Suslavičius, Kristupas Augustas

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.

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.

Introduction Upper blepharoplasty (BP), performed for both aesthetic and functional purposes, is among the most common facial surgical procedures. Studies indicate that up to 38% of patients experience significant preoperativeanxiety before eyelid surgery, which can negativelyaffect both medicaland psychological outcomes. Noninvasive sedation with oral benzodiazepines is a well-established method for perioperative anxiolysis and can improve the patient experience. However,there is a lack of studies evaluating the benefits of premedication in comparison to control groups in facial aesthetic procedures such as blepharoplasty. Aim of the study To assess the effect of preoperative oral bromazepam on pain and anxiety levels in female patients undergoing BP. Materials and methods This retrospective study included 113 female patients who underwentBP at the Republic Vilnius UniversityHospital in 2023. Patients were divided into two groups: the controlgroup (CG) (n=51), which received no premedication, and Group 1 (G1) (n=62), which was administered preoperative oral bromazepam(BZ). Pain and anxiety levels were assessed using the Visual Analog Scale (VAS). Data normalitywas tested using the Shapiro-Wilkand Kolmogorov-Smirnovtests. Statistical analysis was performed using the Mann-Whitney U and unpaired t-tests, with a significance level 0.05. Results No statistically significant differences were observed in demographic parameters between the groups. Patients in CG reported significantly higher levels of pain during anesthetic injections (Mdn=5) compared to those in G1 (Mdn=2) (p<0.0001). Individuals in CG experienced more pain during the operation (Mdn=2) than those in G1 (Mdn=1) (p=0.0123). Postoperatively, a higher proportion of patients reported pain in CG than in G1 (p=0.0327).Individuals in CG also reported significantly higherlevels of preoperative anxiety (Mdn = 5) compared to those in G1 (Mdn=3). A greater percentageof patients in CG felt anxiety during the operation (Mdn=3) comparedto G1 (Mdn = 1). Postoperatively, significantlymore patients in CG experienced anxiety (Mdn=1) than in G1 (Mdn=0). Patients in CG (Mdn=2) reported experiencing pain for more days postoperatively than those in G1 (Mdn=1)(p=0.0025). Conclusions PreoperativeBZ significantlyreducespain and anxiety before, during, and after blepharoplasty. Additionally, it shortens postoperative pain duration by several days. These findings suggest that BZ is an effectivepremedicationstrategy for BP and should be incorporated into daily practice.

Introduction Aesthetic surgery, including abdominoplasty(AP), is increasingly sought after for enhancing physical appearance and restoring body confidence post-pregnancy or significant weight loss. AP focuses on improving the abdominal area by removing excess skin and fat and tightening the abdominal muscles. The Mommy Makeover(MM), combining AP with breast reshaping and liposuction, addresses broader body reshaping needs. Given the popularity of both procedures,this study explores the efficacy and safety of AP both as a standalone procedure and as part of the MM. Aim of the study To evaluate and compare the aesthetic outcomes, patient satisfaction, and safety of AP as an individual procedure versus as a component of the MM. Materials and methods We conducted a retrospective analysis of 92 female patients who underwent AP alone or as part of MM in 2022. Patients were divided into two groups: Group A (GA) (n=39) received only AP, and Group B (GB) (n=53) underwent MM. Both groups had diastasis recti abdominis correction. Pre- and post-operative satisfaction was measured using the 'BODY-Q' questionnaire, which included “Satisfaction with Abdomen Surgery” before (SABS) and after (SAAS), and “Appraisal of Body Contouring Scars” for AP (AAP). Statistical analysis used Mann-Whitney U and unpaired t-tests with a significance level set at 0.05. Results No significant differences were observed between the groups for both age and BMI (p<0,05). When comparing SABS, there was no significant difference in both G1 (Mdn=0) and G2 (Mdn=0).Regarding SAAS, a statistically significant difference was observed, with more patients in G1 (Mdn=93) being satisfied with their abdomen than in G2 (Mdn=74)(U=736, p=0.0478). Appraisal AAP revealed significantly more visible scars in G2 (Mdn=59) compared to G1 (Mdn=100) (U=678.5, p<0.0001). Additionally, more patients experienced complications in G2 (55.56%) compared to G1 (33.33%) (χ²=4.499,p=0.0339). The duration required to return to maximum physical exertion did not differ significantly between groups, with the majority in G1 (47.37%) requiring 3-4 months and in G2 (41.38%) 4-6 months, showing no statistical difference between groups. Conclusions AP alone yielded higher patient satisfaction and lesser visible scarring compared to when performed as part of a MM. Despite similar recovery times, the MM procedure was associated with a higher rate of complications, suggesting that AP alone might be the safer and more aesthetically pleasing option for patients primarily concerned with abdominal aesthetics.

