Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: Analysis of recurrence-free survival.

BACKGROUND AND AIM: Cutaneous squamous cell carcinoma (CSCC) is a malignant epithelial cell tumor. CSCC has a tendency to spread via lymphogenic pathway. Metastases are found in 2%-6% of cases. Prognosis of patients with CSCC is directly related to the morphology and localization of primary tumor. The aim of this study was to evaluate the recurrence-free survival of patients with CSCC after tumor excision and SLNB as well as to analyze morphologic CSCC features related to patient recurrence-free survival. MATERIALS AND MATERIALS: A retrospective analysis of 51 patients with CSCC, who underwent surgical treatment between January 1, 2012, and December 31, 2014, in the Clinic of Plastic and Reconstructive Surgery, Hospital of the Lithuanian University of Health Sciences, was done. The diagnosis of CSCC was verified on a histological examination, and all patients had no clinical evidence of nodal or distant metastases on a physical examination or imaging studies. Sentinel lymph node biopsy (SLNB) was performed for low- and high-risk CSCC patients. RESULTS: A total of 51 patients were enrolled into the study (34 women and 17 men). Total of 68 lymph nodes were removed during sentinel lymph node biopsy. No micrometastases were identified. Until April 1, 2015, no relapse event was documented. The mean time after operation was 27.5 months. During the follow-up period, no distant metastases were identified. CONCLUSIONS: No patient who had no micrometastases in sentinel lymph nodes developed local and distant CSCC metastases during the follow-up period. Our report supports the concept that SLNB can be applied for CSCC. It is obvious that larger prospective studies with longer follow-up period are needed to establish the efficacy of SLNB and define the optimal treatment of occult nodal metastasis for CSCC.

Comparison of otoplasty outcomes using different types of suture materials.

Prominent ears are the most common congenital deformity. Numerous techniques for the correction of this deformity have been described in the literature, but there is no single technique widely accepted by most surgeons. Usually, more attention is focused on sculpturing or suturing techniques but not on suture material. The aim of this study is to evaluate clinical outcomes after otoplasty for surgical correction of prominent ears with different suture materials for the formation of new antihelical fold. During a 3-year period (2006-2008), 133 patients underwent operative correction of protruding ears in a private plastic surgery center. A total of 100 patients came for the follow-up visits, and the data of these patients were included in further analysis. The surgical technique consisted of scoring of the antihelical cartilage, suturing to recreate the fold of the antihelix (in the manner of Nachlas), and conchal setback procedure according to Furnas technique. According to suture material used for formation of new antihelix fold, the patients were divided into three groups: 4/0 Monocryl group (35 patients, 70 ears; Group 1), 4/0 PDS group (27 patients, 54 ears; Group 2), and 4/0 Mersilene group (38 patients, 7 ears; Group 3). Distances from the temporomastoid surface of the skull to the helix border in the upper, middle, and lower parts of the ear were measured before surgery and 6 months following surgery, and these measures were compared among groups. In addition, early and late complications were analyzed. There were 48 men and 52 women, and the median age was 20 years. The groups were matched for age, sex, and protrusion degree. No statistically significant differences were found comparing the groups of different suture material by skull-helical rim distance before operation. Comparison of skull-helical rim distance among groups after surgery showed that this distance in the medial and lower parts of the ear was the same in all groups, but this distance was smaller in the upper part of the ear in the Mersilene group; however, this difference was not statistically significant. Three patients in the Monocryl group (6 ears, 8.57%) and 3 patients in the PDS group (6 ears, 11.11%) had unsatisfactory aesthetic outcome because of recurrence of protrusion in the upper part of the ear. All of them underwent reoperation. In the Mersilene group, no recurrence was documented, but suture extrusion occurred in one patient (2 ears, 2.63%), and the sutures were removed. In our experience, formation of new antihelical fold with a 4/0 Mersilene suture resulted in the lowest rates of late complications. Using this type of suture material, some suture extrusions occurred, but this problem was easily solved by removing sutures. No recurrences of protrusion were documented in this group; therefore, no revision surgeries were necessary.

Reconstruction of nasal defect with the composite expanded forehead flap.

