Razvan Teodoreanu | University of Medicine and Pharmacy "Carol Davila" Bucharest (original) (raw)
Papers by Razvan Teodoreanu
Romanian Journal of Medical Practice
Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts ... more 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.
Romanian Medical Journal, 2020
Treating complex abdominal wall defects is challenging for the reconstructive surgeon as there ar... more 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.
Medicina Moderna - Modern Medicine, 2021
Injuries to the upper limb may determine unexpected simple or complex soft tissue defects, due to... more 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 doe...
Medicina Moderna - Modern Medicine, 2021
Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and s... more 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. Ther...
Romanian Medical Journal, 2021
Upper limb trauma cases vary from simple to high energy impactful injuries, with different etiolo... more 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 s...
1 Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospit... more 1 Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital, Bucharest, Romania 2 »Carol Davila» University of Medicine and Pharmacy, Bucharest, Romania Corresponding author: Andreea Grosu-Bularda Department of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital, Calea Floreasca no. 8, 014461, Bucharest, Romania. E-mail: andreeabularda@gmail.com Abstract
1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic ... more 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic Surgery and Reconstruction Microsurgery, Clinical Emergency Hospital of Bucharest, Romania 3 Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania Corresponding author: Tiberiu Paul Neagu, Assistant Professor, MD, PhD Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital, 8 Floreasca Avenue, 1st District, Bucharest, Romania. E-mail: dr.neagupaul@gmail.com Abstract
Medicina Moderna - Modern Medicine, 2020
Due to its complex structure, the abdominal wall is vital as it serves to protect the internal or... more Due to its complex structure, the abdominal wall is vital as it serves to protect the internal organs, maintain the upright position and regulate the intraabdominal pressure. Complex abdominal defects are a major health problem, with challenging treatment, many complications and risks. It is not a completely elucidated pathology as there is no consensus in literature regarding the defi nition and classifi cation. Although there are various reconstruction techniques, there is no sistematic protocol in literature that allows the surgeon to choose the best treatment suitable for each patient. Therefore, the fi rst step to manage these patients is a carefull assesment of the patient background and only after that, a complete analysis of the actual wound should be made. Second step is appropriate abdominal wall closure. After the analysis of current data from international literature, we identifi ed a decision-making algorithm to offer guidance in surgical management in order to obtain a...
Medicina Moderna - Modern Medicine, 2018
Major burn is considered the most severe type of injury, with high mortality risk and poor qualit... more Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety effi ciency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion.
romanian journal of ophthalmology, 2019
Purpose: This study aimed to characterize the injuries involving periorbital region in our severe... more Purpose: This study aimed to characterize the injuries involving periorbital region in our severely burned patients. Method: A 2 years retrospective study was conducted with a total of 210 severe burns admissions. Periorbital burn injuries (all produced in association with facial injuries) were encountered in 126 patients, representing the study group that was further analyzed for multiple parameters: demographics, mechanism of injury, TBSA (total body surface area), burn depth, inhalation injury, need for intubation and mechanical ventilation. The presence and severity of ocular injuries were also evaluated. Results: Analyzing our study group (n=126), we observed the presence of multiple negative prognosis factors: elderly patients, extensive burns, deep burns affecting functional areas, unfavorable mechanism (electric, chemical or explosions), inhalation injuries, need for intubation and mechanical ventilation, leading to severe morbidity and high mortality level. Ocular injuries were encountered in 37 patients (30 primary and 7 secondary lesions). The predominance of primary ocular lesions is explained trough high severity burns encountered in our patients with high mortality and lack of long-term clinical observations. Conclusion: The clinical outcome for periorbital burn injuries depends on patient characteristics, etiology, burn extension and depth, associated lesions, infectious risk and the quality of the treatment applied. Presence of ocular injuries in various severity degrees impose an adequate evaluation and specialized treatment, being associated with important morbidity. In severely burned patients, it is mandatory to apply preventive measures to avoid ocular complications. If exposure keratopathy is detected, prompt ophthalmologic treatment is essential to avoid functional impairment including loss of vision.
