Knjiga sažetaka Book of Abstracts

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7. HRVATSKI KONGRES PLASTIČNE,
REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
SPLIT, Hrvatska, 01. - 05. listopada 2008.
7 th CROATIAN CONGRESS OF PLASTIC,
RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
SPLIT, Croatia, October 01 - 05, 2008
Knjiga sažetaka
Book of Abstracts
www.studiohrg.hr/plastic-surgery2008
www.hlz.hr/hdprek www.hlz.hr/cspras

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Urednici / Editors
dr. sc. Zdravko Roje, dr. med.
mr. sc. Zlatko Vlajèiæ, dr. med.
Grafièko oblikovanje i tisak / Design and printed by
Studio Hrg d.o.o., Zagreb
Naklada / Printing
200 primjeraka / copies
listopad 2008. / October 2008

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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
SADRŽAJ / CONTENTS
OPÆE INFORMACIJE / GENERAL INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
SA�ECI / ABSTRACTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
AUTOPROTHESIS TECHNIQUE: RECENT ADVANCEMENTS
BOTTI G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
AUGMENTATION - MASTOPEXY: DEMYSTIFYING SURGICAL PLANNING
JANUSZKIEWICZ J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
REFINEMENTS IN SURGICAL AUGMENTATION OF ASYMMETRIC AND CONSTRICTED BREAST
JANUSZKIEWICZ J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
MASTOPEXY AUGMENTATION: TWO OPERATIONS WITH OPPOSING GOALS
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
BREAST AUGMENTATION – PEROAREOLAR APPROACH UPDATE
STANEC Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
WORKSHOP: FOTONA
BENIGN SKIN LEASIONS REMOVAL WITH ER:YAG LASER
KURTOVIĆ D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
LASER TREATMENT OF AXILLARY HYPERHIDROSIS WITH1064 NM PULSED LASER LIGHT
MALETIĆ D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
SKIN REJUVENATION WITH FRACTIONATED ABLATIVE ER:YAG LASER
VOLOVEC L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
WORKSHOP: ANTIAGING
BEAUTY AND THE BREAST
BLASCHKE F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
NINE STEPS FOR SUCCESSFUL TOTAL BODY LIFT
COLIĆ MM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
LIPOABDOMINOPLASTY
GRAF R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
VERTICAL BREAST REDUCTION AND MASTOPEXY WITH A CHEST WALL FLAP
GRAF R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
BREAST REDUCTION: WHAT MATTER MOST, SCARS OR PEDICLES?
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
BODY CONTOURING: ADVANCED CONCEPTS
ROJE Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
LOWER PEDICLE MAMMOPLASTY REVISITED - APPLICATION OF MODERN CONCEPT TO A
STANDARD TECHNIQUE
ŽIC R, Vlajčić Z, Stanec Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
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FACIAL CONTOURING AND FACIAL REJUVENATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
A PROBLEM BASED APPROACH TO RHINOPLASTY
BARUTCU A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
OPEN RHINOPLASTY: DIFFERENT TECHNIQUE OR DIFFERENT APPROACH
BEDEKOVIĆ V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
MID-FACE LIFT BETWEEN AESTHETIC AND FUNCTION: THE BEST WAY TO CORRECT
LATROGENIC LOWER LID DEFORMITIES
BOTTI G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
THANKS TO THE MID FACE LIFT, THERAPY OF THE AGING FACE HAS FINALLY COME TO
COMPLETION
BOTTI G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
CHEMICAL PEELS - A BRUSH IN THE HAND OF A PHYSICIAN
ČARIJA A, Puizina-Ivić N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
RELATION BETWEEN FUNCTIONAL AND AESTHETIC NASAL SURGERY
DOBROVIĆ M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
OVERVIEW TO THE DORSAL NOSE AUGMENTATIONS WITH AUTOGENOUS-ALLOPLASTIC
GRAFTS, TREATMENT AND ITS COMPLICATIONS
EMSEN IM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
THE NEWS IN THE RHINOPLASTY
GLUŠAC B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
ENDOBROW AND MIDFACE LIFTING
GRAF R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
FACIAL REJUVENATION WITH SMASECTOMY AND FAME USING VERTICAL VECTORS
GRAF R, Groth AK, Pace D, Neto LG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
HARMONY IN FACIAL REJUVENATION - AN ECLECTIC PHILOSOPHY
JANUSZKIEWICZ J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
RHYTIDECTOMY: CONTEMPORALY CONCEPT OF FACE AND NECK LIFT FOR FEMALES AND
MALES
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
SELECTING THE BEST PROCEDURES FOR FACIAL REJUVENATION
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
THE NEEDLE VS THE KNIFE IN FACIAL REJUVENATION AND CONTOURING
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
FACIAL ANALYIS AND SURGICAL CONCENQUENCES
PANFILOV D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
SKIN AGING – PREVENTION AND ADEQUATE TREATMENT
PUIZINA IVIĆ N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
GENERAL CONCEPT OF RHINOPLASTY SURGERY
RAČIĆ G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
CURRENT TRENDS IN FACIAL FILLERS
STANEC S, Stanec Z, Žic R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
CHEMICAL FACE AND SKIN IMMEDIATE LIFTING WITH ENDOPEEL TECHNIQUES
TENENBAUM A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
COMPLICATIONS OF FILLERS AND ENDOPROSTHESIS
TENENBAUM A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
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LASER-TISSUE INTERACTION; LASER LIPOLYSIS – OVERVIEW; FRACTIONAL LASER
TECHNOLOGIES – OVERVIEW
VIŽINTIN Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
CONCEPTS IN RHINOPLASTY
ZAMBELLI M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
SMART LIPO (HEAD AND NECK)
ŽGALJARDIĆ Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
FAT GRAFTING
ŽIC R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
UPDATE OF PERFORATOR FLAPS BREAST RECONSTRUCTION
ARNEŽ Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
IMPLANT BASED RECONSTRUCTION
BECKER H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
SIMULTANEOUS MASTOPEXY AND AUGMENTATION
BIGGS T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
PTOTIC AND HYPOTROPHIC BREAST TREATMENT
BOTTI G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
TECHNICAL REFINEMENTS IN VERTICAL MAMMAPLASTY(OPTIMIZING TECHNIQUE IN BREAST
REDUCTION)
BOTTI G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
TUBEROUS BREAST CORRECTION BY MEANS OF PARENCHYMA EXPANSION
BOTTI G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
REDUCING SEROMA FORMATION IN THE LATISSIMUS DORSI FLAP DONOR SITE WITH PRP
AFTER BREAST RECONSTRUCTION
BUDI S, Žic R, Vlajčić Z, Milanović R, Rudman F, Martić K, Stanec Z . . . . . . . . . . . . . . . . . . . . . . . . . . 45
BREAST SURGERY IN CROATIA - WHAT AND HOW WE WORK?
BULIĆ K, Mijatović D, Ivrlač R, Veir Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
SOME CURRENT POSSIBILITIES FOR BREAST RECONSTRUCTION: M AND LD VS. EXPANSION
PLUS IMPLANT
COLIĆ MM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
CORRECTION OF BREAST ASYMMETRY
DŽEPINA I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
SUBFASCIAL BREAST AUGMENTATION - ADVANTAGES AND OUTCOMES ACIAL BREAST
AUGMENTATION
GRAF R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
VERTICAL BREAST REDUCTION AND MASTOPEXY WITH HEST WALL FLAP
GRAF R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
BREAST REDUCTION: FREE SKIN GRAFT OR PEDICLE FLAP FOR THE HE MAMMILLA
IGNATOVSKI B, Bascevan B, Varas Fuenzalida J A, Kovačević J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
FAT NECROSIS AS A LATE COMPLICATION IN CONVENTIONAL TRAM FLAPS
IVRLAČ R, Mijatović D, Jakić-Razumović J, Bulić K, Veir Z, Bagatin D, Smuđ S. . . . . . . . . . . . . . . . . . 49
POST-MASTECTOMY RECONSTRUCTION: OPTIMISING THE ONCOLOGIC AND AESTHETIC
IMPERATIVES
JANUSZKIEWICZ J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
MASTOPEXY WITH 3-D PRESHAPED MESH
JOHANNES S, Brujin HP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
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CORRECTION OF PTOSIS WITH THE BENELLI PERIAREOLARE
KARABEG R , Karabeg A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
AUGMENTOPEXY: A MULTI-PLANE APPROACH FOR AUGMENTATION OTIC BREAST
KHAN UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
COMMON BREAST AND CHEST ASYMMETRIES IN AUGMENTATION MAMMOPLASTY
KHAN UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
MASTOPEXY WITH AUGMENTATION IN MUSCLE SPLITTING BIPLANE
KHAN UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
BREAST RECONSTRUCTIONS WITH IMPLANTS
MARGARITONI M, Selmani R, Bukvić N, Bekić M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
ONCOPLASTIC BREAST SURGERY: WAYS TO MAXIMIZE ONCOLOGICAL TY AND COSMETIC
RESULT
MARGARITONI M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
IMPLANT SELECTION IN PRIMARY BREAST AUGMENTATION
MAYO F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
SECONDARY BREAST IMPLANT SURGERY
MAYO F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
BREAST RECONSTRUCTION WITH PEDICLE LD FLAP
MIJATOVIĆ D, Ivrlač R, Bulić K, Veir Z, Bagatin D, Đurić Ž . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
OUR EXPIRIENCES IN REDUCTION MAMMAPLASTY WITH L SCAR
MIJATOVIĆ D , Ivrlač R , Bulić K , Veir Z , Bagatin D , Đurić K , Smuđ S , Eljuga D . . . . . . . . . . . . . . . . . 59
BREAST AUGMENTATION: SALINE AND SILICON IMPLANT DIFFERENCES HEN SALINE AND
WHEN SILICONE
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
BREAST REDUCTION / MASTOPEXY: TECHNICAL UPDATE AND HNICAL PEARLS (DIFFERENT
VERTICAL TECHNIQUES / SPAIR, BENELLI, MATURA, RIBEIRO AND ECT.)
NAHAI F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
REHABILITATION AFTER BREAST SURGERY AND RECONSTRUCTION
NINKOVIĆ MA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
IMPACT OF RADIATION ON BREAST RECONSTRUCTION
NINKOVIĆ MI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
PEDICLE FLAPS IN BREAST RECONSTRUCTION
NINKOVIĆ MI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
TIMING AND CHOICES USING AUTOLOGOUS BREAST RECONSTRUCTION:DIATE VS. DELAYED
RECONSTRUCTION
NINKOVIĆ MI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
PEDICLE BREAST RECONSTRUCTION
ROJE Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
VERTICAL MASTOPEXY AND REDUCTION WITH RUTH GRAF HNIQUE: OUR EXPERIENCES
ROJE Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
KIN-SPARING MASTECTOMY WITH NAC PRESERVATION AND PRIMARY RECONSTRUCTION -
FOLLOW UP
STANEC Z, Žic R, Stanec S, Budi S, Milanović R,Vlajčić Z, Rudman F, Martić K . . . . . . . . . . . . . . . . . 61
SATELLITE SYMPOSIUM ON BURNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
OUR EXPERIENCES WITH CHILDREN BURNS IN CHILDREN HOSPITAL RIJEKA
GLAVINA N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
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TISSUE ENGINEERING AND SKIN SUBSTITUTES FOR COVERING EXCISED BURN WOUNDS
KOLLER J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
RECENT PROGRESS IN NUTRITIONAL SUPPORT
LOJPUR M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
OUR EXPERIENCES WITH BURNS TREATMENT IN RIJEKA
PIRJAVEC A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
MODERN ASPECTS OF FLUID MANAGEMENT
PRIMOŽA G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
EUROPEAN PRACTICE GUIDELINES FOR BURN CARE AND EUROPEAN PRACTICE
GUIDELINES FOR BURN MANAGEMENT THERAPY
ROJE Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
EXPERIENCES WITH BURNS TREATMENT IN MARIBOR
SPARAŠ B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
A GROUP CASUALTIES, AS A FIRE BURN MASS DISASTER
STRITAR A, Zorman P, Šteblaj S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
OUR EXPERIENCES WITH BURNS TREATMENT IN ZAGREB
TOMIČIĆ H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
OUR EXPERIENCES WITH BURNS TREATMENT IN SPLIT
UTROBIČIĆ I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
FREE TOPICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
SURGICAL AND RECONSTRUCTIVE TREATMENT OF PATIENT WITH ELECTRICAL HIGH
VOLTAGE BURNS
ARIFI H, Zatriqi V, Buja Z, Zejnulahu Y, Klokoci A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
SECONDARY LIP AND NOSE DEFORMITIES IN CLEFT PATIENTS
BAGATIN D, Bagatin T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
SUBTOTAL RECONSTRUCTION OF THE NOSE
CIKOJEVIĆ D, Pešutić-Pisac V, Karadža-Lapić LJ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
PERFORATOR FLAPS IN HEAD AND NECK RECONSTRUCTION
DEDIOL E, Zubčić V, Uglešić V, Leović D, Zubčić Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
SKIN LESIONS TREATED WITH RADIOFREQUENCE KNIFE
DOBROVIĆ M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
RECONSTRUCTIVE APPROACHES IN THE FRONTAL BONE DEFECTS
EMSEN IM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
WITA - PROGRAMME FOR WOUND TISSUE ANALYSES
HULJEV D, Antonić D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
OUR EXPERIENCE IN TREATMENT OF SCARS WITH CONTRACTUBEX
JOVANOVIĆ M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
SURGICAL TREATMENT OF FACIAL NERVE PALSY - AUTHORS’ METHOD
JOVANOVIĆ M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
THE USE OF INTEGRA AS ONE STEP PROCEDURE IN SKIN TUMOR SURGERY
LO RUSSO G, Almesberger D, Calì Cassi L, Facchini F, Dini M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
CHIRUGIA SEXUALIA
PANFILOV D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
RECONSTRUCTION OF THE INFRAORBITAL DEFECTS
PENEVA M, Damevska LJ, Mirchevska E, Trenchev V, Naceska A, Peev I . . . . . . . . . . . . . . . . . . . . . . 80
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INVASIVE, AGGRESSIVE BASAL CELL CARCINOMA - CARCINOMA BASOCELLULARE
TEREBRANS
RONČEVIĆ R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
TREATMENT OF LARGE VENOUS AND LYMPHATIC MALFORMATIONS OF FACE
RONČEVIĆ R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
SENTINEL LYMPH NODE BIOPSY IN TREATMENT FOR MELANOMA - 9 YEARS EXPERIENCE
RUDMAN F, Stanec Z, Žic R, Stanec S, Budi S, Milanović R, Vlajčić Z, Martić K . . . . . . . . . . . . . . . . . 83
FREE MICROVASCULAR AND FASCIOCUTANEUS FLAPS IN THE SOFT TISSUE COVERAGE OF
THE HEEL DEFECTS
SALIHAGIĆ S, Hadžiahmetović Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
LATISSIMUS DORSI FREE FLAP - 0 YEARS AFTER MICRO VASCULAR TRANSFER IN
LJUBLJANA
STRITAR A, Šolinc M, Arnež ZM , Eder E , Banič A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
PRE-EXPANDED RADIAL FOREARM FREE FLAP FOR ONE-STAGE TOTAL PENILE
RECONSTRUCTION IN FEMALE TO MALE TRANSSEXUALS
ŠOLINC M, Košutić D,, Stritar A, Planinšek F, Mihelič M, Lukanovič R . . . . . . . . . . . . . . . . . . . . . . . . . 86
CLASSIFICATION AND TREATMENT ALGORITHM OF POSTSTERNOTOMY WOUND
INFECTIONS
VLAJČIĆ Z, Stanec Z, Žic R, Stanec S, Budi S, Milanović R, Rudman F, Martić K . . . . . . . . . . . . . . . . 87
LOWER EYELID RECONSTRUCTION - CASE REPORT
VUKAŠIN G, Fanfani B, Tomljenović R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
PERFORATOR CRURAL FLAPS - OUR EXPERIENCE
ZATRIQI V, Arifi H, Zatriqi S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
POSTER PRESENTATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
SYNDACTYILI TREATED WITHOUT SKIN GRAFT - CASE REPORT
BITRAKOVSKI Z, Bozinovski S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
ELECTRICAL BURN INJURIES IN KOSOVO - THE EIGHT YEAR REVIEW.
BUJA Z, Arifi H, Terziqi H, Hoxha E, Kllokoqi A, Zejnullahu Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
ANATOMICAL RECONSTRUCTION AFTER HEMIVULVECTOMY
ĐURIĆ Z, Bulić K, Herman M, Corusić A, Mijatović D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
FREE LATISSIMUS DORSI MUSCLE FLAP IN STERNAL RECONSTRUCTION
ĐURIĆ Z, Bulić K, Bagatin D, Veir Z, Duduković M, Ivrlač R, Mijatović D . . . . . . . . . . . . . . . . . . . . . . . 94
DISTALLY BASED SURGICAL SUPERFICIAL ARTERY FLAP IN RECONSTRUCTION OF LOWER
LEG AND FOOT DEFECTS
ERIĆ D, Marić V, Milisavljević M, Šešlija I, Šarenac Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
LOCALISATION AND DIAMETER OF PERFORATORS AT
THE ABDOMINAL ELLIPSE
ERIĆ M, Ravnik D, Hribernik M, Mihić N, Krivokuća D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
OUR EXPERIENCE WITH CHEMICAL BURNS
HOXHA E, Arifi H, Buja Z, Terziqi H, Kllokoqi A, Zejnullahu Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
APPLICATION OF POSTOPERATIVE ADJUSTABILE SALINE IMPLANT AFTER MAXILLECTOMY
JANJATOV B, Živković S, Kendrišić M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
IMPLANT DISPLACEMENTS AND SUBMUSCULAR CORRECTION OFBOTTOMING DOWN IN
SUBGLANDULAR PLANE
KHAN UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
LATERAL QUADRANT SKIN CONSTRICTION AND NIPPLE DISPLACEMENTS IN HORIZONTAL
PLANE
KHAN UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
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CORRECTION OF SADDLE NOSE DEFORMITY USING DERMO-FAT GRAFT IN ASIANS
LEE DG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
THE AVAILABILITY OF MAGGOT IN CHRONIC WOUND
LEE DG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
THE USE OF BIODEGRADABLE MESH PLATE AND DEMINERALIZED BONE MATRIX IN REPAIR
OF BLOW OUT FRACTURE
LEE DG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
SKIN DEFECTS ON THE HAND AND FOOT - FIXED WITH FREE LATERAL ARM FLAP
MADUNIĆ M, Orožim Z, Novak E, Lavrič M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
RECONSTRUCTION OF A DEEP ELECTICAL BURN DEFECT WITH FREE LATERAL ARM FLAP - A
CASE REPORT
NOVAK E, Orožim Z, Madunič M, Lavrič M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
ENDOSCOPE ASSISTED BREAST RECONSTRUCTION WITH LD FLAP
VEIR Z, Mijatović D, Ivrlač R, Bulić K, Bagatin D, Smudj S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Indeks autora / Authors’ Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Zahvala / Acknowledgment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
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DOBRODOŠLICA
Dragi kolege, prijatelji i gosti,
čast mi je i zadovoljstvo u ime Hrvatskog društva za plastičnu, rekonstrukcijsku
i estetsku kirurgiju i Organizacijskog odbora pozdraviti Vas na 7. hrvatskom
kongresu plastične, rekonstrukcijske i estetske kirurgije s međunarodnim
sudjelovanjem.
