Dragos Zamfirescu | University of Medicine and Pharmacy "Carol Davila" Bucharest (original) (raw)

Papers by Dragos Zamfirescu

European Journal of Paediatric Neurology, 2015

Objective The aim of this poster is to analyze the cohort of patients with NBPP followed in the P... more Objective The aim of this poster is to analyze the cohort of patients with NBPP followed in the Pediatric Neurology Department, to identify specific clinical signs, investigations, outcome and to establish a protocol of diagnosis and follow-up for children with NBPP, according to the actual international recommendations adapted to the local needs. Methods The archive of Pediatric Neurology Clinic was retrospectively analyzed over a 6.5 years period (January 2007–July 2013), selecting the patients with NBPP. Clinical data, information about physical therapy, EMG and MRI results (if needed) were extract from the files and Active motor scale, Toronto score and protocol for obstetrical brachial plexus palsy (Hospital for Sick Children Seattle), were retrospectively applied. Also a questionnaire designed by us was applied for evaluation of present neurological status. Results A cohort of 28 cases evaluated in our clinic between Jan 2007-July 2013 was analyzed. 17 (60.7%) of the patients were boys and 11 (39.2%) were girls. 14 (50%) had right brachial plexus palsy, 12 (42.8%) had left brachial plexus palsy and 2 (7.1%) had bilateral involvement. 5 (17.8%) of them had reconstructive surgery. 11 (39.2%) had good to complete recovery with physical therapy. Conclusion A better information of the parents and doctors concerning the steps of evaluation of this diseases and importance of early diagnosis and compliance with the treatment protocol is critical for a better outcome and for avoiding permanent deficit. This is a pilot study, with a proposal of protocol for diagnosis and treatment, according to the international protocols in force, but prospective studies are mandatory to complete and refresh the existent data.

VSNU Open Access deal, Dec 1, 2019

Journal of surgical sciences, Oct 10, 2016

PubMed, Apr 27, 2013

Introduction: The aim of this study was to emphasize the learning curve of hemifacial transplanta... more Introduction: The aim of this study was to emphasize the learning curve of hemifacial transplantation in rats by comparison between 2 operators: medical student trained in basic microsurgery and an experienced microsurgeon. Materials and methods: A total number of 15 hemifacial transplants between Brown Norway as donors and Wistar as receiver rats were performed by two operators: experienced microsurgeon (group II, n=5) and the medical student (group III, n=10). Warm ischemia time and operative time were used as instrument for comparison. All the rats received immunosuppressive treatment with cyclosporine A in monotherapy for 30 days. Results were processed statistically using Microsoft Excel. Results: Transplantation procedure duration time performed by experienced microsurgeon began from 420 min and decreased to 330 min after 5 transplantations, with confidence interval (95% probability)382 ± 37.9 min and the warm ischemia time decreased from 140 min to 50 min, confidence interval of the warm ischemia time being 90 ± 33.52 min. After transplantation the rats were treated with cyclosporine A and monitored for 30 days. Medical student tended to equalize the operative time and warm ischemia time, approximately, after 9 transplantations, from 660 min to 330 min and warm ischemia time from 190 min to 60 min. The confidence interval (95%) of the procedure by duration of the surgery was 467 ± 80.66 min and 133.5 ± 31.44 min for the warm ischemia time. Most of the rats (n=11) survived in both transplanted groups (group II and group III) performed by microsurgeon and student. By analyzing learning curves using two parameters (operative time and warm ischemia time) and survival rates no statistically significant difference was found (p 0.05). Conclusion: Hemifacial transplantation model in rats is a useful tool for preparing experimental and clinical application of the facial transplantation. It is a good model for training young specialists for future transplantation surgery. It is important to notice that the medical student had previous experience in microsurgery and the learning curve was applied only for this specific procedure. Even young specialists in microsurgery could perform such a complex procedure after an appropriate training period (in our study after 9 consecutive transplantations) in the same fashion and with the same results as an experienced microsurgeon. Usage of cyclosporine A as monotherapy gave good immunosuppression results in rats' transplantations for the studied duration of time (30 days).

