We report the extremely rare case of a digital and plantar retractile keloid in a 32-year-old patient with a history of spontaneous keloids. Since childhood, she has developed hypertrophic scars following minor trauma, extending beyond the original wound margins. She currently presents a left IV-V syndactyly and a complete flexion contracture of the fifth finger (Tubiana stage IV), as well as a retraction of the right hallux, resulting in functional impairment. The goal of surgical treatment is to restore extension. Retractile keloids occurring in the context of spontaneous keloids are unusual. Their exact pathophysiology remains poorly understood, and curative treatments are currently disappointing. The primary objective of surgery is functional restoration.

The anatomy and variability of the maxillary artery have been extensively studied through cadaveric dissections and CT angiography, revealing diverse courses of its terminal branches. These studies underscore the importance of understanding regional anatomy, particularly in surgical contexts such as intraoral vertical ramus osteotomy and temporomandibular joint (TMJ) arthroplasty, where proximity to the maxillary artery in the infratemporal fossa poses risks of complications. MRI offers distinct advantages in visualizing soft tissues critical to TMJ function, surpassing conventional imaging modalities like orthopantomography in providing detailed anatomical insights. This study aims to assess the risk of iatrogenic damage to the maxillary artery during arthroscopic procedures using MRI scans. A total of 42 patients, comprising both sexes and varying ages, underwent MRI at the Department of Maxillofacial Surgery, University Hospital Louis Pasteur in Košice. Imaging protocols were standardized on a Toshiba Atlas 1.5 Tesla MRI scanner, ensuring consistent quality with a slice thickness of 6 mm and standardized imaging matrices. Measurements of the maxillary artery's proximity to anatomical landmarks were conducted in axial and parasagittal sections to delineate precise anatomical relationships.

Regenerative medicine has gained significant attention due to its diverse strategies for tissue restoration and restructuring. This therapeutic approach combines knowledge from cellular biology, tissue engineering, and translational medicine, providing new hope for treating conditions that previously lacked definitive therapeutic options. Although natural tissue regeneration occurs in some organs, such as the liver, and in superficial epidermal injuries, this process is limited. Tissue regeneration involves replacing damaged cells with cells of the same type, fully restoring tissue structure and function, while healing often results in scar tissue that may not have the same functional properties. Given this limitation, regenerative medicine aims to enhance the body's regenerative capacity. The manipulation of growth factors, such as platelet-derived growth factor and vascular endothelial growth factor, has been shown to increase vascularization and cell proliferation. Autologous fat grafting has emerged as a vital tool in regenerative medicine, demonstrating efficacy in promoting tissue regeneration due to its rich composition of mesenchymal stem cells and growth factors. Case studies illustrate that lipografting can improve wound healing in patients with chronic ulcers and contribute to aesthetic and functional outcomes in breast reconstruction. This study reports a case of a 27-year-old male who sustained severe trauma to his left hand in a car accident, resulting in complex injuries. Despite the potential for amputation, the decision was made to preserve the limb. A series of surgical interventions, including necrotic tissue debridement and lipografting, were conducted over several weeks, resulting in significant tissue regeneration. By the fifth week, the wound bed exhibited adequate granulation tissue, and a skin graft was applied, demonstrating successful integration and functional recovery. This case underscores the potential of regenerative medicine techniques, specifically lipografting, in limb salvage and tissue repair. Further research is needed to enhance understanding and application of these strategies in treating complex wounds and improving patient outcomes.

Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.

The Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital in Brno, and Faculty of Medicine of Masaryk University, Brno, has a long history of surgical treatment of lymphedema and elephantiasis, which started in 1970s. There were many types of surgeries described and performed at our department - starting with prof. Bařinka's radical operation of elephantiasis, then lower limb end-to-side lymphovenous anastomosis pulled through the wall to the great saphenous vein, and genital lymphedema reduction. We call this era "the first period" of surgical lymphedema treatment. "The second period" started in 2016 by using free flaps with lymph nodes or vascularized lymph nodes and using microsurgical techniques of end-to-end, end-to-side and side-to-end lymphovenous anastomoses to the subcutaneous veins of a small calibre, which then drain the lymph into the blood stream. "The third period" started 2 years ago after the visit of prof. Yang from Taiwan - we started to use the method of single stitch end-to-side anastomosis to big subcutaneous veins like the great saphenous vein or the cephalic vein.

