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1

What does a (general and abdominal) surgeon need to know on plastic surgery?

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Kraus A., Infanger M., Meyer F.

Polish Journal of Surgery

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2019

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vol. 91(5)

42-51

EN

Background: Plastic surgery was first introduced as a sub-specialty of general surgery in Germany in 1978. Since then, this surgical subspecialty/discipline has evolved enormous potential, e.g. in collaboration with other disciplines such as general andabdominal surgery. Aim: To highlight and summarize the basic potential, technical options and novel aspects of plastic surgery, which are relevant for the common interdisciplinary surgical strategies of plastic and general as well as abdominal surgery in clinical practice. Method: Short and compact narrative review based on 1) a selection of relevant references from the medical scientific literature and 2) surgical experiences obtained in daily practice. R esults (selected corner points): 1) Biological protection procedures in vascular surgery by flap coverage after meticulous debridement with or without autogenic vascular reconstruction are used to overcome infection of a vascular prosthesis, a serious problem, associated with the risk of anastomotic rupture and bleeding by transfer of immunological competence due to tissue coverage and finally to induce healing in the area of an infected vascular prosthesis. 2) Fistula treatment for aorto-tracheal or aorto-duodenal fistulas, a big challenge for the referring general surgeon, can be treated by flap coverage, i.e. interposition of the pectoralis-major flap and the omentum-majus flap, respectively. 3) With regard to nerve surgery, encouraging results have been reported after early microsurgical recurrent laryngeal nerve repair, i.e. improved subjective voice quality or reconstitution of respiratory capacity in diaphragmatic. 4) Lymphatic surgery for lymphedema occurring either primarily due to an absence or lack of lymphatic vessels or secondarily due to infection, trauma, radiation therapy or surgery can be indicated in specialized microsurgical centers, e.g. for surgical repair of the lymphatic pathway: I) the interrupted lymphatic system can be reconstructed by an interposition, or II) the lymphatic fluid can be drained extraanatomically (e.g. by a lymphatic-venous anastomosis). Further techniques are the following: free lymph node transplantation included in a free vascularized groin flap or autologous lymphatic vessel transfer or vein graft interposition (used for lymphatic vessel interposition). 5) Mass reduction such as dermolipectomy with subsequent split-thickness is a valuable option, which provides excellent volume reduction. 6) Defect coverage: A. Split- or full-thickness skin grafts are a common method of defect coverage (in cases of clean and well-vascularized wound bed and lacking donor skin, or if the graft bed is of questionable quality) using various allogenic or xenogenic skin substitute materials. B. Further methods offer a wide-range armamentarium of local and free fasciocutaneous and musculocutaneous flaps, e.g. after abdomino-perineal rectum extirpation using the vertical rectus-abdominis myocutaneous flap (VRAM) or propeller flaps according to the “angiosome”. 7) Abdominal wall hernia closure with instable skin coverage, flap closure, either alone or in combination with mesh is superior to mesh closure only. 8) Free flaps: If there is no option for a local or pedicled flap available, free flaps can be well used for abdominal wall defect closure (complication rate in experienced hands is low). Conclusion: Plastic surgery is an indispensable partner for specific surgical problems and clinical situations of general and abdominal surgery, which indicates that each general and abdominal surgeon should be well notified on great options and surgical techniques offered by modern plastic surgery to achieve best outcomes and quality of life for patients and should combine the expertise of these two surgical disciplines.

2

The characteristics of plantar flexors and dorsiflexors strength in patients after complete three-bundle Achilles tendon reconstruction

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Syrek M., Śmigielski R., Staniszewski M., Wychowański M.

Advances in Rehabilitation

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2019

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vol. 33

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issue 2

37-45

EN

Introduction Achilles tendon rupture is an injury resulting from occasional excessive physical activity that is undertaken in the absence of an adequate level of preparation. The calcaneal tendon forms the end of the triceps surae muscle which consists of the gastrocnemius and the soleus. The aim of the research was to evaluate the level of functional performance of the operated limb one and two years after the Achilles tendon reconstruction surgery. Material and methods The study group comprised of 20 men (age – 47.2±8.3 years; height – 182±7cm; weight – 88±12kg) who have undergone the Achilles tendon reconstruction surgery. The measurement of plantar flexor and dorsiflexor muscle torques was conducted in both extended- and flexed-knee position under isometric and isokinetic conditions Results The measurements of the plantar flexor and dorsiflexor muscle torques in the extended knee position performed one and two years after the surgery did not reveal any significant differences between the healthy and operated limb. The tests performed one year after the surgery in the flexed-knee position showed significantly lower values of the plantar flexor and dorsiflexor muscle torques in the operated limb measured under isokinetic conditions. The results obtained two years after the reconstruction surgery proved that muscular deficit was still visible; however, there were no statistically significant differences Conclusions The angular knee joint position affects the plantar flexor muscle torque in the operated limb. Due to the muscle strength deficit observed two years after the surgery, additional training should be implemented after the rehabilitation has been completed. The main focus should be on dynamic exercises performed in the flexed-knee position which help to rebuild deep muscles such as the soleus

3

Elevated preoperative levels of CA 19-9 and CA 125 predicts overall survival time in the pancreatic adenocarcinoma. Single institution series.

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Hogendorf P., Skulimowski A., Durczyński A., Kumor A., Poznańska G., Poznańska A., Oleśna A., Rut J., Øvereng Juliebø S., Szmiel A., Pirowski W., Strzelczyk J.