Iskreno se radujem što smo Kongres ipak uspjeli organizirati u Splitu od 01. do
05. listopada 2008. Split je kulturno i turističko središte Dalmacije. Slaveći 1700
godina svog postojanja, Split Vas dočekuje otvorena srca i duše. Uživat ćete u toplom
prijateljstvu, te hrvatskom i mediteranskom gostoprimstvu. Za mjesto održavanja
Kongresa smo izabrali Le Méridien Lav Hotel, jedan od najljepših i najluksuznijih
hotela na Mediteranu. Omogućit ćemo Vam ugodan boravak i nezaboravna sjećanja.
Smatramo da je stručni program izuzetno kvalitetan. Kao i na svim našim
dosadašnjim kongresima, brojnim predavanjima uglednih predavača prikazat ćemo
najnovija saznanja i tehnologije iz plastične, estetske i rekonstrukcijske kirurgije, kao
i kontroverze u ovim specijalnostima koje brzo napreduju i stalno se mijenjaju.
Posebno ističemo održavanje satelitskog simpozija o opeklinama i brojne radionice.
Split, kao što znate, po drugi put ugošćuje naš kongres i potrudit ćemo se da,
pored stručno-znanstvenog dijela, iskoristimo i dio vremena za zajedničko
neobavezno i opušteno druženje.
Svim sudionicima Kongresa želim puno uspjeha u stručnom radu i ugodan
boravak u Splitu.
dr. sc. Zdravko Roje, dr. med.
Predsjednik Organizacijskog odbora
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WELCOME
Dear colleagues, friends and guests,
It is my honour and privilege, on behalf of the Croatian Society of Plastic,
Reconstructive and Aesthetic Surgery and Organising Committee to welcome you at
the 7th Croatian Congress of Plastic, Reconstructive and Aesthetic Surgery with
international participation.
I am especially delighted that we have managed to organise this Congress in
Split from October 01-05, 2008. Split is a Dalmatian cultural and tourist centre.
Celebrating a 1700 years of its existence, Split is waiting for you with an open heart
and soul. You will enjoy the warm and friendly Croatian and Mediterranean hospitality.
Our Congress venue will be the Le Méridien Lav Hotel, one of the most beautiful and
luxurious hotels in the Mediterranean. We will ensure your stay is filled with maximum
comfort and unforgettable memories.
We believe that the scientific programme has the highest quality. As in our
previous Congresses, numerous eminent guest speakers will be presenting state of
the art lectures covering various areas of our specialty. We will also learn about cutting
edge technologies and discuss controversial topics associated with this fast
advancing and ever changing field. We particularly emphasise the satellite
symposium on burns and numerous workshops.
It is for the second time that Split is hosting our Congress, and we shall do our
best to use this opportunity for professional and scientific work, and relaxed socialising
alike.
I wish all participants much success in their scientific work and a pleasant stay
in Split.
Zdravko Roje, MD, DS
Organising Committee President
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ORGANIZATORI / ORGANISERS
Hrvatsko društvo za plastičnu, rekonstrukcijsku i estetsku kirurgiju Hrvatskog
liječničkog zbora
Croatian Society of Plastic, Reconstructive and Aesthetic Surgery of the Croatian
Medical Association
Medicinski fakultet Sveučilišta u Splitu
University of Split, Faculty of Medicine
Odjel za plastiču kirurgiju i opekline, Kirurška klinika, Klinički bolnički centar Split
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split
MJESTO ODRŽAVANJA / CONGRESS VENUE
Le Méridien Lav Hotel, Grljevačka 2A
21 312 Podstrana - Split, Hrvatska / Croatia
POKROVITELJI / UNDER THE AUSPICES OF
Ministarstvo zdravstva i socijalne skrbi Republike Hrvatske
Ministry of Health and Social Welfare of the Republic of Croatia
Ministarstvo znanosti, obrazovanja i športa Republike Hrvatske
Ministry of Science, Education and Sports of the Republic of Croatia
PREDSJEDNIK KONGRESA / CONGRESS PRESIDENT
dr. sc. Zdravko Roje, dr. med. / MD, DS
e-mail: zroje@krizine.kbsplit.hr, zdravko.roje@st.t-com.hr
Odjel za plastičnu kirurgiju i opekline, Kirurška klinika, Klinički bolnički centar Split
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split
Šoltanska 1 - Križine, 21 000 Split, Hrvatska / Croatia
Tel. / Phone: +385 21 557 457, Fax: +385 21 464 554
ORGANIZACIJSKI ODBOR / ORGANISING COMMITTEE
Predsjednik / President: Zdravko Roje
Dopredsjednici / Vice Presidents: Danko Brajčić, Rado Žic
Tajnik / Secretary: Zlatko Vlajčić
Članovi / Members: Zdenko Stanec, Željka Roje, Mario Zambelli, Marko Margaritoni, Rudolf
Milanović, Zdenka Kekez, Radoje Perišić, Ivan Utrobičić, Bojan Štambuk, Miroslav
Ercegović
ZNANSTVENI ODBOR / SCIENTIFIC COMMITTEE
Članovi / Members: Neven Olivari, Davor Mijatović, Milomir Ninković, Zdravko Roje, Zdenko
Stanec, Sanda Stanec, Ivo Džepina, Mišo Virag, Egon Eder, Andrej Banić, Vedran Uglešić,
Mario Zambelli, Marko Margaritoni, Radojko Ivrlač
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TEME / TOPICS
1. Jednodnevni poslijediplomski simpozij Međunarodnog društva za estetsku
plastičnu kirurgiju: ‘Oblikovanje tijela i dojke’ - 02. listopada 2008. I ISAPS
Postgraduate 1-Day Symposium: Refinements in Breast & Body Contouring -
October 2, 2008
2. Oblikovanje i pomlađivanje lica / Facial Contouring and Facial Rejuvenation
3. Kirurgija i rekonstrukcija dojke / Aesthetic and Reconstructive Breast Surgery
4. Satelitski simpozij o opeklinama / Satellite Symposium on Burns
5. Slobodne teme / Free Topics
POZVANI PREDAVAČI / INVITED SPEAKERS
Foad Nahai (Atlanta, Georgia, SAD / USA)
Thomas Biggs (Houston, Texas, SAD / USA)
Ruth Graf (Paraná, Brazil / Brasil)
Giovanni Botti (Salò, Italija / Italy)
Federico Mayo (Madrid, Španjolska / Spain)
Janek Januszkiewicz (Auckland, Novi Zeland / New Zealand)
Miodrag M. Colić (Beograd, Srbija / Serbia)
Milomir Ninković (München, Njemačka / Munich, Germany)
Marina Ninković (Innsbruck, Austrija / Austria)
Zoran Arnež (Ljubljana, Slovenija / Slovenia)
Zdenko Stanec (Zagreb, Hrvatska / Croatia)
Jan Koller (Bratislava, Slovačka / Slovakia)
Ali Barutçu (Izmir, Turska / Turkey)
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM
SPLIT, Croatia, October 01 - 05, 2008
October 02, 2008
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM
BOTTI G
Salò, Italy
botti@villabella.it
AUTOPROTHESIS TECHNIQUE: RECENT ADVANCEMENTS
AUGMENTATION - MASTOPEXY: DEMYSTIFYING SURGICAL PLANNING
JANUSZKIEWICZ J
Auckland, New Zealand
janek@xtra.co.nz
REFINEMENTS IN SURGICAL AUGMENTATION OF ASYMMETRIC
AND CONSTRICTED BREAST
JANUSZKIEWICZ J
Auckland, New Zealand
janek@xtra.co.nz
NAHAI F
Atlanta, Georgia, USA
nahaimd@aol.com
MASTOPEXY AUGMENTATION:
TWO OPERATIONS WITH OPPOSING GOALS
BREAST AUGMENTATION – PEROAREOLAR APPROACH UPDATE
STANEC Z
Clinic for Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
zstanec@kbd.hr
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - FOTONA)
KURTOVIĆ D
WORKSHOP: FOTONA
BENIGN SKIN LEASIONS REMOVAL WITH ER:YAG LASER
Private Practice Ear - Throught - Nose – Aestetic Surgery, Split, Croatia
The Erbium (Er:YAG) laser is excellent tool for removal of all common superficial
lesions in a very precise and controlled manner. This laser can gently ablate the
epidermis micron layer-by-layer to smooth-out skin without thermally affecting
surrounding tissues, but when needed it can provide controlled deep thermal effects
and coagulation.
The lecture is giving an overview of more than 8 years of experiences in removal of
benign skin lesions with Er:YAG laser.
LASER TREATMENT OF AXILLARY HYPERHIDROSIS WITH1064 NM
PULSED LASER LIGHT
MALETIĆ D
Policlinic "Dr. Maletić", Daruvar, Croatia
Laser treatment of axillary hyperhidrosis is a novel technique, which enables surgeons
to permanently solve the axillary hyperhidrosis problem in a minimally invasive, but
highly effective way.
This lecture describes the procedure which is performed using a pulsed, 1064 nm,
Nd:YAG laser, includes a study of first 10 cases performed in 2008 in Croatia, as well
as a comparison of results attained by other practitioners.
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s međunarodnim sudjelovanjem
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - FOTONA)
SKIN REJUVENATION WITH FRACTIONATED ABLATIVE ER:YAG LASER
VOLOVEC L
AAMV Surgery, Brežice, Slovenia
The Erbium (Er:YAG) laser has been recognized as the most suitable laser for
ablative laser skin rejuvenation treatments. With the recent introduction of the
fractional technique, standard Erbium Peels gained a new modality. Fractionated
Erbium Peels enable less invasive treatments, thus reducing recovery time, and still
maintain high rejuvenation efficacy.
This lecture describes the treatment technique and presents an overview of cases
treated in a one-year period.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - ANTIAGING)
BLASCHKE F
Hamburg, Germany
info@praxis-schwanenwik.de
SPLIT, Croatia, October 01 - 05, 2008
WORKSHOP: ANTIAGING
BEAUTY AND THE BREAST
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - ANTIAGING)
COLIĆ MM
NINE STEPS FOR SUCCESSFUL TOTAL BODY LIFT
Center for Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrad, Serbia
drcolic@eunet.yu
Lower body lift has recently became very desirable procedure due to sudden weight
loss, but on the other hand requires special attention because of various risks,
especially in the postoperative period. Operative time is usually much longer,
depending on the number of the procedures included in the total body lift, such as
volumetric buttock reshaping, inner and outer thigh lift, abdominoplasty, lower leg
reshaping by lipoplasty and brachioplasty.
Different techniques can be applied for each of these procedures, depending on the
tissue mass to be safely removed and the remaining tissues and their shape be
adequately restored.
Proper measurements must be be taken first in the standing position, pulling the
hanging tissues upwards. We usually start the operation with the patient in the prone
position by removal of the excess skin from the back side. That gives us the exposure
to the gluteal mass where the Pascal-LeLouarn flap is outlined, raised and turned
downwards over itself to create the buttock volume. After lateral thigh undermining by
special instrument or liposuction, the tension is released and wound closed in tanga
manner. The patient is then turned on the back and abdominoplasty performed. In
most cases upper abdominal undermining is done by liposuction only (Saldanha or
Avelar technique) so most of the vessels are preserved and seroma formation
prevented. Classical undermining is performed in the medial line only with abdominal
wall tightening and umbilical relocation. After wound closure the incisions then run
obliquely downwards following inguinal creases and the inner thigh skin completely
undermined, pulled upwards and laterally to enable its incomplete rotation which
provides thinning of the entire medial thigh. In extreme cases the vertical incision
cannot be avoided. Reshaping of the lower legs, i.e. inner knees, calves and ancles
is performed with very fine cannulas. The final procedure is usually brachioplasty
which cannot be performed by liposuction only, except in rare cases, but requires
skin resection with longitudinal scar or, in some cases, with the scar hidden in axilla.
Elastic foam bandages are very useful in the postoperative period to avoid excessive
bruises. Very special attention must be paid to the recovery period which can initially
last up to one week, with variations in blood analysis. Minor early complications very
often occur and must be prevented by intensive antibiotics coverage and other
treatments in the intensive care unit. Secondary corrections are also relatively
common as minor procedures under local
anaesthesia.
If necessary, breast lift is usually performed in the second stage.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - ANTIAGING)
GRAF R
LIPOABDOMINOPLASTY
Department of Plastic Surgery, Federal University of Paraná, Paraná, Brazil
ruthgraf@bighost.com.br
Currently, multiple surgical techniques are available for abdominal contouring, based
on variations in patients’ anatomy and their goals, including liposuction, miniabdominoplasties,
and full abdominoplasties, among others.
The advent of liposuction dramatically altered the field of body contouring surgery
and vastly improved our ability to contour the abdomen. There has been an ongoing
debate about performing liposuction on an undermined abdominoplasty flap, the use
of wetting solutions, and the safety of combining plastic surgery procedures with
abdominal contouring surgery.
Abdominoplasty and liposuction have often been performed together by reducing the
skin resection to the region above the pubis [8-10], or by limiting liposuction to the
flank and dorsal areas [4, 5]. These approaches, however, have limitations either of
skin resection, leaving residual skin laxity in the supra-umbilical area, or of abdominal
lipoplasty, since the abdominal skin flap is widely undermined and remains thick after
traditional resection.
One of the most interesting and recently described technique is the "lipoabdominoplasty"
described by Saldanha in 2003 [13, 14]. It combines liposuction of the
entire abdomen and flanks, reduced undermining, complete midline aponeurotic
plication, and traditional abdominal skin flap resection. This new approach offers
some advantages and reduces the most common complications seen with classic
abdominoplasty technique.
With lipoabdominoplasty, we’ve been noticing significant reduction in seroma,
hematoma, and distal flap necrosis. From the last 2 years, we haven’t been using
any drainage system. This became feasible because of the lessened flap undermining
and Baroudi’s quilting sutures reducing dead space.
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - ANTIAGING)
GRAF R
VERTICAL BREAST REDUCTION AND MASTOPEXY WITH
A CHEST WALL FLAP
Department of Plastic Surgery, Federal University of Paraná, Paraná, Brazil
ruthgraf@bighost.com.br
Goals/Purpose. The author used the vertical scar breast reduction/mastopexy and
a chest wall based-flap passing under a loop of the pectoralis muscle to maintain the
upper pole fullness for a long-term follow up.
Technique. As the result of the vertical incision use and the elevation of an inferior
chest wall based-flap, divided at its inferior subcutaneous attachment and maintained
in the cephalic position by a loop of pectoralis muscle, the scar is unobtrusive and the
shape is optimal, with lasting fullness at the upper pole.
The patient is drawn at the upright position and the surgery is done with the patient
at a slight dorso-flexion. The points of the vertical scar are similar to the periareolar
approach and the vertical line is drawn according to the pinching maneuver
maintained 2 cm above the infra-mammary fold.
During the procedure, inside the demarcation area, all the skin is deepithelized and
the breast is divided 1 cm inferior to the areola through the glandular tissue until the
pectoralis muscle. Then the chest wall based-flap is created undermining inferiorly
until the infra-mammary fold and lateral and medially leaving tissue for the future
columns.
Just above these flap a loop of the pectoralis muscle is created 2 cm broad and wide
enough to pass the chest wall based-flap under the loop and to sutured it to the fascia
of the pectoralis muscle until the 2nd intercostal space. At this point the excess breast
tissue is removed and the breast is closed by bringing the columns together first and
then skin without tension.
Results. Long-term follow up indicates the maintenance of the full upper pole of the
breast and satisfaction of nearly all the patients.
All complications, which included steatonecrosis and skin dehiscence below the
areola, resolved spontaneously or with a small additional surgery 6 months later.
Among the advantages of this technique are:
Breast upper pole fullness with the patient in a supine position and maintenance
of breast position with dorsal decubitus.
Adequate breast projection with patients in a supine position. Areola remains in
a good location, with a minimal breast descent.
Vertical scar that does not cross the new inframammary crease with a better
quality due to less skin tension achieved through internal sutures of breast tissue.
Conclusion. An aesthetically pleasing breast requires a proper shape and adequate
skin cover, with a nipple-areola complex at the apex of the mound.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM (WORKSHOP - ANTIAGING)
The technique presented achieves theses goals with a vertical scar and the results
are maintained with the upper pole fullness for a long period.
The achievement of a good aesthetic result in mammaplasty requires an adequate
shape, nice skin coverage and a nipple-areola complex on the top of breast projection.
With the traditional techniques, breast shape was accomplished with dermal sutures
that would relax along the years, resulting in a descent of all breast tissue.
Performing the vertical scar technique associated with chest wall based flap and
bipedicled major pectoralis muscle flap, it is observed a minimal breast descent
providing a better aesthetic outcome in a long-term follow-up. With this technique,
breast tissue is divided and repositioned where desired, maintaining breast shape
regardless of dermal sutures.
NAHAI F
Atlanta, Georgia, USA
nahaimd@aol.com
BREAST REDUCTION: WHAT MATTER MOST, SCARS
OR PEDICLES?
BODY CONTOURING: ADVANCED CONCEPTS
ROJE Z
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split, Split,
Croatia
zroje@krizine.kbsplit.hr
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
ISAPS - POSTGRADUATE ONE-DAY SYMPOSIUM
LOWER PEDICLE MAMMOPLASTY REVISITED - APPLICATION OF MODERN
CONCEPT TO A STANDARD TECHNIQUE
ŽIC R, Vlajčić Z, Stanec Z
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
rado.zic@zg.htnet.hr
In spite of more recent techniques of breast reduction, the inferior pedicle technique
is time-tested and still a very popular option. The reasons for that are the best
sensibility and vascularity of the nipple comparing to any other technique, relatively
ease in learning and performance, and applicability to almost all breast sizes and
iugulum-nipple distances.
The main drawback of this technique, apart from time-consuming deepitelization and
tension at the inverted T junction point which is well known for all Wise pattern
techniques, is descent of the breast tissue over the time causing bottoming out. With
our modification is possible to make a "dermal cage" which will effectively fix and
prevent the descent of the breast tissue.
The difference in the surgical technique compared to the stand method is preservation
of the dermal wings, from the area of skin and breast tissue resection on the sides,
and their fixation to the pectoral fascia above and on the sides thus forming a dermal
cage which will prevent the bottoming out of the breast and will give good projection
to the nipple areola complex.
