Thirty-five years of the Department of Plastic Surgery and Burns Treatment at the University Hospital in Hradec Králové

Introduction

The development of plastic surgery and burns treatment is relatively well do­cumented in the Czech Republic; however, predominantly in close connection with the two most significant and leading units – the Departments of Plastic Surgery in Prague [1–5] and Brno [6–9]. Activities of other institutions are only rarely mentioned [10–14], even though they undoubtedly belong to the mosaic of specialized care in plastic surgery. Together, they create a network en­suring medical and preventive care in the field of plastic surgery in our country. We would like to contribute to the mosaic with this article written on the occasion of the 35^th anniversary of our Department’s establishment.

Plastic surgery at the University Hospital Hradec Králové before 1985

Specialized medical-preventive care in the field of plastic surgery at the Department of Surgery of the then Regional Institute of National Health and the University Hospital  of the Medical Faculty of Charles University was provided by Dr Karel Dlabal, ori­ginally a member of the Department of Military Surgery (KVCH) of the Purkinje Military Medical Academy (VLA JEP). He was trained at the Department of Plastic surgery by the academician Burian in Prague in the years 1964–1967. From 1967, he served as a clinical ordinary and a regional ordinary for plastic surgery of the East Bohemian region. Plastic surgery patients were hospitalized mainly at the ward in Nechanice hospital, where everyone commuted daily by a special hospital line. Dr Dlabal often performed sur­geries in almost all district hospitals in the region as well. Over 13 years, he performed several thousands of operations. Professionally, he was predominantly interested in hand surgery, and he became a top expert in this field. In 1980, Dr Dlabal was appointed the chief physician in the specialized Institute of Plastic and Reconstructive Hand Surgery in Vysoké nad Jizerou on the recommendation of Prof. Karfík. His successor in providing care in the field of plastic surgery at the Department of Surgery became Maj. Dr Ľudovít Pintér, also a member of KVCH VLA JEP. He became a clinical ordinary for plastic surgery in 1982.

The historical context of the establishment of the Department of Plastic Surgery and Burns Treatment

During the 1970s and early 1980s, the dynamic development of individual surgical specialties and the related construction of a new surgical pavilion contributed to the preparations for the division of the existing Department of General Surgery. The three new units were intended to provide medical-preventive care, teaching, and research in individual fields according to their speciali­zations. A modern pavilion was opened on 1 June 1985, and three newly established departments began their operations. The 2^nd Department of Surgery (head: Col. Prof. Dr B. Konečný, CSc.) focused on general surgery, trauma and plastic surgery and treatment of burns. The department also became the clinical basis of KVCH VLA JEP. The Department of Plastic Surgery and Burns Treatment was opened on 1 September 1985.

The 1985–1994 phase

The ward consisted of nine triple and three single rooms, all with their own bathroom. The Department could use 18 beds, burn patients usually occupied single rooms. The operating-and-dressing tract with two operating rooms and a dressing room formed an integral part of the Department. There was also a spacious room intended for rehabilitation exercises. Three physicians in pre-certification training in plastic surgery worked at the Department at that time: Dr Jiří Vosmík, Maj. Dr Leo Klein and Dr Zdeňka Talábová. The Senior Assistant and Ordinary for Plastic Surgery – Dr Ľ. Pintér – joined the Department on 1 January 1986 (Tab. 1).

The beginnings of our activities were really challenging because we did not have any unique instrumentation and material equipment, except for two Humby skin grafting knives. The so-called skin graft meshing procedure used for skin transplantation was performed manually; the skin grafts were perforated with a scalpel while lying on cellophane or plastic foils. Thus, when we obtained the first roller dermatome, we really celebrated the occasion. Over time, however, we managed to supplement the operating instruments and expand the instrumentation with an electrodermatome, Watson’s knives, etc. For training purposes, we were able to obtain an operating microscope used in the vivarium of the VLA JEP. Since 1993, we had an opportunity to use a special air-fluidized bed for the treatment of burns. We had blocked two surgical days for operations under general anaesthesia during the week, operations under local anaesthesia took place in the remaining days, and outpatient activities were concentrated to one day (Friday). The “as we go” general schooling of nurses and their training in the spe­cialized treatment and nursing care of especially burn patients, patients after transplantations, flap surgeries etc., formed an integral part of building the ward. It should be noted that all nurses and other me­dical personnel of the ward welcomed such activities with interest and actively embraced the possibility of deepening their knowledge and skills. Since the beginning, the Department has provided medical and preventive care in a wide range of its specialization – surgical treatment of skin tumours, hand and face traumas, some congenital deformities, and reconstruction of defects provided for other surgical departments within the UH, especially in co-operation with trauma surgeons. We started to conduct operations using various types of the so-called flap surgeries. We also performed corrections of cosmetic defects to some extent. The principles of comprehensive continuous care of burn patients were implemented in the field of burns treatment. The application of the early necrectomy method and temporary biological skin covers was introduced. Moreover, a permanent anesthesiologist joined our Department. We have closely co-operated with the Tissue Bank, Department of Metabolic Care and Gerontology, Institute of Microbio­logy and some others; thus, a functional interdisciplinary burns team has been established. The spectrum and numbers of patients gradually expanded. In the late 1980s and early 1990s, our Department served as a regional burns unit of the then East Bohemian Region. The department physicians were also involved in teaching, publishing activities and scientific research. Two physicians defended their dissertation theses (Dr Pintér in 1991, Dr Klein in 1994). Du­ring this phase, Dr Vosmík left our Department and joined the Department of Plastic Surgery in Prague – Vinohrady on 1 September 1988. Dr Martin Šorma became a member of our Department on 1 January 1990.

