Abstract book - ESPRAS

Croatian Medical Association 

Croatian Society of Plastic, Reconstructive and Aesthetic Surgery 

University Hospital Dubrava, Zagreb, Croatia 

Department for Plastic, Reconstructive and Aesthetic Surgery 

Abstract book 

5th CROATIAN CONGRESS FOR PLASTIC, 

RECONSTRUCTIVE AND AESTHETIC 

SURGERY 

ESPRAS appointed Congress for 2004. 

Editors: Sanda Stanec, Zlatko Vlajčić, 

Krešimir Martić, Franjo Rudman ml. 

Dubrovnik-Cavtat, Croatia 

15th-20th October, 2004

PRAZNO ILI SLIKA 

SESSION H : 

Lower Extremity 

Reconstructions

H1. Long term results of free flap foot reconstruction 

Džepina I., Mijatović D., Unušić J. 

Department of Plastic and Reconstructive Surgery, 

University Hospital “Zagreb” 

Zagreb, Croatia 

Treatment of foot injuries is formidable challenge for reconstructive 

surgeon. In order to obtain good long results we must restore soft tissue 

cover, structural integrity and sensation. 

At the department of plastic and reconstructive surgery, KBC Rebro in 

Zagreb we treated 43 patients with complex foot injuries using microvascular 

free flaps in the period from 1990 to 1993. Injuries were caused by 

explosions and missile fragments an 87% of the cases while traffic accidents 

accounted for 11% and farm injuries 2%. Free flaps used for reconstruction 

were: latissimus dorsi, serratus anterior, rectus abdominis, forearm, scapular, 

DCA and gracilis. Patients were followed-up for 10-13 years. Outcome of 

reconstruction was evaluated using Maryland foot score, pedobarography and 

questionnnaire. 

52% of all patients had good or excellent results, with the rate of secondary 

and tertiarry amputation in 5,2%. 

Free flap reconstruction of complex foot injuries can provide good functional 

outcome in the long term follow-up. 

H2. The versatility of the anterolateral thigh flap for lower 

limb reconstruction 

Keramidas E., Miller G. 

Plastic Surgery, Northern General Teaching Hospital, Sheffield, UK 

Introduction 

Our purpose was to explore the versatility of the free anterolateral thigh flap 

for soft tissue defects of the lower limb. 

Marerial and Methods 

We use the flap in 6 patients to cover defects at the lower limb. In 3 patients 

was used as a fasciocutaneous flap in 2 as a cutaneous flap (supra-thin) and 

in 1 case as a musculucutaneous with part of vastus lateralis muscle. 5 of the 

flaps were based in a musculucutaneous perforator and one in septocutaneous 

perforator. 2 of the flaps were used to cover defects at the lower third of the 

leg, 2 to cover an exposed Achilles tendon , one to cover an exposed knee 

joint, and one to cover the middle third of the leg . 

Results 

All the flaps survived 100%. The mean length of the flap range 10-15cm. 

The mean pedicle length was 12 cm. Three of the donor areas were closed 

direct with very good results the rest 2 was closed with a split thickness skin 

graft. The mean follow-up was 16 months. All patients were satisfied with 

the results. 

Conclusion 

The anterolateral thigh flap has several advantages: 

1) two-surgical teams can work simultaneously, 2) long vascular pedicle 12- 

16cm with diameter of the vessel 2-2,5mm,3) skin with good texture and 

much especially for lower limb reconstruction,4) minor donor site morbidity 

especially when it is closed directly,5) there is no scarification of a major

vessel,6) large skin paddle,7) can be used as a fasciocutaneous, 

musculucutaneous, cutaneous, adipofacial as a flow through, chimeric and as 

a sensate flap. We found this flap very useful and reliable for difficult soft 

tissue defects of the lower limb. 

H3. Using cross tibia transplantation and foot replantation 

in amputation of both lower extremities 

Kempny T., Jelen S., Vresky B., Kysely T. 

Department of Plastic Surgery, University Hospital “Ostrava” 

Ostrava, Czech Republic 

Introduction 

The authors present the case of 40 years men which was subtotaly amputated 

both lower extremities by the train. 

Material and Methods 

We decided to do an tibia replantation from the left calf with the skin like 

through flow flap and replantation of the right foot, and the artificial legon 

the left leg. 

Results 

In the postoperative time were done repeatedly (4x) superficial necrectomy 

and two weeks later was done osteosynthesis with fixateur externe to ensure 

the talocrural joint stability by previous intramedullary osteosynthesis of the 

right tibia. Three months later injury was the patient able to work. 

Conclusions 

In this case of our patient, which had the n.tibialis in continuity we did not 

used the usual crioss calf replantation, but the more complicated right calf 

reconstruction. The result was a original hallux position and 10 mm two 

points discrimination in the n.tibialis innervated area after three years. Patient 

walks by an French crutches and is able to live normal life. 

H4. Importance of soft tissue covering in the treatment of 

chronic osteomyelitis 

Gavrankapetanović I., Gavrankapetanović F, Bišćević M. 

Department for orthopedics, Clinical Center “Sarajevo”, 

Sarajevo, Bosnia and Herzegovina 

Introduction 

in our work we present soft tissue defects after osteomyelitis caused by high 

cinetic projectils. 

Patients and methods 

There is 30 patients with verified osteomyelitis and soft tissue defect who 

were operated on our clinic. Surgical technique were consisted of classical 

treatment with PMMA gentamicin pearls and soft tissue cowering. We have 

had an original statistic form and software support. Follow up time were 8 

years. 

Results 

In group of patients were we have preformed an op0erative procedures ( 30 

patients) with debridement and forage, lavage, aplication of PMMA pearls

and soft tissue cowering during the 8 years we had only two recidivs, solved 

by aditional opeartive procedure. 

Conclusion 

Suggested operative protocol with omplantation of PMMA gentamicin 

pearls with soft tissue cowering in excelent methode in definitive chronical 

myelitis treatment. 

H5. The use of ALT flap in lower extremity reconstruction 

Žic R., Stanec Z., Budi S., Stanec S., Milanović R., Rudman F., 

Martić K. 

Department for Plastic, Reconstructive and Aesthetic Surgery, 

University Hospital «Dubrava», Zagreb, Croatia 

Although microsurgical reconstruction of the foot has allowed us to 

reconstruct foot defects previously requiring amputation the selection of flaps 

to cover large defects is small. With the use of the anterolateral thigh flap we 

have gained a large thin flap which is able to cover large dorsal and plantar 

defects with good contour restoration and early return of ambulation in 

normal footwear. In addition the donor site, even when covered with a split 

skin graft, is functionally and cosmetically acceptable to the patients and no 

functional loss at the donor site is seen. In this paper the authors present 

their experience with the use of the ALT flap in patients with large defects of 

the foot. 

H6. Lower extremity reconstruction experience in 175 patients 

Agir H., Sen C., Dinar S., Cek D. 

Plastic and Reconstructive Surgery Department, Kocaeli Faculty of Medicine, 

Kocaeli University, Kocaeli, Turkey 

Introduction 

Acute or chronic wounds of the lower extremity have still been considered as 

challenging problems of reconstructive surgery despite the major advances in 

local flap closure and microsurgical transfer. 


We reviewed our patients with lower extremity wounds surgically treated 

between 2002 and May 2004 in order to see our results and evaluate own 

management principles. We assessed our outcome according to age, etiology, 

nature of the defect and its anatomical location, preoperative studies, closure 

techniques and complications. 

Results 

There were 258 patients treated due to their various lower extremity wound 

problems. Out of this group, 175 cases (89 males, 86 females) were managed 

with surgical closure methods other than primary repair and secondary 

healing. Mean age was 30.86±20.9 years. In 61 cases, wound was due to 

burn injuries and in 50 cases; defect was caused by diabetic foot. In 19 

patients, trauma was the cause whereas pressure sore was the reason in 16 

patients. In 90 cases, lesion was located distal to the cruris (ankle-foot 

region). Cruris and thigh regions were involved in 63 and 59 patients 

respectively. Free flap closure was used in 11 cases of which two failed. In 

62 patients, random or axial type local flaps were chosen for closure however

25.8% of them had various types of wound healing problems like infection, 

detachment, partial or total necrosis. Majority of these patients had diabetes 

or high tension electric burn injury. 

Conclusion 

Vascular anatomy and etiopathology behind the defect should be very well 

known in the reconstructive approach to the lower extremity wounds in order 

to make a better decision and planning before the closure. Besides, expertise 

on local flap use and skills in microsurgical technique will definitely lower 

the complication and amputation rates in difficult cases of lower extremity. 

H7. Lymphatic reconstruction as a new concept in lymphoedema 

surgical treatment 

Stritar A., Leskovsek A., Solinc M., Beslic N. 

Department for Plastic, Reconstructive Surgery and Burns, Clinical Center, 

Ljubljana, Slovenia 

In the last decade some new surgical methods for restoration of lymph flow 

are described. Some are in experimental research and few are clinically used. 

They represent a vascular implantation of a healthy, new lymphatic tissue 

into lymphoedematous limb, what it means an inner incorporated flap, as a 

conduit for lymph drainage. Reconstruction itself is more complex and 

demanding, as bridging or shunting operations, where free omentum, free 

lymph perinodal - node and vascularised lymphatico adipovenous flaps are 

used. 

All the methods must be individually selected to lymphoscintigraphic 

findings, local tissue conditions, axioms of lymphoedema surgery and 

general condition and aim of a patient. In general, the results of lymphatic 

reconstruction operations are still badly evaluated and our experiences and 

conclusions are positioned. Theoretical considerations are sometimes 

discordant to practical surgical skills and abilities. 

We operated 6 patients, as a microsurgical transfer of a lymph node and 2 

patients as a bridged omentum major flap, while some patients are recruited 

for lymphaticoadipovenous transfer, for secondary lymphoedema. 

Results of a lymph node transfer are not finally completed. Our experiences 

point out, that surgical release of a scar was in benefit, and healthy lymph 

nodes must be selected. According to this fact in a case of lymphatic 

systemic predisposition a donor area must be examined by a 

lymphoscintigraphic or ultrasound findings. 

All mentioned operations above also need more ethical and forensic consent.

SESSION I : 

Miscellaneous

PRAZNO ILI SLIKA

I1. Body dysmorphic disorder 

Nola I. 

Private Dermatovenerology Office, Zagreb, Croatia 

Dissatisfaction with appearance is very prevalent in our society and it is 

practically the norm. But, when someone becomes intensely preoccupied with 

what they believe to be a defect in their appearance, then they may be suffering 

from a mental condition called Body Dysmorphic Disorder (BDD). BDD is 

also known as dysmorphophobia, the psychiatric condition that has been 

described for more than a century. The preoccupation causes emotional distress 

and social impairment. BDD usually takes a chronic course. People with BDD 

often have a history of multiple visits to dermatologists and cosmetic surgeons 

with resulting unsuccessful treatment. So, failure to recognize people with 

BDD frequently lead to cosmetic medical or cosmetic surgical approach but 

demonstrate u unrealistic expectations. People with BDD may blame the 

physician for producing what is perceived as an unacceptable outcome. People 

with BDD frequently develop major depressive episodes and are at risk for 

suicide. So, there is a failure to combine cosmetic surgical treatment with 

psychiatric therapy when treating a person with BDD. 

