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Dan Enescu

Universitatea de Farmacie si Medicina Carol Davila Bucuresti, Chirurgie Plastica, Faculty Member

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Plastic surgeon for children from 30 years

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The University of Texas at Austin

University of California, Santa Barbara

Harvard University

National University of "Kyiv-Mohyla Academy"

Katherine Butler Schofield

King's College London

Lancaster University

Alejandra B Osorio

Wellesley College

Shaun Gallagher

University of Memphis

University of East London

Pennsylvania State University

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Papers by Dan Enescu

Current surgical approach in cleft palate treatment

Practica medicală, Sep 30, 2015

Obiectiv. Evaluarea statusului actual al tratamentului chirurgical al despicăturii palatine bazat... more Obiectiv. Evaluarea statusului actual al tratamentului chirurgical al despicăturii palatine bazat pe studii clinice în urma unei analize extinse a literaturii de specialitate. Material şi metode. Cercetarea a fost efectuată în baza de date PubMed de limbă engleză în perioada 2007-2014, luându-se în considerare tratamentul chirurgical al despicăturii palatine şi eliminându-se articolele care prezentau raportări de caz, serii de cazuri şi review-uri. Rezultate. Au fost descoperite 1.677 de articole cu relevanţă pentru tratamentul palatoschizisului, din care, în urma aplicării criteriilor de excludere, au fost reţinute 43. Dintre acestea, 29 au fost studii retrospective şi 14 studii prospective. Concluzii. Nu există un protocol de tratament recunoscut de toate centrele internaţionale, existând o diversitate a modalităţilor de tratament ce se adresează acestei afecţiuni. Există puţine studii ce abordează tratamentul palatoschizisului şi în special tratamentul chirurgical al acestei malformaţii şi, dintre acestea, foarte multe sunt studii retrospective. Acest review întăreşte importanţa efectuării de studii prospective cu rezultate pe perioadă îndelungată pentru a elucida efectul fi ecărei metode de tratament pentru obţinerea unor rezultate optime.

Neonatal Burns - A Romanian Experience From A Tertiary Care Burn Unit

PubMed, Mar 31, 2022

Burns in neonates is a unique pathology that poses management challenges, as, besides treating th... more Burns in neonates is a unique pathology that poses management challenges, as, besides treating the burn injury, the medical team needs to be familiar with the unique physiology of the newborn. This study aimed to review our center's experience with the management of neonatal burns. A 7-year retrospective study of neonatal burns managed at a tertiary national referral unit in Bucharest, Romania, was performed. Patients were divided into two groups, preterm and term, based on gestational age. Collected data included demographics, treatment, complications and follow-up. Our center managed 13 neonates with burns (5 term and 8 preterm), with a mean age at injury of 8.6 days. All neonatal burns were thermal injuries. For preterm babies, all burns were iatrogenic, consisting of victims of a fire in a Maternity Hospital, while for the term group only one was iatrogenic. Burns were more extensive in the premature group (65% vs. 20% mean TBSA, p=0.0001). All premature patients had associated inhalation injuries. Surgical treatment was indicated for two term patients. Survival rate was 77% and was negatively influenced by inhalation injury, burn shock and TBSA >50%. In conclusion, the majority of hospitalized neonatal burns in Romania were the result of a fire disaster secondary to an infrastructure deficiency. Their management is complex, posing specific challenges, and needs to be led by a multidisciplinary team that can ensure an individualized continuum of acute burn care and recovery.

An alternative for local treatment of superficial burns

PubMed, Sep 30, 2008

There is a wide variety of local therapeutical methods for partial superficial burns. Burns requi... more There is a wide variety of local therapeutical methods for partial superficial burns. Burns require meticulous local treatment as part of the complex therapeutic protocol. Local treatment for burns is essential, influencing the patient's evolution and future. All local burn treatment methods are adapted in relation to the particular aspects of the burn lesion (patient's age, aetiology, localization, associated pathologies). Immerci H3 was clinically tested for partial superficial burns treatment and the results were favourable. Healing was more rapid and there was a decrease in mean hospital stay and treatment costs.

Schwann cell cultures: recent advances and novel approaches to the reconstruction of peripheral nerve defects

PubMed, 2012

Current techniques in tissue engineering may offer a choice regarding the reconstructive strategi... more Current techniques in tissue engineering may offer a choice regarding the reconstructive strategies of peripheral nerves. Schwann cell cultures are to be considered an appropriate option in the reconstruction of peripheral nerve and spinal cord large defects. Schwann cells availability from peripheral nerve autografts creates a great benefit concerning their usefulness in the nervous autogenic transplantation. Allogeneic Schwann cells transplantation can be effective in the reconstruction without delay of peripheral nerve defects.

