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1
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Prof. Dr Hab. Michał Krauss 1927-2010

100%
Polish Journal of Surgery
|
2010
|
vol. 82
|
issue 7
447-448
2
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Gene Therapy in Patients with Epidermolysis Bullosa

72%
3
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Surgical Treatment in Epidermolysis Bullosa

72%
EN
Emergency full thickness abdominal wall defects constitute a challenging problem for surgeons. The aim of reconstruction is prevention of evisceration and hernia formation. Staged surgery is recommended in such cases. The first stage consists of wound healing with skin grafts and creation of "planned hernia". Ultimate reconstruction is delayed until good general health state of the patient. In presented case final skin and subcutaneous tissue reconstruction was achieved with island fasciocutaneous antero-lateral thigh flap. Reconstruction of musculo-aponeurotic layer was completed with compartment separation technique and synthetic mesh. During follow-up no recurrence of deformity was observed.
EN
Use of small autologous skin grafts or leaving the defects and waiting for their spontaneous reepidermization are one of the methods of wound management after surgical treatment of hand contractures in Epidermolysis bullosa. This techniques are believed to allow quick wound healing, however this does not seem universally possible.The aim of the study was to assess healing rate and incidence of early recurrence after using of both techniques.Material and methods. Eleven operations of hand contracture were performed, including two recurrent cases after previous surgeries. Skin grafts were used in eight cases. Kirshner wires were not used and the fingers were stabilized in an extended position only with a supportive dressing. In the early postoperative period, dressings were made in the operation room and patients were admitted for 24-hour hospitalizations no more than once a week.Results. Complete healing before day 35 was achieved only in five cases. In the remaining cases, dressings in the operating room were abandoned between day 35 and 40 and the patients were referred to further treatment in the outpatient setting. Outpatient dressings were done without anesthesia which in the event of unhealed spaces between the fingers, seemed to impair their separation and facilitate early recurrences of syndactyly. Two cases of early recurrence (18%), during the first year after the operation, were noted in one patientConclusions. Our results indicate that the postoperative wound healing does not depend on the use of skin grafts and can be much longer than some previous studies suggested. This shortens the period of full efficiency between the recurrences. Clinical observations also indicate that this affects the risk of early recurrences. Despite that, their number is similar to the value considered good in the literature.
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