PubMed, Mar 4, 2017

Introduction: The potential of the medial calf integument, as donor site for a free flap based on... more Introduction: The potential of the medial calf integument, as donor site for a free flap based on musculocutaneous branches of the medial sural artery, was first identified by Taylor and Daniel, following cadaver investigation. In 1981, Pontén described the fasciocutaneous sural flap as a reconstructive option for soft tissue loss of the lower extremity, particularly around the knee. Two years later, Donski and Fogdestram presented the distally based fasciocutaneous flap from the sural region followed by Montegut and Allen who considered the sural artery perforator flap as a viable alternative for the gastrocnemius myocutaneous flap. The sural flap proved a considerable versatility at the level of the lower leg (from the knee to the ankle and heel) as well as for other anatomical regions. The most common usage of the flap is for the distal-third defects of the leg. Materials and method: A group of 10 patients with soft tissue losses at the ankle or heal due to a various etiopathogeny represented by cancer excision, trauma, unstable scars, chronic osteomyelitis, in which a microsurgical free transfer had no indication or was not wanted, was presented. Our group reported a 30% complication rate in a high-risk patient population, including patients with diabetes mellitus, peripheral vascular disease, and venous insufficiency. Results: All the defects were covered successfully, without major complications. Usually, only a minor margin of the tip of the flap was lost, which was easily solved with a guided secondary healing. Most flaps showed a slight venous congestion, which cleared in a few days. The functional result was very good in all the patients, while the aesthetic appearance was acceptable even in female patients. Discussion: An ideal indication of a reverse sural flap may be a defect over an intact but partially exposed Achilles tendon. Conclusions: The sural reverse flap is useful in the ankle and foot soft tissues reconstruction whenever we have reasons not to use a microsurgical free transfer. Venous congestion with consecutive partial or complete flap loss is a common complication, so this would not be recommended in patients with obvious acute or chronic venous stasis. The reverse sural island flap should no longer be regarded as a flap of secondary choice to free tissue transfer, but as an equally valuable alternative for small and midsized defects around the ankle and heel.

Practica medicală, Sep 30, 2020

The reconstruction of bone defects still represents a great challenge for surgeons mainly because... more The reconstruction of bone defects still represents a great challenge for surgeons mainly because it is aimed to properly restore the site of the defect, to maintain the motor and sensate function, and, not lastly, to recreate or maintain the aesthetics of the region. The fibular flap is a great choice for bone defect reconstruction, with a large array of clinical utilization, but insufficiently used because of its demanding technique of harvesting. The ability to transfer simultaneously bone, muscle and skin in a one-stage vascular anastomosis makes this flap even more appealing when addressing composite defects.

Key Engineering Materials, Jun 1, 2014

This study aims to present the preliminary studies related to the evaluation of the in vivo bioco... more This study aims to present the preliminary studies related to the evaluation of the in vivo biocompatibility using the rat model of bioresorbable composite materials type collagen-tricalciumphophate and colagen-tricalcium phosphate-magnesium for potentially medical application in trauma surgery. These biomaterials could be used as short-term structural support for bone tissue defects and can be reabsorbed into the body after healing are being sought. For in-vivo evaluation of bioresorbable materials on 2 groups of twenty Wistar and brown Norway rats for a period of 18 months. We simulated tissue defects in different anatomical areas of the animals and these two types of biomaterials were implanted. The animals were evaluated periodically with clinical exams, laboratory tests (blood tests, histopatological tests, radiological control) and anatomical dissection for macroscopic examination of the tissues. After different times (3, 6 and18 months) of implantation we sacrificed the animals. We observed the resorbtion rate of the biomaterials into the tissues in conjunction with tissue regeneration. We also note the inflammatory response and foreign body reactions into the adjacent tissue, using histopathological examinations. Due to the reaction of the materials in contact with the bone narrow a layer of magnesium calcium phosphate was formed which contributes to the local tissue healing. Our preliminary investigation results on these materials demonstrate that all the implanted materials were absorbed in vivo without any pathological changes in the rat body. Other future researches will be made in order to validate these biomaterials as orthopedic biomaterials useful in bone defects regeneration.