I2. A multimodale therapy in the treatment of the decubital ulcer 

Crnogorac V 1 ., Wagner D 2 ., Arnold J 2 ., Hebebrand D 1 ., Busching K 1 ., 

1 Clinic for Plastic Surgery,Reconstructive and Hand surgery 

2 Clinic for Internal Medcine, Diakoniekrankenhaus, 

Rotenburg, Germany 

Introduction 

The origin of the decubitus ulcer is adequately well-known. Therefore we have 

especially focused our attention on a specific group of patients with significant 

relapse-endangered and aberrant therapy concepts. Part of this endangered 

group of patients are particularly those with neurological diseases and 

malfunctioning of the urinal-rectal system. Despite greatest preventive 

measures and a multiplicity of industrially manufactured adjuvants it is still 

possible that the decubitus ulcer originates and subsist in a variety of 

seriousness. 

This clinical trial, taking the well-established therapeutic-treatments into 

account, is based on the elimination of incontinence problems in order to 

improve the local dermis state.In addition to the classical surgical decubitus 

ulcer therapy occurs a temporary or permanent stoma probe according to 

Hartmann. If malnutrition or promising results exist, we adment our therapy 

concept with an additive PEG-probe in order to support substitution of the 

calorific nutrition. 


The theraphy scheme of the decubitus ulcer treatment consists of: 

1.The minimisation of pressure by means of adequate storage 

2. Intense hygienic procedures and skincare 

3. Disinfection and cleaning of wound-in extensive necrosis surgical 

debridement 

4. In case of indication of surgical debridement preoperative stomaprobe 

according to Hartmann 

5. PEG-Probe for the applicaiotn of specific probenutrition

6. Cartographic and photographic course record of the woundsituation 

7. final cover of the soft tissue defect with local flaps 

8. continuation of intense storagetherapy and education of the nursing staff and 

patients relatives 

Results 

Up to now 18 patients have been treated with the above-named therapy 

concept. In this number included are 5 patients with an additional nutrition 

programme. A definite advancement considering the woundsituation could be 

observed within 15 patients. Two patients showed no substantial conditioning 

of the wound.The operative defectcover succeeded with a lasting effect within 

17 patients relapseless with typical flaps. One patient has been excluded from 

clinical study for reason of complience. 

Conclusions 

The present data proof the benefit of the preoperative anus praeter-probe for 

local skin and woundsituation. 

In addition to that it reduces and simplifies the high nursing maintenance for 

the nursing staff and the patients relatives.The malnutrition in relation to 

decubitus ulcer has been controversially discussed. Four out of five PEGpatients 

confirm the impression, that the woundsituation and general situation 

can be positively influenced. 

A failure of therapy was only noticed within patients that due to 

contraindications were not able to receive a anus-praeter-probe. 

I3. Self inflicted burns in Afghanistan: the fate of unhappy women 

Echinard C., Leroy P., Brunel M.J., Azzizi MD., Tessier J.L., 

Humani Terra International , Marseille, France 

The authors are reporting their experience about self inflicted burns in women 

during the post taliban period en Afghanistan. 750 burns patients are treated 

every year in the public hospital. 2/3 of them are women and among them, 250 

are suicides by flame. Humani Terra International, a surgical N.G.O. has 

discovered this problem immediatly after the fall of the taliban two years ago. 

Surgeons, anaesthesists and nurses of the N.G.O. are going regularly to Herat 

in order to treat and to set up a modern burn unit in collaboration with 

Handicap International. 

I4. Epibase: a new autologous keratinocyte cultures 

Costagliola M. 

Polyclinique du Parc, Toulouse, France 

Cell therapy is becoming a very interesting solution to replace degenerated or 

damaged tissues. In January 1998, Genevrier Laboratories inaugurated a new 

department especially designed for the production of cultured cells as 

therapeutic agents.Meeting clinician therapeutic needs by providing autologous 

keratinocytes, fibroblasts and chondrocytes in the near future, represents the 

primary aim of the Biotechnology department. Concrete cell-based products 

are already being used for the treatment of burns and cutaneous chronic 

wounds such as the EPIBASE graft; which corresponds to an epidermis sheet 

composed of cultured autologous keratinocytes. Hard to heal venous leg ulcers 

and necrotizing angiodermatitis benefit greatly from EBIPASE treatment.

I5. Future of bioresorbable biomaterials: multifunctionality 

Ashammakhi N. 1,2 , Veiranto M. 1 , Tiainen J. 2 , Niemelä S-M. 2 , 

Törmälä P. 1 

1 Tampere University of Technology, Institute of Biomaterials, Tampere, Finland. 

2 Oulu University Hospital, Department of Surgery, Oulu, Finland 

Aim 

The aim of the study was to characterize properties of multifunctional (MF) 

bioabsorbable rods and screws. 

Material and methods 

Bioaborbable polymers (PLGA 80/20 or PLDLA 70/30) were used as the 

matrix, and bioactive glass (BG) as osteoconductive agent. In MF-1, 

ciprofloxacin (CF) was included and in MFM-2, for a tissue-reaction 

modifying agent was used. The self-reinforced (SR) were sterilized using - 

irradiation. Drug release, mechanical properties, and microstructure were 

evaluated. In vitro cell models were used. In vivo models included the 

implantation in rabbits’ cranial bone & rats’ subcutis. Biomechanical (pull out 

strength) testing was done in cadaver bones. 

Results 

CF was released from the studied screws after 44 wks (P/L/DL)LA) and 23 wks 

(PLGA) in vitr. (0.06 – 8.7 µg/ml/d for P(L/DL)LA and 0.6 - 11.6 µg/ml/d for 

PLGA). Initial shear strength of the studied ciprofloxacin-releasing screws was 

152 MPa for P/L/DL)LA & 172 MPa for PLGA. Studied screws retained their 

mechanical properties for 12 wks (P(L/DL)LA) and 9 wks (PLGA) in vitro at 

the level that ensures their fixation properties. Histology of MF-1 showed 

increased giant cells at the implantation site. Pull-out tests indicated that the 

early version of the MF-1 type of screws have lower values as compared to 

controls. Inhibition of bacterial growth, attachment and biofilm formation was 

significantly different than controls. MF-2: Over 60 d, release. 

Conclusion 

SR-P(L/DL)LA and SR-PLGA MF implants with appropriate drug release, 

structural, mechanical and biocompatibility properties can be produced. 

Clinical studies will be started in near future (MF-1). 

Acknowledgements: 

Research funds from the Technology Development Center in Finland (TEKES, 

Biowaffle Project 40274/03 and MFM Project 424/31/04), the European 

Commission (EU Spare Parts Project QLK6-CT-2000-00487), the Academy of 

Finland (Project 73948) and the Ministry of Education (Graduate School of 

Biomaterials and Tissue Engineering) are greatly appreciated. 

I6. ESPRAS web site 

Echinard C. 

Humani Terra International , Marseille, France

SCIENTIFIC POSTERS

PRAZNO ILI SLIKA

P 1. Management of burn injuries without a burn unit: 

Kocaeli experience 

Agir H., Dinar S., Sen C., Unal C., Cek D. 

Plastic and Reconstructive Surgery Department, Kocaeli Faculty of Medicine, 

Kocaeli University, Kocaeli, Turkey 

Introduction 

Every year more than one hundred burn patients need a standard care of a 

burn unit or center in Kocaeli, central city of a densely populated industrial 

region of Turkey. However, most of these patients are admitted to general 

plastic surgery clinics in the city without a burn unit. University hospital is 

the largest tertiary referral center in the region, which drains more than 50% 

of these cases per year, and it does not have any burn unit service at all. We 

decided to evaluate our results and protocols, besides the particular problems 

we have encountered and the solutions we have found since 1996 in this 

highly demanding field of plastic surgery. 


We included 108 burn injury patients into our study group who were treated 

between May 2002 and May 2004. We scrutinized the medical records and 

studied the cases according to their age, sex, etiology, burn percentage, injury 

region, surgical treatment, complications and outcome. 

Results 

Mean age of the patients was 19.7±19.2 with a male: female ratio of 1.45. In 

53.7% of the cases, a scald was the cause and 18.5% of the patients were 

admitted due to a high-tension electrical burn injury. Head and neck region 

was mostly affected in children below 5 years age. Least affected body area 

was genitalia. Following emergency unit admission, fasciotomy was applied 

in 17 cases. Tracheostomy and escharotomy were done in four and three 

patients respectively. Ten patients were directly admitted to surgical 

intensive care unit. As for the surgery, STSG was undertaken in 77 patients 

whereas local flaps and free flaps were needed in sixteen and eight cases 

respectively. Amputation rate for the high-tension electrical burn injury was 

25%. Mean hospital stay for all of the patients was 37 days while the average 

number of operation per patient was 3.2. In 4% of the patients, severe burn 

contractures were developed despite all preventive measures. More than 50% 

of the pediatric cases with hand burn injury underwent additional surgeries 

for their scar and joint contractures. Most devastating results were obtained 

in electrical burn injury group. Mortality rate was 1.8 %. 

Conclusion 

Most of the plastic surgeons who work in developing countries and treat 

burns in their clinics always need to reevaluate and adjust the burn 

management principles to their own circumstances. In this study, it may be 

concluded that even severe burn injuries can be managed in general plastic 

surgery wards with a relatively low mortality and morbidity rate. However, if 

the complications, hospital stays and the outcomes in functional and cosmetic 

aspects were taken into consideration in comparison to literature, it would be 

hardly suggested that burn units were not very essential in burn injury 

treatment in third world countries.

P 2. Reconstruction of the severely burned face: A case report 

Aljinović-Ratković N., Uglešić V., Krmpotić M.. 

Department of Maxillofacial and Oral Surgery, University Hospital “Dubrava”, 


The reconstruction of the severely burned face often demands multiple 

reconstructive procedures. The authors are presenting a patient with a total 

defect of the soft tissue of the lower face, partial defect of the upper lip and 

nose, contractures of the eyelids and submandibular region and total defect of 

both auricles. The reconstruction was performed in several steps during three 

years. The radial microvascular flap was used for the reconstruction of the 

lower face and lower lip, the forehead flap was used for the reconstruction of 

the tip of the nose and upper lip. Wolf grafts were used for eyelids. Implants 

for auricular epitheses were inserted in the both mastoid region. 

P 3. Treatment and prophylaxis of post-burn cicatrization 

with Contratubex 

Andonovska D., Atanasova E., Marcikik G., Andonovski D., 

Dzorceva M. 

Plastic, Reconstructive and Aesthetic surgery and Burns Center, 

City Surgical Clinic “St.N.Ohridski”, Skopje, Macedonia 

Introduction 

This paper present a single-centre experience with Contractubex® gel 

manufactured by Merz, for the treatment of superficial burns and for 

prophylactics and treatment of hypertrophic scars and keloid. In the period of 

1 year Contractubex ® gel was administered to 100 patients. The 

patients were divided in two groups on the basis of surgical treatment. The 

shortest application period of Contractubex ® gel was 3 months and the 

longest, 6 months. We report very good results in all patients. 


During a period of April 2003 to April 2004, Contractubex ® was 

applied to 100 patients in the Department of Burns and Plastic Surgery at the 

City Surgical Clinic, Skopje, Macedonia. The patients were divided into two 

groups. We used human foetal membranes also known as amniotic 

membrane like biological dressing in 73 cases (73%). 

Surgical escharectomy and skin grafting were performed in only 27 

cases (27%). In first group Contractubex ® gel was applied in a layer of 1 

mm by simple spreading on the skin. In the second group: the preparation 

was applied twice daily with light rubbing massage. Patients were observed 

and results were compared at monthly follow-up examination. 

