Maslauskas, Kęstutis

Background / Objective Breast implant surgery for cosmetic purpose is the most popular plastic surgery and it has been performed for over 100 years. The amount of these procedures has risen significantly in the past decade according to American Society of Plastic Surgeons. It is important to determine changes in implant integrity because most of implant ruptures do not cause any clinical symptoms. The aim of our study was to evaluate the diagnostic value of ultrasound (US) in the detection of intact and ruptured breast implants. Methods In this retrospective study the medical documentation of women who underwent breast implant surgery and US check-ups at Tautrimas Aštrauskas Clinic in Kaunas, Lithuania in 2015-2023 were analyzed. The study included 92 patients with breast implants who underwent breast ultrasound and suspected rupture of one or both implants. An intact breast implant was characterized by even and continuous implant shell and homogeneous intracapsular echo-texture. The signs of a ruptured breast implant were uneven implant shell and inhomogeneous intracapsular echo-texture. The implants were divided into two groups: intact breast implants and ruptured breast implants. Surgery followed every evaluation of implant rupture by US. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Results In this study 184 implants were evaluated. Ultrasound diagnosis of an intact implant was made in 40,8% cases, a certain or suspected implant rupture - in 59,2% of cases. The accuracy of US in diagnosis of implant rupture was 97,3%, sensitivity – 99,1%, specificity – 94,9%, PPV – 96,3%, NPV - 98.7% and of all cases only 0.5% of cases were false negative. Conclusions US is reliable in evaluating breast implant integrity. The reported sensitivity of US for predicting implant rupture varies widely in the literature, from 50 to 94%. In the current study, the sensitivity was very high (99,1%, 96,7% CI, 86% to 101,4%). It can be influenced by the radiologist’s work experience. The new updated FDA 2023 guidelines state that magnetic resonance imaging (MRI) is the most effective method for detecting silent rupture of silicone gel-filled breast implants, but ultrasound is an acceptable alternative test for rupture in asymptomatic patients. The ultrasound is cheaper, faster, more affordable, and also very sensitive for assessing implant integrity. With reference to our study US examination after breast augmentation surgery with silicone gel implants is recommended annually.

Background and objective: Extravasation means the inappropriate or accidental infiltration of chemotherapy drugs into the subcutaneous tissue or subdermal tissues surrounding the administration site. These injuries range from less significant erythematous reactions to skin sloughing and necrosis. Extravasation frequency in adults is considered to be between 0.1%-6% of peripheral infusions and 0.3%-4.7% of implanted central venous access device infusions. " Material and methods: We represent two hand reconstruction cases after chemotherapy drug extravasation and soft tissues ulceration. Both females with maligned lymphoma diagnosis got several chemotherapy treatment courses. Plastic surgeon consultation after 4 and 6 months respectively post ulceration appeared. " Necrectomy procedures and soft tissue reconstruction of the damaged hand with free latissimus dorsi/serratus anterior muscle flap covered with spit thickness skin graft were performed. After one month post operation patients underwent hand rehabilitation: physiotherapy, scar reducing procedures, exercises for increasing joint movement amplitude. " Results and conclusions: Following extravasation of chemotherapeutic drug, the ulceration treatment with free muscle flap covered with partial thickness skin graft seen as an alternative to other reconstruction methods (for exp. radial arm flap). " Chosen reconstruction method allows achieving good treatment results, satisfactory aesthetic appearance of the hand, the possibility of extensor tendons reconstruction and damaged joints arthroplasty. " Early diagnosis and appropriate treatment of extravasation reduces the risk of the damaged area ulceration and functional impairment.

