Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient’s age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon’s reliability in performing a particular procedure. Our study found no advantages of one procedure over the other.
Background/Aim. Neurocutaneous flaps (NF) are the type of fasciocutaneous flaps whose clinical application has increasingly grown over the years. They have become an indispensable step in the reconstructive ladder for the small and medium soft tissue defects of the lower leg and foot. The aim of this study was to analyse the results of the treatment of patients with lower extremity soft tissue defects caused by trauma, infection, tumour removal or unstable scar formation, which were reconstructed with a variety of NF. Methods. This retrospective study includes 32 consecutive patients with soft tissue defects of the lower limb, treated in the Clinical Centre of Vojvodina from January 2004 to April 2017. All the operations were performed in regional anaesthesia with pneumatic tourniquet. Design of the flap and length of the pedicle were determined by the size and position of the recipient site after necessary debridement. The flap was harvested, rotated and positioned in the defect region. The patients and flap data were summarized upon their collection. Results. The average age of the patients, mostly males (81.2%), was 46.7 years. Distally based sural flaps were used in a majority of patients (56.2%), followed by the distally based saphenous (21.9%), lateral sural (12.5%) and proximally based sural flaps (9.4%). Defects were most often localized on the distal third of the lower leg and on the ankle (53.1%). The most common indication for surgery were trauma (46.9%) and chronic infection (31.2%). A satisfactory coverage of the defect was achieved in all 32 patients with no flap loss. A partial necrosis of the flap due to prolonged venous congestion was noted in 3 (9.4%) patients, which were healed by second intention or with delayed skin grafting. Five (15.6%) patients developed a localised infection. The infection signs withdrew spontaneously in 2 cases and after a surgical revision in 3 cases, where osteitis of the tibia had persisted. One of them required the Ilizarov orthopaedic procedure after bone resection. Conclusion. NF proved to be a paramount alternative to free-flap reconstruction of the lower limb. Intensive clinical application can be explained by the fact that it is a less technically demanding and time consuming surgical procedure with no major source vessel sacrifice. The reliability and safety of their utilisation are confirmed by our clinical data.
Treatment is usually based on systemic antimycotic agents (Amphotericin B, Azoles: Fluconazole, Flucytosine). Prophylactic treatment is still a matter of debate. It is not routinely recommended in ICU, but is commonly used in transplant patients.
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