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Radiation injuries, particularly those resulting from therapeutic or accidental exposure, present complex challenges for medical management. These injuries can manifest localized skin damage or extend to deeper tissues, presenting as various clinical entities that require treatment strategies, ranging from conservative management to complex surgical interventions. Radiation treatment constitutes a fundamental component of neoplastic management, with nearly two out of three oncological instances undergoing it as an element of their therapeutic strategy. The therapeutic approach to radiation injury consists of expanding prophylactic measures while maintaining the efficacy of treatment, such as conservative treatment or local debridement followed by reconstruction. The armamentarium of reconstructive methods available for plastic surgeons, from secondary healing to free tissue transfer, can be successfully applied to radiation injuries. However, the unique pathophysiological changes induced by radiation necessitate a careful and specialized approach for their application, considering the altered tissue characteristics and healing dynamics. The therapeutic strategy is guided by both the severity and progression of the injury, with the primary aim of restoring functionality and aesthetic aspects while simultaneously minimizing the risk of complications. This paper explores the various conditions encompassed by the term "radiation injury," reviews both non-surgical and surgical therapeutic strategies for managing these injuries, and highlights the unique challenges associated with treating irradiated tissues within specific oncological contexts. [ABSTRACT FROM AUTHOR]

Melanoma is one of the most aggressive forms of skin cancer. While most melanomas have a discernible primary site, a small subset, approximately 3.2%, present as a metastatic disease without an identifiable primary origin, a condition known as melanoma of unknown primary (MUP). Unusual cases of primary melanoma have also been previously reported in the respiratory, gastrointestinal, and urogenital tracts. MUP typically is found in lymph nodes, subcutaneous sites, and visceral organs, with hypotheses about its origin including spontaneous primary tumor regression and ectopic melanocytes. MUP presents unique challenges in diagnosis and treatment due to the absence of a detectable primary tumor. Understanding its genetic and molecular features, epidemiology, prognostic factors, and treatment options is crucial for optimizing patient care and outcomes in this subset of melanoma patients. We conducted an extensive literature review triggered by a case report of a patient with suspected MUP. A 51-year-old woman was transferred from another hospital where an incision was performed for a suspected superinfected hematoma of the left thigh. Since the patient showed high leukocytosis and redness and swelling of the thigh, local debridement, drainage, and excisional biopsy of the tumor mass were performed in our unit in the emergency setting, and the tumor was taken for histopathology evaluation. Intraoperatively, the mass appeared nonspecific. The permanent histopathology report established a diagnosis of melanoma, with tumor proliferation also involving lymphoid tissue, and despite broad clinical and imagistic assessments, the primary melanoma could not be identified. Clinicians must be aware of the varied clinical manifestations of malignant melanoma, especially in cases of occult melanoma where the primary site is not evident. [ABSTRACT FROM AUTHOR]

The Buschke–Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is a rare, exophytic tumor, arising from pre-existing warty lesions associated with human papillomavirus (HPV) infection, particularly strains 6 and 11, which are considered to have low oncogenic potential. BLT presents as a large, cauliflower-like growth typically affecting the penis, vulva, vagina, perineum, scrotum, anus, and perianal area. Despite being a benign lesion, BLT is locally aggressive with a high recurrence rate, and can potentially undergo malignant transformation into squamous cell carcinoma, contributing to an overall mortality rate of 20–30%. The primary treatment is complete surgical excision with wide margins, frequently requiring complex reconstructive techniques for defect coverage. We report on a 68-year-old patient, with multiple comorbidities, who presented with a two-year history of a large exophytic tumor in the genital region, affecting the penis, along with progressive erectile dysfunction and urinary problems. The tumor was surgically excised with oncological safety margins, and reconstruction was performed using advancement and rotation flaps from the scrotum and intact penile skin. Histopathological examination confirmed the diagnosis of Giant Condyloma (Buschke–Löwenstein tumor), showing acanthosis, papillomatosis, parakeratosis, and koilocytic cell collections, with positive immunohistochemical staining for p16, p63, and ki67. Postoperatively, the patient had a good clinical outcome and a complete surgical cure. This case highlights the critical need for timely intervention and comprehensive management strategies in treating giant condyloma, given its potential for local invasion and substantial impacts on patient quality of life. Early diagnosis and thorough surgical excision are crucial for effective management and to reduce the high recurrence, morbidity and malignant transformation risk associated with this condition. [ABSTRACT FROM AUTHOR]

