Surgical Correction of Ascending Aortic Aneurysm Associated With

Aortic Regurgitation by Correcting Aortic Root Geometry

Author: Bulgaru Iliescu Andra Irina

Co-authors: Tesu Maria Anastasia, Chirvasuta Elena Andreea
Scientific Coordinator: Assistant Professor Cristina Furnica MD PhD

Introduction: Ascending aortic aneurysms are frequently associated with aortic regurgitation
in the absence of structural valvular damage consequently to sinotubular junction geometrical
alterations. Although Bentall and Wheat interventions are traditionally considered the standard
in the treatment of these conditions, normal leaflet morphology might offer the chance for a
valve sparing surgical approach. The method is sustained by two underlining principles:
remodeling of the sinotubular junction and cranial relocation of the aortic annulus by using a
shorter graft for the dilated aortic aneurysm. The second principle represents an improvement
over the remodeling technique proposed by Tirone David due to its hemodynamically better
correction overwhelmed by a greater long term patency.

Materials and Methods: Between 2003-2016 in IBCV Iasi 71 eligible patients (51.0412.07
years) were surgical treated by ascending aorta replacement with Dacron graft simultaneously
with the aortic valve preservation. 22 (30.98%) patients benefit by elective surgery for aortic
aneurysms while 49 (69.01%) cases with aortic dissections were considered as emergencies.
Perioperative echocardiographic and computed tomography analyzes were done in order to
document the degree of aortic valve incompetence and to evaluate the aortic root morphology.
Surgically, the sinotubular junction was remodeled by using Dacron graft or PTFE bands. The
aortic valve plane was relocated in a more cranial/oblique position by using the length of the
Dacron graft thus being restored the normal anatomical alignment.

Results: Preoperatory, all patients presented moderate to severe aortic regurgitation.

Perioperative mortality was 14.28% in the acute dissection group and 0% in the elective
surgery group. During a mean follow-up of 5.73 years aortic regurgitation was absent
(78.87%) or mild (21.13%), while the size of the sinotubular junction and the length of the
ascending aorta had better values throughout echocardiographic examinations.
Postoperative computed tomography revealed a decrease in the aortic
length, a narrowing of the sinotubular junction, a moderate aortic root diameter reduction, and
an angular widening between the aortic root plane and longitudinal spinal axis.

Conclusion: The aortic relocation technique is simple, reproducible, provides satisfactory mid
term results and can be successfully applied in treating aortic insufficiency secondary to
ascending aorta aneurysm.

Keywords: Aortic Aneurysm, Relocation, Annular Plane

The Necessity of Individualized Therapy in Vesicoureteric Reflux. Issues
in Applying the EAU Guidelines

Author: Tams Tth

Co-Author: Ana-Maria Pric, Timea Trk
Scientific Coordinator: Radu-Alexandru Pric MD

Introduction: The treatment of the vesicoureteric reflux (VUR) is the most

controversial and complex issue in pediatric urology. The choice of the diagnostic
procedure, the plan and the timing of the treatment are the limits of an outstanding
uniform algorithm. The success of the healing process is also influenced by the
parents cognitive abilities.

Materials and Methods: Our prospective study included 96 children with VUR
diagnosed in the Pediatrics and Pediatric Surgery Departments in Trgu Mure
between 2014 and 2016. The diagnostic workup and treatment plan followed the
guidelines of the European Association of Urology (EAU). Patients were divided into
three groups according to the risk of kidney damage: low, moderate and high risk
group. The consultant doctor explained the advantages and disadvantages of the
proposed treatment and clarified the misunderstandings for the parents.

Results: In the study are included 60 girls and 36 boys with a total average age of 22
months. From demographic perspective 72.91% (n=70) come from urban area and
27.08% (n=26) from rural area. Most patients are diagnosed with VUR grade II
(39.58%) and III (32.29%) and only 3.12% have VUR grade V. Bilateral VUR is
revealed in 24 cases. According to the EAU guidelines 50.88% belong to the low risk
group, 31.25% to the moderate risk and 15.62% to the high risk group. 18 patients
receive surgical treatment with a success rate of 92%. 57% of them are not registering
any febrile break through infection during follow up and VCUG is without reflux. In
18.3% of the cases the grade of VUR worsens and 24.69% of the patients dont show
up at the follow up control.

Conclusion: The optimal treatment has to be individualized. The doctor has to take
into consideration, beside the guidelines, the compliance of the parents. In patients
belonging to the moderate risk group the surgical treatment can be recommended if
noncompliance is suspected.

Keywords: Vesicoureteric Reflux, Individualized Therapy, Guidelines

Digital Replantation in Children Under 5 Years Old Technical
Particularities, Postoperative Care, Results

Author: Coru Alexandra-Cecilia

Co-Author: Chiuariu Traian
Scientific Coordinator: Lecturer Mihaela Pertea MD, PhD

Introduction: Digital amputation in children has an absolute indication for

replantation, functional and sensorial outcomes being really good. There are some
particularities and difficulties regarding the surgical technique: the osteosynthesis, the
microsurgical anastomosis, the postoperative analgesia, the dressings and recovery
techniques. The very good outcome, fast social reintegration and satisfaction of the
parents, deserve all the needed effort.

Materials and Methods: The study is based on 3 cases of digital amputation in

children (2 boys and 1 girl) aged between 3 and 4 years and 6 months old. In 2 cases,
the amputation was at the first and second phalanx of the index. In one case, the
amputation was at the second phalanx of the fourth finger. The trauma occurred
during housekeeping activities such as wood cutting using an ax. Bone repair was
difficult due (with needle) to the need of keeping the growth cartilage intact. The
small vessel diameter constrained us to use 11-0 suture thread and a reduced number
of stitches. Postoperative analgesia played an important role in preventing vasospasm
and increased the chance of a successful replantation. The splinting was done taking
into account the principles of immobilization in children. The 4 year old child
developed a postoperative venous insufficiency that we managed successfully. In one
case a secondary surgical intervention was necessary for the extensor apparatus
reconstruction.

Results: The results are very good in all three cases, with total functional and
sensorial recovery. There was a secondary intervention needed in only one of the
cases, for the reconstruction of the extensor system.

Conclusion: Replantation of the amputated finger in children has an absolute

indication. The younger the patient the more difficult the surgical repair is, but is
counterbalanced by the good functional and aesthetic results.