The aim of our study was to compare the number of detected sentinel lymph nodes and the incidence of micrometastases between two groups of patients with cutaneous melanoma. Methods: 100 patients were divided in to two groups: group V and group D. Group V patients (50) with melanoma underwent a single-stage surgery - radical excision of the tumour with sentinel lymph node biopsy (study group "V"). Group D patients (50) with melanoma underwent two-stage surgery; initially primary diagnostic excision of the tumour (0.5 cm from margins of the lesion) followed by a radical re-excision of the post-operative scar and sentinel lymph node biopsy (study group "D"). Results: Study groups "V" and "D" were tested for homogeneity with regard to age, melanoma thickness, location of melanoma, type of melanoma, and ulceration. The groups were found to be homogenous. The average number of removed sentinel lymph nodes in group "D" was 1.0 more than in group "V" (p < 0.05). The averages were 3.7 and 2.7 respectively with a SD of 1.8. The relationship between the SL node staining and type of surgery was (p < 0.05). 49.6% stained radioactive sentinel lymphnodes at the time of surgery was found in group "V", while 33.9% in group "D". Conclusions: Using two different early-stage cutaneous melanoma management techniques significantly more sentinel lymph nodes (p = 0.006) were detected using the two-stage surgery approach. However, there was no significant difference between the two approaches regarding the number of sentinel lymph nodes with micrometastases that were detected and excised.

Tyrimo tikslas. Įvertinti odos plokščiųjų ląstelių karcinomos (OPLK) chirurginio gydymo veiksmingųmą bei naviko išplitimą sergantiesiems OPLK. Įvadas. OPLK – išorinės ir vidinės patirties turinio (įvairių patologinių lygių) suvokimai tai piktybinis epidermio navikas. Tyrimo medžiaga ir metodai. Atlikta retrospektyvioji duomenų analizė 129 sergančiųjų OPLK, kurie gydyti 2004-2011 m. LSMU KK Plastinės ir rekonstrukcinės chirurgijos klinikoje. Rezultatai. Tarp ištirtų pacientų buvo 67 moterys ir 62 vyrai. Tiriamųjų vyrų amžius – nuo 30 metų iki 90 metų (vidurkis – 71,77 ± 11,83 metų), atitinkamai moterų – nuo 37 metų iki 92 metų (vidurkis – 74,45 ±10,41 metų). Dažniausiai OPLK nustatyta veido srityje. Analizuojant šią sritį, 26 proc. navikų buvo ausies kaušelio anatominėje srityje. Iš 129 sergančiųjų OPLK po 0,5-5 metų dviems pacientams rasta metastazių sritiniuose limfmazgiuose, trims – vidaus organų metastazių. Išvados. OPLK dažniausiai formuojasi veido srityje ir po pirminio naviko pašalinimo nustatomas ligos išplitimas, todėl tikslinga OPLK mikrometastazių diagnostikai atlikti SLB.

Extravasation means the inappropriate or accidental infiltration of chemotherapy drugs into the subcutaneous tissue or subdermal tissues surrounding the administration site. These injuries range from less significant erythematous reactions to skin sloughing and necrosis. Extravasation frequency in adults is considered to be between 0,1-6,0% of peripheral infusions and 0,3-4,7% of implanted venous access device infusions. We represent two hand reconstruction cases after chemotherapy drug extravasation and soft tissues ulceration. Both females with maligned lymphoma diagnosis got several chemotherapy treatment courses. Plastic surgeon consultation after 4 and 6 months respectively post uleration appeared. Necrectomy procedures and soft tissue reconstruction of the damaged hand with free latissimus dorsi/serratus anterior muscle flap covered with spit thickness skin graft were performed. After one month post operation patients underwent hand rehabilitation: physiotherapy, scar reducing procedures, exercises for increasing joint movement amplitude and functional impairment. Following extravasation of chemotherapeutic drug, the ulceration treatment with free muscle flap covered with partial thickness skin graft seen as an alternative to other reconstruction methods (for exp. radial arm flap). Chosen reconstruction method allows achieving good treatment results, satisfactory aesthetic appearance of the hand, the possibility of extensor tendons reconstruction and damaged joints arthroplasty. Early diagnosis and appropriate treatment of extravasation reduces the risk of the damaged area ulceration and functional impairment.