Negative Pressure Wound Therapy (NPWT) to Treat Complex Defect of the Leg after Electrical Burn

PubMed, May 14, 2016

Negative pressure wound therapy is a non-invasive treatment that uses under atmospheric pressure ... more Negative pressure wound therapy is a non-invasive treatment that uses under atmospheric pressure to increase blood supply to the wound, stimulating the formation of granulation tissue, angiogenesis, proliferation of fibroblasts and endothelial cells. Negative pressure therapy has also the ability to decrease the bacterial load, reduce swelling and decrease exudate while maintaining a moist environment that facilitates healing. Our patient, a 17 year old male, suffered major third and fourth-degree high voltage electrical burns on 60% of the body surface, in November 2011. After the excision of the necrotic tissue (muscles and tendons), the lower extremity of the right leg- the tibial bone, the fibula, external and internal malleoli became exposed circularly. The soft-tissue defect was partially covered by using an internal twin muscle flap and free split skin. Then, a cross leg flap technique has been used, partially covering the defect with a contralateral thigh flap. Surface swab cultures were positive for Pseudomonas aeruginosa. In October 2013 the patient was transferred to our department. The clinical examination of the right leg showed that the tibial bone had been exposed on an area of 15/3 cm in the lower half. The peroneal malleolus had also been exposed. The resection of the devitalized, exposed tibia and the avivement of the wound edges were performed. Then the NPWT was started and performed by intermittent suction. Local cleansing, soft-tissue avivement and dressing changes were performed twice a week for 6 weeks. After six weeks of NPWT and eleven dressing changes under general anaesthesia, the wounds were ready for skin grafting. Granulation tissue was formed, covering the entire surface of both the tibia bone and the peroneal malleolus. Both receptor beds were covered with free skin graft harvested from the ipsilateral thigh. The mechanical suture of the skin grafts was performed and the grafts were covered with damp dressing. By using the NPWT it was possible to cover major chronic soft tissue defects, thus avoiding the amputation of the member.

Procesul de vindecare fără cicatrizare – review de literatură

Revista română de pediatrie, Sep 30, 2019

Vindecarea leziunilor tegumentare rezultate secundar traumatismelor sau arsurilor se soldează cu ... more Vindecarea leziunilor tegumentare rezultate secundar traumatismelor sau arsurilor se soldează cu apariţia ţesutului cicatricial, ce poate determina dizabilităţi semnificative. Studierea particularităţilor pielii fetale aduce în discuţie abilitatea acesteia de a se vindeca printr-un proces de regenerare, fără formarea cicatricilor. Înţelegerea mecanismelor celulare şi moleculare ale fenotipului fetal capabil să se vindece fără cicatrizare este de o importanţă deosebită, întrucât poate genera noi ţinte terapeutice cu potenţial de a reduce formarea ţesutului fibrotic secundar vindecării plăgilor postnatale. Scopul acestui articol este prezentarea concisă a caracteristicilor unice ale procesului de vindecare fetală regenerativă ce ar putea facilita vindecarea fără cicatrizare.

Research Related to Capsular Contracture after Breast Augmentation for Cosmetic or Reconstructive Purposes

Revista De Chimie, Jun 15, 2019

The upward trend of patients opting for elective breast augmentation, as well as the large number... more The upward trend of patients opting for elective breast augmentation, as well as the large number of patients benefiting from alloplastic breast reconstruction, require further studies on the safety profile of these techniques. Without any doubt, the incidence of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has drawn attention to the possible unknown complications characteristic of these procedures, creating the context of further studies devoted to this issue. The present research examines the capsular contracture rate on a group of 253 patients between 2015 and 2019, also proposing a scoring system based on the integration of the main diagnostic criteria related to the capsular contracture. The results of the literature review indicate that a lower incidence of capsular contracture could be achieved by using the newest techniques in the field involving the application of chemical substances on the surface of the latest generation of silicone breast implants.

The Use of NPWT in Treating Electrical Burn Wounds

Recent clinical techniques, results, and research in wounds, Nov 7, 2017

Complex wounds represent a challenge for the wound care specialist. The aim of treatment of elect... more Complex wounds represent a challenge for the wound care specialist. The aim of treatment of electrical burn wounds is to achieve skin cover of the soft-tissue defects, prevent infection, and allow a good function of the affected anatomical segment. Surgical reconstructive techniques for soft-tissue defects covering, such as muscle flaps, free flap transfers, and cross-leg techniques, are frequently used in treating sequelae after electrical burns. In some cases, when the patient cannot be a candidate for free flap surgery the use of negative-pressure wound therapy (NPWT) is an effective alternative that can minimize the traditional reconstructive surgery methods and can reduce the surface of the soft-tissue defect by filling it with new formed granulation tissue, creating a skin graft receptor bed.