Key words: Inferior pedicle-Modification-Breast reduction-Reduction Mammoplasty
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
7 th Croatian Congress Of Plastic,
Reconstructive And Aesthetic Surgery
October 02 - 05, 2008
FACIAL CONTOURING AND FACIAL REJUVENATION
SPLIT, Croatia, October 01 - 05, 2008
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s međunarodnim sudjelovanjem
FACIAL CONTOURING AND FACIAL REJUVENATION
BARUTÇU A
A PROBLEM BASED APPROACH TO RHINOPLASTY
Plastic and Reconstructive Surgery Department, Dokuz Eylül University Hospital, Izmir,
Turkey
bapras@alibarutcu.com
In 1931, Jacque Joseph described the rhinoplasty in his book: "Nasenplastik und
Sonstige Gesichtplastik nebst Mammoplastik". He set the stages of rhinoplasty, what
would later become the standard rhinoplasty technique of the seventies. He gave us
the incisions and showed us that we could incise and trim alar and upper lateral
cartilages, remove bone and cartilaginous hump and fracture and position of nasal
bones. He demonstrated that we could safely alter the size and the shape of the nose
and give the patient more acceptable aesthetic results.
Many plastic surgeons advocated some changes in Joseph’s technique. But however,
many of these changes were merely different ways of doing the same technique
rather than improvements in the end result or in the philosophy.
After using this standard technique for more than twenty years, I have noticed that I
was doing the same noses on different faces. When people see my patients, they
agree with: "Yes, they are Dr. Barutçu’s noses." Or in your country: "Yes, they are Dr.
Zambelli or Dr. Vlajčić’s noses." Because they are as factory made.
The same noses in different faces brought me to a problem based approach for each
nose. In this approach I classify the noses into two main group:
1. Easy noses: They don’t require all classic steps of rhinoplasty and they only
need small surgical procedures.
2. Difficult noses: They require additional surgical procedures over classical
rhinoplasty steps.
With this approach I’m doing different noses for each face, ritting their own faces.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
BEDEKOVIĆ V
OPEN RHINOPLASTY: DIFFERENT TECHNIQUE OR
DIFFERENT APPROACH
University Hospital "Sisters of Charity", Zagreb, Croatia
MID-FACE LIFT BETWEEN AESTHETIC AND FUNCTION: THE BEST WAY TO
CORRECT LATROGENIC LOWER LID DEFORMITIES
BOTTI G
Salò, Italy
botti@villabella.it
THANKS TO THE MID FACE LIFT, THERAPY OF THE AGING FACE
HAS FINALLY COME TO COMPLETION
BOTTI G
Salò, Italy
botti@villabella.it
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
FACIAL CONTOURING AND FACIAL REJUVENATION
CHEMICAL PEELS - A BRUSH IN THE HAND OF A PHYSICIAN
ČARIJA A, Puizina-Ivić N
Clinical Hospital Split, Split, Croatia
antoanela.carija@st.t-com.hr
Reversing the aging process has generated tremendous interest throughout history.
Ancient texts describe the application of certain substances to the skin in an attempt
to rejuvenate the appearance. The modern era of chemical peeling was introduced
at the turn of the century beginning with MacKee, a dermatologist who began using
phenol to treat facial scars. Scientific investigation was finally undertaken by plastic
surgeons and dermatologists, who delineated the indications and limitations of these
procedures and improved safety and efficacy.
The chemical peel produces a controlled partial thickness injury to the skin. Following
the insult to the skin, a wound healing process ensues that can regenerate epidermis
from surrounding epithelium and adnexal structures, decrease solar elastosis, and
replace and reorient the new dermal connective tissue. The result is an improved
clinical appearance of the skin, with fewer rhytides and decreased pigmentary
dyschromia. Chemical peel may also remove pre-cancerous skin growths. There is
some evidence that it may reduce the risk of skin cancer.
Several products are currently available for rejuvenating the skin, including over-thecounter
superficial peeling agents and deeper peeling agents that should be applied
only by a physician in a controlled setting. In our presentation, we would like to give
an overview of types of chemical peels, their indications, performing techniques,
advantages and disadvantages.
Although chemical peel may be performed in conjunction with a facelift, it is not a
substitute for such surgery, nor will it prevent or slow the aging process. The clinician
should assess each patient, explain the alternatives, and then decide on a course of
action. The correct peeling agent needs to be chosen if chemoexfoliation is decided.
If performed correctly, the chemical peel can give excellent results with many satisfied
patients.
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02_tema F:Layout 1 24.9.2008 16:10 Page 29
7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
RELATION BETWEEN FUNCTIONAL AND AESTHETIC NASAL SURGERY
DOBROVIĆ M
Private Otorhinolaryngological Practice, Zagreb, Croatia
mladen.dobrovic@zg.t-com.hr
Many surgeons consider cosmetic rhinoplasty to be one of the most challenging facial
plastic surgical procedures. What distinguishes the art of rhinoplasty from other facial
plastic procedures is the paramount importance that the nose plays in both form and
function. Preoperative endonasal assesment and causes of functional nasal disorders
are discussed. The rhinoplasty surgeon must be cognisant of this vital function of the
nose at all times that he may either correct a preexisting functional impairement or
avoid the potential pitfall of creating one.
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
FACIAL CONTOURING AND FACIAL REJUVENATION
OVERVIEW TO THE DORSAL NOSE AUGMENTATIONS WITH AUTOGENOUS-
ALLOPLASTIC GRAFTS, TREATMENT AND ITS COMPLICATIONS
EMSEN IM
Department of Plastic Reconstructive and Aestethic Surgery, Numune State Hospital,
Erzurum, Turkey
ilterisemsen@hotmail.com
Background: Nasal augmentation required following a trauma or a rhinoplasty
operation poses a challenging problem to many plastic surgeons. Currently, allografts
and autologous tissues are used for nasal augmentation; however, an ideal technique
has not yet been described. Although preferred for augmentation of different parts of
the body or alloplastic materials, most of are still controvery for nasal augmentation.
Material and methods: we followed up the patients for 5 years review in 17
secondary cases. First used grafts or materails in each patient were presented.
Unpleasant appearance in each patient was reviewed and our choice was presented.
Oldest operation date was 1994. Eight men, Nine women patients were included to
this study. All cases were secondary case.
Results: We found that major cause of the absorption in autogenous groups was no
used cover tissue of the autogenous. In alloplast groups, major causes of the infection
was that non-sterile placement and using of the alloplast more than necesaary.
Discussion: In this study, the early and late results of the graft materials for nasal
augmentation are presented, and their advantages and disadvantages are discussed
with a review of the literature. Operated patients in different centers were also
included to this study to show the long follow up results. Their operation techniques
in that centers and using materials or grafts were mentioned in case presentations.
After studying this article, the participant should be able to:
1. Understand about which material will use, possible side effects and its
symptoms, and ideal treatment options for nasal augmentation.
2. Answers were presented to basic questions on reconstruction for nasal
augmentations.
3. Solutions were advised on the light of the complications and satisfactory
results.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
GLUŠAC B
THE NEWS IN THE RHINOPLASTY
Private Practice Ear - Throught - Nose, Makarska, Croatia
glusac.surgery@hi.t-com.hr
Rhinoplastic surgery is the oldest, the most common, and the most controversial
surgical procedure in esthetic facial surgery.
Modern goal of rhinoplasty would be to solve both functional and esthetic problem of
the patient. First goal is functional and than the esthetic correction of the nose.
Now days tendency is a traumatic approach, minimal invasive surgery, with maximal
result, without postoperative scars (edema, bleeding, swelling), and with fast recovery.
Already 5 years we use endoscopic approach in rhinoplasty, by fiberendoscop,
endocamera and monitor we control during the operation bone and cartilage of the
hump, septum, and soft tissue of the pyramid. Thanks to modern technology, precise,
sharp instruments and optical control, there are no more complications like residue
of the hump, open roof of the pyramid, etc. We save time, what is very important for
the fast recover of the patient.
Presentation of the patient, closed technique 7 minutes - endoscopic approach.
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
FACIAL CONTOURING AND FACIAL REJUVENATION
GRAF R
ENDOBROW AND MIDFACE LIFTING
Department of Plastic Surgery, Federal University of Paraná, Paraná, Brazil
ruthgraf@bighost.com.br
Aesthetic improvements of the upper third of the face have been a challenge for
nearly a century. Brow ptosis management has undergone evolutionary changes from
the classic coronal open brow and anterior hairline techniques to the more recently
described less-invasive techniques such as minimal incision lateral brow lift and
endoscopic brow lift.
Since the introduction of endoscopic brow lifting in the mid 1990’s, videoendoscopic
surgery has become widely accepted as a method for rejuvenation of the upper third
of the face, mainly to achieve eyebrows and forehead elevation. It has many
indications and it is performed to correct eyebrow ptosis and to treat glabellar rhytids
created by corrugators, depressor supercilii and procerus muscles.
Several factors, including natural aging, facial nerve injuries and facial trauma may
cause brow ptosis, although congenital or hereditary factors may also cause this
condition. Aging and gravitational forces lead fat and soft tissue of the cheek to drift
downward in relation to the underlying bony skeleton. Eyebrow lifting and/or forehead
lifting is not a new concept, however, videoendoscopic technique for these procedures
is relatively new.
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02_tema F:Layout 1 24.9.2008 16:10 Page 33
7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
FACIAL REJUVENATION WITH SMASECTOMY AND FAME
USING VERTICAL VECTORS
GRAF R 1 , Groth AK 2 , Pace D 2 , Neto LG 2
1 Department of Plastic Surgery, Federal University of Paraná, Paraná, Brazil
2 Pietà Medical Center, Curitiba, Brazil
ruthgraf@bighost.com.br
The quest for better results in the midface after a face lift has led to the repositioning
of a structure called the malar fat pad. Finger-assisted malar elevation (FAME)
consists of detaching the malar fat pad from the underlying SMAS, which allows for
the elevation of this structure.
Two hundred five patients (189 females and 16 males) from January 2002 to August
2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty,
SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty,
and lipofilling. The midface fixation technique consisted of a stitch from the malar fat
pad and SMAS flap to the periosteum at the zygomatic arch which was performed in
every case.
Elevation of the midface and improvement of the nasolabial fold and the mandible
contour were obtained in all cases. Facial aging should be evaluated as a global
process instead of a segmented one. Aging occurs in every structure of the face in
different ways, depending on the vector of descent, thereby treatment must be
individualized. We have observed improvement of the midface when using the FAME
procedure in a rhytidoplasty with SMASectomy with deep fixation.
Key words: Facial rejuvenation, FAME, SMAS, Rhytidoplasty
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
FACIAL CONTOURING AND FACIAL REJUVENATION
HARMONY IN FACIAL REJUVENATION - AN ECLECTIC PHILOSOPHY
JANUSZKIEWICZ J
Auckland, New Zealand
janek@xtra.co.nz
There are conflicting doctrines or schools of thought for the best surgical approach
to the ageing face. Patients and surgeons alike can be seduced by the promise of
'the latest greatest new procedure'. Adopting or promoting a new technique of
facelifting will have merit when motivated by scientific advancement and improved
patient outcomes, less so when stimulated by commercial opportunity.
A more certain path to sustainable success includes responsibly balancing the drive
for progress against the core values and ethics of surgical practice, and finding that
balance between innovation versus conservatism. Pushing surgical boundaries and
evolving new techniques is commendable but not a license to abandon surgical
integrity, nor a permit to crass promotionalism.
This paper describes my personal approach to planning, communication and surgical
strategy borrowing eclectically from the many excellent contributions of our surgical
'fathers'. The objective is the patients own youthful ideals to create a harmony of
features rather than a distortion of nature.
The emphasis is on vertical vectors without tension on the soft tissue profile while
enhancing the malar and submalar regions, shrewd use of lipostructure or fat grafting,
and only opening the neck when necessary.
Successful facial rejuvenation in the modern era requires an aesthetic awareness
particularly for youthful beauty, a broad knowledge of the diverse operative strategies
available to surgeons, and clinical insight as to when best to apply these various
techniques. No one method will serve every case.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
NAHAI F
RHYTIDECTOMY: CONTEMPORALY CONCEPT OF FACE AND NECK
LIFT FOR FEMALES AND MALES
Atlanta, Georgia, USA
nahaimd@aol.com
SELECTING THE BEST PROCEDURES FOR FACIAL REJUVENATION
NAHAI F
Atlanta, Georgia, USA
nahaimd@aol.com
NAHAI F
Atlanta, Georgia, USA
nahaimd@aol.com
THE NEEDLE VS THE KNIFE IN FACIAL REJUVENATION
AND CONTOURING
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FACIAL CONTOURING AND FACIAL REJUVENATION
PANFILOV D
Serbia
panfilov@clinicolymp.com
FACIAL ANALYIS AND SURGICAL CONCENQUENCES
We have learned about faces more in the last 20 years as in the 20.000 years before.
There are 10 200 different possible facial expressions (compared with only 10 180 chess
game variations theoretically possible). We need anatomic, physiologic, psychological
knowledge and artistic ability to search after the ultimate demand of our patients to
look better and not altered.
Evolutional and social changes should be respected and we should employ a lot of
fantasy to compose such a facial harmony which is up to date. A new entity of
PROSOPOPLASTY has been created to describe a combination of changes of
different mosaic stones of the face standing in front of us. Each and every face is
unique. Therefore the planning and prescription for any facial surgery must be
individually created.
Different projections of the face will be discussed as well as the new entity of
dermography. Complication and pitfalls should be discussed to enable us to avoid
them and treat them if they occur.
MIDI facelift should be presented as authors’ preference for patients between 35 and
45 years of age. Analysis of 200 MIDI factelifts within 4 years will be discussed.
Author will use his experiences of over 2000 facelifts which were the foundation for
his textbook by “Springer”: ”AESTHETIC SURGERY OF THE FACIAL MOSAIC”
which was announced as the most competent in this field worldwide (“PRS”, July-
August 2007).
SKIN AGING – PREVENTION AND ADEQUATE TREATMENT
PUIZINA IVIĆ N
Surgical Clinic, Clinical Hospital Center Split, Split, Croatia
RAČIĆ G
Split, Croatia
GENERAL CONCEPT OF RHINOPLASTY SURGERY
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
STANEC S, Stanec Z, Žic R
CURRENT TRENDS IN FACIAL FILLERS
1 Policlinic "Edumed", Zagreb, Croatia
2 Clinic for Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
sstanec@edumed.hr
Aesthetic volume rejuvenation with fillers continues to be a very popular procedure
that is sought by growing number of patients who seek a more youthful appearance.
Recent advances in soft tissue augmentation materials, techniques and approaches
have greatly increased the therapeutic options available to our patients. With proper
techniques and skills, these products can restore the facial youthfulness with relative
ease and little or no downtime for patient recovery. The following presentation will
focus on the most popular dermal and subdermal fillers that have stood the test of
time, as well as those that offer innovative advances and approaches.
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FACIAL CONTOURING AND FACIAL REJUVENATION
CHEMICAL FACE AND SKIN IMMEDIATE LIFTING WITH ENDOPEEL
TECHNIQUES
TENENBAUM A
Health, Medicine, Social Services, Lugano, Switzerland
drpeeling@aol.com
Aims of endopeel techniques using carbolic acid mixed with fatty acids:
1. To realize a face and neck lifting chemically without any scars with immediate
results but with half a year duration.
2. To propose to the patients a chemical lifting instead of surgery.
3. To realize a chemical lifting in the forbidden or dangerous surgical areas.
4. To maintain longer a surgical lift.
5. To have an alternative to botulinum toxinum for the muscles of the 1/3 lower part
of the face in hyperfunction, without paralysy.
6. To have an alternative to skin tightenings medical devices with immediate effect,
without pain and ½ year duration.
Methods: On animals. An injection of 0.1 ml of carbolic acid 7% into the pretibial muscle
of the 25 Wistar rats has been done to evaluate the alteration in its gait and the
histopathological alteration in the applied muscle. The choice of the pretibial muscle of
rats was made because of the shape similarity and weight of the depressor muscle at
the corner of the mouth in humans. A subcutaneous injection of 0.5 ml of same product
has been done on 4 Wistar rats. The animals were observed for up to 205 days.
Results:
1. Endopeel techniques produce a myofibro(fibrillo)lysis and inflammatory reaction
for a period of approximately 1 month.
2. The muscular changes are reversible almost totally.
3. The muscle is the best place to apply endopeel techniques owing to the efficacy,
control and time of its action.
4. There was no signs of necrosis or abscesses during all of the study.
Conclusion and applications for patients:
Endopeel techniques use a product made of carbolic acid mixed with fatty acids, which
provokes an immediate muscular mass lifting by the process of intermyofibers
vacuolization with a complete restitution ad integrum after 7 months.Endopeel
techniques are a new weapon for plastic surgeons,allowing in less than half an hour to
lift up the eyebrow, the cervico facial area (chemical lifting without scar) and to provoke
in the same time a skin volumetric tightening (1/3 medium of the face).
Endopeel techniques stretch also the skin anywhere where applied. Endopeel
techniques are also used for the treatment of the platysma bands as the sad baggy low
jowls with immediate effect, with better improvement due to the immediate amelioration
of the physical quality of the skin.
Endopeel techniques are also improving the unaesthetic problems due to the
hyperfunction of the muscles of the lower lip.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
TENENBAUM A
COMPLICATIONS OF FILLERS AND ENDOPROSTHESIS
Health, Medicine, Social Services, Lugano, Switzerland
drpeeling@aol.com
Most of plastic surgeons as dermatologists still think that resorbable fillers are not
dangerous and that permanent fillers are dangerous.
In fact, all kind of fillers give the same complications like granulomas, nodules, necrosis,
migrations, infections, persistent oedema and so on.
Granulomas are the most frequent complication, which can appear even after lipofilling!
Any patient who got filler or an endoprosthesis should get systematically each 6 months
an ultrasonography 20 mHz and not 7.5 MHz for the follwoing reasons:
1. Which seems to be a capsula post filler or endoprosthesis on 20 MHz is in fact
a convergence of refringerent structures, which may be fibroblasts and not a real
capsula. That explains migrations.
2. On 7.5 mHz the diagnosis is restablished.
3. Also on 7.5 mHz before granulomas manifest them clinically, they can be
detected and through the aspect of the granuloma in ultrasonography, it is now
possible to know which filler or endoprosthesis is involved.
4. So it is easily demonstrated that granulomas resulting from silicon injection are
stable and less dangerous than granulomas resulting from polylactic acid - This
prooves that silicon (permanent filler) is less dangerous in case of granuloma
complication than polylactic acid (resorbable filler) .
5. Also the most dangerous granulomas which are unstable and destroy the whole
dermis are those resulting from mixed biphasic fillers, combining a metacrylat
(permanent) with collagen (resorbable) or hyaluronic acid (resorbable). Such
granulomas can never be stopped even if treated by corticotherapy or 5 fluro
uracil.
But such mixed biphasic fillers are presented commercially as "resorbable fillers with
longer duration"!
Acrylats are less dangerous if they are:
- not hydrogel,
- if they have no monomers,
- if they contain no metallic ions,
- if their stability is done with gamma sterilization.
