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Biomedical subjects

L Drazan

Publications and source records attributed to L Drazan.

13 recordsLinked to original sources
PubMed2001

Microsurgery in the diabetic foot.

The treatment of serious tissue defects on the diabetic foot is complicated and tedious because of a combination of pathogenetic mechanisms that influence healing. Diabetic neuropathies (sensory, motor, vegetative), ischaemia and microangiopathies contribute in varying degrees to the adverse healing. The submitted three-year prospective study was focused on an analysis of the pathogenetic factors with the objective of defining the indications for one of three types of microsurgical transfer: 1. a free flap sutured directly to the vessels at the site of the defect (in predominantly neuropathic defects); 2. a free flap sutured to a politeopedal bypass (in predominantly ischaemic defects); 3. a "nourishing" flap sutured by means of a long venous graft to vessels of the medial and upper leg (in patients in whom an inadequate outflow tract does not make revascularisation possible). In the first year of the investigation, thirteen patients were operated on by means of a free muscle flap incl. three "nourishing" and ten sutured at the site of the defect. Twelve flaps were flaped healed; one patient died from myocardial infarction on the second day after surgery.

Diabetic Foot↗
PubMed2001

DIEP flap breast reconstruction--new experience.

One of the important microsurgical procedures in our department is breast reconstruction after ablations. For many years, the standard method was reconstruction with autologous tissues--a free TRAM flap with a recipient vessels vasa mammaria. We are convinced that this give very satisfactory results with microsurgical safety of operations. We use this method of reconstruction in 17-20 patients per year. The standard time of unilateral reconstruction is 2.5-4 hours, of bilateral reconstruction 4-6 hours. Postoperative morbidity in the abdominal region is, as a rule, associated with a weakening of the abdominal wall and the development of hemias (Galli et al., 1992); a perforator flap in which neither muscle nor fasciae are used creates the prerequisite condition for markedly reduced the morbidity associated with the site of flap collection. Although we used a perforator flap three times for reconstructions of the extremities as early as three years ago, we began to use it for breast reconstruction from the beginning of 2000. No doubt this late use of a large skin flap supplied by 1-2 perforators was due to a lack of trust in the provision of adequate blood perfusion for the large amount of tissue of the flap. From the beginning of 2000, in the course of five months, nine DIEP flaps were used for breast reconstructions, in two cases for bilateral reconstruction. In two instances sensory nerves of the flap were sutured to the branch of the intercostal nerves at the site of insertion. Seven flaps healed p.p.i; in two instances we were faced with the complication of postoperative venostasis, calling for revision and connection of the superficial venous system of the flap to the circulation. Subsequent healing was without complications. Preparation of the flap appears to be relatively easy, and the only pitfall is the selection of a suitable perforator. The operation is longer by half an hour than the classical free TRAM; when the sensory nerve of the flap is sutured, it is ca 1 hour longer. We like to use the DIEP flap for breast reconstruction, and it is a reliable method even for the reconstruction of large pendulous breasts. The donor site morbidity is significantly lower.

Abdominal Muscles↗
PubMed2000

Woven vascular microsurgical prostheses in our experimental practice.

The authors have been concerned for six years with the development of woven microsurgical prostheses in experiments on laboratory rats, beagle dogs and domestic white pigs. In rats, in 224 experiments employing 38 types of prostheses with an inner diameter of 2 mm, a reliable prosthesis was selected, described as No. 36, with a 100% patency after insertion of a 1 cm long portion into a defect in the abdominal aorta in 40 experiments. The follow-up of this type of prosthesis lasted 12 months. In large animals this type of prosthesis was implanted into a defect of the radial artery and cephalic vein in dogs and into the femoral artery and the artery of a vascular pedicle of groin and lateral thigh flap. These experiments on large animals are not yet complete and will be the subject of a separate paper.

Animals↗
PubMed1998

Microsurgical reconstruction during treatment of oncological diseases of head and neck.

In 37 oncological patients where extensive resections of the face, maxilla, mandible or calva were necessary, microsurgical reconstructions were used in 27 cases as primary operations at the time of resection, and in 10 cases delayed or secondary operations were made. 49 flaps were used. In five cases two flaps were used in a single stage reconstruction, i.e. one flap for reconstruction of the mandible or buccal and on the other for facial side of the face. During operations a multidisciplinary approach of the surgical team comprising a maxillofacial surgeon, ENT and plastic surgeon is preferred.

Head and Neck Neoplasms↗
PubMed1998

Functional and aesthetic consequences in the forearm after harvesting the Chinese flap.

