Varkalys, Karolis

Background. Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models.
Methods. This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July–November 2014) and GlobalSurg-2 (January–July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator (‘LASSO’)) and machine learning (extreme gradient boosting (‘XGBoost’)). Final model selection was based on prognostic accuracy and clinical utility.
Results. There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept −0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion. The ‘Global Surgical-Site Infection’ score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.

Background and Objective: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a technique of local anesthesia commonly used in the surgical treatment of a wide variety of conditions affecting the upper extremity, including Carpal Tunnel Syndrome (CTS). The recent retrospective studies investigated patient experiences in a wide variety of hand disorder-related cases. The aim of our study is to evaluate patient satisfaction regarding open surgical treatment for CTS using the WALANT technique. Material and Methods: we enrolled 82 patients with CTS without medical record of surgical treatment for CTS. For WALANT, a hand surgeon used a combination of 1:200,000 epinephrine, 1% lidocaine, and 1 mL 8.4% sodium bicarbonate solution without tourniquet application and sedating the patient. All patients were treated in a day-care setting. For assessment of patient experience, Lalonde’s questionnaire was adapted. Participants completed survey twice: one month and six months after the surgical treatment was performed. Results: the median pre-operative pain score for all patients was 4 (range 0–8) after one month and 3 (range 1–8) after six months. The median intraoperative pain score for all patients was 1 (range 0–8) after one month and 1 (range 1–7) after six months. The median post-operative pain score for all patients was 3 (range 0–9) after one month and 1 (range 0–8) after six months. More than half (61% after one month and 73% after six months) of the patients responded by stating that their real experience of WALANT was better than their initial expectations. An absolute majority of patients (95% after one month and 90% after six months) would recommend WALANT treatment to their relatives. Conclusions: overall, patient satisfaction with treatment for CTS using WALANT is high. Furthermore, complications related to the performed treatment and persistent post-operative pain could be associated with more reliable patient recall of this healthcare intervention. A longer period of time between intervention and assessment of patient experience could possibly be a reason for recall bias.

Įvadas. Sustorėjęs A1 skaidulinis žiedas, esantis ties delnakaulio galva, neleidžia sausgyslei laisvai judėti kanale. Pasireiškus šiam sutrikimui, pacientai, lenkdami ar tiesdami pirštą, Jaučia vietinį skausmą ir strigimą. Tikslas. Įvertinti pacientų, sergančių stenozuojančiu tenosinovitu, ankstyvuosius ir vėlyvuosius rezultatus, pritaikius atvirąjį chirurginį gydymą, atliekant anulotomiją. Metodika. Tiriamiesiems atlikta standartinė operacija - atviras chirurginis plaštakos piršto skaidulinio A1 žiedo atvėrimas (anulotomija). Skausmas (verbalinė skausmo skalė), plaštakos ir rankos funkcijos (QuickDASH) bei komplikacijos vertinta po operacijos praėjus 1 sav., 3 mėn. ir 6 mėn. Rezultatai. Tyrime dalyvavo 45 pacientai, iš jų - 29 (64 %) moterys, 16 (36 %) vyrų. Didžiausią skausmą pacientai jautė prieš operaciją (mediana - 5; TKN 5), mažiausią - praėjus 6 mėn. po operacijos (mediana - 2; TKN 2). Skausmo rezultatų skirtumas prieš operaciją ir praėjus 1 sav., 3 mėn. bei 6 mėn. po operacijos - statistiškai reikšmingas (p < 0,001). Rankos ir plaštakos funkcijos blogiausiai vertintos prieš operaciją ir praėjus 1 sav. po operacijos (mediana atitinkamai: 52 (TKN 33) ir 52 (TKN 35). Plaštakos funkcija pacientams atkurta praėjus 6 mėn. po operacijos (mediana - 0; TKN 11). Skirtumas statistiškai reikšmingas (p < 0,001). Išvados. Atviroji anulotomija - viena iš efektyviausių stenozuojančio tenosinovito gydymo metodikų. Atlikus šią operaciją, gerėja plaštakos funkcija, mažėja skausmas. Vis dėlto pooperaciniu laikotarpiu nemažai daliai pacientų kyla tam tikrų nepatogumų ar komplikacijų, iš kurių dažniausiai minėtinas nepatogus randas. Neretai pacientus vargina rando jautrumas.