The hemiface transplant in rodent model

Open Medicine, Dec 1, 2014

The composite allotransplant of tissues was recently introduced on the list of potential procedur... more The composite allotransplant of tissues was recently introduced on the list of potential procedures for complex face reconstruction. To assess the technical and immunological aspects and the potential of the clinical applicability of this new approach in facial reconstruction, samples of total and hemifacial transplant with rats have been introduced. We have proposed in this study checking the versatility of the facial transplant sample in rats by performing the hemiface transplant between two neco-blood species of laboratory rats. Meanwhile, study included the verification of mono-therapy efficiency with A cyclosporine in inducing immune tolerance against the composite tissue graft, which consists of skin, subcutaneous tissue, blood vessels and ear cartilage, transferred against the hystocompatibility barriers, as well as the verification of the procedures adjacent to transplant: anesthesia and surgical technique. In this study,14 laboratory rats have been included and divided into 3 lots. Lot No. 1 was represented by 2 Brown Norway rats used for the anatomic study of the vascular formations which are going to be coopted during a facial transplant. Lot No. 2 consisted of 3 Brown Norway rats used as donors and 3 Wistar rats used as acceptors, with these transplants being associated immunosuppression protocols postop. Llot No. 3 consisted of 3 Brown Norway rats used as donors and 3 Wistar rats used as acceptors, which, after the intervention, did not receive an immunosuppression treatment. Conclusions. The experimental sample of the facial transplant is an essential and mandatory stage in preparing the clinical application of the face transplant. Our study confirms the good tolerance of the hemiface transplant against the major hystocompatibility complex granted by the immunosuppression with A Cyclosporine in rodents.

Characteristics of traumatic amputations of fingers in children

Revista medicală română, Dec 31, 2015

REZUMAT Obiective. Analiza cazurilor de amputaţie traumatică la nivelul degetelor la copiii inter... more REZUMAT Obiective. Analiza cazurilor de amputaţie traumatică la nivelul degetelor la copiii internaţi, în vederea identificării unor caracteristici pe baza cărora să se optimizeze algoritmii de prevenţie şi tratament. Materiale şi metode. Au fost obţinute datele din protocoalele operatorii privind copii internaţi în Clinica de Chirurgie plastică şi Arsuri a Spitalului de Urgenţă pentru copii "Grigore Alexandrescu", între anii 2005 şi 2013, cu amputaţii traumatice ale degetelor. S-au cules informaţii referitoare la vârsta şi sexul pacienţilor, circumstanţele producerii traumatismului, mecanismul de producere, nivelul amputaţiei, tipul operaţiei şi numărul intervenţiilor chirurgicale. Rezultate. Un număr de 42 de copii cu amputaţii traumatice ale degetelor au fost operaţi, practicându-se aco perirea bontului în 81% dintre cazuri şi reimplantarea segmentului amputat în doar 19% dintre cazuri. Două treimi dintre pacienţi au fost băieţi. Degetele mâinii au fost afectate în 95% dintre cazurile care s-au prezentat în clinică cu acest tip de traumatism. Concluzii. Datele obţinute au fost în concordanţă şi cu alte studii care au indicat incidenţa crescută a amputaţiilor traumatice ale degetelor în rândul băieţilor, în cursul desfăşurării unor activităţi casnice care implică manipularea unor ustensile cu un puternic caracter de vătămare în cazul utilizării de către copii. Posibilităţile tehnice de reimplantare există şi sunt eficiente, dar cazurile care sunt eligibile pentru acest tip de tratament sunt puţin numeroase, astfel încât accentul trebuie pus în continuare pe prevenţie.

Treatment of chemical burns

Practica medicală, Sep 30, 2018

Arsurile reprezintă una dintre cele mai frecvente cauze de accidente şi sunt împrejurări medico-c... more Arsurile reprezintă una dintre cele mai frecvente cauze de accidente şi sunt împrejurări medico-chirurgicale, psihologice şi sociale extrem de grave, cu risc vital şi cu potenţial invalidant. Obiectivele terapeutice esenţiale sunt supravieţuirea, prevenirea complicaţiilor de fază acută, prezervarea funcţiilor segmentelor afectate, un rezultat cosmetic acceptabil, precum şi limitarea consecinţelor psihologice, pentru a permite pacientului o reinserţie socială rapidă şi de bună calitate (4). Au luat fiinţă astfel centrele de arsuri, care au dezvoltat în timp abilităţi şi strategii specifice, menite să asigure maximum de supravieţuire şi de calitate a vieţii pentru victimele arsurilor. Indiferent de gravitatea sau de modul de producere a unei arsuri, tratamentul trebuie să înceapă în momentul şi la locul de producere a accidentului. Prezentăm cazul unei fetiţe de 4 ani care a suferit leziuni de arsură chimică la nivelul regiunii cervicale anterioare, toracelui anterior şi capului, grad II şi III, produse de către un amestec de acizi-Asevi.

Peripheral nerve allograft, a reconstructive solution: outcomes and benefits

PubMed, Oct 3, 2012

Every year millions of individuals worldwide require complex reconstructive procedures as a resul... more Every year millions of individuals worldwide require complex reconstructive procedures as a result of various traumatic events. Recent success in composite tissue allotransplant, has shown that allografts generally present an enormous potential in reconstructive surgery. Peripheral nerve allograft represents a relatively new research field, therefore many aspects are still to be clarified. The main interests of this study concerning nerve allograft are directed to harvesting from cadaver or living donor, allografts denaturation and conservation, recipient tolerance to allograft, immunosuppressive medication, and quantifying the outcomes of nerve regeneration.

Scarless wound healing – a literature review

Revista română de pediatrie, Sep 30, 2019

The healing of skin lesions, such as traumas or burns, can often result in severe scarring causin... more The healing of skin lesions, such as traumas or burns, can often result in severe scarring causing important disabilities. The study of fetal skin particularities brings into light its ability of healing wounds in a scarless manner, through regeneration. Understanding the cellular and molecular mechanisms of fetal scarless phenotype is of utmost importance as it can result in new therapeutic targets that could have the potential to reduce scarring in postnatal wounds. The aim of this review is to summarize the unique features of fetal wound healing process that may facilitate a scarless wound repair.