Darier disease (Keratosis folicullaris) was described independently by Darier and White in 1989. It is one of the most common genodermatoses, with an incidence of 1:30,000 – 100,000. This disease is a result of mutation in the ATP2A2 gene. The typical lesions are yellow – brown keratotic papules or plaques, usually found in the seborrheic areas such as scalp, forehead, retroauricular folds, neck, chest, axillae and extremities. Aim: The Aim is to evaluate the results of surgical treatment of Darier disease. Materials and Methods: A 41-year-old man presented with keratotic lesions on the feet and palms since 25 years. Patient was treated with emolliants, keratolytics (salicylic acid, urea), PUVA therapy, and systemic retinoids (isotretinoin), but treatment was without improvement. Examination revealed multiple keratotic yellow plaques on the palms. Exophytic keratotic warty texture papules were seen on the feet. Cysts and closed comedones were on the skin of face and chest. Surgical excision of keratotic masses surgical on feet was made. Firstly, partial excision of medial surface on the right sole on the level of healthy derma was made. The wounds were left for epithelization. Second keratotic masses excision was made after five months on the right sole and after six months on the left sole. Results: Re-ephitelialization on the excision site was observed and there weren’t evident signs of infection and recurrence. Conclusions: Surgical excision of keratotic masses can be successesful treatment of Darier disease for patients who don’t respond to topical and systemical treatment.

Chirurgija – mokslas ir menas. Vadovaujantis šiuo teiginiu, sudaryta vadovėlio "Chirurgija" antrojo leidimo antrasis tomas, jame pateikiama medžiaga, skirta specialiajai chirurgijai. Knygoje aprašomi endokrininių liaukų, krūties chirurgijos principai. Specializuoti skyriai skirti pilvo sienos, stemplės, skrandžio, plonosios žarnos ligoms. Ypatinga vadovėlio dalis skirta storosios žarnos bei kepenų, tulžies sistemos ir kasos chirurginėmis ligomis, plastinės chirurgijos savitumas. Antrojo leidimo naujovė – skyrius, skirtas metabolinei bei nutukimo chirurgijai. "Chirurgijos" antrasis tomas išssiskiria informacijos pateikimo paprastumu. Kiekviename skyriuje struktūrizuotai pateikiami chirurginių ligų etiologijos, patogenezės principai, daug diagnostikos naujovių. Gydymo metodikų skyriai paremti šiuolaikiniais, įrodymais pagrįstos medicinos principais. Tai yra puikus žinių šaltinis medicinos studentams. Knyga – nepakeičiamas žinių šaltinis ir bendrosios chirurgijos gydytojams bei rezidentams, norintiems gilinti bei atnaujinti specializuotos pilvo chirurgijos žinias.

"Chirurgijos" vadovėlio antrasis papildytas leidimas labai laukiamas studentų ir gydytojų praktikų. Tai Lietuvos sveikatos mokslų universiteto Medicinos akademijos Chirurgijos klinikos kolektyvo: pedagogų, mokslininkų ir klinikinį darbą dirbančių gydytojų chirurgų kūrinys. Pirmojo vadovėlio tiražas labai greitai buvo išpirktas ir tai rodo didelę vadovėlio paklausą ir aktualumą. Jį įsigijo ne tik daugelis chirurgijos specialistų, bet ir gastroenterologai, šeimos gydytojai, kitų specialybių gydytojai. Šiuolaikinis medicinos mokslas, sparčiai tobulėjančios chirurgijos technologijos, naujovės, keičia ne tik chirurgijos diagnostikos algoritmus, gydymo taktikas, bet neretai paneigia ilgus metus buvusias ir atrodo neginčytinas aksiomas. Leidinio autoriai, kurie dalyvauja pasaulinės chirurgijos pažangos procese, ir pateikia naują požiūrį ir akivaizdžiais mokslo įrodymais pagrįstus teiginius. Laikantis holistinio požiūrio, vadovėlyje aptariama ne tik grynoji chirurgija, bet įtraukti viso organizmo funkcijų sutrikimų ir jų korekcijos klausimai. Manome, kad bendrojoje vadovėlio dalyje tikslinga plačiau aptarti bendruosius organizmo sutrikimus, sukeliamus įvairių patologinių būklių. Todėl papildytame vadovėlyje yra homeostazės sutrikimų ir jos korekcijos, šoko, kraujo krešėjimo sutrikimų skyrius, kuriuose be bendrųjų dalykų aiškinami chirurginėms ligoms būdingų organizmo funkcijų sutrikimai ir jų terapinė korekcija. Pažymėtina, kad labai svarbus chirurginio gydymo aspektas – kraujo krešėjimo sutrikimai ir jų korekcija, beje, labai retai aptariamas chirurgijos vadovėliuose. Manome, kad skaitytojų patogumui, racionalu vadovėlį padalyti į dvi dalis, t.y., du tomus. Pirmajame vadovėlio tome aptariami bendrieji organizmo pokyčiai, o antrajame – specialieji chirurgijos klausimai. Vadovėlio pirmame tome pateikiami dažniausi ūminio pilvo sidromai: peritonitas, žarnyno nepraeinamum