Results 

In both groups, we observed the following scar variables: size, height, 

softness, elasticity, paraesthesia, itching, skin temperature and type of 

consequence after epithelialization or autotransplantation. After applying, 

patients feel less itching; color and consistency and tension of the scar have 

significant difference than that of scars treated differently. 

Conclusions 

The preparation Contractubex ® gell by Merz is perfect choice for 

epithelialized superficial burns and to deeper burns covered by plastic 

surgery.

P 4. Dilemas about diagnosis and treatment of melanoma in 

our clinical material 

Arifi H., Zatriqi V., Buja Z. Berisha A. 

Department for Plastic Surgery, Clinical Center, Priština, Kosovo 

Opste je poznato u svetu sto se tice diagnostike te lecenja malignog 

melanoma odavno prevazidjeno sto nije slucaj kod nas. Dileme oko 

diagnostike i ako u posljednjih petljeca usavarsana,nova spoznanja na polju 

diagnostike kao:ELM,DELM,UZV ne invazivne metode,te invazivnih 

metoda citoloska punkcija pigmentirane promjene preko identifikaciji i 

biopsiju santinel limfnog cfora novije su dostignuca koje kod nas zbog 

nedostatka tehnickih uvjeta kao i nedovoljnog profesinalizma pogorsavaju 

prognozu malignog melanoma.Pogorsanje prognozi doprinosi i nemogucnost 

aplikaciji jedinstvenog protokola lecenja malignog melanoma. 

Cilj rada: nam je da preko nekoliko klinickih slucajeva da prikazeme koje 

su najcesce dileme oko diagnostike i lecenja MM na nasem klinickom 

materjalu. 

Pitanje koje nama kirurzima muci jeste najvise na polju lecenja, sto se tice 

kirurskog tipa lecenja ona uklapa u savremene principe dok preostalji dio 

koje pripada polji onkologiji ono je kompljetno otpustena na volju samog 

pacienta i obitelja pacienata zbog nedostatka onkoloskog instituta oni su 

obavezni da ostalji dio lecenja obavljati van zemlje. 

P 5. A multicenter study on resorbable craniomaxillofacial 

osteofixation 

Ashammakhi N. 1,7 , Dominique R. 2 , Arnaud E 2 ., Marchac D. 2 , 

Ninković M. 3 , Donoway D. 4 , Jones B. 4 , Serlo W. 5 , Laurikainen K. 6 , 

Pertti Törmälä 1 , Timo Waris 7 

1 

Tampere University of Technology, Institute of Biomaterials, Tampere, Finland. 

2 

Hopital Necker-Enfants Malades, Craniofacial Unit, Paris, France 

3 

University of Innsbruck, Department of Plastic and Reconstructive Surgery, 

Innsbruck, Austria 

4 

Great Ormond Street Hospital for Sick Children, Craniofacial Unit, London, UK. 

5 

Oulu University Hospital, Department of Pediatrics, Oulu, Finland 

6 

Linvatec Ltd., Tampere, Finland 

7 

Oulu University Hospital, Department of Surgery, Oulu, Finland 

Bioabsorbable osteofixation devices were developed to avoid problems 

associated with metals. Bioabsorbable devices are mostly made of the 

polymers polylactide (PLA), polyglycolide (PGA) and their copolymers 

(PLGA and P(L/DL)LA). Using the technique of self-reinforcement of 

bioabsorbable materials, it is possible to manufacture osteofixation devices 

with ultra high strength. Self-reinforced (SR) polyglycolide-co-polylactide 

(SR-PLGA) 80/20 was selected to make devices (Biosorb TM PDX) for this 

study because of its favorable degradation characteristics. The aim of this 

study was to evaluate the efficacy of using SR-PLGA (Biosorb TM ) plates and 

screws in the fixation of osteotomies in craniomaxillofacial (CMF) surgery. 

In a prospective study, 165 patients (161 children and 4 adults) were operated 

on in four EU centers (Paris, Innsbruck, London and Oulu) from May 1 st , 

1998 to January 31 st , 2002. Indications included correction of dyssynostotic

deformities (n=159), reconstruction of bone defects following trauma (n=2), 

tumor removal (n=2), and treatment of encephalocoele (n=2). Plates used 

were 0.8, 1 or 1.2 mm thick and screws had an outer (thread) diameter of 1.5 

or 2 mm and a length of 4, 6 or 8 mm. Tacks had an outer diameter of 1.5 or 

2 mm and a length of 4 or 6 mm. Intraoperatively the devices were easy to 

handle and apply and provided stable fixation apart from two cases. 

Postoperative complications occurred in 12 cases (7.3%), comprising 

infection (n=6), bone resorption (n=4), diabetes insipidus (n=1), delayed skin 

wound healing/skin slough (n=2), and liquorrhea (n=1). Accordingly, SR- 

PLGA 80/20 (Biosorb) plates and screws can be used safely and with 

favorable outcome in corrective cranioplasties, especially in infants and 

young children. 

Keywords 

Bioabsorbable, biosorb, bone, fixation, polylactide, polyglycolide, selfreinforced 

Acknowledgements 

Research funds from The Technology Development Center in Finland 

(TEKES, 90220, Biowaffle Project 40274/03 and MFM Project 424/31/04), 

The European Commission (Biomedicine and Health Programme, 

European Union Demonstration Project BMH4-98-3892, R&D Project 

QLRT-2000-00487, EU Spare Parts Project QLK6-CT-2000-00487) and The 

Academy of Finland (Projects 37726 and 73948) and the Ministry of 

Education (Graduate School of Biomaterials and Tissue Engineering) are 

greatly appreciated. 

P 6. Uloga radiologa u rekonstrukcijskoj kirurgiji dojke 

Brnić Z., Zagreb, Croatia 

P 7. New method of relocation of NAC in male 

Budi S. 

Department for Plastic, Reconstructive and Aesthetic Surgery, 

University Hospital «Dubrava», Zagreb, Croatia 

Introduction 

The cause for bilateral loss is seldom congenital, and usually destruction 

from trauma, particularly burn injury. Quite a similar problem is the creation 

of the NAC in female-to-male transsexuals and after correction of extreme 

bilateral gynaecomastia. As there are only few reports on anatomical 

approaches to contour a male chest such as the precise localisation of NAC, 

a prospective study on this question was carried out. 

Material and method 

A total of 100 healthy men aged 20-36 years were examined. The study was 

concentrated on the precise localisation of the NAC on the thoracic cage in 

relation to various measurements such as weight, height of the body, 

circumference of the thorax, length of sternum, position in the intercostal 

space and all the various distances such as the distance between sternal notch 

and nipples and, between midline of sternum and nipples. 

Results 

Circumference of the thorax and length of the sternum were estimated as the 

best predictors of the NAC location. To localize the NAC on the thoracic

wall de novo, at least two reproducible measurements proved to be 

necessary, composed of two lines, in this study, two radius. The upper radius 

has a stating point in sternal notch, while stating point of another radius is in 

processus xiphoideus. Intersection point of these two radius is the position of 

the nipple. Formulas have been calculated for all variables. For the maximal 

precision tables have been calculated, and the work sheet in Microsoft Excel 

has also been created. A precision of this method has been proved on a 

control group (n = 52). 

Conclusion 

The appropriate localization of the NAC in male, in cases of bilateral 

absence, can be calculated by means of this method derived from the 

circumference of the thorax and the length of the sternum of the patient. 

P 8. Foreign body in the maxillar sinus-Case report 

Gjorgievska J., Dzokic G., Tudzarova-Gorgova S., 

Zogovska-Mircevska E. 

Department of Plastic and Reconstructive 

Clinical Center Skopje, Med. Faculty “St.Cyril and Methodius”, 

Skopje, Macedonia 

Introduction 

Foreign bodies are very rare in the maxillary sinus. There is no mention of 

them in the standard textbooks. An interesting case of piece of branch of a 

tree left in the maxillary sinus it’s reported for a rarity. 

Case report 

A 61 year old man presented with chronic fistula and secretion in the left 

infraorbital region. Three months ago he had minor accident by falling down 

on his face, he felt pain while the foreign body entered in the left infraorbita 

region. The patient himself took out some peaces of wood. He went twice to 

an Ophtalmologist , but after 20 days from the fall the wound closed and 

healed from the outside. Now the patient complains about secretion in the 

left infraorbital region on the place where he had the wound. He is accepted 

at our department and operated, we had extracted the foreign body, which 

was wood long about 8cm with diameter about 1cm. Post operatively the 

patient had no complications such as infection and secretion from the nose. 

Discussion 

The infraorbital region and upper part of maxillary sinus are relatively easily 

penetrated by foreign bodies and objects. However, their incidence is 

increasing with a rise in the incidence of vehicular accidents and gang wars. 

The above case demonstrates the potential danger of foreign bodies injuries 

in the midfacial region with possible serious complications. 

P 9. Carpal tunnel syndrome: One day surgery at our hospital 

Huis M., Šoštar K. 

Department of Surgery, General Hospital Zabok, Zabok, Croatia 

Introduction 

Carpal Tunnel Syndrome is a condition caused by compression of the median 

nerve at the wrist, which can lead to pain and weakness in the hand. The

median nerve supplies sensations to the thumb and first two fingers, and also 

to some of the muscles of the hand. 

Surgical Anatomy 

The carpal tunnel is composed of two walls–the deep wall is the bones of the 

wrist and the superficial wall is a thick ligament located just under the skin of 

palm side of the wrist. The tendons which flex the fingers and the median 

nerve pass through this tunnel. 

Patient and Methods 

A 52 years-old-female came to our hospital with clinical and EMNG signs of 

the Carpal Tunnel Syndrome; Hoffman–Tinel was positive. According to 

examination she suffered from problems two years ago. After standard 

preoperative tests, she underwent Open Carpal Tunnel Release Surgery in 

Local Anaesthesia and Bloodless Operative Field provided by the tourniquet 

placed over the upper arm. An Incision, about 4 centimetres was made in the 

palm, extending from the skin crease to the wrist. The ligament was exposed 

and then carefully discised along its length, making the median nerve entirely 

visible in the tunnel. The nerve was carefully inspected to be sure it is free 

along its length in the tunnel and not compressed. After the minuciuos 

hemostasis the wound was closed. Procedure was performed in 10 minutes. 

The patient was released from hospital 2 hours after the procedure. 

Results 

Control postoperative examination was next morning. Sutures were removed 

10 days after the surgery. 3 weeks later the patient underwent, 1 month, 

Supervised Hand Physical Therapy Program. 3 months after the surgery 

control EMNG showed good results; Hoffman – Tinel was negative. Pain, 

tingling and night time symptoms disappeared. 

Conclusions 

We believe, according to our results and One–Day–Surgery Program, that the 

Open Carpal Tunnel Release Surgery in Local Anaesthesia and Bloodless 

Field provides good treatment for our patients with Carpal Tunnel Syndrome. 

P 10. Analysis of data of reduction mammaplasty in our region 

Janjić Z., Momčilović D., Jovanović M., Erić M., Nikolić J. 

Clinic for Plastic and Reconstructive Surgery, University Hospital, 

Novi Sad, Serbia and Montenegro 

Introduction 

The goal of this study is to achive clear indications for reduction 

mammaplasty on regional level. Motivation for this retrospective study is 

the fact that in our country, as well as in most others, there is not clear 

separation between “cosmetic” and “medical” mammaplasty. 