Keywords: Replantation, Child, Vascular Anastomoses

Laparoscopic Management of Hiatal Hernia and GERD

Author: Graiana Georgescu

Co-Author: Florentina Floritean, Maria Gospodin
Scientific Coordinator: Lecturer Rzvan Popescu, MD, PhD

Introduction: Hiatal hernia is a common pathology nowadays frequent associated

with symptomatic GERD.

Materials and Methods: We present our personal experience in the last four years
regarding hiatal hernia repair using different types of antireflux procedures and
cruroplasty with or without mesh reinforcement. In cases of large hiatal defect we
performed Nissen fundoplication besides cruroplasty. We also used Dor or Toupet
procedures adapted at each case.

Results: We analyzed the results of different types of antireflux procedures in terms

of quality of life of the patients and the efficacy to reduce the GERD symptoms.

Conclusion: Laparoscopic treatment is gold standard in hiatal hernia therapeutical

management regarding the functional results and the prevention of recurrence.

Keywords: Hiatal Hernia, GERD, Cruroplasty

Peripheral Venous Catheter - Associated Phlebitis - Iatrogenic Lesion-
Easy To Prevent, Hard To Treat

Author: Adina Georgiana Para

Co-Author: Stefania Gherghe-Moise
Scientific Coordinator: Lecturer Mihaela Pertea MD, PhD

Introduction: Peripheral venous catheter is the most common device used in medical
activity. 70-80% of superficial and deep thrombophlebitis cases, localized at the
thoracic limb level are iatrogenic caused by venous catheterizations. The purpose of
the presentation is to bring to the fore the etiology and symptomatology of the
catheter thrombophlebitis in order to acknowledge its diagnostication and treatment
process. Severe complications involving complex and long-lasting surgical treatment
can be easily avoided, which makes us highlight how simple it is to prevent this type
of pathology.

Materials and Methods: The study included 10 patients diagnosed with peripheral
venous catheter-associated phlebitis on various levels. 4 cases presented an easy form
demanding a simptomatologic treatment, 5 cases requesting a surgical intervention for
the excision of the thrombosed vein. One case was diagnosed with ulcero-necrotic
lesions needing, after surgery,VAC therapy and skin graft with a long time
hospitalization (one month).

Results: The cases evolution was favorable with full recovery, without functional,
sensorial or motorial sequelae. The patient with ulcero-necrotic lesion has motor
sequelae with limiting finger flexion at 30 degrees. The patients needed
hospitalization between 3 days and 1 month.

Conclusion: Peripheral venous catheter-associated phlebitis is defined as a

complication of the venous catheterization which can be prevented and/or early
discovered in order to avoid multiple surgical interventions with repeated anesthesia
and a long period of hospitalization.

Keywords: Peripheral Venous Catheter-Associated Phlebitis, Venous Catheter,

Surgical Treatment
Intestinal Malrotation and its Surgical Implications in Adults

Author: Stefana Eugenia Moldovanu

Co-Author: Iuliana Stefanuca, Paula Georgiana Plaiasu
Scientific Coordinator: Assoc. Prof. Cristina Furnica MD, PhD; Assistant Prof.
Lacramioana Perianu MD, PhD; Lecturer Nutu Vlad MD, PhD

Introduction: Intestinal malrotation is defined as any change in rotation and fixation

of the intestine during the embryonic development. Common mesentery is one of the
primitive gut abnormalities rotation, characterized by the complete absence of the
intestines adhesion. The disease is very rare in adults, most cases are diagnosed in
the newborn or in the first year of life. The aim of this paper is to evaluate several
cases of common mesentery and its implications in surgical practice.

Materials and Methods: We present 3 cases of patients with common mesentery. All
the patients were women aged 18, 33 and 79 years old, respectively. The BMI was 21,
26 and 22 kg/ m2. All the patients were admitted for diffuse abdominal pain, nausea
and vomiting. Physical exam revealed peri umbilical tenderness in all cases and
abdominal meteorism in one case. Biological explorations revealed an inflammatory
syndrome. The ultrasound examination was not relevant; CT scan reveals
inflammatory infiltration of the ileo-cecal area without intraperitoneal fluid
collections and a look of malrotation bowel mesentery common type in 2 cases and
intestinal occlusion in the 3rd case.

Results: The diagnosis was acute appendicitis related to an abnormal intestinal

rotation and laparoscopic appendectomy was performed in 2 cases. In the 3rd case an
open approach was performed which allows the diagnosis of intestinal volvulus on
intestinal malrotation and adhesions (previous cholecystectomy) and adhesiolysys
was performed with uneventful postoperative course.

Conclusion: Intestinal malrotation is rare in adults. It is asymptomatic and diagnosed

during the exploration for other diseases. Common mesentery and the lack of the
colon adhesions is a real challenge for imagistic diagnosis and surgery. Laparoscopy
allows is a good approach in non-occlusive cases and allows complete abdominal
exploration and appendectomy. The open approach is the choice for intestinal
occlusion.

Keywords: Intestinal Malrotation, Common Mesentery, Acute Appendicitis

Laparoscopic Management of Severe Forms of Acute Cholecystitis

Author: Alexandru - Ionel Tlban

Co-Author: Loredana - Sorina Smrndache, Lior Uziel
Scientific Coordinator: Dumitru Sandu Ramboiu MD, Teaching Assistant Tudor
Bratiloveanu

Introduction: Upon increasing surgical experience, the indication of laparoscopic

approach for acute cholecystitis was widely broadened, the majority of cases being
solved this way as often as possible.

Materials and Methods: The clinical study was conducted between 2009-2014 in
our department. There have been analyzed a total of 1496 cases of acute cholecystitis
with surgical indication, of which 680 (45.45%) acute and 916 (54.55%) chronic. We
have followed the anatomo-clinical aspects, intraoperative incidents and accidents,
cases with conversion and postoperative complications.

Results: Laparoscopic approach was performed in 89.75% of cases with a conversion

rate of 10.29%. Gangrenous forms were found in 217 cases (31.9%). The common
incident during surgery was the perforation of the cholecyst during dissection - 80
cases (11.74%). Injury of the common bile duct was recorded in 2 cases (0.29%). The
main cause of conversion was the pericholecystic adherential block in 30 cases
(4.4%). Postoperative mortality was 0. The most important prognostic factor for
conversion was the intensity and the severity of the vesicular and perivesicular
inflammatory process. Other risk factors are represented by sex, age, surgery
performed after more than 4 days from the onset the symptoms diseases and surgeon's
experience. This procedure is reliable, confirmed by the low incidence of the common
bile duct: 0.29%, postoperative morbidity of 8% and mortality 0.

