Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity

Hemangiomas belong to one of the most common type of tumors occurring in childhood. They are benign and often do not require any treatment, with the tendency to. frequently disappearing spontaneously at the age of 5-7 years. The tumors usually develop in the head and neck area, whereas vascular malformations (AVMs) are rare congenital anomalies, which may occur anywhere. In upper limb, they may amount to 30-60% of cases. It is common for these changes not to require any surgical treatment. In case they do, the main indications for such treatment of upper limb AVMs may be as follows: signs of compression of the peripheral nerves, limited mobility of the fingers because of the tumor, which entails difficulties in the functioning of the whole arm, pain and aesthetic considerations. Aim of the study was to present the results of surgical treatment of vascular tumors (hemangiomas and AVMs) in the upper limb that was applied in our department, as well as a broader discussion on epidemiology, diagnosis, and treatment of these changes. Material and methods. In 2003-2011 period we treated 11 patients aged 24-39, suffering from vascular tumors (hemangiomas / vascular malformations) in the upper limb; the group included 3 men and 8 women. In this group we diagnosed 2 cases with arm hemangiomas, 2 cases of intramuscular hemangiomas of the forearm, 2 cases of hemangiomas in metacarpal area, 2 cases of AVMs of the finger and metacarpal area, and 4 cases of isolated vascular malformations (mainly arteriovenous malformations) of the fingers. All preparations were examined histologically. Results. No complications or recurrence were found in 7 cases, recurrences of AVMs were observed in 4 patients with finger changes. In one patient with AVMs of the index finger, we observed a treble recurrence, which severely impaired functioning of his hand. We eventually suggested to him the finger amputation, to which the patient agreed Conclusions. Upper extremity is a rare location of hemangiomas and other vascular malformations requiring surgery. hemangiomas are more common in women, and the occurrence of AVMs in both males and females is similar. Surgical treatment of hemangiomas and AVMs of the upper extremities is doubtlessly an arduous task, which calls for great microsurgical skills

Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. The aim of the study was to present the results of treating lower extremity defects with various modifications of the reverse sural flap. Material and methods. Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. Results. All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partialthickness skin graft. Conclusions. The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps

Epidemiological Characteristic of Acute Pancreatitis in Trzebnica District

Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas