Marjolinov ulkus (MU) je redka, vendar izjemno agresivna oblika ulcerativnega ploščatoceličnega karcinoma, ki nastane iz kronične rane, najpogosteje po opeklinski poškodbi. Naš cilj je opozoriti na ...nevarnost maligne preobrazbe nestabilne brazgotine kot kronične rane (nastanek Marjolinovega ulkusa) ter možnosti njenega zdravljenja pri nas ter drugod po svetu. V Univerzitetnem kliničnem centru Ljubljana na Kliničnem oddelku za plastično, rekonstrukcijsko, estetsko kirurgijo in opekline smo v obdobju zadnjih 13 let obravnavali 5 bolnikov, operiranih zaradi nestabilne brazgotine, ki se je izkazovala kot kronična rana. Za potrebe članka smo opravili pregled angleške literature na temo ulceracije nestabilne opeklinske brazgotine.
Marjolinov ulkus je epiteliomska sprememba, ki jo je možno preprečiti. Vsaka večja rana, ki se prepusti sekundarnemu celjenju, ima potencial za razvoj v kronično rano, ki lahko ulcerira in vodi v maligno spremembo. Še posebej moramo biti pozorni pri opeklinskih ranah ter brazgotinah. Če se pojavi kronična rana, je potrebna biopsija in kasnejše zdravljenje. Uspešnost zdravljenja je bila največja, kadar se je rana obravnavala, še preden se je preobrazila.
Lice zavzema največji del obraza in je pogosto mesto nastanka pridobljenih mehkotkivnih sprememb. Najpogostejši vzroki so poškodbe in kožni malignomi. Slednje je potrebno izrezati z varnostnim robom, ...kar ima za posledico velike tkivne vrzeli. Za kritje take vrzeli na licu primarni šiv rane ni mogoč, zato moramo razmisliti o načinu rekonstrukcije z VY, cervikofacialnim ali submentalnim režnjem. Cervikofacialni reženj smo uporabili za kritje vrzeli vzdolž celotne nazolabialne gube v 1. estetski podenoti lica, VY reženj za kritje velike vrzeli superomedialnega dela te podenote, submentalni pa za kritje velike vrzeli v 2. estetski podenoti. Prispevek temeljito opisuje njihove značilnosti, tehnike priprave in klinične primere. Za boljše razumevanje opiše tudi estetske podenote, kožne linije in del anatomije obraza.
Priporočila za obravnavo bolnikov z limfedemom Planinšek Ručigaj, Tanja; Kozak, Matija; Slana, Ana ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
09/2018, Volume:
87, Issue:
7-8
Journal Article
Peer reviewed
Open access
V prispevku so predstavljena priporočila za obravnavo bolnikov z limfedemom. Prikazana je klinična slika, diagnosticiranje in različni načini obravnave.
The cheek occupies the largest facial area and is a common location of acquired soft-tissue defects. They are most frequently caused by trauma and skin malignomas. The latter demand radical tumour ...excision with safety margins and, consequentially, a significant tissue loss. Large tissue gaps cannot be covered by primary closure; therefore, we must consider the reconstruction with VY, cervicofacial or submental flap. A cervicofacial flap was used to cover gaps along the entire nasolabial fold in the first aesthetical subunit of the cheek, VY to cover large gaps in superomedial part of the first subunit, and submental to cover gaps in the second subunit. We describe in detail characteristics, flap harvest techniques, and present three clinical cases. For a better understanding of the article, we also describe aesthetical subunits, skin lines and part of the facial anatomy.
Malignant pilomatrixoma is a rare malignancy with just 136 cases reported in the English literature. The tumour is described as locally aggressive, with possibility of reoccurrence and distal ...metastasis. Histology remains the gold standard in diagnostic. Wide surgical excision is preferred to simple excision. In the present study a case of first malignant pilomatrixoma in our hospital is described. We made an excision of the tumour and the tissue was sent on histopathology. The skin defect was covered with a local ulnar flap. Through our case report and literature review we focus on the most suitable treatment option. The tumour was not excised with appropriate safety surgical margin based on the histopathology report. Patient refused another excision and any additional treatments. The most optimal treatment has not yet been established. Most of the article’s state that primary wide surgical excision should be done, with surgical margins still being debateable. The best results were given when using Mohs micrographic surgery.