Conclusion: Our results confirm that the laparoscopic approach is appropriated also
in cases of acute cholecystitis, with a success rate of almost 90%. Although the
conversion rate was higher in gangrenous forms of acute cholecystitis, the technique
maintains its minimal invasive advantages and we consider that all the patients should
benefit of laparoscopic approach.

Keywords: Cholecystitis, Laparoscopy, Severe Cholecystitis

Simple Minimal Invasive Repair for Inguinal Hernia

Author: Nithiya Kadampattu John

Co-Author: Sandra Susan Roy, Midhun Mathew
Scientific Coordinator: Stoica Alin MD, Dumitru Loredana MD, Fruntelata Radu
MD

Introduction: Inguinal hernia is a usual pathology in a pediatric surgery department

in boys also in girls. Many surgical techniques are developed for the repair, including
minimal invasive techniques. The main objective of all these techniques is to reduce
the surgical trauma and to be scar less.

Materials and Methods: The authors are presenting a study of 46 patients operated
in this fashion. The surgical technique is single port laparoscopy, using a single 3 mm
grasper, a needle 22G used for spinal anesthesia and a single 3-0 nonabsorbable
thread. The technique is used in boys and girls.

Results: This technique is simple and effective especially for girls but can be tricky in
boys. The duration of the intervention is comparable with the open technique and the
learning curve is spectacular. This minimal invasive approach determined the
increased rate of diagnosis of bilateral forms in girls.

Conclusion: This laproscopic technique was completed in 46 patients whom it was

attempted. The reccurent rate was low. A short hospital stay and minimal blood loss
were documented. The minimal invasive repair appear to be safe and effective.

Keywords: Single Port Laparoscopy, No Scar, Bilateral Hernia

Surgical Management of Mitral Regurgitation: Valve Repair versus
Valve Replacement

Author: Vicentiu Alexandru Grama

Co-Author: Alin Stefan Grosu
Scientific Coordinator: Associate Professor Radu Nitu MD, PhD

Introduction: Mitral regurgitation is frequently caused by degenerative changes of

the tissue associated with aging. Left untreated, this affection has a bad prognostic
and can lead to myocardial infarction and abnormally heart rhythm. The surgical
treatment can be done either by mitral plasty or valve replacement, but there is
incertitude when choosing between these two. The aim of the present review is to
consider and summarize the available data on the clinical outcomes following mitral
valve repair compared with replacement.

Materials and Methods: We centralized the information from two databases of Duke
Clinical Research Institute and made a retrospective analysis over all the procedures
of mitral valve replacement and mitral valve repair performed on 266 patients over a
period of 3 years. We examined the mortality summary in both types of surgery and
considering the demographics, associated comorbidities and also the anterior surgical
interventions, we made a detailed comparison between the two surgical techniques.
The data were independently extracted by the two reviewers and meta-analyzed based
on predefined criteria of study.

Results: In comparison with patients that underwent mitral valve replacement, the
inmates operated on for mitral valve repair had a lower rate of operative and post-
operative mortality which demonstrates significantly reduced risks. Recurrence of at
least mild mitral regurgitation was greater in mitral valve repair, but the percentage of
re-operations was somehow similar.

Conclusion: In the current analysis it is demonstrated that although mitral valve

replacement is a durable solution associated with freedom from re-intervention, mitral
valve repair is the procedure of choice because of the low mortality risk involved.
However, the different characteristics of the patients must be taken into consideration
when choosing the right procedure.

Keywords: Mitral Regurgitation, Mitral Valve Repair, Mitral Valve Replacement

Abdominal Compartment Syndrome, a Life-Threatening Complication of
Acute Severe Pancreatitis

Author: Chatzigianni Olympia-Evangelia

Co-Author: Marc-Andre Heller, Estefana Hernando Cases
Scientific Coordinator: Irina Trifescu MD

Introduction: Abdominal compartment syndrome (ACS) is defined as sustained

intraabdominal pressure above 20 mmHg which can be a life-threatening
complication of acute severe pancreatitis (ASP).

Materials and Methods: In a period of three years (2013-2016) 270 patients were
admitted to Sf. Spiridon Hospital, 3rd Surgery department, Iasi. 54 patients (20%)
were diagnosed with ASP of diverse origin, of which 20 (37%) presented with early
ACS. These patients (median age n=43, female n=11, male=9) were included in this
study. Treatment and postoperative course were assessed.

Results: To achieve abdominal decompression 15 patients underwent vacuum

laparostomy while the remaining five were operated with classic laparostomy. Both
approaches partly included cholecystectomy with biliary drainage, necrosectomy and
drainage of pancreatic and parapancreatic pus collections. Surgical decompression
was chosen two days post diagnosis of ACS, when medical treatment in the ICU
proved to be insufficient. Peritoneal fluid cultures were positive in all cases for
Klebsiella Pneumoniae and Acinetobacter, multiple resistant strains. 16 of 20 patients
with ACS passed away due to septic shock and multiple organ failure (mortality rate
80%). This equals 29.6% of the 54 patients initially presenting with ASP. The
surviving 4 patients were discharged after lengthy hospitalization.

Conclusion: Acute severe pancreatitis complicated with abdominal compartment

syndrome has a high mortality despite ICU support, therefore careful observation of
the progress of medical therapy is paramount. Surgical treatment options (abdominal
decompression) should be considered in time, and not delayed, if indicated.

Keywords: Abdominal Compartment Syndrome, Pancreatitis, Decompression

Achalasia of the Cardia Current Laparoscopic Treatment

Author: Luana-Andreea Bosoteanu

Co-Author: Karina Boiagian, Geilan Buri
Scientific Coordinator: Associate Professor Razvan Popescu MD, PhD

Introduction: The therapeutic management of achalasia has thoroughly modified

through the last decades, laparoscopic Heller cardiomyotomy becoming a standard
treatment. The association with an anti-reflux procedure diminishes the potential risk
of post-operative pathological gastroesophageal reflux.

Materials and Methods: Between January 2014 and December 2016, in the General
Surgery Clinic of the County Emergency Hospital, Constantza, specific surgical
procedures were performed on 6 patients presenting this disease, the diagnosis being
sustained by clinical and radiological information. Laparoscopic Heller
cardiomyotomy, correlated with an anterior Dor hemi-valve, was practiced in all of
these cases.

Results: The cases approached in a laparoscopic manner did not require conversion to
the traditional open surgery. The postsurgical evolution was bereft of complications,
allowing the patient discharge 3-5 days after the intervention. The follow-up of the
subjects was conducted over a period of 3-18 months and consisted of clinical
examination and radiological investigations; the excellent obtained results proved a
lack of dysphagic complaints during the medical surveillance period.

