Microsurgery, a pivotal surgical field that changed medical perspectives in the 20th century, presents numerous technical challenges due to the precision it requires from the surgeon. To acquire the requisite skills, comprehensive training is imperative. Initiation into microsurgical training on experimental models is a prerequisite before translating these skills to clinical applications. The employment of non-living models in medical training offers a myriad of advantages, notably characterized by their accessibility and cost-effectiveness. Non-living models, such as latex gloves, leaves, flower petals, silicon tubes and chicken legs, provide aspiring microsurgeons an opportunity to train the essential technical skills required in microsurgical practice. Such models significantly alleviate ethical concern associated with the use of live specimens and human cadaveric models. Furthermore, they exhibit a satisfactory emulation of human vascular properties, providing a realistic context for medical practice. Although the primary focus of this paper is on non-living models, it is important to highlight the transition to living models, specifically small animal models, as a mandatory and advanced phase in microsurgical training, before translating to clinical practice.

Infections represent the most common complication occurring during the evolution of the severely burned patient, hence requiring closer study and targeted result analysis. The fungal infections are one of the most aggressive types of existing infections, their opportunistic character enabling them to cause invasive infections, ultimately leading to a higher morbidity and a higher rate of mortality. The present study focuses on the presence of Candida spp. in 19 out of a total of 70 patients admitted to the Critical Care Burn Unit in the Clinical Emergency Hospital Bucharest, between 01.01.2019-31.12.2019. No other fungal species, besides Candida spp., were identified in this patient lot. The aim of this study was to analyze the risk factors and the dynamics of the biological parameters of the patients presenting Candida spp. infections, in order to determine how these contribute to the prognostic and final outcome of these patients. We can conclude that a precise diagnostic and prompt treatment can make a significant difference in the outcome of severely burnt patients presenting with a fungal infection.

Facial nerve paralysis is a debilitating condition with multiple etiologies, with aesthetic, functional, psychological and social impact. Given the complex multitude of causes that may generate such condition, a therapeutic algorithm is mandatory when attempting reconstruction. Severity, timing, patient adherence to a rehabilitation program, status of ipsilateral and contralateral facial nerves and particularities of each patient are all criteria which should be accounted when choosing a treatment option. After initial assessment, a variable treatment panel is available based on condition type include medicamentous therapy, rehabilitation program, dynamic and static procedures surgical procedures, having as primary aim functional restoration achieving aesthetic balanced facial features. This paper summarizes current knowledge in facial paralysis reconstruction and presents an algorithmic approach that eases decision making and therapeutic strategy.

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.
Therapeutic approach comprises of non-surgical (conservative) therapy, which is mandatory as initial therapy and surgical procedures for selected cases. Most patients with lymphedema benefit from conservative treatment alone. In non-responsive cases, in patients with progressive disease, in late stage complicated lymphedema, and also recently added as prophylactic strategy, surgical treatment, trough recent developed techniques, offer very good results in long-term control of disease.
Surgical options are classified firstly in physiologic procedures that aim to create new lymphatic channels, promote physiologic drainage of the lymph and should be considered early in the course of the disease, and secondly ablative procedures that reduce through liposuction or various excision techniques the volume of the affected limb.
Both types of techniques can be combined to ensure the best functional outcome of the patient.

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 does it provide an ideal solution, with high adaptability to each case, but it also may enhance short- and long-term outcome, offering an optimal reconstructive option in any upper limb trauma situation, regardless of etiology. We aim to describe our therapeutic strategies in a series of challenging trauma cases involving digital structures from the upper limb. Interposed vein grafts were used to re-stablish sensate function in a patient with a collateral digital nerve defect, but also to bridge vital digit arterial defect in a torsion-avulsion thumb amputation, as well as re-establishing venous flow in patients with Urbaniak II finger degloving injury.

Severe burn injuries represent a major challenge to the entire healthcare system in developing countries and even for states with a high standard of care. A clear understanding of the physiopathology of burn injuries is essential for providing an adequate prompt treatment to ensure an optimal patient outcome. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. Specific treatment must be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance. A diagnostic and therapeutic algorithm is presented, centered on infectious source prevention and control with early surgical excision and skin grafting together with culture-guided antimicrobial therapy. It is a known fact that, indifferent of the involved germ, the best intervention for both prophylaxis and treatment of infections in the burn patient is the early excision of the devitalized tissue and subsequent closure of burn wounds with skin grafts, measures that diminish local and systemic mediator releasing effects in burnt tissue, attenuating the progressive inflammatory chain.

