Comparative analysis of surgycal procedures for treatment of large acquired scalp defects

Uvod: Poglavinu (eng. scalp) čine meka tkiva koja pokrivaju kalvariju odnosno krov lobanje. Značaj poglavine i kostiju lobanje proističe iz činjenice da formiraju štit oko mozga. Ove strukture su povezane kako fizički, tako i brojnim dinamičkim fiziološkim procesima. Njihova oštećenja stoga mogu dovesti do brojnih i ozbiljnih komplikacija. S obzirom da poglavina posle lica predstavlja jedan od najupadljivijih delova ljudske figure, estetska razmatranja su vrlo značajna pri planiranju rekonstrukcije. Izbor optimalne metode za rekonstrukciju poglavine zasniva se na analizi većeg broja ulaznih varijabli. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata rekonstrukcije skalpa različitim hirurškim tehnikama, kao i: 1. Utvrditi distribuciju stečenih defekata poglavine po starosnim grupama i prema polu ispitanika. 2. Utvrditi distribuciju stečenih defekata poglavine prema veličini, dubini i lokalizaciji i ispitati uticaj ovih parametara na izbor rekonstruktivne procedure. 3. Utvrditi značaj pušenja, zračenja, kvaliteta okolne kože i komorbiditeta za odabir metode rekonstrukcije i utvrditi njihov uticaj na učestalost komplikacija. 4. Utvrditi najčešće komplikacije i njihovu učestalost u zavisnosti od veličine, dubine defekta i primenjene operativne tehnike. 5. Uporediti prednosti i nedostatke primene fasciokutanih režnjeva sa drugim operativnim tehnikama primenjenim za zatvaranje defekata iste veličine i dubine poglavine, sa posebnim osvrtom na regije. 6. Utvrditi i uporediti zadovoljstvo pacijenata postignutim rezultatima zatvaranja defekata u zavisnosti od primenjene metode rekonstrukcije. 7. Na osnovu rezultata istraživanja i dostupne literature napraviti algoritam za izbor optimalne hirurške procedure za zatvaranje stečenih defekta poglavine različite etiologije, veličine i dubine. Materijal i metode: Studijom je obuhvaćeno 135 ispitanika, pacijenata sa stečenim defektima poglavine lečenih na Klinici za opekotine, plastičnu i rekonstruktivnu hirurgiju i Klinici za neurohirurgiju Kliničkog centra Srbije u periodu od 1.1.2001. do 31.12.2011. godine..

Comparative analysis of surgycal procedures for treatment of large acquired scalp defects

Uvod: Poglavinu (eng. scalp) čine meka tkiva koja pokrivaju kalvariju odnosno krov lobanje. Značaj poglavine i kostiju lobanje proističe iz činjenice da formiraju štit oko mozga. Ove strukture su povezane kako fizički, tako i brojnim dinamičkim fiziološkim procesima. Njihova oštećenja stoga mogu dovesti do brojnih i ozbiljnih komplikacija. S obzirom da poglavina posle lica predstavlja jedan od najupadljivijih delova ljudske figure, estetska razmatranja su vrlo značajna pri planiranju rekonstrukcije. Izbor optimalne metode za rekonstrukciju poglavine zasniva se na analizi većeg broja ulaznih varijabli. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata rekonstrukcije skalpa različitim hirurškim tehnikama, kao i: 1. Utvrditi distribuciju stečenih defekata poglavine po starosnim grupama i prema polu ispitanika. 2. Utvrditi distribuciju stečenih defekata poglavine prema veličini, dubini i lokalizaciji i ispitati uticaj ovih parametara na izbor rekonstruktivne procedure. 3. Utvrditi značaj pušenja, zračenja, kvaliteta okolne kože i komorbiditeta za odabir metode rekonstrukcije i utvrditi njihov uticaj na učestalost komplikacija. 4. Utvrditi najčešće komplikacije i njihovu učestalost u zavisnosti od veličine, dubine defekta i primenjene operativne tehnike. 5. Uporediti prednosti i nedostatke primene fasciokutanih režnjeva sa drugim operativnim tehnikama primenjenim za zatvaranje defekata iste veličine i dubine poglavine, sa posebnim osvrtom na regije. 6. Utvrditi i uporediti zadovoljstvo pacijenata postignutim rezultatima zatvaranja defekata u zavisnosti od primenjene metode rekonstrukcije. 7. Na osnovu rezultata istraživanja i dostupne literature napraviti algoritam za izbor optimalne hirurške procedure za zatvaranje stečenih defekta poglavine različite etiologije, veličine i dubine. Materijal i metode: Studijom je obuhvaćeno 135 ispitanika, pacijenata sa stečenim defektima poglavine lečenih na Klinici za opekotine, plastičnu i rekonstruktivnu hirurgiju i Klinici za neurohirurgiju Kliničkog centra Srbije u periodu od 1.1.2001. do 31.12.2011. godine..