Etiology Of Neonatal Burns: A Systematic Review

PubMed, Sep 30, 2022

Burns in neonates are a rare pathology with a significant impact on the patient, the family and t... more Burns in neonates are a rare pathology with a significant impact on the patient, the family and the healthcare system. At present, scarce information exists on the etiology of this type of injury. A comprehensive worldwide literature review of all publications, including our personal case series, was conducted in order to analyse the etiology of neonatal burns and summarize the available evidence. A total of 41 publications were identified in the last 4 decades, comprising of 105 cases from 20 countries, thus confirming that neonatal burns are, indeed, a rare pathology. All types of burns were recorded in neonates, the most frequent being contact burns, followed by flames and scalds. Almost 60% of burns occurred in a hospital setting due to human factors, malfunctioning devices, or hospital infrastructure deficiency. Compared to domestic burns, iatrogenic injuries occurred at an earlier age (5.4±9.1 days vs. 15.7±9.8 days, p<0.0001) and in neonates with significantly smaller weights (2102.7±1350g vs. 3197±300.8g, p<0.0001). The number of cases was almost equally distributed between developed and developing countries, but developed countries were characterised by a significantly higher preponderance of iatrogenic burns, while in developing countries domestic burns were more frequent (p<0.0001). We believe that this systematic review outlines the potential causes of neonatal burns and provides essential information for formulating prevention strategies.

Study on Reconstruction Techniques of the Nipple-Areola Complex

Revista De Chimie, May 15, 2019

Increasing the incidence of breast cancer worldwide is an alarming factor for the medical communi... more Increasing the incidence of breast cancer worldwide is an alarming factor for the medical community and also an additional reason for accountability. Oncological treatment, followed by subsequent reconstructive stages, are traumatic events that without a doubt exert their adverse effects on the quality of life of these patients. The reconstruction of the nipple-areola complex represents the final element in the treatment of patients who have suffered from breast cancer and must follow basic principles such as: reproducibility, efficacy, short duration of treatment and low rate of complications. The present material presents the various surgical techniques dedicated to the reconstruction of the nipple-areola complex, presenting their advantages and disadvantages based on a 5-year study. The use of single-stage techniques associated with medical tattooing were the main factor in increasing the satisfaction of the patients included in the research.

Optimal timing for burned hands in children

PubMed, Mar 31, 2015

Hand burns in children are frequent, severe, and require adequate treatment. A fundamental, thoug... more Hand burns in children are frequent, severe, and require adequate treatment. A fundamental, though problematic aspect of this treatment is the assessment of the burn depth as this determines the surgical strategy. From a retrospective study of 369 hand burns admitted to our clinic, we were able to identify some patterns. A total of 14.91% required surgery, with varying etiology among these patients. Differences were also noticed in the number of days post-burn prior to surgical intervention. The patterns revealed by our results are reviewed in order to improve therapeutic strategy.

Surgical treatment of anogenital hemangiomas of infancy

Acta Medica Marisiensis, Oct 1, 2014

hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children an... more hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal. Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option. Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture. Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a "healthy" hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.

Pediatric burns in Romania

Burns, Feb 1, 2007

The impact of COVID-19 pandemic on the activity of a pediatric burn center in Bucharest, Romania

Burns, Dec 1, 2020

The ongoing SARS-CoV-2 pandemic is challenging the 6 medical community to cope with different cli... more The ongoing SARS-CoV-2 pandemic is challenging the 6 medical community to cope with different clinical protocols 7 and to adapt on the way to new public health regulations. 8 These changes in the daily activity affect all medical fields, 9 including burn care. We have followed with extreme interest 10 the recently published researches and reviews [1À3] on 11 COVID-19 in relation with burn care and burn center 12 functioning. Since we are the only specialized Pediatric 13 Plastic Reconstructive Surgery and Burns Department in 14 Romania, our goal was to keep taking care of the burned 15 children, under the best conditions, despite the pandemic.

Uncommon location of pyogenic granuloma in a child – case report and mini-review

Archives of the Balkan Medical Union, 2020

Introduction. Le granulome pyogène (GP) est une hyperplasie inflammatoire vasculaire qui affecte ... more Introduction. Le granulome pyogène (GP) est une hyperplasie inflammatoire vasculaire qui affecte la peau et la muqueuse buccale, souvent associée à une irritation ou un traumatisme local, ou à une grossesse. La localisation intra-orale affecte généralement la gencive, mais l’aspect tumoral peut être trompeur, en particulier dans les localisations extra-gingivales. Une évaluation et un diagnostic approfondis sont donc importants pour garantir un traitement approprié. Présentation du cas. Nous présentons le cas d’un garçon de 12 ans qui est venu pour une consultation concernant la tumeur croissante et saignante de sa muqueuse de la lèvre inférieure. La tumeur a été étiquetée comme « hémangiome ». Elle se développait depuis plusieurs semaines et avait été associée à un traumatisme muqueux mineur mais répété. Bien que la localisation anatomique ne soit pas courante, les antécédents du patient suggéraient un diagnostic de GP. Après une consultation dermatologique qui proposait un diagnos...

