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1
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Radial Wrist Extensors as a Dynamic Stabilizers of Scapholunate Complex

100%
Elsaftawy A.
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vol. 85
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issue 8
452-459
EN
Wrist stabilization is ensured by the complex of stabilizers, both static (intrinsic and extrinsic ligaments) and dynamic ones (flexor and extensor sinews of the wrist). Extrinsic carpal ligaments link both carpal rows with forearm, while the intrinsic ones connect individual carpal bones. From among intrinsic ligaments, the most significant from clinical point of view is scapholunate ligament (scapholunate lig. - SL). Instability of the SL resulting from SL ligament tear is the most frequent type of carpal instability. If untreated or undiagnosed, it may lead to destabilization of the carpal rows, and in the final stage to massive degenerative changes with SLAC (scapholunate advanced collapse). The aim of the study was to present a hypothesis of a possible influence of radial extensors of the wrist as dynamic stabilizers for SL complex, based on which it is possible to discern the partial ligament tear with accompanying damage of static stabilizers of the complex. Material and methods. This hypothesis was based on radiological tests carried out on 5 patients, with acute partial SL ligament tear, which was confirmed during wrist arthroscopy. The outcome was presented as well, with its visualization in radiological tests. Results. The picture of rotary subluxation of the scaphoid -signet ring sign in PA view and strengthening in stress position (clenched fist) was demonstrated in all 5 patients. In 2 patients who had wrist arthroscopy performed it was observed that the palmar and proximal part of SL ligament were injured, yet no damage of dorsal part was reported. In MRI tests of these patients, an additional injury of dorsal intercarpal ligament was revealed. Conclusions. Correction of the scaphoid reduction in position of clenched fist may result from influence of radial extensors of the wrist (both short and long) as dynamic stabilizers of SL complex. This imagining is a completion of the radiological symptoms so far occurring in this SL instability. In case of acute, partial scapholunate ligament tear, reduction of scapholunate subluxation and its internal fixation with the lunate and capitate for a 6-week period may be an optional procedure
2
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Proposition of a new classification for scapholunate instability

100%
Elsaftawy A.
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vol. 85
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issue 11
676-680
EN
Scapholunate (SL) instability is the most common pattern of instabilities in the wrist. If untreated or undiagnosed, it may lead to degenerative changes with SLAC (scapholunate advanced collapse) wrist. There are a few of of well-known SL instability classifications. The one that takes into account a dynamic or static nature of SL instability is the most accepted and used. The arthroscopic classifications are also becoming more and more popular. The aim of the study was the critical review of most popular classifications of SL instability, yet at the same time we proposed a new SL instability classification. Results. The new classification was found to be very useful in the process of diagnosis and decision making concerning further treatment of patients with SL instability in our department. Conclusions. The proposed new classification combines the opportunity of evaluating the scapholunate interosseus ligament (SLIL) tear and lesions of the secondary static stabilizers of SL ligament complex that can coexist with or without DISI deformity (Dorsal Intercalated Segmental Instability).
3
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Radiological Investigation of Relationship Between Lunate type and Ulnar Variance

100%
Elsaftawy A.
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vol. 85
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issue 10
576-580
EN
Some variances and anatomical proportions of the wrist may contribute to development of avascular necrosis of the lunate. Kienböck’s disease is more often encountered in young males, who suffer, among others, from type II of the lunate (with two joint surfaces for the capitate and hamate) and/or negative variance of ulna in relation to radius. The aim of the study was to investigate whether there exists interdependence between the simultaneous occurrence of individual types of the lunate with one of the variances of ulna in both genders. Material and methods. A retrospective analysis of 394 (n=394) radiological tests of the wrist in 174 (44%) women and 220 (56%) males aged 18-83 years (average age 39 years). From the entire pool, 265 X-rays were educed in 104 females and 161 males, and no fractures or wrist instability features were could be observed. The X-rays were obtained from computer lab and archive data base at St Hedwig Hospital in Trzebnica from the beginning of January 2011 to the end of December 2012. Results. 196 cases (74%) were found with type I of the lunate and 69 cases (26%) with type II. Ulnar variance amounted to from +4.7 mm to -4.2 mm (mean value +0.9 mm). Positive ulnar variance was stated in 44 patients (16.6%), negative in 63 (23.7%) and neutral accounted for the biggest group of other 158 (59.7%) patients. Conclusions. Neutral variance of ulna is the one that occurs most often in the Polish population. There is no correlation between gender and ulnar variance. There is also lack of direct connection between occurrence of individual lunate types and ulnar variance.
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Umbilical Cord And Foetal Placenta Vessels As Biological Material In Microsurgical Techniques Training - Own Experiments

