Ioan Lascar

Ioan Lascar

The importance of high flow nasal cannula (HFNC) oxygen therapy

High flow nasal cannula (HFNC) oxygen therapy devices are used on a daily-basis in many intensive care units and postoperative wards. Such a device deliver a mixture of air and oxygen, warmed, humidifi ed, with gas flow between 20-60 L/min, and inspired oxygen fraction between 0.21-1. Therefore, it improves oxygenation, decreases dead space, washes out the carbon dioxide (CO2) from patients’ airways, improves thoraco-abdominal synchrony and decreases the work of breathing. Studies have shown effi cacy of HFNC oxygen therapy use for acute hypoxemic respiratory failure, for patients with exacerbations of chronic pulmonary diseases, after extubation in order reduce the need for mechanical ventilation, in perioperative period to prevent atelectasis and in palliative care, in order to reduce breathlessness. It isn`t feasible for patients with severe altered neurological status, facial trauma, basal skull fracture, complete airway obstruction or epistaxis. There are no standardized recommendation for the use or contraindication of HFCN oxygen therapy. The weaning is realised according with patients’ tolerance, oxygen saturation, respiratory and heart rates.

Read More »

Results in Breast Reconstruction - Retrospective Study

In the last century, the breast reconstruction after mastectomy has become an important element of the multicentric treatment of the patients suffering from breast cancer. Breast reconstruction was initially developed to reduce the complications of mastectomy and the deformations of the thoracic wall. Currently, it is known the fact that reconstruction can improve the psychosocial state and the quality of life of the patients with breast cancer[1]. [...]

Read More »

Negative Prognostic Factors in Severe Burns - Implication for Clinical Outcome

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. [...]

Read More »

The Versatility, Plasticity and Esthetic Aspect of Latissimus Dorsi Muscle-Cutaneous Flap in Breast Reconstruction - Case Report

In the last decades, the approach manner of the defects of the soft parts post-mastectomy developed significantly together with the innovative surgical techniques of oncoplastic surgery.
Among these techniques, the reconstruction of the breast with LD flap and implant continues to be a reliable and easy to perform method, both by the experi-enced surgeons and also for the beginners[1]. [...]

Read More »

Versatility of the Cross-Finger Flap for Reconstruction of the Thumb

It is well known that the thumb is responsible for 40% of the hand function. Th erefore, preserving its length and mobility represents the main objective of the plastic surgeon while choosing the most appropriate reconstruction technique[1]. When resurfacing of the fingers is needed after hand injuries, cross-finger flaps have proved themselves very useful[2]. Since its premier many years ago[3], this type of flap remains an elegant method in order to cover exposed bones or tendons of the fi n-ger, in order to ensure length preservation and function recovery. [...]

Read More »

Predictive Factors in Compressive Neuropathies Treatment Outcome

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]. [...]

Read More »

A Curious Case of Rhinophyma in a 73-Year-Old Patient

Rhinophyma is a benign tumor characterized by a pro-gressive hypertrophy of the nose soft tissues, with a re-ddish and bulky appearance, affecting most frequently elderly Caucasian males[1], which may also cause functional airway obstruction. It is believed to be the end stage of severe acne rosacea, but the real cause and the exact etiology remain unknown[1]. The male to female ratio of rhinophyma patient varies between 5 to 1 and 30 to 1 [2,3]. The diagnosis is based on the clinical features of this rare and disfiguring disease using Rhinophyma Severity Index Score (RHISI)[4]. The main differential diagnosis is the basal cell carcinoma (BCC), with an occult incidence of 3% to 10% in patients with rhinophyma[1]. [...]

Read More »

Single-Stage Reconstruction of Distal Third of the Dorsum Nasi Using a Nasolabial Flap after Removal of Basal Cell Carcinoma

The nose represents a common site for skin cancer, especially for Basal Cell Carcinoma (BCC) which is the most common malignant tumor in humans[1-3]. The removal of the tumor will lead to a defect that can involve skin, cartilage and even nasal mucosa. Therefore, reconstruction of this tridimensional structure can be a challenge even for the most experienced surgeons[4]. There are many techniques described in the literature for restoring the lining and skeletal framework[1-8], but all of these techniques should be adapted to the patient’s needs. In this paper we described our preferred surgical method to cover a medium defect of the distal third of the dorsum nasi after tumor excision using a nasolabial flap. In order to perform a single-stage reconstruction, we pushed the limits of the flap measurements and did some tricks so as the pedicle to be well fitted, leading to good aesthetic results. [...]

