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Introduction. Pyogenic granuloma (PG) is a vascular inflammatory hyperplasia involving the skin and oral mucosa, often associated with local irritation or trauma, or with pregnancy. Intraoral location usually affects the gingiva, but tumoral aspect can be misleading, especially in extra-gingival locations. A thorough assessment and diagnosis are therefore important for ensuring the proper treatment. Case presentation. We report the case of a 12-year-old boy who presented for a growing and bleeding tumour of his lower lip mucosa. The tumour was labeled as “hemangioma”. It was growing for several weeks and associated with minor, but repeated mucosal trauma. Although the anatomic location was not common, the patient history suggested a diagnosis of PG. After a dermatologic assessment, which proposed a differential diagnosis with oral papilloma, a soft tissue ultrasound sustained the clinical diagnosis. The tumour was surgically excised and the defect was closed directly with absorbable sutures. Three weeks later the mucosa had a healthy appearance, without signs of impaired healing or tumour recurrence. The histopathological exam confirmed the clinical diagnosis. Conclusions. There are several types of soft tissue solid or vascular tumours that can be mislabeled and the diagnosis of hemangioma is commonly used for various vascular anomalies. In our case, the clinical aspect, together with the tumoral growing pattern and the history of repeated trauma, led us to the correct diagnosis and treatment. Surgical excision completely removes the PG and ensures rapid and esthetically convenient healing, without complication or tumour regrowth.

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft tissue and muscle defects and an open abdominal cavity that needed reconstruction. We designed two pedicled tensor fascia lata flaps with extra fascia for abdominal support. Healing was marked by a pseudomonas aeruginosa infection that led to skin graft sloughing and marginal wound breakdown, which was treated with antibiotics and local wound care. Eventually the wounds healed, and the patient left the hospital 11 weeks after admittance. The outcome of the case was good considering the initial extent of the infection. The cosmetic shortcomings were not shared by the patient and future scar corrections are planned.

One of the most frequent causes of accidents in children are burns, regardless of aetiology, without displaying a noteworthy gender disparity, and they represent one of the most complex diseases with which a body can be afflicted. The differences amongst patients who arrived at the emergency room, as well as those who were hospitalised on the Plastic Surgery and Burns department within the Clinical Emergency Hospital ”Gr. Alexandrescu”, regarding their age, gender, percentage of the afflicted body surface area, the location of the burn lesions on their bodies, have been monitored and analysed, in order to create an equation which defines the profile of the patient hospitalised within the plastic surgery departments

Vindecarea leziunilor tegumentare rezultate secundar traumatismelor sau arsurilor se soldează cu apariţia ţesutului cicatricial, ce poate determina dizabilităţi semnificative. Studierea particularităţilor pielii fetale aduce în discuţie abilitatea acesteia de a se vindeca printr-un proces de regenerare, fără formarea cicatricilor. Înţelegerea mecanismelor celulare şi moleculare ale fenotipului fetal capabil să se vindece fără cicatrizare este de o importanţă deosebită, întrucât poate genera noi ţinte terapeutice cu potenţial de a reduce formarea ţesutului fibrotic secundar vindecării plăgilor postnatale. Scopul acestui articol este prezentarea concisă a caracteristicilor unice ale procesului de vindecare fetală regenerativă ce ar putea facilita vindecarea fără cicatrizare.

The healing of skin lesions, such as traumas or burns, can often result in severe scarring causing important disabilities. The study of fetal skin particularities brings into light its ability of healing wounds in a scarless manner, through regeneration. Understanding the cellular and molecular mechanisms of fetal scarless phenotype is of utmost importance as it can result in new therapeutic targets that could have the potential to reduce scarring in postnatal wounds. The aim of this review is to summarize the unique features of fetal wound healing process that may facilitate a scarless wound repair.

The upward trend of patients opting for elective breast augmentation, as well as the large number of patients benefiting from alloplastic breast reconstruction, require further studies on the safety profile of these techniques. Without any doubt, the incidence of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has drawn attention to the possible unknown complications characteristic of these procedures, creating the context of further studies devoted to this issue. The present research examines the capsular contracture rate on a group of 253 patients between 2015 and 2019, also proposing a scoring system based on the integration of the main diagnostic criteria related to the capsular contracture. The results of the literature review indicate that a lower incidence of capsular contracture could be achieved by using the newest techniques in the field involving the application of chemical substances on the surface of the latest generation of silicone breast implants.

Increasing the incidence of breast cancer worldwide is an alarming factor for the medical community and also an additional reason for accountability. Oncological treatment, followed by subsequent reconstructive stages, are traumatic events that without a doubt exert their adverse effects on the quality of life of these patients. The reconstruction of the nipple-areola complex represents the final element in the treatment of patients who have suffered from cancer breast and must follow basic principles such as: reproducibility, efficacy, short duration of treatment and low rate of complications. The present material presents the various surgical techniques dedicated to the reconstruction of the nipple-areola complex, presenting their advantages and disadvantages based on a 5-year study. The use of single-stage techniques associated with medical tattooing were the main factor in increasing the satisfaction of the patients included in the research.