Conclusion: The laparoscopic Heller cardiomyotomy, accompanied by an anti-reflux

scheme, epitomizes a feasible and efficient method of treating achalasia, attaining
favorable long-term outcomes, as far as the amelioration of dysphagic symptoms is
targeted. Quick recovery and decreased hospitalization duration stand for the election
of the presented procedure as a viable and optimal alternative to endoscopic therapies
- consisting of successive dilations or Botox injections.

Keywords: Achalasia, Heller Cardiomyotomy, Anti-Reflux

Ectopic Pregnancy in Caecarean Section Scar

Author: Sandra Susan Roy

Co-Author: Nithiya Kadampattu John, Midhun Mathew
Scientific Coordinator: Zorila Lucian MD

Introduction: Cesarean section scar pregnancy is a rare serious complication that is diagnosed
with increasing frequency recently. It occurs when implantation takes place at the site of
previous uterine scar. The possible incidence of this abnormality is 1:1800.

Materials and Methods: A 22 year old woman presented with 9 weeks of amenorrhea, lower
abdominal pain and a positive urine pregnancy test with history of a previous cesarean section.
Trans-abdominal ultrasound shows an empty uterine cavity and cervical canal. A gestational
sac having a fetal pole with cardiac activity, situated in the lower part of the anterior uterine
wall within 1-2 mm of myometrium at the site of the cesarean section scar was noted. Crown
Rump Length measure is 1.73cm corresponding to 8 weeks and 1 day gestation. With these
ultrasound criteria, an ectopic implantation in the previous cesarean section scar was
considered. The differential diagnosis includes spontaneous abortion and cervico-isthmical
pregnancy.

Results: The case was managed by arresting fetal growth by systemic methotrexate injection at
first then locally in trophoblast and gestational sac along with evaluation of beta HCG level,
combined with bilateral uterine artery embolization for minimizing risk of life threatening
hemorrhage. It was followed by dilation and evacuation as the sac progressed to uterine cavity.

Conclusion: This serious complication must be suspected in pregnant woman with previous
uterine scar when early ultrasound shows a gestational sac implanted anteriorly in lower uterine
segment, near uterine scar. Treatment modalities are either medical or surgical. Treatment must
be individualized according to sac size, presence of fetal heart, BHCG level, the desire for
future fertility and the experience and facilities available. Early detection and timely
intervention is recommended to avoid serious consequences like uterine rupture and life
threatening hemorrhage in such cases and for the future fertility of the patient.

Keywords: Caesarean Section Scar Pregnancy, Methotrexate, Uterine Artery Embolization

Atypical Clinical Case of Teratoma Associated With Germinoma

Author: Mohammad Ibrahim

Co-Author: Ilie Ilona Alina, Toia Diana Ionela
Scientific Coordinator: Ana-Simona Drochioi MD PhD

Introduction: The malignant germ cell tumors account only for 3% of all cranial tumors.
Intracranial teratoma and germinomas are considered to be derived from the intracranial germ
cells. Clinical presentation can be related to the endocrine abnormalities, visual disturbances
and increased intracranial pressure. Two types of teratomas were identified: intra-axial
teratoma which can be diagnosed before birth or during the birth, this leads to an increased
head circumference; and the extra-axial teratomas being diagnosed during the childhood or
adulthood, having the location in the pineal or sellar region.

Materials and Methods: Atypical clinical presentation of a 7 years old girl, admitted to the
3rd Paediatric Clinic of the Iasi Saint Mary Children Hospital, in December 2016 presenting
the following symptoms 4 days prior to admission: frontal headache, nausea, vomiting and
drowsiness, symptoms associated with intracranial hypertension. Clinical examination showed
mediocre general condition, the weight was 18 kg, pale skin and normal cardiac and pulmonary
sounds. First suspicion was viral meningitis, but lumbar puncture ruled it out. Cerebral MRI
shows an expansive intracranial process located in the 3rd ventricle, bilateral monro foramina,
hypothalamus, the infundibulum of the hyphophyseal gland, rising the suspicion of teratoma,
being confirmed by the anatomo-pathology report and associated with germinoma. The patient
was transferred to the Neurosurgery Hospital to undergo the tumor resection procedure.

Results: The surgery had a good impact on the outcome of the patient, being the only treatment
that we have in this moment for teratoma.

Conclusion: The presented case is revealed in an unusual way, to show us that the symptoms
cannot be always associated from the first look with a certain disease, medicine being a
continous challenge for us. Isolated vomiting without other digestive symptoms should be
investigated thoroughly, especially the vomiting often associated with headache which can be
the first sign of CNS malignancies.

Keywords: Atypical, Teratoma, Diagnosis

A Rare Case of Limited Infarction of the Small Bowel Associated With
Myocardial Infarction in a 30 Year Old Male

Author: Laura-Stefana Galatanu

Co-Author: Ioana Roxana Galatanu, Andrei Vicol
Scientific Coordinator: Madalina Palaghia MD

Introduction: Infarction is tissue death caused by a reduction/stoppage in blood flow

due to artery blockages, mechanical compression, rupture, or vasoconstriction. In this
article we discuss the peculiar aspects of multiple organ infarction.

Materials and Methods: A 30 year old male patient was admitted to the Institute of
Cardiovascular Diseases on the Coronary Intensive Care Unit, with chest pain
associated with syncope episodes and mild abdominal pain. The echocardiography
showed there were thrombus engaged in his coronary arteries. He began treatment,
but the pain was persistent. An abdominal CT scan was performed with intravenous
contrast agent, but it revealed no abnormalities. After 3 days he was transferred to the
department of General Surgery with signs of bowel obstruction, facies dolorosa,
paleness of the skin and specific fetid halitosis. The rectal examination showed no
abnormalities, but the abdominal echography revealed edematous, dilated small
bowel with no peristaltic movement.

Results: An exploratory laparotomy was performed and we found a partial jejunal

ischemia, approximately 1 meter in length, starting from 60-70 cm from the
duodenojejunal flexure. We proceeded with the resection of the necrotic part,
followed by an end-to-end anastomosis. All this time the patient was treated with low
molecular weight heparin. After discharge he was redirected to cardiology for further
investigation in order to identify the etiology of the hypercoagulability status.

Conclusion: This case report shows us the importance of timely diagnosis and
cooperation between different specialties to solve a not so common course of events.