Current surgical approach in cleft palate treatment

Practica medicală, Sep 30, 2015

Obiectiv. Evaluarea statusului actual al tratamentului chirurgical al despicăturii palatine bazat... more Obiectiv. Evaluarea statusului actual al tratamentului chirurgical al despicăturii palatine bazat pe studii clinice în urma unei analize extinse a literaturii de specialitate. Material şi metode. Cercetarea a fost efectuată în baza de date PubMed de limbă engleză în perioada 2007-2014, luându-se în considerare tratamentul chirurgical al despicăturii palatine şi eliminându-se articolele care prezentau raportări de caz, serii de cazuri şi review-uri. Rezultate. Au fost descoperite 1.677 de articole cu relevanţă pentru tratamentul palatoschizisului, din care, în urma aplicării criteriilor de excludere, au fost reţinute 43. Dintre acestea, 29 au fost studii retrospective şi 14 studii prospective. Concluzii. Nu există un protocol de tratament recunoscut de toate centrele internaţionale, existând o diversitate a modalităţilor de tratament ce se adresează acestei afecţiuni. Există puţine studii ce abordează tratamentul palatoschizisului şi în special tratamentul chirurgical al acestei malformaţii şi, dintre acestea, foarte multe sunt studii retrospective. Acest review întăreşte importanţa efectuării de studii prospective cu rezultate pe perioadă îndelungată pentru a elucida efectul fi ecărei metode de tratament pentru obţinerea unor rezultate optime.

Neonatal Burns - A Romanian Experience From A Tertiary Care Burn Unit

PubMed, Mar 31, 2022

Burns in neonates is a unique pathology that poses management challenges, as, besides treating th... more Burns in neonates is a unique pathology that poses management challenges, as, besides treating the burn injury, the medical team needs to be familiar with the unique physiology of the newborn. This study aimed to review our center's experience with the management of neonatal burns. A 7-year retrospective study of neonatal burns managed at a tertiary national referral unit in Bucharest, Romania, was performed. Patients were divided into two groups, preterm and term, based on gestational age. Collected data included demographics, treatment, complications and follow-up. Our center managed 13 neonates with burns (5 term and 8 preterm), with a mean age at injury of 8.6 days. All neonatal burns were thermal injuries. For preterm babies, all burns were iatrogenic, consisting of victims of a fire in a Maternity Hospital, while for the term group only one was iatrogenic. Burns were more extensive in the premature group (65% vs. 20% mean TBSA, p=0.0001). All premature patients had associated inhalation injuries. Surgical treatment was indicated for two term patients. Survival rate was 77% and was negatively influenced by inhalation injury, burn shock and TBSA >50%. In conclusion, the majority of hospitalized neonatal burns in Romania were the result of a fire disaster secondary to an infrastructure deficiency. Their management is complex, posing specific challenges, and needs to be led by a multidisciplinary team that can ensure an individualized continuum of acute burn care and recovery.

An alternative for local treatment of superficial burns

PubMed, Sep 30, 2008

There is a wide variety of local therapeutical methods for partial superficial burns. Burns requi... more There is a wide variety of local therapeutical methods for partial superficial burns. Burns require meticulous local treatment as part of the complex therapeutic protocol. Local treatment for burns is essential, influencing the patient's evolution and future. All local burn treatment methods are adapted in relation to the particular aspects of the burn lesion (patient's age, aetiology, localization, associated pathologies). Immerci H3 was clinically tested for partial superficial burns treatment and the results were favourable. Healing was more rapid and there was a decrease in mean hospital stay and treatment costs.

Schwann cell cultures: recent advances and novel approaches to the reconstruction of peripheral nerve defects

PubMed, 2012

Current techniques in tissue engineering may offer a choice regarding the reconstructive strategi... more Current techniques in tissue engineering may offer a choice regarding the reconstructive strategies of peripheral nerves. Schwann cell cultures are to be considered an appropriate option in the reconstruction of peripheral nerve and spinal cord large defects. Schwann cells availability from peripheral nerve autografts creates a great benefit concerning their usefulness in the nervous autogenic transplantation. Allogeneic Schwann cells transplantation can be effective in the reconstruction without delay of peripheral nerve defects.