Background: Severe burns pose significant therapeutic challenges due to their complex pathophysiology, the potential for life-threatening complications, long-term sequelae and the need for a multidisciplinary approach. In this retrospective study, we aimed to comprehensively analyze burns involving over 50% of the total body surface area (TBSA) treated in our institution over six years. Materials and methods: We performed a retrospective study including 91 patients. The following epidemiological and clinical characteristics were documented: age, sex, comorbidities, admission modality, mechanism of injury, TBSA burned, burn depth, presence of inhalation injury, outcome, length of stay and associated costs. Results: In the study group, subjects had a mean age of 54.4 years (24-93), with a male-to-female ratio of 2.5:1. The median percentage of TBSA burned was 70% (50-99%) and 93.4% of patients had third-degree burns. Inhalation injury was present in 71.4% of patients. Flame burns occurred in 90.1% of patients. Prediction scores were assessed, with 60.4% of patients having an ABSI score above 12. Mortality in our study group was 84.61% and 39.5% of patients died in the first week after burn injury. The most frequent systemic complications were respiratory complications (95.6%), followed by cardiocirculatory (93.4%), metabolic (84.6%), hematological (74.7%), renal (64.8%), hepatic (59.3%) and infectious complications (38.4%). Conclusions: Managing major burns is a highly complex process, which requires specialized care and infrastructure to improve outcomes. Extensive burns, especially over 50% TBSA, have high morbidity and mortality, with factors like age, severity and inhalation injury affecting prognosis. A multidisciplinary approach is essential for treatment, addressing not only the burns but also systemic complications to prevent multiple organ dysfunction syndrome and death. [ABSTRACT FROM AUTHOR]

Background and objectives: Burn injuries are the most severe type of trauma, with complex biological consequences associated with high rates of morbidity and mortality. Prompt recognition and management of burn-related complications are imperative for improving the vital and functional prognosis of the patient. Changes in biological parameters can be essential determinants in the prognosis of the burned patient. Thrombocytopenia in critically ill patients is linked to an elevated risk of mortality. We sought to investigate the significance of thrombocytopenia in severely burned patients while considering the limited available data in the literature. Materials and methods: A two-year retrospective study was conducted on 90 patients with severe burns admitted to our Burn Centre. Demographic data, burn lesion characteristics, and daily total blood counts, including platelet assessment, complications, and mortality, were recorded and analyzed. Results: Patients with extensive burns in our study had a poor prognosis based on their Abbreviated Burn Severity Index score (ABSI), age, percentage of total body surface area (TBSA) burned, presence of third-degree burns, and inhalation injuries. Regardless of the moment, patients with thrombocytopenia in our study died significantly more frequently. Compared with the survivors, the platelet count was significantly lower at any given time in the non-survivors group. Significant statistical associations between thrombocytopenia and ABSI score, burn surface area, presence of third-degree burns, and inhalation injuries were identified at different timeframes post-burn injury. Sepsis was encountered in one-third of the patients. Thrombocytopenia was more frequent in patients with sepsis who did not survive compared to survivors and did not normalize until the time of death. Conclusions: Thrombocytopenia represents an early indicator of severe complications and outcome predictor in severely burned patients. It is correlated with recognized negative prognostic factors and also with sepsis occurrence. Future research efforts should focus on refining early detection parameters and interventions to improve the prognosis of burn patients. [ABSTRACT FROM AUTHOR]