Keywords: Infarction, Laparotomy, Hypercoagulability, Jejunal Ischemia

Rare Case of Arthrogryposis Discovered in Iasi

Author: Luminita Amaranducai

Co-Author: Adina Olaru, Basel Abukhalaf
Scientific Coordinator: Agnes Bacusca MD

Introduction: Arthrogryposis Multiplex Congenita (AMC) is a rare condition with a

prevalence sustained by a study to be 1:3000 cases in Asia, while another study
suggest 1:11.000-12.000 among European newborns. Most of the joints of the patient
with arthrogryposis is affected (84% involve all limbs, 11% only the legs, 4% only
the arms). Most common causes are: defects in the fetal blood supply, secondary to
fetal akinesia caused by oligohydramnios, hyperthermia, limb immobilization and
rarely viral infections or myasthenia gravis. Other causes are intrinsic factors such as
molecular, muscle and connective tissue development disorders or neurological
abnormalities. Hypertrophic Pyloric Stenosis (HPS) is one of the most common
conditions met in pediatric surgery with a male to female ratio of 5:1 in Caucasian
infants. The etiology is still unknown.

Materials and Methods: A thirteen-months-old infant had been diagnosed since

birth with AMC, which records the first entry in the last 17 years in Iasi. The
pregnancy had been known with severe oligohydramnios and possible multiple
malformation syndrome from the gestational age of 24 weeks. The delivery had been
made by c-section at the gestational age of 35 weeks. Hypertrophic pyloric stenosis
was diagnosed at the age of 2 months, with no surgery required as a treatment.

Results: Surgical management of AMC is not the primer treatment. The patient is
currently undergoing physical therapy, some joint contractures still persisted. Hence
the surgical option was scheduled for the following year in order to provide that
patient with a better quality of life.

Conclusion: The documentation of this case holds a historical significance due to its
rareness. The diagnosis will often be made by the associated symptoms, signs and
genetic tests. Physical therapy early started is essential.

Keywords: Arthrogryposis, Oligohydramnios, Stenosis

Resection vs Palliation: Massive Pancreatic Tumour

Author: Basel Abukhalaf

Co-Author: Mariana Reis Penaforte Pedroso, Amaranducai Luminita
Scientific Coordinator: Associate Professor Lidia Ionescu MD

Introduction: Pancreatic cancer is the fourth leading cause of cancer deaths. The
tumour metastasizes to regional lymph nodes, then invades surrounding organs. Only
20% of the patients diagnosed are eligible for surgical resection, because it is usually
diagnosed at an advanced stage. Whipple procedure is the most commonly performed
surgery to remove tumours of the pancreas. Standardly the surgeon removes the head
of the pancreas, the gallbladder, part of the duodenum and the pylorus. However, in
the common case of advanced stage, palliative care is considered. It focuses on
improving the symptoms and side effects such as pain, biliary obstruction, pancreatic
insufficiency, anorexia-cachexia and depression.

Materials and Methods: In a case that routinely undergo palliative care. A seventy
six-years-old female patient presenting a huge palpable upper abdominal tumour,
weight loss and denutrition diagnosed with an advanced cephalic pancreatic tumour.
Exploratory laparotomy revealed normal liver and a cephalic pancreatic tumour of
11cm. The team of doctors decided to proceed surgically instead of palliation. On
frozen section, peritumoral lymph nodes were negative for tumour cells, leading to
the decision of vascular plane dissection first. Tedious dissection was performed at
the superior mesenteric portal vein confluence noting a free plane between tumour
and vein.

Results: The Standard Whipple Procedure undertook 4 hours, the vascular injury risk
was overcome and the patient necessitating one unit of blood. The patient was
discharged in the ninth postoperative day after an uneventful course.

Conclusion: Advanced age and imagistic suspicion of unresectabletumours are not

enough to contraindicate an operative resection. Vascular approach first can decide
the tumourresectability before considering Palliative care. While a successful
Whipple procedure has a 25% survival rate at 5 years, the option of Palliative care
doesnt prolong life expectancy.

Keywords: Resection, Tumour, Whipple

Good Functional Results at a Young Patient after Arm Replantation

Author: Cosmin Mihai Petrea

Co-Author: Valentin Daniealopol, Horaiu Chi
Scientific Coordinator: Dorin Dorobanu MD, Ana-Maria Bumbu MD, Adelina Pop
MD

Introduction: In reconstructive surgery, one of the most challenging operations is the

replantation of the upper extremity. In present, the reattachment of the hand and digits is
common, but the replantation of the arm is still rare. In this case we need to evaluate many
more aspects, such as: prolonged regeneration time of the nerves, reduced functional recovery
due to joint stiffness, muscular degeneration. Therefore, the decision for replantation in the
proximal regions should be taken more carefully than in distal amputations.

Materials and Methods: We describe the case of a 22 years old male patient, presented to the
emergency department with an arm amputation after an avulsion injury. Emergency surgery
was performed by a multidisciplinary team, including orthopedics, vascular and plastics
surgeons in attempting replantation of the upper limb. Osteosynthesis of the proximal humerus
fracture was first performed, followed by the vascular reconstruction using saphenainterna vein
graft. Revision surgery was performed 7 days later, with reconstruction of the major nerves
using grafting techniques. During 43 days admission period, several other operations were
required to complete the soft tissue coverage.

Results: Preliminary results, after 3 months from the replantation, include good soft tissue
healing, with no wound infection, and a promising neurological response described by discrete
flexion of the elbow. Further EMG tests will reveal the nerve regeneration and with an
appropriate rehabilitation program could set the basis of a good recovery.

Conclusion: Despite the promising early results after replantation, the recovery time after such
a devastating injury is extended over many years. The selection criteria of the patient for this
operation should be very carefully considered: young patient with no comorbidities, good
condition of the amputated arm, long-term physical therapy, a good patient compliance, also
completed with psychological counselling and support.

Keywords: Arm Replantation, Graft, Nerve Regeneration

Particularities in the Surgical Treatment of Pheochromocytoma

Author: Padure Rares Cristian

Co-Author: Sandu Gabriel, Constantinescu Angela
Scientific Coordinator: Teaching assistant Cristian Velicescu, MD, PhD

Introduction: Pheochromocytoma (PCC) is a rare (1/100.000 cases) neuroendocrine

tumor of the medulla of the adrenal glands or extra-adrenal chromaffin tissue that
secretes high amounts of catecholamines. Those affected by PCC develop perpetual
or paroxysmal elevated blood pressure, usually accompanied by palpitations - due to
tachycardia- cephalalgia and diaphoresis.

