Clinical Presentation and Outcomes of Surgery for Upper Extremity Lipomas

Background. Lipomas are benign neoplasms arising from fat tissue, with an incidence in the upper extremity of 1%-3,8%. There is scarce literature on the outcomes of the treatment of lipomas in this region. The objective of this study was to assess clinical manifestations and outcomes of surgery for upper extremity lipomas. Material and methods. The sample comprised 40 patients, including 26 women (65%) and 14 men (35%), at a mean age of 37 years, with lipomas located in the upper limbs. Treatment outcomes were assessed at a mean of 4.2 years after surgery in 27 patients from this group. Results. Most of the tumours (29 cases, 73%) were located in the forearm and arm, with 11 patients (27%) presenting with lipomas of the metacarpus and wrist. In 35 patients (87%), lesions were located superficially, within subcutaneous tissue, whereas in 5 (13%) they were located more deeply, in the metacarpus and in the forearm muscles. The follow-up assessment was conducted as telephone interviews in 27 patients. No recurrence was noted. Seven patients (26%) complained of mild tenderness of the postoperative scar. Conclusions. 1. Lipomas are moderately frequent benign lesions occurring in the upper limb. 2. Surgical treat­ment is effective and the recurrence rate is very low.

A Combination of Nursing Intervention and External Asiaticoside on Postoperative Scar Recovery and Mental State of Patients with Breast Cancer

We have evaluated the effect of a combination of nursing intervention and external asiaticoside on postoperative scar recovery and mental state of patients with breast cancer. To this end, 98 patients with breast cancer whose stitches had been removed 15 days after modified radical mastectomy and completely healed incisions were randomly divided into control and experimental groups. The control patients received the conventional nursing intervention, while those in the experimental group also received external asiaticoside. Compared with the control group, the incidence rate of postoperative complications in the experimental group was significantly lower with respect to their functional recovery status, psychological status, and daily living ability. In conclusion, the use of scar care exercises in combination with topical application of asiaticoside can greatly improve patients’ mobility and reduce the occurrence of complications, thus improving the patients’ ability to take care of themselves and enabling them to better integrate into the society.

A Ruler for Abdominoplasty Preoperative Markings: The Potential of Best Scar Symmetry

Background. Scar appearance is an important outcome in abdominoplasty surgery, and its asymmetry can have a significant impact on patient and surgeon satisfaction. Here, we compared the scar symmetry reached with a ruler specially designed for the preoperative marking in abdominoplasty to the classic preoperative incision marking. Methods. In this randomized, uni-blind study, 42 patients were allocated to 2 different groups. Group 1 patients had their preoperative marking made by a group of surgeons that used the classic technique as described by Baroudi (n = 21), and Group 2 patients received their preoperative marking by another group of surgeons, using a ruler specially designed to fit the abdominal contour (n = 21). Patients were evaluated using a standard questionnaire that collected information about general patient’s characteristics. On the follow-up period, we evaluated the presence of late surgical complications, need for revision surgery, patient’s satisfaction concerning the postoperative scar, and 4 distances were measured in both groups to assess symmetry. Statistical analysis was made. Results. A total of 42 patients underwent abdominoplasty and were evaluated on the follow-up period (mean time: 4 months). The mean difference of corresponding measures on each side (A-B vs. A-B’ and A-C vs. A-C’) was higher in Group 1 comparing to Group 2. The level of correlation between corresponding measurements was higher in Group 2. Better satisfaction regarding the scar symmetry was achieved in Group 2, being this result statistically significant ( P = .004). Conclusions. The use of the specialized ruler may help surgeons achieve a better scar symmetry with higher patient satisfaction.

Influence of polypropylene mesh on local and systemic production of cytokines during thoracoplasty in experiment

Introduction. The question of the body's immune reactivity when using mesh implants for plastic surgery of the chest frame remains not fully understood.Aims. The effect of the polypropylene mesh endoprosthesis "Surgipro" on systemic and local cytokine production after reconstruction of the chest frame was evaluated.Materials and methods. The work was performed on male Wistar rats weighing 250 50 grams (n=21). The main group consisted of rats with musculo-aponeurotic plasty (n=9), the comparison group consisted of animals that underwent chest plasty after removal of the posterior segment of the IV rib measuring 1.0 cm and overlapping over the mesh (n=9). Healthy rats without surgery served as control (n=3). The animals were taken out of the experiment on days 1, 10 and 30 after the operation. Determination of cytokines TNF-, IFN- and IL-10 in the blood serum and biopsy of the postoperative scar was performed by the method of enzyme-linked immunosorbent assay.Results. It was found that in the experiment, the plastic of the chest frame affects the systemic and local production of cytokines TNF-, IFN- and IL-10. A more intense increase in serum and local anti-inflammatory cytokines was recorded with the use of the implant (p˃0.05). At the same time, the production of anti-inflammatory IL-10 was recorded at values below the control (p˃0.05).Conclusions. The conducted experimental study revealed that the use of a mesh endoprosthesis in the restoration of a defect in the thoracic frame causes more pronounced systemic and local production of cytokines TNF-, IFN- and reduces the production of IL-10.