O2 deprivation induces stress in living cells linked to free-radical accumulation and oxidative stress (OS) development. Hypoxia is established when the overall oxygen pressure is less than 40 mmHg in cells or tissues. However, tissues and cells have different degrees of hypoxia. Hypoxia or low O2 tension may be present in both physiological (during embryonic development) and pathological circumstances (ischemia, wound healing, and cancer). Meanwhile, the kidneys are major energy-consuming organs, being second only to the heart, with an increased mitochondrial content and O2 consumption. Furthermore, hypoxia-inducible factors (HIFs) are the key players that orchestrate the mammalian response to hypoxia. HIFs adapt cells to low oxygen concentrations by regulating transcriptional programs involved in erythropoiesis, angiogenesis, and metabolism. On the other hand, one of the life-threatening complications of severe burns is acute kidney injury (AKI). The dreaded functional consequence of AKI is an acute decline in renal function. Taking all these aspects into consideration, the aim of this review is to describe the role and underline the importance of HIFs in the development of AKI in patients with severe burns, because kidney hypoxia is constant in the presence of severe burns, and HIFs are major players in the adaptative response of all tissues to hypoxia.

Introduction. In Romania the number of electrocutions has risen significantly in the last ten years compared to figures in other European countries. We have a higher number of patients suffering from high voltage burns than low voltage (domestic) injury. Objective. To establish the current state of management of treatment for electrocution post-burn sequelae in pediatric patients in Romania. Materials and methods. Observational descriptive single-center study: 1a/electrocution burns on pediatric patients; 2a/the collection of data concerning the treatment of patients inclusive in electrical phenomena. Results. The study took place over a period of October 2012 – December 2014 at Emergency Hospital for Children Grigore Alexandrescu, Bucharest: 72% developing electrocution post- burn sequelare lesions and 28 patients% non developing electrocution post-burn sequelae lesions. Conclusion. Too many healthy pediatric patients develop electrocution post-burn sequelae lesions after this exposurefor this kind of event.

Burns are entirely particular lesions, which must always be regarded as severe, especially at extreme ages, which affect the body in its entirety. Both the local lesion and the general bodily reaction are dynamic and entail characteristic sequences, which can be anticipated and prevented, in order to reduce the risk of complications and to provide the best possible vital, functional and aesthetic prognosis. The human skin, the largest organ of the body and the most important immune organ, consists of two layers – epidermis and dermis. The action of the thermal agent, irrespective of its aetiology, most commonly affects the epidermis and more or less deep areas of the dermis, depending on the temperature and duration of exposure. In the most severe cases, the dermis is destroyed in its entirety and sometimes, sub-dermic structures are affected as well.

Burning by electrocution presents one of the most complex pathologies with a sever impact at a systematic and local level on the human body. This is more extensive when it appears at a young age, because of the implications related to developing, social and functional integration of the future adult. It is mandatory to create a unitary therapeutical algorithm for the treatment of the sequelaes by electrocution in order to optimize the life of the person exposed to such a particular burn. We are trying to justify a standard and an implementation of the therapeutical algorithm in order to monitor the results during the established study. The purpose is to improve survival, decrease the damage of the injuries, have a better quality of life and reintegrate the electrocuted patient in a psychological and social way.

Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident. Clinical examination revealed a Gustilo-Anderson IIIB open fracture of the left leg, with the avulsion of the fifth toe, disarticulation of the fifth metatarsal bone, extensively damaged skin and subcutaneous tissue in the medium and distal third of the left leg and left foot. The bone was exposed in the distal part of the leg, external malleolus and left calcaneus. Profuse lavage, reduction of the tibial fracture and elastic intramedullary nailing, amputation of the fifth left toe, necrectomy and debridement of devitalised tissue were performed. NPWT was started, with the dressing changed every five days. After 55 days of using NPWT, granulation tissue covered the soft tissue defect and created a wound bed for the skin graft. NPWT helped the management of this open wound, achieving a wound bed for the skin graft, avoiding the use of complex reconstructive methods.

Introduction: Extensive lower limb traumatic injuries are particularly challenging when they associate skin and soft tissue defects, moreover when the patient is a child. In view of more frequent recommendations and reports of negative pressure wound therapy (NPWT) use for severe trauma and extensive soft tissue defects of the lower extremity, we aimed at reviewing the indications and outcomes of this technique in our pediatric plastic surgery department. Method: We performed a retrospective study for the period 2016–2019, in order to identify patients having suffered injuries of the ankle and foot, for who NPWT was used in the therapeutic protocol. Results: For the study period we identified a total of 9 children with ankle and foot injuries who had NPWT in their therapeutic protocol. The average age was 10 years (range 3 years 5 months to 14 years 4 months) and 8 of them were pedestrians, victims of traffic accidents. Five patients presented with associated injuries and fractures in other anatomic locations. NPWT was started 1–3 days after admission and it was used in average for 21.77 days, with good results in all cases. For 8 patients NPWT was sufficient to contract the wound and cover exposed bone and tendons before closing with split thickness skin graft (STSG). One patient needed also a free muscular flap transfer before grafting. All patients achieved complete healing and started physical therapy before discharging. Conclusion: NPWT has proven to be an easy to use, safe and effective therapeutic tool for pediatric patients, with considerable improvement for healing in case of traumatic injuries of foot and ankle, presenting extensive skin and soft tissue defects and bone exposure in children. NPWT is also suitable for children since its use implies less frequent dressing changes, and decreases the level of pain and anxiety, and spares donor areas needed for more complicated procedures and, by creating an optimal grafting bed, it ensures good outcomes, in the short term and long term as well.

Objective. Impact assessment of cleft palate only on weight gain in children who did not receive surgery yet. Methods. This paper is a synthesis of a retrospective study conducted during 2005-2008 on 21 patients with cleft palate only and operated in Pediatric Surgery and Plastic Surgery Clinics of „Grigore Alexandrescu“ Emergency Children’s Hospital, Bucharest, taking into account patients’ sex, age and weight in the time of surgery and cleft palate type. Results. This study shows that most patients with cleft palate only who didn’t performed reconstructive surgery have low weight compared with the weight for age growth standards. Thus, 38.09% of patients were under p25 percentile weight curve. The trend is more visible in females: 36.36% of girls’ weight, compared to 27.27% of boys’ weight, is located below this line. Cleft palate type directly correlates with the degree of malnutrition in these patients: 87.5% of children with complete cleft palate showed preoperative weight beneath p25. Conclusions. Cleft palate only children have a weight lower than the average weight for age in preoperative period, a finding that reinforces the need for surgery of this malformation. The study also highlights the importance of closely monitoring the weight of these patients before reparative surgery in order to improve the outcomes.

Objective. The analysis of the traumatic amputation of fingers of hospital admitted children in order to identify certain characteristics to form the basis for optimizing the prevention and cure algorithms. Materials and methods. The data was extracted from the surgical protocols of the children admitted to the Clinic of Plastic Surgery and Burns of “Grigore Alexandrescu” Clinical Emergency Children’s Hospital, between 2005 and 2013, with traumatic amputations of the fingers. Information was gathered related to the age and sex of the patients, the circumstances of occurrence of the trauma, the manner of occurrence, the amputation level, the type of surgical procedure and the number of surgical interventions. Results. A total of 42 children with traumatic amputations of the fingers have undergone surgery, the coverage of the stump being employed in 81% of cases and the replantation of the amputated segment in only 19% of instances. Two thirds of the pacients were boys. The fingers were affected in 95% of the cases presented to the clinic with this type of trauma. Conclusions. The data obtained has been in accordance with other studies that had indicated the rising incidence of traumatic finger amputations among boys, during household activities that involve manipulating tools having a high potential of injury when use by children. The technical possibilities of replantation are both available and effective, but the cases eligible for this type of treatment are few, hence the focus should still be set on prevention.

Objective. The analysis of the soft tissue coverage types employed in complex limb trauma in children towards a potential subsequent optimization of their management. Materials and methods. Data regarding the children admitted to the Burns and Plastic Surgery Clinic of ‘Grigore Alexandrescu’ children’s hospital, between 2005 and 2013 with complex limb trauma requiring soft tissue coverage was obtained from the surgical protocols. Information was gathered regarding patients’ sex and age, the type of incident, the mode of occurence, the region in need of coverage, the number and type of surgical procedures, as well as regarding the type of coverage employed. Results. A number of 80 children required soft tissue coverage in complex limb trauma. Boys accounted for approximately two thirds of all cases. The pacients had a minimum age of 1 year and a maximum one of 16 years. There were approximately 50% more trauma of this type affecting the upper limb than the lower one. The fingers required coverage in the majority of cases (77.5%). In the majority of cases at this level (77%) split-level thickness grafts and local flaps were applied. Conclusions. The majority of the complex pediatric soft tissue limb coverage cases were boys. Fingers were the predominantly affected area and most often the usage of split-level thickness grafts or of local flaps was required. The accidents were predominantly home related. The cases had an uncomplicated evolution, the coverage solutions employed being successful in over 90% of the situations.