Journal of Surgical Sciences, 2015

Complex limb trauma are extremely severe and pose a threat both to the patient’s life, because of... more Complex limb trauma are extremely severe and pose a threat both to the patient’s life, because of their systemic impact, as well as to the vitality of the traumatized limb, because of potentially severe septic complications. Post-traumatic (post fracture) osteitis is most often a consequence of an open fracture (always contaminated) or a closed operated fracture which was contaminated by pathogenic germs, the most common of which is Staphylococcus aureus (but Gram-negative bacteria, such as Klebsiella, Pseudomonas and Proteus are also worth mentioning). The consequence of an acute osteitis which was incompletely or inadequately treated is chronic osteitis, which requires long-term treatment, with inconsistent outcome results. To describe this topic, we present the case of a 15 year old pacient, which presents at the hospital as a surgical emergency, following a complex high energy trauma cause by a smash-up, whose survival and then healing, in spite of complete and correct approach,...

Journal of Surgical Sciences, 2015

The most frequent type of entrapment neuropathy is the carpal tunnel syndrome, represented by a c... more The most frequent type of entrapment neuropathy is the carpal tunnel syndrome, represented by a constellation of signs and symptoms in which no test absolutely confirms the diagnosis. The bifid median nerve is an anatomic variation that can be associated with this syndrome and the surgeon must be aware of this condition preoperatively in order to plan correctly the surgical approach. Ultrasonography and magnetic resonance imaging can be successfully used for the detection of the anatomic variation of the median nerve, for the complete evaluation of the carpal tunnel soft tissue and its anatomic structures in order to obtain better results. We present two cases of unilateral carpal tunnel syndrome with bifid median nerve diagnosed preoperatively by means of ultrasonography and the good outcome after the open decompression procedure. The existence of anatomic variation of the median nerve along with other possible pathologies in the carpal tunnel determine us to select the open proced...

Plastic and Reconstructive Surgery, 2014

Transplantation Journal, 2012

Modern Medicine, Dec 30, 2016

Controversy exists with regard to the nomenclature, treatment and outcome of a group of well-diff... more Controversy exists with regard to the nomenclature, treatment and outcome of a group of well-differentiated lipomatous tumors sometimes labelled as atypical lipomatous tumors. For elimination of inadequate or excessive treatment it has been advocated that the term well-differentiated liposarcomas be retained for retroperitoneal/mediastinal tumors and atypical lipomatous tumors for the rest of the sites. The most important prognostic factor for ALT/WD liposarcoma is anatomic location, overall mortality ranging from 0% for ALT of the extremities to more than 80% for WD liposarcomas occurring in the retroperitoneum if the patients are followed up for 10-20 years. Primary treatment of ALT/WD liposarcoma is represented by a complete, preferably wide-margin surgical resection. The role of radiation therapy for atypical lipomatous tumors/well-differentiated liposarcomas is still unclear. Despite the side effects of postoperative radiation therapy it has been shown that in patients with positive surgical margins postoperative RT in doses over 64Gy, improves local control.

Plastic and Reconstructive Surgery - Global Open, 2018

CONCLUSION: The face consists of six major aesthetic units. 3 Cheek is one of them and it is comp... more CONCLUSION: The face consists of six major aesthetic units. 3 Cheek is one of them and it is comprised of medial, zygomatic, lateral and buccal subunits. In our study, we mostly reconstructed the medial subunit of the cheek and we believe that V-Y advancement results in more aesthetically appealing scar by reconstructing the subunit with alike tissue. Especially for larger defects of medial cheek or combined defects of cheek and other regions (such as nasal sidewall, lower eyelid, etc), V-Y closure should be preferred over propeller flap. Free style facial perforator flaps are highly reliable flaps with wide range of motion. 4, 5 In addition, they provide single stage closure with aesthetic subunit reconstruction. With the current knowledge of reconstruction and skills of microsurgery, they can be easily the first choice for the closure of mid-facial defects.