Comprehensive Evaluation of Quality of Life following Upper Eyelid Blepharoplasty: A Prospective Analysis

Background and Objectives: Upper eyelid blepharoplasty is a surgical procedure that addresses both aesthetic and functional concerns, offering transformative potential for patients’ overall well-being. This study systematically evaluates the comprehensive impact of upper eyelid blepharoplasty on patients’ quality of life, employing rigorous methodologies and standardized assessment protocols. Materials and Methods: A prospective, randomized controlled trial was conducted, involving 348 patients aged 49 to 87 years. Patients were randomly assigned to receive either continuous or intradermal sutures following upper eyelid surgery. Validated FACE-Q questionnaires were used to assess various outcomes, including early-life impact, expectations, satisfaction with eyes, overall face satisfaction, satisfaction with the outcome, psychological function, social function, and adverse effects. Results: Results indicate significant improvements in multiple domains of patient-reported outcomes following upper eyelid blepharoplasty, including satisfaction with eyes, overall face satisfaction, satisfaction with the outcome, psychological function, and social function. Notably, no significant differences were observed between suturing techniques regarding patient satisfaction and well-being. Adverse effects were minimal and improved over time. Conclusions: The study underscores the transformative nature of upper eyelid blepharoplasty in enhancing patients’ quality of life, addressing both cosmetic and functional concerns. Utilizing standardized assessment tools like the FACE-Q questionnaire facilitates a comprehensive understanding of treatment outcomes and enables patient-centered care. Overall, this research contributes to the growing evidence supporting the positive impact of upper eyelid blepharoplasty on patients’ well-being, emphasizing the importance of continued research and standardized assessment protocols in advancing patient care in cosmetic surgery

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients

Primary Melanoma Histopathologic Predictors of Sentinel Lymph Node Positivity: A Proposed Scoring System for Risk Assessment and Patient Selection in a Clinical Setting

Background and Objectives: The careful selection of adequate SLNB candidates not only aims at reducing the surgical risk while identifying SLN metastasis, but also plays a crucial role in identifying the patients eligible for adjuvant therapy. Objectives: The purpose of our study was to investigate the clinical and histologic aspects of primary melanomas that correlate with the likelihood of a positive SLNB result. Materials and Methods: A total of 101 primary melanoma patients who underwent sentinel lymph node biopsies were included in the study. General patient demographics were obtained as well as localization and melanoma-specific characteristics of primary melanoma from histologic reports in addition to data derived from SLNB melanoma histopathology reports. Results: The patients with positive SLN results had a statistically significant increased Breslow thickness (3.8 mm vs. 1.97 mm, p = 0.002), higher mitotic index rate (5/mm2 vs. 2/mm2, p = 0.009), as well as the presence of ulceration (68.4% vs. 31.6%, p = 0.007). Univariate regression analysis showed the Breslow thickness (p = 0.008), the mitotic index rate (p = 0.054), the presence of ulceration (p = 0.009), as well as the pT3-4 stage (p = 0.009) to be significant predictors of SLN positivity. The optimal cut-off values for Breslow thickness and the number of mitoses scores were determined based on ROC curve analysis. Using the Breslow thickness, mitotic index rate, presence of ulceration, and pT3-4 stage significant coefficients from the univariate regression model, a chance prediction score was developed. Conclusions: The newly developed and proposed scoring system can aid in patient selection for SLN biopsy by facilitating a more efficient risk assessment in the detection of lymph node metastases in melanoma patients