I. Dzepina - Academia.edu (original) (raw)
Papers by I. Dzepina
European Journal of Plastic Surgery, 1992
Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provid... more Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provides the thinnest possible flap. The authors present their own experience with the use of the forearm septofascial flap in 23 patients. A free septofascial flap was used in 15 patients and an island flap in 8 patients. Seven days later, only 25%
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 1994
The authors emphasize that the knowledge of terminal ballistics is important for understanding th... more The authors emphasize that the knowledge of terminal ballistics is important for understanding the pathophysiology of war wounds. They present their own experiences in the treatment of war wounds in 504 casualties treated at the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. The locations of soft-tissue defects were: head and neck, 103; trunk, 90; and extremities, 903. War wounds were divided into four main categories with regard to the type of the injury and the extension of soft-tissue defect, thus showing the differences in primary excision and reconstruction of the wounds. About 30% of head and neck injuries were treated by primary or delayed primary reconstruction. All thoraco-abdominal wounds were type I or II, and most of them (53.3%) were reconstructed with split-thickness skin grafts. The greatest number of sophisticated reconstructions were performed on extremity injuries (63 wounds were reconstructed by local fl...
Lijec̆nic̆ki vjesnik
Although free jejunum transfer has become an accepted form of hypopharyngeal reconstruction, an i... more Although free jejunum transfer has become an accepted form of hypopharyngeal reconstruction, an ideal method of monitoring the viability of the graft has not been devised yet. The method of direct visualisation through the incision in the skin above the transferred jejunum has proven very reliable and easy to perform, especially for the nursing staff. This reliable method of monitoring free vascularised jejunum to the neck region has been used in two patients. After two days of direct monitoring, the incision in the skin healed without additional sutures. No failures of the graft occurred, and 12 days later the patients were able to swallow fluids without difficulty. The effectiveness of this technique has surpassed that of all previously published methods.
Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi, 1994
We present our experience in the treatment of war wounds in 174 patients treated in the Institute... more We present our experience in the treatment of war wounds in 174 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. The wounds were divided into four categories depending on the type of injury and the extension of the soft tissue defect which showed the differences in primary excision and reconstruction of wounds. Patients were placed in one of two groups depending on their primary treatment and time of definitive reconstruction. Group A comprised 79 patients who were initially treated by plastic surgeons and whose reconstructive procedure was done within five days. Group B comprised 95 patients who were initially treated in a field hospital and referred later to the plastic surgery unit for definitive reconstruction more than five days after the injury. Sixty-nine (87%) of the patients in group A had only one or two debridements before definitive closure and stayed in hospital 20 days or less. In group ...
Chirurgia maxillofacialis & plastica
In the anatomical investigation the authors dissected 20 fresh cadaveric forearms to study septof... more In the anatomical investigation the authors dissected 20 fresh cadaveric forearms to study septofascial layers. It's vascularization was based on radial artery and concomitant veins. We perfused those flaps with methylene blue in the proximal part of radial artery. In 10 cases we found fine vascular network colored in blue. In the second group we isolated free septofascial tissue which was perfused with radiopaque contrast Hexabrix. Five flaps were perfused in the proximal part of vascular pedicle and five in the distal part. Afterwards the radiographs confirmed good vascular network, independent of flow direction. Fascia dimension in the proximal part of the forearm varied from 7-15 cm and in the distal part from 6-10 cm, depending on the forearm size. Fascia length varied from 21-27 cm. The authors found thicker and stronger fascia in the ulnar part of the forearm. The length of vascular pedicle was reversely proportional with the flap dimension. This anatomical investigation ...
Pediatric Surgery International, 2004
Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pe... more Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pediatric surgical practice. Increased survival of low birth weight infants and advances in invasive diagnostic procedures have resulted in a dramatic increase in the number of these injuries. Formation of pseudoaneurysm of the brachial artery in infants is a very rare complication of venipuncture, with only two cases reported in the literature. We report three cases of brachial artery pseudoaneurysm in infants following venipuncture who were operated upon in our institution, aged 43-64 days at the time of operation. The period from the injury to the operation ranged from 25 to 42 days. All three infants were referred from different institutions. In two infants, the pseudoaneurysms and the involved part of the artery were resected, and arterial continuity was restored with an end-to-end anastomosis; in the other infant, reconstruction was done using a venous interposition graft. All three infants were diagnosed with duplex ultrasonography, and the child requiring a more complex reconstructive procedure was also evaluated with helical contrast computed tomography. Brachial artery pseudoaneurysms are a rare but possible complication of multiple venipuncture in infants. Early diagnosis and microvascular reconstruction are key points in managing these injuries.