We have evaluated the donor site after harvesting the chinese flap in 40 patients operated at the Clinic of Plastic and Aesthetic Surgery of Brno between 1989 and 1994. We conclude that: 1--The hand function is not oustandly altered after harvesting the flap, but in our study 11 patients (27.5%) indicated that they have some limitation or impairment of their hand function. 2--Tolerance to forearm deformity is considerable, but it depends on degree of the defect for which the flap is transferred: 25 patients (62.5%) would like to elect a different flap. 3--It is necessary to think about cosmetic consequences of the chinese flap and consider other possibilities of the flap choice. Secondary defect may be for the patient a problem even several years after operation.

Adolescent↗
PubMed1994

Ruben's fat pad for breast reconstruction: a peri-iliac soft-tissue free flap.

We present a single patient with a successful breast reconstruction using the peri-iliac fat pad as a free flap based on the deep circumflex iliac artery and vein. Although the follow-up is short, in this patient the donor site has been acceptable, and we believe that this flap will have a place in the selection of donor sites for autogenous tissue breast reconstruction.

Adipose Tissue↗
PubMed1994

[The V-Y surgical flap vascularized by the musculoaponeurotic layer for covering scalp defects].

The author describes a method for covering skin defects of the scalp combining the principles of V-Y plasty and vascularization by means of the musculoaponeurotic layer. It is a simple operation, using the hairy skin in the vicinity of the defect with direct closure of the defect after transposition of the flap. With regard to the satisfactory cosmetic results, the method is suitable not only for primary defects after excision of tumours but also for medium-sized alopecias.

Adolescent↗
PubMed1993

A mechanical leech for transverse rectus abdominis musculocutaneous flaps.

Venous congestion in the intraoperative and postoperative period can be a problem with some transverse rectus abdominis musculocutaneous flaps. We evolved a technique to allow us the ability to bleed the congested flap in a controlled manner both intra- and postoperatively. Arteriotomy cannulae are placed within the lumens of the deep inferior epigastric artery (DIEA) and vein (DIEV) and they are brought out on the lateral aspect of the reconstructed breast. We believe that intermittent venous bleeding from the DIEV allows a congested flap time to improve venous outflow and adapt to the new reversed blood circulation. When laser Doppler flow meter is simultaneously used as a monitor, bleeding from the DIEV or DIEA can improve balance between arterial and venous pressure in the flap.

Adult↗
PubMed1993

Immediate TRAM flap breast reconstruction: 128 consecutive cases.

The purpose of this article is to determine whether or not the transverse rectus abdominis musculocutaneous (TRAM) flap procedure is a practical operation for immediate breast reconstruction. Our series reports 128 consecutive patients who underwent immediate breast reconstruction with the TRAM flap from 1985 to 1990. Of these patients, 86 underwent conventional TRAM, while 40 underwent free TRAM breast reconstruction. Two-thirds of the patients underwent bilateral breast reconstruction. Comparison within this series of the free TRAM versus the conventional TRAM flap revealed improved statistics with regard to the free TRAM flap in a shorter hospitalization time and a decreased incidence of fat necrosis. There is no evidence to date that there is an increased chance of local recurrence with immediate breast reconstruction in this series, and chemotherapy was delayed in a single patient because of healing problems after immediate reconstruction. Operative times and the complication rate seem to be improving as compared with other series previously reported. The TRAM procedure, particularly the free TRAM procedure, is a primary choice for immediate breast reconstruction after mastectomy.

Breast Neoplasms↗
PubMed1991

Bilateral breast reconstruction after mastectomy.

The authors discuss the development of breast reconstruction following mastectomy in Czechoslovakia and present their first case of bilateral reconstruction employing the technique of the TRAM flap. In addition, they explore the possibility of eliminating high-risk parenchyma during with contralateral reconstruction.

Abdominal Muscles↗
PubMed1991

[Reconstruction of the breast after mastectomy].

The author analyzes some causes preventing the development of reconstruction of the breast after mastectomy, mentions the reasons for reconstruction and reflects on contraindications of this operation. He demonstrates a case of bilateral reconstruction of the breasts by means of a TRAM flap.

Adult↗
PubMed1990

[Replantation of traumatically amputated parts of extremities-- indications and nomenclature].

The authors submit a brief report on replantation activities during the past five years and discuss the problem of indications and terminology of traumatic amputations. The paper contains instruction regarding communication by telephone between the attending surgeon and a specialized microsurgical department. There are also instruction how to handle the amputated portion of the limb and how to transport the patient and the amputated portion of the limb. The authors discusses traditional procedures in replantation surgery on the basis of his own experience with 292 replantations or revascularizations.

Arm Injuries↗