While fasciotomy is the only urgent treatment option for compartment syndrome, the resulting open wound leaves room for complications. Closure of the wound can be done by different techniques, including split-thickness skin grafts, negative pressure therapy, an absorbable barbed suture system and a cable ties system. The aim of this paper is to demonstrate how a combined application of these methods can reduce their respective individual disadvantages. Our combined method was tried in two patients, one with an open tibial fracture and the other who underwent ulnar nerve reparation. Both patients started exhibiting signs of compartment syndrome within 3 hrs after surgery. Firstly, absorbable barbed suture systems were positioned with the running intradermal technique. Following this the cable ties were inserted and the limb in question was placed in an elevated position. Complete closure of the patient's wounds was achieved within 2 weeks without complications. This result is a testament to the added benefit of a combination of these methods in comparison with the results they produce individually.

Ischemic limb necrosis due to high dose of norepinephrine (NE) in a patient with septic shock is uncommon. Unfortunately, amputation of necrotic parts is the only available treatment. Reconstruction with skin autografts for defects resulting from the amputation of the lower limbs is challenging. Herein we report a case of digit necrosis in the upper and lower limbs after administration of a high dose of NE > 1 μcg/kg/min in a patient with septic shock. The source of infection that led to septic shock was not detected. Surgical amputation was performed as it was impossible to repair impaired vasculature and patients' life was endangered. Large defects were covered with skin autografts from the patient's thighs. The included figures demonstrate the extremities' appearance before, after amputation, during and after skin graft transplantation.

The purpose of this study was to collect and present all the available evidence regarding avascular maxillary necrosis following maxillary osteotomy for orthognathic surgery. We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library dataset in accordance with the PRISMA guideline. We included studies that report on avascular maxillary necrosis after any maxillary osteotomy used in the frame of orthognathic surgery. Sixteen studies reporting a total of 65 patients with postoperative avascular maxillary necrosis were included. Those reported avascular necrosis in 32 female patients and 19 male patients. Multisegmented Le Fort I osteotomy was the most common type of related operation amongst the patients followed by single segment Le Fort I osteotomy. Although avascular maxillary necrosis is a very rare complication after maxillary orthognathic surgery it can be complicated with partial / complete loss of the maxilla. A personalized selection of the surgical technique should be made for any patient. Caution is warranted in cleft patients and in patients undergoing multisegmented Le Fort I osteotomies, so that the vitality of the maxilla and especially its anterior part is preserved. In the case when avascular necrosis arises, management should be immediate and precise. As for the reconstruction, it needs to be tailored according to the maxillary defect.

Groin flaps have been used as pedicled and free flaps by plastic surgeons for time immemorial. The superficial circumflex iliac artery perforator (SCIP) flap has evolved from the groin flap in which the entire skin territory of the groin flap can be harvested based on the perforators of the superficial circumflex iliac artery (SCIA) and only apart of the SCIA can be taken along with. The pedicled SCIP flap can also be utilized in alarge number of cases which is described in our article. Between January 2022 to July 2022, 15 patients were operated on using the pedicled SCIP flap. Twelve patients were males and 3 patients were females. Nine patients presented with adefect in the hand/forearm, 2 patients had adefect in the scrotum, 2 patients had adefect in the penis, 1 patient had adefect in the inguinal region overlying the femoral vessels and 1 patient had adefect in the lower abdomen. There was apartial loss of one flap and acomplete loss of one flap from pedicle compression. The donor site healed well in all cases with no evidence of wound disruption or seroma or hematoma formation. As all the flaps were quite thin, no debulking was needed as an additional procedure. The dependability of the pedicled SCIP flap implies that this flap should be used more often in reconstructions in and around the genital area and also in cases of upper limb coverage instead of the classical groin flap.