Plastinės ir rekonstrukcinės chirurgijos klinika (K360000)

Background: Botulinum toxin type A (BoNT-A) has been proposed as an adjunct to orthognathic surgery because its temporary neuromuscular effects may reduce muscular loading during postoperative healing and potentially influence fixation stability, skeletal relapse, and postoperative recovery. This systematic review aimed to evaluate the available clinical evidence regarding the adjunctive use of BoNT-A in orthognathic surgery. Methods: A systematic literature search was conducted in PubMed, the Cochrane Library, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies directly comparing orthognathic surgery with and without adjunctive BoNT-A administration and reporting outcomes related to mechanical stability, skeletal stability, or postoperative recovery were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials and ROBINS-I for the non-randomized study. Results: Three studies met the eligibility criteria, comprising two randomized controlled trials and one retrospective comparative study. Considerable heterogeneity was observed in surgical procedures, targeted muscles, BoNT-A doses, timing of administration, and evaluated outcomes. Individual studies reported associations between BoNT-A administration and a lower incidence of fixation plate fracture, reduced anteroposterior skeletal relapse at the Pogonion, or lower preanalgesic pain scores and postoperative opioid consumption. However, these findings were derived from different studies evaluating distinct interventions and outcomes and were not consistently demonstrated across comparable outcome measures. Conclusions: BoNT-A may represent a promising adjunct to orthognathic surgery, with potential benefits for fixation-related mechanical stability, selected parameters of skeletal relapse, and postoperative pain management. However, the limited number of studies, methodological limitations, and substantial clinical heterogeneity preclude definitive conclusions. Further well-designed randomized controlled trials with standardized injection protocols and longer follow-up are required before routine clinical use can be recommended.

Objective Traumatic penile amputation is a rare urological emergency that requires surgical strategy. Published clinical replantation cases (2015-2023) are few, numbering only 46 over 7 years. Reconstruction using local flaps following major traumatic corporal amputation is exceptionally rare and remains largely unquantified in systematic reviews. When replantation is impossible, reconstruction using local tissues must be considered. We present a case of penile amputation management using a two-stage local flap reconstruction to restore both function and aesthetics.

Methods A 33-year-old male with chronic alcohol use, presented disoriented and anemic with severe, delayed genital trauma. Examination showed a deep, contaminated cut-laceration with bilateral testicular loss and a 4-5 cm corporal remnant. Amputated parts were unrecovered. Stage 1 involved meticulous debridement, securing urinary drainage and targeted antibiotic adjustment after multi-pathogen growth. Once inflammation subsided, the reconstructive second stage was performed. Longitudinal incision lines were made along the palpable remnants of the corpora cavernosa. Scar tissue was dissected and the suspensory ligament of the penis was released. The remaining cavernous bodies were then elevated together with the overlying skin flap, resulting in an observed penile lengthening. The ventral tissue defect formed beneath the penis was covered by advancement and elevation of adjacent scrotal tissues and overlying skin to construct a neophallus.

Results In this case, the patient presented with severe contamination, delayed trauma, severely limited definitive treatment options. The unsuitability of replantation and the high complication risk associated with complex microsurgical free flap procedures in this setting required a staged, local reconstruction approach. The use of a scrotal advancement flap was crucial, as it provided well-vascularized and elastic tissue ideally suited for covering the remaining corporal stump. This tailored two-stage management optimized the functional and aesthetic outcome using only native local tissue.

Conclusion Reconstruction after penile amputation is a complex challenge. Our case demonstrates that meticulous debridement and planned local flap reconstruction provide a strong foundation for success, restoring urinary function and achieving an acceptable aesthetic outcome, even when replantation is precluded.