The field of transplantation, including the specialized area of vascularized composite allotransplantation (VCA), has been transformed since the first hand transplant in 1998. The major challenge in VCA comes from the need for life-long immunosuppressive therapy due to its non-vital nature and a high rate of systemic complications. Ongoing research is focused on immunosuppressive therapeutic strategies to avoid toxicity and promote donor-specific tolerance. This includes studying the balance between tolerance and effector mechanisms in immune modulation, particularly the role of costimulatory signals in T lymphocyte activation. Costimulatory signals during T cell activation can have either stimulatory or inhibitory effects. Interfering with T cell activation through costimulation blockade strategies shows potential in avoiding rejection and prolonging the survival of transplanted organs. This review paper aims to summarize current data on the immunologic role of costimulatory blockade in the field of transplantation. It focuses on strategies that can be applied in vascularized composite allotransplantation, offering insights into novel methods for enhancing the success and safety of these procedures. [ABSTRACT FROM AUTHOR]

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Facial nerve paralysis is a debilitating condition with multiple etiologies, with aesthetic, functional, psychological and social impact. Given the complex multitude of causes that may generate such condition, a therapeutic algorithm is mandatory when attempting reconstruction. Severity, timing, patient adherence to a rehabilitation program, status of ipsilateral and contralateral facial nerves and particularities of each patient are all criteria which should be accounted when choosing a treatment option. After initial assessment, a variable treatment panel is available based on condition type include medicamentous therapy, rehabilitation program, dynamic and static procedures surgical procedures, having as primary aim functional restoration achieving aesthetic balanced facial features. This paper summarizes current knowledge in facial paralysis reconstruction and presents an algorithmic approach that eases decision making and therapeutic strategy. [ABSTRACT FROM AUTHOR]

Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts and benign tumors. We present a case series of five patients with peripheral nerve compression in the upper limb due to tumor or cystic masses- ulnar nerve compression in the Guyon’s tunnel due to a ganglion cyst, large median nerve schwannoma compressing anterior interosseous nerve and median nerve, voluminous lipoma compressing median nerve in the proximal forearm, superficial branch of radial nerve compression by a synovial cyst and elbow region lipoma compressing radial nerve. In the beginning, those benign lesions are asymptomatic but, as they continue to grow adjacent to a peripheral nerve clinical manifestations appear progressively as compressive neuropathies. After a preoperative imagistic analysis, tumor resection with careful dissection, in order to preserve the neurovascular structures, is the elective surgical procedure in order to obtain an optimal functional recovery. [ABSTRACT FROM AUTHOR]

Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and secondary etiologies. The most common type of secondary lymphedema in western countries is represented by breast cancer related upper limb lymphedema. This condition, once installed, determines limb structure changes, progressive functional impairment, specific complications, consequently impacting the quality of patient’s life. An accurate diagnosis is mandatory, using both clinical and imagistic methods with clear definition disease extent as per standardized staging systems, in order to further provide an adequate therapeutic strategy. The main therapeutic goal in patients with lymphedema is represented by limb volume reduction with subsequent symptoms relief, improving quality of life and avoiding complications such as recurrent infections. Through this paper, we aim to present a comprehensive overview of current therapeutic options of breast cancer upper limb related lymphedema. Therapeutic approach comprises of non-surgical (conservative) therapy, which is mandatory as initial therapy and surgical procedures for selected cases. Most patients with lymphedema benefit from conservative treatment alone. In non-responsive cases, in patients with progressive disease, in late stage complicated lymphedema, and also recently added as prophylactic strategy, surgical treatment, trough recent developed techniques, offer very good results in long-term control of disease. Surgical options are classified firstly in physiologic procedures that aim to create new lymphatic channels, promote physiologic drainage of the lymph and should be considered early in the course of the disease, and secondly ablative procedures that reduce through liposuction or various excision techniques the volume of the affected limb. Both types of techniques can be combined to ensure the best functional outcome of the patient. [ABSTRACT FROM AUTHOR]