In this study we have statisticaly analised clinical and outpatient data of 

patients who had bilateral reduction mammaplasty on The Clinic for 

Plastic and Reconstructive Surgery, Clinical Centre-Novi Sad, Vojvodina, 

Serbia and Montenegro. Analisys od objective criteria included: body 

weight, hight, body mass index (BMI), weight of ressection tissue of 

braests and body weight after the operation. After that, we created the 

questionnaire, which was sent by post to the operated patients. The

questions were relating to physical and psychological discomfort before 

and after the breast reduction operation. 

Results 

Analysis of data included only 19 operated patients from which we 

received correctly filled questionnaires. We got following regional data: 1. 

Average age of our patients was 27 years (16 to 50 years old). All 

examined patients had physical difficulties because of breast hypertrophy, 

and most of them had neck and back pain (17 patients – 98,47%). 

Psychological discomfort (incapability for exercises, avoiding of 

appearance in public) had 15 patients (78,94%). Average value of BMI in 

our patients was 29,2 (from 26,4 to 33,2). Thirteen patients (68,42%) were 

overweight and 6 patients were obese. Analysis of body weight after 

operation showed reduction of weight in 15 patients (78,94%). All the 

patients emphasize that they were in better condition after the operation, 

especially related to physical troubles. Only one patient (5,26%) was 

dissatisfied with her appearance. 

Conclusions 

In conclusion we would like to emphasize that BMI is not decisive factor 

to set indication for “medical” breast reduction, because all our patients, 

even they with overweight or obesity, improved their haelth condition after 

operation. 

P 11. Melanoma malignum of the trunk 

Janjić Z., Jovanović M., Pisarev-Šoć M., Nalić B., Popović A. 



Introduction 

Authors have shown the results of five years retrospective study for 

patients with melanoma localized of the trunk. It is well known that 

localizations of tumor on the body influence the surviving rate and that is 

important prognostic factor. We wanted to show all aspects and differences 

comparing trunk localization melanoma with other body localizations. 

Materials and Methods 

Materials for this study include patients treated in the hospital and as 

outpatients at the Clinic for Plastic and Reconstructive Surgery, Clinical 

Center Novi Sad, Vovjodina, Serbia and Montenegro. Material was shown 

tabulary and graphically and was later statistically analyzed. Obtained data 

were compared with other localizations for same period of time and also 

with previous data (same authors), comparing five and ten years morbidity 

and mortality. 

Results 

Results shows that in the last five years there were 245 operated patients 

with primary melanoma of the skin and complications (metastasis and local 

recurrence). The greatest number of operated patients had localization on 

the trunk (80 patients-32,65%). In total there are moderate female 

domination (130-53,06% female: 115-46,93% male), while considering 

only trunk localization there are opposite situation (48-60% male: 32-40% 

female). Distribution of the patients among age groups shows that the most 

often involved are population in the sixth and seventh decade of life.

Considering only trunk localization the incidence of this disease in this age 

group is even higher (60% trunk: 49% others). The trunk localization had 

more superficial spreading melanoma (45 patients-56,25%), while other 

localizations had almost equal number of nodular and superficial type of 

melanoma (54 patients- 32,72%). From entire number of 11 patients 

(4,48%) who were reported with primary tumor and metastasis, 9 (11,25%) 

of them had melanoma of the trunk. Only two patients with local 

recurrence that we had in our study had it’s localization on the trunk. 

Tumor exulceration, as well as greater deepness of skin invasion is also 

characterization of this region of body. 

Conclusions 

For all this reasons, comparing to other localizations, it is obvious why 

melanoma of the trunk gives earlier and numerous complications witch 

influence the mortality. 

P 12. Adrenaline solution in flap surgery 

Jovanović M., Janjić Z., Jeremić P. 



Introduction 

Many doubts are expressed in medical literature and in clinical practicas to 

the usage of adrenaline on the tissue with intact or damaged circulation. In 

this experimental study we tried to clarify some of the dilemmas relating to 

the indications and optimal dosage and concentration of adrenaline in 

plastic surgery with minimal risk for possible local complications. On our 

experimental model we tried to evaluate local influence of adrenaline 

solution on flap circulation after subcutaneous injections, according to the 

tested concentrations and time intervals of administration. 


Research was carried out on 50 rabbits. We used local retrograde flap on 

rabbit ear as experimental model for examination of local influence of 

adrenaline on traumatized tissue. We elaborated the blood stream in flaps 

(arteriography, fluorescine, metilen blue), measured the surface of distal 

flap necrosis by computer programme and eventually we evaluated the 

results of pathohistologic samples of tissue. 

Results 

Local activity of adrenaline solution on intact and traumatized tissue was 

almost the same in both examined concentrations. Infiltration of only one 

dose of adrenaline solution did not provoke the progrediation of necrosis in 

both concentrations. We got the significant increase of average percentage 

of flap necrosis by increasing the time interval between administration of 

two doses of adrenaline solution. 

Conclusions 

Four times higher concentration of adrenaline solution shows almost the 

same effects on intact and traumatized tissue (1:50.000 – 1:200.000). 

Single usage of adrenaline solution in examined concentrations is harmless 

on flap vitality. Statistically, injection of repeated doses of adrenaline 

solution in time interval of 35 minutes, will significantly increase the 

average percentage of flap necrosis (13%). Namely, it will cause 

irreversible damage of flap tissue.

P 13. Our experience in wound closure with V.A.C. 

Jurišić D., Pirjavec A. 

Plastic Surgery Unit, Clinical Hospital Center, Rijeka, Croatia 

V.A.C. therapy is new non invasive meted, which acts on the principle of 

localized and controlled negative pressure, either continuous or intermittent 

that acts over the inert medication made of medical polyuretan. This 

material is porous, sterile, can be adapted to the wound size and does not 

contain any medicaments. 

Patient preparation 

- necrectomy, 

- shaving of the surrounding skin (if possible), 

- flush the wound with the saline solution, 

- dry up the skin around the wound, 

- choose appropriate length of the medication, 

- take care that the tubus is not placed to close to the wound. 

Changing the medication 

- every 48 hours ( if not indicated differently, 

- every 12 hours if the wound is infected (CFU >150). 

Changing the container with the exudat 

- when fluid level reaches 250cc, 

- once a weak no matter of fluid level. 

Indications 

- ulcus cruris, 

- decubital wounds, 

- preparation for surgical procedures (transplantation), 

- deep combustions, 

- infected surgical wounds. 

Contraindications 

- fistulae, 

- osteomielytis 

- malignant wounds. 

Results 

- the pictures of pre and post therapy status will be shown 

P 14. Comparison of transthecal to traditional block for anesthesia 

of the finger 

Keramidas E., Rodopuolou S., Tsoutsos D. Miller G., Ioannovich I., 

Plastic Surgery, Northern General Teaching Hospital, Sheffield, UK 

Introduction 

Chiu in 1990 was the first to desccribe the transthecal (TT) digital block, 

using the flexor tendon sheath for anesthetic infusion. Our purpose was to 

compare the TT digital block with the traditional block (TD) with regards, 

the onset of time to achieve anesthesia and pain during the infiltration 


A randomized double blind study was performed in 50 patients to compare 

the transthecal (TT) to traditional subcutaneous infiltration (TD) 

techniques of digital block anesthesia. All the patients had sustained injury 

involving two or four fingers of the hand. Each patient served as his/her

own control, having one finger infiltrated with the TT technique and the 

other with the TD technique. Time to loss of pinprick sensation and pain 

(at the time of the infiltration and 24 hours postoperatively) was assessed 

using a visual analogue scale and verbal response score. A total of 104 

blocks (52TT and 52TD) were performed. 

Results 

All these blocks were successful. Mean time to achieve anesthesia with TT 

block was 165 seconds compare with 100 seconds for the TD block. Mean 

analogue pain score was higher for TT blocks than for TD blocks (3.2+/- 

0.19 versus 1.6+/- 0.14). Twenty four hours post operatively 24 patients 

who had the TT block experienced pain at the injection site of the digit. 

However, none of the patients who were delivered TD block complained 

for pain at the digit. The patient’s preferred technique of anesthesia for 

their finger was the TD block as it causes less pain. 

Conclusions 

Our results confirm the efficacy of the TT block to achieve anesthesia of 

the finger however because it is more painful procedure it is not 

recommended. 

P 15. Milestones in the formation of fibrous tissue joint construct 

Länsman S 1 , Pääkkö P 2 , Kellomäki M 3 , Törmälä P 3 , 

Ashammakhi N 3,4 

1 

Oulu University Hospital, Department of Ophthalmology, Oulu, Finland. 

2 

University of Oulu and Oulu University Hospital, Department of Pathology, 

Oulu, Finland 

3 

Tampere University of Technology, Institute of Biomaterials, Tampere, Finland 

4 


Background 

Bioabsorbable synthetic materials can be used to induce fibrous tissue 

formation and be used to develop small joints. 

Aims 

To study the poly-L/D-lactide (PLDLA) 96/4 (96/4, molar ratio of L/D 

lactide) scaffolds in vivo in the subcutaneous tissue of rats. 


Cylindrical knitted mesh scaffolds were made of PLDLA 96/4 fibers, with 

each fiber made of 8 PLDLA filaments (15 x 3.5 mm). Three types were 

evaluated: Dense (weight 30 g), ordinary (25 g) and loose (20 g). Four 

scaffolds were implanted in the dorsal subcutis of each of the used 32 rats. 

The implants were retrieved after 3 days, 1, 2, 3, 6, 12, 24 and 52 weeks 

postoperatively, examined for tissue reaction and fibrous tissue ingrowth. 

Results 

Tissue ingrowth reached the innermost part of the implants within 3 wks. 

Fibrin was the first to fill in the scaffold followed by the cells and at last 

collagen fibers were found in the structure. The orientation of the collagen 

fibers inside the implant changed from non-oriented to highly oriented 

fibers forming septae. Macrophages increased in number over time. The 

material was not fragmented at 52 wks. 

Conclusions 

Upon implantation in rats, fibrous tissue ingrowth proceeds from all sides 

of the scaffold filling it completely by 3 wks. Collagen fibers get more 

organized by time. Single PLA fibers were not fragmented by 52 wks. 

Acknowledgements

Research funds from the Technology Development Center in Finland 

(TEKES, Biowaffle Project 40274/03 and MFM Project 424/31/04), the 

European Commission (EU Spare Parts Project QLK6-CT-2000-00487), 

the Academy of Finland (Project 73948) and the Ministry of Education 

(Graduate School of Biomaterials and Tissue Engineering) are greatly 

appreciated. 

P 16. Evaluation of Plastic Surgery patients in Zagreb 

Leppee M. 

Zavod za javno zdravstvo grada Zagreba, Zagreb, Croatia 

P 17. Vertical mammoplasty-mastopexy for ptotic breasts-our 

experiance 

Marcikik G., Andonovska D., Stevkovska M., Gorceva M., 

Atanasova E. 

Department of Plastic and Reconstructive 

Clinical Center Skopje, Med. Faculty “St.Cyril and Methodius”, 

Skopje, Macedonia 

Introduction 

There are a lot of surgical techniques that describe correction of the ptotic 

breasts. Vertical mammoplasty gives a good approach and good aesthetic 

results, without horizontal scars, good neurovascular supply to the nipple 

areola complex and a good shape of the breast. 