The factors which lead mostly to granulomas are the dental focus, the parodontosis, the
facelift , the mesotherapy, the acupuncture, botox, and so on, 6 months before and 6
months after the filler or endoprosthesis procedure.
Mixing fillers in same areas lead to the highest percentage of granulomas.
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FACIAL CONTOURING AND FACIAL REJUVENATION
VIŽINTIN Z
Slovenia
LASER-TISSUE INTERACTION; LASER LIPOLYSIS – OVERVIEW;
FRACTIONAL LASER TECHNOLOGIES – OVERVIEW
ZAMBELLI M
Private Policlinic "Zambelli", Rijeka, Croatia
dr@mariozambelli.com
ŽGALJARDIĆ Z
Opatija, Croatia
CONCEPTS IN RHINOPLASTY
SMART LIPO (HEAD AND NECK)
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FACIAL CONTOURING AND FACIAL REJUVENATION
ŽIC R
FAT GRAFTING
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
rado.zic@zg.htnet.hr
Many fillers are suggested for filling different type of deformities only few have
survived the test of time and have proven themselves good enough for continuous
use. The characteristics that are required for an ideal filler to have are numerous and
different types of fillers meet them in different aspects.
Its needles to say that fat tissue is one of the most important structural elements of
human body and has crucial part in shaping every individuals body. Many of our
colleagues in the past realized the importance of fat tissue and tried in numerous
ways to use it for aesthetic and reconstructive procedures.
Fat tissue has many characteristics of ideal filler as its nontoxic, biocompatible,
autogenous, gives a natural change and can be placed anywhere where we have a
good blood supply. Not only that you can sculpture the body by liposuction but you
can use the same fat cells as filler in another region. The technique of lipofilling is well
defined today and good results can be achieved if it is used correctly.
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FACIAL CONTOURING AND FACIAL REJUVENATION
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
SPLIT, Croatia, October 01 - 05, 2008
AESTHETIC AND RECONSTRUCTIVE
BREAST SURGERY
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s međunarodnim sudjelovanjem
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
ARNEŽ Z
UPDATE OF PERFORATOR FLAPS BREAST RECONSTRUCTION
Ljubljana, Slovenia
zoran.arnez@kclj.si
IMPLANT BASED RECONSTRUCTION
BECKER H
The Hilton Becker Clinic of Plastic Surgery, Florida, USA
BIGGS T
Houston, Texas, USA
tbiggsmd@aol.com
BOTTI G
Salò, Italy
botti@villabella.it
BOTTI G
Salò, Italy
botti@villabella.it
BOTTI G
Salò, Italy
botti@villabella.it
SIMULTANEOUS MASTOPEXY AND AUGMENTATION
PTOTIC AND HYPOTROPHIC BREAST TREATMENT
TECHNICAL REFINEMENTS IN VERTICAL MAMMAPLASTY
(OPTIMIZING TECHNIQUE IN BREAST REDUCTION)
TUBEROUS BREAST CORRECTION BY MEANS
OFPARENCHYMA EXPANSION
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
REDUCING SEROMA FORMATION IN THE LATISSIMUS DORSI FLAP
DONOR SITE WITH PRP AFTER BREAST RECONSTRUCTION
BUDI S, Žic R, Vlajčić Z, Milanović R, Rudman F, Martić K, Stanec Z
Clinic for Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
sbudi@kbd.hr
Aim: The aim of this study is to gain of the benetift of platelet-rich-plasma (PRP) in
reducing seroma formation in the latissimus dorsi flap donor site after breast
reconstruction.
Methods: The authors evaluated the efficacy of PRP in conjunction with closed
suction drainage in a series of 5 latissimus flap donor sites comparing with other 5
patients who underwent breast reconstruction with latissimus dorsi flap operated in
traditional way (closed suction drainage without PRP).
Results: The PRP patients had clinically detectable postoperative seroma rate of
20% (1 patient) comparing with detectable postoperative seroma rate of 80% (4
patients) among the untreated patients. Seroma measurements have been done on
8 th postoperative day in both groups.
Conclusion: Despite only a few patients (5) treated with PRP, the use of PRP in
latissimus flap donor site seems to be effective in reducing postoperative seroma.
Further research in form of controlled trials is required.
BREAST SURGERY IN CROATIA: WHAT AND HOW WE WORK?
BULIĆ K, Mijatović D, Ivrlač R, Veir Z
Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
kresimir_bulic@yahoo.com
Breast surgery represents an important part of plastic, aesthetic and reconstructive
surgery. We will present the results of a survey conducted among the members of
Croatian Society for Plastic, Aesthetic and Reconstructive Surgery regarding the
amount and type of breast operations performed in their institutions. Aesthetic
operations will be analyzed separately from oncological and from reconstructive
operations. We will try to compare results with other similar studies and try to identify
strong and weak sides of breast surgery in Croatia.
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s međunarodnim sudjelovanjem
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
SOME CURRENT POSSIBILITIES FOR BREAST RECONSTRUCTION:
TRAM AND LD VS. EXPANSION PLUS IMPLANT
COLIĆ MM
Center for Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrad, Serbia
drcolic@eunet.yu
The pedicled TRAM flap based on superior epigastric artery is very safe and reliable
flap which provides sufficient autologous tissue for natural breast reconstruction.
Depending on quantity of abdominal tissue used for reconstruction, the breast can be
sufficiently large and ptotic to achieve symmetry in a single operative procedure.
Latissimus dorsi musculocutaneous flap based on the thoracodorsal artery should
always be combined with an implant and inserted through the separate incision in
the new submammary fold, to achieve adequate volume and symmetry with the
opposite breast.
On the other hand Becker type prosthesis-expander in a single device can also
provide very good result and create natural breast shape. Through the mastectomy
scar, we first make large skin envelope and then put the device under the great
pectoral muscle. Through the valve placed subcutaneously in anterior axillary line it
is gradually filled afterwards. Special attention is paid to the lower part of the pocket
in order to create submammary crease symmetrical to the opposite side. Since outer
lumen is gel-filled and inner lumen saline-filled, usually a nice breast shape can be
obtained, but always after a certain period of overexpansion to create some degree
of ptosis.
Both methods are compared since they are performed a single operative procedure
except in cases of opposite breast suspension. Valve is removed and the nippleareola
complex reconstructed after the final shape is obtained.
DŽEPINA I
"Glumičić" Medical Group, Zagreb, Croatia
ivo.dzepina@zg.htnet.hr
CORRECTION OF BREAST ASYMMETRY
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
SUBFASCIAL BREAST AUGMENTATION - ADVANTAGES AND OUTCOMES
IN SUBFACIAL BREAST AUGMENTATION
GRAF R
Department of Plastic Surgery, Federal University of Paraná, Paraná, Brazil
ruthgraf@bighost.com.br
Since the initial use of implants for breast augmentation, surgeons have been seeking
the proper plane into which the implant might be placed. The original site, behind the
gland, resulted in implant edge visibility, especially in thin women, and was believed
to result in a higher incidence of fibrous capsular contractures than the later
retropectoral plane. Despite the advantage of concealing the implant border, some
surgeons felt that implant distortion occurred with contraction of the muscle. The use
of the retrofascial plane seems to yield benefits of both planes without the deficits.
The purpose of this technique is to demonstrate a new pocket for the mammary
implant. The development of the subfascial technique brings a new concept in
shaping the breast, in an effort to create a more natural appearance.
Regarding the access for breast augmentation, both inframammary and transaxillary
endoscopic approaches can be used. In the patients with post partum breast atrophy
with skin flaccidity, the periareolar incision is indicated to remove skin excess.
The main reason for using the implant in the subfascial space is that it enables us to
get the soft tissue coverage at the superior pole of the implant without the downside
of raising the muscle.
VERTICAL BREAST REDUCTION AND MASTOPEXY WITH
A CHEST WALL FLAP
GRAF R
Department of Plastic Surgery, Federal University of Paraná, Paraná, Brazil
ruthgraf@bighost.com.br
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AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
BREAST REDUCTION: FREE SKIN GRAFT OR PEDICLE FLAP FOR THE
SUPPLY OF THE MAMMILLA
IGNATOVSKI B, Bascevan B, Varas Fuenzalida JA, Kovačević J
Policlinic for Plastic Surgery and Gynecology "Arcadia", Daruvar, Croatia
poliklinika@poliklinika-arcadia.hr
Reduction mammaplasty in gigantomasty is a very convenient procedure because it
improves the appearance of breasts, alleviates or eliminates the consequences of
hypertrophy, such as back pain and poor posture, and it has a very positive impact
on patient's psychological condition.
In young women, reduction mammaplasty is a preventive measure, which prevents
the development of functional consequences mentioned in this paper. In elder women,
reduction mammaplasty is of great benefit because of improved posture and more
efficient brething. Above all, the patient will feel more comfortable in her own body,
and therefore happier.
In this paper, special attention is paid to the choice of the method of reduction
mammaplasty surgical technique in younger and elder patients. A constant dilemma
remains of weather to use the free skin flap or one of the flaps on the pedicle for the
supply of the mammilla.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
FAT NECROSIS AS A LATE COMPLICATION IN CONVENTIONAL
TRAM FLAPS
IVRLAČ R, Mijatović D, Jakić-Razumović J, Bulić K, Veir Z, Bagatin D, Smuđ S
Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
radojko.ivrlac@zg.htnet.hr
The transverse rectus abdominis myocutaneous flap has played a substantial role in
the reconstruction of defects secondary to mastectomy. Fat necrosis is a particularly
important finding during postoperative period becouse it can be mistaken for a local
recurrence. Alternatively, local recurrences may be dismissed as areas of fat necrosis.
Fat necrosis is a relatively minor of complication of TRAM flap breast reconstruction
but one that can induce anxiety and inconvenience for patients and concerns about
tumor recurrence.
Although such reconstruction has not been shown to adversely affect survival or local
recurrence, specific screening modalities for recurrence in this population of patients
have not been delineated.
Group of 6 patients with evident fat necrosis were examined retrospectively at the
author's institution, among 25 patients who had undergone reconstruction with
conventional unilateral TRAM flaps, during the period from 2002 - 2004.
Fat necrosis is usually presented as the formation of a small, firm area of scar tissue
in the flap. On a mammogram this may appear as an area of increased density with
or without calcifications, a nodular density, or an area of lucency.
A review of the literature demonstrates that mammography, ultrasound, magnetic
resonance imaging,computed tomography, scintimammography and biopsy have all
been used as adjuncts to clinical examination in detecting recurrence.
Conclusion: The diagnosis of fat necrosis is usually a clinical one, made by palpation
of a nodule. This diagnosis is necessarily subjective, and can be detected
mammographically when calcifications were found in the reconstructed breast.
The most reliable form of diagnosis of fat necrosis after TRAM flap reconstruction
remains fine-needle, core or open biopsy if indicated.
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AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
POST-MASTECTOMY RECONSTRUCTION: OPTIMISING THE ONCOLOGIC
AND AESTHETIC IMPERATIVES
JANUSZKIEWICZ J
Auckland, New Zealand
janek@xtra.co.nz
A review of my personal experience of more than 500 breast reconstructions over
the past 15 years will focus on technique-oriented lessons learned. How to marry
established method with innovative procedures including modern prostheses,
endoscopic flap harvesting and 'scarless' reconstruction.
The first principle of breast reconstruction is that the reconstruction must not interfere
with the oncologic management. A study of outcomes of 248 immediate breast
reconstructions in 212 patients (1996-2003) compared results in 173 patients with
early stage breast cancer versus 39 patients with advanced stage (Stage IIb or
greater) breast cancer. Mean follow-up was 42 months. Autogenous tissue only
reconstruction was used in 82% of advanced stage patients versus 67% of early
stage disease. Only 1 patient in the advanced disease group experienced delay to
commencing adjuvant therapy, there was no evidence that reconstruction negatively
influenced disease progression in the advanced stage group (local recurrence rates
5.1%, distant recurrence 10.3%) and the incidence of surgical complications and
reoperation rates were both lower in the advanced stage group than in the early stage
group. Patient satisfaction scoring outcomes were equally high in the two groups.
The surgical outcomes of immediate breast reconstruction in advanced stage breast
cancer are comparable those in early stage disease.
Immediate breast reconstruction should be considered for all patients irrespective of
disease stage...but patient selection is critical.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
JOHANNES S, De Brujin HP
Johannesburg, South Africa
sjohannes@infodoor.co.za
MASTOPEXY WITH 3-D PRESHAPED MESH
Numerous techniques for mastopexy and breast reduction have been described,
indicating the absence of a generally accepted method that fulfils the essential criteria
of obtaining a pleasing long lasting result.
To present recurrent ptosis, mesh has been inserted into the breast successfully and
safely for almost three decades. A mesh implant system has recently been developed
consisting of 3-dimentional, preshaped, feather soft woven mesh in different sizes,
with concomitant sizers to facilitate the insertion.
It acts as an internal bra and replaces the attenuated natural suspensory system of
the breast. Indications are breast ptosis, breast hypertrophy with ptosis and contra
lateral ptosis correction after cancer reconstruction. A total of 170 patients (327
breasts) were treated with the longest follow-up of five years. No serious
complications were encountered.
Physical and x-ray examinations were still possible. The mesh composite shows a
high pliability, resulting in being very supple and not palpable under the skin, thus
contributing to a normal and pleasing texture and feeling of the elevated female
breast. No recurrent ptosis or scar hypertrophy has been observed.
Pre-shaped, three-dimensional knitted polyester mesh appears to posses the ideal
characteristics to reinforce a ptotic breast during mastopexy in order to prevent
recurrent ptosis.
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AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
CORRECTION OF PTOSIS WITH THE BENELLI PERIAREOLAR
MASTOPEXY TECHNIQUE
KARABEG R 1 , Karabeg A 2
1 Clinic for Plastic, Reconstructive and Hand Surgery, University Clinical Centre Sarajevo,
Sarajevo, Bosnia and Herzegovina
2 Private Policlinic for Aesthetic Surgery "Karabeg", Sarajevo, Bosnia and Herzegovina
rkarabeg@hotmail.com
Introduction: Most patients seeking mastopexy would like have fuller and lifted
breasts. Of course, evaluation of the ptotic breasts always take into accounts quality
of skin and gland, skin-gland relationship and nipple position. Goals of mastopexy
are restoration of shape,volume and nipple-areola position.
Choosing the best option is very challenging .There are several mastopexy
approaches: periareolar, vertical, short horisontal "T", "J or L", long horisontal (longer
or traditional full lenghth). Especially, problems arrises when patient doesn't want any
scar except periareollar.
Aim: Present our results in cases of moderate to major ptosis when patients doesn't
accept any scar except periareollar.
Patients and method: We operated 54 patients but present 44 cases (which could
be followed up) operated in period of 48 months (2002 - 2006) in Policlinic "Karabeg".
Patients were operated with typical Benneli method (four glandular flaps and
periareolar round block cerclage stich): 32 have had augmentation mastopexy and 12
have been operated with mastopexy technique allone.
Results: Patients were satisfied in most cases. Just two of them accepted more
appropriate technique in secondary operations(short horisontal "T"). We haven't had
infection, postoperative bleeding or neuroma formation with chronic pain. Implant
malposition occured in one case just on one side. Scars were acceptable. In five
cases (three wide scars and two irregular areolla) we did secondary operation:
reexcision and closure in proper shape.
Conclusion: Periareolar mastopexy is indicated in cases with minimal to moderate
nipple displacement, normal skin elasticity, minimal skin excess, firm and fibrous
parenchyma and firmly adherent skin-parenchyma complex.
We can obtain acceptable results (for patients) even in less then optimal situations
and in cases for which more appropriate method of mastopexy is at least vertical
mastopexy.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
AUGMENTOPEXY: A MULTI-PLANE APPROACH FOR AUGMENTATION
IN A PTOTIC BREAST
KHAN UD
Belveder Private Clinic, London, UK
mrumarkhan@aol.com
Aim: Augmentation mammoplasty in a ptotic breast is a challenging operation and
augmentation with mastopexy can have a potentially high morbidity. On the other
hand, many patients are reluctant to have obvious external scarring on the breast.
Augmentopexy is a multi-plane approach for augmentation with internal-pexy in Class
A and early Class B ptosis using an inframammary incision. It can also be useful for
improving minor nipple areolar complex positional asymmetries in vertical axis.
Materials and methods: Augmentopexy procedure was performed in 32 patients
(10 unilateral, 22 bilateral) for augmentation and internal lift in minor to moderate
ptosis. Average age of the patient was 33.5 years (range 19-50) with an average size
implant of 340cc (range 200-605). Infra mammary incision was used and submuscular
muscle splitting biplane procedure was dissected for implant placement and
prepectoral/subglandular plane was used for lifting and anchoring breast parenchyma
at a higher level. All procedures were performed with out drains as day cases.
Results: All patients had unremarkable recovery with aesthetically good results
obviating obvious external scarring. One patient is expected to require conventional
skin reduction and nipple repositioning who did not agreed initially to a formal
envelope reduction mastopexy with augmentation.
Conclusion: Augmentopexy is a multi-plane approach for augmentation in breasts
with Class A and early Class B ptosis. Procedure can also be used to improve minor
nipple areolar complex positional asymmetries. In selected cases, this approach
avoids external scarring in patients who are not prepared to accept formal envelope
reduction mastopexies.
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s međunarodnim sudjelovanjem
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
KHAN UD
INCIDENCE OF COMMON BREAST AND CHEST ASYMMETRIES IN
AUGMENTATION MAMMOPLASTY
Belveder Private Clinic, London, UK
mrumarkhan@aol.com
Aims: Breast and chest asymmetries are commonly seen in patients requesting for
augmentation mammoplasty. A careful preoperative assessment is required to identify
these asymmetries and planning must include an informed consent, different options
available and their possible limitations. Surgical approach may need some
adjustments to obtain an optimal result.
Material and methods: From January 2007 to December 2008, 312 augmentation
mammoplasties were performed. Mean age of the patients was 30.4 years + 9.1
(range 18 - 58). Mean size of the implant was 325 cc + 53 (range 200 - 620). Different
size implants were used in 9% patients with a mean difference of 56.3 cc + 33.7
(range 20 -180). Patients were assessed for asymmetry of breast, chest, distance
between jugular notch to nipple areolar complex and nipple areolar complex to
inframammary crease. Overall prevalence of tuberous breast was also recorded.
Muscle splitting biplane technique was used and the same surgeon performed
procedures.
Results: Chest was symmetrical in 89.7% (n = 280) and chest deformities or
asymmetries were seen in 11.3% (n = 32). Chest was more full or prominent in 6.7%
(n = 21) on the left side as compared to 1.9% (n = 6) on the right and was significant
(P value < 0.003) Pectus excavatum and carinatum was seen in 0.6% and 1%
respectively. Breasts were symmetrical in 53.5% (53.5%). Left breast was larger in
29.8% (n = 93) as compared 16.7% (n = 52) on the right and the difference was
significant (P value < 0.001).