Objectives. To establish the anatomical and functional correlations which are necessary in feminizing genitoplasty through the study of the specialized literature, following the changes in surgical procedures gained with the improvement of anatomical knowledge. Materials and method. There were studied references from internet database, some with historical importance but representative as evolutionary steps in establishing the current procedures accessed in feminizing surgery. There were searched case reports, reviews, technical presentations, descriptive, retrospective and prospective studies, also book chapters. Results. Of the studied materials have been selected 43 titles, including articles and papers that bring in the fore the importance of the anatomical and functional features present within the studied pathology, making correlations that developed, perfected and refined surgical techniques used in feminizing genitoplasty. Some observations and technical applications have historical value in these days but aspects were reiterated in this study, trying to select some surgical procedures in according with current requirements. Conclusions. Although techniques have gained value thanks to the thorough study of functional anatomy, each surgical stage winning accuracy and functional value, keeping the sensitivity of the genital area through the observance of structures with tactile and erectile importance, there are controversies which are emphasized by the pitiful of long-term outcomes, but also by ethical and deontological implications of this type of treatment. For cases of Congenital Adrenalian Hyperplasia keeping the integrity of the tissue and reproductive function is the main reason which eases the surgical decision.

Objective. To evaluate the present state of cleft palate surgical treatment based on clinical studies after an extensive research of medical literature. Methods. The research was made in PubMed database between 2007-2014 taking in consideration surgical treatment of cleft palate and eliminating case reports, case series and reviews. Results. There was 1,677 articles with relevance for cleft palate surgical treatment and after applying exclusion criteria were retained 43 – 29 retrospective studies and 14 prospective. Conclusion. There isn’t a protocol treatment recognized by all the cleft palate centers, existing a variety of ways to manage this malformation. There are few studies that adress treatment of cleft palate and in particular the surgical treatment of this disease and of these many are retrospective studies. This review reinforces the importance of performing prospective studies with long-term outcomes to elucidate the effect of each protocol for obtaining optimal results.

Complex wounds represent a challenge for the wound care specialist. The aim of treatment of electrical burn wounds is to achieve skin cover of the soft-tissue defects, prevent infection, and allow a good function of the affected anatomical segment. Surgical reconstructive techniques for soft-tissue defects covering, such as muscle flaps, free flap transfers, and cross-leg techniques, are frequently used in treating sequelae after electrical burns. In some cases, when the patient cannot be a candidate for free flap surgery the use of negative-pressure wound therapy (NPWT) is an effective alternative that can minimize the traditional reconstructive surgery methods and can reduce the surface of the soft-tissue defect by filling it with new formed granulation tissue, creating a skin graft receptor bed.

Introduction Infantile hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal. Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option. Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture. Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a “healthy” hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.

The composite allotransplant of tissues was recently introduced on the list of potential procedures for complex face reconstruction. To assess the technical and immunological aspects and the potential of the clinical applicability of this new approach in facial reconstruction, samples of total and hemifacial transplant with rats have been introduced. We have proposed in this study checking the versatility of the facial transplant sample in rats by performing the hemiface transplant between two neco-blood species of laboratory rats. Meanwhile, study included the verification of mono-therapy efficiency with A cyclosporine in inducing immune tolerance against the composite tissue graft, which consists of skin, subcutaneous tissue, blood vessels and ear cartilage, transferred against the hystocompatibility barriers, as well as the verification of the procedures adjacent to transplant: anesthesia and surgical technique. In this study,14 laboratory rats have been included and divided into 3 lots. Lot No. 1 was represented by 2 Brown Norway rats used for the anatomic study of the vascular formations which are going to be coopted during a facial transplant. Lot No. 2 consisted of 3 Brown Norway rats used as donors and 3 Wistar rats used as acceptors, with these transplants being associated immunosuppression protocols postop. Llot No. 3 consisted of 3 Brown Norway rats used as donors and 3 Wistar rats used as acceptors, which, after the intervention, did not receive an immunosuppression treatment. Conclusions. The experimental sample of the facial transplant is an essential and mandatory stage in preparing the clinical application of the face transplant. Our study confirms the good tolerance of the hemiface transplant against the major hystocompatibility complex granted by the immunosuppression with A Cyclosporine in rodents.

The main role of the melanin production belongs to the keratinocyte-Langerhans-melanocyte complex that within a burn injury might be destroyed. A particular aspect has the pediatric patient with burns due to a deficit in pigment synthesis and particularities involving the growth process of facial structures. This article presents four eloquent cases of pediatric patients with sequelae, consequence of facial burns that varied in depth and etiology. The age of patients at time of admission was between four and 18 years, and the interval between production of the primary lesion and admission was variable (0-17 years). Conservative treatments prove to be insufficient, requiring the destroyed structures to be replaced with compatible tissue by surgical intervention. The therapeutic success of skin grafts and dermal substituents acknowledges the main role of plastic surgery. New technologies as well as new cell focused studies support the clinical proven results as well as they enlarge the spectrum of potential available therapeutic methods in order to obtain the best therapeutic results.