MF Plastinės ir rekonstrukcinės chirurgijos klinika (04.33)

Technological advancements have profoundly reshaped healthcare systems, transforming workflows, communication, and education. This paper explores the integration of digital health innovations, including electronic health records (EHRs), artificial intelligence (AI), and virtual reality (VR), within Lithuanian healthcare institutions, educational settings and research initiatives. It emphasizes the pivotal role of health care professionals and nursing informatics in adapting to digital transformation, while also addressing key challenges such as digital competence, system usability, and implementation costs.

At Lithuania’s largest hospital, Kaunas Clinics, digital systems such as Hospital Information Systems (HIS, AREST), and automated monitoring tools are enhancing care coordination and clinical decision-making. A case study from Kėdainiai District Hospital highlights disparities in digital competence between nurses and nursing assistants, underscoring the need for systematic and personalized training programs.

In healthcare education, the Lithuanian University of Health Sciences (LSMU) incorporates simulation technologies, VR, and AI to strengthen students’ clinical reasoning and technical skills in safe, immersive environments. The paper also presents a collaborative initiative with Kaunas University of Technology (KTU) to develop an AI-and XR (extended reality)-based educational model focused on critical clinical scenarios, such as the management of anaphylactic shock. Despite technical and linguistic barriers, innovations like GPU-accelerated speech recognition and AI-driven virtual patients offer promising solutions to enhance health care students’ critical thinking and decision-making in acute care settings.

The authors conclude that the integration of advanced digital technologies and interdisciplinary innovations in both healthcare practice and education not only improves clinical workflows and patient outcomes but also transforms medical training. This ensures future professionals are equipped with the skills and tools essential for delivering high-quality care in modern clinical environments. The paper further highlights the importance of interdisciplinary collaboration in research as a driving force shaping the future of digital health.

Introduction Bilateral partial hand amputations severely reduce function. Losing multiple fingers, especially thumbs, which provide about 40 % of hand function [1] limits grasp and independence. Crush injuries often cannot be fully reconstructed [2]. Partial hand prostheses fill a gap when reconstructive surgery is not possible [3]. Modern 3D scanning and printing allow rapid individualised prostheses. Case Presentation A 62 y music performer’s hands were crushed by a press, causing traumatic amputations of all fingers except the right thumb and index, part of the left thumb. Emergency surgery involved debridement, osteosynthesis of the remaining digits, attempted replantation. Nonviable fingers were amputated. Over the next year the right index developed chronic osteomyelitis with a comminuted fracture. After failed conservative care, sequestrectomy and Masquelet technique with a polymethylmethacrylate (PMMA) spacer reinforced the bone. Prostheses were considered only when no other treatments remained. Once the wounds healed, palms were laser scanned with a HandySCAN 700 to capture residual anatomy. Anonymised 3D scans were transferred into Fuse CAD to create digital models of a mechanical left hand prosthesis with custom sockets, finger segments. Discussion Digital fabrication provided precise, patient specific prosthesis. Reports show that custom 3D printed devices improve grasp and fit [4]. A mechanical design was chosen because body powered prostheses are lighter and more durable than myoelectric prostheses [5]. The HandySCAN 700 captures up to 480000 measurements s⁻¹ using laser triangulation enabling accurate custom prosthetic design [6]. Although many body powered partial hand devices can be coupled to preserved joints, digits this case used a self contained mechanical prosthesis without residual finger actuation. Masquelet technique reinforced the index finger. Its PMMA spacer fills bone cavities and provides structural support [7]. Conclusions Digital 3D scanning and CAD based fabrication produced a custom mechanical partial hand prosthesis that should restore functional grasp and improve the patient’s independence. Precisely matched to the residual palm this printed lightweight body powered device provided a stable, comfortable interface and may offer a feasible option when multiple digits are amputated and not reconstructable.

Introduction Liquefied petroleum gas is colorless, odorless hydrocarbon mixture. Rapid evaporation cause cold injury, as the resulting drop in temperature can lead to frostbite [1]. Frostbite represents a cold induced injury in which tissue temperatures fall low enough to allow ice crystal formation within superficial deep layers [2]. For frostbite injuries, initiating reperfusion directed therapy early is associated with superior tissue protection compared with conventional conservative care, defined as noninvasive management without active restoration of microvascular flow [3]. Case Presentation This case describes a 34 y.o. man who sustained a right hand injury while refueling a car with LPG. Immediately after the incident, his hand became numb and cold. Examination showed diffuse redness, swelling, and hypoesthesia. He was admitted to the ICU for thrombolysis. After treatment swelling stabilized and a single serous blister appeared dorsally, the dorsal hand and medial side of the fifth finger were paler, but all fingers remained warm. Further management included LMWH aspirin ibuprofen and wound care with paraffin mesh and sterile dressings. Early antithrombotic therapy and local wound care preserved perfusion, halted injury progression and resulted in complete hand viability. At discharge swelling and sensory deficits had resolved, skin integrity was restored and no ischemic changes were present. Discussion When exposed to cold, the body responds by alternating vasoconstriction and vasodilation to protect the extremities from cold induced damage [4]. However this protective response can also lead to severe injury, including progressive thrombosis and tissue ischemia [5]. Early thrombolytic therapy has been shown to reduce amputation rates in severe frostbite [6]. In our case, early assessment and prompt medical reperfusion therapy stabilized perfusion and improved tissue recovery. Conclusions This unique case highlights the potential severity of LPG induced frostbite and the importance of early recognition of frostbite as a thrombotic injury. Prompt vascular assessment and monitoring of tissue perfusion guided targeted treatment. Early thrombolytic and antithrombotic therapy improved perfusion halted injury progression and resulted in complete preservation of hand viability with full functional recovery.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