Nipple areolar complex level (NAC) was same on two sides in 67.2% (n = 207). Left
NAC was lower in 21.4% (n = 66) than 11.2% (n=35) on the right and the difference
was significant (p value

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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
KHAN UD
MASTOPEXY WITH AUGMENTATION IN MUSCLE
SPLITTING BIPLANE
Belveder Private Clinic, London, UK
mrumarkhan@aol.com
Aim: Augmentation with mastopexy is a commonly performed procedure to restore
breast volume and to re-establish inframammry crease and nipple areolar interrelationship.
Muscle splitting biplane is a newly described pocket for augmentation
and is combined with periareolar and vertical mastopexy.
Materials and methods: Vertical scar and peri-areoalar mastopexies markings are
used for skin envelope reduction and nipple mobilisation and muscle splitting biplane
pocket is used for implant placement. Procedure was performed, in 35 consecutive
mastopexies, 11 vertical scar and 24 were periareolar mastopexies. After initial
subcutaneous dissection down to inframammary crease, lower subglandular pocket
is dissected and submuscular muscle splitting pocket is reached at the level of middle
and lower third of sternum. Average age of the patient was 32.6 years (range 19 - 43)
with average implant size of 315cc (range 200 – 525 cc) with an average blood loss
of 44 gms (range 10 - 111). Patients had no drains and were mostly treated as a day
case.
Results: Correction of ptosis is achieved with good three-dimensional results without
any nipple areolar complex or skin envelope vascular compromise. No infection,
haematoma or wound problems were recorded. A follow-up of three years showed
one minor residual periareolar puckering correction with other wise good results.
Conclusion: Muscle splitting biplane pocket is a good option for mastopexy with
augmentation in primary as well as secondary procedures. The pocket can be used
in periareolar as well as vertical scar skin reductions.
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s međunarodnim sudjelovanjem
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
BREAST RECONSTRUCTIONS WITH IMPLANTS
MARGARITONI M, Selmani R, Bukvić N, Bekić M
County Hospital Dubrovnik, Dubrovnik, Croatia
marko.margaritoni@du.htnet.hr
Aim: The authors analyze 8-year experience in breast reconstructions with implants
as a common part of breast cancer treatment.
Methods: We have analysed period of last eight years of breast reconstructions
performed on Dept. of plastic and breast surgery County Hospital Dubrovnik
comparing the number and results of ; reconstructions with autologues tissues and
prothesis, primary vs. secondary reconstructions and results of breast cancer tretment
with radical or conservative surgery vs. skin-sparing mastectomies with
reconstructions. We present our results and discuss possible early and late
postoperative complications.
Results: On our department we perform about 300-350 breast surgery procedures
annually including diagnostic and oncologic breast surgery as well as prophylactic,
oncoplastic, reconstructive and finally aesthetic breast surgery.
In last 8 years we have analyzed 223 breast reconstructions (out of more than 2400
breast surgery procedures) with or without intervention on the opposite breast. Out
of them, 106 (47,5 %) were performed by various techniques of autologues tissues
alone, 95 (42,6 %) patients were treated with implants alone, and 22 (9,9 %)
reconstructions were performed with combination of autologues tissues and prothesis.
In the same period we have also performed additional 79 reconstructive procedures
(reconstructions of NAC complex, reconstruction of thoracic wall and corrections of
the shape, volume or scar).
The number of serious early or late postoperative complications is insignificant.
Conclusions: Breast reconstruction is not only aesthetic, but first of all functional
surgical approach in breast cancer treatment. It became a common and integral part
of comprehensive breast surgery which is oncologically more radical than breast
conserving surgery with better local control, mostly avoiding postoperative
radiotherapy and decreasing number of local recurrence and sometimes offering also
better cosmetic results.
We prefer primary reconstructions whenever it is possible as well as reconstructions
with autologues tissues especially in younger patients, but in last several years we
follow up increasing interest for breast reconstructions with implants becouse of less
time-consuming surgery, less scars and no donor site morbidity.
On our department, breast reconstructions are routine procedures which are planned
from the beginning of entire treatment for each patient individually.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
ONCOPLASTIC BREAST SURGERY: WAYS TO MAXIMIZE ONCOLOGICAL
SAFETY AND COSMETIC RESULT
MARGARITONI M
County Hospital Dubrovnik, Dubrovnik, Croatia
marko.margaritoni@du.htnet.hr
IMPLANT SELECTION IN PRIMARY BREAST AUGMENTATION
MAYO F
Private Practice, Madrid, Spain
info@doctormayo.es
Breast augmentation with implants is the one of the most frequent plastic surgery
procedures all over the world. Last year it were implanted 50000 silicon prosthesis in
Spain, and this number will increase in 2008. Between the different shapes and
volumes of the silicon implants I have developed a personal method to select what I
think is the best option for each patient. I consider in my decision different aspects,
such as the patient desires, the preoperative breast volume, the quality of the skin,
and the sports practice. I also consider five measures of the breast: sternal notchnipple
distance, areola diameter, breast wide, desired breast wide and areolainframammary
fold distance. In the last 3 years 552 prosthesis were implanted with
this method with a very satisfactory result. 96% were under pectoralis Major muscle
and 4% subglandular. 65% with and inframammary scar and 35% periareolar. 65%
were anatomical and 35% round. All of them are filled with cohesive silicone gel.
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AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
MAYO F
Private Practice, Madrid, Spain
info@doctormayo.es
SECONDARY BREAST IMPLANT SURGERY
Nowadays breast surgery with implants is one of the most habitual procedures in our
professional practice. This has led to more frequent visits in which we receive patients
who already have breast implants and require difficult surgical solutions. Secondary
breast surgery with implants is in my opinion one of the most demanding surgeries
for the plastic surgeon and where the diagnosis and a correct surgical plan are
essential to be able to solve these complicated situations.
Infections, capsular contracture, rotational problems, doubble buble, water fall
deformity, implant malpositioning or bad scars are situations that we need how to
evaluate and properly treat. In my personal practice, 20% of the surgery with implants
is secondary, and that is something that is going to increase in the future, due to the
great number of breast augmentation patients with implants.
BREAST RECONSTRUCTION WITH PEDICLE LD FLAP
MIJATOVIĆ D, Ivrlač R, Bulić K, Veir Z, Bagatin D, Đurić Ž
Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
head.plasurg@kbc-zagreb.hr
During the period 1996 - 2008 we have performed 166 breast reconstruction using
pedicled myocutaneous latissimus dorsi flap. In most cases we have used breast
implants to improve the aesthetic postoperative result.
It is less time consuming method for breast reconstruction in comparison with free
flaps and allows us to inlarge the number of breast reconstruction.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
OUR EXPIRIENCES IN REDUCTION MAMMAPLASTY WITH
VERTICAL SCAR
MIJATOVIĆ D 1 , Ivrlač R 1 , Bulić K 1 , Veir Z 1 , Bagatin D 1 , Đurić K 1 , Smuđ S 1 , Eljuga D 2
1 Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
2 Private Practice "Eljuga", Zagreb, Croatia
head.plasurg@kbc-zagreb.hr
We are presenting our expiriences using the vertical mammaplasty in breast
reduction. By our opinion this is the metod which allowes the best aesthetic results
in breast reduction.
BREAST AUGMENTATION: SALINE AND SILICON IMPLANT DIFFERENCES
- WHEN SALINE AND WHEN SILICONE
NAHAI F
Atlanta, Georgia, USA
nahaimd@aol.com
BREAST REDUCTION / MASTOPEXY: TECHNICAL UPDATE AND
TECHNICAL PEARLS (DIFFERENT VERTICAL TECHNIQUES / SPAIR,
BENELLI, MATURA, RIBEIRO AND ECT.)
NAHAI F
Atlanta, Georgia, USA
nahaimd@aol.com
REHABILITATION AFTER BREAST SURGERY AND RECONSTRUCTION
NINKOVIĆ MA
Innsbruck, Austria
marina.ninkovic@uibk.ac.at
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s međunarodnim sudjelovanjem
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
NINKOVIĆ MI
IMPACT OF RADIATION ON BREAST RECONSTRUCTION
Munich, Germany
milomir.ninkovic@uibk.ac.at
NINKOVIĆ MI
Munich, Germany
milomir.ninkovic@uibk.ac.at
PEDICLE FLAPS IN BREAST RECONSTRUCTION
TIMING AND CHOICES USING AUTOLOGOUS BREAST RECONSTRUCTION:
IMMEDIATE VS. DELAYED RECONSTRUCTION
NINKOVIĆ MI
Munich, Germany
milomir.ninkovic@uibk.ac.at
PEDICLE BREAST RECONSTRUCTION
ROJE Z
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split, Split,
Croatia
zroje@krizine.kbsplit.hr
VERTICAL MASTOPEXY AND REDUCTION WITH RUTH GRAF
TECHNIQUE: OUR EXPERIENCES
ROJE Z
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split, Split,
Croatia
zroje@krizine.kbsplit.hr
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
SKIN-SPARING MASTECTOMY WITH NAC PRESERVATION AND PRIMARY
RECONSTRUCTION – FOLLOW UP
STANEC Z, Žic R, Stanec S, Budi S, Milanović R,Vlajčić Z, Rudman F, Martić K
Clinic for Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
zstanec@kbd.hr
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s međunarodnim sudjelovanjem
AESTHETIC AND RECONSTRUCTIVE BREAST SURGERY
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with international participation
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SATELLITE SYMPOSIUM ON BURNS
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s međunarodnim sudjelovanjem
SATELLITE SYMPOSIUM ON BURNS
GLAVINA N
Rijeka, Croatia
KOLLER J
OUR EXPERIENCES WITH CHILDREN BURNS IN
CHILDREN HOSPITAL RIJEKA
TISSUE ENGINEERING AND SKIN SUBSTITUTES FOR COVERING
EXCISED BURN WOUNDS.
Department for Burns and Reconstructive Surgery, University Hospital Bratislava, Bratislava,
Slovakia
koller@ruzinov.fnspba.sk
Aim: Tissue engineering (TE) is an emerging interdisciplinary area of research and
product technology focused on the development of biologically based replacement of
cells, tissues and organs for the repair or restoration of tissues or organs. In tissue
engineering, autologous or allogenic cell populations are usually expanded by in vitro
culturing and seeded onto scaffolds which then guide the growth and proliferation of
new cells in three dimensions. One of the subjects of TE is human skin replacement.
As a matter of fact, tissue engineered skin was the first commercially available product
of tissue engineering.
Methods: In extensive full thickness skin burns large amounts of necrotic skin are
a big source of a variety of toxic substances. They serve as an excellent nutrient
medium for the growth of all kinds of pathogenic microorganisms as well. Infection,
originating from the burn wound itself, has deleterious effects on the progress and
outcome of the burn disease. For these reasons it is necessary to excise the necrotic
tissues as soon and possible and to cover and/or close the large wound subsequently.
For burn wound coverage, which is temporary, many products can be found on the
market. Burn wound closure can be long-term, or permanent. Skin substitutes for
wound closure are of biological, synthetic, or biosynthetic origin. For the last few
decades allogenic skin was the mostly preferred skin substitute for wound closure.
Progress in biological sciences and in tissue engineering resulted in development of
combined biosynthetic products which combine synthetic scaffolds seeded either
immediately, or later, by in vitro cultured both autologous and allogeneic cells.
Results: At the Bratislava University Hospital Burn Department several options for
post-excision wound closure are available. Biological skin substitutes are produced
at the Central Tissue Bank, which is integral part of the department. They include
cadaveric skin allografts, porcine skin xenografts and amniotic membranes. In vitro
cultures of keratinocytes, fibroblasts, and other cell types are provided routinely in
the cell culture laboratory. Biosynthetic membranes based on collagen and
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with international participation
SATELLITE SYMPOSIUM ON BURNS
hyaluronan conjugate and human amniotic membranes are used as cell carriers. Our
experience with the use of commercially available dermal substitutes like Integra ® is
limitred. We developed our own surgical tactics for excision and closure of extensive
burn wound, which will be presented.
Conclusions: Success in excisional treatment of extensive deep burns depends on
the availability to close the excised wound immediately. In cases, where the extensive
burn surface precludes closure by autologous skin grafts, availability of skin substitues
plays a decisive role. Recent developments in tissue engineering expanded the
choice of skin substitutes used for burn wound closure.
LOJPUR M
Split, Croatia
RECENT PROGRESS IN NUTRITIONAL SUPPORT
OUR EXPERIENCES WITH BURNS TREATMENT IN RIJEKA
PIRJAVEC A
Department of Plastic Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia
spirjavec@yahoo.com
PRIMOŽA G
Slovenia
MODERN ASPECTS OF FLUID MANAGEMENT
EUROPEAN PRACTICE GUIDELINES FOR BURN CARE AND EUROPEAN
PRACTICE GUIDELINES FOR BURN MANAGEMENT THERAPY
ROJE Z
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split, Split,
Croatia
zroje@krizine.kbsplit.hr
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s međunarodnim sudjelovanjem
SATELLITE SYMPOSIUM ON BURNS
SPARAŠ B
Maribor, Slovenia
EXPERIENCES WITH BURNS TREATMENT IN MARIBOR
A GROUP CASUALTIES, AS A FIRE BURN MASS DISASTER
STRITAR A, Zorman P, Šteblaj S
Department of Plastic Surgery and Burns, University Medical Centre Ljubljana Ljubljana,
Slovenia
albin.stritar@amis.net
Introduction: Doctrine of a burn disaster management is mostly organised and
planned by military-sanitary authorities and civil disaster health care services.
Regarding a disaster fire/burn plan, a Burn centre must be able also, by a law, to
admit a group of fire/burn victims 24 hours a day.
There is no exact consensus how much patients could be hospitalised. It depends to
severity of burn trauma and other logistic circumstances. If a Burn centre seems to
be overloaded, some triaged victims must be transported to other burn units. Nearly
every five years we come across with a burned group hospitalisation and the last one
is analysed.
Methods: Six burned patients were admitted to a Ljubljana Burn centre, regard a
dust explosion in a tyre factory (01.08.2005). At emergency – trauma ward they where
triaged as one outpatient burn, three minor burns and two big burns. At start, they had
been transported by ambulances of an urgent medical care service. By a rescue
scheme, it was still a micro level, where there was not a need for extra additional
emergency support.
In the University hospital all of trauma surgeons and anaesthetists were mobilised,
as a plastic surgeon too. One patient was directed to an outpatient department, five
of them were admitted to a Burn centre department. Two big burn patients were
intubated and had entered a department through an intensive zone, where they
stayed. They were monitored by an anaesthetist. Three minor burn patients had
entered parallel a department through a non-intensive zone, where they were treated
by a surgeon.
Results: It must be stressed, that a double-lane enter of victims had shortened a
time of acceptance. We had found too, a very good horizontal coordination in between
a plastic surgeon and three anaesthetists. In surgical working process a plastic
surgeon on call was mobilised for toileting and getting ready a patients for next day
surgery. Also some ward nurses and scrub nurses were mobilised for additional help.
Next day a primary surgery of major burns was done, while minor burns were
operated in next five days. All burned victims survived.
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SATELLITE SYMPOSIUM ON BURNS
Conclusion: Burn centre must be ready for a group burn disaster. Outer vertical
communication and inner horizontal action must be guaranteed with full responsibility
and self-sacrifice of a staff. If any step of a treatment scheme and surgical ladder is
totally completed, an adequate final result is achieved.
TOMIČIĆ H
Zageb, Croatia
OUR EXPERIENCES WITH BURNS TREATMENT IN ZAGREB
OUR EXPERIENCES WITH BURNS TREATMENT IN SPLIT
UTROBIČIĆ I
Division of Plastic Surgery and Burns, Surgical Clinic, Clinical Hospital Center Split, Split,
Croatia
iutrobicic@krizine.kbsplit.hr
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SATELLITE SYMPOSIUM ON BURNS
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with international participation
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FREE TOPICS
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FREE TOPICS
SURGICAL AND RECONSTRUCTIVE TREATMENT OF PATIENT WITH
ELECTRICAL HIGH VOLTAGE BURNS
ARIFI H, Zatriqi V, Buja Z, Zejnulahu Y, Klokoci A
Department of Plastic Surgery, University Clinic Center of Kosovo, Prishtina, Kosovo
arifihysni@yahoo.com
Electrical burns in our country is common. Patient E.H. born year 1965 is admitted as
urgent center with Electrocutio, Haemorrhagia subarachnoidalis.
After the situation stabilized patient is transferred in plastic surgical department.
Main goal of this presentation is to present a rare localization of burns with destructive
changes of soft tissue and partially bones and this left tempro-parietal region, upper
part of auricular,central frontal part with heavy damages of the left eye which results
in lost of view, 2/3 of dorsum nasi with complete necrosis of ala nasi left side.
After the 15-th day of accident and when situation is stabilized the general situation
performed necrectomy the region of the head on the dorsum and radix in the nose.
After the two week total demarcation of burned parts it was indicated for intervention
and in general anesthesia we perform radical necrectomy in 2/3 upper part of nose
and reconstruction of that defect with epicrano-frontal *Converss flap, secondary
frontal defect with full thicknness graft from supraclavicular region. In the same act we
perform full necrectomy of temporal area and covering with autotransplant with partial
thickness, taken from right femoral region.
In the second operative act whch will happened after 5 weeks where is performed
dividing of the frontal flap, reconstruction of ala nasi with naso-labial flap and with
complexe auto transplants from oppositely auricular.
Patient will continue with reconstructive procedures and is planed to refine the ectropy
of the left eyelid, temporal alopecia with tissue expandes and with aesthetic and
functional correction.
Conclusion: As and any other localizations and in this our case radical necrectomy
and defect reconstruction in some phases with reconstructive methods are effective
methods and successful in minimizing the functional and easthetic consequences of
the patient.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FREE TOPICS
SECONDARY LIP AND NOSE DEFORMITIES IN CLEFT PATIENTS
BAGATIN D 1 , Bagatin T 2
1 Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
2 Policlinic for Maxillofacial, General and Plastic Surgery "Bagatin", Zagreb, Croatia
dinkobagatin@gmail.com
Aim: Secondary deformities after cleft lip and nose repair are rule not exception
although the initial repair may produce an optimal result. All patients are evaluated for
secondary surgery before the start of school.
Methods: Authors analyse most common deformities of lip and nose in clefts after
cheiloplasty and they try to explain their origin, prevention and correction. Also
patients with secondary lip and nasal deformities are analysed and new secondary
corrections of nasal deformities are presented.
Results: After cheiloplasty wider nostril/nostrils are corrected and nostril/nostrils are
shaped, collumella is elongated in bilateral deformities if necesary. Secondary
correction of the lip are individualised to the patients needs.
Conclusion: Author modifications of lip and nasal deformities give satisfactory result
in secondary procedures.
