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Biomedical subjects

P Brychta

Publications and source records attributed to P Brychta.

At least 19 recordsLinked to original sources
PubMed2006

Cutometrical measurement confirms the efficacy of the composite skin grafting using allogeneic acellular dermis in burns.

Measurement of viscoelasticity of the skin using the device called cutometer seems to be a very precise and promising diagnostic method in different skin pathologies. However, only a very limited number of reports dealing with the use of cutometer in burns is available. The composite skin grafting using an allogeneic acellular dermis covered with a thin epidermal autologous graft is supposed to improve viscoelastic properties of grafted skin in full-thickness burns. Cutometer MPA 580 has been used for examination of healthy skin, healed and maturated autologous split-thickness skin grafts, and in two patiens 6 years after composite skin grafting using the allogeneic acellular dermis + thin autologous epidermal graft in one stage. Typical curves defined by values of R0-R9 parameters are presented. These data document significantly better viscoelastic properties of composite skin grafts than those of conventional split-thickness skin grafts after 6 years. Measurements of viscoelasticity of the skin, using a cutometer, will probably bring useful and precise data for evaluation of the reconstructed skin in burns. Significantly better properties of the composite skin graft were assessed clinically and measured by Cutometer MPA 580 6 years after surgery.

Adolescent↗
PubMed2005

Laser techniques associated with facial aesthetic and reparative surgery.

Chronological aging is a natural biological event that is seen particularly in the face. Attempts to correct the results of this facial loss of structural form are sometimes successful. The skin itself is usually neglected, and surgery sometimes fails to achieve the goals expected by the patient. The surgical laser offers an extremely elegant and powerful solution to this problem to complement or enhance the results of selected surgical facial aesthetic procedures as follows: (1) ablative full-face CO2 laser resurfacing in combination with facelifting; (2) laser surgical technique for upper eyelid ptosis; (3) lower eyelid blepharoplasty with the aid of the CO2 laser; (4) full-face resurfacing following minilifting of the lower part of the face; (5) endoscopic eyebrow lifting combined with laser resurfacing; (6) perioral CO2 laser resurfacing in combination with facelifting; and (7) several miscellaneous procedures (e.g., treatment of upper and lower xanthelasma with laser upper blepharoplasty, laser resurfacing in combination with fillers, and laser resurfacing of periocular wrinkles after surgical blepharoplasty). In the hands of the authors, the combination of laser and standard surgical procedures presented herein has consistently produced good results and high patient satisfaction. The complication rate is low and the recovery rate is excellent. Laser treatment enhances the natural look obtained by conventional surgeries.

Blepharoplasty↗
PubMed2003

[Ulnar-carpal impingement after fractures of the distal radius].

The authors describe the group of 23 patients (16 women, 7 men), who were operated during 2000-2003 on ulna-carpal impingement or the syndrome of ulna impact on the basis of "plus variant" of ulna or also "long ulna". There was a fracture of distal radius in anamnesis of all these patients. The condition was solved in 18 patients (mean age 51 years) by reducing the ulna by 4.5 cm on the average (range 2-10 mm). In five patients (mean age 49 years), the radius-ulna desis sec. Sauvé-Kapandij was performed. The results are evaluated with the time lapse of 6 months on the average (range 3-26). The resulting evaluation indicates that in all patients, who were not affected by radius-ulna arthrosis, a simple reduction of ulna resulted in an improvement of the extent of movements and improved subjective complaints. Patients with radius-ulna arthrosis, where the ulna-carpal impingement was solved by radius-ulna desis, suffer from worse long-term functional results. The authors also analyze complications of the interventions. Posttraumatic deformations in the area of distal forearm should be solved early before degenerative changes develop. The is the only way how to expect good results of the operation and favorable effect for the patient.

Adult↗
PubMed2003

Unusual course of treatment of a patient diagnosed with Pemphigus Vulgaris (case report).

The case report is describing patient with an autoimmune disease, Pemphigus Vulgaris. This patient arrived to the general practitioner with Pemphigus Vulgaris after 20 days from the first manifestation of the disease. Despite intensive care, patient dies forty-seventh day after first clinical manifestation of the illness of candidemia. Candidiasis was diagnosed only in postmortem examination.

Candidiasis↗
PubMed2003

The influence of moisture wound healing on the incidence of bacterial infection and histological changes in healthy human skin after treatment of interactive dressings.