Materials and Methods: We present the case of a 59 year old male admitted for left
renal lithiasis and constant fatigability. The patient is known to have a history of
cardiovascular pathologies (paroxysmal elevated blood pressure, painless/indolent
chronic ischemia) and a high level of cholesterolemia. Even if the patient was under
antihypertensive treatment, his blood pressure values continued to oscillate. During
the CT that was conducted in order to evaluate the left renal lithiasis, it was observed
that a tumoral mass was present on the right adrenal gland. Further investigations
were conducted in form of radiological examination and MRI that detected a 7cm
growth on the surface of the right adrenal gland. The tests for catecholamines and for
the vanillylmandelic acid the end stage metabolite for catecholamines has shown
increased blood levels of both. All the clinical and paraclinical data pointed towards a
diagnosis of pheocromocytoma and the necessity of adrenalectomy was definitive.

Results: A laparoscopic procedure was initiated for the excision of the right adrenal
gland and the microscopic examination concluded that there was indeed a
pheocromocytoma. Postoperative, the patient was monitored in the Intensive Care
Unit and because of the favourable evolution he was released after 4 days.

Conclusion: Even though the symptomatic treatment is of use on short term, the
golden standard for pheochromocytoma remains laparoscopic surgery due to the
pathological synthesis of cathecolamines. However, the adrenalectomys risks are not
to be forgotten, as the possibility of increased blood pressure variations and atrial
fibrillation during surgery is present.

Keywords: Pheochromocytoma, Elevated Blood Pressure, Laparoscopic

Adrenalectomy
Eso-Cardio Tuberozitar Neoplasm Treated By Laparoscopic and
Thoracoscopic Esogastrectomy

Author: Platon Liviu Razvan

Scientific Coordinator: Lecturer Daniel Timofte, MD, PhD

Introduction: The esophageal carcinoma is well known for its aggressivity. It has the
tendency to invade local lymph nodes, disseminating trough submucosal lymphatics.
The lack of serous, favors the invasion of adjacent structures (pericardium, aorta,
stomach and diaphragm).

Materials and Methods: A 65 years old patient, is arriving at the hospital with a
pronounced dysphagia, weight loss, reduced appetite, symptoms that started gradually
approximately 3 months before. From previous medical history, we remember that the
patient has permanent atrial fibrillation, essential hypertension, chronic ischemic heart
disease, scleroemphzema. The endoscopic examination reveals a supracardial
malignant type lesion, at cardial level and supero-cardial level are distinguished
lesions that are matching. Pathological examination is confirming a moderately
differentiated ulcerated adenocarcinoma with fibrin-leukocyte surface detritus.

Results: The approach is multidisciplinary (surgical, medical, oncological). The

surgical treatment used is total laparoscopic and thoracoscopic esogastrectomy, with
intrathoracic latero-lateral anastomosis and jejunostomy used for patient`s nutrition.
Laparo and thoracoscopic approach confers some advantages (low postoperatory
morbidity) and the short time recovery.

Conclusion: This type of intervention is requiring a fair amount of time (9 hours),

and is very stressful for both medical and anesthetic team. This laparoscopic and
thoracoscopic version of this surgical intervention has lowered significantly the risk
of medical complications, pulmonary complications consecutive to a classic
thoracotomy have a 40% chance to appear. The patient was discharged after 8 days
from the surgery, without complications and fully dietary resumption.

Keywords: Esograstrectomy, Neoplasm, Laparoscopic

An Extremely Rare Case of Disseminated Intraabdominal Synovial
Sarcoma. Clinical Case and Literature Review

Author: Georgiana Radu

Co-Author: Paduraru Dan Nicolae MD, Bolocan Alexandra MD
Scientific Coordinator: Associate Professor Ion Daniel MD

Introduction: We present a very rare case of disseminated intraabdominal synovial

sarcoma. Typically this type of tumor occurs 95% of the time in the limbs, originating
from the synovial membrane of articulations. Even in cases where the tumor appears
at a different site, it is usually solitary.

Materials and Methods: A 49-year old male patient came to the surgical department
accusing diffuse pain in his left inferior abdominal quadrant. The clinical exam
revealed multiple non-painful masses all over the right half of his abdomen. After CT
examination the suspicion of Pseudomyxoma Peritonei was raised. He associated
reactive thrombocytosis (PLT = 477x 10*3/uL). During surgical intervention many
intraperitoneal identical tumors were observed. The biggest one and a few others were
resected, while smaller ones were electrocauterized. Another bigger mass was
observed retroperitoneally, but because of its intimate rapport with the vena cava, the
surgical excision was considered inopportune. Excised tumors were sent for a
histopathological exam.

Results: The histopathological aspect of the analyzed tumors advocates for synovial
3rd degree monophasic sarcoma. After careful research through available medical
literature, we found no similar cases.

Conclusion: Synovial sarcomas are rare entities to appear within the abdominal
cavity. There are few cases described in literature and most of them talk about
sarcomas that had appeared either in the intraperitoneal or retroperitoneal spaces,
usually as solitary tumors. Our case features the dissemination of multiple identical
tumors throughout all abdominal cavity.

Keywords: Synovial, Intraabdominal, Sarcoma

Orthotopic Kidney Transplantation and Its Outcome

Author: Alexandru - Dan Costache

Co-Author: Nicoleta Dumitrescu, Bogdan-Marian Tarcu
Scientific Coordinator: Assistant Professor Corneliu Moroanu MD, PhD,
Angelica Gramaticu MD

Introduction: End stage chronic kidney disease (ESRD) remains one of the most
significant health issues with a rising prevalence in recent years. Kidney
transplantation represents the most effective renal replacement therapy.

Materials and Methods: We are reporting the case of a 22-year-old female patient
with ESRD on hemodialysis for 12 years who underwent a kidney transplant from a
deceased donor in January 2016. The standard renal transplant procedure involves
placement of the donor kidney in the iliac fossa. However, in this particular case, due
to renal dwarfism of the receiver and the size of the renal graft the procedure was
performed using an orthotopic approach.

Results: The renal transplantation was successful with no surgical complications and
followed by a rapid decrease of serum creatinine levels from 9.2 to 0.5 mg/dl.
Afterwards, the patient presented two episodes of acute cellular rejection that required
metilprednisolone bolus therapy. At eleven months after transplantation the patient
presented a new acute graft dysfunction episode with a rise in serum creatinine level
up to 3.1 mg/dl (eGFR-estimated glomerular filtration rate of 26.9 ml/min/1.73m2).
After excluding other specific causes a renal biopsy was performed. The renal biopsy
showed signs of humoral rejection that was treated with plasmapheresis and i.v.
immunoglobulin, followed by an increase of 13.8ml/min/1.73m2 in eGFR.