We have had 4 women in this last year on the age of 26-55 years. Four 

vertical mastopexy according to Lajoure technique were performed. 

Preoperative we did the markings on the skin on the breasts, then during 

the operation we did the deepithelisation and mastopexy with the suture to 

the thoracic wall and then with a few sutures we made the shape of the 

breasts. We use drainage for 5 days. 

Results 

We have had satisfactory results for both patients and the operating team. 

We took out the stitches (5-0, 3-0 Nylon, Prolen) 10-15 postoperative day. 

We had one seroma, that healed spontaneously. The shape of the breasts is 

projection and with time the scars are minimal visible. 

Conclusion 

Vertical mammoplasty is a good solution for ptotic breasts with good 

sensibility of the nipple areola complex, minimal scars (without horizontal 

scars), good shape and projection of the breasts. Vertical mammoplasty is a 

technique that could always be our choice. 

P 18. Reconstruction of the areola-nipple complex 

Margaritoni M., Bukvić N., Kostopeč P., Selmani R. 

Department of Surgery, Division of Plastic and Breast Surgery, 

County Hospital Dubrovnik Dubrovnik, Croatia

Reconstruction of the areola-nipple complex is important part of breast 

reconstructive surgery with notable influence on final cosmetic result. A 

few different techniques are usually performed trying to improve better 

shape, volume and pigmentation of areola-nipple complex.The authors 

represent their own experience in areola-nipple reconstruction. 

P 19. Operative treatment of the fractures and pseudoarthrosis 

of scaphoid – 8 th year follow up 

Matec B., Šurjak Ž., Vlahović T., Malović M., Rabić D. 

Clinic for Traumatology, Zagreb, Croatia 

P 20. Children with cleft lip and palate: inhalation anaesthesia 

vs. general balanced 

Milić M., Gašparović S., Butorac Rakvin L., Knežević P., 

Uglešić V. 

Department for Anaestesiology and Intensive Care, 

Department for Maxillofacial and Oral Surgery, 

University Hospital Dubrava, Zagreb, Croatia 

Background and objective 

The children with cleft lip and palate need special attention from 

anesthesiologist. Due to position of malformation, difficult ventilation and 

intubation are very often. Postoperative complications have higher 

incidence than in other patients. The aim was to compare inhalation 

anesthesia (sevoflurane) with balanced general anesthesia (midazolam, 

fentanyl,vecuronium). 

Materials and methods 

In prospective study we analyzed heart rate, ECG II lead, haemoglobine 

and haematocrite before, intra and postoperativly in 117 children. They 

were divided in two groups: I group in 63 children anesthesia were induced 

with sevoflurane (5-8%) and maintaned with fenatnyl (0,005mg/kg), 

vecuronium (0,1mg/kg), and midazolam (0,05mg/kg) and in II group 54 

children get sevoflurane/oxygen/air mixture supplemented with fentanyl 

(0,005mg/kg). 

Results and discussion 

One hundred and seventeen children were between 5 days and 3 years of 

age (mean age 11,4 months). Our patients’ mean body weight were 12,2 

kg.The children with body weight more than 5 kg were premedicated with 

midazolam and atropin intramuscular and induction in both group were 

with sevoflurane. There were no differences between values of heart rate, 

haemoglobine and haematocrit in both groups. Six children had difficult 

intubation.The estimated intraoperative blood loss exceeded 10-20% 

estimated circulating blood volume in 5 children(I group 3, II group 

2).Seventeen children which get sevoflurane for maintaining anaesthesia 

developed postanaesthesia excitation. So we concluded that balanced 

general anesthesia would be our choice.

P 21. The usage of Ilizarov's methode in congenital anomalies 

of lower extremity 

Nikolayeva N. 

Odessa State Medical University, Odessa, Ukraine 

Purpose 

To define opportunities of Ilizarov’s method in the treatment of congenital 

anomalies of lower extremity. 


48 children with congenital anomalies of lower extremity were 

investigated. In 12 cases occurred congenital hypoplastic femur (in 3 cases 

accompanied with congenital coxa vara and congenital dislocation of 

patella), in 6 cases – congenital tibial shortening, 14 – congenital 

pseudoarthrosis of tibia and fibular, 5 – fibular hemimelia, 3 – tibial 

hemimelia, 7 – congenital typical clubfoot (relapses after traditional 

surgery or postponed diagnostics), 1 – congenital atypical clubfoot. 

Clinical, X-ray, ultrasound, laboratorial methods of investigation were 

used. 

Surgical treatment included liquidation of malformations in Ilizarov’s 

frame by closed ostheosynthesis (polylocal longitudinal and transversal) in 

combination with open interventions and following distraction. 

Results 

Good results achieved in all cases. The results of usage of Ilizarov’s 

method showed advantages of such approach – possibility of simultaneous 

multiplan operations: 

- in congenital hypoplastic femur – closed compactotomy & following 

distraction (m.b. corrigative osteotomy & transposition of patella); 

- in congenital pseudoarthrosis – resection of pathological tissues & 

Ilizarov’s frame & closed compactotomy & following distraction; 

- in fibular hemimelia – removal of fibrous fibular rudiment & 

tendoligamentocapsulotomy & reduction of dislocation in ankle joint & 

closed tibial compactotomy & following distraction; 

- in tibial hemimelia – fibular transposition & reduction of dislocation in 

ankle joint & closed fibular compactotomy & following distraction. 

- in clubfoot-closed ligamentocapsulotomy & compactotomy & following 

distraction. 

Conclusion 

The usage of Ilizarov’s method is the best decision in the treatment of such 

congenita anomalies of extremities as congenital femoral and tibial 

shortening, hemimelia, pseudoarthrosis, problematic clubfoot. Ilizarov’s 

method allows to decide plural reconstruclive problems effectively and 

simultaneously. 

P 22. Evaluation of PLDLA scaffolds & mesenchymal stem cells 

for bone engineering 

Oudina K 1 , Potier E 1 , Arnaud E 2 , Ellä V 3 , 

Kellomäki M 3 , Ashammakhi N 3,4 , Petite H 1 

1 Université D. Diderot, Faculté de Médecine Lariboisière Saint-Louis, Laboratoire 

de Recherches Orthopédiques UMR CNRS 7052, Paris, France 

2 Hopital Necker-Enfants Malades, France Craniofacial Unit, Paris, France 

3 Tampere University of Technology, Institute of Biomaterials, Tampere, Finland 

4 Oulu University Hospital, Department of Surgery, Oulu, Finland

Introduction 

The aim of this study is to assess the influence of fluid flow on MSC 

loaded onto 12 filaments PLDLA scaffolds and to determine the kinetics of 

proliferation and differentiation of MSCs when cultured on 4 and 12 

filaments PLDLA scaffolds for 40 days in a bioreactor. 

Methods 

MSCs were isolated from rat bone marrow and expanded in alpha-MEM + 

10 % FBS supplemented with dexamethasone, Ascorbate2-phosphate and 

β-glycerophosphate. Knitted 12 or 4 filament Poly-L,D-lactide (PLDLA, 

L/D ratio 96/4) scaffolds were used. At passage P3-P5, 12 fil. scaffolds 

were soaked for 1 h in a MSC cell suspension at 10 6 cells/ml and then 

placed in 50 ml cell culture tube. Constructs were then cultured either on a 

stoval low profile roller at 6 rpm or left still. At day 28, DNA content, ALP 

activity and calcium content were determined. 4 and 12 PLDLA filament 

constructs were prepared as aforementioned and DNA content, ALP 

activity and calcium content were determined every 3 days from day 0 to 

day 40 (n=3). 

Results 

DNA content (87000 ± 23000 versus 56000±13000cells per scaffold), ALP 

activity (64 ± 20 versus 2±1 UI), and calcium content per scaffold (289 ± 

34 versus 21 ± 6 ng /construct), were significantly higher in dynamic 

culture when compared to static cultures. No significant differences in 

DNA content, ALP activity or calcium content between the different 

scaffolds with different fiber thicknesses. 

Discussion and Conclusions 

MSCs proliferation and differentiation was significantly enhanced when 

fluid flow was applied. A 10 fold increase in calcium content per scaffold 

was observed when MSCs were cultured in the presence of fluid flow. 

PLDLA scaffolds were able to support MSC osteogenic differentiation. 


This research was supported by grants from the EU [PROJECT N° QLRT- 

2000-00487 (chondral and osseous tissue engineering “Spare parts”), Spare 

Parts Project QLK6-CT-2000-00487], the Technology Development 

Center in Finland (TEKES, Biowaffle Project 40274/03 and MFM Project 

424/31/04), the Academy of Finland (Project 73948) and the Ministry of 

Education (Graduate School of Biomaterials and Tissue Engineering). The 

authors wish to thank Dr Benoit from the service de pharmacie, 

Lariboisière for her help in this study. 

P 23. TRAM and latissimus flap in palliative breast surgery 

Pašić A., Rifatbegović A., Mujkanović N., Burgić M. 

Plastic and Reconstructive susrgery, UKC “Tuzla”, 

Tuzla, Bosnia and Herzegovina 

We can’t say with a sure is increase number of malignanat disease in 

realy increase or is it result of better diagnostic procedures. Theoreticly, on 

appearance and number of carcinomas because of early diagnosis we can 

affect by : preventive measures, mass screening procedures, treatment and 

new researches. New diagnostic procedures contribute to considerable 

number of breast cancer diagnosis in women. It’s evident that number is 

higher from day to day, and frequency has moved to younger ages. Breast

cancer is frequently malignant tumor in women. Appearance of breast 

cancer is unusual before 20.th years of age, but it’s more frequently 

between 50.th and 70.th years of age. Risk for appearance of breast canacer 

is 1 : 8, and it mean that one of eight women will become ill during a life. 

Risk to get a cancer is higher with ages. Although , appearance of breast 

cancer is possible in any life ages, but this disease is unusual in women 

before 35 years of age. Approximative, 75% discovery cases of new breast 

cancers are in women older than 50 years of age. In this work is analised 

30 progressive egzulcerative breast cancer and 25 progressive local relaps. 

At progressive breast cancers pathohistological and immunohistological 

analysis are done and corresponding therapy. After that patients had been 

operated and defects had been provide with TRAM and latissimus flap. 

P 24. Surgical treatment of tumor recurrences localized at 

medial angle of eye 

Rifatbegović A., Mujkanović N., Pašić A., Burgić M. 



Morfology medial angle of eyes specifical, and tumors of this region can 

very often, and very fast infiltreted “ deeper structures “. Relativly often 

tumors has atendency for intraneural and perineural metastasis. That are 

the reasons for serious preoperative treatment ( CT scan of orbits and 

paranasal sinuses ). Operative traetment require redical excision and 

patohistological verification of resectional borders. 

After first excision recidiv is in 5,36% after second excision 17 %, and 

after tird and fourth excision 50 %. In this article we would like to present 

and analized cases with recidivans tumors, causes, mistakes and definitive 

results. 

P 25. Anterior transfer of tibialis posterior tendon in treatment 

of peroneal palsies 

Salihagić S., Fazlić A. 

Clinic for Plastic and Reconstructive Surgery, 


Introduction 

Tendon transfer is the shifting of the insertion of a muscle 

from its normal attachement to another side to replace active muscular 

action that was lost by paralysis and to restore dynamic muscle 

balance.Peroneal palsies can be treated with anterior transfer of tibialis 

posterior tendon with correction of drof foot.This type of transfer can be 

used for correction of pes equinovarus and varus deformity combined with 

spastic cerebral palsy. 