Plastic and Reconstructive Surgery - Global Open

Journal of Medicine and Life, 2015

Background. Successful tongue reconstruction after total glossectomy for advanced tongue or base ... more Background. Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis. Methods. The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer. Results. Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved. Conclusions. The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation.

Plastic and Reconstructive Surgery, 2014

Chirurgie de la Main, 2013

Plastic and Reconstructive Surgery, 2012

The American Journal of Dermatopathology, 2011

Liposarcomas are extremely rare in the skin. When they involve the skin, it is usually by upward ... more Liposarcomas are extremely rare in the skin. When they involve the skin, it is usually by upward spread from a subcutaneous or deeper seated liposarcoma. Very rarely, liposarcoma metastasize to the skin or arise as a primary dermal lesion. We describe 2 cases of atypical lipomatous tumor "well-differentiated liposarcoma" located in dermis. Both presented clinically as a skin tag. The neoplasms arose in a 56-year-old female and a 69-year-old male patient. Both lesions were treated by excision and reexcision. In addition to classical morphology of atypical lipomatous tumor with evidence of lipoblasts and atypical adipocytes, immunohistochemistry with nuclear murine double-minute type 2 protein and cyclin-dependent kinase-4 expression as well as fluorescence in situ hybridization analysis showing an amplification of murine double-minute type 2 protein and cyclin-dependent kinase-4 were helpful to establish the diagnosis. None of the cases recurred after surgical treatment. These 2 cases show the importance of not to misdiagnose lesions which clinically may appear to be benign.

Plastic and Reconstructive Surgery Global Open, 2017

RESULTS AND CONCLUSION: The challenge of craniopagus separation is due to the complexity of the v... more RESULTS AND CONCLUSION: The challenge of craniopagus separation is due to the complexity of the venous plexus and shared dural venous sinus. Therefore, separation of the venous system of the twins requires meticulous planning and stereoscopic appreciation of the vasculature. Both VSP and 3D printed models were critical as references of the venous anatomy during separation and to the survival of both twins. VSP and 3D printing were also employed successfully in predicting the scalp and skull defects and designing custom guides and jigs which were used intraoperatively and facilitated surgical reconstruction.

European Journal of Paediatric Neurology, 2015

Objective The aim of this poster is to analyze the cohort of patients with NBPP followed in the P... more Objective The aim of this poster is to analyze the cohort of patients with NBPP followed in the Pediatric Neurology Department, to identify specific clinical signs, investigations, outcome and to establish a protocol of diagnosis and follow-up for children with NBPP, according to the actual international recommendations adapted to the local needs. Methods The archive of Pediatric Neurology Clinic was retrospectively analyzed over a 6.5 years period (January 2007–July 2013), selecting the patients with NBPP. Clinical data, information about physical therapy, EMG and MRI results (if needed) were extract from the files and Active motor scale, Toronto score and protocol for obstetrical brachial plexus palsy (Hospital for Sick Children Seattle), were retrospectively applied. Also a questionnaire designed by us was applied for evaluation of present neurological status. Results A cohort of 28 cases evaluated in our clinic between Jan 2007-July 2013 was analyzed. 17 (60.7%) of the patients were boys and 11 (39.2%) were girls. 14 (50%) had right brachial plexus palsy, 12 (42.8%) had left brachial plexus palsy and 2 (7.1%) had bilateral involvement. 5 (17.8%) of them had reconstructive surgery. 11 (39.2%) had good to complete recovery with physical therapy. Conclusion A better information of the parents and doctors concerning the steps of evaluation of this diseases and importance of early diagnosis and compliance with the treatment protocol is critical for a better outcome and for avoiding permanent deficit. This is a pilot study, with a proposal of protocol for diagnosis and treatment, according to the international protocols in force, but prospective studies are mandatory to complete and refresh the existent data.