Conclusion: The particularities of this case are the orthotopic approach of renal
transplantation, the rapid onset of humoral graft rejection, despite the high
immunological compatibility and the increase in eGFR after treatment.

Keywords: Orthotopic Kidney Transplantation, Graft Rejection, Chronic Kidney

Disease
Recurrent Gastrointestinal Stromal Ileal Tumor at a Patient following A
3 Years Treatment with Imatinib: Case Report

Author: George Preda

Co-Author: Ingrid Georgiana Nicolau
Scientific Coordinator: Octavia Rusu, MD, PhD

Introduction: Gastrointestinal stromal tumors (GISTs) are produced in the smooth muscle
pacemaker, interstitial cells of Cajal, or other similar cells. They are defined as tumors of the
connective tissue, in which genetic mutations play an important role. GISTs account for less
than 1% of all the gastrointestinal tumors. Most (66%) occur in the stomach, where they have a
lower malignant potential, 20% in the small intestine and less than 10% in the esophagus.
Large tumors disseminate to the liver, omentum and peritoneal cavity and they rarely appear in
other abdominal organs.

Materials and Methods: We report the case of a 57 year-old man who presented to the ER
accusing intense abdominal pain localized in the right flank and hypogastric area, fatigue,
asthenia, dizziness and slowed intestinal transit. Presented symptoms appeared a month ago and
accelerated in the last 3 days. The patient had no conclusive family history. His personal
medical history showed that he underwent surgery for a previously diagnosed ileal GIST in
2012. In 2012 adjuvant chemotherapy medication with Imatinib was initiated following a 2
years regimen. After these 2 years, laboratory and imaging investigations assessed the patient
as a high risk for developing metastases and tumor recurrence, therefore Imatinib was re-
administered for another year.

Results: Surgical treatment consisted in pelvic tumor excision, partial omentectomy,

hemostasis, lavage and drainage. Postoperatively, the patient was administred Clexane.
Subsequently he revealed pelvic and retroperitoneal haemorrhage, haemoperitoneum and
severe posthaemorrhagic anemia. Therefore he underwent a second surgery during which
secondary tumors were discovered and excised.

Conclusion: After the two operations the patient`s clinical status was significantly improved.
Further imaging investigations showed no signs of postoperative haemorrhage. The patient was
prescribed Imatinib at a rate of 300mg/day and is currently under observation.

Keywords: GIST, Imatinib, Haemorrhage

Post-Traumatic Brachial Artery Pseudoaneurysm Associated With
Ischemia on A Young Patient. Case Presentation and Aknowledgement of
the Critical Surgical Points

Author: Andra-Carmina Necula

Co-Author: Stefan Iacob
Scientific Coordinator: Lecturer Livia-Genoveva Baroi, MD, PhD

Introduction: A pseudoaneurysm, also termed a false aneurysm, is a leakage of

arterial blood from an artery into the surrounding tissue with a persistent
communication between the originating artery and the resultant adjacent cavity. A
pseudoaneurysm arising from the brachial artery is a rare injury, significantly more
rare than popliteal, femoral, subclavicular, carotid or axillar aneurysms and it usually
occurs after a blunt trauma or as an iatrogenic injury.

Materials and Methods: We are presenting the case of a 35 years old male patient,
which was admitted in the Vascular Surgery Unit for a nonpulsatilepseudotumoral
mass located on the left arm, which appeared one month before his admission,
associated with 4 out of the 6 classical signs of limb ischemia: palor, pulselessness,
paresthesia and perishing cold. A Doppler echography was conducted, highlighting a
pseudoaneurysm of the brachial artery, partially trombosed, with reduced flow and
with positive Doppler signal on the left radial and cubital arteries. The echography
also revealed the pseudoaneurysms tendency for posterior fistulization. The patient
has undergone a partial aneurysmectomy and a brachio-brachial bypass with an
inverted autologous venous graft obtained from the left internal saphenous vein. The
patient benefitted of prophylactic perioperative antibiotherapy.

Results: The postoperatively evolution was favorable, with the recovery of the pulse
on the left radial and cubital arteries and with the disappearance of the ischemic
clinical signs. The patient was dismissed with anticoagulant treatment.

Conclusion: The particularities of the case consists of: on one hand the prolonged
evolution with a progressive gaining in size of the pseudoaneurysm and the lack of
the acute ischemia manifestations and on the other hand a postero-lateral fistulazition.

Keywords: Pseudoaneurysm, Brachial Artery, Surgery

Case Report-Morgagni Hernia

Author: Ciubotariu Mihaela-Alina

Co-Author: Dabuleanu Ana-Maria
Scientific Coordinator: Lecturer Vasilescu Alin-Mihai, MD, PhD

Introduction: The Morgagni hernia was first described in 1769 and it is a

diaphragmatic hernia that appears due to a congenital defect of the anatomy of the
anterior diaphragm. The prevalence of this pathology is between 1% and 3%.
Generally, this disease is diagnosed during childhood, but it can also be diagnosed in
adults in emergency, as the symptomatology is nonspecific, consisting of an oclusive
and a peritoneal syndroms.

Materials and Methods: The patient (70 years old) came to the hospital with pain in
the superior abdominal area, nausea, vomiting, and the interruption of intestinal
transit for 3 days. The patient had been admitted in the Gastroenterology and
Hepatology Clinic Iasi for epigastric pain, vomiting and nausea, symptoms that were
treated with proton-pump inhibitors and antispastic drugs. The imagistic
investigations showed a herniar sac in the thorax of 10cm/9cm. Using conservatory
treatment the symptoms were ameliorated, but 7 days after being discharged, the pain
reappeard, being aggravated by cough, physical effort and postprandial, therefore the
patient was admitted to the hospital for surgical treatment. We have done a
laparoscopic intervention, then we have reduced the herniar sac and have introduced a
double-layer mesh which has been permanently fixed in 4 points.

Results: The post-op evolution was good, the alimentation was possible the next day,
the symptoms disappeared, and 3 days later the patient was discharged.

Conclusion: The diaphragmatic hernia of Morgagni is a rare pathology that occurs in

the anterior diaphragm, and that is usually diagnosed in children by accident or in
aduls in emergency. The diagnosis is suggested by the radiography of thorax (postero-
anterior and lateral incidence) and it is confirmed by computer tomography. The
treatment consists in closing the defect, with or without using a prostethic implant,
put either through thoracic or abdominal access.