Introduction Stenosing tenosynovitis also known as Trigger finger is a common condition which may cause significant functional impairment of the hand. Repetitive use of flexor tendonsheath complex results in chronic inflammation response. In addition, chronic inflammation induces thickening of flexor tendon which causes clinical manifestation of pain and locking of the finger movement [1]. Percutaneous or open release of the A1 pulley is considered the treatment of choice in management of stenosing tenosynovitiswhen conservative treatment is inefficient [2]. Aim To evaluate early outcomes of open surgical treatment of stenosing tenosynovitis. Methods A prospective study was conducted on patients with isolate tenosing tenosynovitis of II, III, IV or V fingers. Patients were included only after they met all inclusion criteria of research: patient is older than 18 years and diagnosed with isolate stenosing tenosynovitis of II, III, IV or V fingers without surgical treatment of fingers in past medical history. Pregnant women and all patients with autoimmune diseases were excluded. All patients were treated in plastic and reconstructive surgery department of Kaunas clinics. Open surgical release of A1 pulley was used for the treatment of patients. Valid QuickDASH questionnaire was used to measure patient hand function. For the short- term functional outcomes QuickDASH questionnaire was applied one week and three months after the surgical treatment. Evaluation of early postoperative complications were recorded at each follow-up visit. Analysis was performed using SPSS 22.0 software package. For the statistical analysis a nonparametric related samples Friedmanʻs test was used. Results 17 patients with stenosing tenosynovitis were included in the trial over the course of 6 months. […].

Šiame straipsnyje apžvelgiami Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (toliau - Kauno klinikų) Plastinės ir rekonstrukcinės chirurgijos klinikoje auksinio svarelio implantacija bei šonine kantopeksija gydytų pacientų po veidinio nervo paralyžiaus, rezultatai. Pacientų būklė po operacijos buvo vertinama po septynių dienų bei po 3-4 mėn.

End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.

Darbo uždavinys. Išmatuoti pirštų lenkimo amplitudės pokyčius goniometru, taikant ankstyvą aktyvią reabilitaciją. Tyrimo metodika. Atliktas prospektyvinis tyrimas, į kurį įtraukti 18 Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų pacientų su izoliuotomis plaštakos lenkiamųjų sausgyslių traumomis, gydytų nuo 2017 metų rugsėjo iki 2018 metų gegužės mėnesio. Pacientams, iš kurių 13 vyrų (72,2 proc.), 5 moterys (27,8 proc.), buvo taikyta ankstyva aktyvi reabilitacija. Tiriamųjų amžiaus mediana 48,5 (20 – 68) metų. Gauti rezultatai lyginti neparametriniu Vilkoksono (Wilcoxon) kriterijumi, statistiškai reikšmingu skirtumu laikėme p < 0,05. Apžvelgę tarptautinės literatūros rekomendacijas, sudarėme operacinį protokolą, kuriuo rėmėmės tyrimo metu. Rezultatai. Įvertinus pirštų judesių amplitudę goniometru po 2 ir po 4 savaičių gauti rezultatai atitinkamai: mediana 85 (65 – 90) laipsniai ir mediana 110 (85 – 120) laipsnių. Gautas statistiškai reikšmingas skirtumas p < 0,001. Išvada. Ankstyva aktyvi „Saint John“ reabilitacija yra naujas ir efektyvus metodas pacientams po izoliuotų plaštakų lenkiamųjų sausgyslių sužalojimų, jeigu užtikrinaname tinkamą sausgyslės susiuvimą ir pooperacinę priežiūrą.