Read More »

Breast Reconstruction Particularities after Radiotherapy - Case Report

Postmastectomy radiation therapy decreases the incidence of locoregional disease recurrence in patients with invasive breast cancer and has been proven to reflect a survival advantage for patients with node positive disease[1,2]. The optimal timing and technique of breast reconstruction procedures in patients requiring post-mastectomy radiation therapy are controversial[1] . Patients undergoing postmastectomy breast reconstruction, with a history of prior radiation therapy, present a particular clinical scenario. This is because of their well-documented higher complication rates, secondary to deleterious effects of irradiation on the soft tissue envelope of the remaining breast. [...]

Read More »

Comparison of Osteosynthesis Using Plates and Screws Versus Kirschner Wire Fixation for Unstable Metacarpal Fractures: a...

Hand surgery is considered to be the biggest challenge for every plastic surgeon. The social value of the hand is appreciated by any individual, butmostly by plastic surgeons which are, par excellence, hand-working persons. When a hand injury is treated you must consider the Hippocratic concept which states that "healing is a matter of time but it is sometimes also a matter of opportunity". The hand forms a functional unit with the forearm which is a high-precision machine, with multiples levers, who has tactile intelligence that ensure its auto-mechanism, being able to grab and maintain, in any spatial position, large and small tools invented by human genius. The hand is both a motor and sensory organ, and in terms of society,it is an organ of defense, an organ of creation and expression. This is why hand surgery is very important, both in medical and social terms, and any research in this domain has one purpose: improving the treatment of hand injuriesin order to obtain functional results closer to the genetic scale of the divine creation. The purpose of this study was to assess different osteosynthesis techniques in order to establish which one is better in matters of functional results. [...]

Read More »

Is Vascularized Composite Allotransplantation a Suitable Reconstructive Option for Extensive Defects in Burned Patients?...

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]. [...]

Read More »

Lipoma of the Proximal Forearm with Compression of the Superficial Radial Nerve

Compressive neuropathies in the upper limb represent a common and admittedly more and more frequent pathology, given how certain peripheral nerves posess an inherent risk of becoming injured due to anatomical positioning. [14] Obesity rate increase and the ageing of population altogether suggest that compressive neuropathies in the upper limb will become even more frequent in the next decade. [14] Themost common sign of nervous compression is the carpal tunnel syndrome, prevailing in approximately 3% of the general population, followed by the cubital tunnel syndrome, and finally the radial tunnel syndrome, which is quite rare. [9] [...]

Read More »

Enhancing the Patency Rates for Native Arteriovenous Access for Dialysis: A Classical Two-Step Superficialization of a Deep...

Native arteriovenous fistulae (AVF) are the best options for chronic hemodialysis (HD) access. Unfortunately, not every patient fulfils the requirements necessary for this type of vascular access: the artery and the vein implicated in dialysis fistula creation must accomplish some criteria which makes them suitable for this procedure. If these criteria are not fully met, the chances to a successfully intervention and a quick and qualitative maturation of the fistula are dropping [1-5]. An artery that is suitable for AVF creation has an inner diameter > 2 mm, optimal initial flow and elastic walls allowing dilatation to accommodate a supplementary 10 - 20 fold blood flow increase after the AVF is performed [1,2,5-11]. The participating vein must be superficial enough (less than 5 mm from the skin surface), wide enough (a caliber bigger than 2.5 mm) and its walls must allow important dilatation (without fibrosis, injuries, and thickenings). In elderly, diabetics or patients with late initiation of HD some of these demands are frequently absent we need to adapt surgical procedures, taking advantage of any oppor tunity to overcame shortcomings and create a native dialysis access [1,2,5,9].

Read More »

Experimenting on LAB Rodents - Ethical Principles

People have reported themselves differently regarding different species of animals and had different reactions about the animal species. The attention paid to them depends on the role held by them in human life, either as pets or as a method of entertainment, either as research subjects.
Some species enjoy privileges as pets (dogs cats, birds, turtles), others are used to satisfy human native instincts as hunting animals.

Read More »

The Distally Based Superficial Sural Artery Angiosome Flap Concept: Anatomy, Indications, Surgical Technique, Results...