Annals of Plastic Surgery, 1993
In this article, we emphasize that knowledge of terminal ballistics is essential for understandin... more In this article, we emphasize that knowledge of terminal ballistics is essential for understanding the pathophysiology of war wounds. We present our own experiences in treatment of high-energy war wounds in 75 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. Patients were divided into three groups with regard to the time of definite reconstruction, using local or free microvascular flaps. About 12% of patients underwent flap reconstruction in the acute phase, associated with low complication rate and the shortest hospital stay. Group II was comprised by 18% of the patients and, considering the number of complications, presented the most unfavorable time for reconstruction. Flap reconstruction in the chronic phase resulted in a substantial prolongation of the hospital stay in 82% of patients. Therefore, we advocate proper primary treatment of wounds aimed at early flap closure. This type of management results in a significantly shorter hospitalization and leads to more effective rehabilitation and recovery of patients.
European Journal of Plastic Surgery, 2003
The purpose of this study was to analyze morphological changes in the sural nerve which resulted ... more The purpose of this study was to analyze morphological changes in the sural nerve which resulted from nerve harvesting using two methods; parallel transverse incisions (PTI) and longitudinal incisions (LI) and to evaluate the influence of those changes on the quality of sensory and motor recovery. Out of 617 patients with nerve injuries, 40 patients with an injury of the ulnar or median nerve in the distal part of the forearm and a nerve gap ranging from 4 to 6 cm were enrolled in this study. They were divided into two groups of 20 patients each. In group I the sural nerve was harvested using LI and in group II using PTI. Electron microscopy revealed considerable structural damage in the nerves harvested with PTI, while nerves harvested with LI showed little signs of damage. Patients in group I, in whom LI was used, also had better motor and sensory recovery.
European Journal of Plastic Surgery, 1992
Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provid... more Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provides the thinnest possible flap. The authors present their own experience with the use of the forearm septofascial flap in 23 patients. A free septofascial flap was used in 15 patients and an island flap in 8 patients. Seven days later, only 25%
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 1994
The authors emphasize that the knowledge of terminal ballistics is important for understanding th... more The authors emphasize that the knowledge of terminal ballistics is important for understanding the pathophysiology of war wounds. They present their own experiences in the treatment of war wounds in 504 casualties treated at the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. The locations of soft-tissue defects were: head and neck, 103; trunk, 90; and extremities, 903. War wounds were divided into four main categories with regard to the type of the injury and the extension of soft-tissue defect, thus showing the differences in primary excision and reconstruction of the wounds. About 30% of head and neck injuries were treated by primary or delayed primary reconstruction. All thoraco-abdominal wounds were type I or II, and most of them (53.3%) were reconstructed with split-thickness skin grafts. The greatest number of sophisticated reconstructions were performed on extremity injuries (63 wounds were reconstructed by local fl...
Lijec̆nic̆ki vjesnik
Although free jejunum transfer has become an accepted form of hypopharyngeal reconstruction, an i... more Although free jejunum transfer has become an accepted form of hypopharyngeal reconstruction, an ideal method of monitoring the viability of the graft has not been devised yet. The method of direct visualisation through the incision in the skin above the transferred jejunum has proven very reliable and easy to perform, especially for the nursing staff. This reliable method of monitoring free vascularised jejunum to the neck region has been used in two patients. After two days of direct monitoring, the incision in the skin healed without additional sutures. No failures of the graft occurred, and 12 days later the patients were able to swallow fluids without difficulty. The effectiveness of this technique has surpassed that of all previously published methods.
Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi, 1994
We present our experience in the treatment of war wounds in 174 patients treated in the Institute... more We present our experience in the treatment of war wounds in 174 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. The wounds were divided into four categories depending on the type of injury and the extension of the soft tissue defect which showed the differences in primary excision and reconstruction of wounds. Patients were placed in one of two groups depending on their primary treatment and time of definitive reconstruction. Group A comprised 79 patients who were initially treated by plastic surgeons and whose reconstructive procedure was done within five days. Group B comprised 95 patients who were initially treated in a field hospital and referred later to the plastic surgery unit for definitive reconstruction more than five days after the injury. Sixty-nine (87%) of the patients in group A had only one or two debridements before definitive closure and stayed in hospital 20 days or less. In group ...
Chirurgia maxillofacialis & plastica
In the anatomical investigation the authors dissected 20 fresh cadaveric forearms to study septof... more In the anatomical investigation the authors dissected 20 fresh cadaveric forearms to study septofascial layers. It's vascularization was based on radial artery and concomitant veins. We perfused those flaps with methylene blue in the proximal part of radial artery. In 10 cases we found fine vascular network colored in blue. In the second group we isolated free septofascial tissue which was perfused with radiopaque contrast Hexabrix. Five flaps were perfused in the proximal part of vascular pedicle and five in the distal part. Afterwards the radiographs confirmed good vascular network, independent of flow direction. Fascia dimension in the proximal part of the forearm varied from 7-15 cm and in the distal part from 6-10 cm, depending on the forearm size. Fascia length varied from 21-27 cm. The authors found thicker and stronger fascia in the ulnar part of the forearm. The length of vascular pedicle was reversely proportional with the flap dimension. This anatomical investigation ...
Pediatric Surgery International, 2004
Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pe... more Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pediatric surgical practice. Increased survival of low birth weight infants and advances in invasive diagnostic procedures have resulted in a dramatic increase in the number of these injuries. Formation of pseudoaneurysm of the brachial artery in infants is a very rare complication of venipuncture, with only two cases reported in the literature. We report three cases of brachial artery pseudoaneurysm in infants following venipuncture who were operated upon in our institution, aged 43-64 days at the time of operation. The period from the injury to the operation ranged from 25 to 42 days. All three infants were referred from different institutions. In two infants, the pseudoaneurysms and the involved part of the artery were resected, and arterial continuity was restored with an end-to-end anastomosis; in the other infant, reconstruction was done using a venous interposition graft. All three infants were diagnosed with duplex ultrasonography, and the child requiring a more complex reconstructive procedure was also evaluated with helical contrast computed tomography. Brachial artery pseudoaneurysms are a rare but possible complication of multiple venipuncture in infants. Early diagnosis and microvascular reconstruction are key points in managing these injuries.
Annals of Plastic Surgery, 1993
In this article, we emphasize that knowledge of terminal ballistics is essential for understandin... more In this article, we emphasize that knowledge of terminal ballistics is essential for understanding the pathophysiology of war wounds. We present our own experiences in treatment of high-energy war wounds in 75 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. Patients were divided into three groups with regard to the time of definite reconstruction, using local or free microvascular flaps. About 12% of patients underwent flap reconstruction in the acute phase, associated with low complication rate and the shortest hospital stay. Group II was comprised by 18% of the patients and, considering the number of complications, presented the most unfavorable time for reconstruction. Flap reconstruction in the chronic phase resulted in a substantial prolongation of the hospital stay in 82% of patients. Therefore, we advocate proper primary treatment of wounds aimed at early flap closure. This type of management results in a significantly shorter hospitalization and leads to more effective rehabilitation and recovery of patients.
European Journal of Plastic Surgery, 2003
The purpose of this study was to analyze morphological changes in the sural nerve which resulted ... more The purpose of this study was to analyze morphological changes in the sural nerve which resulted from nerve harvesting using two methods; parallel transverse incisions (PTI) and longitudinal incisions (LI) and to evaluate the influence of those changes on the quality of sensory and motor recovery. Out of 617 patients with nerve injuries, 40 patients with an injury of the ulnar or median nerve in the distal part of the forearm and a nerve gap ranging from 4 to 6 cm were enrolled in this study. They were divided into two groups of 20 patients each. In group I the sural nerve was harvested using LI and in group II using PTI. Electron microscopy revealed considerable structural damage in the nerves harvested with PTI, while nerves harvested with LI showed little signs of damage. Patients in group I, in whom LI was used, also had better motor and sensory recovery.