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FREE TOPICS
SUBTOTAL RECONSTRUCTION OF THE NOSE
CIKOJEVIĆ D 1 , Pešutić-Pisac V 1 , Karadža-Lapić LJ 2
1 Clinical Hospital Split, Split,Croatia
2 General Hospital Šibenik, Šibenik, Croatia
drasko.cikojevic@st.t-com.hr
Basal cell carcinoma (BCC) is the most common skin cancer, slow growing and
ulcerating with indolent behavior, however, if not resected, may cause severe injure
expanding to contiguous tissues with a biological invasive behaviour. BCC of the
nose is often a highly aggressive neoplasia with infiltrative growth pattern. It is treated
with surgical excision resulting in defects that require closure. The surgeon is faced
with many reconstructive options and but forehead, nasolabial and free flap are
commonly used technique.
In our study we present 88-year-old woman affected by basal cell carcinoma of the
nose that lasted 20 years, with downward and lateral extension to the adjacent facial
structures requiring wide resection for oncological management. Therefore, she
underwent surgical radical excision with free margin disease at ex tempore histological
examination. The definitive histological evaluation pointed out infiltrative BCC pattern
without margins involvement. In this case, the reconstruction was performed in one
stage with bilateral nasolabial advancement flap.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FREE TOPICS
PERFORATOR FLAPS IN HEAD AND NECK RECONSTRUCTION
DEDIOL E 1 , Zubčić V 2 , Uglešić V 1 , Leović D 2 , Zubčić Z 3
1 Department Maxillofacial Surgery, University Hospital "Dubrava", Zagreb, Croatia
2 Department of Maxillofacial Surgery, University Hospital Osijek, Osijek,Croatia
3 Department of Ear, Nose and Throat, University Hospital Osijek, Osijek, Croatia
emildediol@yahoo.com
Aim: Perforator flaps have proven advantages over the other soft tissue flaps,
including the potential for large flaps with long vascular pedicle of large caliber to be
appropriate for microsurgical transfer or local reconstruction. However, there are also
recognised disadvantages.Anatomic anomalies are the norm and should be
expected. Prior Doppler verification of the perforator is necessary.
Methods: From August 2006 until May 2008 at the Department of Maxillofacial
Surgery,University Hospital, Osijek and Department of Maxillofacial Surgery,
University Hospital Dubrava, Zagreb we used 22 microvascular and 7 local perforator
flaps for various head and neck sites. Prior Doppler identification of the perforator
was performed in each case.
Results: Mostly harvested free flap was anterolateral thigh flap in 19 cases (succcess
rate 18/19, 1 total loss due venous thrombosis), followed by 3 tensor fasciae latae
perforator flaps (success rate 3/3). FAMM flap was used in 4 cases (success rate
4/4), submental perforator flap in 2 cases (1 partial flap necrosis occured) and facial
artery perforator flap in 1 case (succes rate 1/1).
Conclusion: Despite the fact that surgical harvest of the flaps is more tedious and
time consuming the reality is that there is a role for these important flap types
considering their advantages (minimal donor site morbidity, accessibility, diversity,
size, bulk).
DOBROVIĆ M
SKIN LESIONS TREATED WITH RADIOFREQUENCE KNIFE
Private Otorhinolaryngological Practice, Zagreb, Croatia
mladen.dobrovic@zg.t-com.hr
Radiosurgery is surgical technique which uses waves of electrons at radiofrequency
1.7 - 4.0 Mhz to incise, excise, ablate or coagulate tissues. The fundamental
principles, historical development and applications of this technology are presented.
Radiowave surgery has been shown to rival laser and cold steel methods for healing
and precision especially in facial aesthetic surgery. Patient acceptance and cosmetic
result are clearly superior in most cases to that obtained using traditional surgical
technique.
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FREE TOPICS
RECONSTRUCTIVE APPROACHES IN THE FRONTAL BONE DEFECTS
EMSEN IM
Department of Plastic Reconstructive and Aestethic Surgery, Numune State Hospital,
Erzurum, Turkey
ilterisemsen@hotmail.com
Background: The search for the ideal bone-graft or alloplastic material substitutes
of the frontal bone defects have been the focus of many research and clinical studies.
Autografts and alloplastics are various material that combines osseointegration with
maintenance of implant volume and excellent durability.
Material and methods: The author presented his experience in 7 patients ranging
in age from 21 to 51 years (mean age 35.4 years) who underwent secondary frontal
and frontoorbital cranial reconstruction of large to medium contour defects utilizing
various (autogenous and alloplastic) materials. Follow-up ranges from 12 to 48
months (mean 30 months). Indications for secondary surgery included residual bony
contour defects of the frontal bone, fronto-orbital areas, and fronto-temporal area.
Results: There was no seen the infection, seroma, bulging and extrusions in used
materials. And, also no required revision for underfilling and another for overfilling.
Permanent contour improvement was obtained with a smooth skin surface in patients.
Discussion: Currently, surgeons have still many options in frontal bone defects
reconstruction. Many autogenous and alloplastic materials have been found and used
in reconstructions of these defects. Most important factor is to understand and decide
to which one is the most suitable in which patient. Perfect technological devices
(Three Dimension Comptuted Tomography assisted with computers), and
measurement of sizes of implant of graft could be very helpful to surgeon in preoperation.
Side effects, advantages, and disadvantages of each material have been
also extensively discussied within text.
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FREE TOPICS
WITA - PROGRAMME FOR WOUND TISSUE ANALYSES
HULJEV D 1 , Antonić D 2
1 General Hospital "Sveti Duh", Zagreb, Croatia
2 Faculty of Electrical Engineering in Osijek, Osijek, Croatia
dubravko.huljev@zg.t-com.hr
Aim: Accurate wound measurement is important task in chronic wounds treatment,
because changes of the wound size and tissue types are indicators of the healing
progress. Towards elimination of subjective wound parameters estimation, we
developed colour image processing software which analyze digital wound image, and
based on learned tissue samples performs tissue classification. Wounds generally
have a non-uniform mixture of yellow slough, black necrotic tissue and red granulation
tissue. Information about the percentage of each area is important determining factor
for the healing state of the wound.
Methods: Developed application implements advanced statistical pattern recognition
algorithm to classify individual pixels of the wound image based on colour information.
Classification parameters were learned from examples presented to the application
during the learning process. Application includes the therapy proposition module,
implemented as the fuzzy expert system with 36 rules.
Results: Results of the analysis contains the wound image represented in pseudo
colours (necrotic tissue is black, granulation red, fibrin yellow and unclassified parts
blue) as well as percentage of tissue types within the wound area. Therapy for the
analyzed wound is also proposed, based on calculated tissue percentages and user
defined wound exudation, the depth of the wound and infection.
Conclusions: Developed application for wound analysis gives objective, reliable and
reproducible results, allowing unique and objective comparison of treatment results
between different methods and different institutions. Expert knowledge is built into
the application, which means that the quality of wound image analysis depends solely
on training samples selected by a medical expert and image quality. To ensure the
wound image quality it is necessary to control the lighting conditions and the camera
settings.
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FREE TOPICS
JOVANOVIĆ M
OUR EXPERIENCE IN TREATMENT OF SCARS WITH
CONTRACTUBEX
Clinic for Burns, Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrad,
Serbia
aes.surg@eunet.yu
Excessive growth of scar may be manifested as hypertrophic scar or keloid. The
hypertrophic scar is characterized by its localization within wound margins and
tendency of partial regression, while keloid is characterized by its extension beyond
the wound margins and absence of tendency toward spontaneous regression since
its growth occasionally continues even several months and even years after injury.
Tissue has inner potential to restore either by creating new cells of the same type
(regeneration) either by replacing them with new connective tissue (cicatrization).
Every wound healing is a result of replacement of damaged tissue with new
connective tissue - cicatrization (except of fetal healing which is accomplished by
regeneration, without any scaring).
Aim: Goal of our work is to examine effect of Contratubex on wound healing and
forming of fine linear scar which is hard to detect visually.
Methods: We applied Contratubex gel on third day after suture removal in every
surgical intervention. Contratubex contains extract of Cepae (which has
antiinflammatory and anitproliferative attributes and reduces connective tissue
synthesis), Heparin natrii (provokes hydratation and softening of collagen’s structure)
and Alantoin (assistes in wound healing and provokes hydratation). All patients were
controlled after 1 month, 3 months, 6 and 12 months after surgery. Contractubex was
applied with care on scare region several times daily until all gel was absorbed.
Results: Results were excellent, scars were soft and linear. Only in several cases we
had mildly hypertrophic scars in patients who had significantly hypertrophic scaring
on previous occasions. In one case we had mild allergic local reaction.
Conclusion: Early application of Contractubex after surgical intervention contributes
in obtaining fine linear scars, coloured like normal skin, which were hardly visible.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FREE TOPICS
SURGICAL TREATMENT OF FACIAL NERVE PALSY - AUTHORS’ METHOD
JOVANOVIĆ M
Clinic for Burns, Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrad,
Serbia
aes.surg@eunet.yu
After the injury of facial nerve, facial muscles are subjected to complex series of
biochemical and histological changes, which lead to muscular atrophy if reinnervation
is not restored. Facial palsy is very difficult to manage completely.
Aim: The plan of correction has to be directed towards the following: restoration of
normal function, normal facial appearance at rest, symmetry in voluntary movements
as well as symmetry in involuntary and emotional movements.
Methods: In our study, we are using dynamic methods: using Karapandcic flaps
(transposition orbicularis oris muscle with healthy nonparalyzed side). For up part
face (beside eye) we are combined with static methods (using fascia lata) as
accessories method. All patients had unilateral complete facial nerve palsy but one
female patient who experienced the palsy of frontal branch of facial nerve.
Results: This method was successfully used to lift the eyebrow, the lid and to improve
lagophthalmus on the paralytic side, then the angle and paralytic part of the lip, to
reinforce buccal wall of oral cavity as well as to reconstruct new nasolabial fold.
Conclusion: The results were satisfactory and permanent, and also patients very
contented.
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FREE TOPICS
THE USE OF INTEGRA AS ONE STEP PROCEDURE IN SKIN
TUMOR SURGERY
LO RUSSO G, Almesberger D, Calì Cassi L, Facchini F, Dini M
Department of Plastic and Reconstructive Surgery, School of Medicine, University of
Florence, Florence, Italy
daria_almes@yahoo.it
The nose is one of the most affected areas of cutaneous malignancies. Basal
carcinoma represents the most common skin cancer and the 25% of these tumors are
located on the nose. Satisfactory cosmetic reconstruction of surgical defects of the
nose remains one of the most frequently challenge for the plastic surgeon, who has
to be aware of all the available surgical options 1 .
In the majority of the cases, nasal wounds, after cancer resection have traditionally
been covered with local flaps or skin graft, but in particular cases, our clinical
experience can demostrate a new approach to these kind of tumors. A one-step
operative procedure of composite skin graft; using INTEGRA as a dermal template
for a split full thickness auto graft.
On the basis of different pre clinical investigations 2,3 , we used INTEGRA as a dermal
component, and put on it the epidermal autograph in a one step operative procedure.
This product is particularly useful to treat small to medium skin excisions, where
complex flap-repairing techniques would be required to close the wounds. Its main
advantages are: the immediate closure of the full thickness defects, a cosmetically
acceptable appearance in terms of colour, texture, deformity and scars, the possibility
of a single surgical session and the relatively trouble-free procedure for both the
surgeon and the patient.
References:
1. Roeningk RK, Ratz JL, Bailin PL, Wheeland RG. Trends in the presentation and the
treatment of basal cell carcinomas. J Dermatol Surg Oncol.1986 aug; 12(8):860-5.
2. Fiona M. Wood Marie L. Stoner, Bess V. Fowler, Mark W. Fear. The use of a non cultured
autologous cell suspension and Integra dermal regeneration template to repair fullthickness
skin wounds in a porcine model. Burns.2007 Sep;33(6):693-700. Epub 2007
May7.
3. Chi-Sing Chu, Albert T. McManus, Natalia P. Matylevich, Cleon W. Goodwin, and Basil A.
Pruitt, Jr., Integra as a Dermal Replacement in a meshed Composite Skin Graft in a Rat
Model: A One. Step Operative Procedure, J trauma. 2002 Jan; 52(1):122-9.
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PANFILOV D
Private Clinic "Olymp", Novi Sad, Serbia
panfilov@clinicolymp.com
CHIRUGIA SEXUALIA
Looking back when I had seen the first naked patients 44 years ago, there were
(almost) no tatoos, no piercings, no special hairdressing for pubic hairs, (almost) no
underwears with indicative or ultimative messages. Since some 15 years we saw all
these things coming more and more often. The new wave of body conciousness
includes since 12 years also the gender aesthetics.
No wonder that, since about the same time we have been faced with an indication
field of our patients unknown before: reduction of labia minora/maiora and
enlargement resp. elongation of penis. In the same chapter of "CHIRURGIA
SEXUALIA" or sexual surgery, we would count: gluteal augmentation and gluteal uplift,
umbiliconeoplasty, enlargement of female breasts and lips.Special attention
should be paid to the multiple simbolism and importance of the female breast.
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FREE TOPICS
RECONSTRUCTION OF THE INFRAORBITAL DEFECTS
PENEVA M, Damevska LJ, Mirchevska E, Trenchev V, Naceska A, Peev I
Clinic of Plastic and Reconstructive Surgery, Skopje, Macedonia
mapeneva@yahoo.com
Aim: This report presents our experience with 30 patients who had infraorbital soft
tissue defects.
Methods: Most of the operations were performed under local anaesthesia.
Pathological diagnoses included basal cell carcinoma, spinall cell carcinoma,
melanoma as well as benign tumours. There was tumour infiltration in the anterior wall
of the maxillary sinus in 12% of the cases. All postoperative defects were primarily
closed using primary closure, sliding flaps (advancement, rotational), lifting flaps
(transposition), skin grafting.
Results: The follow up of the patients is 5 years. The results of the repair were
satisfactory with respect to colour match, texture and functional properties.
Conclusion: The infraorbital region is an important subunit for facial aesthetics.
Improper closure of skin defects involving this region may lead to deformity in the
lower lead and to ectropion.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FREE TOPICS
INVASIVE, AGGRESSIVE BASAL CELL CARCINOMA - CARCINOMA
BASOCELLULARE TEREBRANS
RONČEVIĆ R
Center for Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrad, Serbia
ronac@eunet.yu
Introduction: The most malignant form of basal cell carcinoma is carcinoma
basocellulare terebrans - Ulcus terebrans. The tumor occurs most frequently in the
middle part of face and the scalp. The tumor infiltrates and destroys skin, subcutis,
fascia, muscle, cartilage, bone, meninges and brain.
Patients and method: A retrospective analysis of 93 patients with aggressive
terebrans basal cell carcinoma treated surgically was performed. After excision of
the tumor in all patients various reconstructive procedures were performed / split
thickness skin grafts, large local flaps, vascularized musculocutaneous flaps,
musculocutaneous flaps transferred by microsurgical technique /.
Results: In 15 patients /16%/ the tumor developed primarily, in 30 patients /32%/
after surgical therapy, and in 49 patients /52%/ after radiation therapy. In all patients
radical surgical resection was performed. In 54 of this patients, wide, extensive,
mutilating excision were performed. In 30 of these 54 patients, postoperative radiation
therapy was given and fatal recurrence occurred in nine case /30%/. In 24 patients
postoperative radiation was not given and fatal recurrence occurred in 10 cases
/41%/.
Conclusion: The basal cell terebrans carcinoma develops mainly on recurrences,
that is on residual tumors, after inadequate surgical and radiation therapy. The most
aggressive tumors are those, which develop in residual tumors after radiation therapy.
Even with extensive, mutilating operations one can never be sure that the tumor is
radically removed. That is why in such cases, after extensive, mutilating operations,
radiation therapy is recommended, if possible. In practice, it is the last possible
therapy for such patients. The clinical picture, treatment, and course of aggressive
basal cell carcinoma of the face, scalp and neck in 10 patients will be presented.
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FREE TOPICS
RONČEVIĆ R
TREATMENT OF LARGE VENOUS AND LYMPHATIC
MALFORMATIONS OF FACE
Center for Plastic and Reconstructive Surgery, Clinical Center of Serbia, Belgrad, Serbia
ronac@eunet.yu
Introduction: Large venous /cavernous hemangioma/ and lymphatic /lymphangioma/
malformations of the face infiltrating surrounding structures present a big functional,
aesthetic and therapeutic problem.
Patients and methods: Over the years in 33 patients with large diffuse venous and
lymphatic malformations of the face, nose and ear different therapeutic procedures
were used: sclerosation, irradiation therapy, embolisation and most frequently surgical
excision of tumefaction after embolisation or intratumor ligatures.
Results: Sclerosation of venous malformation hardly gives any effect. Irradiation
therapy leaves ugly scars and irregularity on the face due to uneven involution of
tumefaction. By the excision of malformations after embolisation or intratumor
ligatures good results were achieved in all cases (19 patients). In all patient with
lymphatic malformation good results were achieved by surgical excision / 5 patients
/ or by drainage in patients with hygroma cysticum / 2 patients /.
Conclusion: By surgical excision of venous malformation after massive embolisation
or intratumor ligatures it is possible to achieved significant results. In cases with
lymphatic malformation almost always it is possible to achieved good results by
surgical excision or by drainage.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FREE TOPICS
SENTINEL LYMPH NODE BIOPSY IN TREATMENT FOR MELANOMA
- 9 YEARS EXPERIENCE
RUDMAN F, Stanec Z, Žic R, Stanec S, Budi S, Milanović R, Vlajčić Z, Martić K
Clinic for Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
frudman@inet.hr
Sentinel lymph node biopsy (SLNB) in surgical treatment for melanoma was
introduced in 1992. Since that time SLNB has taken very important place in treatment
for melanoma. Sentinel lymph node is the first node that drains specific area of the
body.
Sentinel lymph node localization is done using triple technique (limphosyntigraphy,
vital dye, intraoperative location with gamma probe).
In patients with positive sentinel lymph nodes therapeutic lymphadenectomy should
be preformed, while in patients with negative sentinel lymph nodes routine follow up
is necessary. Therefore, SLNB, minimally invasive procedure distinguishes high and
low risk patients, and patients that require systemic treatment.
Authors will present their experience with SLNB in treatment for melanoma since
1999.
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FREE TOPICS
FREE MICROVASCULAR AND FASCIOCUTANEUS FLAPS IN THE SOFT
TISSUE COVERAGE OF THE HEEL DEFECTS
SALIHAGIĆ S 1 , Hadžiahmetović Z 2
1 Clinic for Plastic and Reconstructive Surgery, Clinical Centre University of Sarajevo,
Sarajevo, Bosnia and Herzegovina
2 Center for Emergency Medicine, Clinical Centre University of Sarajevo, Sarajevo, Bosnia
and Herzegovina
sanelasalihagic@hotmail.com
The soft tissue coverage of the heel defects with different etiology represents a difficult
reconstructive problem. The difference between the cutaneus coverage of the plantar
surface of the foot and that on the dorsum has important implication for reconstruction
of the defects in these areas. The plantar skin has unique characteristics, very difficult
for proper reconstruction and there is no ideal reconstruction of that area. We have
compared two operative techniques, free micro vascular flap from different donor
areas and fasciocutanus flap from the lateral and medial tibial region.