Electrocutions are a particular type of trauma, usually affecting young active people, leading to high morbidity and mortality rates in extensive injured patients. Those patients require complex, multidisciplinary treatment in specialized burn centers. We conducted a three-year retrospective study in the Burn Unit of the Clinical Emergency Hospital Bucharest, Romania, aiming to identify different factors that characterize electrical injuries, with the goal to improve our clinical practice, in order to decrease overall complications, the morbidity and mortality rates and obtain an optimal functional prognosis for those severely injured patients. Patient-related and injury-related parameters were analyzed, and particularities observed in our burn unit were noted. A clear understanding of the physiopathology of those injuries and their complications is essential for providing an optimal therapeutic strategy. Rapid initiation of systemic supportive measures, accurate diagnostic and an adequate surgical treatment, correctly conducted, are essential for improving the vital and functional prognostic of patients who suffer electric injuries. [ABSTRACT FROM AUTHOR]

Upper limb trauma cases vary from simple to high energy impactful injuries, with different etiologies; situations which frequently require unique, demanding and challenging endeavors in order to obtain the most favorable outcome. Experience, good decision-making and knowledge of functional goals are mandatory in order to elaborate a therapeutic plan and execute it accordingly. Although cases differ in nature and prognosis, respecting a set of therapeutic principles whilst dealing with either simple or complex cases, will enhance patient outcome and give the surgeon the confidence to tackle any kind of upper limb trauma. After clearing out vital threat, the emergency surgery represents the first threshold in achieving and restoring normal function and biomechanics, mostly in young and labor active patients, with the mindset to salvage as much tissue as possible, with a thorough debridement and step-by-step approach to different types of tissues. Secondary surgery and reconstructive surgery can be planned timely, with prior discussion with both the therapist and the patient in order to enhance patient’s upper limb function and aesthetic and ensure social reintegration. [ABSTRACT FROM AUTHOR]

Burn injuries are unique in comparison to other types of trauma because of their severity and major systemic impact produced by extensive lesions with disfunctions that can persist even several years after the injury. Multiple complications can occur during burn injury evolution, from which infections are the most severe and the most frequently encountered, requiring adequate diagnosis and treatment. In most burn centers, increased mortality rates associate with severe burn injuries aggravated by the development of sepsis. There are multiple sources of infections in burned patients: lungs, wounds, catheters, gastrointestinal and urinary tract. Pathogens are often multi-resistant bacteria but also fungi and viruses appear as opportunistic infections. The main goal is represented by prevention of organ dysfunction development through specific supportive measures that avoid its onset. Early excision of the burn eschar and wound grafting is essential for patient outcome, decreasing duration of hospitalization, infectious risk and mortality. As a principle, antibiotic treatment in burn infectious complications is started empirically, with broad spectrum agents if the results of microbiological cultures are not available and immediately after the antibiogram is available, targeted antibiotic is introduced. De-escalation strategy is promoted in order to prevent antimicrobial resistance: narrow spectrum drugs with proven efficacy on determined germs are administered, avoiding if possible, reserve antibiotics. [ABSTRACT FROM AUTHOR]

Severe burn injuries represent a major challenge to the entire healthcare system in developing countries and even for states with a high standard of care. A clear understanding of the physiopathology of burn injuries is essential for providing an adequate prompt treatment to ensure an optimal patient outcome. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. Specific treatment must be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance. A diagnostic and therapeutic algorithm is presented, centered on infectious source prevention and control with early surgical excision and skin grafting together with culture-guided antimicrobial therapy. It is a known fact that, indifferent of the involved germ, the best intervention for both prophylaxis and treatment of infections in the burn patient is the early excision of the devitalized tissue and subsequent closure of burn wounds with skin grafts, measures that diminish local and systemic mediator releasing effects in burnt tissue, attenuating the progressive inflammatory chain. [ABSTRACT FROM AUTHOR]

