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

100%
Ulatowski Ł.
Polish Journal of Surgery
|
2012
|
vol. 84
|
issue 3
119-125
EN
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.
2
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Neurilemoma of the Median Nerve - Surgical Strategies Based on a Case Report

63%
Ulatowski Ł., Kaniewska A.
Polish Journal of Surgery
|
2015
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vol. 86
|
issue 9
429-432
EN
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.
3

Continuous thoracic epidural anesthesia and lumbar spinal anesthesia in breast reconstruction surgery – a case report

45%
Krzęczko P., Chutkowski R., Malec-Milewska M., Molski M., Ulatowski Ł.
Ból
|
2012
|
vol. 13
|
issue 2
48
EN
Breast cancer is the most common cancer in women. The treatment is mastectomy with subsequent adjuvant therapy. Women after surgery feel mutilated not only physically but also mentally. Therefore the number of breast reconstruction procedures is rising. Free tissue flap breast reconstruction provides very good cosmetic results. These procedures take many hours, are extensive and very painful. This article presents a case report of a 49-year-old woman after right-sided mastectomy due to breast lobular cancer, who underwent right free flap breast reconstruction. The procedure was carried out under continuous thoracic epidural anesthesia and lumbar spinal anesthesia.
PL
Rak piersi jest najczęstszym nowotworem u kobiet. Podstawową metodą leczenia jest mastektomia i leczenie uzupełniające. Kobiety po tym zabiegu czują się okaleczone nie tylko fizycznie ale i psychicznie. Dlatego też coraz częściej wykonuje się zabiegi rekonstrukcji piersi. Bardzo dobre efekty kosmetyczne dają rekonstrukcje piersi wolnymi płatami. Operacje te trwają wiele godzin, są rozległe i bardzo bolesne. Przedstawiamy przypadek 49-letniej kobiety z rozpoznaniem: stan po prawostronnej mastektomii z powodu raka zrazikowego piersi. U pacjentki wykonano rekonstrukcję piersi prawej wolnym płatem. Zabieg został przeprowadzony w znieczuleniu zewnątrzoponowym ciągłym w odcinku piersiowym i znieczuleniu podpajęczynówkowym w odcinku lędźwiowym.
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