Negative Pressure Wound Therapy (NPWT) to Treat Complex Defect of the Leg after Electrical Burn

PubMed, May 14, 2016

Negative pressure wound therapy is a non-invasive treatment that uses under atmospheric pressure ... more Negative pressure wound therapy is a non-invasive treatment that uses under atmospheric pressure to increase blood supply to the wound, stimulating the formation of granulation tissue, angiogenesis, proliferation of fibroblasts and endothelial cells. Negative pressure therapy has also the ability to decrease the bacterial load, reduce swelling and decrease exudate while maintaining a moist environment that facilitates healing. Our patient, a 17 year old male, suffered major third and fourth-degree high voltage electrical burns on 60% of the body surface, in November 2011. After the excision of the necrotic tissue (muscles and tendons), the lower extremity of the right leg- the tibial bone, the fibula, external and internal malleoli became exposed circularly. The soft-tissue defect was partially covered by using an internal twin muscle flap and free split skin. Then, a cross leg flap technique has been used, partially covering the defect with a contralateral thigh flap. Surface swab cultures were positive for Pseudomonas aeruginosa. In October 2013 the patient was transferred to our department. The clinical examination of the right leg showed that the tibial bone had been exposed on an area of 15/3 cm in the lower half. The peroneal malleolus had also been exposed. The resection of the devitalized, exposed tibia and the avivement of the wound edges were performed. Then the NPWT was started and performed by intermittent suction. Local cleansing, soft-tissue avivement and dressing changes were performed twice a week for 6 weeks. After six weeks of NPWT and eleven dressing changes under general anaesthesia, the wounds were ready for skin grafting. Granulation tissue was formed, covering the entire surface of both the tibia bone and the peroneal malleolus. Both receptor beds were covered with free skin graft harvested from the ipsilateral thigh. The mechanical suture of the skin grafts was performed and the grafts were covered with damp dressing. By using the NPWT it was possible to cover major chronic soft tissue defects, thus avoiding the amputation of the member.

Procesul de vindecare fără cicatrizare – review de literatură

Revista română de pediatrie, Sep 30, 2019

Vindecarea leziunilor tegumentare rezultate secundar traumatismelor sau arsurilor se soldează cu ... more Vindecarea leziunilor tegumentare rezultate secundar traumatismelor sau arsurilor se soldează cu apariţia ţesutului cicatricial, ce poate determina dizabilităţi semnificative. Studierea particularităţilor pielii fetale aduce în discuţie abilitatea acesteia de a se vindeca printr-un proces de regenerare, fără formarea cicatricilor. Înţelegerea mecanismelor celulare şi moleculare ale fenotipului fetal capabil să se vindece fără cicatrizare este de o importanţă deosebită, întrucât poate genera noi ţinte terapeutice cu potenţial de a reduce formarea ţesutului fibrotic secundar vindecării plăgilor postnatale. Scopul acestui articol este prezentarea concisă a caracteristicilor unice ale procesului de vindecare fetală regenerativă ce ar putea facilita vindecarea fără cicatrizare.

Research Related to Capsular Contracture after Breast Augmentation for Cosmetic or Reconstructive Purposes

Revista De Chimie, Jun 15, 2019

The upward trend of patients opting for elective breast augmentation, as well as the large number... more The upward trend of patients opting for elective breast augmentation, as well as the large number of patients benefiting from alloplastic breast reconstruction, require further studies on the safety profile of these techniques. Without any doubt, the incidence of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has drawn attention to the possible unknown complications characteristic of these procedures, creating the context of further studies devoted to this issue. The present research examines the capsular contracture rate on a group of 253 patients between 2015 and 2019, also proposing a scoring system based on the integration of the main diagnostic criteria related to the capsular contracture. The results of the literature review indicate that a lower incidence of capsular contracture could be achieved by using the newest techniques in the field involving the application of chemical substances on the surface of the latest generation of silicone breast implants.

The Use of NPWT in Treating Electrical Burn Wounds

Recent clinical techniques, results, and research in wounds, Nov 7, 2017

Complex wounds represent a challenge for the wound care specialist. The aim of treatment of elect... more Complex wounds represent a challenge for the wound care specialist. The aim of treatment of electrical burn wounds is to achieve skin cover of the soft-tissue defects, prevent infection, and allow a good function of the affected anatomical segment. Surgical reconstructive techniques for soft-tissue defects covering, such as muscle flaps, free flap transfers, and cross-leg techniques, are frequently used in treating sequelae after electrical burns. In some cases, when the patient cannot be a candidate for free flap surgery the use of negative-pressure wound therapy (NPWT) is an effective alternative that can minimize the traditional reconstructive surgery methods and can reduce the surface of the soft-tissue defect by filling it with new formed granulation tissue, creating a skin graft receptor bed.

The hemiface transplant in rodent model

Open Medicine, Dec 1, 2014

The composite allotransplant of tissues was recently introduced on the list of potential procedur... more The composite allotransplant of tissues was recently introduced on the list of potential procedures for complex face reconstruction. To assess the technical and immunological aspects and the potential of the clinical applicability of this new approach in facial reconstruction, samples of total and hemifacial transplant with rats have been introduced. We have proposed in this study checking the versatility of the facial transplant sample in rats by performing the hemiface transplant between two neco-blood species of laboratory rats. Meanwhile, study included the verification of mono-therapy efficiency with A cyclosporine in inducing immune tolerance against the composite tissue graft, which consists of skin, subcutaneous tissue, blood vessels and ear cartilage, transferred against the hystocompatibility barriers, as well as the verification of the procedures adjacent to transplant: anesthesia and surgical technique. In this study,14 laboratory rats have been included and divided into 3 lots. Lot No. 1 was represented by 2 Brown Norway rats used for the anatomic study of the vascular formations which are going to be coopted during a facial transplant. Lot No. 2 consisted of 3 Brown Norway rats used as donors and 3 Wistar rats used as acceptors, with these transplants being associated immunosuppression protocols postop. Llot No. 3 consisted of 3 Brown Norway rats used as donors and 3 Wistar rats used as acceptors, which, after the intervention, did not receive an immunosuppression treatment. Conclusions. The experimental sample of the facial transplant is an essential and mandatory stage in preparing the clinical application of the face transplant. Our study confirms the good tolerance of the hemiface transplant against the major hystocompatibility complex granted by the immunosuppression with A Cyclosporine in rodents.

