslavia. The preoperative, intraoperative and postoperative procedures were systematized. Early and late complications in donor and recipient regions were shown. The primary success was 63.6% and the total one was 93.9%. The efficiency of the vascularized fibular graft in the treatment of bone defects caused by war injuries could be compared with bone defects caused by trauma or by resection of malignant tumors.

Adolescent↗

PubMedDate not supplied

[Reconstructive methods in the treatment of soft tissue defects below the knee].

The specificity of the lower leg is in sparse collateral blood flow of the skin cover in the middle and distal part, reduced subcutaneous tissue and the prominence of the front side of tibia immediately under the skin. These characteristics of the lower leg make the application of the standard plastic reconstructive principles, which have been applied in the other regions of the body to a certain degree impossible. The progress of anatomical knowledge in relation to vascularization of the tissue territories--angiosoma, and the anatomy of the vascular skin system of the lower leg, along with the technological progress represented by the application of the surgical microscope, new surgical instruments and suture materials, provides the reconstructive surgeon, not only with classic but also with the modern surgical methods in this region: microvascular transplantation of the tissue and the application of the fasciocutaneous reversible flaps. The aim of this study was to show the available reconstructive methods in the treatment of the lower leg soft tissue and to analyze its application in the management of war wounds in the injured from the civil war in the former Yugoslavia. On the basis of our experiences in the management of war wounds, especially of the lower leg with the tissue defects, we would like to point on the existence of the clear indications for the application of certain reconstructive methods depending on the size, localization and tissue defect structure, as well as the advantages and disadvantages of the available reconstructive procedures.

Humans↗

PubMedDate not supplied

[Histopathologic changes in the skin of transplanted microvascular flaps].

During the microvascular transfer, the free flaps tissue is exposed to series of pathophysiological changes (tissue anoxia, tissue acidosis, anaerobic metabolism, wound healing and cicatrisation, degeneration of nerves fibers in the free flaps tissue, etc.) In 1993-1998 period, at the Clinic for Plastic Surgery and Burns at the Military Medical Academy, we analyzed histopathologic changes in the skin taken from the transferred flaps and from the recipient region surroundings of 31 patients with microvascular tissue transfer. The bioptic materials were taken between 6 and 36 months following the free tissue transfer--average 23.6 months. By light microscopy we analyzed histopathologic changes of the epidermis, collagen's fibers, skin adnexa, blood vessels and nerve fibers. The data obtained showed considerable difference in the histopathology test results of the epidermis, collagen's fibers, the skin adnex and the nerve fibers in the transferred free flaps compared to the results obtained from testing recipient region surroundings. The histopathologic tests of the blood vessels did not show considerable comparative difference.

Humans↗