During period 1992 - 2001 67 patient have been treated 

with anterior transfer of tibialis posterior tendon, with ireparabile 

leasions of peroneal nerve. 

Results

With this type of operation, we established lost dorsiflexion of 

foot. Optimal timing for operation is 1,5 - 2 years after injury of peroneal 

nerve. 

Conclusion 

This operation is method of choise in treatment of peroneal 

palsies. 

P 26. Novel method for correction of trigonocephaly in children 

Serlo W. 1 , Törmälä P. 2 , Waris T. 3 , Ashammakhi N. 2,3 

1 Oulu University Hospital, Department of Pediatrics, Oulu, Finland. 



We report on the feasibility of applying bioabsorbable tacks using a new 

tack-shooter to fix bioabsorbable plates applied endocranially for the 

correction of three cases of trigonocephaly. Tacks do not require tapping or 

tightening because they are applied using a tack-shooter directly into drill 

holes in the bone. Hence, the technique saves valuable operative time. A 1.5- 

to 2.0-cm broad supraorbital bar (bandeau) was raised and reshaped. The 

corrected shape was maintained using a Biosorb plate (Bionx Implants Ltd, 

Tampere, Finland), and tacks were applied on the endocranial side of the bar. 

The plate extended a few centimeters laterally beyond the edge of the 

supraorbital bar, and it was fixed with Biosorb miniscrews and/or tacks 

affixed to the temporal bones. Other molded bone pieces were fixed using 

Biosorb plates, screws, and/or tacks. The technique of using tacks was easy, 

and it provided secure osteofixation. Cosmetic results were excellent, and no 

complications were encountered except for palpability of plate edges on the 

right side of the skull in one case. 




European Commission (EU Spare Parts Project QLK6-CT-2000-00487), the 

Academy of Finland (Project 73948) and the Ministry of Education 


appreciated. 

P 27. Adductor tenotomies in children with cerebral palsy 

Talić A., Gavrankapetanović I., Mahić Z., Biščević M. 

Department for orthopedic and traumatology, 

Clinical center Sarajevo, 


Aim of work is to point on adductor tenetomy importance in operative 

treatment of children with cerebral palsy. 

Indications for adductor tenotomy at children with cerebral palsy are 

established on consiliar meeting for neuromuscular disseases on our 

Department. Children with cerebral palsy whose hip abduction is less than 

20 degrees are candidates for this operation which will allow and better 

hygiena of patient. Adductor tenotomy is a first phase of treatment protocol 

in descendent program of treatment. After billateral adductor tenotomy,

abdominofemoral plastercast is to aplicate for four weeks and later 

admition on Department to start with physioterapy. 

Results 

With this operative procedure, we achieve verticalisation of child, solve 

contracture of hips and improove a walk at children who have had walking 

disturbances. 

P 28. Follow-up of resorption of PLGA 80/20 screws for 1,5 year 

in rabbits 

Tiainen J 1 , Soini Y 2 , Törmälä P 3 , Waris T 1 , Ashammakhi N 1,3 


2 

Oulu University Hospital, Department of Pathology, Oulu, Finland 

3 


The aim of this study was to assess tissue reactions to bioabsorbable selfreinforced 

polylactide/polyglycolide (SR-PLGA) 80/20 miniscrews in 

rabbit cranial bone. One PLGA screw was implanted on one side and one 

titanium screw on the other side of the sagittal suture (n=21). Three 

animals were sacrificed after 2, 4, 8, 16, 24, 54 and 72 weeks. In 

histological examination the numbers of macrophages, giant cells, active 

osteoblasts and fibrous tissue layers were assessed and degradation of the 

bioabsorbable screws was evaluated. After two weeks, macrophages were 

seen near the heads of both screws. After 4 and 8 weeks, the bioabsorbable 

screws were surrounded by fibrous tissue. Osteoblastic activity and groups 

of several giant cells were seen. After 24 weeks, a significant change in the 

morphology of the PLGA screws had occurred. Osteoblastic activity and 

the amount of giant cells had decreased. After one year, some PLGA 

biomaterial was still present. PLGA screws had been replaced by adipose 

tissue, fibrous tissue and “foamy macrophages” which had PLGA particles 

inside them. After 1½ years, the amount of biomaterial remaining had 

decreased remarkably. The particles of biomaterial were inside “foamy 

macrophages”. SR-PLGA 80/20 screws are biocompatible and have no 

clinically manifested complications when used in cranial bone of rabbits. 

No contraindications as regards their clinical use in craniofacial surgery 

was found when studied in cranial bone of rabbit. 

Keywords 

Cranial bone, rabbit, SR-PLGA, tissue reaction, titanium 




European Commission (Project BMH4-98-3892, Project QLRT-2000- 

00487, EU Spare Parts Project QLK6-CT-2000-00487), the Academy of 

Finland (Projects 37726 and 73948), and the Ministry of Education 


appreciated.

P 29. Assessment of guided cranial bone defect regeneration 

Vesala A-L 1 , Kallioinen M 2 , Törmälä P 3 , Kellomäki M 3 , 



2 Oulu University Hospital, Department of Pathology, Oulu, Finland 


The aim was to evaluate the use of self-reinforced poly-L,D-lactide 96/4 (SR- 

PLA96) sheets for cranial bone tissue engineering in experimental defects in 

rabbits. Square defects of 10 x 10 mm were created in the right parietal bone. SR- 

PLA96 implants (15x15 mm) were used to cover these defects in 12 New 

Zealand White rabbits. Similar defects were created in the left parietal bone, but 

no sheets were used (controls). The rabbits were killed after 6, 24, or 48 weeks. 

Histology and histomorphometry were used to evaluate healing of the defects. 

Defects covered with SR-PLA96 sheets showed more abundant bone formation 

than control (non-covered) defects. At 6 weeks, the defects were occupied mainly 

by fibrous tissue. At 24 weeks, healing with bone formation was more obvious in 

the covered defects. At 48 weeks, bone completely bridged defects covered with 

SR-PLA96 sheets, and incomplete bridging was seen in non-covered control 

defects. Hence, bone tissue engineering in experimental cranial bone defects in 

rabbits can be achieved using SR-PLA96 sheets to guide bone regeneration. 

Key words: Bioabsorbable, guided bone regeneration, polylactide, tissue 

engineering 


Research funds from the Technology Development Center in Finland (TEKES, 

Biowaffle Project 40274/03 and MFM Project 424/31/04), the European 

Commission (EU Spare Parts Project QLK6-CT-2000-00487), the Academy of 

Finland (Project 73948) and the Ministry of Education (Graduate School of 

Biomaterials and Tissue Engineering) are greatly appreciated. 

P 30. Fractures of the base of first metacarpal bone. 

Vlahović T 1 ., Šurjak Ž 1 , Malović M 1 ., Matec B 1 ., Tadic J 1 , Rabić D 1 , 

Veir Z. 2 

1 Clinic for Traumatology, Zagreb, Croatia 

2 Department for Surgery, General Hospital “Josip Benčević”, 

Slavonski Brod, Croatia 

Fractures of the base of the firts metacarpal are particularly common. The 

present excemination was carried out in order to find out a correlation 

between the clinical outcome and type of fracture, the quality of reduction, 

the surgical procedure and the extent of osteoarthrosis. Mechanysm of 

injury is an axially directed force through the partially flexed metacarpal 

shaft. We had 146 cases of fractures of the base of the first metacarpal 

bone which we devided into four types: 44% Bennet fractures, 39% 

extraarticular fractures, 112% Rolando fractures and 5% comminuted 

fractures. Patients were predominantlly between 20 and 39 years old ( 69% 

males ). We used conservative and operative treatment methods, depending 

on fracture type. Most extraarticular fractures can be treated 

conservativelly with good outcome results depending on achived reduction 

and fragment stability. Intraarticular fractures present treatment challenges 

because they tend to displace due to deforming force acting at base of

thumb. are particularly common. The present excemination was carried out 

in order to find out a correlation between the clinical outcome and type of 

fracture, the quality of reduction, the surgical procedure and the extent of 

osteoarthrosis. Mechanysm of injury is an axially directed force through 

the partially flexed metacarpal shaft. We had 146 cases of fractures of the 

base of the first metacarpal bone which we devided into four types: 44% 

Bennet fractures, 39% extraarticular fractures, 112% Rolando fractures and 

5% comminuted fractures. Patients were predominantlly between 20 and 

39 years old ( 69% males ). We used conservative and operative treatment 

methods, depending on fracture type. Most extraarticular fractures can be 

treated conservativelly with good outcome results depending on achived 

reduction and fragment stability. Intraarticular fractures present treatment 

challenges because they tend to displace due to deforming force acting at 

base of thumb. 

P 31. Perilunate dislocations – our experience 

Vlahović T 1 ., Malović M 1 , Šurjak Ž 1 ,., Matec B 1 ., Veir Z. 2 , 

Rabić D 1 , 

1 Clinic for Traumatology, Zagreb, Croatia 

2 Department for Surgery, General Hospital “Josip Benčević”, 

Slavonski Brod, Croatia 

With this poster we would like to present our experiance in treating 

perilunate injuries. The wrist is a complex of joints between seven bones 

whose function is to provide motion to and transmit force between the hand 

distally and the forearm proximally. Most clinically important carpal 

dislocations and fracture-dislocations result from falls on the palm of the 

hand resulting in a hyperextension injury to the wrist. We classified 

perilunate injuries in classification made by Mayfield and co-workers who 

has made IV stages of perilunate instability. Perilunate dislocations and 

fracture dislocations are uncommon injuries, constituting about 10% of all 

carpal injuries. These injuries tend to remain undiagnosed for varying 

lenghts of time and when discovered treatment varies and is controversial. 

Periluanr dislocations are very unstabile injuries and and we prefer to be 

treated with OR IF. OR gives the best oportunity for primary repair of 

ligaments and fixation to obtain good results. This poster examines the 

clinical presentation, diagnostic techniques, and management options 

applicable to the emergency practitioner 

P 32. Surgical facial wounds. Simple interrupted percutaneous 

suture (SIPS) versus running intradermal suture (RIS) 

Vukašin G., Bednar S., Berebrić B., Lazić G. 

Department for ENT, General Hospital Karlovac, Karlovac, Croatia 

The purpose of this study is to compare the esthetics of scars resulting from 

surgical facial wounds sutured either with simple interrupted percutaneous 

( SIPS ) or with running intradermal suture ( RIS ). We admited and 

followed sixty patients, and managed seventyone surgical wounds from 

simple excisions and primary closure.

Thirtythree wounds were sutured with SIPS and thirtyeight with RIS. All 

the patients were informed with procedure and signed the consent form. All 

surgical procedures were performed by the same surgeon and under the 

same conditions. 

Evaluation of each scar was made blindly by two independent observers 

and by the patients the first, the third and the sixth moth after surgery. 

Judged by independent observers the first month after surgery ( early 

results ), excellent 90% results were obtained with RIS to just 22% 

excellent results with SIPS. Three months after surgery the results were 

improved in the group of patients sutured with SIPS. Excellent results 

raised to 64%, judged by independent observers. 

Finally, six months after surgery esthetic results were fairly very close in 

both groups of patients sutured either with RIS or SIPS suture. 

There is advantage in using RIS over SIPS in early days, months, after 

surgery and practically no advantage six months after surgery in the type of 

facial wounds described. 