We have evaluated early complications (haematoma, total or partial necrosis) and
late complication (stress ulcers, as result of the compression on the weight-bearing
area) in different percent using both operative techniques and functional status of the
foot in two-year postoperative period. The best operative option depends on general
and local condition, patient age, preexisting diseases, concomitant tauma and status
of the vascular system, evaluated by arteriography preoperatively.
Fasciocutaneus flap is operative options in the case of absence of the recipient vessel
for vascular anastomosis, which does not exclude micro vascular flap as a superior
method for the heel reconstruction.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
FREE TOPICS
LATISSIMUS DORSI FREE FLAP - 30 YEARS AFTER MICRO VASCULAR
TRANSFER IN LJUBLJANA
STRITAR A 1 , Šolinc M 1 , Arnež ZM 2 , Eder E 3 , Banič A 4
1 Department of Plastic Surgery and Burns, University Medical Centre Ljubljana, Ljubljana,
Slovenia
2 UCO Plastic Surgery, University of Trieste, Trieste, Italy
3 Praxis for Aestethic and Plastic Surgery, Cologne, Germany
4 University Hospital Bern, Bern, Switzerland
albin.stritar@amis.net
Objectives: Latissimus dorsi muscle, as a flat muscle of a back, was anatomically
described and operatively used in a history of medicine (Tansini 1895). After 70 years,
it was reharvested again for breast reconstruction.
Approach: Experimental and pioneered free micro vascular transfer in Ljubljana is
dated in the middle of 70`s. When a pedicle flap was reused in breast reconstruction
(Olivari 1976), microsurgical team of Ljubljana, encouraged of the author, decided to
do a free, microsurgical transfer (Godina 1978).
Methods: Mostly a free flap was used for defects of chronic lower leg osteomyelitis.
Later, a free flap was used as an urgent free flap for acute trauma defects and as a
filler flap. Rarely, in a case of bone defect a flap is harvested as a chondro-muscle
flap, because reconstruction is completed with elongation of a bone (Ilizarov 1951)
or a bone spongioplasty. Modifications, as tailored, fascia-gliding and prefabricated
flap are used, depending to a character of a defect.
Results: By experiences, short term and long term results, it was realised, that a
healthy and well vascularised tissue maintain a good tissue covercle, good healing
and regeneration of bone and anti-oedema as anti-inflammatory effect in zone of
lesion. This is a benefit in osteitis healing. First urgent free flap was done 1979. As a
filer flap it was routinely used in Romberg hemi facial atrophy with moderate results.
In covering big defects, mega flap is very well described, when muscles latissimus
dorsi and serratus anterior and scapular flap are harvested on same thoracodorsal
pedicle.
Conclusion: We pay attention that latissimus dorsi free flap still represent a golden
standard in armamentarium of a plastic surgeon, although new conservative methods
compete to a microsurgical transfer. A routine use of a "working horse" - latissimus
dorsi free flap must not ignore an anatomical considerations and operative indications
by a surgeon.
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FREE TOPICS
PRE-EXPANDED RADIAL FOREARM FREE FLAP FOR ONE-STAGE TOTAL
PENILE RECONSTRUCTION IN FEMALE TO MALE TRANSSEXUALS
ŠOLINC M 1 , Košutić D 2,3 , Stritar A 1 , Planinšek F 1 , Mihelič M 3 , Lukanovič R 3
1 Department of Plastic Surgery, Clinical Center Ljubljana, Ljubljana, Slovenia
2 Department of Plastic Surgery, Clinical Center Maribor, School of Medicine, University of
Maribor, Maribor, Slovenia
3 Department of Urology, Clinical Center Ljubljana, Ljubljana, Slovenia
plasticsurgeonzg@yahoo.com
Aim: Free radial forearm fascio-cutaneous flap is well established option for total
penile reconstruction in female to male transexual patients. However, limited width
of the flap usually does not allow urethral reconstruction and prostheses implantation
simultaneously therefore necessitating two-stage procedure. Pre-expanded radial
forearm fascio-cutaneous free flap may substantially increase both length and width
of the flap to enable successful one-stage total penile reconstruction.
Methods: Two female to male transexual patients underwent total penile
reconstruction with pre-expanded radial forearm fasciocutaneous free flap two months
after bilateral mastectomy with free nipple-areola grafting, hysterectomy and
ophorectomy. During this first phase of gender re-assignement surgery a 300cc ovalshape
tissue expander was implanted under the fascia of planned fascio-cutaneous
radial forearm free flap which was partially dissected.
A forearm fascia was incised distally and ulnarly to allow expansion. Tissue expander
was gradually inflated with normal saline twice a week during the period of two
months. After desired expansion was accomplished, a one-stage total penile
reconstruction was performed with simultaneous urethral reconstruction and silicone
prostheses implantation in both patients. Both flaps were anastomosed to the
superficial and deep contralateral epigastric vessels.
Results: Healing was uneventful and both flaps survived completely with satisfactory
aesthetic and functional result as well as patient satisfaction. Donor site morbidity
was acceptable.
Conclusion: Pre-expanded radial forearm fascio-cutaneous free flap may enable
one-stage total penile reconstruction allowing simultaneous urethral reconstruction
and prostheses implantation with satisfactory aesthetic and functional results.
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FREE TOPICS
CLASSIFICATION AND TREATMENT ALGORITHM OF POSTSTERNOTOMY
WOUND INFECTIONS
VLAJČIĆ Z, Stanec Z, Žic R, Stanec S, Budi S, Milanović R, Rudman F, Martić K
Clinic for Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava",
Zagreb, Croatia
zvlajcic@kbd.hr
The treatment of sternal wound infection still carries a high mortality. Treatment
preferences range from more conservative treatments that do not include flaps, to
more aggressive reconstructions using different types of flaps, and these could be
resolved and standardised using a proper classification with a treatment algorithm.
We propose modification of the existing classification, with different proposals for
treatment, stressing the importance of the radicality of debridement, and report our
results in 31 patients, 24 of whom were well satisfied.
Eleven were left with some pain in the chest wall, and eight each with some muscular
weakness and less than adequate cosmesis. We would also like to recommend the
omental flap as the first choice for selected cases. With our selective approach we
have achieved good functional and aesthetic results with satisfied patients.
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FREE TOPICS
LOWER EYELID RECONSTRUCTION - CASE REPORT
VUKAŠIN G, Fanfani B, Tomljenović R
General Hospital Karlovac, Karlovac, Croatia
gvuk@net.hr
Eyelid tumor excision and trauma are two common causes of eyelid defects requiring
surgical reconstruction.
Wide varieties of surgical techniques are available, and the plastic surgeon must be
able to execute technically these techniques to close eyelid defects. Preoperatively
several factors must be analyzed carefully, since they affects the surgical plan and
outcome.
Now days we have several surgical options, techniques to repair lower eyelids. The
most often used, out of direct closure are, Tenzel semicircular rotation flap,
Tarsoconjunctival bridge flap /Hughes/, Free tarsoconjunctival graft, Mustarde cheek
rotation flap.
In our General Hospital Karlovac at ENT department, we were dealing, recently, with
two patients who needed lower eyelid reconstruction /repair/.
First one was a man, 23 years old, motorist, sustained very nasty wound of his face
in a traffic accident, where lower eyelid has been involved. His problem was medium
defect and lack of hight of the lower eyelid. He suffered from epiphora, corneal
exposure and often conjunctivitis. His problem was resolved by using Tenzel
semicircular rotation flap+free mucosacartilage graft from the nasale septum.
Second patient was a woman, 83 years old, suffered from ectropion, which has
been appeared after lower eyelid tumor excision. She had epiphora end very often
conjunctivitis.
To resolve this problem we used local cutaneous Emet flap and free skin graf.
Results in both cases are very good. A man has aesthetically acceptable lower eyelid,
good hight and tension, no epiphora and infection present. Second patient an old
lady, has good tension of the lower eyelid, no ectropion, no epiphora present.
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FREE TOPICS
PERFORATOR CRURAL FLAPS - OUR EXPERIENCE
ZATRIQI V, Arifi H, Zatriqi S
Department of Plastic Surgery, University Clinic Center of Kosovo, Prishtina, Kosovo
vzatriqi@yahoo.com
Introduction: The reconstruction of soft tissue defects in crural region is still
considered as complex surgical problem even today, were the advancement of
reconstructive operative methods are very high. Lately the interest of surgeons is
been growing in reconstructing these defects with perforator flaps mostly in lower 2/3
of crural region and calcaneal region.
Material and methods: During 2006 in our ward we had 11 patients with
reconstruction of soft tissue defects in crural region by perforating flaps.
Results: Average year of patients were 52 year. 7 females and 5 males. In two cases
the defects were post traumatic and in three cases were trophic decubital ulcers.
Conclusion: Our experience in application of perforated flaps at soft tissue defects
in crural region requires better selection of patients, preoperative identification of
perforating arteries by Echo-Doppler and well trained surgical team.
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FREE TOPICS
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POSTER PRESENTATIONS
SYNDACTYILI TREATED WITHOUT SKIN GRAFT - CASE REPORT
BITRAKOVSKI Z, Bozinovski S
St. Erazmo Special Hospital for Orthopedic Surgery and Traumatology, Ohrid, Macedonia
zbitrak@t-home.mk
We are presented case of 7y. old girl with complicated syndactyli of left hand, treated
without skin graft. Treatment was in two stages; first one with application of mini
fixateur of Ilizarov and progressively divide bone and geting redundancy skin to cover
bone after division.
Method is usable for complicated syndactyli with bone convergence or fussion.
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with international participation
POSTER PRESENTATIONS
ELECTRICAL BURN INJURIES IN KOSOVO - THE EIGHT YEAR REVIEW.
BUJA Z, Arifi H, Terziqi H, Hoxha E, Kllokoqi A, Zejnullahu Y
Department of Plastic Surgery, University Clinic Center of Kosovo, Prishtina, Kosovo
zejnbuja@hotmail.com
Introduction: Electrical injuries are very aggressive pathological lesions, which
results with heavy finctional and asthetic consequences.The presentation of the
influence of the bed electrical-energetics situation in the incidence of electrical injuries
in Kosovo, clinical characteristics and treatment of of electrical burns.
Materials and methods: This retrospectiv study includes anamnestic, mechaism of
injury, the level of voltage, as well as operative data for all patients underwent surgery
for treated electrical burns from January 2000 until December 2007 in University
Clinic Center of Kosovo, Clinic of Surgery, Department of Plastic Surgery in Prishtina.
Results: Out of 1068 patients with burns treated in our depatment from January 2000
until December 2007, 182 were with electrical burns (17.25 %). There were 171 men
(93.96%) and 11 women (6.04 %) ranging in age from 2 to 67 years (mean age 33.6
year). Under mechanism of injury, 126 cases (69.23%) were with arc electrical burns
and 56 cases (30.77%) were with contact electrical burns. Under level of voltage, 36
cases (64.28%) were with low voltage electrical burns, and 20 cases (35.72%) were
with high voltage electrical burns.From total number of injuried patients 56, at only 16
cases (28.58%) are applied amputations of limbs.From analysis of sort of covering of
wound, notice that more frequent is used skin graft in 20 cases (46.51%), and other
cases local, distance, fasciocutaneus and cross flaps. The mortality rate of contact
electrical burns was 7.14%, only 4 cases had dead.
Conclusions: In Kosovo as in many of developing countries, the incidence of
electrical burns still is high, therefore requests a more active approach and more their
modern treatment.Also is very more importance the role of early necrectomy in the
treatment and prevention of acute complications of electrical burns, that can be fatal
for pained.
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POSTER PRESENTATIONS
ANATOMICAL RECONSTRUCTION AFTER HEMIVULVECTOMY
ĐURIĆ Z 1 , Bulić K 1 , Herman M 2 , Corusić A 2 , Mijatović D 1
1 Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
2 Department of Gynecologic Oncology, Clinic for Female Diseases and Labours, Zagreb,
Croatia
Bartholin gland malignancies are rare entities and therefore no consensus concerning
optimal surgical treatment exists.
Although there is a tendency toward less radical surgery, i.e. hemivulvectomy, it is still
disfiguring operation devastating to self-esteem and female identity.
We report on a case of vulvar reconstruction with short gracilis muscular flap.
Considering the relative young age of patient procedure is reliable and offers
aesthetically and functional acceptable vulva.
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POSTER PRESENTATIONS
FREE LATISSIMUS DORSI MUSCLE FLAP IN STERNAL RECONSTRUCTION
ĐURIĆ Z, Bulić K, Bagatin D, Veir Z, Duduković M, Ivrlač R, Mijatović D
Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
Herein we report on a case of sternal reconstruction with free latissimus dorsi muscle
flap in a diabetic patient after coronary artery bypass surgery.
Although multiple techniques have been proposed to treat these complications ideal
reconstructive procedure is still a mater of debate.
Sternal wound infection is a serious and potentially lethal complication of cardiac
surgery.
Radical sternectomy and immediate reconstruction provide control of sternal infection,
thus reducing ICU stay and hospital costs.
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POSTER PRESENTATIONS
DISTALLY BASED SURGICAL SUPERFICIAL ARTERY FLAP IN
RECONSTRUCTION OF LOWER LEG AND FOOT DEFECTS
ERIĆ D, Marić V, Milisavljević M, Šešlija I, Šarenac Z
Clinical Center East Sarajevo, Clinical and Hospital Services in Foča, Foča, Bosnia and
Herzegovina
drazan_eric@spinter.net
Aim: The aim of this work is to contribute to solving problems of complex defects of
the distal third of the lower part of the leg and foot, especially heel, which is a
challenge for the reconstructive surgeon due to poor circulation of the mentioned
regions.
Methods: We used distally based superficial artery flap in 20 patients treated
because of the defects of the lower part of the leg and foot during the period from
2004 to 2007. The mentioned defects were due to trauma, complicated diabetes,
decubital ulcerations and radical excisions of tumors.
Results: The flaps were accepted without any major complications in 17 patients.
There was complete necrosis of the flap in one patient, in two cases there were border
necrosis of the flat, while in one patient there was loss of the transplant in the lower
region of the posterior aspect of the lower part of the leg. Secondary defects in these
patients were covered by free skin transplants.
Conclusion: The advantages of flaps are easy and fast dissection, thickness and
quality of the flap as well as saving main arteries of the lower part of the leg. The
disadvantages of the flaps are sacrifice of nervus suralis and donor’s scar after
application of the free skin transplant.
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with international participation
POSTER PRESENTATIONS
LOCALISATION AND DIAMETER OF PERFORATORS AT
THE ABDOMINAL ELLIPSE
ERIĆ M 1 , Ravnik D 2 , Hribernik M 2 , Mihić N 1 , Krivokuća D 1
1 Department of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
2 Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
mirela.eric@gmail.com
Aim: The lower abdominal skin and fat has become a standard for breast
reconstruction in terms of skin texture, suppleness and color. The aim of this study
was to establish localisation and diameter of perforators at the abdominal ellipse.
Methods: The study is performed at the Institute of Anatomy in Ljubljana. Dissection
of 10 fresh cadavers (4 male and 6 female), with an average age at death of 77.8
years, is performed. We divided the abdominal ellipse in four equal parts (A, B, C, D).
After that, we divided each part into nine regions (1-9).
Results: Average size of flaps was 27.2 x 12.6cm. In part A we found 9 perforators,
in part B we found 58 perforators, in part C we found 63 perforators, and in part D we
found 11 perforators. Perforators were detected in all regions of the medial parts (B
and C) and in upper medial regions of the lateral parts of flaps (regions 3 and 6 in part
A and regions 1 and 4 in part D). The highest number of perforators at the part A we
found in region 6 (6 perforators), at the part B in region 5 (14 perforators), at the part
C in region 8 (13 perforators) and at the part D in region 4 (7 perforators). The highest
diameter of perforators at the part A we found in region 3 (average 1.2mm), at the part
B in region 1 (average 1.0 mm), at the part C in region 2 (average 1.0 mm), and at
the part D in region 1 (average 0.9 mm).
Conclusion: The highest number of perforators is located at the midpoint of the
medial parts (B and C) and in upper medial regions of the lateral parts (A and D) of
the flaps. The highest diameter of perforators we found at the part A in region 3.
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POSTER PRESENTATIONS
OUR EXPERIENCE WITH CHEMICAL BURNS
HOXHA E, Arifi H, Buja Z, Terziqi H, Kllokoqi A, Zejnullahu Y
Department of Plastic Surgery, University Clinic Center of Kosovo, Prishtina, Kosovo
eho92@yahoo.com
Introduction: Chemical burns, usually caused by caused by strong acids or alkalis,
are most often the result of industrial accidents, assaults, or the improper use of harsh
solvents and drain cleaners.The aim of the study is to presented the incidence and
our experience in their treatment.
Materials and methods: A review of 21 patients with chemical burns treated in our
department for the year 1999 - 2007.
Results: Most of the patients were mail (16 cases)and just 5 of them female. From
all of those cases: 7 of them were burned with acetic acid conc.; 5 of them with
bitumen ; 5 with lime; 4 cases with silicon foam.
Lower extremitetes were most attacked in 15 cases; head- 4 cases and 2 cases in
upper extremitetes. Management of these burnings consists on surgical treatment (9
cases) and conservative treatment other cases. In surgical treatment includes
necroectomia and split skin grafting, otherwise for conservativ treatment we used
ung. Dermazin.
Conclusion: Cemical burns can cause deep defects of tissue that needs surgical
treatment. So early management of them - necroectomia and skin grafting, are most
important things in prognosis and healing of the patient.
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with international participation
POSTER PRESENTATIONS
APPLICATION OF POSTOPERATIVE ADJUSTABILE SALINE IMPLANT
AFTER MAXILLECTOMY
JANJATOV B, Živković S, Kendrišić M
Department of ENT and Maxillofacial Surgery, Health Center, General Hospital, Sremska
Mitrovica, Serbia
banemfh@gmail.com
Background: reconstruction after maxillectomy is continuous controversy about the
most appropriate method of rehabilitation in any case for surgeons.
In this case we present a patient who underwent right subtotal maxillectomy without
orbital exenteration for squamous cell carcinoma of oral cavity. The reconstruction
was done in few steps. We used subtotal maxillectomy with frozen section and
functional neck dissection. Post-maxillary defect was reconstructed with a tamponade
and an immediate prosthesis. The next step is the radiation therapy. After appropriate
follow-up (three year) the defect on the hard palate was reconstructed with a tongue
flap. The final reconstruction was with an expander of skin during three weeks and
postoperative adjustable saline implant was applied.
Conclusions: The reconstruction after maxillectomy for malignant disease to require
follow-up, multidisciplinary procedure (dental rehabilitation - immediate and final,
radiotherapy, speech therapy) and few operations. Surgeons are still searching for the
best way to find good acceptable aesthetic and functional result for post-maxillectomy
defects. This technique also shows a different method as a solution to the problem.
