Author/Editor		Arnež, Tine; Ahčan, Uroš G
Title		Plastična kirurgija: preteklost, sedanjost, prihodnost
Translated title		Plastic surgery: past, present, future
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 78, št. 1
Publication year		2009
Volume		str. 45-52
Language		slo
Abstract		Background Plastic surgery has been an independent branch of surgery for a relatively short period of time. And yet its beginnings stretch back as far as 600 BC. The history of plastic surgery can be best reviewed through the development of flaps, which have always been a very useful tool in the hands of plastic surgeons. They started as local flaps with random blood supply. The first breakthrough came after the First World War, with the development of the tubed pedicle flap by Sir Gilles. Later on, the accumulation of knowledge about blood circulation, resulted in the development of axial (deltopectoral, inguinal) flaps, which enabled the transposition of large amounts of tissue. Conclusions The next important (perhaps most important) turning point was the development of free flaps. The »Ljubljana school« was an active contributor in this segment. Nowadays much care is taken to minimise the morbidity of the donor site for free flaps. Perforator and chimeric flaps are being used. There have also been advances in preoperative diagnostics and postoperative monitoring of flaps. The future of plastic surgery is probably a tissue engineering, that is transplantation by microsurgical technique of patient’s own tissues developed in vitro. This will probably mean the use of different multipotent cells. There is also an intense research of the effect of a host of tissue factors and mediators on the circulation and survival of flaps. Most surgical procedures will become minimally invasive.
Summary		Izhodišča Plastična kirurgija je kot samostojna veda sorazmerno mlada. Pa vendar lahko o začetkih govorimo že okoli leta 600 pr.n.š. Razvoj plastične kirurgije je najlaže spremljati skozi razvoj režnjev, ki so od nekdaj pomembno orodje plastičnih kirurgov. Sprva so bili samo lokalni, z naključno prekrvitvijo. Po prvi svetovni vojni je prvo večjo prelomnico pomenil razvoj vezanega cevastega režnja (Sir Gilles). Kasneje so nova spoznanja o prekrvitvi tkiv povzročila razvoj osnih režnjev (deltopektoralni, ingvinalni reženj), ki so omogočali prestavljanje večjih količin tkiva. Naslednjo veliko (morda najpomembnejšo) prelomnico je pomenilo odkritje prostih režnjev. Na tem področju je svoj pečat pustila tudi t. i. Ljubljanska šola. Zaključki Danes se posveča veliko pozornosti predvsem zmanjšanju obolevnosti na odvzemnem mestu za proste režnje. Uporabljajo se prebodnični, himerni režnji itd. Izboljšale so se možnosti predoperativne diagnostike ter pooperativnega nadzora režnjev. Prihodnost plastične kirurgije je verjetno tkivno inženirstvo, torej presajanje in vitro vzgojenih bolniku lastnih tkiv z mikrokirurško tehniko. Pri tem se bodo verjetno uporabljale različne multipotentne celice. Intenzivno se proučujejo tudi vplivi raznih mediatorjev in dejavnikov na prekrvitev in posledično preživetje režnjev. Poudarek bo na minimalni invazivnosti posegov.
Descriptors		SURGERY, PLASTIC SURGICAL FLAPS