In this article the authors discuss the problem faced by physicians when trying to use moisture-retentive dressing in pressure sores (decubitus ulcers). First, they report the results of an in vitro study using a new model of experimental wound (radio-isotopic investigation) that assesses the release of Ringer's solution from interactive dressings continually during fourteen hours. Second, they perform an animal experiment that assesses the incidence of wound infection in defects treated conventionally or using interactive dressings. The defects treated with interactive pads had lower incidence of wound infection, and the process of wound healing was rapid. Finally, the authors discuss their experience in four paraplegic patients with decubitus ulcers where they used moisture-retentive dressing on ulcers and on the surrounding intact skin before surgical procedure to detect the possibility of maceration of healthy skin. Histological evaluation was performed in order to find microscopically changes after moisture healing. The changes of healthy skin were not significant after treatment of moisture-retentive dressings.

Aged↗
PubMed2003

Depth of the graft bed influences split-skin graft contraction.

Contraction of a split-thickness skin graft used for coverage of large defects remains a great problem in plastic, burn and reconstructive surgery. In this study we evaluated healing of split-thickness skin grafts transplanted in wounds on the subcutaneous fat and muscle fascia in pigs. Four young domestic female pigs were included in the study, and the contraction was measured planimetrically during a 3-months' follow-up. At the end of the study the scar tissue was histologically assessed. From day 42 till the end of the study grafts transplanted on the muscle fascia were significantly more contracted than grafts on the subcutaneous fat without (p < 0.001) and with (p < 0.005, unpaired t-test) correction for the growth of the animal. The histological assessment showed that after 3 months the regenerated dermal tissue in the muscle fascia wounds was thicker, and less remodeled (higher tissue cellularity and thinner collagen bundles). In conclusion, in pigs, split-thickness skin grafts transplanted into deeper wounds contract more, and scar tissue maturation seems to last longer.

Adipose Tissue↗
PubMed2003

Reconstruction of functional handgrip in traumatic tetraplegia--case study.

The objective of this study is reconstruction of functional handgrip in tetraplegic patients, using transfers of the forearm tendons. Authors present two case studies of tendon transfers--the first case introduces reconstruction of fingers and thumb extension--the second case introduces reconstruction of fingers and thumb flexion. The two case studies explain basic principles of tendon transfers and assessment criterions. The aim of this study is to point out the possibility to create functional unit from a plegic hand by surgical intervention, and to improve significantly quality of patients' lives.

Adult↗
PubMed2002

Cultured epidermal allografts: Quantitative evaluation of their healing effect in deep dermal burns.

This study summarizes the Brno Burn Centre experience with the application of cultured epidermal allografts (CEAl) in the treatment of deep dermal burns. In a prospective randomised trial on 30 patients with deep dermal burns CEAl obtained from young healthy and examined donors and fixed on tulle grass carrier (Grasolind) were compared with empty Grasolind as the lowest layer of dressing. All the other layers were identical.Both kinds of dressing were applied simultaneously on the same deep dermal burn wound between 6th and 10th day after burn. Six days later the non-healed wound areas were recorded through painting on cellophane membrane and scanned in the computer. The percentage of wound reduction was calculated and statistically evaluated.The reduction of the non-epithelialized wound area was 86.5% when covered through CEAl and only 71.2% when covered with tulle grass (Grasolind) only. This difference is statistically significant.In conclusion it can be stated that cultured epidermal allografts strongly stimulate reepithelialisation in deep dermal burns.

Journal Article↗
PubMed2002

Effectiveness and Safety of the PEGT/PBT Copolymer Scaffold as Dermal Substitute in Scar Reconstruction Wounds (Feasibility Trial).