Key words: reconstruction, maxillectomy
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POSTER PRESENTATIONS
IMPLANT DISPLACEMENTS AND SUBMUSCULAR CORRECTION OF
BOTTOMING DOWN IN SUBGLANDULAR PLANE
KHAN UD
Belveder Private Clinic, London, UK
mrumarkhan@aol.com
Background: In an augmented breast, implant displacement is the second most
common reason for revision surgery and bottoming down is the most common
presentation of implant displacement. Submuscular muscle splitting pocket relocation
was combined with capsulotomies and multi-layer capsuloraphy when bottoming
down was seen in subglandular plane.
Material and methods: Bottoming down in subglandular plane was selected and 43
breasts were treated between 2005 and 2008, 3 had unilateral and 20 had bilateral
bottoming down with a mean nipple areolar complex to inframammary crease
distance of 10.5 cm (range 9 - 14).
Results: Average NAC to IMC distance was reduced to 8.6 cm (range 8.3 - 10.5).
Follow-up of up to three years showed stable IMC and NAC relationship with good to
excellent results.
Conclusion: Correction of bottoming down in subglandular plane combined with
relocation of implant into submuscular muscle splitting biplane is a good option and
provides support to breast envelope in its upper aesthetic unit and helps to stabilise
relocated inframammary crease.
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with international participation
POSTER PRESENTATIONS
LATERAL QUADRANT SKIN CONSTRICTION AND NIPPLE DISPLACEMENTS
IN HORIZONTAL PLANE
KHAN UD
Belveder Private Clinic, London, UK
mrumarkhan@aol.com
Aim: Displacements of nipple areolar complex in horizontal plane are common and
is not much studied or described. Prospective measurements of pre-operative,
marked and post-operative medial and lateral quadrants of 323 augmentation
mammoplasties were done.
Material and methods: Each breast was measured separately in 323 patients
between January and Dec of 2007. Mean age of the patient was 30.4 years (range
18 - 58 + 9.1). With patients standing, medial and lateral quadrant of each breast was
measured in centimetres. Medial boundary of each breast was taken as the beginning
of the medial fold or cleavage to the medial edge of the nipple and lateral boundary
was taken as the lateral boundary of the breast fold to the lateral edge of the nipple.
Patients were grouped on the basis of visual appearance of the normal looking
(control), right lateralised, right medialised, left medialised, left lateralised, bilaterally
lateralised and bilaterally medialised nipples. In patients with lateralised nipples,
implant pockets are dissected little laterally from the mid line to medialised the visual
appearance of the nipples. All procedures are done in submuscular muscle splitting
biplane,
Results: Of the 323 patients who were measured, 39 (12%) of the patients had
displacements of nipple areolar complex in horizontal plane. Of these, 29 (9%) were
right lateralised, 4 (1.2%) were left lateralised, 5 (1.5%) were bilaterally lateralised and
1 (0.3%) was bilaterally medialised. No unilateral medialisation was seen in this
sample. In the more common right lateralised nipple group (n = 25), mean medial
quadrant measurement was 8.76 + 1.22 cm as compared to 8.96 cm in normal
looking control group (n = 170) with no statistical significance (p = 0.45) however
lateral quadrant measurements in the same group (n = 25) showed 9.06 + 1.53 cm
in lateralised nipples as compared 9.7 + 1.67 cm in normal looking or control group
(n = 169) and showed an insignificant statistical value (p = 0.06) or a border line
significant value.
Conclusion: Lateral or medial quadrant skin envelope constriction exists in otherwise
normal breasts and should be identified preoperatively. In an augmentation
mammoplasty, adjustments of pocket dissection may be required to achieve an
aesthetically position nipple in this group of patients.
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POSTER PRESENTATIONS
LEE DG
CORRECTION OF SADDLE NOSE DEFORMITY USING DERMO-FAT
GRAFT IN ASIANS
Department of Plastic and Reconstructive Surgery, College of Medicine, Chungbuk National
University, Cheongju, Republic of Korea
dglee@chungbuk.ac.kr
Saddle nose deformity was developed from several causes. Especially in Asians the
nasal trauma is one of the most common causes. It is characterized by depression
of the nasal dorsum and collapse of septal cartilage. Saddle nose correction is based
on the use of supporting graft to solve aesthetic and functional problems. Various
materials have been used as supporting graft such as bone, cartilage, and synthetic
materials.
The author used dermo-fat as dorsal supporting graft that harvested from intergluteal
fold.
The operation is performed using the open approach. The saddle nose correction
includes septoplasty, spreader graft, tip plasty, and dorsal augmentation. Occasionally
septal extension graft is needed in Asians.
Three patients have been included in study undergoing rhinoplasty with dermo-fat
grafts for correction of saddle nose. The deformity was the result of trauma in all
patients. Five to 14-month follow up had no complications. Functional and aesthetic
outcome was satisfactory in all patients.
The dermo-fat has an advantage of natural image of nose not artificial compared with
other materials. The saddle nose correction using dermo-fat graft is one of the valid
options and allow more predictable and reliable than the conventional dorsal grafts.
And no donor site morbidity is remained.
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with international participation
POSTER PRESENTATIONS
LEE DG
THE AVAILABILITY OF MAGGOT IN CHRONIC WOUND
Department of Plastic and Reconstructive Surgery, College of Medicine, Chungbuk National
University, Cheongju, Republic of Korea
dglee@chungbuk.ac.kr
Chronic wound problem has been a complex difficulty in wound management.
Especially in person with medical problem such as a diabetes, peripheral vascular
disease, and burn injury, it is a life-threatening to patient or an important problem of
demanding a sacrifice of his or her foot. It has been known that maggots have potent
debriding ability of removing necrotic tissue. In the early 20th century, the Maggot
debridement therapy (MDT) had been an important treatment in all kinds of wounds
all over the US and Europe. With the advent of antimicrobials, maggot therapy
became rare until the early 1990s. However with the appearance of antimicrobial
resistant organism, it was re-introduced. And so we performed a study to observe
the effect of MDT in chronic wound and wound characteristics influencing outcome
of healing.
In the period between September 2007 and March 2008, patients with chronic wound
including diabetic foot, burn wound, pressure ulcer or necrotic tissue who seemed
suited for MDT were enrolled in the study. In total, 10 patients with 10 lesions were
treated. Most wounds were worst-case scenarios, in which maggot therapy was a
treatment of last choice. Sterile maggots of Lucilia (Phaenicia) sericata, are used for
treatment. Up to 200 maggots are introduced in the wound and stayed for 2 to 3 days.
In all of the cases, significant debridement of necrotic tissue was achieved. The
majority of patients do not complain of any discomfort during the application of maggot
except for a tickling or itching sensation. But 2 patients complained of their wound pain
during the MDT and are treated with analgesics.
In total, all wounds of 10 patients were converted to acute wound after application of
MDT. Six patients were received a soft reconstructive surgery right after MDT. After
surgery the wound were cured completely or significantly. In the other patients who
not to receive a surgery, the wounds have maintained a good condition to help a
normal healing process. In our study, MDT has been proven to be an effective
modality for managing chronic wounds and initiating wound healing process. And
also MDT have played a good role in converting a characteristics of chronic wound
into an acute wound. MDT is a simple and cost-effective modality for the treatment
of chronic wound, which do not respond to conventional treatment and surgical
intervention.
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POSTER PRESENTATIONS
THE USE OF BIODEGRADABLE MESH PLATE AND DEMINERALIZED BONE
MATRIX IN REPAIR OF BLOW OUT FRACTURE
LEE DG
Department of Plastic and Reconstructive Surgery, College of Medicine, Chungbuk National
University, Cheongju, Republic of Korea
dglee@chungbuk.ac.kr
The blow-out fracture is the most common type of facial bone fracture. Various
materials have been used to reconstruct the orbital wall in blow-out fracture. Recently
the biodegradable materials is popular used for replacement of the fractured orbital
wall. But a pitfall of the biodegradable material is limitation to use in the large defect
of orbital wall.
The author used the combination of the biodegradable mesh and demineralized bone
matrix in reconstruction of a large blow-out fracture. The criteria of the combination
use is a defect larger than 1 square centimeter. The operation is performed using the
transconjunctival or subcilliary approach. Twenty patients have been included in
study. The patient’s age is ranged from 16 to 49 years old. Six persons are included
in medial wall fracture, 8 persons in orbital floor fracture, and 3 persons in inferomedial
wall fracture, and 3 persons in complex zygoma fracture. The operation time was
about 1.5 hours. No postoperative complication was observed. Six to 30-month follow
up had no complications. Functional and aesthetic outcome was satisfactory in all
patients.
The combination use of the biodegradable mesh and demineralized bone matrix in
reconstruction of a large blow-out fracture is one of the valid options and allow more
predictable and reliable than only use of the biodegradable mesh in large orbital wall
defect.
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with international participation
POSTER PRESENTATIONS
SKIN DEFECTS ON THE HAND AND FOOT - FIXED WITH FREE
LATERAL ARM FLAP
MADUNIĆ M, Orožim Z, Novak E, Lavrič M
Department of Plastic and Reconstructive Surgery, Burns and Hand Surgery, General
Hospital Celje, Celje, Slovenia
edumed@vodatel.net
Review of two cases:
Both examples indicate two clinical cases in which skin defects were covered with free
lateral arm flap.
First case: Patient aged 57 with injury on his left hand, resulting from the explosion
of a field vole fighting device, consequently producing composite tissue loss: the loss
of skin, nerves and tendon. Whilst digital nerve defects were resolved with nerve
suralis graft, the tendon defects of long thumb flexor were fixed with the transposition
of superficial flexor from the fourth finger. Skin defect were reconstructed with free
lateral arm flap.
Second case: Patient aged 19 with epidermal burns on the arm and left hand, and a
deep dermal burn on the leg and subdermal burn on the foot. Injuries were caused
by careless contact with power cable. The right leg area was covered with thin dermoepidermal
graft, while the foot skin defect on outer maleola was reconstructed with
free lateral arm flap.
Both cases resulted in good functional and esthetic outcome.
Lateral arm flap is a thin slice with maximum size of 14x20 with good sensitivity,
because it has nerve.
In both demonstrated cases, the choice turned out to be excellent reconstructive
method.
SPLIT, Croatia, October 01 - 05, 2008
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
POSTER PRESENTATIONS
RECONSTRUCTION OF A DEEP ELECTICAL BURN DEFECT WITH FREE
LATERAL ARM FLAP - A CASE REPORT
NOVAK E, Orožim Z, Madunič M, Lavrič M
Celje General Hospital, Celje, Slovenia
ernest.novak@guest.arnes.si
Aim: Electrical burn injuries represent a special type of lesion in which disability is
high, and functional and aesthetic sequelae very important. Injuries range from the
very mild, as seen with an electrical shock caused by low-voltage household current,
to the truly devastating, as seen with high-tension electrical injuries. The treatment of
electric injuries has to be very careful because of the specific effect on nonviable
tissue covered by healthy uninjured skin. Full-thickness injury over major vessels,
tendons and bones should be debrided promptly and definitive coverage provided
as soon as possible. Our clinical case demonstrates the treatment of deep thermal
damage caused by the passage of electric current.
Methods: In March 2008, 19 years old patient, suffered injuries to left upper limb and
right lower limb, caused by accidental contact with high-voltage electric current.
Clinical examination showed high-voltage electric entry wounds on left upper arm
and exit wound in a region of a right ankle. On the antero-medial side of the right
ankle, there was a deep thermal wound with exposed tendons and bone. Angiography
revealed patency of all 3 vessels of the right leg. Patient was operated, necrectomy
was performed and the defect was covered with free lateral arm flap.
Results: Healing of the wounds proceeded normally, and the entire flap survived.
There were no postoperative complications. Mobility improved, the contour deformity
was minimal and the patient did not feel any pain.
Conclusion: Electrical burns represent only a small percentage of burn injuries, but
the incidence of complications, morbidity and disability, especially in high-voltage
injury, is high. In some cases a free flap was the method of choice - this required a
very precise estimation of healthy vascular tissue. In cases of deep tissue injuries,
when for example tendons, bones and nerves are injured and necrotized, coverage
by some type of skin flap is the best treatment.
SPLIT, Hrvatska, 01. - 05. listopada 2008.

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with international participation
POSTER PRESENTATIONS
ENDOSCOPE ASSISTED BREAST RECONSTRUCTION WITH LD FLAP
VEIR Z, Mijatović D, Ivrlač R, Bulić K, Bagatin D, Smuđ S
Department of Plastic Surgery, Clinical Hospital Center Zagreb, School of Medicine,
University of Zagreb, Zagreb, Croatia
veir.zoran@gmail.com
Minimal invasive surgery, i.e. endoscopic surgery is widely spread in all branches of
surgery because of its many advantages and patients' shorter recovery period.
Endoscopic procedures in gynecology, abdominal surgery have become gold
standard.
Endoscopic procedures have found their way in plastic surgery, where patients expect
minimal scare.
The main disadvantage of breast reconstruction by latissimus flap is remarcable back
scar.
Using endoscopic and appropriate instruments it has become possible to lift the flap
with minimal scin incision. Under control of endoscopic camera the surgeon can easily
visualize latissimus muscle, whereupon the latter is lifted and inserted on the place
of the breast to be reconstructed.
Application of the ultrasound harmonic scissors contributes to safety and diminishes
the time of procedure as well as it shortens patients' recovery period.
Key words: breast reconstruction, endoscopic surgery, ultasound harmonic scissors,
latissimus flap
SPLIT, Croatia, October 01 - 05, 2008
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s međunarodnim sudjelovanjem
POSTER PRESENTATIONS
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INDEKS AUTORA
AUTHOR´S INDEX
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Almesberger D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Antonić D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Arifi H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89, 93, 98
Arifi H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Arnež Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Arnež ZM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Bagatin D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49, 58, 59, 71, 94, 107
Bagatin T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Banič A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Barutçu A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Bascevan B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Becker H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Bedeković V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Bekić M 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Biggs T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Bitrakovski Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Blaschke F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Botti G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 27, 44
Bozinovski S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Budi S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 61, 83, 87
Buja Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70, 93, 98
Bukvić N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Bulić K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 49, 58, 59, 94, 95, 107
Calì Cassi L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Cikojević D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Colić MM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 46
Corusić A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Čarija A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Damevska Lj . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
De Brujin HP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Dediol E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Dini M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Dobrović M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29, 73
Duduković M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Džepina I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Đurić K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Đurić Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58, 94, 95
Eder E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Eljuga D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Emsen IM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30, 74
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Erić D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Erić M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Facchini F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Fanfani B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Glavina N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Glušac B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Graf R 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 22, 32, 33, 47
Groth AK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Hadžiahmetović Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Herman M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Hoxha E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93, 98
Hribernik M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Huljev D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Ignatovski B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Ivrlač R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 49, 58, 59, 94, 107
Jakić-Razumović J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Januszkiewicz J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 34, 50
Janjatov B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Johannes S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Jovanović M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76, 77
Karabeg A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Karabeg R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Karadža-Lapić Lj . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Kendrišić M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Khan UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53, 54, 55, 100, 101
Kllokoqi A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93, 98
Klokoci A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Koller J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Košutić D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Kovačević J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Krivokuća D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Kurtović D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Lavrič M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 106
Lee DG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102, 103, 104
Leović D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Lo Russo G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Lojpur M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Lukanovič R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Madunič M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 106
Maletić D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
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Margaritoni M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56, 57
Marić V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Martić K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 61, 83, 87
Mayo F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57, 58
Mihelič M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Mihić N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Mijatović D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 49, 58, 59, 94, 95, 107
Milanović R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 61, 83, 87
Milisavljević M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Mirchevska E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Naceska A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Nahai F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 23, 35, 59
Neto LG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Ninković MA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Ninković MI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Novak E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 106
Orožim Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 106
Pace D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Panfilov D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36, 79
Peev I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Peneva M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Pešutić-Pisac V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Pirjavec A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Planinšek F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Primoža G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Puizina-Ivić N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28, 36
Račić G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Ravnik D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Roje Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23, 60, 65
Rončević R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81, 82
Rudman F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 61, 83, 87
Salihagić S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Selmani R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Smuđ S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49, 59, 107
Sparaš B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Stanec S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37, 61, 83, 87
Stanec Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 24, 37, 45, 61, 83, 87
Stritar A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66, 85, 86
Šarenac Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Šešlija I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
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Šolinc M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85, 86
Šteblaj S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Tenenbaum A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39
Terziqi H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93, 98
Tomičić H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Tomljenović R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Trenchev V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Uglešić V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Utrobičić I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Varas Fuenzalida JA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Veir Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 49, 58, 59, 94, 107
Vižintin Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Vlajčić Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24, 45, 61, 83, 87
Volovec L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Vukašin G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Zambelli M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Zatriqi S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Zatriqi V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70, 89
Zejnulahu Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70, 93, 98
Zorman P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Zubčić V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Zubčić Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Žgaljardić Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Žic R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24, 37, 41, 45, 61, 83, 87
Živković S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
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7. HRVATSKI KONGRES PLASTIČNE, REKONSTRUKCIJSKE I ESTETSKE KIRURGIJE
s međunarodnim sudjelovanjem
Zahvale / Acknowledgments
Organizacijski i Znanstveni odbor zahvaljuju svim institucijama i tvrtkama koje su
pridonijele uspješnom održavanju 7. hrvatskog kongresa plastične, rekonstrukcijske i
estetske kirurgije s međunarodnim sudjelovanjem.
Organising and Scientific Committee would like to express their gratitude to all
institutions and firms who made this 7 th Croatian Congress of Plastic, Reconstructive
and Aesthetic Surgery with international participation, and its scientific and
social events possible.
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7 th CROATIAN CONGRESS OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
with international participation
Izlagači / Exhibitors
COLOPLAST
ELASTIC
FOTONA
JOHNSON & JOHNSON
MEDICAL INTERTRADE
MEDTRONIC
SANYKO
OKTAL PHARMA
PAUL HARTMANN
ROZI STEP
STOMA MEDICAL
Sponzori i donatori / Sponsors and Donors
CROATIA OSIGURANJE
GRAD SPLIT / CITY OF SPLIT
HRVATSKA TURISTIČKA ZAJEDNICA / CROATIAN TOURIST BOARD
MEDICAL INTERTRADE
MEL MEDICAL
MILSING
MINISTARSTVO ZDRAVSTA I SOCIJALNE SKRBI RH / MINISTRY OF HEALTH
AND SOCIAL WELFARE OF THE REPUBLIC OF CROATIA
MINISTARSTVO ZNANOSTI, OBRAZOVANJA I ŠPORTA RH / MINISTRY OF
SCIENCE, EDUCATION AND SPORTS OF THE REPUBLIC OF CROATIA
PLIVA - Članica Barr Grupe / A Member of the Barr Group
SER. CO. TEC.
TOYOTA
TURISTIČKA ZAJEDNICA GRADA SPLITA / SPLIT TOURIST BOARD
SPLIT, Croatia, October 01 - 05, 2008
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SPLIT, Hrvatska, 01. - 05. listopada 2008.