Characteristics of traumatic amputations of fingers in children

Revista medicală română, Dec 31, 2015

REZUMAT Obiective. Analiza cazurilor de amputaţie traumatică la nivelul degetelor la copiii inter... more REZUMAT Obiective. Analiza cazurilor de amputaţie traumatică la nivelul degetelor la copiii internaţi, în vederea identificării unor caracteristici pe baza cărora să se optimizeze algoritmii de prevenţie şi tratament. Materiale şi metode. Au fost obţinute datele din protocoalele operatorii privind copii internaţi în Clinica de Chirurgie plastică şi Arsuri a Spitalului de Urgenţă pentru copii "Grigore Alexandrescu", între anii 2005 şi 2013, cu amputaţii traumatice ale degetelor. S-au cules informaţii referitoare la vârsta şi sexul pacienţilor, circumstanţele producerii traumatismului, mecanismul de producere, nivelul amputaţiei, tipul operaţiei şi numărul intervenţiilor chirurgicale. Rezultate. Un număr de 42 de copii cu amputaţii traumatice ale degetelor au fost operaţi, practicându-se aco perirea bontului în 81% dintre cazuri şi reimplantarea segmentului amputat în doar 19% dintre cazuri. Două treimi dintre pacienţi au fost băieţi. Degetele mâinii au fost afectate în 95% dintre cazurile care s-au prezentat în clinică cu acest tip de traumatism. Concluzii. Datele obţinute au fost în concordanţă şi cu alte studii care au indicat incidenţa crescută a amputaţiilor traumatice ale degetelor în rândul băieţilor, în cursul desfăşurării unor activităţi casnice care implică manipularea unor ustensile cu un puternic caracter de vătămare în cazul utilizării de către copii. Posibilităţile tehnice de reimplantare există şi sunt eficiente, dar cazurile care sunt eligibile pentru acest tip de tratament sunt puţin numeroase, astfel încât accentul trebuie pus în continuare pe prevenţie.

Treatment of chemical burns

Practica medicală, Sep 30, 2018

Arsurile reprezintă una dintre cele mai frecvente cauze de accidente şi sunt împrejurări medico-c... more Arsurile reprezintă una dintre cele mai frecvente cauze de accidente şi sunt împrejurări medico-chirurgicale, psihologice şi sociale extrem de grave, cu risc vital şi cu potenţial invalidant. Obiectivele terapeutice esenţiale sunt supravieţuirea, prevenirea complicaţiilor de fază acută, prezervarea funcţiilor segmentelor afectate, un rezultat cosmetic acceptabil, precum şi limitarea consecinţelor psihologice, pentru a permite pacientului o reinserţie socială rapidă şi de bună calitate (4). Au luat fiinţă astfel centrele de arsuri, care au dezvoltat în timp abilităţi şi strategii specifice, menite să asigure maximum de supravieţuire şi de calitate a vieţii pentru victimele arsurilor. Indiferent de gravitatea sau de modul de producere a unei arsuri, tratamentul trebuie să înceapă în momentul şi la locul de producere a accidentului. Prezentăm cazul unei fetiţe de 4 ani care a suferit leziuni de arsură chimică la nivelul regiunii cervicale anterioare, toracelui anterior şi capului, grad II şi III, produse de către un amestec de acizi-Asevi.

Peripheral nerve allograft, a reconstructive solution: outcomes and benefits

PubMed, Oct 3, 2012

Every year millions of individuals worldwide require complex reconstructive procedures as a resul... more Every year millions of individuals worldwide require complex reconstructive procedures as a result of various traumatic events. Recent success in composite tissue allotransplant, has shown that allografts generally present an enormous potential in reconstructive surgery. Peripheral nerve allograft represents a relatively new research field, therefore many aspects are still to be clarified. The main interests of this study concerning nerve allograft are directed to harvesting from cadaver or living donor, allografts denaturation and conservation, recipient tolerance to allograft, immunosuppressive medication, and quantifying the outcomes of nerve regeneration.

Scarless wound healing – a literature review

Revista română de pediatrie, Sep 30, 2019

The healing of skin lesions, such as traumas or burns, can often result in severe scarring causin... more The healing of skin lesions, such as traumas or burns, can often result in severe scarring causing important disabilities. The study of fetal skin particularities brings into light its ability of healing wounds in a scarless manner, through regeneration. Understanding the cellular and molecular mechanisms of fetal scarless phenotype is of utmost importance as it can result in new therapeutic targets that could have the potential to reduce scarring in postnatal wounds. The aim of this review is to summarize the unique features of fetal wound healing process that may facilitate a scarless wound repair.