VSNU Open Access deal, Dec 1, 2019

Journal of surgical sciences, Oct 10, 2016

PubMed, Apr 27, 2013

Introduction: The aim of this study was to emphasize the learning curve of hemifacial transplanta... more Introduction: The aim of this study was to emphasize the learning curve of hemifacial transplantation in rats by comparison between 2 operators: medical student trained in basic microsurgery and an experienced microsurgeon. Materials and methods: A total number of 15 hemifacial transplants between Brown Norway as donors and Wistar as receiver rats were performed by two operators: experienced microsurgeon (group II, n=5) and the medical student (group III, n=10). Warm ischemia time and operative time were used as instrument for comparison. All the rats received immunosuppressive treatment with cyclosporine A in monotherapy for 30 days. Results were processed statistically using Microsoft Excel. Results: Transplantation procedure duration time performed by experienced microsurgeon began from 420 min and decreased to 330 min after 5 transplantations, with confidence interval (95% probability)382 ± 37.9 min and the warm ischemia time decreased from 140 min to 50 min, confidence interval of the warm ischemia time being 90 ± 33.52 min. After transplantation the rats were treated with cyclosporine A and monitored for 30 days. Medical student tended to equalize the operative time and warm ischemia time, approximately, after 9 transplantations, from 660 min to 330 min and warm ischemia time from 190 min to 60 min. The confidence interval (95%) of the procedure by duration of the surgery was 467 ± 80.66 min and 133.5 ± 31.44 min for the warm ischemia time. Most of the rats (n=11) survived in both transplanted groups (group II and group III) performed by microsurgeon and student. By analyzing learning curves using two parameters (operative time and warm ischemia time) and survival rates no statistically significant difference was found (p 0.05). Conclusion: Hemifacial transplantation model in rats is a useful tool for preparing experimental and clinical application of the facial transplantation. It is a good model for training young specialists for future transplantation surgery. It is important to notice that the medical student had previous experience in microsurgery and the learning curve was applied only for this specific procedure. Even young specialists in microsurgery could perform such a complex procedure after an appropriate training period (in our study after 9 consecutive transplantations) in the same fashion and with the same results as an experienced microsurgeon. Usage of cyclosporine A as monotherapy gave good immunosuppression results in rats' transplantations for the studied duration of time (30 days).

PubMed, Mar 4, 2017

Introduction: The potential of the medial calf integument, as donor site for a free flap based on... more Introduction: The potential of the medial calf integument, as donor site for a free flap based on musculocutaneous branches of the medial sural artery, was first identified by Taylor and Daniel, following cadaver investigation. In 1981, Pontén described the fasciocutaneous sural flap as a reconstructive option for soft tissue loss of the lower extremity, particularly around the knee. Two years later, Donski and Fogdestram presented the distally based fasciocutaneous flap from the sural region followed by Montegut and Allen who considered the sural artery perforator flap as a viable alternative for the gastrocnemius myocutaneous flap. The sural flap proved a considerable versatility at the level of the lower leg (from the knee to the ankle and heel) as well as for other anatomical regions. The most common usage of the flap is for the distal-third defects of the leg. Materials and method: A group of 10 patients with soft tissue losses at the ankle or heal due to a various etiopathogeny represented by cancer excision, trauma, unstable scars, chronic osteomyelitis, in which a microsurgical free transfer had no indication or was not wanted, was presented. Our group reported a 30% complication rate in a high-risk patient population, including patients with diabetes mellitus, peripheral vascular disease, and venous insufficiency. Results: All the defects were covered successfully, without major complications. Usually, only a minor margin of the tip of the flap was lost, which was easily solved with a guided secondary healing. Most flaps showed a slight venous congestion, which cleared in a few days. The functional result was very good in all the patients, while the aesthetic appearance was acceptable even in female patients. Discussion: An ideal indication of a reverse sural flap may be a defect over an intact but partially exposed Achilles tendon. Conclusions: The sural reverse flap is useful in the ankle and foot soft tissues reconstruction whenever we have reasons not to use a microsurgical free transfer. Venous congestion with consecutive partial or complete flap loss is a common complication, so this would not be recommended in patients with obvious acute or chronic venous stasis. The reverse sural island flap should no longer be regarded as a flap of secondary choice to free tissue transfer, but as an equally valuable alternative for small and midsized defects around the ankle and heel.