Skin defects left after excision of hypertrophic scars were treated with a dermal substitute and split-thickness skin grafts transplanted after vascularisation of the substitute. The used substitute was a synthetic porous scaffold made from the biodegradable copolymer polyethyleneglycol-terephtalate and polybuthylene-terephtalate. The study was designed to assess the rate of granulation tissue formation, graft take, and after 3 and 12 months the quality of life (pain, comfort of treatment, cosmetic or functional nuisance), scar formation and wound contraction. In addition, scaffold biodegradation and scar tissue formation were evaluated histologically.Seven patients with different causes of burn injury were enrolled, of which 5 completed the study. In the first 4 patients the time between scaffold application and split-thickness skin overgrafting was in between 17 and 24 days. The time point of overgrafting was significantly reduced to 10-12 days by meshing of the dermal scaffold as evidenced in the last 3 patients. Histological evaluation at 3 months revealed normal generation of dermal tissue, however, the collagen bundles were parallel organized like in scar tissue. In the deeper layers of the neodermis, fragments of the dermal substitute were present, causing a mild inflammatory response. One year post-treatment, some fragments of the copolymer were still observed. The extent of wound contraction after successful overgrafting ranged from 30% to 57% after 1 year. All 5 patients showed an improvement in the total Vancouver Scar Score compared to the value before scar removal being similar to what can be expected when treated with split-thickness skin grafts alone. No unanticipated adverse effects due to application of the substitute were observed.We conclude that although this synthetic dermal substitute can be safely used in humans, the presence of 3D dermal template in a full-thickness skin defect will not automatically improve the skin tissue regeneration process or inhibit wound contraction.

Journal Article↗
PubMed2002

Quality of prehospital management of patients with burn injuries--a retrospective study.

The authors evaluate the quality of burn patient management prior to admission to a specialized department. The most frequent mistake was found to be inadequate airway management (no intubation) and a lack of an i.v. line and volume resuscitation. These problems could be seen especially in the patients admitted to the specialized department as secondary transfers, following initial treatment in another healthcare facility. Prehospital care of the patients admitted as primary transfers was found to be satisfactory in the majority of cases. The authors conclude that some mistakes in diagnosis may be caused by the development of the burn over time as well as by the fact that certain clinical experience is necessary for determining the correct diagnosis. The predominant cause of inadequate management in patients with severe thermal injuries is underestimating the severity of the injury and ignorance of the possible consequences of inadequate management of the patients for transfer.

Adolescent↗
PubMed2002

The most frequent problems in the initial stage of burn management.

On the basis of three case reports discussed in the article, the authors demonstrate the most frequent serious drawbacks occurring in the initial stage of care of severely burned patients. The first case report highlights the importance of correct determination of the extent of the burn trauma, which should be correctly assessed by every first contact physician. The second case report demonstrates the need for adequate management of patients with severe burn trauma (especially airway management and i.v. establishment). In the third case (a little baby) again the need for correct patient assessment, timely airway management and beginning of resuscitation and especially of appropriate and immediate transfer of the burned patient to the specialized burn facility are highlighted.

Adult↗
PubMed2002

[Post-traumatic corrective osteotomy of the distal radius with a new plate].

PURPOSE OF THE STUDY: Mal-union of distal radius fractures cause functional limitation and progressive degenerative changes of the wrist. The authors evaluate both radiograph and functional outcomes in a group of patients with a post-traumatic deformation of the distal radius treated by corrective osteotomy and fixation by a newly developed T-plate. MATERIAL: A retrospective evaluation covered a group of 13 patients of the average age of 51 years (range, 35-60 years) operated on in 2001 for post-trauma symptomatic mal-union of the distal radius of the Colles type. The group included only patients in which a new implant was used. The time interval between the primary fracture and corrective osteotomy was on average 11 months. METHODS: Corrective osteotomy for Colles deformations was performed in all patients from the dorsal approach with the application of a cortico-cancellous bone graft. Stabilisation was performed by the mentioned plate. Radiograph and functional outcomes were evaluated statistically. RESULTS: The radiographic evaluation proved the restoration of the normal anatomic relationship between the distal radius and ulna as well as statistically significant improvement of the function of the hand as concerns the range of motion and muscular strength Except for one patient, all involved evaluated the outcome as a subjective improvement. DISCUSSION: Corrective osteotomy of the distal radius is a standard surgery performed routinely by plate fixation with the application of a cortico-cancellous bone graft. Despite a perfect coverage of the issues relating to potential consequences resulting from non-anatomic position of the articular surface of the distal radius, this surgery was not very frequent in the past. Nevertheless, recently, there is a growing number of works in the literature dealing with corrective osteotomies for mal-union of the distal radius after fractures not only for the Colles but also Smith type. CONCLUSIONS: Treatment of deformation of the distal radius is a rewarding procedure which brings the patients a significant improvement of the function of the hand. The implant used by the authors proved useful for a plate fixation on the distal radius.

Adult↗
PubMed2001

Special features of burn injuries in elderly patients.