Journal of medicine and life, Jan 15, 2014
Taking into account the incidence and the severity of electrocutions, we consider it extremely ne... more Taking into account the incidence and the severity of electrocutions, we consider it extremely necessary to find effective, appropriate and particularized therapeutic solutions aimed at improving the survival, decreasing the mortality, ensuring a superior functional and aesthetic effect and facilitating the social reintegration. Given the severity of the general condition of the electrically injured patient and the fact that any worsening of the lesions has a systemic echo, the selection of the timing for re-excision is very important. The postponement of the surgical timing can break the precarious metabolic equilibrium and can hasten the installation of the multisystem organ failure (MSOF). The study is intended to establish a possible connection between the clinical evolution of the electrically injured patient and the dynamics of three important biological parameters, able to provide data concerning the therapeutic attitude to be followed. The patients with a diagnostic of high-...
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2014
Injuries by high voltage electrocution represent rare and very complex accidents. In order to pro... more Injuries by high voltage electrocution represent rare and very complex accidents. In order to provide support to surgical therapy, to limit the extension of injuries or to support the natural process of tissue repair, we oriented towards the use of two growth factors, insulin and platelet-enriched plasma (PRP) administered locally, on the injury site. The therapeutic protocol was applied on three cases of electrocution with promising results in reducing the duration of surgical and pharmacological treatment and of time of hospitalization. The influence of growth factors on healing wounds, the mechanism of action and recent therapeutic applications are also discussed.
Romanian Journal of Clinical Research, 2019
Nasal amputation is a disabling aesthetical and functional deformity, which raised the need for n... more Nasal amputation is a disabling aesthetical and functional deformity, which raised the need for nasal reconstruction. It is very important to use a well-established plastic reconstruction technique because of its importance in the aesthetic of the face. Every structure is important and all the missing layers of the nose must be reconstructed. In our case a three-stage procedure was done. First stage: Reconstruction of the cover using a paramedian forehead flap, harvesting a strut graft to recreate a columella to support the height of the nasal tip. Second stage: Re-elevation of the flap, thinning of the layers, and reconstruction of the framework. Third stage: Division of the pedicle. This type of nasal reconstruction had both good and stable results aesthetically and functionally.
Plastic and Reconstructive Surgery, Global Open, 2018
Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome ... more 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.
Romanian Journal of Medical Practice
Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts ... more 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.
Romanian Medical Journal, 2020
Treating complex abdominal wall defects is challenging for the reconstructive surgeon as there ar... more 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.
Medicina Moderna - Modern Medicine, 2021
Injuries to the upper limb may determine unexpected simple or complex soft tissue defects, due to... more 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 doe...
Medicina Moderna - Modern Medicine, 2021
Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and s... more 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. Ther...
Romanian Medical Journal, 2021
Upper limb trauma cases vary from simple to high energy impactful injuries, with different etiolo... more 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 s...
1 Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospit... more 1 Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital, Bucharest, Romania 2 »Carol Davila» University of Medicine and Pharmacy, Bucharest, Romania Corresponding author: Andreea Grosu-Bularda Department of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital, Calea Floreasca no. 8, 014461, Bucharest, Romania. E-mail: andreeabularda@gmail.com Abstract
1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic ... more 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic Surgery and Reconstruction Microsurgery, Clinical Emergency Hospital of Bucharest, Romania 3 Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania Corresponding author: Tiberiu Paul Neagu, Assistant Professor, MD, PhD Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital, 8 Floreasca Avenue, 1st District, Bucharest, Romania. E-mail: dr.neagupaul@gmail.com Abstract
Medicina Moderna - Modern Medicine, 2020
Due to its complex structure, the abdominal wall is vital as it serves to protect the internal or... more Due to its complex structure, the abdominal wall is vital as it serves to protect the internal organs, maintain the upright position and regulate the intraabdominal pressure. Complex abdominal defects are a major health problem, with challenging treatment, many complications and risks. It is not a completely elucidated pathology as there is no consensus in literature regarding the defi nition and classifi cation. Although there are various reconstruction techniques, there is no sistematic protocol in literature that allows the surgeon to choose the best treatment suitable for each patient. Therefore, the fi rst step to manage these patients is a carefull assesment of the patient background and only after that, a complete analysis of the actual wound should be made. Second step is appropriate abdominal wall closure. After the analysis of current data from international literature, we identifi ed a decision-making algorithm to offer guidance in surgical management in order to obtain a...
