Volodzkaitė, Karolina

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.

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].

Aprašomas 11 metų pacientės plačių QRS kompleksų tachiaritmijos klinikinis atvejis. Dėl neefektyvios adenozino ir amjodarono terapijos pacientė buvo perkelta į tretinio lygio įstaigos vaikų intensyviosios terapijos skyrių. Elektrokardiogramoje nustatytas prieširdžių virpėjimas per įtariamą slaptą papildomą laidumo pluoštą. Atkūrus sinusinį ritmą su didesne amjodarono doze, elektrokardiogramoje stebėtos delta bangos. Elektrofiziologinio tyrimo metu nustatytas Volfo-Parkinsono-Vaito sindromas – atliekant perkateterinę radiodažnuminę abliaciją, kairėje užpakalinėje širdies sienoje sunaikintas papildomas laidumo pluoštas. Po perkateterinės radiodažnuminės abliacijos delta bangos išnyko, elektrokardiograma normalizavosi.

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].

Introduction. BRCA gene mutations lead to a 45% to 75% lifetime risk of developing breast cancer. The most effective prevention of breast cancer incidence in high–risk populations is surgical removal of breast tissue. Prophylactic subcutaneous mastectomy reduces breast cancer incidence in BRCA gene mutation carriers by approximately 90%. However, subcutaneous mastectomy with implant placement often results in breast implant rippling. Case Report. A 29–year–old female with a confirmed BRCA2 gene mutation and a positive family history of breast cancer underwent prophylactic subcutaneous mastectomy and immediate reconstruction with implants. The surgical procedure involved axillary and inframammary fold incisions on both sides, with ultrasound assistance to separate the breast glandular tissue from the skin, subcutaneous tissue, and pectoralis major muscle. Microtextured implants were placed, covered superiorly by the m. pectoralis major and by the skin and residual tissue inferiorly. Seven months later, a III–degree capsular contracture of the left breast implant was diagnosed. Revision surgery involved the release and refixation of the pectoralis major muscle. Two flaps – the serratus anterior muscle and remaining pectoralis major muscle with capsule - were rotated anteriorly to cover the inferior pole of the replaced smooth implant to provide suspension. Summary. Ultrasound assistance and the double–incision technique reduce blood loss, minimize tissue injury, shorten hospitalization, and improve skin and subcutaneous tissue homogeneity. Implant placement under the pectoralis major muscle allows coverage of the superior portion of the implant, reducing the risk of implant rippling. Conclusions. BRCA2 mutation significantly increases breast cancer risk. Prophylactic subcutaneous ultrasound–assisted mastectomy with immediate reconstruction using implants, combined with axillary and inframammary fold incisions provides an excellent breast cancer preventative result. The serratus anterior muscle and the remaining pectoralis major muscle with capsule could be used for lower part breast reconstruction when implant capsular contracture occurs.

Objectives. The McKissock’s vertical bipedicle flaps technique is one of the methods applied in breast reduction as well as for breast lift surgeries. Nonetheless, a considerable lack of large-scale investigations suggests discrepancies in the literature, undermining the technique’s effectiveness and its low complication rate. This study aimed to evaluate the prevalence of intraoperative and postsurgical complications encountered with this approach. Materials and methods. A retrospective study was conducted by evaluating the results of patients who underwent reduction mammaplasty or mastopexy at Tautrimas Aštrauskas Clinic between the years 2012 and 2022. McKissock’s technique was consistently utilized in all of the cases that were part of the research. Results. A total of 1943 surgeries were performed, with the average age of the patients being 43 years. The mean of removed tissue was 460g, with the highest nipple lift reaching 20cm. The study showed that 90% of patients maintained undisturbed nipple sensation while there were no reported cases of nipple and glandular necrosis. The most common complication observed was wound dehiscence, affecting 1,8% of patients. Less frequently occurring issues were hematomas (0,1%), uprising inframammary scar (0,36%), and unpredictable scarring (0,56%). Fat grafting was applied in most of the cases to achieve a superior aesthetic effect at the breast gap. Conclusions. McKissock‘s technique is a highly effective approach for breast reduction and mastopexy of various size breasts. Through a combination of expertise, experience and precision, this method prevents nipple necrosis by ensuring optimal circulation of the nipple-areola complex and has a favourable probability of nipple sensation preservation, providing breastfeeding ability. Moreover, fat grafting ensures a pleasing projection of the breasts with minimal occurrence of postoperative complications. However, further and more extensive research is needed in this domain.