Types of burns and other aspects of burn injuries and case outcomes were assessed in a group of geriatric patients (> 60 years) and a younger group of patients (40-59 years). Between 1990 and 1999, 137 geriatric patients (47 [34%] males and 90 [66%] females) were admitted to the Burn Centre and Reconstructive Surgery Centre at University Hospital in Brno. We compared findings in this elderly group to those in 176 younger burn patients (126 [72%] males and 50 [28%] females) who were treated at the centre during the same time period. Age and concomitant chronic disease contribute to the high mortality and a higher frequency of complications in geriatric patients who suffer burn injuries. In this study, the complication rates for geriatrics during hospitalization (44% in males and 32% in females) and the elderly patients' mortality rates (26% in males and 17% in females) differed statistically from the corresponding rates in the younger patient group. It is important to know the special needs of elderly burn patients because this patient group is expected to grow in parallel with the rising average age of the Czech Republic's population.

Adult↗
PubMed2000

[Use of skin substitutes in treatment of large hypertrophic scars due to burn injury].

The study concerns a clinical experiment in two patients with a dermal substitute based on atelocollagen and hyaluronic acid, and allogeneic acellular dermis. In both cases two-step grafting was performed. At the first step the dermal substitute was implanted into the wound and it was grafted at the second step with thin dermoepidermal autograft. Large hypertrophic scars after burn injury were treated. In both patients the quality of skin cover was significantly improved.

Adult↗
PubMed2000

[The moist wound healing system in an experiment and clinical practice].

We compared two types of moisture-retentive dressings (dressings that are capable of maintaining a moist environment) in wound healing. The conventional method of using an impregnated gauze in combination with a moist wound dressing was compared with TenderWet. First, we report results from an in vitro study and an animal experiment that included assessment of reepithelization and incidence of wound infection. Secondly, we discuss our experience using TenderWet in a clinical setting. Two cases of deep dermal burns are described and documented in detail. The results of our work suggest that a moist wound environment is more effective in facilitating wound healing than conventional methods.

Animals↗
PubMed2000

Inhalation injury.

Inhalation injury is an acute insult of the respiratory tract, caused by steam or toxic inhalants. A suspicion of inhalation trauma (closed-space exposure, facial burns, etc.) is an indication for an immediate endotracheal intubation. Precise objective case history is also very important point for making the diagnosis. Up-to-date methods of examination in case suspicion of inhalation injury are described in our contribution. The main therapeutical points are mentioned as well.

Burns, Inhalation↗
PubMed2000

Our experience with transconjunctival, laser-assisted lower blepharoplasty.

INTRODUCTION: Transconjunctival lower blepharoplasty has become more popular in the last decade with the introduction of the CO2 laser as a cutting and resurfacing tool. The authors have 4 years experience with this procedure. METHOD: Patient selection, preoperative evaluation and the surgical technique are described in detail. The operation itself is divided into two parts: 1. Laser-assisted transconjunctival exposure and resection of prolapsed fat pads, 2. Laser resurfacing of the lower eyelid skin. RESULTS: 36 patients underwent transconjunctival, laser-assisted lower blepharoplasty in the author's department in the period 1997-2000. Transitional hyperpigmentations were treated in 4 patients (11.1%). No severe complications were noted. All patients except one were satisfied or very satisfied. DISCUSSION: Transconjunctival and transcutaneous lower blepharoplasties are compared: 1. Transcutaneous blepharoplasty is simpler to perform, some skin resection is possible and no laser device is needed. 2. The danger of ectropion is relatively high in transcutaneous blepharoplasty, and the scar may not be fully acceptable for the patient. 3. Aged and sun-damaged skin is not influenced with the transcutaneous approach except for some improvement of rhytides. 4. Transconjunctival lower blepharoplasty is a relatively safe procedure with very good cosmetic results avoiding an incision and scar of the lower eyelid. 5. There is much less risk of ectropion and other complications in transconjunctival blepharoplasty than in the transcutaneous one. 6. An unpleasant side effect in transconjunctival blepharoplasty is erythema of the lower eyelids persisting for about 2-3 months. CONCLUSION: Laser-assisted transconjunctival lower blepharoplasty requires a shorter operating time and causes less bleeding and less patient discomfort. This is full-value alternative to the conventional transcutaneous lower blepharoplasty.

Adipose Tissue↗