Introduction:
In the last two decades some new surgical methods for lymphoedema treatment are used at Department of Plastic Surgery and Burns in Ljubljana.
As physiological operations, we have ...experiences by lymphatic reconstruction, when a new lymphatic tissue is microsurgicaly implanted into lymphoedematous limb. While for ablative surgery, we usually perform a liposuction or total excisions using dermal regeneration template (DRT).
Total subcutaneous excision, originally described by Charles (1912), and commonly used since then, this operation is an extensive procedure that removes all of the skin, subcutaneous tissue - except in the foot and region overlying the calcaneal tendon - and deep fascia. The bared muscle is covered by split or full thickness grafts. Although split thickness grafts are technically easier in comparison to full thickness graft and initially appear satisfactory. Late scarring is marked and the grafts ulcerate and develop a severe hyperkeratotic, weeping, chronically infected dermatitis. Long-term postoperative results are bad with substantial scarring and lymphatic fibrosis.
Methodology and Material:
We operated 7 patients by DRT usage. They underwent an ablative surgery of subcutaneous tissue of a lower leg. After debridement a dermal regeneration templates (DRT) were used to cover exposed area. Grafts where protected by a foils dressing and secondary dressing. After, nearly 3 weeks, silicon layer was peeled off and neodermis was covered with autologous split thickness skin grafts. All the surgery and dressings were done according to producer’s guidelines orders.
Results:
No infection or inflammation was found and primary ingrowths of templates were present, as also of skin grafts. Some areas showed granulation tissue in-between grafts. Later, skin covercle showed a suitable result, without a moose like appearance. After six weeks, patient started to wear elastic hoses.
Conclusions:
Simple skin grafting represents unstable epithelial layer, while using DRT represents better quality of a skin cover. In chronic, long-standing lymphedema, where there is a substantial element of an extensive fibrosis, this may be the best technically feasible procedure available
Introduction:
More than three decades, Department of plastic surgery and burns in Ljubljana presents a surgical epitaph for lower leg reconstruction.
All practical and theoretical parts are precised ...as meticulous debridement of soft tissues and bone in the zone of injury, by fracture stabilization by either external or internal fixation, by assuring good circulation with a direct artery repair or by the use of venous or arterial grafts, and by closure of the soft-tissue defect with a suitable free flap with microvascular anastomoses (Godina et al). Later, it was evident by results, that emergency treatment of complex lower leg injuries gives predictably better results that delayed treatment.
Methodology and Material:
In last five years (2007 - 2012), an emergency treatment dropped down, while a soft tissue defect after a bone fixation undergo to treatments, as a special dressings, permanent dermal xenografts, VAC drainage and hyperbaric oxygenation by orthopedic surgeons. Delayed defect is smaller and sinkless, what needs suitable flap, as m. serratus free flap, even gracilis flap instead of latissimus dorsi free flap.
Results:
At present, plenty of aged patients, with angiographic examined occlusive vascular disease, indicate a use of a local or distant axial pedicle flap. In some cases, innovated suralis flap completed on peroneal perforators was harvested. On upper third of lower leg, the best solution is a single or double gastrocnemius transfer to cover exposed patella or even joint or protrusion of functional or tumor prosthesis.
Respecting propeller flaps, short-term results are acknowledged as advantages. Long term results are not still precisely evaluated in comparison to free flaps. In our routine praxis we realize, that an absence of microanastomosis on bigger vessels cannot jeopardize an important vascularization and viability of a lower extremity.
Sometimes, an amputation, as a part of reconstructive ladder, seems to be better solution, as a high number of operations or long hospitalization.
Conclusions:
However, a repair must be individually adapted to new conditions and surgical requests. Finally, a restore of soft tissue, requires active cooperation between orthopaedic and plastic surgeon and organization of a continuous microsurgical service.
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