Replantation is the reattachment of a part that has been completely amputated. In developing a treatment plan for multiplex injuries of the hand, the surgeon must keep in mind the seven basic functions of the hand: precision pinch, opposition pinch, key pinch, chuck grip, hook grip, span grasp, and power grasp. Depending on the severity of injury, some of these functions may not be restored. The Aim is to evaluate hand function after fingers amputation. Materials and methods: 21 years old men injured his right hand with comber of wool. The hand was multiplex injured: it were amputations of I-V fingers, dorsal hand site skin defect, soft tissue defects, extensor tendons of fingers defects, metacarpal bones fractures and defects. The first and fifth fingers were replantated. The rotating flap and skin graft were placed into the defect of dorsal site of hand. Results: Fingers were examined after 9 months after replantation. It was observed that the patient did not have difficulty in performing daily activities such as buttoning, use of forks, spoons and handwriting, and had a considerably improved pinching crucial for functional independence losses of active range of motion of the metacarpophalangeal and interphalangeal joints were within the rage of 10 to 30 degrees in both hands. In the assessment of sensation, static and dynamic two-point discrimination test results were 6.3 mm of thumb and 4.1 mm of fifth finger respectively. Conclusions: With loss of the three central digits, the small finger effectively assumes 50% of hand function.

Replantacija - amputuotos kūno dalies prisiuvimas atkuriant jos gyvybingumą. Darbo tikslas. Įvertinti plaštakos funkciją po rauminės pirštų amputacijos. Medžiaga ir metodai. 21 m. vyras darbo metu su vilnos karšimo aparatu susižalojo dešinę plaštaką. Plaštaka daugybiškai sužalota: I-V pirštų amputacijos, nugarinės plaštakos dalies odos ir poodžio defektas, pirštų tiesiamųjų sausgyslių defektai, delnakaulių lūžimai ir defektai. Nykštys ir V pirštas buvo replantuoti, II-IV delnakauliai sutrumpinti, odos ir minkštųjų audinių defektai padengta pasukamaisiais odos-poodžio lopais bei odos autotransplantatais. Rezultatai. Plaštakos funkcionalumas vertintas po 9 mėn. nuo replantacijos. Pacientas rekonstruotą plaštaką aktyviai taiko kasdieninėje veikloje: gali suimti ir su jėga išlaikyti šaukštą, šakutę, peilį; pacientas gali suimti pieštuką ir rašyti; pilna pirštų suėmimo funkcija. Replentuotuose pirštuose pilno judesio trūkumas svyruoja tarp 10-30 laipsnių. Vertinant plaštakos jėgą dinamometru, plaštakos (pirštų) jėga 9 kg. Jutimai pirštuose pilnai atsistatę. Išvados. Netekus II-III-IV pirštų, V pirštas sudaro 50 proc. plaštakos darbingumo.