Dan Mircea Enescu

Dan Mircea Enescu

Timing, Logistics and Bureaucratic Process in Planning an Experimental In Vivo Nerve Regeneration Project from A to Z

Every research project begins with an idea and a theory. After a thorough examination of previous publications related to the idea (in order not to re-invent the wheel), the idea must be put in practice to test the hypothesis. When it comes to in vivo experiments, there are several bureaucratic demands which need to be fulfi lled before commencing any project. Furthermore, the experiments require similar clinical conditions for surgery and postoperative care in order to obtain irrefutable results. Apart from the logistics necessary for the surgical intervention and the postoperative care, logistics referring to proper accommodation and food supplies for the animals to be experimented on is also to be considered from the beginning. Last but not least, the human resource is most valuable in such projects, as the surgical interventions are time consuming and require for sterile conditions at least 2 people (the surgeon and the assistant). The personnel involved in the project needs to allocate time for the postoperative care, the following clinical tests as well as the daily time spent for cleaning, feeding and providing water for the animals in the study. In nerve regeneration studies, this can take up to months, therefore all the resources should be well planned before the beginning of the project.

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The Romanian National Breast Reconstruction Program - Results and Conclusions after 5 Years

The optimization of the breast reconstruction treatment protocols and the introduction of state-subsidized national programs are global priorities. The present paper presents the results obtained within the National Program of Breast Reconstruction at the „Bagdasar-Arseni” Emergency Clinical Hospital, highlighting the advantages and disadvantages of the surgical techniques used. Materials and Methods: The results obtained after 71 surgical interventions were used for the study. The methodology used involved the use of demographic data, patient history, and the description of the surgical methods and techniques that were used. Results: Among the main results, the paper highlights the fact that mammary reconstruction by using the ‘expander-implant’ surgical technique was 5 times more frequent than the „implant-myocutaneous flap” technique. Post-operative complications have been present in 57% of the patients who associate comorbidities. Breast reconstruction using the TRAM (transverse rectus abdominis muscle1) flap was the rescue solution for severe complications. Conclusions: The TRAM flap was proven to be the best technique in the treatment of diffi cult cases. Carrying out these statistical analyzes related to projects of a national scale form the solid foundation of documented studies that bring a significant contribution to the development of the Romanian medical system.

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Three Paediatric Cases Study with Over 80% TBSA Burn Injury - Surgical Treatment by Using Skin Allografts: A Viable Option...

Burn is the most severe type of injury that a human being may suffer which can be quantified and evaluated by surface and depth of lesions. Treatment of this kind of injuries needs complex teams, competent and devoted, consistent therapeutic principles, specific conditions of care and specific funding.
In full thickness burns, deep partial burns on important functional area (hand, foot, periarticular regions) and burns up to 40% TBSA, predominantly deep, surgical treatment consists in early excision and grafting, which improve prognosis compared to the burned area and also cosmetic and functional results.

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Particularities and Surgical Treatment of Constriction Band Syndrome Syndactyly, in Children

Constriction band syndrom syndactyly is a sporadic condition, that may be present in association with other congenital anomalies such as musculoskeletal (including total amputation of the limb), craniofacial (like cleft lip and cleft palate) and thoraco-abdominal disorders (such as gastroschisis and extrathoracic heart), neural tube defects, scoliosis and hemangiomas (1, 2, 3, 4, 5, 6). Some of these manifestations are uncommonly noted at birth because they result in spontaneous abortion.
There are two main theories about constriction band syndrome etiology, the first of which is the intrinsic theory proposed by George Streeter, the director of embryology at Carnegie Institute, in 1930 which is called, "Streeter’s Dysplasia". Streeter suggested that an intrinsic defect in the subcutaneous germplasm resulted in focal mesenchymal hypoplasia, tissue loss, and scarring (7, 8).

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Long-terme Evaluation of Primary Syndactyly Treatment in Children, Using a Flatt Modified Technique

Syndactyly is one of the two most common congenital hand abnormalities, the other being polydactyly (1, 2, 3). It occurs in about 1: 2,500 live births, more commonly in males, and is most often seen in the third web space (2, 4). The condition has a strong familial tendency and is bilateral in half of the cases (4, 2, 5). Inheritance is thought to be autosomal dominant with variable penetrance and expressivity, which may explain the male predominance (6).
Unlike secondary syndactyly, which occurs due to abnormal fusion of initially individualized fingers, primary syndactyly mainly occurs due to the failure of differentiation between adjacent digits, caused by the absence of apoptosis in the interdigital mesenchyme during the seventh and eighth weeks of gestation (7,8). Syndactyly may occur as an isolated event or it may be linked to other anomalies in the body, being known as syndromic syndactyly (7).

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PERFORATORS OF THE CALF ARTERIES - ANATOMICAL STUDY

In reconstructive surgery, perforator flaps have a short history. Not more than 27 years ago, Nakajima et al. described the six types of perforator vessels known at present: direct cutaneous, direct septocutaneous, direct cutaneous branch of muscular vessel, perforating cutaneous branch of muscular vessel, septocutaneous perforator and musculo-cutaneous perforator [1]. (Fig. 1)
The knowledge about these perforator vessels continuously grew, by identifying the vascular networks of the entire body, formed by the perforator vessels. Therefore, it became possible to create a lot of perforator flaps based on these perforator vessels [2]. Thus, perforator flaps can be considered the latest milestone in the evolution of reconstructive flap surgery. Many methods are used for investigating the exact location of the perforators, such as imaging methods: computed tomography, magnetic resonance angiography and lately thermal imaging that became also reliable [3]. The exact knowledge of the location and caliber of perforators became a real help for plastic surgeons, especially in the calf area, where the reconstructive method has to accomplish the functional and aesthetic needs for both reconstructed and donor areas.

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