Background and Objectives: Implant-based breast reconstruction following subcutaneous mastectomy is widely performed; however, the optimal strategy for implant support remains controversial. Absorbable synthetic meshes have emerged as lower-cost alternatives to acellular dermal matrix (ADM), yet their clinical and economic value remains incompletely defined. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. Studies evaluating implant-based breast reconstruction with absorbable synthetic meshes, ADM, or without mesh were included. Outcomes of interest comprised postoperative complications, operative time, material costs, aesthetic outcomes, and patient-reported satisfaction. Methodological quality and risk of bias were assessed using design-appropriate appraisal tools. Results: Absorbable synthetic meshes were associated with low complication rates, including infection (3–8%), seroma (0–5%), hematoma (1–4%), skin necrosis (4–6%), and implant loss (3–6%). Compared with ADM, complication rates appeared comparable, while shorter operative times were reported in comparative studies. Material cost reductions of up to 90% were reported in comparative studies. Several studies reported favorable aesthetic outcomes and high patient satisfaction, although assessment methods were not standardized. Most included studies were retrospective or single-arm observational studies, with substantial clinical and methodological heterogeneity and an overall moderate risk of bias. Conclusions: Available evidence, derived predominantly from studies of polyglactin mesh, suggests that absorbable synthetic meshes may represent a feasible option for selected implant-based breast reconstructions, with potential advantages in terms of material costs and operative time. Evidence regarding polydioxanone mesh remains very limited, and the methodological limitations of the available studies preclude definitive conclusions.

Aim/Introduction: Marjolin’s ulcer is a malignant degeneration of chronically injured skin, usually arising in longstanding scars or non-healing wounds. Diagnosis relies on history, clinical and laboratory evaluation. Most lesions are squamous cell carcinomas. Typically affecting lower limbs and often emerge decades after injury. Method/Case presentation: A 64-year-old man developed a chronic wound on his left ankle following a soft-tissue injury treated with a free flap 30 years earlier. Recurrent ulceration and poor healing progressed in an 8 × 10 cm ulcer. Clinical suspicion for squamous cell carcinoma (SCC) led to a planned wide excision with sentinel lymph node excision. Postoperative negative-pressure wound therapy (VAC) was applied while awaiting histological confirmation. The patient developed a purulent infection caused by P. aeruginosa requiring antibiotic treatment and daily dressings. VAC therapy was continued once the infection subsided. Histology confirmed a radically excised, well-differentiated invasive SCC. VAC therapy promoted granulation tissue formation over two weeks, after which a meshed split-thickness skin graft was applied to cover the defect. Results / Discussion: Marjolin’s ulcer is an aggressive malignant transformation of chronically scarred or non-healing skin that is easily overlooked, leading to delayed and sometimes inadequate treatment. In our patient, decades of impaired perfusion, chronic irritation, and recurrent ulceration in a post-traumatic scar eventually led to malignant transformation, highlighting the slow progression of Marjolin’s ulcer and the importance of biopsying any ulcer that fails to heal within 3 months. Conclusion: Marjolin’s ulcer is a rare but aggressive malignancy. Early recognition and biopsy of ulcers persisting beyond 3 months are crucial. In our case, wide excision with VAC followed by split-thickness skin grafting led to successful healing and avoided amputation.

Žaizdų, tiek ūminių, tiek lėtinių, gydymas - viena aktualiausių šiuolaikinės medicinos sričių. Nors tradiciniai gydymo metodai, tokie kaip tvarsčiai, nekrektomijos, infekcijos kontrolė, išlieka būtini klinikinėje praktikoje, pastaraisiais metais vis daugiau dėmesio skiriama inovatyviems gydymo būdams, galintiems aktyviai veikti ląstelinius ir molekulinius gijimo procesus. Nanoterapija, kamieninių ląstelių terapija, amniono membrana, 3D biospausdinimas, užląstelinės matricos, trombocitų prisotinta plazma, šaltos atmosferinės plazmos terapija ir mikroRNR pagrįsti metodai atveria naujas individualizuoto, regeneraciją skatinančio žaizdų gydymo galimybes [1, 2].

Kojų venų ligos apima platų lėtinių būklių, pažeidžiančių apatinių galūnių veninę sistemą, spektrą - nuo kosmetinių telangiektazijų iki sunkiai gydomų veninių opų. Šiomis ligomis Jungtinėse Amerikos Valstijose serga daugiau nei 25 milijonai suaugusių asmenų. Kojų venų ligos sukelia reikšmingą neigiamą poveikį tiek pacientų gyvenimo kokybei, tiek sveikatos priežiūros sistemai, ypač didelę ekonominę naštą lemia veninių opų gydymas [1].