Endoscopic mucosal resection and conventional polypectomy in colon adenomas

Aim: to compare the early and long-term results of endoscopic mucosal resection (EMR) and conventional polypectomy for benign epithelial colon neoplasmsPatients and methods: the retrospective study included 344 patients with histologically verified adenomas of the size of up to 40 mm in the colon, who underwent EMR or conventional polypectomy. Mucosectomy (EMR) was performed in 207 patients, while conventional polypectomy was performed in 137.Results: there were no significant differences in the postoperative morbidity rates between the methods (OR = 1.8; 95% CI = 0.7–4.8, p = 0.3). Fragmentation significantly more often occurred in the group of conventional polypectomy (OR = 3.5; 95% CI = 2.3–5.5, p = 0.001, especially when the size of the neoplasm was over 1 cm (OR = 3.1; 95% CI = 1.1–8.9 = 0.037). Recurrence occurred in 19/173 (10.9%) in 12 (8.3%) patients of the EMR group. In the polypectomy group, recurrence developed in 22 (23.1%) patients, in 24/108 (22.2%) cases at the site of the postoperative scar. It was found that the adenoma recurrence in the area of endoscopic excision occurs significantly more often after conventional polypectomy (OR = 2.3; 95% CI = 1.2–4.4; p = 0.016).Conclusion: EMR and conventional polypectomy both are the safe methods with low morbidity rates. However, the EMR is the preferred method of endoscopic excision for adenomas larger than 1 cm due to the fact that it allows for deeper and more complete resection of the tissue than conventional polypectomy.

Copper-Coated Spacer for Total Femoral Replacement in Recurrent Periprosthetic Joint Infection: A Case Report

Background. There are few cases of entire femur modular replacement with hip and knee joints in patients with periprosthetic joint infection (PJI) in literature. They report encouraging results in patients of elderly and senile age. We present case of a copper-coated femoral spacer implantation to 50-year-old patient with multiple PJI episodes and osteomyelitis of the entire femur.Clinical presentation. A 40-year-old male patient after resection of the proximal part of the right femur for fibrotic osteodysplasia underwent total hip arthroplasty with replacement of 15 cm of the femur. In December 2010 (20 months after implantation), instability of the femoral component developed, revision arthroplasty was performed with stem recementation. After 4 months, sinus tract formed in the area of the postoperative scar. After another 4 months, the head of the prosthesis was dislocated. In September 2011, the endoprosthesis components were removed and a unipolar cement spacer was implanted. The limb immobilized in a hip spica cast. Methicillin-sensitive S. epidermidis (MSSE) was detected in the preoperative joint aspiration puncture and periprosthetic tissues. After 3 months (December 2011), patient underwent revision total hip arthroplasty (25 cm defect was replaced). 5 years of PJI remission followed. In November 2016 after PJI recurrence the endoprosthesis was removed, and an articulating spacer was implanted. P. aeruginosa was detected in periprosthetic tissues. For the past 2.5 years there were periodically sinus tracts formations. In August of 2019 spacer’s migration resulted in an intercondylar fracture of the right femur. In September 2019, spacer was removed, and MSSE was detected in the surrounding tissues. An articulating cement spacer based on an oncological modular total femur coppercoated endoprosthesis was implanted. At each control examination during the year copper concentration in blood serum was determined, it did not exceed 900–1200 mcg/l. No local or systemic side effects were detected. The patient started working 3 months after surgery. After 6 months poor functioning sinus tract formed in the postoperative scar area in the lower third of the thigh. 1.5 years after the operation, the functional condition is satisfactory.Conclusion. The use of the copper-coated spacer based on modular total femur endoprosthesis with hip and knee joints in a patient with multiple PJI allowed to improve the function of the limb and reduce the severity of the infectious process. No local or systemic toxic effects of copper were detected.