Introduction. Development of malignancy in chronic burn scars is described i n 2 % of cases, with cutaneous squamous cell carcinoma (cSCC) being the most frequent. It develops several years after the ...burn injury, as a consequence of malignant transformation in chronically in-flamed tissue. Melanoma in a burn scar is, however, quite rare; in several cases, a synchronous or metachronous appearance of melanoma and cSCC was noted. Based on the previous rare reports, melanoma and cSCC can concurrently arise on thermal burn scars, as well as on the areas treated with skin grafts. Case report. We reported a case of a 6 7-year-old male who was accidentally scalded by boiling water at the age of 14. The patient subsequently developed melanoma at the age of 60, according to clinical and dermoscopic examination at the site of the burn scar, and after excision and histopathological analysis, the diagnosis of melanoma was confirmed (superficial spreading melanoma, Breslow 0.87 mm, with ulceration, pT1b). Complete surgical excision was done, and the diagnosis was confirmed with histopathological analysis. After the diagnosis of melanoma, regular follow-up every six months was scheduled, and three years later, cSCC was suspected and confirmed after surgical excision and histo-pathologic analysis. Conclusion. This case highlights the importance of long-term dermatological follow-up after burn injuries and early detection and treatment of skin cancer that can lead to better outcomes in these patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background/Aim. Planning an elliptical excision of the facial skin, caused by lines of minimum tension, is very important in order to achieve good aesthetic results. The width of the tumor excision ...affects the possibility of a direct closure of the post-excision defect. The aim of the study was to determine the minimum width of excision that does not affect postoperative symmetry of the face, in relation to the preoperative one, using an objective scanning method with a line laser scanner. Methods. The study included 50 patients of both sexes, older than 50 years, who had verified facial skin tumor and established medical indication for surgical elliptical excision and direct suture. All patients had laser scanning preoperatively, and then seven days and 90 days postoperatively, giving x, y, and z coordinates of 5 cephalometric points on the face, which determined the shape of the examined region. Patients were divided into three groups depending on the width of the excision (< 10 mm, 10?15 mm, > 15 mm). The shape of the examined region among different width of excision was compared, preoperatively, 7 days and 90 days postoperatively, using Procrustes analysis and analysis of the coordinates of cephalometric points. Results. Taking into account preoperative and postoperative x, y and z coordinates of the cephalometric points, statistically significant differences between the group of patients with the width excision < 10 mm and the other two groups (excision width 10?15 mm and > 15 mm) were found. Conclusion. The width of the skin tumors excision < 10 mm does not affect the postoperative facial asymmetry when a post-excisional defect is closed by direct suture.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background/Aim. Most surgeons, at the end of corrective rhinoplasty, use endonasal tamponade and external splinting, primarily because of hemostasis and immobilization. Possible complications of this ...surgery are various. Pain, nose edema, palpebral swelling and ecchymosis, are the most common and usual. The aim of our study was to evaluate the incidence of nonaesthetic complications and the efficiency of corrective rhinoplasty without the use of tamponade and external splint. Methods. One hundred and fiftyone patients, who underwent primary corrective rhinoplasty without endonasal tamponade and without an external splint, were analyzed at the Clinical Centre ?Kragujevac? in Kragujevac, Serbia, in the period 1999?May 2016. The surgeries were done by the same surgeon. Instead of a splint, sterile skin adhesive tapes were used. Study was prospective, consecutive case-series type. We analyzed the possible complications and subjective estimates of the patients who underwent primary corrective rhinoplasty in described fashion. In assessing postoparative pain, the visual analogue scale (VAS) in a range of 1 to 5 was used. Palpebral swelling and ecchymosis, were estimated 24h after surgery, by the Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) scale ranging from 0 to 5. The degree of restriction of nasal respiration was evaluated by the scale 1?4. The overall comfort of patients in the postoperative period was evaluated according to a scale: good, no opinion, bad. The patient satisfaction with the aesthetic result was analyzed on 7th and 30th day after surgery, by a scale from 1 (very satisfied) to 5 (very dissatisfied). Results. There were 151 patients aged between 18?47 years. Females were more frequent (72.18%). Most of the patients (40.39%) had moderate pain. None of the patients had neither severe nor the worst pain and 59 patients had no pain at all. Eyelid edema and periorbital ecchymosis were moderate in all patients (100%). The other complications did not occur, apart from one (0.66%) unilateral epistaxis, on postoperative day 10. Most of the patients (52.97%), immediately after surgery, could freely breathe through the nose. The general impression of the patient comfort after surgery was mainly good (74.17%). The majority of patients (52.28%), were satisfied with aesthetic result after 7 days, and 52.32% after 1 month. There were very satisfied patients: on day 7 - 27.15% and on day 30 - 39.73%. Conclusion. We concluded that the rhinoplasty without using tamponade and immobilization was safe, comfortable and economical. The degree of pain, edema and ecchymosis were low, as well as the incidence of other complications.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Dupuytren’s disease is a progressive disease of the palmar and digital fascial structures, with functional limitations. There are no clear recommendations about the optimal time of surgical repair, ...concerning the hand impairment. The aim of our study was to investigate the relation between finger’s contracture degree and success of surgical treatment of the Dupuytren's disease.
