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L9. Malignant melanoma. Contemporary diagnostic procedures,treatment, and perspectives for the future Prof. Krzysztof Drzewiecki Department of Plastic Surgery, Rigshospitalet University Hospital Copenhagen, Denmark Cutaneous Malignant Melanoma (CMM) comprises 3% of all malignancies. The incidence rate has tripled during the last 40 years. Middle-aged persons are most often hit by this tumour. Females are slightly overrepresented. UVspectrum of sunlight is the most important external ethiological factor. Constitutional predisposing factors are freckled persons, who are sensitive to sunshine, persons with many naevi and congenital naevi. 4-10% of patients with CMM report about other single cases of CMM in their families. However, in less than 1% of the melanoma cases a gene defect can be detected. Dermatoscopy and SIA-scopy enhance the probability of a correct clinical diagnosis, provided the doctor is accustomed with this method. Clinical examination, sentinel node procedure, and microscopy are necessary to classify a CMM correctly – before the treatment. The American Joint Committee on Cancer (AJCC) has a staging system based on a TNM assessment, which should be used The standard treatment of CMM is surgery for primary lesion, surgery for secondary regional lymph node deposits and surgery when ever technically possible for distant metastases. Hypertherm Regional Perfusion treatment for regional metastases on the extremities is widely accepted. X-ray treatment is used for CMM metastases that are not accessible for surgery. Chemotherapy, biological modifiers and vaccines should only be used as part of a clinically controlled study, because they are experimental treatments. Interferons and vaccines are used in a clinical experimental setting as an adjuvant therapy following surgery in suitable patients. L10. Functional free flaps reconstruction Prof. Milomir Ninković Department of Plastic, Reconstructive and Hand Surgery, Burn Centre, Technical University - Hospital Bogenhausen, Munchen, Germany The transfer of a free microvascular flap is a well-established method in the reconstructive surgery. It provides tissue with a rich blood supply, which improves healing process, its resistance to infections, and quality of reconstruction. The technique settles freedom in flap design for optimal contour in accordance with size and shape of the defect. The timing of free tissue transfer after upper extremities injury seems to be a very important issue. The free flap closure can be divided according to time of reconstruction into three categories: primary free flap closure (within 24h), delayed primary free flap closure (2-7 days, and secondary free flap closure (after one week). Many factors besides timing of closure and the success of flap survival alone influence the functional outcome of the upper extremity reconstruction. For instance severity of injury, particular the nerve and muscle damaged, as well as length of bone loss etc. In this presentation all factors which influence the final result of upper extremity are discussed and principles of treatment are defined.
L11. Replantation Prof. Aurelio Portincasa Plastic and Reconstrucive Surgery Department University of Foggia, Foggia (Italy) Definitions: Replantation: if a part is completely amputated, i.e. cut off without any attaching structures (vessels, nerves, tendons, bone) whatsoever, it will be replanted Revascularization: if a part has been deprived of its main blood supply, but there are connecting structures remaining, such as tendon or nerve, the part has been incompletely amputated and will be revascularized i . Currently the ultimate success of a replantation attempt is judged by functional as well as cosmetic parameters.Meyer ii state that patients with amputations proximal to the wrist joint but close to it are good candidates for replantation, as evidenced by Chen Grade I or II recovery in 80%.In general, upper extremities amputated proximal to the midforearm should not be replanted if the warm ischemia time exceeds 6 hours. The following are universal contraindications to replantation: - concomitant life-threatening injury - multiple segmental injuries in the amputated part - severe crushing or avulsion of the tissues - extreme contamination - inhibiting systemic illness (small vessel disease, diabetes mellitus, etc) - prior surgery or trauma to the amputated part precluding replantation Return of function in forearm replantations depends largely on two factors: (a) the degree of nerve regeneration, and (b) the hand rehabilitation program iii . The most frequent complications in upper limb replantation and revascularization are: infection (30%); inadequate debridement; nonunion and intrinsic muscle function weak or absent. Excellent or good results are noted in patients with clean, guillotine-type distal amputations or incomplete proximal amputations with intact nerves. Fair and poor results are associated with crush or avulsion injuries. The potential for functional recovery is directly proportional to the amount of viable tissue remaining iv v . In the hand, all other criteria being favorable few surgeons would argue against replantation in the following circumstances: - multiple finger amputations - thumb amputations - complete amputations of the hand at the palm or wrist - all amputations in children Replantation is still controversial in the following clinical situations: - loss of a single digit other than the thumb, especially the index and digitorum superficialis (FDS) tendon insertion - single-digit amputations distal to the FDS insertion - ring finger avulsion injuries Other contraindications to replantation have been listed above.
Page 1 and 2: Croatian Medical Association Croati
Page 3 and 4: 5th CROATIAN CONGRESS FOR PLASTIC,
Page 5 and 6: ORGANIZING COMMITTEE CONGRESS PRESI
Page 7 and 8: CONTENTS Lectures 1 SESSION A : Hea
Page 9 and 10: LECTURES
Page 11 and 12: L1. Craniofacial deformity Prof. Ia
Page 13: Lateral videofluoroscopy most usefu
Page 17: eview of current replantation liter

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