Introduction: Immunohistochemistry is a widely used diagnostic technique in pathology, the antibodies used for unvailing a tissue’s origin being made up of proteins, more specifically aminoacids. Malignant peripheral nerve sheath tumors have a distinct immunohistochemistry profile, with great emphasis concerning those with rhabdomyoblastic differentiation being positive for S-100 protein, myogenin, vimentin, CD99, p63, GFAP, caldesmon, desmin, and p53 and Myo-D1 (the later two revealing the striated muscle differentiation). Materials and methods: A case study concerning a patient suffering from a moderately differentiated (G2) non-keratinizing squamous cell carcinoma of the lung highlighted the development of an ndifferentiated sarcomatous proliferation on the left hemithorax, 7 years after the initial external radiotherapy treatment for the malignant lung tumor. Results: The immunohistochemistry analysis of the thoracic wall invasive tumor revealed it to be a malignant peripheal nerve sheath tumor with rhabdomyoblastic differentiation (Triton tumor) with the positivity for the specific aforementioned markers and a proliferation index – Ki67 of 90%. Chemotherapy was the elective treatment which was followed for 1 month, the patient having a rapid downward evolution towards exitus, with a 33 month post-diagnosis survival.

Conclusions: This case was presented due to the rarity and difficulty of the diagnosis, consisting of a rare subtype of malignant peripheral nerve sheath tumor for which there is no therapeutic consensus and with an un-favorable prognosis.

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 definition and classification. 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 first 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 identified a decision-making algorithm to offer guidance in surgical management in order to obtain an optimal functional outcome. The foundation of the algorithm is the idea of gradually improving the local tissue status, in order to deal with a clean wound as much as possible. This way, the success rate of the surgical reconstruction improves.

Infections are the most severe and the most frequent complication in major burns requiring adequate diagnosis and treatment. Extensive burned areas, impaired immune system and antibiotic therapy contribute to the development of opportunistic fungal infections. An important aspect is the increased level of antimicrobial resistance in our country. We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. We noted the main infectious complications and established a dinamic microbian mapping during patient hospitalization. Fungal infections were noted. We performed microbiological screening: testing at admission and once a week or in case of clinical signs from all potential sites. For the clinical therapy of mycoses, it is mandatory to know whether a fungal colonization or a fungal infection is involved. Unfortunately, often in severe burned patients, clinical presentation is unspecific and sensitivity of diagnostic results may be unreliable. Invasive fungal infections due to Candida species and Aspergillus species are important emerging causes of morbidity and mortality. The systemic use of antifungal agents is conducted depending on the general condition of the burn patient, the fungal species involved and the confirmation of fungemia. In conclusion, specific treatment of infectious complications has to be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance.

Burn injuries are a major public health problem all over the world and despite significant improvements in critical care and surgical treatment, major burns are associated with high morbidity and mortality and poor recovery outcome. Patients with severe burns need immediate intervention and rapid initiation of speci-alized treatment in a dedicated critical care burn unit in order to minimize morbidity and mortality. The complex nature of burn injuries requires an integrative approach, by a multidisciplinary team in order to obta-in an optimal care. [...]

Major burn represents the most severe type of trauma, requiring high standard of treatment into regional specialized bun care centers[1]. According to American Burn Association(ABA), a major burn, which requires hospitalization in burn units, is represented by at least one of the following situations[2,3] [...]

Peripheral nerve damage may lead to substantial mor-bidity, and the costs associated with these conditions can be elevated for both the individual and society.
Nerve entrapment syndromes represent a common occurrence, but sometimes are not correctly diagnosed. They appear more frequently and are better known in upper limb. Carpal tunnel syndrome has the higher prevalence, of 3.72% in USA[1]. [...]

Vascularized composite tissue allotransplantation (VCA) is a recent reconstructive entity that bases on the restoration of deformity by the allotransplantation of a vascularised tissue unit with more components (skin, muscle, bone, cartilage, bone marrow, tendon, nerve). Since the field emerged with the first hand transplant performed in France in 1998, VCA showed a huge potential in replacement of extensive tissue defects and disfigurements (after burns, severe high energy trauma like gunshots, congenital facial malformations), offering a viable treatment option for injuries that involve multiple layers of functional tissue, impossible to repair using conventional surgical techniques, permitting restoration of extensive defects in just one stage procedure with good functional and aesthetic results. A significant number of those procedures have been reported worldwide for various anatomic locations including upper and lower extremities, face, tongue, trachea, larynx, abdominal wall, uterus and penis. These procedures are offered for quality of life and functional indications rather than life-saving indications [1-7]. [...]