Treating complex abdominal wall defects is challenging for the reconstructive surgeon as there are many possible complications and high reccurence rates. To date, there is no consensus on a definition of complex abdominal wall defects, as the level of complexity can be different from case to case. Thorough knowledge of the etiology of defects and relevant anatomy, adequate management during hospitalization and in postoperative period are key elements in obtaining optimal functional results. Although the etiology of abdominal wall defects is varied, reconstructive goals are well established, including recovery of structural integrity to ensure visceral coverage and maintenance of intraabdominal pressure, prevention of hernia formation, if possible with an aesthetic pleasant result; long hospitalizations increasing morbidity and costs should be avoided. Choosing the right therapeutic strategy may be very demanding, because there is no standard treating protocol to guide the management of these patients.. We present, through five clinical cases, our experience with managing abdominal wall defects having in mind the general reconstructive priciples and trying to individualize the treatment for each of them. [ABSTRACT FROM AUTHOR]

Introduction. The field of composite tissue allotransplatation became a clinical reality since first hand transplant performed in 1998 at Lyon, France and has been progressing over the past two decades. Vascularized composite allotransplantation (VCA) is now performed for life enhancing indications in a selected group of patients under institutional protocols. Aim. This paper is an attempt to review the outcomes of VCA to date. Method. Analysis of relevant publications of composite tissue allotransplantation was performed, including the International Registry on Hand and Composite Tissue Transplantation (IRHCTT). Results and discussion. To date, there are more than 200 composite tissue allograft transplants performed worldwide, including upper limb, face, larynx, trachea, abdominal wall, lower limb, penis, and uterus. The technical aspects of VCA are no longer the factors limiting the widespread application of this treatment modality in the clinical setting. The feasibility of the procedure has been established, and the functional outcomes have been very good so far. The major challenge is at the immunologic level, long-term goal being to promote donor-specific tolerance and to avoid the toxicity of immunosuppression. Conclusions. Vascularized composite allografts transplatation is a viable treatment option well on the way of becoming a standard of care for those who have lost extremities and suffered large tissue defects. The initial ethical dilemmas and concerns of safety and feasibility have been overcome recently and with further standardized surgical and immunological protocols the field is likely to grow significantly in the future. [ABSTRACT FROM AUTHOR]

Introduction: Severe burn injuries still are a major challenge for the entire healthcare system. Multiple predictive factors may influence the prognosis of burn patients and a careful management of those parameters will decrease the morbidity and mortality and will determine an improvement in patient's final functional outcome. Material and Methods: We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. A detailed analysis was performed on those 210 critical patients in order to determine the parameters that aggravate the prognosis of burn injuries. A large data panel was taken into consideration regarding burn severity, mechanism of injury, patient characteristics, associated illnesses, promptitude in hospitalizing the patient in our burn center; ABSI score was used to evaluate the mortality risk, burn injury-associated complications were noted and analyzed. Results and discussion: We highlighted a series of parameters regarding therapeutic management that influence the outcome of the patient after severe burn injury: an adequate hydro-electrolytic resuscitation in the acute phase, further support of vital functions, early excision and grafting of deep burn injuries, comorbidities treatment and adherence to rehabilitation and follow-up program. ABSI Score is an important tool in the assessment of mortality in burn patients. Multiple complications were encountered in our patients: infections, pulmonary, cardiac, renal, thrombo-embolic, hematologic, digestive and neurologic disorders. Conclusion: A detailed analysis of the physiopathology of burn injuries and their complications is essential for providing an adequate prompt treatment for decreasing morbidity and mortality. Mortality still represents the primary outcome evaluation for burn care, therefore scoring systems aim to use the most predictive patient and injury-related parameters to appreciate an expected mortality for a given patient. Early excision of the devitalized tissue and subsequent grafting reduce the local and systemic effects of the mediators released from the burned tissue with cessation of the progressive inflammatory chain. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. [ABSTRACT FROM AUTHOR]