Practica medicală, Sep 30, 2020

The reconstruction of bone defects still represents a great challenge for surgeons mainly because... more The reconstruction of bone defects still represents a great challenge for surgeons mainly because it is aimed to properly restore the site of the defect, to maintain the motor and sensate function, and, not lastly, to recreate or maintain the aesthetics of the region. The fibular flap is a great choice for bone defect reconstruction, with a large array of clinical utilization, but insufficiently used because of its demanding technique of harvesting. The ability to transfer simultaneously bone, muscle and skin in a one-stage vascular anastomosis makes this flap even more appealing when addressing composite defects.

Key Engineering Materials, Jun 1, 2014

This study aims to present the preliminary studies related to the evaluation of the in vivo bioco... more This study aims to present the preliminary studies related to the evaluation of the in vivo biocompatibility using the rat model of bioresorbable composite materials type collagen-tricalciumphophate and colagen-tricalcium phosphate-magnesium for potentially medical application in trauma surgery. These biomaterials could be used as short-term structural support for bone tissue defects and can be reabsorbed into the body after healing are being sought. For in-vivo evaluation of bioresorbable materials on 2 groups of twenty Wistar and brown Norway rats for a period of 18 months. We simulated tissue defects in different anatomical areas of the animals and these two types of biomaterials were implanted. The animals were evaluated periodically with clinical exams, laboratory tests (blood tests, histopatological tests, radiological control) and anatomical dissection for macroscopic examination of the tissues. After different times (3, 6 and18 months) of implantation we sacrificed the animals. We observed the resorbtion rate of the biomaterials into the tissues in conjunction with tissue regeneration. We also note the inflammatory response and foreign body reactions into the adjacent tissue, using histopathological examinations. Due to the reaction of the materials in contact with the bone narrow a layer of magnesium calcium phosphate was formed which contributes to the local tissue healing. Our preliminary investigation results on these materials demonstrate that all the implanted materials were absorbed in vivo without any pathological changes in the rat body. Other future researches will be made in order to validate these biomaterials as orthopedic biomaterials useful in bone defects regeneration.

Journal of Surgical Sciences, 2015

Complex limb trauma are extremely severe and pose a threat both to the patient’s life, because of... more Complex limb trauma are extremely severe and pose a threat both to the patient’s life, because of their systemic impact, as well as to the vitality of the traumatized limb, because of potentially severe septic complications. Post-traumatic (post fracture) osteitis is most often a consequence of an open fracture (always contaminated) or a closed operated fracture which was contaminated by pathogenic germs, the most common of which is Staphylococcus aureus (but Gram-negative bacteria, such as Klebsiella, Pseudomonas and Proteus are also worth mentioning). The consequence of an acute osteitis which was incompletely or inadequately treated is chronic osteitis, which requires long-term treatment, with inconsistent outcome results. To describe this topic, we present the case of a 15 year old pacient, which presents at the hospital as a surgical emergency, following a complex high energy trauma cause by a smash-up, whose survival and then healing, in spite of complete and correct approach,...

Journal of Surgical Sciences, 2015

The most frequent type of entrapment neuropathy is the carpal tunnel syndrome, represented by a c... more The most frequent type of entrapment neuropathy is the carpal tunnel syndrome, represented by a constellation of signs and symptoms in which no test absolutely confirms the diagnosis. The bifid median nerve is an anatomic variation that can be associated with this syndrome and the surgeon must be aware of this condition preoperatively in order to plan correctly the surgical approach. Ultrasonography and magnetic resonance imaging can be successfully used for the detection of the anatomic variation of the median nerve, for the complete evaluation of the carpal tunnel soft tissue and its anatomic structures in order to obtain better results. We present two cases of unilateral carpal tunnel syndrome with bifid median nerve diagnosed preoperatively by means of ultrasonography and the good outcome after the open decompression procedure. The existence of anatomic variation of the median nerve along with other possible pathologies in the carpal tunnel determine us to select the open proced...

