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1
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Variety of Clinical Manifestations of Rupture of Iliopsoas Muscle Belly

100%
Paruzel M., Jabłecki J., Całka K.
Polish Journal of Surgery
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2009
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vol. 81
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issue 8
354-358
EN
Three patients are presented who sustained a lesion of iliopsoas muscle belly accompanied by intramuscular haematoma. Diagnosis was stated by means of CT scans. The accident such as fall of the stairs was the cause of the lesion in only two patients. The clinical manifestation of the illness significantly differed in symptoms such as: presence of subcutaneous haematomas, muscle tension, extent of pain, a drop of hemoglobin serum - level and others. The common feature of this mutilation was the maximal localization of the pain at the groin region of the affected side, difficulties in thigh dorsiflexion and external rotation as well as subsiding of symptoms after short-term conservative treatment. The characteristic of this rarely-diagnosed mutilation was analyzed on the basis of medical literature.
2
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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
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2007
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vol. 79
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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.
3
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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
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2009
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vol. 81
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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.
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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.
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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.
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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.
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vol. 85
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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.
6
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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
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2007
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vol. 79
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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.
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