This prospective analysis included 60 patients operated on due to Dupuytren’s contracture. According to preoperative contracture degree of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint, patients were divided into three groups: the group 1: < 15°, the group 2: 15−30° and the group 3: > 30°. All the patients underwent operation of partial palmar fasciectomy. Postoperative improvement was expressed with contracture reduction INDEX.
There were 60 patients with 85 fingers affected. The groups 1, 2 and 3 had 22 (37%), 37 (62%) and 26 (43%) fingers with MCP contracture and 32 (37.4%), 24 (28.2%) and 29 (34.1%) fingers with PIP contracture, respectively. Postoperative contractures of MCP joint in these groups were 0, 0.135° and 5°, and of PIP joint 0, 2.08 ° and 16.89°, respectively. After six months all MCP contractures resolved, while PIP joint contracture in the group 3 remained 13.62°. The reduction INDEX was 98.85%, 97.62% and 75.52% in the groups 1, 2 and 3, respectively. There was a statistically significant difference in the INDEX value between the groups (p = 0.0001).
The degree of PIP joint contracture is related to the outcome of surgical treatment of Dupuytren’s disease. Optimal results are achieved when contracture degree is between 15° and 30°. Surgical treatment of MCP joint contracture is successful regardless of the preoperative joint contracture degree.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Treatment of wounds, especially in patients with systemic diseases, is very difficult and time consuming, and it represents great challenge. Complications like infections and impaired healing are ...regularly seen in these patients, sometimes leaving almost no other treating option, but amputation surgery. In wound healing process, platelets play one of key roles, both in hemostasis, and, by releasing many growth factors, in reepithelization and tissue remodeling. Platelet concentrates are defined as autologous or homologous platelet derivatives with a platelet concentration higher than it is usually in human blood. Concentration of platelets needed to affect wound healing should be 1,000,000/μl. This is a report about patient with pemphigus vulgaris and Type 2 diabetes mellitus, who got injury of the left lower leg. Traditional surgical methods of wound closure and vacuum‐assisted closure therapy were ineffective. Homologous platelet gel was used topically, resulting in wound closure, without any adverse effects.
Background/Aim. Complications of breast augmentation, as one of the most common cosmetic surgery, may be different. Besides usual early, local postoperative complicatons, the most common late ...complication is capsular contracture. As a specific complication of skin functions after this operation only disturbance of sensibility is described. Since the skin has other functions as well, and because there are no literature data available, the aim of this research was measuring the skin temperature before and after surgery. Methods. A prospective intervential study was done in 49 adult women. Bilateral augmentative mammaplasty was performed for breast hypoplasia or on the personal request of a patient with autrophic breasts. Measuring the temperature of the breast skin was done in two points, before the operation, and seven days and three months after surgery. The temperature measurement was done by the infrared thermometer (Pyrometer TROTEC BP21). Statistically significant difference was determined using the t-test for related samples. Differences were considered statistically significant if p was less than 0.05. Eta squared coefficient was use to determine the import size and according to the Cohen criteria everything over 10:14 signified a major impact. The data were analyzed by the IBP SPSS Statistics v20. Results. In a majority of patients the breasts were hypoplastic (69.39%). The most commonly used implants were 275?500 mL volume (46.94%), and the least common implants were over 500 mL (16.33%). In a little less than 2/3 of the patients submammary incision was used (61.22%). In a majority of patients (67.35%) the prosthesis were placed subglandularly. The average value of the temperature before the operation at the point 1 was 34.49?C, seven days after surgery 34.81?C, and three months after surgery 34.10?C; and at the point 2: 34.60 ?C, 34.91?C and 34.19?C in the same time intervals. In relation to the size of the breasts before operation and the size of the implant manufacturer, the localization of the incision and placement of the localization of the prosthesis, no statistically significant differences in the temperature of the skin of the breast before and after surgery was observed. Conclusion. Our results on the change of skin temperature after the breast augmentation could be significant preoperative information for the patients.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background/Aim. The group of genes, known as PAX (paired box), has a great role in organogenesis, as well as in maintaining the normal function of certain cells after the birth. In addition to these ...genes, the impact on the organogenesis, at the cellular level, has a transmembrane tetratricopeptid group of genes (TMTC). The term polymorphism in the human genome implies variations in the hereditary basis that occur in human populations, the presence of two or more different alleles of one genome in the population. The aim of the work was to determine whether there is an association of PAX3 and TMTC2 genes polymorphism with changes of the face morphology after skin tumor excision and direct suture closure. Methods. The study included 130 patients of both sexes, older than 50 years, with the medical indication for the elliptical surgical excision of