Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl
Preferences help
Polish version English version Language
enabled [disable] Abstract
Number of results

Results found: 10

Number of results on page
first rewind previous Page / 1 next fast forward last

Search results

help Sort By:

help Limit search:
first rewind previous Page / 1 next fast forward last
1
Content available remote

Application of Leeches in Treatment of Microcirculation Disturbances of Replanted Fingers - a Preliminary Report

100%
Paruzel M., Jabłecki J., Domanasiewicz A., Kaczmarzyk L.
Polish Journal of Surgery
|
2007
|
vol. 79
|
issue 8
548-554
EN
The aim of the study was to present the possibilities of application of leeches in cases of disturbances of venal out-flaw in replanted digits.Material and methods. In the period of 28 months 11 male patients aged between 19 and 51 years were subject to treatment with leeches. The group comprised 11 patients who had finger replantation or revascularization performed, and one patient who had second-toe-transfer. The indication for treatment were venal out-flaw disturbances of different etiology and their prophylaxis. Leeches were usually applied every 12 hours (two leech on one finger), the duration of treatment was from 2 to 6 days (4 days on average). After an effective application the animals were utilized. The antibiotics of aminoglicozides group were used as a prophylaxis of Aeromonas hydrophilia's infection.Results. All of the fingers treated with leeches survived. A dramatic improvement of local state of the fingers could be seen soon after the application of leeches. All of the patients did not complain of any discomfort associated with the therapy.Conclusion. The application of leeches in cases of disturbances venal out - flaw in replanted digits seems to be a valuable alternative of other methods commonly used.
2
Content available remote

Early Results of Open Fasciotomy as a Treatment of Dupuytren's Disease in Elderly Patients

100%
Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Kaczmarzyk J.
Polish Journal of Surgery
|
2007
|
vol. 79
|
issue 12
746-752
EN
The demand for treatment of Dupuytren's disease by a procedure of limited invasiveness and quick recovery is increasing in accordance with aging of the Polish population. Such a demand is fulfilled by different types of fasciotomy (open, percutaneous needle fasciotomy).The aim of the study was to asses the early results of the open fasciotomy in elderly patients.Material and methods. We treated 38 patients (61 fingers) whose mean age was 72 (SD 12) by open fasciotomy; 43 fingers presented stage III Tubiana contracture, 18 stage IV. The pre-operative total passive extension deficit was 123° (78° for stage III group, 111° for stage IV group). All the procedures were performed in outpatient setting. Patients used splint for 5 days, then performed finger - extension exercises and were encouraged to use their hands normally after 1 week.Results. The evaluation of the results was performed 4 weeks post-op. The greatest improvement in both of the groups was noted in MCP joint - 80% and in PIP joint - 48%, this difference is statistically significant. The general improvement ratio was 76%, greater in stage III group - 82% whereas in stage IV group 69%, but this difference was not statistically significant. All of the wounds healed up to 3 weeks, no complications were observed.Conclusion. The open fasciotomy is a recommendable short term treatment in patients of advanced age, suffering from stage III and stage IV of Dupuytren's disease.
3
Content available remote

Osteomyoperiosteal Decortication Supplemented by Bony Transplants in the Treatment of Primarily Created Bony Defects of the Forearm Bones in Patients After Forearm Replantation

100%
Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Kaczmapzyk J.
Polish Journal of Surgery
|
2008
|
vol. 80
|
issue 2
69-74
EN
Amputation-type mutilation of forearm caused by crush or explosion mechanism result in bone defects of different size, which after successful replantation require filling by secondary reconstructive procedures.The aim of the study was presentation of the results of filling these defect by means oste-musculoperiosteal decortication with supplementation of cortico - canceleous bony transplants.Material and methods. From Jan. 1993 till Oct. 2006 14 men (mean age 31.3 y) were operated on for bone defects after 15.8 weeks on average. Defects of average size of 3.2 cm (range: 1.5 - 10 cm) were localized in shafts of forearm bones: radial bone (n=7), ulnar bone (n=4), both of the bones (n=3). The patients were free of any inflammatory process within the forearm. All patients had the osteosynthesis made by Rush pins (in 4 patients the previously made unstable osteosynthesis was removed and rush pins were inserted). Osteo-musculo-periosteal decortication of bony shafts was followed by implementation of bony transplants in subperiosteal space. These were bridging the defect. After operations the plaster cast was applied for 10.2 weeks on average.Results. X-ray control performed every 6 - weeks enabled the assessment of evolution of bony union within the defects. The final control was made 12 months after the operation. Healing of all of the wounds was uncomplicated. One patient was reoperated because of resorbtion of the bony transplants, but a proper bony union was achieved finaly after 15 weeks. In all of the other 13 patients the unification was achieved after 15.4 weeks on average (range from 14-18 weeks).Conclusion. Osteo-musculo-periosteal decortication is an effective method of filling the bony defects in patients after replantation of forearm.
4
Content available remote

Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity

100%
Jabłecki J., Elsaftawy A., Kaczmarzyk J., Kaczmarzyk L.
|
|
vol. 85
|
issue 3
107-113
EN
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.
5
Content available remote

Hand Replantation in 83 Year Old Man - Case Report

100%
Kaczmarzyk L., Jabłecki J., Kaczmarzyk J.
Polish Journal of Surgery
|
2009
|
vol. 81
|
issue 5
242-245
EN
Indications for hand replantation need to take into account the patients general condition and the severity of the trauma. The advanced age of the patient is generally considered as a limiting factor of the replantation but does not absolutely disqualify a patient.The case of a right - handed man, 83 years of age is presented, who had a circular- saw wrist level amputation of his dominant hand. As the general condition of the patient was satisfactory, the wound was clean, and the ischemia time was only 3 hrs the replantation of the hand was decided. The procedure was performed in a standardized way, the revascularization took place 7 hrs after injury. In the early post-operative period within the replanted part skin and soft tissue necrosis developed. It was treated with hyperbaric oxygen therapy, pediculed skin flap, and after its failure omental flap. The early functional result was poor (Chen's IV°). Patient died 27 weeks after replantation due to complications of coronaroplasty. The problems involved in replantation of hands of senile patients are discussed.
6
Content available remote

Filling of Tissue Defects in the Hand With A Pediculed Osteocutaneous Groin Flap

100%
Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Paruzel M.
Polish Journal of Surgery
|
2009
|
vol. 81
|
issue 5
230-235
EN
The aim of the study was to evaluate the efficacy of pedicled osteocutaneous groin flaps in treatment of tissue defects of the hand.Material and methods. Twelve pedicled osteocutaneous groin flaps were used to fill bone defects of the hand in the same amount of patients (10 males and 2 females) aged 20-53 years (mean 33.4 years, SD 12 years). The defects affected metacarpal bones and wrist in 2 cases, metacarpus alone in 3 cases, fingers - in 4 (total amputations of 3 or 4 fingers), and thumb in 3 (total amputations). The osseous fragment measured from 6-18 ccm (mean 12.4 ccm). The osteosynthesis was performed using K-wires (10 patients) or AO headless cortical screw (2 patients). The flaps were detached gradually starting from postoperative day 18 with the final detachment performed on p.o. day 24-33 (mean 27.2 days, SD 6 days). Once after flap detachment the patients maintained the limb immobilized in a plaster cast for 5 weeks.Beside local abscess which was successfully treated with compresses, healing of the surgical site was uncomplicated. The bony union was assessed radiological and occurred after 9-13 weeks (mean 11.1 weeks, SD 5 weeks). Due to delayed bone union, one patient required bone slivers grafting which finally lead to unification. All the patients needed secondary plastic surgery of subcutaneous tissue of the flap; however, only 9 of them consented to it. In three patients we substituted the sensibility with a nerve graft according to Holevich.Results. The described operation did not improve function in patients with wrist-level and metacarpal osseous defects but improved its esthetical aspect; in the other patients the hand function was significantly restored.Conclusions. In patients disqualified for other methods of reconstructions of the thumb, fingers and bone defects of the hand a satisfactory result may be achieved by using pedicled osteocutaneous flaps from the iliac crest. This method proved to be highly effective.
7
Content available remote

Management of Extensive or Infected Soft Tissue Defects in Upper Limb by Means of Pediculated Omental Flaps

100%
Domanasiewicz A., Kaczmarzyk L., Paruzel M., Jabłecki J.
|
|
issue 11
503-511
EN
The basis for the treatment of deep tissue defects, particularly those that are infected, is coverage of the exposed anatomical structures with well vascularized tissues. To this end various kinds of vascularized-pedicled and free flaps are utilized. Post-trauma, soft tissue defects in the region of the upper extremity often involve areas of tissue poorly perfused, affected by necrosis and bacterial colonization. The size of the defect with accompanying intense purulence limits the application of local reconstruction and fasciocutaneal and muscle flaps. The greater omentum is one of the most promising and universal flaps on account of it's bactericidal and angiogenetic properties. The first report regarding a successful application of omentum in plastic surgery dates from 1965 year.The aim of the study was to present treatment results of extensive as well as infected tissue defects of upper limb with the application of pedicled omental flaps in material from Sub-Department of Limb Replantation in Trzebnica.Material and methods. Between 2005-2009 in the St. Hedwig's Hospital 35 patients (30 M, 5 F) avg age 38.3 (range 10-73) were treated using omentum flaps. The causes of defects were primarily crush injuries (13), burn wounds (2), secondary necrosis of replanted/revascularized limb tissues (14) including chronic bone infections, contaminated degloving injuries of upper limb (4). The area of tissue defect amounted to avg 84 cm2 (range 25-227 cm2)Most of this, 31/35 (89%) posed infected wounds (Staphylococcus aureus 11, Escherichia coli 12, Enterococcus faecalis 11, Staphylococcus coagulsonegative 10, Pseudomonas aeruginosa 5, Acinetobacter baumanii 6, Proteus mirabilis 6, Enterobacter cloacae 4). The procedure was based on covering of the defects with pedicled omental flap obtained during epigastric laparotomy, with split- thikness skin graft. After the procedure apart from the surgical prophylaxis general antiobtic therapy was not applied, nor locally. After 3-4 weeks the pedicle of flap was cuted and it's appearance was modeled as well as covered using skin graft.Results. Complete healing with good fuctional and cosmetic results was achieved in 32/35 cases, after transplantation of omentum in 52% of wounds a change in bacterial flora was observed to saprofitic and antibiotic-sensitive, and in 38% donor site was aseptic. Cultures were attained, in the remainder signs of infection receded despite the presence of pathological flora. In 2 cases complete or partial necrosis of flap was observed, in one the vital flap was removed due to amputation of limb (crush syndrome). Complication in the form of hernia were observed in 5/35 patients, however no complaints of abdominal pain or abscess of space drawing.Conclusions. Free and pedicled omental flaps appear to be the ideal solution in the treatment of tissue defects and bone infections chronically infected with antibiotic-resistant cultures. The omentum also is a appropriate material for covering of fresh defects with exposed ligaments, nerves and bones. The complications at the obtaining site in our material occured rarely when compared to the available published data. Currently it is possible also to harvest the omentum laparoscopically.
8
Content available remote