Nasal tip and septal perforations may lead to significant upper airway problems as well as disturbing esthetic changes in the external contour of the nose. Nasal defects impede normal social contact and create great self-identity problems for the patients. We report the case of a 37-year-old woman, taking drugs for 10 years, who had sepsis and nasal abscess with necrosis of the nasal tip and septum. Using a composite expanded forehead flap for reconstruction of the nose, good esthetic and functional results were achieved.

Surgical treatment of pressure ulcers: an 11-year experience at the Department of Plastic and Reconstructive Surgery of Hospital of Kaunas University of Medicine.

UNLABELLED: The aim of this study was to evaluate morphological characteristics of pressure ulcers, methods of surgical treatment and its effectiveness in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital. MATERIAL AND METHODS: A retrospective data analysis of 139 patients with pressure ulcers treated in the Clinic of Plastic and Reconstructive Surgery, Kaunas University of Medicine Hospital, from January 1996 to January 2007 was performed. RESULTS: A total of 139 patients were surgically treated for pressure ulcers at the Clinic of Plastic and Reconstructive Surgery, Kaunas University of Medicine Hospital, from January 1996 to January 2007. Eighty-one patients were treated repeatedly (from 1 to 7 admissions; M=1). Pressure ulcers were healed completely in 94 patients who underwent surgery during the treatment in the hospital; in 45 patients who underwent surgical treatment, pressure ulcers were partially healed, and on discharge from hospital, only small wounds were left. Pressure ulcers most commonly occur in tuber ischii area (69 cases). The mean age of patients was 42+/-13.65 years (M=31); pressure ulcers were for 8.9+/-8.5 months on average (M=31). At admission to Kaunas University of Medicine Hospital, the mean size of pressure ulcers was 42.62+/-53.27 cm(2) (M=10). The results showed that the size of pressure ulcers depends on the duration of paraplegia (P<0.05). In 93 cases, pressure ulcers were treated using myocutaneous flaps; 17 of them were closed with V-Y advancement technique over the sacral area, 35 were closed with m. gluteus rotation flap, and in 41 cases, V-Y advancement technique using hamstring flaps was used. CONCLUSIONS: In patients with paraplegia, the first pressure ulcer occurs after 74.79+/-61.34 months from the onset of the disease. Pressure ulcers most commonly occur over tuber ischii area. The most effective surgical treatment of pressure ulcers is closure of the wound using myocutaneous flaps (use of the hamstrings); fasciocutaneous flaps were the most commonly used method in patients who underwent surgery for the second time.

The comparison of two methods of treatment evaluating complications and deficiency of functions of hands after deep partial skin thickness hand burns.

UNLABELLED: Hands actively participate in daily activities of a human; therefore, hands are the most vulnerable parts of the human body. People injure hands so often because namely hands are in the closest position to the dangerous equipment. According to the data of various authors, the injuries of hands and fingers make even 30-75% of all industrial traumas, and burns of hands account for about 6% of all traumas of hands. The aim of the study was to compare the effectiveness of active surgical treatment method with conservative treatment method, applied for the treatment of deep dermal partial skin thickness burns of the hands, wrists, and forearms of distal third. MATERIALS AND METHODS: A total of 49 patients with burned hands participated in the perspective study of random sample (totally 79 hands). All these patients were treated in the Department of Plastic and Reconstructive Surgery, Hospital of Kaunas University of Medicine, during the period of 2001-2005. The patients were assessed after 3, 6, and 12 months. RESULTS: Applying conservative method of treatment of deep partial skin thickness burns, the frequency of infectious complications was increased. In order to evaluate the state of scar, we applied the scale of Vancouver and analyzed the pigmentation of a scar, its height, flexibility, and color. After statistical analysis had been performed, we determined that more changes of skin were seen in the group, which received active surgical treatment (P<0.05). CONCLUSIONS: Statistically significantly fewer complications were in the group of active surgical treatment in the early (fewer infectious complications, smaller area of unnaturalized autograft) and in the late (scars were less rough, with less changes of pigmentation) postoperative periods.

Analysis of burned hand function (early versus delayed treatment).