Background Keratoacanthoma (KA) is a well-differentiated benign tumor of the skin, occurring globally at a rate of 100 to 150 cases per 100,000 individuals annually. Characterized by rapid growth and potential for spontaneous regression, KA can escalate to serious complications such as cutaneous horn (CH) and squamous cell carcinoma (SCC). Increased risk is associated with factors such as ultraviolet (UV) radiation exposure, fair skin phenotype, and advanced age. This case highlights one of the largest CHs ever reported, emerging from a KA, underscoring the complex challenges posed by such large-scale dermatological conditions in geriatric care. Case Report A 91-year-old female from a nursing home presented to the Department of Plastic and Reconstructive Surgery at Republican Vilnius University Hospital with a recurrent CH on her right hand. Initially noted three years prior, this CH was removed multiple times but consistently recurred, each instance showing progressive enlargement. The most recent presentation involved a CH that measured an extraordinary 10 cm in length, making it one of the largest recorded in medical literature, complicated further by the development of SCC. Surgical management included excision under regional anesthesia followed by full-thickness skin grafting. Postoperative treatment comprised anticoagulants and analgesics, with histopathological examination revealing significant hyperkeratosis and invasive squamous cell carcinoma. Conclusions This case of an exceptionally large CH originating from KA exemplifies the critical need for vigilant monitoring and proactive management in elderly patients. It highlights the necessity for aggressive treatment strategies and thorough follow-up to prevent recurrence and manage complications effectively. The presence of such an unusually large CH from KA provides a unique insight into the potential severity of skin lesions that can arise in high-risk patients, advocating for enhanced multidisciplinary approaches to care and further research into the factors contributing to such extreme manifestations.

Aim: To illustrate a holistic approach in the initial and reconstructive surgical treatment of individuals with periorbital necrotizing fasciitis, using a clinical case as an example to showcase the multidisciplinary strategy. Method: We present the case of a 61-year-old woman with no predisposing comorbidities, who presented with unilateral periorbital necrotizing fasciitis (PNF) caused by Streptococcus pyogenes. The patient underwent intravenous antibiotic therapy along with multiple debridement and reconstructive surgeries, complemented by hyperbaric oxygen therapy. Each of these modalities contributed to a favorable outcome for the patient. Results/Discussion: PNF is a very rare condition with often devastating consequences such as blindness or death. The pivotal factors for successful management of necrotizing fasciitis involve extensive debridement and timely administration of IV antibiotics. Debridement in PNF is challenging due to critical anatomical structures also requiring consideration for subsequent reconstructive surgery methods. Adjunctive therapies, such as hyperbaric oxygen therapy, provide supplementary benefits in the treatment of PNF. Incorporating these considerations into our treatment regimen, our patient provides an example of a favorable functional and aesthetic outcome. Conclusion: We believe that our case study may assist health care professionals in refining treatment strategies for this rare and debilitating condition.