Medicina Moderna - Modern Medicine, 2018
Major burn is considered the most severe type of injury, with high mortality risk and poor qualit... more Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety effi ciency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion.
romanian journal of ophthalmology, 2019
Purpose: This study aimed to characterize the injuries involving periorbital region in our severe... more Purpose: This study aimed to characterize the injuries involving periorbital region in our severely burned patients. Method: A 2 years retrospective study was conducted with a total of 210 severe burns admissions. Periorbital burn injuries (all produced in association with facial injuries) were encountered in 126 patients, representing the study group that was further analyzed for multiple parameters: demographics, mechanism of injury, TBSA (total body surface area), burn depth, inhalation injury, need for intubation and mechanical ventilation. The presence and severity of ocular injuries were also evaluated. Results: Analyzing our study group (n=126), we observed the presence of multiple negative prognosis factors: elderly patients, extensive burns, deep burns affecting functional areas, unfavorable mechanism (electric, chemical or explosions), inhalation injuries, need for intubation and mechanical ventilation, leading to severe morbidity and high mortality level. Ocular injuries were encountered in 37 patients (30 primary and 7 secondary lesions). The predominance of primary ocular lesions is explained trough high severity burns encountered in our patients with high mortality and lack of long-term clinical observations. Conclusion: The clinical outcome for periorbital burn injuries depends on patient characteristics, etiology, burn extension and depth, associated lesions, infectious risk and the quality of the treatment applied. Presence of ocular injuries in various severity degrees impose an adequate evaluation and specialized treatment, being associated with important morbidity. In severely burned patients, it is mandatory to apply preventive measures to avoid ocular complications. If exposure keratopathy is detected, prompt ophthalmologic treatment is essential to avoid functional impairment including loss of vision.
Journal of medicine and life, Jan 15, 2014
Taking into account the incidence and the severity of electrocutions, we consider it extremely ne... more Taking into account the incidence and the severity of electrocutions, we consider it extremely necessary to find effective, appropriate and particularized therapeutic solutions aimed at improving the survival, decreasing the mortality, ensuring a superior functional and aesthetic effect and facilitating the social reintegration. Given the severity of the general condition of the electrically injured patient and the fact that any worsening of the lesions has a systemic echo, the selection of the timing for re-excision is very important. The postponement of the surgical timing can break the precarious metabolic equilibrium and can hasten the installation of the multisystem organ failure (MSOF). The study is intended to establish a possible connection between the clinical evolution of the electrically injured patient and the dynamics of three important biological parameters, able to provide data concerning the therapeutic attitude to be followed. The patients with a diagnostic of high-...
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2014
Injuries by high voltage electrocution represent rare and very complex accidents. In order to pro... more Injuries by high voltage electrocution represent rare and very complex accidents. In order to provide support to surgical therapy, to limit the extension of injuries or to support the natural process of tissue repair, we oriented towards the use of two growth factors, insulin and platelet-enriched plasma (PRP) administered locally, on the injury site. The therapeutic protocol was applied on three cases of electrocution with promising results in reducing the duration of surgical and pharmacological treatment and of time of hospitalization. The influence of growth factors on healing wounds, the mechanism of action and recent therapeutic applications are also discussed.
Romanian Journal of Clinical Research, 2019
Nasal amputation is a disabling aesthetical and functional deformity, which raised the need for n... more Nasal amputation is a disabling aesthetical and functional deformity, which raised the need for nasal reconstruction. It is very important to use a well-established plastic reconstruction technique because of its importance in the aesthetic of the face. Every structure is important and all the missing layers of the nose must be reconstructed. In our case a three-stage procedure was done. First stage: Reconstruction of the cover using a paramedian forehead flap, harvesting a strut graft to recreate a columella to support the height of the nasal tip. Second stage: Re-elevation of the flap, thinning of the layers, and reconstruction of the framework. Third stage: Division of the pedicle. This type of nasal reconstruction had both good and stable results aesthetically and functionally.
Plastic and Reconstructive Surgery, Global Open, 2018
Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome ... more 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.