Polish Journal of Surgery最新文献

The COVID-19 pandemic has impacted many medical specialties throughout the world, including hand surgery. Emergency hand surgery deals with a wide spectrum of injuries, including bone fractures, nerve, tendon and vessel cuts, complex injuries and amputations. These traumas occur independently to the phase of the pandemic. The objective of this study was presentation of changes in organization of activity of hand surgery department during the COVID-19 pandemic. Modifications of the activity were described in details. Over a period of the pandemic (from April 2020 to March 2022), a total of 4150 patients were treated, in this number 2327 (56%) with acute injuries and 1823 (44%) with common hand diseases. Forty-one (1%) patients were diagnosed COVID-19 positive, 19 (46%) with hand injuries and 32 (54%) with hand disorders. One case of work-related COVID-19 infection was registered in the 6-people clinic team in analysed period. Results of this study show effectiveness of measures undertaken in the authors institution to prevent the coronavirus infection and viral transmission in hand surgery staff.

BACKGROUNDThe free anterolateral thigh (ALTP) and free medial sural artery perforator (MSAP) flaps are time tested donor for head and neck, and extremities defect reconstruction. Proponents of either flap have concluded each as workhorse flap in their large cohort studies. However, we could not find any literature comparing the donor morbidities, or recipient site outcomes of these flaps, objectively.METHODSRetrospective data, such as demographic details, flap characteristics and post operative course, from patients who underwent free thinned ALTP (25 patients) and MSAP flap (20 patients) were included. At follow-up, donor site morbidity and recipient site outcomes were assessed, using previously defined protocols. These were compared in-between the two groups. RESULTSFree thinned ALTP (tALTP) flap had significantly more pedicle length and vessel diameter and harvest time than free MSAP flap (p value<.00). The differences in incidence of hyperpigmentation, itching, hypertrophic scar, numbness, sensory impairment and cold intolerance at the donor site in-between the two groups, were not significant statistically. Scar at free MSAP donor site was considered a significant social stigma (p value=.005). Recipient site cosmetic outcome was comparable (p value=.86), measured using aesthetic numeric analogue.CONCLUSIONSThe free tALTP flap is superior to free MSAP flap in terms of pedicle length, vessel diameter, donor site morbidity, while the latter takes lesser time for harvest.

IntroductionCarotid arthrosclerosis can be a cause of visual impairment. It has been observed that carotid endarterectomy has a positive effect on ophthalmic parameters. The aim of this study was to evaluate the impact of endarterectomy on the optic nerve function.Materials and methods54 asymptomatic patients (19 women and 35 men - 108 eyes) with unilateral carotid stenosis >70% of internal carotid artery, were recruited to the study. All of them were qualified for the endarterectomy procedure. The whole study group underwent Doppler ultrasonography of internal carotid arteries and ophthalmic examination before the surgery, with 22 of them (11 women and 11 men) were examined after the endarterectomy. The ophthalmic examination included; distant best-corrected visual acuity, measurement of the intraocular pressure, electrophysiology (pattern visual evoked potentials), perimetry, and optical coherent tomography (the retinal nerve fiber layer thickness).DiscussionCarotid arteries supply brain and face with blood. Extensive research has observed a concomitant improvement in eyesight after enduring carotid endarterectomy in patients with artery stenosis. This effect was associated with a better blood flow in the ophthalmic artery and its branches, the central retinal artery and the ciliary artery; the major blood supply of the eye.ResultsThe present study proved that carotid endarterectomy has a positive impact on the function of the optic nerve. The visual field parameters and amplitude of pattern visual evoked potentials significantly improved. Preoperative and postoperative values of intraocular pressure and the retinal nerve fiber layer thickness remained stable.

A left-sided gallbladder (LSG) represents a rare anatomical variation defined by the location of the gallbladder to the left side of the liver falciform and round ligaments, which is often not discovered until surgery. The reported prevalence of this ectopia ranges from 0.2% to 1.1%, however, those values may be underestimated. It is mostly an asymptomatic condition, thus not causing the patient any harm, and being few reported cases in the current literature. Based on clinical presentation and standard diagnostic procedures, LSG can remain undetected and represent accidental intraoperative finding. The attempts to explain the cause of this anomaly have been different, but the numerous variations described do not allow a clear definition of its origin. Although this debate is still open, it is of considerable importance to know that LSG is frequently associated with alterations of both the portal branches and the intrahepatic biliary tree. The association of these anomalies, therefore, represents an important risk of complications in cases when surgical treatment is necessary. In this context, our literature review aimed to summarize possible anatomical anomalies coexisting with LSG and discuss the clinical significance of the LSG, when the patient requires cholecystectomy or hepatectomy.