UNLABELLED: The aim of this study was analyze the results of hand function in adult patients with deep partial thickness hand burns. All patients were treated in Kaunas University of Medicine Hospital in Lithuania during the period 2001-2004. MATERIAL AND METHODS: A total of 79 cases were reviewed prospectively. We divided the studied patients into two groups by the envelope method (A group of early and B of delayed necrectomy and plasty). Two treatment methods--early and delayed surgery--have been analyzed. We present results of analysis of hand function in the periods of 3 and 12 months after the burn injuries of the hands. RESULTS: During the study we ascertain that the deficiency of hand function in group A 3 and 12 months after the injury was lower than that in group B. The deficiencies of hand and arm functions decreased over time. After a period of 12 months the deficiency of hand and arm functions in group A reached 12%, while in group B the deficiencies of hand and arm function reached 23% and 26.5%, respectively. The study revealed that the deficiency of hand function because of wrist and hand burn depended on the age of patient, the area of hand burn, time period from the injury to the arriving to a hospital and time to the operation. The strength of digit pinch and hand grasp was larger in group A. Twelve months after the burn the strength measured in A and B groups was larger than that measured 3 months after the burn. The strength of hand grasp in group A in male patients regenerated up to 76%, in female--61% of norm. In group B the strength of hand grasp in male patients regenerated up to 60.8% and in female--39.36%. CONCLUSIONS: During the perspective analysis it was determined that after periods of 3 and 12 months after the injury the strength pinch and grip was statistically significantly larger in group A. The deficiency of hand function, which indicates the general hand function, was statistically significantly lower in group A.

The epidemiology and treatment of adult patients with hand burns in Kaunas University of Medicine Hospital in 1985, 1995, 2001 and 2002.

This study reviews the epidemiology of adult patients with hand burns admitted to Kaunas University of Medicine Hospital in Lithuania during selected four years (1985, 1995, 2001 and 2002). Two hundred and forty six cases were reviewed retrospectively with 74.4% of males and 25.6% of females among them. Median of age was 40 years (38 males, 45 females). Fire (71.9%) was the most common cause of injury; scalds (15.4%) were the second most common reason. The median of burned total body surface area was 12%. Analyzing the burns, 58.9% of them occurred in urban area (57.1% full-thickness burns), and 41.1% in rural (42.9% full-thickness burns). The study revealed that 17.1% (42) males and 3.7% (9) females were affected by alcohol at the time of injury. Early skin grafting was performed in 29.4% cases (mostly in 2001, 2002), delayed--70.6% (mostly in 1985, 1995) of all skin grafting operations. Early grafting was found to give better results in the length of hospital stay. Overall, the median of hospital stay significantly decreased and was 24 days (35 days in 1985, 19 days in 2002).

[Analysis of treatment outcomes after electric injuries (1991-2000)]. / Pacientu, patyrusiu elektros traumas, gydymo analize (1991-2000).

During the 1991-2000 year period 1728 children and 1967 adults have been treated in the Unit of Plastic Surgery and Burns of Kaunas Medical University Hospital. A retrospective analysis of patients who sustained electric injuries during these years period was carried out. Among all patients 93 (2.517%) were injured by electricity. 38 (40.86%) of them were children and 55 (59.14%)--adult patients. Seven (18.42%) children and 13 (23.64%) adults underwent high voltage electrical injury, 29 (76.32%) children and 22(40%) adult underwent low voltage injury and 2 (5.26%) children and 20(36.36%) adult were injured by Voltaic arc. Twenty two patients were treated conservatively, 55 necrectomies, 74 skin grafts, 5 microvascular flap transplantations were performed. During this study we find that severity of injury depends on current voltage. Tissue damage and rate of complications were much larger for patients who underwent high voltage electric injury than for patients who sustained low voltage or Voltaic arc injury. For 6 (of 7) children who underwent high voltage injury amputations were performed. For one child amputation of upper arm was performed, for 3 patients--amputation of forearm, for all the rest amputations of fingers were performed. These patients had more severe injuries with deep necrosis of muscular tissue, tendons and bone. Three patients who underwent low voltage injury needed amputation of digits. For other 2 patients from this group was necrosis of tendons and they required transplantation of microvascular flap. Five patients of adult high voltage injury group needed amputation. Three of them needed amputation of forearm, one--of upper arm and one--of the calf. From low voltage injury group 3 patients needed amputations of one or two fingers and only one patient needed amputation of upper arm.