Background and aim of the study. Reduction mammaplasty, or breast reduction, is an increasingly prospering surgery developed to alleviate physical discomfort caused by disproportionately large breasts. Numerous approaches involving different pedicles and their combinations have been described in the literature, though there is no unanimous agreement on the superiority of a single technique. This study aims to evaluate the incidence of complications by comparing four methods applicable in breast reduction surgeries: superior, medial, inferior pedicles, and McKissock‘s technique. Methods and materials. A retrospective study evaluated the results of patients who underwent reduction mammaplasty at Tautrimas Aštrauskas Clinic between the years 2000 and 2022. Patient characteristics, preoperative measurements, and surgical outcomes were compared between the four methods. Results. In total, reduction mammaplasty was performed on 3978 breasts. The McKissock technique demonstrated significant advantages, including the preservation of nipple sensitivity in 90% of cases, with no incidents of nipple necrosis, and required less time to perform compared to other methods. Although the medial pedicle approach was characterized by a low incidence of reoperation or corrective procedures, it resulted in the highest number of partial nipple necrosis and liponecrosis cases with only a 30% success rate in preserving nipple sensation. The superior pedicle approach exhibited the lowest frequency of hematoma formation, as well as reduced rates of hypertrophic scarring and wound dehiscence, however, it required the longest amount of time to complete. The inferior pedicle technique, while showing a low incidence of hypertrophic scarring, displayed the highest rate of hematoma formation. Conclusions. The study of breast reduction techniques revealed a relatively low complication rate among all methods; however, each approach had some advantages and limitations associated with each approach. The cardinal variation was found in nipple sensitivity preservation, ranging from 30% to 90%.

Introduction BRCA gene mutations lead to a 45% to 75% lifetime risk of developing breast cancer [1]. To this date, the most effective prevention of breast cancer incidence in high–risk populations is surgical removal of breast tissue [2]. Prophylactic subcutaneous mastectomy reduces breast cancer incidence in BRCA gene mutation carriers by approximately 90% [3]. However, subcutaneous mastectomy with implant placement often results in breast implant rippling. Case Presentation A 29-year-old female with a confirmed BRCA2 gene mutation and a positive family history of breast cancer underwent prophylactic subcutaneous mastectomy and immediate reconstruction with implants. The surgical procedure involved axillary and inframmary folds incisions on both sides, with ultrasound assistance to separate the breast glandular tissue from the skin, subcutaneous tissue, and pectoralis major muscle. Microtextured implants were placed, covered superiorly by the m. pectoralis major and by the skin and residual tissue inferiorly. Seven months later, a III degree capsular contracture of the left breast implant was diagnosed. Revision surgery involved release and refixation of the pectoralis major muscle. Two flaps – the serratus anterior muscle and remaining pectoralis major muscle with capsule - were rotated anteriorly to cover the inferior pole of the replaced smooth implant to provide suspension. The final step was fat grafting to achieve symmetry. Discussion Ultrasound assistance and the double-incision technique reduce blood loss, minimize tissue injury, shorten hospitalization, and improve skin and subcutaneous tissue homogeneity. Implant placement under the pectoralis major muscle allows to cover the superior portion of the implant reducing the risk of implant rippling. Conclusions The use of ultrasound and fat grafting helps achieve uniform tissue thickness while creating a smooth breast contour by reducing the likelihood of implant rippling. The two-incision technique aids in bleeding control and shortens the duration of hospitalization. The serratus anterior muscle and the remaining pectoralis major muscle with capsule could be used for lower part breast reconstruction when implant capsular contracture occurs.

Background and aim of the study. The McKissock’s vertical bipedicle flaps technique is one of the methods applied in breast reduction as well as for breast lift surgeries. Nonetheless, considerable lack of large-scale investigations suggests discrepancies in the literature, undermining the technique’s effectiveness and its low complication rate. This study aimed to evaluate the prevalence of intraoperative and post-surgical complications encountered with this approach. Methods and materials. A retrospective study was conducted by evaluating the results of patients who underwent reduction mammaplasty or mastopexy at Tautrimas Aštrauskas Clinic between the years 2012 and 2022. McKissock’s technique was consistently utilized in all of the cases that were part of the research. Results. A total of 1943 surgeries were performed, with the average age of the patients being 43 years. The mean of removed tissue was 460g, with the highest nipple lift reaching 20cm. The study showed that 90% of patients maintained undisturbed nipple sensation while there were noreported cases of nipple and glandular necrosis. The most common complication observed was wound dehiscence, affecting 1,8% of patients. Less frequently occurring issues were hematomas (0,1%), uprising inframammary scar (0,36%), and unpredictable scarring (0,56%). Fat grafting was applied in most of the cases to achieve a superior aesthetic effect at the breast gap. Conclusions. McKissock‘s technique is a highly effective approach for breast reduction and mastopexy of various size breasts. Through a combination of expertise, experience and precision, this method prevents nipple necrosis by ensuring optimal circulation of the nipple-areola complex and has a favourable probability of nipple sensation preservation, providing breastfeeding ability. Moreover, fat grafting ensures a pleasing projection of the breasts with minimal occurrence of postoperative complications. However, further and more extensive research is needed in this domain.

Introduction In 1987, the concept of sustainability was introduced by the United Nations and began its path in theory and policy development. [1]. In recent years, international awareness of the complexity of the relationship between healthcare and the environment has been raised, but no significant steps have been taken to improve the situation. The healthcare system continues to be a substantial contributor to the environmental footprint, mostly through waste products including both hazardous and non-hazardous materials, as well as air pollution, yet maintains its pivotal role in improving human well-being. [...].