IntroductionAnastomotic leak (AL) is a serious complication following colorectal surgery. This study aimed to identify factors associated with the development of AL and analyze its impact on survival.Materials and MethodsAll consecutive adult colorectal cancer resections with curative intent and anastomosis formation were included from a prospectively maintained bi-national database between 2007 and 2020. The primary outcome measure was the rate of AL. The secondary outcome measure was 5-year overall survival (OS).ResultsThere were 7566 eligible patients. The rate of AL was 2.3% and 4.4% in patients with colon and rectal cancer respectively. AL was a significant independent predictor of reduced 5-year OS in patients who underwent curative surgery for rectal cancer (Odds ratio 1.999, p = 0.017). Emergency surgery (p = 0.013), surgery at a public hospital (p < 0.01), and an open surgical approach (p = 0.002) were all significantly associated with a higher risk of AL in patients with colon cancer, with higher rates of AL noted in left colectomies as compared to right hemicolectomies (6.8% vs 1.6%, p < 0.05). In rectal cancer patients, ultra-low anterior resections had the highest risk of AL (4.6%), and associations were found with neoadjuvant chemotherapy (p = 0.011), surgery in a public hospital (p = 0.019), and an open approach (p = 0.035). Anastomosis formation technique (hand-sewn vs stapled) did not impact on rate of AL.DiscussionClinicians should be cognizant of the predictive factors for AL and consider early intervention for patients at risk of this.

Objective: The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects.

Methodology: This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (< 3 cm), medium (4-8cm) and large defects (> 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction.

Results: After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects.

Conclusion: Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.

Background: Silver nanoparticles (AgNP) are a novel therapeutic approach to wound dressings because of their antibacterial properties. Silver has been used throughout history for many purposes. However, evidence-based information about the benefits of AgNP-based wound dressings and potential adverse effects is still required. This study is to comprehensively review the benefits and complications of AgNP-based wound dressings for different wound types and address the knowledge gaps.

Material and methods: We collected and reviewed the relevant literature from available sources.

Results: AgNP-based dressings have antimicrobial activity and promote healing with only minor complications, making them suitable for several types of wounds. However, we could not identify any reports on AgNP-based wound dressings for common acute traumatic wounds, such as lacerations and abrasions; this includes comparative studies of AgNP-based and conventional wound dressings for such wound types.

Conclusions: AgNP-based dressings benefit traumatic, cavity, dental, and burn wounds with only minor complications. However, further studies are needed to discern their benefits for specific traumatic wound types.

Currently used techniques of flexor tendon repair and methods of postoperative rehabilitation differ significantly from those used still 10-15 years ago. Techniques of the repair evolved from 2-strand sutures (the Kessler suture) in the direction of much stronger 4-strand and 6-strand sutures (the Adelaide and Savage sutures), what reduced the risk of failure of the repair and made possible more intensive rehabilitation. Also rehabilitation regimes changed on more comfortable for patients than older protocols and allowed to achieve better functional outcomes of the treatment. This study presents updated trends in management of flexor tendon injuries in the digits, with regard to operative technique and postoperative rehabilitation protocols.

We aim to systematically review the psychological and social outcomes of patients post-bariatric surgery. The comprehensive search using keywords yielded 1224 records utilizing search engines PubMed and Scopus. After a careful analysis, 90 articles were found to be eligible for complete screening that collectively reported the use of 11 different BS procedures reported among 22 countries. This review is unique in that we collectively presented the result of various psychological and social outcome parameters (depression and anxiety, self-confidence, self-esteem, marital relationship, and personality traits) after BS. Regardless of the BS procedures performed, most studies over months to years presented a positive outcome of the parameters considered, while few presented contrasting unsatisfactory results. Thus, the surgery was not a cessation factor for these results to be permanent and thus suggested psychological interventions and long-term monitoring for assessing the psychological effects after BS. Additionally, the patient's endurance to check weight and eating habits after surgery is ultimately necessary.

Introduction: Liver biopsy is a safe and helpful diagnostic tool for many liver disorders. It can be performed using various techniques. Regardless of the technique, the liver biopsy is considered to be a safe procedure.

Aim of the study: We aimed to analyze the indications, techniques, results, and complications of liver biopsies in the paediatric age group.

Material and methods: We retrospectively obtained the data from the medical history records of 63 paediatric patients who underwent the liver biopsy. The data were analyzed statistically.

Results: The most often performed type of biopsy was core needle biopsy (tru-cut), followed by core needle aspiration biopsy, fine-needle aspiration biopsy, open biopsy, and laparoscopic biopsy. Complications in the form of hematoma occurred only in 2 cases. The most common indications for the procedure were viral hepatitis monitoring/diagnosis, focal lesions, and autoimmune hepatitis. The histopathological results were predominantly hepatitis (viral and non-viral) and neoplasm.

Conclusions: Liver biopsy is a safe procedure regardless of the technique used to obtain a tissue sample. Therefore, it should not be avoided when it is indicated.