Colour Doppler Assessment of the Perforators of Anterolateral Thigh Flap and its Usefulness in Preoperative Planning

The role of the anterolateral thigh flap (ALTF) in reconstructive microsurgery grows systematically from mid-eighties of the twenty century until now. Significant anatomic variability of the perforators supplying the ALTF was described in literature.The aim of the study was ultrasonographic assessment of the ALTF perforators in terms of localization, symmetry, diameter and flow velocity.Material and methods. The study was performed using ultrasound machine with 12 MHz linear transducer. Both thighs of 30 healthy volunteers (15 men and 15 women) aged from 18 to 60 (mean 37.9) were examined. The line from anterior superior iliac spine (ASIS) to lateral border of the patella was traced, and divided into 10 equal segments. Point where perforator pierces the deep fascia was marked and its diameter was measured and recorded. Maximal flow velocity was measured and recorded. Symmetry of perforator location was confirmed as positive if difference in position of two perforators on both thighs was less than 1.5 cm in diameter.Results. Total number of 119 perforators supplying skin of 60 thighs was found (mean 1.98 perforator per thigh). No perforators were found in 4 thighs (6.6%). Perforators were most abundant in segments from 5 to 7 (74.6%). Perforators with largest diameters and maximal flow velocity reaching 30-47 cm/s were localized in segments 5 and 6. Perforators in segments 4 and 5 were more abundant in men (50.9%) than in women (36.7%). Septal perforators make up to 26.9% of the total. Eighty percent of the septal perforators were localized in segments 5 and 6. Perforator distribution was elicited in the middle of the ASIS - patella line. In the range of ±1.5 cm from the midpoint of the line 33.6% of the perforators were found.Conclusions. 1. Most of perforators with large diameter and big flow velocity are located in segments 5 and 6. 2. Perforators are more common in men in segments 4 and 5 than in women. 3. No perforators found in 4 thighs suggests that preoperative perforator mapping should become a preoperative routine, which can spare intraoperative dilemmas

Анджею Пеплонскому в ответ, или о „заказе на Улатовского”

Łukasz Ulatowski ustosunkował się do recenzji Andrzeja Pepłońskiego

BREAST-Q questionnaire: tool for evaluation of quality of life following breast reconstruction with DIEP/SIEA flap

Breast cancer management is important for both oncologists and plastic surgeons. We can observe a considerable progress in knowledge and treatment modalities in this type of cancer. Treatment often requires reconstruction of the removed breast. Modern methods are becoming better and more suited to patient’s needs. At the same time, we observe a steadily increasing interest in quality of life after medical procedures. This tendency is particularly visible in plastic surgery, where simple analysis of complication rate is insufficient. In order to effectively help, a scrupulous evaluation of the outcomes by the patient herself is necessary. The aim of the study is to discuss and present the use of BREAST-Q questionnaire. It allows to assess patient’s satisfaction with the breast treatment as a whole and medical care. In this article, we present BREAST-Q questionnaire scores in 20 patients following secondary breast reconstruction with DIEP flap without rib removal when accessing internal mammary vessels. The assessment of quality of life is necessary for the reconstructive surgeon to evaluate his own work. It enables deeper understanding of needs and better advice for future patients during preoperative consultation. The results can also be useful for payers in order to decide about reimbursement of specific procedures

Neurilemoma of the Median Nerve - Surgical Strategies Based on a Case Report

The study presented a case of a patient with a neurilemoma of the median nerve. It presented as a six centemeters tumor, at the level of the proximal one third of the arm with only mild paraesthesias within frst to third ray of the hand. MRI showed the relationship of the tumor and the median nerve, and allowed for the preliminary diagnose of a benign peripheral neural sheath tumor (neurilemoma or neurofibroma). During the first operation the tumor has not been excised, because nerve reconstruction technique was not available. During the second procedure excision of the tumor has been performed without resection of the median nerve trunk with no postoperative deficiencies. The paper provides a detailed description of a surgical procedure. The presented case, like current publications shows that peripheral neural sheath tumor may be usually excised without resection of the nerve trunk, although the possibility of nerve fascicles injury or the need to excise them in the case of neurofibroma clearly suggest that these type of operations should be carried out in centers with microsurgical facilities

Kwestionariusz BREAST-Q: narzędzie do oceny jakości życia pacjentek po rekonstrukcji piersi płatem DIEP/SIEA

Leczenie raka piersi stanowi ważne zagadnienie dla onkologów i chirurgów plastycznych. Dokonuje się znaczący postęp dotyczący wiedzy i sposobów terapii tego nowotworu. Leczenie niejednokrotnie wymaga rekonstrukcji amputowanej piersi. Współczesne metody są coraz doskonalsze i coraz bardziej dopasowane do potrzeb pacjentki. Jednocześnie obserwowany jest stały wzrost zainteresowania oceną jakości życia po wykonywanych procedurach medycznych. Taki trend obserwowany jest szczególnie w chirurgii plastycznej, gdzie prosta ocena ilości powikłań nie jest wystarczająca. Aby skutecznie pomagać, istnieje potrzeba skrupulatnej oceny leczenia dokonanej przez pacjentki. Celem pracy jest omówienie i przedstawienie zastosowania kwestionariusza BREAST-Q. Pozwala on na ocenę zadowolenia chorej ze zrekonstruowanej piersi, satysfakcji z całego procesu leczenia rekonstrukcyjnego i opieki medycznej. W pracy przedstawiono wyniki badania jakości życia kwestionariuszem BREAST-Q u 20 pacjentek po wtórnej rekonstrukcji piersi płatem DIEP bez usuwania żebra podczas uzyskiwania dostępu do naczyń dawczych. Ocena jakości życia pacjentek służy chirurgowi zajmującemu się rekonstrukcją do analizy swojej pracy. Pozwala na głębsze zrozumienie potrzeb i lepsze doradzanie kolejnym pacjentkom podczas konsultacji przedoperacyjnych. Uzyskane wyniki mogą być też przydatne dla płatnika przy podejmowaniu decyzji odnośnie do poziomu refundacji poszczególnych procedur