This retrospective study evaluates surgical outcomes in 93 patients undergoing facial melanoma surgery between 2016 and 2023. Key factors analyzed include tumor localization, morphology, surgical radicality (R0, R1, Rx), excision width and recurrence rates. Lentigo maligna spectrum was the most common type (77.4%), with the left cheek being the most frequent tumor site (45.2%). R0 resections with a minimum margin of 0.6 cm significantly reduced recurrence, while R1 resections had higher recurrence rates, particularly in lentigo maligna cases. These findings highlight the importance of precise surgical planning to optimize oncological and functional outcomes.

The growing complexity of healthcare systems and the imperative for collaborative practice underscore the pressing need to innovate interprofessional education. This paper presents a multidimensional pedagogical framework that integrates blended classroom-based learning, high-fidelity simulation (HFS), and AI-enhanced extended reality (XR) technologies to develop interprofessional competences and improve preparedness for emergency care. Grounded in socio-constructivist and student-centred educational theories, the approach combines theoretical knowledge acquisition with immersive and experiential learning environments that reflect the realities of clinical practice. HFS provides a controlled setting to cultivate critical thinking, decision-making, and collaborative skills. In parallel, AI-enhanced XR introduces adaptive, gamified scenarios that foster digital competence, emotional resilience, and situated cognition. Together, these elements form a cohesive educational strategy that prepares nursing, midwifery, and medical students for high-stakes clinical situations such as anaphylaxis and trauma care. The framework contributes to enhanced patient safety, learner engagement, and the cultivation of future-ready professionals. It also responds to international calls for digital transformation and innovation in healthcare education. By harmonising traditional teaching methods with emerging technologies, this framework offers a globally relevant, scalable solution for advancing interprofessional learning across diverse healthcare contexts.

High-pressure injection injuries pose serious risks to hand function and are often underestimated. They occur when fluid or air under pressure punctures the skin leading to internal damage that can be devastating. Immediate surgical intervention, including debridement and irrigation, is essential to prevent long-term complications. Despite advancements in treatment, long-term morbidity and functional impairment are common, highlighting the need for thorough management and postoperative physiotherapy. This case emphasizes a crucial aspect: although high-pressure injection injuries may present initially as benign they should be treated as urgent situations that could be missed without thorough history-taking and appropriate diagnostic measures.

Introduction: Reduction mammaplasty effectively alleviates symptoms of breast hypertrophy, but long-term ptosis and pseudoptosis remain challenges. The superomedial pedicle technique ensures reliable nippleareola complex (NAC) vascularity and upper pole fullness, though lower pole support is limited. This study evaluates the impact of adding an inferior dermal flap on postoperative breast shape stability.

Dermatochalazė (akių vokų odos perteklius) ir antakių ptozė (antakių nusileidimas) susiformuoja esant minkštųjų audinių pertekliui dėl vidinių veiksnių, tokių kaip senėjimo sukelti anatominiai veido pokyčiai, ir išorinių, pavyzdžiui, žymaus svorio sumažėjimo ar saulės poveikio, ir gali sukelti funkcinius regėjimo sutrikimus. Odos pertekliaus pašalinimas atliekant viršutinių vokų plastikos ir antakių pakėlimo operacijas padidina akiplotį ir pagerina viršutinį regos lauką [1].

Žaizdų gydymas istoriškai yra viena pagrindinių sveikatos srities patirčių. Nuo senovės Egipto iki šių dienų nepavyko ir turbūt niekada nepavyks visiškai išvengti žaizdų. Su laiku keičiasi tik supratimas apie žaizdas, jų gydymo ir priežiūros metodai, daugėja žinių apie žmogaus kūne vykstančius biologinius procesus. Senovės medicinoje bene labiausiai iš visų sričių buvo persipynę magija, religija ir mokslas, žaizdos gydytos užkalbėjimais ir naminiais pūkų tvarsčiais, o šiandien mokslas žengia septynmyliais žingsniais - sukurtos technologiškai pažangios žaizdų gydymo ir priežiūros priemonės, gydytojai ir slaugytojai gali taikyti modernius ir efektyvius gydymo būdus.