The 1995–1998 phase

It was by far the most difficult and challenging phase in the history of the Department. After the November Revolution in 1989, fundamental political, economic, and societal changes took place in the country, which, of course, affected the health care, too. Since 1990, there was, once again, only one Department of Surgery under the leadership of Assoc. Prof. Dr J. Bedrna, CSc. The Department was created by merging the two previous units. The general enthu­siasm and pursuit of free enterprise, which manifested in many spheres in the early 1990s, along with a change in so­cietal values, encouraged physicians and other professionals, who had worked until then in a unified centrally managed healthcare system, to start providing their services in a way based on other principles. The field of plastic surgery was particularly affected by these changes significantly, and the changes also influenced our Department. On 1 March 1995, Dr Pintér, Dr Talábová and Dr Šorma left the Department for the private sphere and joined the newly established facility of the First Private Surgical Centre (SANUS) in Hradec Králové. Along with them, several experienced nurses left the ward and the operating theatre part of the Department. Thus, only one certified plastic surgeon, Lt. Col. Dr Klein remained at the Department. Nevertheless, surgeries, outpatient activities, teaching and scientific work continued to a certain level. The Department’s daily operation was enabled only thanks to a maximal effort and personal commitment, regardless of the time and energy spent. For example, non-acute medical counselling at other departments were carried out on the weekends. The outpatient clinic operated even after official working hours, after the student lectures, etc. In 1995, young physicians Maj. Dr František Hošek (1 January) and Dr Vladimír Janeček (1 May) joined the team. The operation team stabilized, and the Department fully provided specialized care in the region covered by the UH. We also found the time for additional professional activities, as we organized scientific conferences of burns medicine with international participation in 1995 and 1997. Scientific research also continued, and its results formed the basis of successful habilitation (Dr Klein 1998). Moreover, after getting real experience with activities in the private sector, Dr Talábová asked the UH mana­gement if she could return and join the team, once again, on 1 June 1996. Therefore, the Department employed four physicians (two certified and two physicians preparing for their certifications). The Department, thus, successfully overcame a critical period of a year and a half, despite the initially expressed fears (even on the part of the management) that the Department would pro­bably cease to exist.

The 1999–2007 phase

Brig. Gen. Assoc. Prof. Klein has temporarily left the Department, on 1 January 1999, and was sent on a mission abroad. In 1999–2002, he served as Medical ­Advisor to the Supreme Commander, and Chief of the Medical Department of ­NATO Supreme Headquarters Allied Po­wers in Europe (SHAPE). When the fo­reign mission was concluded, he held the position of Surgeon General of the Czech Armed Forces. After leaving for the reserve, in 2004–2008, he was appointed the Head of the Department of Burns Medicine of the 3^rd Medical Faculty, Charles University and the UH Královské Vinohrady in Prague.

The management of the Department was entrusted to Dr Talábová, who continued to ensure its smooth running. In co-operation with pediatric surgeons, the range of operations in treating specific congenital deformities were expanded. The attention also focused on cosmetic surgeries. Lt. Dr Robert Čáp joined the team, and Dr Talábová ­created conditions for his training and launching microsurgeries by him. Micro­surgical instruments and a new ope­rating microscope were purchased. The team began to perform surgeries and research in the sentinel node in malignant melanoma. Dr Janeček left for private practice on 30 April, 2005. Furthermore, Dr Pavel Horyna joined the team on 1 September 2005.

On 1 September 2004, Lt. Col. Dr Čáp, PhD was appointed the chief by the management of the Department. The team launched the first clinical microsurgeries. Dr Čáp also performed the first successful replantation of a thumb. Together with trauma surgeons and other specialists, the team co-operated in the reconstruction phases of the trauma or cancer treatment using free flap transfers by the microsurgery techniques.