Keywords: Morgagni, Hernia, Laparoscopy

Actinomycosis A Rare Cause of Tumors

Author: Ioana Laura Jolobceasti

Co-Author: Claudia Brnz, Alexandra Zavoi
Scientific Coordinator: Teaching Assistant Ionu Huanu MD

Introduction: Pelvic actinomycosis is a rare disease, caused by Actinomyces spp. an

anaerobic Gram-positive bacteria, that can result in abscess formation, bowel
obstruction and other serious complications. Furthermore, the correct diagnosis can
seldom be established before radical surgery, because the disease often mimics pelvic
neoplasms.

Materials and Methods: We present a case of pelvic actinomycosis that was

admitted to the Iai Regional Oncology Institute and review the management of this
condition and its misleading signs and symptoms. We review a 47-year-old patient
known with cardiovascular disease and type 2 diabetes, who was initially diagnosed
through a CT scan with bilateral ovarian neoplasm. During surgery, it was discovered
a tumoral mass invading the uterus and its annexes, the rectum and the urinary
bladder, extending also to the anterior abdominal wall. The presence of ascites in
medium quantity was also revealed.

Results: The ablation of the pelvic mass with no urinary bladder and rectal cleavage
plans called for the Hartmanns operation. Unexpectedly, the histopathological exam
results refuted the presumptive diagnosis, showing that the patient was, in fact,
suffering from a pelvic actinomycosis infection, caused by Actinomyces israelii.
Thus, the following stage of the treatment, consisting in the administration of
antibiotics, was initiated. No longer than one year after the antibiotherapy had begun,
the patient developed an ureteral stricture as complication, immediately taken care of
by performing an emergecy left nephrostomy. Two years after, the urinary continuity
was restored by supressing the nephrostomy and reimplanting the left ureter.

Conclusion: The case presented underlines the importance of establishing a complex

diagnosis, one that does not leave out the possibility of an actinomycosis infection in
patients with similar manifestations to the ones shown above.

Keywords: Actinomycosis, Pelvic, Hartmann

Iatrogenic Injury to The Biliary Tract after Laparoscopic Cholicystectomy

Author: Mohammed Zafran

Co-author: Syed Shah Mohammed Emmad Masood, Hassan Tahir Khokhar
Scientific coordinator: Professor Cristian Lupascu, MD, PhD

Introduction: The case report that we intend to present is that of an iatrogenic

injury to the biliary tract in a 45 year old female who underwent a laparoscopic
cholicystectomy.

Materials and Methods: The patient in question presented to Sf. Spiridon

hospital in Iasi with acute onset jaundice, abdominal pain and vomiting eight days
after undergoing the procedure. In addition to the icterus, physical examination
elicited right upper quadrant and epigastric tenderness but an absence of axillary
and inguinal lymphadenopathy.

Results: Biochemical evaluation revealed elevated bilirubin, alkaline phosphatase,

ALT, AST and GGT. An ultrasound scan identifying the presence of significant
fluid in the pouch of Douglas raised significant suspicions on intra-peritoneal
pathology and when the patient was evaluated further with ERCP and CT scan an
undilated, obstructed common bile duct was identified. Biliary tract injuries are the
most serious and potentially life threatening complications of
laproscopiccholicystectomy.

Conclusion: We intend to provide a summary of biliary tract injuries as well as an

outline of the presentation, investigations and management in relation to this case.

Keywords: Iatrogeny, Biliary Tract Injury, Laparoscopic Cholicystectomy

Breast Tuberculosis: A Rare Form of Breast Tumour

Author: Syed Shah Mohammed Emmad Masood

Co-author: Mohammed Zafran, Mohammed Abdul Rehman Tahir Khokar
Scientific coordinator: Professor Cristian Lupascu MD, PhD

Introduction: The case we are presenting is that of breast tuberculosis in a 46 year

old female who presented to the health services with a 3cm lump in the lower lateral
quadrant of the left breast without any additional symptoms of note.

Materials and Methods: This presentation was preceded by a previous diagnosis

of pulmonary TB one year prior to this incident which was treated by a 9 month
course of triple TB therapy. Physical examination revealed a painless, non mobile,
firm lump without visible signs of inflammation and absence of axillary
lymphadenopathy.

Results: Baseline biochemical investigations proved unremarkable however the

presence of left pachypleuritis on a chest radiograph raised suspicions of
tuberculous involvement which was confirmed on biopsy. We are presenting this as
a case of breast tuberculosis which is a rare form of breast tumour.

Conclusion: It is our intention to outline the main facets pertinent to this disease in
addition to summarising the specific manifestations with regards to the presentation
of this patient and her management.

Keywords: Tuberculosis, Breast, Tumour

The Advantages of Negative Pressure Therapy (Vac - Therapy) in The
Soft Tissue Defects Treatment

Author: Stefania Gherghe-Moise

Co-author: Adina Georgiana Para
Scientific coordinator: Lecturer Mihaela Pertea MD, PhD

Introduction: The purpose of the presentation is to bring to the fore the results of
using negative pressure therapy on soft tissue defects in order to highlight the
advantages of this technique, such as: shortening the recovery period by stimulating
the development of granulation tissue, decreasing the concentration of germs at the
wound level, septic isolation of a possible outbreak, decreasing demand and
frequency of surgical wound toilet, increasing the patients comfort, using only one
skin graft without involving complex surgical techniques.

Materials and Methods: The study included 9 patients with infected wounds,
localised at the level of the thoracic and pelvic limbs: 3 cases of leg infection (2 of
them with trophic ulcers and 1 with posttraumatic injuries), 6 cases with hand and
forearm injuries (2 with posttraumatic injuries, 2 with soft tissue defects with various
etiologies and 2 with post peripheral venous catheter-associated phlebitis). The
negative pressure therapy (VAC) was used immediately after surgical debridement of
the injuries until the appearance of the granulation tissue, followed by the application
of a free split skin graft.

Results: In all of the 9 cases, the VAC therapy allowed a significant reduction of the
healing period, obtaining good quality granulation after surgical debridement,
protecting noble elements exposed (nerves, tendons, etc). The complications were
limited to a single case of an allergic reaction which required a short time period
discontinuation of the treatment.

Conclusion VAC therapy is a highly recommended method. Its application hastens

the healing process by decreasing the need for repeated surgical toilet, daily dressings
and eliminating active pathological secretions and necrotic tissues.

Keywords: Negative Pressure, Granulation Tissue, Skin Graft