Aštrauskas, Tautvydas

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.

Universitetinės plastinės ir rekonstrukcinės chirurgijos tradicijos Kaune – seniausios Lietuvoje. Čia buvo įkurtas pirmasis rekonstrukcinės chirurgijos skyrius, skirtas vienai sunkiausių traumų – nudegimams – gydyti. Prasidėjusi nudegimų rekonstrukcinės chirurgijos skyriaus įsteigimui Kauno klinikose 1972 metų gruodžio 7 dieną, istorija sėkmingai tęsėsi vykdant gydomąją praktinę veiklą ligoninėje bei mokslinę ir pedagoginę veiklą Kauno medicinos institute, vėliau – Kauno medicinos akademijoje, Kauno medicinos universitete, o nuo 2011 metų – Lietuvos sveikatos mokslų universitete (LSMU). Šiandieną LSMU ir LSMU ligoninės Kauno klinikų Plastinės ir rekonstrukcinės chirurgijos klinika – pripažinta lyderė ne tik Lietuvoje, bet ir Baltijos regione. Čia kasmet gydoma per du tūkstančius pacientų, atliekama 2,5 tūkstančio operacijų. Klinikoje iki šiol sėkmingai veikia nedegimų centras, kuriame gydomi sunkiausi nudegę pacientai iš visos Lietuvos, ir unikalus žaizdų chirurgijos sektorius, kuriame atliekamos sudėtingos operacijos pragulų ir negyjančių trofinių opų turintiems pacientams. Taip pat klinikoje visą parą teikiama pagalba galūnių amputacijas patyrusiems pacientams, atliekamos mikrochirurginės operacijos plaštakos ir kitų sužalojimų atvejais, šalinami odos ir minkštųjų audinių onkologiniai augliai, platikos būdu rekonstruojami susidarę audinių defektai. [...].

Aim: To introduce and evaluate a new technique in pedicle TRAM flap reconstruction using a Laser Doppler (LD) to achieve the maximal volume preservation of tissues. Tasks of the study were to reasure that: 1. the offered technique does not increase the risk of comlications in postoperative period; 2. LD could provide a bigger volume of tissues in comparison with a common operation techniques; 3. a new technique is easily applied. Materials and Methods: During the year 2009-2010 there were 15 pedicle TRAM flap breast reconstructions performed in our clinic. All patients had a risk for complications of the first or the second defree according to Hartrampf's classification. 8 patients had undergone breast reconstruction based on the common technique (control group) and the rest 7 had undergone breast reconstruction using the LD (LD group). [...].

Prominent ears are the most common congenital deformity. Numerous techniques for the correction of this deformity have been described in the literature, but there is no single technique widely accepted by most surgeons. Usually, more attention is focused on sculpturing or suturing techniques but not on suture material. The aim of this study is to evaluate clinical outcomes after otoplasty for surgical correction of prominent ears with different suture materials for the formation of new antihelical fold. During a 3-year period (2006-2008), 133 patients underwent operative correction of protruding ears in a private plastic surgery center. A total of 100 patients came for the follow-up visits, and the data of these patients were included in further analysis. The surgical technique consisted of scoring of the antihelical cartilage, suturing to recreate the fold of the antihelix (in the manner of Nachlas), and conchal setback procedure according to Furnas technique. According to suture material used for formation of new antihelix fold, the patients were divided into three groups: 4/0 Monocryl group (35 patients, 70 ears; Group 1), 4/0 PDS group (27 patients, 54 ears; Group 2), and 4/0 Mersilene group (38 patients, 7 ears; Group 3). Distances from the temporomastoid surface of the skull to the helix border in the upper, middle, and lower parts of the ear were measured before surgery and 6 months following surgery, and these measures were compared among groups. In addition, early and late complications were analyzed. There were 48 men and 52 women, and the median age was 20 years. The groups were matched for age, sex, and protrusion degree. No statistically significant differences were found comparing the groups of different suture material by skull-helical rim distance before operation. [...].

Ginekomastija (gr. gynec- moteriškos, mastos- krūtys)- tai vyrų krūtų padidėjimas, proliferavus liaukiniam krūties audiniui. Dažniausiai ši būklė esti nepiktybinė, išnyksta savaime. Vis dėlto kartais ginekomastija yra sunkios sisteminės ar endokrininės ligos, retai- net piktybinio proceso požymis.

Objective. In early nineties in endoscopic aesthetic face rejuvenation procedures horizontal vector was fundamental and it used to cause so called mask effect. Nowadays priority is given for vertical vector as the face becomes more projecting (atsikišęs) and its upper part gains more volume. Our aim was review endoscopic technique possibilities in face rejuvenation operations. Material and methods. In Kaunas Plastic surgery center 310 aesthetics frontal endoscopies were performed since 1997 till 2008 : 55 front lifts, 102 front lifts with upper blepharoplasties, 153 front lifts with face lift procedures at the same time. 286 female patients and 24 male patients were operated. [...].

Objective. Every breast augmentation method has its own indications but usually surgeons choose that one which is the most predictable, atraumatic and gives the best results (natural appearance and fast recovery). Our aim was to find the advantages and disadvantages of breast augmentation using transaxillary incision and to compare it with periareolar and inframammary techniques. Materials and methods. 199 patients underwent breast augmentation during the year 2006-2008 in Kaunas Plastic surgery center. The patients were divided into 3 groups: I - transaxillary incision (114 patients): 87 submuscular placement and 27 subfascial placement of an implant; II - periareolar incision (62): 37 submuscular and 26 subfascial placement of an implant; III - inframammary incision (23): 20 submuscular and 3 subfascial placement of an implant. The duration of the operation, hospital stays, extent of postoperative bleeding and postoperative complications of each method were evaluated and compared. [...].

Objective. The purpose of this study was to compare 3 different techniques of autologous breast reconstruction in their indications to calculate their complication rates and to design a simple algorithm for breast reconstruction based on indications. Methods. Women after mastectomy or breast-conservative surgery or those who had congenital breast defects and who underwent breast reconstruction with thoracodorsal (TD) or transverse rectus abdominis myocutaneous TRAM flaps or had autologous fat inhections (AFI) in Kaunas Medical University Clinics and Kaunas Oncology Hospital from the year 2000 to year 2008 were included in the study. The indications or criteria on which the surgeons decided to choose one of the 3 procedures were determined. The postoperative outcomes were evaluated and analysed statistically. [...].

Aim: Due to the improvement inmanagement of the oncology patients not only the lifetime but also the rate of long-term complications after radiotherapy is increasing. One of the most common and troublesome long-term complications of radiotherapy is a radiation ulcer. [...].