BACKGROUND Median and ulnar nerve injuries are common, whether isolated or combined injury of both nerve. A nerve graft, if performed in a tensionless manner, has been shown to generally have better results than an end-to-end approximation performed under tension. OBJECTIVE The aim of this study is to analyze the long-term results of sensory recovery after secondary reconstruction median and ulnar nerve by autograft in patients who were treated on Clinic for Plastic and Reconstructive Surgery in the period from January 1st 1993 to December 31st 2005. We analyzed the influence of the patients age, level of injury, the size of the graft and the period between the injury and operation on the late results. PATIENTS AND METHODS Evaluation was performed in 55 patients with adequate follow-up. The mean follow-up period was 3.9 years. Reconstructions were applied on the median nerve in 31 patients and ulnar nerve in 24 patients. Criteria for inclusion in the study was median and ulnar nerve grafting in the forearm region. Patients were divided by age in two groups, below 25 and over 25 years, by injury level in the distal and proximal forearm injuries, by the length of autograft up to 5 cm and other group with graft length over 5 cm, by the period between injury and operation in group with denervation time up to 6 months and the group with denervation time over 6 months. Rating of sensibility was presented on the Highet Scale as modified by Dellon and more precise rating of sensibility was presented by Moberg's rating scale of sensibility. Calculation of frequencies and percentual values was performed for all included variables. For establishment of differences between the frequencies the /2-test was used (Chi square test) at the level of statistical importance (p < 0.05) with contingency tables. RESULTS We analyzed the results of reconstruction of median and ulnar nerves with respect to factors affecting functionally the result of operation, which are age, injury level, graft length and denervation time. We had 31 patients with median nerve grafting and we achieved sensory recovery S4 in 3 (10%) patients, S3+ in 9 (29%) patients, S3 in 8 (25.5%) patients, 52 in 9 (29%) patients and S2 in 2 (6.5%) patients. We had 24 patients with ulnar nerve grafting and we achieved S4 sensory recovery in 2 (8.5%) patients, S3+ in 6 (25%) patients, 53 in 5 (21%) patients, S2 in 10 (41%) patients and S2 in 1 (4%) patient. There was not significant difference in sensory recovery of median and ulnar nerve (chi-square = 1.00; df = 4; p = 0.909). There was not statistically significant difference by age and level of injury. The results were significantly better in patients with short grafts than in long ones (chi-square = 12.6; df = 4; p = 0.014) and in patients who had undergone surgical repair within 6 months (chi-square = 10; 2 df = 4; p = 0.038). CONCLUSION There was not significant difference in sensory recovery of median and ulnar nerves. The graft length and denervation time significantly influenced the functional outcome in sensory recovery. Mechanism of injury impacted on the results. Two point discrimination testing using a paperclip is a cheap, easily and quickly performed reproducible test of tactile gnosis, and should be included in nerve assessment protocols. We recommended using Moberg's rating scale for further research.

Introduction: Thermal injury causes the destruction of dermo-epidermal barrier, a natural isolator, which then speeds up the bacterial contamination of the burn wound. Patients and methods: The study is of a retrospective-descriptive character and covers the period from Jaunary 1st 2004 through December 30th 2006. During the survey we took and analyzed the bacterial swabs of 54 patients with burn injuries. Goal: The goal of our study was to present the frequency rate of the infection with the patients with burn injuries treated at the Plastic and Reconstructive Surgery Clinic in Sarajevo. Survey results: Infection was not found with only 7 patients (14,5%). The most frequent causes of infection in the control group of patients were as follows: S. epidermidis (27,4%), S. aureus (21,6%), P. aeruginosa (19,6%). Conclusion: The presence of infection and antibiotic resistance of the isolated bacteria were the cause of a prolonged hospitalisation as well as increased treatment costs of the patients with burn injuries.

Background: Trauma of peripheral nerves are common and it is one consequence of a traumatic extremity injury. Recovery of muscle and tendon activity and restoration of sensibility are essential for a functional extremity. Management of injuries of peripheral nerves are challenge for decision-maker. It is important to make the right decision in the management of peripheral nerve injury. Objective: The aim of this study was to show the importance of algorithm that we use in the treatment of peripheral nerve injury of upper extremities and to explore the factors that influence the decision-making process. Patients and methods: In retrospective study, we analyzed 48 patients who were treated at the Clinic for Plastic and Reconstructive surgery in the period from January 1st 2000 to January 1st 2005, aged from 8 to 57 years (mean 31 years). In the study were included patients with nerve injury of upper extremity. Results: The percentage of patients with neurapraxia who successfully recovered without surgery was 88%. In complete nerve lesion with extensive damaged surrounding tissue or burned tissue, we had adequate results in 71%, while in isolated sharp injury we had adequate results in 20 patients (80%). In all patients with inadequate results, we preformed satisfying re-operation, which mean neurolysis, placement of a nerve graft or tendon transfer. Conclusion: The algorithm that we use and which we have accepted, made possible to get good results that we were satisfied. A sharp laceration, such as a knife wound, has a good prognosis. If a crush component is present, the wound should be free of debris and contamination that may compromise healing. Neurapraxia has a relatively short recovery time, and full function is expected without intervention by 12 weeks after presentation.