Infekcinės žaizdos išsivysto sutrikus odos barjerinei funkcijai, kai į audinius patekus mikroorganizmų kyla uždegiminis atsakas. Siekiant efektyvaus gydymo, reikalingos visapusiškos priemonės: būtina tinkama žaizdos higiena (valymas, nekrektomija, kraštų atnaujinimas ir tinkamas tvarstymas), mikrobiologiniai tyrimai ir, esant indikacijų, sisteminė antibiotikoterapija. Vietiniam infekcijos valdymui svarbūs antimikrobiniai tvarsčiai, mažinantys bakterinį užterštumą ir palaikantys gijimui palankią aplinką. Papildomai gali būti taikomi pažangūs metodai, tokie kaip neigiamo slėgio terapija, kuri efektyviai šalina eksudatą, slopina infekcinį procesą ir skatina audinių regeneraciją.

Amiloidozė yra didelė gana retų ligų grupė, joms visoms būdingas nenormalaus, netirpaus baltymo – amiloido susikaupimas audiniuose ir dėl to išsivystantis įvairių organų pažeidimas, jų funkcijos sutrikimas. Šiai ligai būdinga ir širdies pažaida – amiloido kaupimasis miokardo užląstelinėje terpėje – lemia restrikcinės kardiomiopatijos fenotipą, progresuojantį širdies nepakankamumą, bei ankstyvą mirtį. Širdis dažniausiai pažeidžiama sergant lengvųjų grandinių (AL) ar transtiretino (ATTR) amiloidoze.

Aim: Total scalp avulsion is the detachment of scalp tissues from the periosteum, affecting areas like the hairline, eyebrows, ears, and nose. This study aims to present clinical cases of scalp avulsion, and the treatment strategies employed at our hospital over a 5-year period. Method: Over the past five years, our hospital has managed three cases of scalp avulsion within its service area. Initial management involved attempts at scalp replantation as the primary treatment modality, however, subsequent complications, including infection and tissue necrosis, necessitated the use of both full-thickness and split-thickness skin grafts for the management of craniofacial wounds. In cases where the periosteum sustained damage, multiple cranial perforations and the application of negative pressure wound therapy (NPWT) were utilized. Following adequate granulation tissue development and favorable outcomes in wound healing, autologous skin grafting (autodermoplasty) was performed. These cases present significant complexity, with associated risks such as sepsis and long-term physical, aesthetic, and psychological consequences. Results / Discussion: In cases of complex scalp avulsion injuries, replantation remains the primary therapeutic approach, though its success rate can be variable. In instances where the periosteum is absent, osteoperforation techniques should be considered as a viable method to promote granulation tissue formation. Additionally, the use of advanced wound management strategies can facilitate more rapid healing and improve overall treatment outcomes. Conclusion: In our clinical experience, when scalp replantation was not feasible, skin grafting was the most frequently employed technique. In cases involving periosteal damage, a combination of osteoperforation, autodermoplasty, and negative pressure wound therapy was utilized. The integration of advanced wound management, psychological support, and rehabilitation facilitates a more rapid return to normal daily activities for the patient.

Spenelio rekonstrukcija – galutinis krūties rekonstrukcijos etapas. Jis yra svarbus pacienčių psichosocialinei gerovei, tad jų pasitenkinimas atlikta procedūra – reikšmingas veiksnys, vertinant ilgalaikę rekonstrukcijos sėkmę. Literatūroje sutinkama įvairių spenelio atkūrimo būdų, tačiau praktikoje dažniausiai taikoma rekonstrukcija C-V lopu. Atlikus sisteminę literatūros apžvalgą, į kurią įtraukta 11 mokslinių publikacijų, pastebėta, jog, nepaisant spenelio projekcijos praradimo bėgant laikui, pacientės šią operaciją vertina teigiamai. C-V technika pasižymi mažu komplikacijų dažniu ir gali būti taikoma vienos operacijos su krūties rekonstrukcija metu.