Problems Associated with Forearm Reimplantation

88%
Jabłecki J., Kaczmarzyk J., Kaczmarzyk L., Domanasiewicz A., Kocięba R.
Polish Journal of Surgery
|
2007
|
vol. 79
|
issue 2
70-77
EN
The aim of the study was to present the technical and qualification problems associated with forearm reimplantation.Material and methods. The analysed group included 29 patients, 25 male and 4 female, who had in the period of 10 years (between January 1994 and December 2003) undergone 10 reimplantations and 19 revascularisations (partial amputation) of the forearm. The age of the patients ranged from 19 to 63 years. Due to massive limb destruction, 8 patients only underwent wound revision. The number of operations performed within the 4 distinct zones of the forearm was as follows: I - 8 patients, II - 17, III - 3, IV - 1; 20 (69%) of cases were the result of crush-avulsion injuries. The bones were stabilised by means of intramedullary nails, muscle bellies were sutured with mattress sutures, and the torn-off tendons were reinserted to the bellies by Chen's method. We attempted anastomosis of two main forearm arteries and the greatest possible number of veins, and a vein graft was applied in 2 cases. The operative wound was closed with skin graft in 4 patients.Results. There were 5 failures (17.2%). Nine patients required secondary reconstructive procedures for bone issues, 4 patients for nerves, and 3 for tendons. The operations were performed between 20 to 29 months after the reimplantation. The functional results were assessed according to Chen's scheme. 2 patients achieved grade I, 9 grade II, 13 grade III, and 5 grade IV. Two patients, the farmers, regained their previous profession. All of the patients were satisfied with regaining the limb.Conclusions. Problems encountered in forearm reimplantation are due to unfavorable mechanisms of trauma. The technical aspects of such surgeries require a highly qualified surgical team. The prognosis for survival and functional recovery is lower in proximal as compared to distal injuries.
9
Content available remote

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

76%
Elsaftawy A., Jabłecki J., Domanasiewicz A., Paruzel M., Kaczmarzyk J., Kaczmarzyk L.
|
|
vol. 85
|
issue 4
192-197
EN
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.
10
Content available remote

First Polish Hand Allograft - 6-Month Report

76%
Jabłecki J., Kaczmarzyk L., Patrzałek D., Domanasiewicz A., Paruzel M., Chełmoński A., Kaczmarzyk J.
Polish Journal of Surgery
|
2007
|
vol. 79
|
issue 3
232-238
EN
The transplant recipient is a 32 year-old man who lost his right, dominant upper limb on the level of the midpoint of his forearm in an accident 14 years ago. After a comprehensive pretransplantation evaluation and informed consent process he received a transplant of the right forearm, matched for size and skin tone, of a brain-dead man aged 47. The donor's limb was amputated at the elbow and irrigated with UW solution. We dissected the donor and recepient limbs simultaneously. Appropriate lengths of anatomical structures were matched. Bone fixation was performed with Rush pins, without bony transplants; the muscles were anastomosed in layers and the skin wound was closed without a skin transplant. The cold ischemia time was 10.5 hours. Immunosuppresion included simulect, tacrolimus, mycophenolic acid, and prednisone. Maintanance therapy included tacrolimus (15 ng/ml), mycophenolic acid, and encorton.There were no intraoperative or early postoperative complications. No episodes of rejection were observed. Immunosupression was well tolerated. The intensive physiotherapy led to satisfactory progress of motor function recovery. Reinnervation was excellent, and after 6 months, Tinel's sign was present over 40% of the respective lengths of the median and ulnar nerves. Follow-up included routine post-transplant laboratory tests, skin biopsies, bacteriological tests, and physiotherapy.
first rewind previous Page / 1 next fast forward last
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.