BACKGROUND Tensor fascia lata pedicled flap is one of the most useful flaps for reconstruction pressure sore defects on trochanteric region. Debate exists on the safe dimension of the flap, as distal tip necrosis can be encountered. The aim of the current study is to report experience of Clinic for Plastic and Reconstructive Surgery, Clinical University Center of Sarajevo, with tensor fascia lata pedicled flap in reconstructing trochanteric pressure sore defects. PATIENTS AND METHODS From January 1993 to December 2007, 39 pedicled TFL flaps were used for reconstruction trochanteric pressure sore defects in 34 patients. We used 3 local flaps for reconstruction of small trochanteric defects and one direct suture. In our study we had 43 trochanteric pressure sores and in 9 patients pressure sores were bilateral. The age ranged from 9 to 65, with average age 41,2. RESULTS The resulting trochanteric defects in this study were due to debridement of pressure sore. The size of the flaps used ranged from 15 x 6 cm to 30 x 15 cm. All flaps survived. Distal tip necrosis occurred in 4 cases. All 4 cases developed in a very large flap beyond the safe limits. Wound dehiscence occurs in 3 cases. There was minimal donor side morbidity in the form of partial skin loss in 1 case. The average follow up period in this study ranged from 6 months to 15 years. CONCLUSION Tensor fascia lata flap is reliable flap. Donor site morbidity is minimal. Problem with the flap can be encountered if the flap is not harvested with the safe limits and properly designed. Proper preoperative preparations must be taken into consideration. Chronic skin ulcers, such as pressure sores, that are refractory to conventional local wound therapies, are good examples of potential beneficiaries of the TFL musculocutaneous flap.

Background: Health information system, as most other information systems, is devoted to management and decision-making. The purpose of any information system is to provide accurate and updated information for making decisions promptly. Decision-making is an integral part of medical profession. This was simplified with diagnostic and therapeutic algorithms. Objective: The purpose of this paper is to show the importance of algorithms in daily doctor practice. Great help is provided by diagnostic algorithms in setting the diagnosis and determining the treatment of a complex disease such as malignant melanoma. An algorithm is a procedure or formula for solving a problem. They simplify our work and through a series of logical steps lead to the ultimate goal as fast as possible - to diagnosis. Our goal is to show algorithms that we use in decision-making for diagnosis and treatment of malignant melanoma. Patients and methods: In retrospective study, we analyzed 96 patients who were treated at the Clinic for Plastic and Reconstructive Surgery in the period from January 1st 2005 to January 1st 2008, aged 19 to 82 years. In all patients, sentinel lymph node biopsy was performed with later pathohistology verification. We showed the results of analysis of patients with a diagnosis of malignant melanoma in a period of three years. Data was analyzed regarding sex, age, tumor location, histological type, level of invasion and frequency of metastasis in sentinel lymph node and in regional lymph nodes. Results: Analysis of patients by age groups showed that the largest number of patients was in the age group from 40 to 60 years of age (50% of patients). The largest number of patients had a superficial spreading melanoma, in 61%, and nodular melanoma in 32% of patients. The largest number of patients had level III (32%) and IV (30%) using Clark. In 40% of patients metastases were found in the sentinel lymph nodes. The results showed that the metastases in regional lymph nodes with positive sentinel lymph node was present in 47% of patients. Conclusion: Decision-making is an integral part of medical profession. This is facilitated with diagnostic and therapeutic algorithms.

Background: Osteoid osteoma is small, painful benign tumor of bone that usualy occurs in the long bones of the lower extremities. Phalanx of finger are extremly rare involved. The pain increases from mild to severe with progression during the night. The male to female ratio is approximately three to one and peak incidence is in the second decade. Radiography is the imaging modality of the first choice. If further characterization is necessary computed tomography can be helpful in cases where conventional radiography are indistinct. If uncertainty remains, bone scanning may be helpful, but some lesions require biopsy. Case Report: We report a case of an osteoid osteoma of the 28th female patient of the middle phalanx of the left middle finger treated by resection, curettage, and autologous bone grafting. Previously we perform a X-ray an CT scan imaging. Radiologist suggests after X-ray and CT scan images the bone biopsy for definitively diagnosis. Laboratory tests were within normal ranges. Discussion: Osteoid osteoma is slow growing, benign tumor, incidentally discovered at an early age as a palpable bony nodule. It is usually smaller than 2 cm and described by an osteoid nidus in a highly loose, vascular connective tissue. The nidus may contain a variable amount of well-demarcated calcification. Normal bone and zone of sclerosis surround the nidus. CT scanning is recommended when the nidus is not visible on conventional radiographs Conclusion: Osteoid osteoma is a benign lesion. Diagnosis could be based on the case history and the non-aggressive X-ray behavior of the lesion and occasionaly CT scan. A definite diagnosis can be ended only after the en-bloc resection and pathohistological verification.