64%
Elsaftawy A., Jabłecki J.
Polish Journal of Surgery
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2010
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vol. 82
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issue 10
581-583
EN
For dozens of years microsurgical techniques have been successfully applied in various procedural areas mainly in ophthalmology, laryngology, female infertility treatment, urology, plastic surgery and reconstruction as well as hand surgery. Courses enabling acquisition of basic qualifications within the microsurgical techniques area are the starting point for such activity, there is however an urgent need for further training as it goes without saying that without adequate training one may quickly forget all the experience gained during such trainings. Our department have been using foetal placenta obtained from maternity ward (following a written consent from a parturient) to carry out microsurgical trainings for 13 months now.
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Acute compartment syndrome after open forearm fracture – scale of the problem and case report

64%
Elsaftawy A., Jabłecki J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
44-47
EN
Acute compartment syndrome is caused due to a sudden increase in the tissue pressure in a given fascial compartment. Missed and undiagnosed or not treated in time can lead to irreversible damage to limb muscles and nerves due to ischemia mechanism. This paper presents a case of a patient with an open forearm fracture treated conservatively in plaster.
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Post-Traumatic Thumb Reconstruction with Radial Forearm Flap

64%
Elsaftawy A., Jabłecki J.
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vol. 85
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issue 6
351-353
EN
The study described a case of a 37-year-old patient, who had undergone avulsion amputation of the thumb, and was subject to a primary thumb reconstruction by means of thumb reconstruction with radial forearm flap, with the use of osseous fragments of the amputated thumb parts.
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Unsuccessful replantation of metacarpal hand after venous thrombosis – case report

64%
Elsaftawy A., Jabłecki J.
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vol. 85
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issue 12
721-726
EN
Trans-metacarpal hand replantation is one of the most complex and difficult procedures in the reconstructive microsurgery. As far as we know the arrangement of the palmar arterial network, the problem lies in the absence of accurate venous maps at the dorsum of the hand. The quality of venous circulation structure at the replanted hand determine the success of the surgery. In this paper we present a case of a failed replantation of a metacarpal hand after early thrombosis at the venous microcirculation system.
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Epidemiological Characteristic of Acute Pancreatitis in Trzebnica District

51%
Bogdan J., Elsaftawy A., Kaczmarzyk J., Jabłecki J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 2
70-75
EN
Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas.
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Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity

51%
Jabłecki J., Elsaftawy A., Kaczmarzyk J., Kaczmarzyk L.
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vol. 85
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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.
10
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„Dangerous” Anatomic Varieties of Recurrent Motor Branch of Median Nerve

51%
Elsaftawy A., Gworys B., Jabłecki J., Szajerka T.
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vol. 85
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issue 8
419-423
EN
Carpal tunnel release became one of the most common operations in the field of hand surgery. Many controversies has been made about frequency of the so-called dangerous variations of motor branch of the median nerve. Knowledge of all the anatomical variations motor branches is the duty of every surgeon dealing with the subject. The aim of the study was to present the incidence of dangerous variants of median nerve motor branch in the carpal tunnel based on both clinical experience and anatomical studies performed on 20 cadaver wrists. Material and methods. Between 2006-2012 during minimally open carpal tunnel release we made photographic documentation of all visible dangerous varieties of recurrent motor branches of the median nerve. We also studied 20 cadaver wrists in the Department of Anatomy Medical University in Wrocław. Results. Dangerous varieties of the motor branch of median nerve was found in three clinical cases and in one cadaver wrist. Also In one wrist we found one regular branche, which, however, has atypical two separate branches supplying the thenar muscles. Conclusions. Dangerous varieties of the motor branch of median nerve occur very rare in the population, but does not release from the fact that in each case special attention must be given.We also conclude that, at the minimally open carpal tunnel release procedure, the transverse carpal ligament should be released rather from the line of radial border of the 4th finger to minimize the risk of injury to the recurrent motor branch of median nerve
11
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Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

39%
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.
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