Etiology Of Neonatal Burns: A Systematic Review

PubMed, Sep 30, 2022

Burns in neonates are a rare pathology with a significant impact on the patient, the family and t... more Burns in neonates are a rare pathology with a significant impact on the patient, the family and the healthcare system. At present, scarce information exists on the etiology of this type of injury. A comprehensive worldwide literature review of all publications, including our personal case series, was conducted in order to analyse the etiology of neonatal burns and summarize the available evidence. A total of 41 publications were identified in the last 4 decades, comprising of 105 cases from 20 countries, thus confirming that neonatal burns are, indeed, a rare pathology. All types of burns were recorded in neonates, the most frequent being contact burns, followed by flames and scalds. Almost 60% of burns occurred in a hospital setting due to human factors, malfunctioning devices, or hospital infrastructure deficiency. Compared to domestic burns, iatrogenic injuries occurred at an earlier age (5.4±9.1 days vs. 15.7±9.8 days, p<0.0001) and in neonates with significantly smaller weights (2102.7±1350g vs. 3197±300.8g, p<0.0001). The number of cases was almost equally distributed between developed and developing countries, but developed countries were characterised by a significantly higher preponderance of iatrogenic burns, while in developing countries domestic burns were more frequent (p<0.0001). We believe that this systematic review outlines the potential causes of neonatal burns and provides essential information for formulating prevention strategies.

Study on Reconstruction Techniques of the Nipple-Areola Complex

Revista De Chimie, May 15, 2019

Increasing the incidence of breast cancer worldwide is an alarming factor for the medical communi... more Increasing the incidence of breast cancer worldwide is an alarming factor for the medical community and also an additional reason for accountability. Oncological treatment, followed by subsequent reconstructive stages, are traumatic events that without a doubt exert their adverse effects on the quality of life of these patients. The reconstruction of the nipple-areola complex represents the final element in the treatment of patients who have suffered from breast cancer and must follow basic principles such as: reproducibility, efficacy, short duration of treatment and low rate of complications. The present material presents the various surgical techniques dedicated to the reconstruction of the nipple-areola complex, presenting their advantages and disadvantages based on a 5-year study. The use of single-stage techniques associated with medical tattooing were the main factor in increasing the satisfaction of the patients included in the research.

Optimal timing for burned hands in children

PubMed, Mar 31, 2015

Hand burns in children are frequent, severe, and require adequate treatment. A fundamental, thoug... more Hand burns in children are frequent, severe, and require adequate treatment. A fundamental, though problematic aspect of this treatment is the assessment of the burn depth as this determines the surgical strategy. From a retrospective study of 369 hand burns admitted to our clinic, we were able to identify some patterns. A total of 14.91% required surgery, with varying etiology among these patients. Differences were also noticed in the number of days post-burn prior to surgical intervention. The patterns revealed by our results are reviewed in order to improve therapeutic strategy.

Surgical treatment of anogenital hemangiomas of infancy

Acta Medica Marisiensis, Oct 1, 2014

hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children an... more hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal. Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option. Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture. Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a "healthy" hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.

Pediatric burns in Romania

Burns, Feb 1, 2007

The impact of COVID-19 pandemic on the activity of a pediatric burn center in Bucharest, Romania

Burns, Dec 1, 2020

The ongoing SARS-CoV-2 pandemic is challenging the 6 medical community to cope with different cli... more The ongoing SARS-CoV-2 pandemic is challenging the 6 medical community to cope with different clinical protocols 7 and to adapt on the way to new public health regulations. 8 These changes in the daily activity affect all medical fields, 9 including burn care. We have followed with extreme interest 10 the recently published researches and reviews [1À3] on 11 COVID-19 in relation with burn care and burn center 12 functioning. Since we are the only specialized Pediatric 13 Plastic Reconstructive Surgery and Burns Department in 14 Romania, our goal was to keep taking care of the burned 15 children, under the best conditions, despite the pandemic.

Uncommon location of pyogenic granuloma in a child – case report and mini-review

Archives of the Balkan Medical Union, 2020

Introduction. Le granulome pyogène (GP) est une hyperplasie inflammatoire vasculaire qui affecte ... more Introduction. Le granulome pyogène (GP) est une hyperplasie inflammatoire vasculaire qui affecte la peau et la muqueuse buccale, souvent associée à une irritation ou un traumatisme local, ou à une grossesse. La localisation intra-orale affecte généralement la gencive, mais l’aspect tumoral peut être trompeur, en particulier dans les localisations extra-gingivales. Une évaluation et un diagnostic approfondis sont donc importants pour garantir un traitement approprié. Présentation du cas. Nous présentons le cas d’un garçon de 12 ans qui est venu pour une consultation concernant la tumeur croissante et saignante de sa muqueuse de la lèvre inférieure. La tumeur a été étiquetée comme « hémangiome ». Elle se développait depuis plusieurs semaines et avait été associée à un traumatisme muqueux mineur mais répété. Bien que la localisation anatomique ne soit pas courante, les antécédents du patient suggéraient un diagnostic de GP. Après une consultation dermatologique qui proposait un diagnos...