P 33. Evaluation of biomechanical properties of bioabsorbable 

implants 

Waris E 1 , Happonen H 2 , Raatikainen T 3 , Kaarela O 4 , Törmälä P 5 , 

Santavirta S 3 , Konttinen YT 3 , Ashammakhi N 4,5 

1 University of Helsinki, Biomedicum Helsinki, Institute of Biomedicine/Anatomy, 

Helsinki, Finland. 

2 

Linvatec Biomaterials Ltd., Tampere, Finland 

3 

Helsinki University Central Hospital, Helsinki, Finland 

4 


5 


Bioabsorbable fixation devices offer a useful option to treat small hand 

fractures. In a biomechanical study in tranversally osteotomized cadaver 

metacalpal bones, self-reinforced (SR) poly-L/DL-lactide (P(L/DL)LA) 

70/30 and polylactide-polyglycolide (PLGA) 80/20 miniplatings were 

compared with standard metallic fixation methods. 112 fresh-frozen 

metacarpals from humans had 3-point bending and torsional loading after 

transverse osteotomy followed by fixation using seven methods: dorsal and 

dorsolateral 2.0-mm SR-PLGA plating, dorsal and dorsolateral 2.0-mm SR-P 

(L/DL)LA plating, dorsal 1.7-mm titanium plating, dorsal 2.3-mm titanium 

plating, and crossed 1.25-mm Kirschner wires. In apex dorsal and palmar 

bending, dorsal SR-PLGA and SR-P(L/DL)LA plates provided stability 

comparable with dorsal titanium 1.7-mm plating. When the bioabsorbable 

plates were applied dorsolaterally, apex palmar rigidity was increased and 

apex dorsal rigidity was decreased. Bioabsorbable platings resulted in higher 

torsional rigidity than 1.7-mm titanium plating. In another biomechanical 

study in obliquely (radial to ulnar orientation) osteotomized pig metacarpal 

bones, we compared the stabilities of various bioabsorbable fixation devices 

with metallic fixation devices. 1.5 mm self-reinforced poly-L-lactide (SR- 

PLLA) pins provided fixation rigidity comparable with 1.5 mm Kirschner 

wires in dorsal and palmar apex bending, whereas in lateral apex bending and 

in torsion the rigidity was equal to that of 1.25 mm Kirschner wires. 2.0 mm 

SR-P(L/DL)LA screws provided rigidity comparable with that of 1.5 mm 

Kirschner wires in all testing modes. The bioabsorbable plate considerably 

enhanced the bending stabilities of the fixation system, but a single

interfragmentary screw provided only limited rotational rigidity. The results 

demonstrate that using ultra-high strength SR implants, adequate fixation 

stability for hand fracture fixation can be achieved. Accordingly, 

bioabsorbable miniplating can be used safely in the clinical stabilization of 

metacarpal and phalangeal fractures. 







appreciated. 

P 34. Experience with bioresorbable fixation of mandibular fractures 

Ylikontiola L 1 , Sundquist K 1 , Sandor GK 2 , Tormala P 3 , 


1 University of Oulu, Oulu University Hospital, Department of Oral and 

Maxillofacial Surgery, Oulu, Finland. 

2 University of Toronto, The Hospital for Sick Children, Toronto, Canada 



Objective 

Bioresorbable osteofixation devices are being increasingly used in 

orthognathic surgery and in cases of trauma to avoid problems associated 

with conventional metal osteofixation devices. The aim of this clinical study 

was to assess the reliability and efficacy of bioresorbable self-reinforced 

poly-L/DL-lactide (SR-P(L/DL)LA 70/30) plates and screws in the fixation 

of mandibular fractures in adults. 

Study Design 

Ten patients (20 to 49 years old) with isolated anterior mandibular 

parasymphyseal fractures were treated by means of open reduction and 

internal fixation using SR-P(L/DL)LA 70/30 bioresorbable plates and 

screws. 

Results 

During the minimum of 6 months of follow-up, no problems were 

encountered except for 1 case where a plate became exposed intraorally and 

infected. This required debridement and later excision of the exposed part of 

the plate. Despite this setback the fractured bone healed well. 

Conclusions 

SR-P(L/DL)LA 70/30 plates and screws are reliable for internal fixation of 

anterior mandibular fractures in adults. Proper soft tissue coverage should be 

ensured to avoid plate exposure. Should implant exposure occur, it might be 

necessary to excise the exposed part after fracture healing (6-8 weeks 

postoperatively). 







appreciated.

P 35. Ultrasound in aesthetic breast surgery 

Ignatovski B., Bartoš V., 

Polyclinic for Surgery, Ginaecology and Plastic Surgery «Arcadia», 

Daruvar, Croatia 

Breasts are the symbol of feminisity, and an organ of the female body 

which is a subject to numerous diseases ranging from inflammatory 

processes, through different stages of mastoparhy , to benign and malign 

tumours. 

Breasts shaping, as an individual surgery, holds the first place in frequency 

in aestethicplastic surgery. It is important to have a complete insight of the 

breasts condition at the moment of performing an aestetic surgery. 

The importance of ultrasound diagnostics as a procedure in the preparation 

for surgery and monitoring of patients condition after surgery will be 

discussed in the paper. It is especially important in the augmentative 

mammaplastics since we have to monitor two subjects; the brest and the 

implant. 

P 36. News in rhinoplasty (endoscopic and atraumatic approach) 

Glušac B. 

Private ENT Office, Makarska, Croatia 

Rinokirurške operacije su najstarije, najčešće i ujedno 

najkontraverznije u estetskoj kirurgiji lica. U zadnjih 10 godina 

rinoplastikaje doživjela najveće promjene u odnosu na ostalu 

kirurgiju lica. 

Današnji moderni cilj rinoplastike bio bi da u jednom aktu riješi 

funkcijiski i estetski problem pacijenta. Prvi cilj estetske kirurgije 

nosa bila bi funkcija (sjetimo se da septuma ima oko 10 svojih 

funkcija i 9 sastavnih dijelova) pa onda estetska korekcija nosa. 

Danas težimo atraumatskom pristupu tj. minimalnoj invazivnoj 

krirurgiji, sa maksimalnim efektom, bez ožiljka, postoperacijskih 

otoka, krvarenja, podljeva, te sa brzim oporavkom. 

Već 5 godina rabimo endoskopski pristup u rinoplastici pomoću 

fiberendoskopa, endo mikrokamere, monitora. Kontroliramo tijekom 

operacije koštano-hrskavičnu grbu, septum te meka tkiva piramide. 

Zahvaljujući modernoj tehnologiji, preciznim, oštrim instrumentima, 

te optičkoj kontroli, nemamo više nikakvih komplikacija u smislu 

ostataka grbe ili otvorenog krova piramide, te dobivamo na vremenu, 

što je jako bitno za brzi oporavak pacijenta. 

Prikaz (u u živo) na DVD-u, zatvorena tehnika, 7 minuta, 

endoskopski pristup.

P 37. Digital photography and patohystological analysis ex tempore 

Burgić M. 



Tumors of perorbital region always require histological analysis of resection 

borders because we would like to be sure that borders are clean of tumor. If 

the tumor are infiltrated deeper structures surgical treatment must be in 2-3 

acts ( if is retrobulbar tissue or bone are infiltrated ). In this cases surgeon 

can not to interpreted analysis. Because we took a pictures interoperate with 

digital camera . We took a pictures of excision zones and layers. On pictures 

we put the sings on excision zones and adequate landmark and than we send 

pictures to histological analysis. On this way surgeon has adequate 

interpretation of analysis and reliable and most quality situation for patient 

prognosis and good possibility to continue therapy. 

P 38. Endoscopically assisted suctioning of lipomas 

Gverić T., Huljev D., Zdilar B., Simon S., Skok I. 

General Hospital “Sveti Duh”, Zagreb, Croatia 

Within the group of 32 patiens with citologically verified lipoma, 16 had 

been operated in the classical way, and 16 with endoscopiclly assisted 

suctioning. After 12 month of monitoring, there was not established any 

difference as far as recidivism is concerned. Endoscopically assisted 

suctioning was approved as safe and effective method in removing lipoma on 

visible locations, which resulted also with minimale scarnes and cosmeticaly 

great result, shorterpostoperative recovery and shorter absence. 

P 39. Necrotizing fasciitis of abdominal wall, V.A.C. As a 

support method 

Huljev D., Gverić T., Kučišec-Tepeš N. 

General Hospital «Sveti Duh» Zagreb, Croatia 

Necrotizing fasciitis is an acute surgical condition which demands a prompt 

andcombined treatment. Early recognition and aggressive surgical 

debridement, along with a target antibiotic treatment,significantly affect the 

overall course of treatment and, ultimately, survival. A case of a femal 

patient with necrotizing fasciitis of the abdominal wall, the course and 

methods used in the treatment, particulary the microbiological aspect and the 

use of V.A.C. ( vacum assisted closure) as an auxiliarymethod, are presented 

in this work.

P 40. V.A.C. As a method for treatment of postoperative 

hematoma after abdominoplasty, case report 

Gverić T., Huljev D. 

General Hospital «Sveti Duh» Zagreb, Croatia 

In this work the authors describe the use of a vacuum assisted closure in 

treatment of postoperative hematoma of abdomen after classical 

abdominoplasty. Fully closed treeatment of the hematoma minimizes the 

possibility of infectons and makes classical bandaging and axpensive 

dressing unneccessary. V.A.C. was approved axcellent within the aspect of 

patient confort, quicker recovery and shorter medical treatment. 

P 41. Reconstruction of the brachial artery pseudoaneurysms 

following venipuncture in infants 

Bulić K., Unušić J., Džepina, Mijatović D. 

Department of Plastic and Reconstructive Surgery, 

University Hospital “Zagreb”, Zagreb, Croatia 

Advances in invasive diagnostic procedures and increased survival of low 

birth weight infants have resulted in an increase of pediatric vascular 

injuries, representing a challenging problem in surgical practice. Only two 

cases of pseudoaneurysms of the brachial artery following venipuncture in 

infants have been reported in the literature. 

We report three cases of brachial artery pseudoaneurysms following 

venipuncture in infants operated upon in our institution, the age of infants 

ranging from 43 to 64 days. Infants were operated 25 to 42 days following 

the injury. While in two infants the arterial continuity following resection 

was restored with an end-to-end anastomosis, in the third infant, the use of 

a venous interposition graft was necessary. Duplex US was used in 

preoperative evaluation and postoperative follow-up of all three infants. 

The child requiring a more complex reconstructive procedure was also 

evaluated with helical contrast computed tomography. 

The key points in managing these injuries are early diagnosis and 

microvascular reconstruction.