Introduction: Upper eyelid blepharoplasty is the second most popular cosmetic surgical procedure among women and men. Eyelid surgeries are routinely performed under local anesthesia to save operation time, prevent systemic risks associated with general anesthesia and provide faster recovery. To improve patient experience in blepharoplasty various combinations of premedication can be used. Premedication for blepharoplasty consists of medications such as sedatives, anxiolytics, and analgesics that are administered prior to the surgery to help relax the patient, reduce anxiety, and manage any potential discomfort during the procedure. The aim is to evaluate the influence of diverse premedication protocols on both intraoperative and postoperative pain and anxiety levels in blepharoplasty. Methods: The retrospective study included 98 female patients who underwent blepharoplasty across three different clinical settings in 2023: the Hospital of Lithuanian University of Health Sciences, the Republican Vilnius University Hospital, and a private clinic. The study groups comprised the control group (CG), receiving no premedication, Group A, administered preoperative oral benzodiazepines, and Group B, given a combination of preoperative oral benzodiazepines, EMLA eyelid ointment, and oral Ultracod tablets. Data normality was assessed using the Shapiro-Wilk test, and descriptive statistics included means (±) and median values (minmax). Statistical analyses utilized the Mann–Whitney, Kruskal– Wallis, and ANOVA tests, with a significance level of 0.05 for hypothesis testing. Results: No statistically significant differences were observed in demographic parameters between the three groups. The median age was 53 (37–70), and the mean BMI was 27.36 ± 4.678. An ANOVA test indicated a statistically significant effect of pain during anesthetic injections among the different groups (F(2,95) = 9.066, p = 0.0107). Post hoc analysis using Dunn’s test showed that there was statistically higher pain during anesthetic injections in CG than in Group A and Group B. A significant difference in pain throughout the entire operation was observed among the groups (H(2) = 11.10, p = 0.0039). Dunn’s test indicated that the CG exhibited statistically higher pain during the operation compared to Group B, while no significant difference was found between the CG and Group A. A statistically significant difference was found in preoperative anxiety levels among the groups (F(2, 95) = 3.881, p = 0.024). The Tukey test revealed a statistically higher level of anxiety in the CG (M = 4.12 ± 2.948) compared to Group A (M = 2.47 ± 1.988), with no significant difference between the CG and Group B. No statistically significant differences were observed between the compared groups in terms of postoperative pain (p = 0.6837) and anxiety during the operation (p = 0.0922). Conclusions: All premedication protocols mitigate the perception of injection-related discomfort. Preoperative administration of Benzodiazepines, EMLA eyelid ointment, and oral Ultracod tablets is the most efficacious in alleviating pain throughout the entire surgical procedure, albeit postoperative anxiety is reported to be more pronounced. On the other hand, the administration of benzodiazepines as a stand-alone premedication strategy proves most effective in reducing both pre- and postoperative anxiety. Conversely, premedication demonstrates no significant influence on postoperative pain.

Objectives. The realm of aesthetic surgery continually evolves, offering patients diverse options to enhance their appearance and well-being. Within this spectrum, the choice between standalone breast reduction (BR) and its integration into Mommy Makeover (MM) procedures becomes a pivotal decision for both surgeons and patients. The question remains whether performing one operation at a time changes patients’ aesthetic satisfaction, scar healing and complication rates after surgery. Materials and methods. A retrospective study involved 108 female patients who underwent BR or MM at a private clinic in 2022. Group 1 (G1) (n=49) comprised patients who received only BR, while Group 2 (G2) (n=59) consisted of patients who underwent MM. Patients were administered the “BREAST-Q” questionnaire including “Satisfaction with breasts” before (SBBS) and after (SBAS) the surgery and the “Appraisal of Body Contouring Scars” for BR (ABR). Descriptive statistics included means (±) and median (Mdn) values. Statistical analyses employed the Mann-Whitney U and unpaired t-test. Results. No significant differences were observed in demographic parameters between groups, with a mean age of 41.41 ± 9.391 and BMI 26.57 ± 3.506. When compared SBBS, with no significant difference between G1 (Mdn=0) and G2 (Mdn=0) there was huge dissatisfaction with breasts before the operation. When compared SBAS, significantly patients were more satisfied with breasts in G1 (Mdn=100) than in G2 (Mdn=82) (U=892, p=0.029). When compared ABR, significantly more scars were visible in the breast area in G1 (Mdn=78) than in G2 (Mdn=100) (U=1049, p=0.0296). Significantly more patients experienced complications in G2 (55.93%) compared to G1 (34.69%) (χ ²=4.856, p=0.0275). Conclusions. Patients undergoing only BR reported higher satisfaction, fewer complications, and more visible scars compared to MM. Despite increased scar visibility, BR alone appears safer with better outcomes. Hence, unless specific indications dictate otherwise, a single surgery is more advisable.