Nerve entrapment syndromes in the upper extremity represent a common occurrence, but in many cases these are not correctly diagnosed, leading to severe complications. Carpal tunnel syndrome is the most frequent compressive syndrome. The promptitude in establishing a correct diagnosis and initiating an adequate treatment is essential in reducing the morbidity associated with nerve compression in upper limb, improving the quality of life of the patient and also ensuring a faster socio-professional reinsertion. Nerve lesions demonstrate a variable evolution, with different recovery and prognosis. We developed a prospective clinical study with the aim to evaluate a series of patient characteristics that influence the disease evolution and may serve as predictive factors for treatment outcome in compressive neuropathies. Further manipulation of those parameters may direct our therapeutic strategies for obtain a maximal functional recovery, the supreme desiderate in peripheral nerves pathology. [ABSTRACT FROM AUTHOR]

Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome in patients with extensive defects, involving multiple layers of functional tissue, often necessitating numerous, and staged, surgical interventions with unsatisfactory results. Transplantation of vascularized composite allografts(VCA) opened a new, promising era in reconstructive surgery, offering a unique restorative opportunity for those complex situations. VCA transplantation have been performed for life enhancing indications in a selected group of patients under institutional protocols. The controversy of those procedures, having functional benefits and the goal of quality of life restoration, rather than life-saving indications, resides to the life-long required immunosuppressive therapy, with implicit side effects. In order to extend VCA indications, translational studies are needed to develop less toxic immunosuppressive regimens and possibly achieve donor-specific tolerance, the ideal situation in transplantation. Extensively burned patients, especially of the face and cervical region, having severe mutilations and also unilateral or bilateral hand amputations, like after high voltage electric injuries, present functional and aesthetic deficits, with devastating impact on their quality of life and, constituting potential candidates for receiving a vascularized composite allotransplantation, as the only reconstructive solution. With this paper, we discuss the indications and limits, from clinical and immunological perspectives, of the consideration of VCA as surgical option for burn patients with complex tissue defects, impossible to approach by conventional techniques. [ABSTRACT FROM AUTHOR]

Nerve entrapment syndromes in the upper extremity represent a common occurrence, but in many cases these are not correctly diagnosed, leading to severe complications. Carpal tunnel syndrome is the most frequent compressive syndrome. The promptitude in establishing a correct diagnosis and initiating an adequate treatment is essential in reducing the morbidity associated with nerve compression in upper limb, improving the quality of life of the patient and also ensuring a faster socio-professional reinsertion. Nerve lesions demonstrate a variable evolution, with different recovery and prognosis. We developed a prospective clinical study with the aim to evaluate a series of patient characteristics that influence the disease evolution and may serve as predictive factors for treatment outcome in compressive neuropathies. Further manipulation of those parameters may direct our therapeutic strategies for obtain a maximal functional recovery, the supreme desiderate in peripheral nerves pathology. [ABSTRACT FROM AUTHOR]

Since 1998, when the first successful hand transplant was performed in France, at Lyon, an unpredicted development of reconstructive transplant surgery (transplant of VCA: vascularized composite allografts) occurred. Those procedures represents the only option for patients having extensive, complex tissue defects, involving multiple anatomical layers, impossible to approach using conventional reconstructive techniques. More than two hundred VCA procedures were reported worldwide, including: upper and lower limbs, face, larynx, trachea, abdominal wall, penis, uterus, knee allotransplant. Important aspects arise in the study of immunological mechanisms of acceptance and rejection of the allograft, the mode of action of immunosuppressive agents and protocols currently used in transplant programs for vascularized composite allografts. Immunosuppressive regimens that are used for solid organ transplantation (kidney, heart) are also effective for VCA transplants with good results regarding survival and functionality of the allografts. Current goal is the minimization of immunosuppression, composite tissue allotransplantation procedures being addressed for functional recovery (are not life-saving interventions like solid organ transplants). The ideal situation, which would allow a large scale utilization of VCA procedures, is the possibility of induction the donor-specific tolerance, allowing allograft acceptance without the need of immunosuppressive therapy. Currently this circumstance is difficult to achieve in clinical practice, resulting in large transplant centers ongoing research focusing on immunological difficult aspects. [ABSTRACT FROM AUTHOR]

Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome in patients with extensive defects, involving multiple layers of functional tissue, often necessitating numerous, and staged, surgical interventions with unsatisfactory results. Transplantation of vascularized composite allografts(VCA) opened a new, promising era in reconstructive surgery, offering a unique restorative opportunity for those complex situations. VCA transplantation have been performed for life enhancing indications in a selected group of patients under institutional protocols. The controversy of those procedures, having functional benefi ts and the goal of quality of life restoration, rather than life-saving indications, resides to the life-long required immunosuppressive therapy, with implicit side effects. In order to extend VCA indications, translational studies are needed to develop less toxic immunosuppressive regimens and possibly achieve donor-specifi c tolerance, the ideal situation in transplantation. Extensively burned patients, especially of the face and cervical region, having severe mutilations and also unilateral or bilateral hand amputations, like after high voltage electric injuries, present functional and aesthetic defi cits, with devastating impact on their quality of life and, constituting potential candidates for receiving a vascularized composite allotransplantation, as the only reconstructive solution. With this paper, we discuss the indications and limits, from clinical and immunological perspectives, of the consideration of VCA as surgical option for burn patients with complex tissue defects, impossible to approach by conventional techniques. [ABSTRACT FROM AUTHOR]

The clinical applications of the fibula flap for reconstructing bone defects in the limbs have been widely studied. This study aims to investigate the use of the fibula flap in the treatment of bone defects resulting from trauma, infections, or oncological pathology. Additionally, the study focuses on analyzing preoperative experiences, including imaging and intraoperative aspects, to optimize preoperative planning. The study includes a retrospective analysis of adult patients who underwent surgical treatment for extensive bone defects from 2014 to 2020. Demographic data, surgical interventions, and postoperative complications were collected. Specific anatomical elements of the fibula flap, such as vascularization and dimensions, were also studied. The findings of this study provide valuable insights into the clinical applications and optimization of the fibula flap for reconstructive surgery. [ABSTRACT FROM AUTHOR]

Injuries to the upper limb may determine unexpected simple or complex soft tissue defects, due to different types of underlying injury mechanism, clean cut/stabs, crushing, torsion, avulsion or mixed types, which pose a challenge for the reconstructive surgeon. Ideally, all arterial, venous and nervous lesions, in the distal upper limb should be repaired in an end-to-end technique, outside of injury zones, with healthy ends, in a tension free manner. However, situations arise where, either a tension-free repair is not possible, or a considerable defect is met, often representing a challenge to the surgeon. Therefore, a timely decision is imposed in order to find the most favorable approach to restore limb or segment perfusion, ensuring efficient venous return, as well as providing a sensate repair. Usage of vein grafts represents an essential tool comprised in the reconstructive surgeon’s armamentarium, with high versatility in nerve, arterial and venous reconstruction. Not only does it provide an ideal solution, with high adaptability to each case, but it also may enhance short- and long-term outcome, offering an optimal reconstructive option in any upper limb trauma situation, regardless of etiology. We aim to describe our therapeutic strategies in a series of challenging trauma cases involving digital structures from the upper limb. Interposed vein grafts were used to re-stablish sensate function in a patient with a collateral digital nerve defect, but also to bridge vital digit arterial defect in a torsion-avulsion thumb amputation, as well as re-establishing venous flow in patients with Urbaniak II finger degloving injury. [ABSTRACT FROM AUTHOR]