Background Split-thickness skin grafting (STSG) is the most commonly used technique in the treatment of traumatic, post-burn, and post-operative wounds, when direct wound edge closure is unavailable. There is currently no general agreement on the optimal thickness of skin grafts. We aimed to analyze the early results of recipient wound healing after STSG, using grafts of different thicknesses. Methods This randomized, controlled, and parallel-group pilot clinical trial included 98 adult patients who underwent STSG transplantation surgery for post-burn, post-traumatic, or post-operative skin defects. Patients were randomized into three groups to receive a skin graft of 0.2, 0.3, or 0.4-mm thickness. After skin transplantation, the healing parameters of the recipient wounds were evaluated after 3 days, 7 days, 2 weeks, and 1 month. At each time, epithelialization and pain parameters were evaluated. Results Our study showed that thinner split-thickness skin grafts had better epithelialization scores at the second post-operative week. However, thinner split-thickness skin grafts caused greater pain to the patients. Conclusions Thickness of the skin graft is a significant factor affecting recipient wound healing parameters. It is necessary to evaluate healing of the donor wound, as well as distant treatment outcomes, such as scarring, pigmentation, and esthetic results of skin grafting with different thickness grafts.

Introduction. In 1918 the zone II in the hand was known as „no man‘s land“. At that time it was believed that no man should attempt a repair within this area. Greatfully, today this belief is no longer a common practice. Allthough zone II injuries remain difficult task for hand surgeons. These injuries are seen commonly and it‘s important to find the best postoperative rehabilitation method to reach the best results in returning the range of motion in the injured fingers. Therefore we‘re the first ones in Lithuania using and comparing „The Kleinert“ dynamic immobilization vs early active rehabilitation „The Saint John“ after flexor tendon injuries in the zone II, which have showed a promising results in foreign clinical trials. Aim To compare “The Kleinert” dynamic immobilization vs “The Saint John” early active rehabilitation effect to range of motion in patients after flexor tendon injuries. Methods. Our team performed a pilot randomised, controlled, parallel-group clinical trial designed to compare “The Kleinert” dynamic immobilization and “The Saint John” early active rehabilitation after flexor tendon injuries in zone II of the hand. The study took place in the Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences Kaunas Clinics, Lithuania. .All patients had isolated flexor tendon injuries in zone II of the hand and were treated surgicaly. Flexor tendons were sutured using tripple Kessler technique with 2-3/0 non-absorbable sutures and one 5/0 running suture with “Prolene”. Distance between the beginning of the suture and the ending of the tendon was from 7 to 10 mm. After surgery all patients had rehabilitation. After surgery all patients had rehabilitation and have been followed up for the effect to range of motions after 2 weeks and after 1 month. At both time points a goniometer was used to measure angles of the injured fingers to establish rehabilitation efficiency. [...].

Aim: To present a clinical case of the left breast hypertrophic scar treatment after radiotherapy. Method: 46 year old lady diagnosed with left breast dermatofibrosarcoma had surgery and radiotherapy 3 years ago. Hyperpigmentation, scarring and several skin sores have appeared soon after radiotherapy. Conservative treatment was prescribed with antiseptic greases. Scarring in the left breast increased, widened became painful and hyperpigmentated. The patient was admitted to the Plastic and Reconstructive surgery clinic for further treatment. In the clinic following procedures were performed: scar excision using Z plastic and breast reconstruction with fat from the medial thigh. Skin lesions were dressed with an antiseptic wound and mucous solution* and bandages with paraffin. Additionally, compression therapy and medication improving blood flow were prescribed. A thin and discreet dressing* patch was recommended after removing the sutures. Results / Discussion: Applied treatment was successful. Scarring in the left breast reduced. Patient was satisfied with the esthetic results of the treatment. Conclusion: Complex view is necessary in order to be successful in treating scars after radiotherapy. A combination of surgical and conservative treatment showed the best possible esthetic results for our [...].