Plastic and Reconstructive Surgery, 2014

Transplantation Journal, 2012

Modern Medicine, Dec 30, 2016

Controversy exists with regard to the nomenclature, treatment and outcome of a group of well-diff... more Controversy exists with regard to the nomenclature, treatment and outcome of a group of well-differentiated lipomatous tumors sometimes labelled as atypical lipomatous tumors. For elimination of inadequate or excessive treatment it has been advocated that the term well-differentiated liposarcomas be retained for retroperitoneal/mediastinal tumors and atypical lipomatous tumors for the rest of the sites. The most important prognostic factor for ALT/WD liposarcoma is anatomic location, overall mortality ranging from 0% for ALT of the extremities to more than 80% for WD liposarcomas occurring in the retroperitoneum if the patients are followed up for 10-20 years. Primary treatment of ALT/WD liposarcoma is represented by a complete, preferably wide-margin surgical resection. The role of radiation therapy for atypical lipomatous tumors/well-differentiated liposarcomas is still unclear. Despite the side effects of postoperative radiation therapy it has been shown that in patients with positive surgical margins postoperative RT in doses over 64Gy, improves local control.

Plastic and Reconstructive Surgery - Global Open, 2018

CONCLUSION: The face consists of six major aesthetic units. 3 Cheek is one of them and it is comp... more CONCLUSION: The face consists of six major aesthetic units. 3 Cheek is one of them and it is comprised of medial, zygomatic, lateral and buccal subunits. In our study, we mostly reconstructed the medial subunit of the cheek and we believe that V-Y advancement results in more aesthetically appealing scar by reconstructing the subunit with alike tissue. Especially for larger defects of medial cheek or combined defects of cheek and other regions (such as nasal sidewall, lower eyelid, etc), V-Y closure should be preferred over propeller flap. Free style facial perforator flaps are highly reliable flaps with wide range of motion. 4, 5 In addition, they provide single stage closure with aesthetic subunit reconstruction. With the current knowledge of reconstruction and skills of microsurgery, they can be easily the first choice for the closure of mid-facial defects.

Plastic and Reconstructive Surgery - Global Open

Journal of Medicine and Life, 2015

Background. Successful tongue reconstruction after total glossectomy for advanced tongue or base ... more Background. Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis. Methods. The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer. Results. Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved. Conclusions. The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation.

Plastic and Reconstructive Surgery, 2014

Chirurgie de la Main, 2013

Plastic and Reconstructive Surgery, 2012

The American Journal of Dermatopathology, 2011

Liposarcomas are extremely rare in the skin. When they involve the skin, it is usually by upward ... more Liposarcomas are extremely rare in the skin. When they involve the skin, it is usually by upward spread from a subcutaneous or deeper seated liposarcoma. Very rarely, liposarcoma metastasize to the skin or arise as a primary dermal lesion. We describe 2 cases of atypical lipomatous tumor "well-differentiated liposarcoma" located in dermis. Both presented clinically as a skin tag. The neoplasms arose in a 56-year-old female and a 69-year-old male patient. Both lesions were treated by excision and reexcision. In addition to classical morphology of atypical lipomatous tumor with evidence of lipoblasts and atypical adipocytes, immunohistochemistry with nuclear murine double-minute type 2 protein and cyclin-dependent kinase-4 expression as well as fluorescence in situ hybridization analysis showing an amplification of murine double-minute type 2 protein and cyclin-dependent kinase-4 were helpful to establish the diagnosis. None of the cases recurred after surgical treatment. These 2 cases show the importance of not to misdiagnose lesions which clinically may appear to be benign.

Plastic and Reconstructive Surgery Global Open, 2017

RESULTS AND CONCLUSION: The challenge of craniopagus separation is due to the complexity of the v... more RESULTS AND CONCLUSION: The challenge of craniopagus separation is due to the complexity of the venous plexus and shared dural venous sinus. Therefore, separation of the venous system of the twins requires meticulous planning and stereoscopic appreciation of the vasculature. Both VSP and 3D printed models were critical as references of the venous anatomy during separation and to the survival of both twins. VSP and 3D printing were also employed successfully in predicting the scalp and skull defects and designing custom guides and jigs which were used intraoperatively and facilitated surgical reconstruction.