The 2008–2014 phase

On 1 April 2008, Assoc. Prof. Klein returned to his alma mater (Fig. 1). The Department continued to perform all its tasks in medi­cal care, teaching and scien­tific activities. The co-operation with the 3^rd Internal Department of Metabolic Care and Gerontology in treating non-healing wounds and chronic defects continued. We expanded the application of the vacuum assisted therapy method and broadened the interdisciplinary co-operation within the UH. We managed to increase the number of physicians and even recruited one nurse for the operating theatre section. In co-operation with the UH management, an operating system focused on cosmetic surgery of self-paying patients was ­created. Assoc. Prof. Klein was appointed the supervisor of the theses of three successful PhD graduates (Dr Čáp, Dr Klosová, Dr Fibír). Furthermore, in 2012, we organized the 17th Annual Czech-Slovak Conference on Burns Medicine.

The personnel aspect of the Department continued to be subjected to a continuous generational change. On 30 April 2009, after passing his attestation exam, Dr Horyna left for the Department of Plastic Surgery in Prague-Vinohrady. On the contrary, Dr Lucie Hasenöhrlová and Dr Igor Slaninka started to work at the Department on 1 September 2009. On 1 October 2013, Capt. Dr Adam Bajus, a member of the Central Military Hospital in Prague, started his long-term training (until 28 February 2017) at our ­Department prior to his attestation exam. On 1 December 2013, Dr Ondřej Šedivý entered our employment.

On 1 September 2014, Assoc. Prof. Klein handed over the position of the head of the Department to Dr Aleš Fibír, PhD after a successful selection procedure. On 31 December 2014, Dr Čáp terminated his activities at the Department and left to be the head of the plastic surgery department in the private sector.

The 2015–2020 phase

Dr Fibír came as an experienced plastic surgeon with many years of experience in the private sector. He got quickly orien­ted and has continued to develop the Department purposefully. As a member of the younger generation, he extensively uses digitalization to manage and co-ordinate the ope­ration of the Department, to plan outpatient and ope­rational activities, as well as teaching activities. As a prominent expert in hand surgery, he has expanded the range of surgical procedures in this area. After purchasing the necessary instruments, he put into practice endoscopic surge­ries of entrapment syndromes on upper extre­mities. In co-operation with trauma surgeons, microsurgeries using free flap transfers have developed, especially in reconstructive operations. Prophylactic surgeries were introduced, and reconstructive surgeries have developed as part of the comprehensive treatment of breast cancer. We managed to gain additional room for our outpatient care and increase the number of physicians and nurses in the operating and outpatient section of the Department. Dr Talábová terminated her activities at the Department on 1 September 2016 and left for a private outpatient practice. In 2017, we admitted two new physicians – Dr Michaela Široká on 1 July, and Dr Kateřina Kubíčková on 1 September. Dr Kubíčková, however, left after less than three years and moved to the Department of Plastic Surgery in Prague-Vinohrady on 1 July 2020. Dr Slaninka defended his PhD thesis in May 2018. On 28 February 2020, shortly after passing the attestation exam, Dr Šedivý left for the Department of Plastic Surgery in Brno-Královo Pole. With the arrival of the youngest physician Dr Jan Jaroš on 1 June 2020, this natural and permanent cycle has, within this phase, concluded.

Conclusion

Over the past 35 years, the Department of Plastic Surgery and Burns Treatment of the Department of Surgery in Hradec Králové has been firmly entrenched in the spectrum of specialized activities of the UH. It provides full-scale medical care in the given field. Since its beginning, the Department has relied on the principles of interdisciplinary and interdepartmental co-operation because physicians – members of three ministries, namely the Ministry of Health (UH), the Ministry of Youth, Education and Sports (LFUK), and the Ministry of Defence (Faculty of Military Health Sciences of the University of Defence, formerly VLA JEP) – have been working at our Department (and at the Department of Surgery as well). Incorporating a specialized department into the framework of a multidisciplinary clinic of surgery provides opportunities for mutual contacts and professional progress as well as for the development of direct and immediately accessible co-operation. This fact undoubtedly represents a significant benefit for patients, teaching, and research. Moreover, this aspect is also of great importance for the education of young physicians in the conditions of the current super-specialized medicine.

Disclosure: There is no conflict of interest to declare.

Assoc. Prof. Leo Klein, MD, CSc.

Department of Plastic Surgery and Burns Treatment

University Hospital

Sokolská 581, 500 05 Hradec Králové

Czech Republic

e-mail: leo.klein@fnhk.cz

Submitted: 09. 04. 2021

Accepted: 09. 05. 20