SPONSORS & EXHIBITORS : 

SPONSORS 

Belupo d.d., Zagreb, Croatia 

Brodomerkur d.d., Split, Croatia 

Coca Cola Beverages Hrvatska d.d., Zagreb, Croatia 

Croatia Airlines, Zagreb, Croatia 

Dalekovod d.d., Zagreb, Croatia 

Drager Croatia d.o.o., Zagreb, Croatia 

Elektromaterijal d.d., Rijeka, Croatia 

Fotona d.d., Ljubljana, Slovenija 

Hebe d.o.o., Zagreb, Croatia 

Hrvatska turistička zajednica, Zagreb, Croatia 

Hrvatske ceste d.o.o., Zagreb, Croatia 

Tehnički pokrovitelj : HG Spot d.d., Zagreb, Croatia veći logo, pola strane 

INA d.o.o., Zagreb, Croatia 

MES 

Razvitak Farmaceutika d.d., Zagreb, Croatia 

Sanyko 

Segestika, Sisak, Croatia 

Turistička zajednica grada Zagreba, Zagreb, Croatia 

Znanje d.d., Zagreb, Croatia 

Zrinjevac d.o.o., Zagreb, Croatia

EXHIBITORS 

Algoritam 

Bauerfeind d.o.o., Zagreb, Croatia 

Carl Zeiss d.o.o., Zagreb, Croatia 

Elastic d.o.o., Daruvar, Croatia 

Elman 

Expo Comm d.o.o., Zagreb, Ljubljana, Slovenia 

Holos Biomet-Merck, Zagreb, Croatia 

Instrumentaria d.d., Zagreb, Croatia 

Johnson & Johnson S.E.d.o.o., Zagreb, Croatia 

Labaratories Eurosilicone, France 

Medias, Zagreb, Croatia 

Mini Major, Zagreb, Croatia 

M.T.F. d.o.o., Zagreb, Croatia 

Oktal Pharma, Allergan, Zagreb, Croatia 

Pliva Hrvatska d.o.o., Zagreb, Croatia 

Rozi Step, Zagreb, Croatia 

Stoma Medical 

Tyco Healthcare 

Zepter

Prof. Zoran Arnež 

Ljubljana, Slovenia 

Prof. Andrej Banić 

Zurich, Switzerland 

LIST OF PARTICIPANS 

A) FACULTY 

Beatriz Berenguer, MD 

Madrid, Spain 

Pietro Berrino, MD 

Genova, Italy 

Prof. Edgar Biemer 

Munchen, Germany 

Prof. Phillip Blondeel 

Gent, Belgium 

Prof. John Boorman 

London, UK 

Srećko Budi, MD, PhD 


Horacio Costa, MD 

Oporto, Portugal 

Prof. Michel Costagliola 

Toulouse, France 

Prof. Kris T. Drzewiecki 

Copenhagen, Denmark 

Christian Echinard, MD 

Marseille, France 

Egon Eder, MD 

Koln, Germany 

Prof. Jens Jorgen Elberg 

Copenhagen, Dennmark 

Javier Enriquez de Salamanca, MD 

Madrid, Spain 

Beatriz Gonzalez, MD 

Madrid, Spain 

Prof. Ian Jackson 

Southfield, USA 

Krešimir Martić, MD 


Jaume Masià, MD 

Barcelona, Spain 

Rudolf Milanović, MD, MS 


Gavin Miller, MD 

Sheffield, UK 

Roland Ney, MD 

Montreux, Switzerland 

Prof. Jean-Philippe Nicolai 

Groningen, Netherlands 

Prof. Milomir Ninković 

Munchen, Germany 

Prof. Marina Ninković 

Innsbruck, Austria 

Prof. Rolf R. Olbrisch 

Dusseldorf, Grmany 

Prof. Neven Olivari 

Wesseling, Germany 

Nicholas Parkhouse, MD, MCh, FRCS

London, UK 

Prof. Aurelio Portincasa 

Foggia, Italy 

Stefano Piccolo, MD 

Rimini, Italy 

Dirk F.Richter MD 

Wesseling, Germany 

Franjo Rudman MD 


Prof. Richard C. Sadove 

Tel Aviv, Israel 

Sanda Stanec MD, PhD 


Prof. Zdenko Stanec 


Tiew C. Teo MD 

London, UK 

Christoph Wolfensberger MD 

Zurich, Switzerland 

Zlatko Vlajčić MD 


Rado Žic MD, PhD 

Zagreb, Croatia

B) AUTHOR INDEX 

A 

Agir H. A14, A15, H6, P1 

Aljinović Ratković N. A13, A16, P2 

Andonovska D. P3, P17 

Andonovski D. P3 

Arifi H. P4 

Arnaud E. P5, P22 

Arnež Z. L3, G6, 

Arnold J. I2 

Ashammakhi N. I5, P5, P15, P22, 

P26, P28, P29, P33, 

P34 

Atanasova E. P3, P17 

Azzizi M.D. I3 

B 

Bagatin D. A4 

Bagatin M. A4 

Bagatin T. A4 

Bahia H. B12 

Banić A. W1, L8 

Bartoš Vlado 

Bednar S. P32 

Begic A. C5 

Bekić M. D6 

Berebrić B. P32 

Berenguer B. A1 

Berisha A. P4 

Berrino P. B3, D10 

Beslič N. H7 

Biemer E. A7, W2, L4, 

Biščević M. H4, P27 

Blondeel P. L2, W3, 

Boorman J. C2, W4, L7 

Brajčić D. E2, F4, 

Brnić Z. P6, 

Brockmann A. B13 

Brunel M.J. I3 

Budi S. C4, H5, P7, 

Budinščak I. B9 

Buja Z. P4 

Bukvić N. D6, P18 

Bulić K. D3, P41 

Burgić M. A17, P23, P37 

Busching K. B13 

Bušić V. C5 

Butorac L. A11, P20 

C 

Cek D. A14, H6, P1 

Costa H. A10, B7 

Costagliola M. A5, E1, I4 

Crnogorac V. B13, I2 

D 

Das Gupta R. C5 

David D.J. A15 

Dinar S. H6, P1 

Dobrović M. B11 

Dominique R. P5 

Donoway D. P5 

Drviš P. G3 

Drzewiecki K.T. L9, E4 

Džepina I. D3, H1,P41 

Dzokic G. P8 

Dzonov B. F9 

Dzorceva M. P3 

E 

Echinard C. D7, I3, I6 

Eder E. D12, D2 

Elberg J.J. C1, W5 

Ella V. P22 

Enriquez de Salamanca J. F1 

Erić M. P10 

F 

Fazlić A. P25 

G 

Gašparović S. B6 

Gavrankapetanović F. H4 

Gavrankapetanović I. H4, P27 

Gjorgievska J. P8, 

Glamuzina R. A11 

Glumičić S. B9 

Glušac B. P36 

Gonzalez B. A2 

Gorceva M. P17 

Grmek M. G6 

Gruden Stanič O. G5 

Gverić T. P38, P39, P40 

H 

Happonen H. P33 

Hebebrand D. B13 

Huis M. P9 

Huljev D. P38,P39,P40 

I 

Ignatovski B. P35 

Ioannovich I. P14

J 

Jackson I. L1, W6 

Janjić Z. P10, P11, P12 

Jelen S. H3 

Jeremić P. P12 

Jokić D. A3, A18, B6 

Jones B. P5 

Jovanović M. P10, P11, P12 

Juri J. B5 

Jurišić D. P13 

K 

Kaarela O. P33 

Kallioinen M. P29 

Kalogjera L. G3 

Karabeg A. D14 

Karabeg R. D14 

Kellomaki M. P15, P22, P29 

Kempny T. H3 

Keramidas E. P14, D13, F5, F7, H2, 

Kleinert H. F2 

Knežević P. A3, A9, A11, A12, A18, 

B6, B10, P20 

Konttinen Y.T. P33 

Kostopeč P. D6, P18 

Kovačić J. A3 

Krmpotić M. P2 

Krpan I. P30 

Kučišec-Tepeš N. P39 

Kysely T. H3 

L 

Lacević S. D14 

Lansman S. P15 

Laurikainen K. P5 

Lazić G. P32 

Leppee M. P16 

Leroy P. I3 

Leskovšek A. H7 

Lukšić I. A9 

M 

Mahić Z. P27 

Malović M. P19, P30, P31 

Mandal A. B12 

Marchac D. P5 

Marcikik G. P3, P17 

Margaritoni M. D6, P18 

Margić K F6, F8 

Martić K. C4, D4, H5 

Masia J. A8, C3 

Matec B. P19, P30, P31 

Mijatović D. D3, H1,P41 

Milanović R. C4, H5 

Milenović A. A9 

Milić M. A11, B10, P20 

Miller G. F5, F7, F11, H2, P14 

Mircevska-Zogovska E. F9, P8 

Mircevski V. F9 

Momčilović D. P10 

Mujkanović N. A17, P23, P24 

N 

Naceska A. F9 

Nalić B. P11 

Nanković V. W14 

Ney R. W13 

Nicolai J-P. W7, W15, G1 

Niemela S-M. I5 

Nikolayeva N. P21 

Nikolić J. P10 

Ninković Ma. F10 

Ninković M. W8, L10, P5 

Nola I. I1 

Novak E. G4 

O 

Olbrisch Rolf R. B8, L6, W15 

Olivari N. D5, D9 

Oudina K. P22 

Ožegović I. A3 

Ozkeskin B. A14 

P 

Paakko P. P15 

Parkhouse N. A6 

Pašić A. A17, P23, P24 

Pavlic R. G4 

Peart F. F2 

Pegan B. G3 

Petite H. P22 

Petrović I. G3 

Piccolo S. W11 

Pirc J. F8 

Pirjavec A. P13 

Pisarev-Šoć M. P11 

Podbregar M. G4 

Popović A. P11 

Portincasa A. W9, D1, L11 

Potier E. P22 

R 

Raatikainen T. P33 

Rabić D. P19, P30, P31 

Richter D.F. B2, D11, W10 

Rifatbegović A. A17, P23, P24 

Rodopoulous S. F5, P14 

Roje Z. E2, F4 

Roje Ž. E2, F4 

Rudman F. C4, D4, H5 

S, Š 

Sadove R.C. B4, L5 

Salihagić S. P25

Sandor G.K. P34 

Santavirta S. P33 

Schnitt D.E. A15 

Selmani R. D6, P18 

Sen C. A14, H6, P1 

Serlo W. P5, P26 

Shejbal D. G3 

Simon S. P38 

Skok I. P38 

Smith G.D. F2 

Soini Y. P28 

Solomos M. F5 

Spyriounis P.K. G2 

Stanec S. C4, C6, D4, H5 

Stanec Z. C4, C6, D4, 

G6, H5 

Stevkovska M. P17 

Stewart K. B12 

Stiglmayer N. B5 

Stritar A. G6, H7 

Sundquist K. P34 

Šolinc M. H7 

Šoštar K. P9 

Šurjak Ž. P19, P30, P31 

T 

Talić A. P27 

Teo T.C. F3, W12 

Tessier J.L. I3 

Tiainen J. I5, P28 

Tojagić M. B5 

Tormala P. P15, P26, P28, 

P29, P33, P34 

Tsoutsos D. P14 

Tudzarova-Gorgova S. P8 

U 

Uglešić V. A3, A9, A11, A12, A18, 

B6, B10, P2, P20 

Unal C. P1 

Unušić J. D3, H1, P41 

Us J. G6 

Ustundag E. A14 

Utrobičić I. E2, F4 

V 

Veir Z. P31 

Veiranto M. I5 

Vesala A-L. P29 

Virag M. A9, A13 

Vlahović T. P19, P30, P31 

Vlajčić Z. C4, C6 

Vresky B. H3 

Vukašin G. P32 

W 

Wagner D. I2 

Waris E. P33 

Waris T. P26, P28 

Wolfensberger C. B1 

Y 

Ylikontiola L. P34 

Z,Ž 

Zambelli M. D8, E3 

Zatriqi V. P4 

Zdilar B. P38 

Zubčić V. A12 

Zubčić Z. A12 

Zupičić B. A12 

Žic R. C4, C6, D4, H5

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