Located between the popliteal fossa and the midportion of the calf, centered over de midline raphe, between the medial and lateral heads of the gastrocnemius muscle, the sural flap is the best known neurocutaneous flap of the leg. [1,2]
The sural angiosome was first introduced in practice by Ponten in 1981, when he reported the use of 23 fasciocutaneous proximally based flaps for soft tissue defects.[3] Donski and Fogdestam described the anatomy of the distally based sural flap and presented three clinical cases in 1982. [4]

Read More »

Treatment Management of Bilateral Lower Eyelids Basal Cell Carcinomas with Total Lower Eyelid Reconstruction

Basal cell carcinoma (BCC) is known as the most common type of skin cancer with a rapidly rising incidence, 90 % of the cases occurring in the head and neck region. (1) The eyelids are involved in 10% of these cases, making it the most prominent eyelid malignancy. (2) It predominantly affects fair-skin individuals, notably type I and II Fitzpatrick photo types, most of them presenting with a positive history of chronic sunlight exposure. Etiology may be multifactorial, but sun exposure has been involved in most of the cases. (3) Basal cell carcinomas arise from the basal layer of the epidermis, probably as a result of activating the proto-oncogenes and inactivating the suppressor genes in the keratinocytes. (4)

Read More »

Botulinum Toxin Type A - Possible Anti-Nociceptive Effect on Mice

Botulinum neurotoxin has been used in the treatment of various groups of cronic neuromuscular diseases, which include neuromuscular junction signaling, non-neuromuscular transmission, cholinergic, or non-cholinergic.
Having specificity on releasing neurotransmitter vesicles with acetylcholine in the synaptic gap, the main usage of botulinum toxin was as a muscle relaxant drug in painful or painless spastic syndromes.

Read More »

Malignant Peripheral Nerve Sheath Tumor Relapse Detected by Positron Emission Tomography

Malignant peripheral nerve sheath tumors (MPNST) are soft tissue tumors showing neuroectodermal differentiation. They arise in connection to a major nerve trunk, a peripheral nerve or a preexisting neuroma in patients with hereditary neurofibromatosis type 1. [1, 2] They usually develop in the deep soft tissue between anatomic compartments, the root of the limbs (inguinal region, the axilla) being one of the most common sites of occurrence.

Read More »

The Rubens Flap - Breast Reconstruction - Anatomical Dissection on a Cadaver

The concealment of cutaneous and subcutaneous defects has always been a challenge in surgery. The breast is one of the most important and defining elements of feminine beauty. Neoplastic pathology has always made it difficult to aesthetically repair the extirpated mammary tissue. Plastic and aesthetic surgery and reconstructive microsurgery, through microsurgical techniques of autologous free flap transfers, try to solve these problems.

Read More »

Total Lower Lip Reconstruction - What Techniques Should We Choose

While the incidence of lip cancers incidence in the central Europe is low 0.7% of all malignant tumors compared to the 1-2% generally considered (2-5), they are extremely important from a clinical and surgical point of view because of the morphological and functional changes involved. More than 90% of these tumours are squamous cell carcinomas (SCCs) and, in lesser numbers, basal-cell tumours (BCCs) however, some adenocarcinomas deriving from the minor salivary glands can be observed and, even more rarely, melanomas, sarcomas and lymphomas. BCCs generally occur in the upper lip and do not usually present lymph node metastases (4, 6). In contrast, SCCs develop most often in the lower lip, with a possibility of neck metastases. Lip carcinomas frequently appear on top of precancerous lesions, such as radiodermitis, chronic chelitis and xeroderma pigmentosum. The diagnosis and treatment of these pre-cancerous lesions, facilitated by a direct view of the lesions, is, therefore, crucially important in order to avoid their evolving into actual tumours. The subjects most at risk of this type of tumour are fair-skinned elderly people who work in the open air. Men are more at risk than women, (1.3% men and 0.3% women) (1) probably because the latter use lipstick or lip-salve (2, 7-9).

Read More »

The Inferior Gluteal Flap - Breast Reconstruction - Anatomic Dissection on a Cadaver

The breast has been the expression of beauty and fertility since ancient times. The aesthetic reconstruction of the breast is and has been a challenge for plastic surgeons. Microsurgical techniques of dissection and free transfer are commonly used. During the dissection of one fresh, female cadaver, age 67, a free inferior gluteal flap was taken from gluteal region, using loupe magnification. The dissection preparations were photographed with a high definition camera.

Read More »

"Medicina Moderna" - A New Step in Sharing Medical Experience

Starting with the first issue, published in 1994, the aim of "Medicina Modern?" Journal has been to promote the significant achievements of the Romanian medical activity, to communicate and share medical knowledge and to be a valuable database of Romanian research. Because the Journal is under the patronage of Bucharest College of Physicians and Romanian Academy of Medical Sciences, doctors and researchers from all Romania and also from abroad can submit their work and most significant results, assuring them of the high standards of morality and ethics of our Journal.

Read More »