the skin tumor. DNA was isolated from 5 mL of peripheral blood. Gene polymorphisms were analyzed with pre-designed single nucleotide polymorphisms (SNP) assays, by allelic discrimination method on REAL-TIME apparatus. The patients were subjected to a laser scanning preoperatively, and 7 and 90 days postoperatively, in order to obtain x, y and z coordinates of 5 cephalometric points on the face, which determined the shape of the medial cheek region. The shape of the medial cheek region, as well as the coordinates of 5 cepahlometric points, were compared among genotypes of both genes preoperatively, as well as 7 days and 90 days postoperatively. Results. A statistically significant difference in the shape of the medial cheek region between wildtype and mutant of PAX3 gene was found preoperatively, while the statistically significant difference in the shape of the medial cheek region was not found between wild-type and heterozygote, nor between wild-type and heterozygote and mutant of PAX3 gene, nor among genotypes of TMTC2 gene. Seven days and 90 days postoperatively, there were no statistically significant differences in the shape of the examined region among genotypes of both genes. Conclusion. Polymorphisms of PAX3 and TMTC2 genes are not associated with the change in the face morphology after the skin tumor excision and direct suture closure of the defect.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA)
infection (CDI) in surgical patients, its frequency per surgical wards and ...in-hospital-mortality at a single hospital.
Risk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI.
The overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (
= 0.007, OR: 10.62, 95% CI: 1.93-58.4), the admission to intensive care unit (
= 0.004, OR:3.00, 95% CI:1.41-6.40), and the administration of 3rd generation cephalosporins (
= 0.014, OR:2.27, 95% CI:1.18-4.39). Patients with HA CDI had significantly higher in-hospital mortality compared to controls (
: 0.007; OR: 8.95; 95% CI: 1.84-43.43).
CDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.
Complex defects of skull bones with different etiology, still present the challenge in reconstructive surgery. The goldstandard for cranioplasty is the autologous calvarial bone graft removed during ...surgery which cannot be always applied, especially in gunshot wounds for sometimes complete bone destruction. Autologous reconstruction with split calvarial, rib bones or iliac bone graft is also possible. Materials routinely used for reconstructions like titanium mesh, polymethyl metacrylate (PMMA), and other have numerous disadvantages and limitations.
We presented a patient with gunshot injury to the head with residual large bone defect in the frontal region, with involvement of the skull base, and open frontal sinus. After conservative treatment, six months after the injury, reconstruction of the residual bone defect was performed. The chosen material was computerdesigned PEEK-OPTIMA® implant, manufactured on the basis of MSCT scan. This material has not been used in this region so far. The postoperative and follow-up period of the next 12 months passed without surgical complications, neurological deficit, with satisfactory functional and aesthetic results.
Implanted bone replacement was designed and manufactured precisely according to the skull defect, and we found it suitable for the treatment of complex defects of the cranium. Early results are in favor of this cranioplasty method over standardized materials. Therefore, this material is expected to become a method of choice for reconstructive surgery of bony defects of the face and skull especially in complex cases.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Introduction: Breast augmentation has been one of the most popular aesthetic
procedures. Early complications, like infection, seroma, hematoma and
capsular contracture like one of the most frequent ...long term complication,
might be related to wound drainage. Aim of the study was to investigate the
rate of the complications of breast augmentation procedure performed without
drainage. Material and Methods. Retrospective analysis of all patients
underwent breast augmentation in the period of 2003-2013 was performed. From
the medical history of the patients, data related to demographic
characteristics of the patients, surgical technique and rate of complications
were collected. Wound drainage has not been used in any of the patients.
Patients were followed at the discharge, after 7 days, three months and
yearly thereafter. Wound seroma, wound hemathoma, wound infection and
capsular contracture were followed. Results. There were 726 patients with
average age of 28,5 year (22-48). Breast augmentation using silicone implants
was performed with inframammary approach using subglandular, submuscular and
dual plane technique. Average implant size was 339cc (200-520). Subglandular
augmentation had 545 (75%), while, 181 (25%) received an implant in
submuscular plane. Those, who were operated with dual plane technique were 86
(47,5%).In early postoperative period, there was no infection, five seromas
(0,7 %) and eight hematoma (1,1%), while five of them required surgical
evacuation. There was no statistical significant difference between the two
surgical techniques in terms of complication rate. During follow up, there
were three capsular contractures (0,4%). Conclusions. The incidence of
complications in our group of patients after breast augmentation is low even
though no drainage was used. Still, further randomized trials are needed to
prove role of drainage in prevention of complications after breast
augmentation.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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