Objectives. Invasive facial procedures can cause anxiety, discomfort and pain that nondrug methods and local anaesthetics might not fully relieve. To maintain periprocedural comfort and while avoiding systemic anaesthesia risks, noninvasive conscious sedation, using benzodiazepines like midazolam or bromazepam, can be used. The purpose of the research was to determine which premedication is most effective in blepharoplasty. Materials and methods. A retrospective study involved 85 female patients who underwent blepharoplasty at the Hospital of Lithuanian University of Health Sciences in 2023. The study participants did not exhibit any co-morbidities or harmful habits. The study groups comprised Group 1 (n=45), who received oral midazolam, and Group 2 (n=40), who administered oral bromazepam. Descriptive statistics included means (±) and median (Mdn) values (min-max). Statistical analyses employed the Mann-Whitney U and unpaired t-test. Results. No statistically significant differences were observed in demographic parameters between groups, with a mean age of 57.61 ± 8.154 and BMI of 26.58 ± 4.362. Patients in Group 1 reported significantly higher levels of preoperative anxiety (Mdn=4) compared to Group 2 (Mdn=2) (U=531, p=0.0069). However, there was no statistically significant difference between Group 1 (Mdn=2, (0–6)) and Group 2 (Mdn = 1, (0–4)) regarding anxiety during surgery (p=0.9785). Concerning postoperative anxiety, significantly more patients experienced it in Group 1 (Mdn=2, (0–6)) than in Group 2 (Mdn=0, (0–3)) (U=380, p<0.0001). The majority of participants in both Group 1 (63.64%) and Group 2 (58.33%) reported that “the surgical procedure exceeded their expectations” (p=0.6281). Conclusions. In comparison to midazolam, bromazepam demonstrates a superior reduction in both preoperative and postoperative anxiety. While there were no significant differences in anxiety during surgery, the overall findings suggest that bromazepam may be considered a more effective premedication option in blepharoplasty.

Introduction. Lipomas are non-malignant neoplasms that arise from the mesodermal germ cell layer, which most commonly occur in specific anatomical regions, including the thigh, shoulder, and trunk. Although lipomas affect ~1 % of the population, intermuscular lipomas IL are rare, representing only 0.3% of all lipomas. Case description. A 75-year-old woman with a 3-month history of discomfort due to a lump in the left breast was admitted to the hospital. Palpation of the left breast evoked tenderness. The patient had no history of trauma and no family history of breast cancer. Mammography revealed a heterogeneous tissue composition. A partially encompassing fatty density structure of ~13 cm on the left was noted along the chest wall. Ultrasonography (US) revealed a substantial structure. Adjacent to and slightly above the nipple, mixed echogenicity was observed. MRI revealed a mass between the major and minor pectoral muscles in the left breast. Using BI-RADS, the left breast was 4a, indicating a probability of malignancy. The patient underwent surgical excision. Intraoperatively, an elevated major pectoral muscle was observed, with a soft mass. A 22 × 11cm lipoma was carefully excised by dissection following the trajectory of the major pectoral muscle toward the sternum, with a sharp separation of the medial edge. Histological analysis confirmed the diagnosis of an IL. Summary. A 75-year-old woman with breast discomfort was admitted. Mammography showed a fatty density structure, and US revealed a large lipoma-like mass. MRI indicated a mass between pectoral muscles, categorized as BI-RADS 4a (probable malignancy). Surgical excision and histological analysis confirmed a 22 × 11cm lipoma. Conclusions. Giant ILs between the major and minor pectoral muscles are rare but cause discomfort, pain, and sensory disturbances. US, MRI are valuable practical tools for diagnostic confirmation and surgical excision is the preferred treatment approach.