Biomedical subjects
Publications and source records attributed to D Stockarová.
The reflections pertain to operations of the female breast in the 20th century as they were introduced and abandoned at the Bulovka Clinic in Prague. The author emphasizes the modern concept of senology as a multidisciplinary field, where surgery--amputation as well as reconstruction and plastic surgery--still play a decisive role.
The objective of the work was to demonstrate possibilities of radical treatment of a perineal sinus, a very unpleasant complication after proctectomy. The authors prefer the use of a fasciocutaneous gluteofemoral flap based on the descendent branch of the inferior gluteal artery. The authors describe the whole surgical procedure and recommend to assemble experience with solution of decubital defects in the pelvic region.
In a group of 28 decubiti in 21 paraplegic patients, operated during the past five years the authors draw attention to the advantages of the use of three types of musculocutaneous (MC) flaps for surgical and radical treatment of ischial decubiti. The method using musculocutaneous flaps makes it possible to restore a relatively satisfactory cover of the defect by a multilayer long-lasting flap.
Fasciocutaneous flaps proved useful for covering soft tissue defects in the region of the leg. After experience with the use of these flaps in six patients the authors recommend this method for covering these defects. In all patients very satisfactory results were achieved.
In a group of 17 patients with chronic osteoarticular infection for filling of the chronic cavity the sartorius muscle was used. In eight instances chronic osteomyelitis of the distal femur was involved, in nine instances by means of the sartorius muscle the acetabulum was filled (after removal of an infected total endoprosthesis or after resection of the hip joint on account of purulent coxitis). In the first group the authors recorded 75% satisfactory results and therefore they recommend to use the sartorius muscle for filling chronic osteomyelitic cavities in the distal part of the femur with a fistula on the inner side of the thigh. In the second group of patients, where the sartorius muscle was used to fill the acetabulum, poor results were recorded in 55.5%. This is obviously associated with the blood supply of the muscle used, which does not permit such an extensive mobilization and rotation of the muscle without jeopardizing its nutrition. Therefore the authors do not recommend the use of the sartorius muscle for filling the acetabulum and propose other muscle flaps which gave preliminary, satisfactory results.
Treatment for chronic osteomyelitis with musculocutaneous and muscular flaps is a highly effective modern method. It is effective even in such unfavourable localizations as the calcaneus. The scope of use provided by muscles in the plantar region is wide enough to permit the treatment of foci in the heel bone of diverse localizations. The range of possibilities includes use of m. abductor digiti quinti. A muscular or musculocutaneous flap elevated from the muscle is well suited for the treatment of defects on the external side of the heel. The group consisted of six patients with osteomyelitis of seven heel bones operated on as described above at the author's clinics between 1983 and 1987. One patient had both heel bones affected. The mean age was 47 years, ranging from 23 to 62 years. All of the patients showed clinical and X-ray signs of healing of the soft tissue defects and full remission of inflammatory complication. Control check-ups were made at 2-5 years postoperatively with an average postoperative period of 38 months. None of the patients developed any chronic osteomyelitis relapse at any point during that period.
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