Polish Journal of Surgery

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2020

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vol. 92(3)

32-38

EN

Introduction: Pancreatic cancer is a devastating disease, being the seventh cause of cancer-related deaths worldwide. Its aggressiveness is due to its specific biology and the late diagnosis of cancer. Therefore, the prognosis for patients suffering from this cancer is dismal, with 5-year overall survival rate of around 6–10%. Up to date, only a complete surgical resection of the cancerous entity warrants a significant improvement in patients’ survival. Nevertheless, the pancreatic cancer’s biology is still not fully elucidated, so that the accuracy of prognosis for certain patients is highly uncertain. Consequently, the importance of both clinical and basic research aiming to reveal the crucial molecular factors affecting long-term prognosis should be highlighted. There is a growing number of evidence that biomarkers of PC not only reflect the presence of tumor itself but also present a “hint” regarding its physiology. Thus the aim of this study was to assess the levels of commonly measured biomarkers and their influence on patients’ overall survival. Materials and methods: The retrospective analysis of data on 129 patients admitted to our Department due to the diagnosis of pancreatic cancer was carried out. On the day of admission all the patients had their levels of CA19-9, CA125, CEA and CA15-3 measured. The overall survival (OS) was defined as time elapsing from the day of admission to the day of death. The Kaplan- Meier curves were built for all potential factors, Cox regression model was applied to carry out a multivariate analysis. Results: We retrospectively analyzed 129 patients with a mean age of 62 years. As many as 95 of them had an unresectable lesion and 34 underwent curative operation. In total, the analyzed patient group was characterized by a median survival of 7 months and 12 days. Cumulative 1-year, 2-year and 4-year survival rates were 35%, 16% and 15%, respectively. In univariate analysis, factors such as age >= 60, inoperable lesion, CA19-9 >= 200, CA125 >= 20 and Neutrophile to Lymphocyte Ratio (NLR) >= 5 were associated with a lower median OS. In multivariate analysis, three factors, CA19-9 >= 200, CA125 >= 20 and age >= 60, were found to be statistically significant. Indeed, patients possessing all of them noted much poorer outcomes regarding OS factors: 89 days versus 235 days for the other patients (log rank test P = 0.02). Conclusions: Our study fortifies the evidence that preoperative levels of CA19-9 and CA125 have a direct influence on the longterm OS. Interestingly, in our patient group, the correlation of biomarkers with OS was higher than that of resectability. However, our study has some limitations regarding, for instance, the lack of data on chemotherapy, comorbidities etc. In the view of recent molecular studies on mucin involvement in PC development, it provides a strong clinical evidence to prove their importance.

4

Postoperative pain relief in general surgery – recommendations of the Association of Polish Surgeons, Polish Society of Anaesthesiology and Intensive Therapy, Polish Association for the Study of Pain and Polish Association of Regional Anaesthesia and Pain Treatment

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Wordliczek J., Zajączkowska R., Dziki A., Jackowski M., Richter P., Woroń J., Misiołek H., Dobrogowski J., Paśnik K., Wallner G., Malec-Milewska M.

Polish Journal of Surgery

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2019

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vol. 91(1)

47-68

EN

It is estimated that there are over 310 million surgeries performed in the world every year. Appropriate analgesic management in the perioperative period constitutes a fundamental right of every patient, significantly reducing the number of postoperative complications and the time and costs of hospitalization, particularly in the high-risk group of patients (ASA III-V) subject to extensive surgical procedures and hospitalized in intensive care units. Despite such significant arguments speaking for the conduct of effective analgesia in the perioperative period, nearly 79% of patients operated in hospitalization settings and 71% of patients operated in outpatient settings (so-called first day surgery) experienced postoperative pain of moderate, strong or extreme intensity. Hence, effective relief of postoperative pain should constitute one of the priorities of integrated, modern perioperative management, the components of which apart from adequate analgesia involve early nutrition through the alimentary canal, early patient activation and active physiotherapy. In the currently published “Guidelines”, a team of authors has updated the previous “Recommendations” primarily in terms of methods for optimizing postoperative pain relief and new techniques and drugs introduced for postoperative pain therapy in recent years. The algorithms of postoperative pain management in different treatment categories were also updated.

5

Ocena jakości leczenia bólu pooperacyjnego u pacjentów oddziału chirurgicznego leczonych metodą laparoskopową

75%

Krajewska K.

Innowacje w Pielęgniarstwie i Naukach o Zdrowiu

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2022

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vol. 7

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issue 2

7-27

EN

Introduction. Laparoscopy is one of the most effective methods of surgical treatment. The main benefits of laparoscopic treatment include faster recovery, fewer complications, small scars, and less pain. The aim. The aim of the study is to analyse the assessment of the quality of postoperative pain treatment after laparoscopic surgery and the possibilities of its improvement in everyday nursing practice. Material and methods. The study used the method of diagnostic survey using the survey technique. The research tool used to conduct the research was an own questionnaire with a standardized tool - the Polish Version of the Scale of Clinical Quality Indicators of Postoperative Pain Management. The research analysis involved 100 patients of the surgical ward of the Specialist Provincial Hospital in Włocławek, treated with the laparoscopic method. Results. The obtained results are similar to studies conducted by other researchers. The general assessment of the quality of the nursing care provided in minimizing the experienced pain proves the need to improve care in the sphere of the environment and communication. Conclusions. The nursing staff has knowledge in the field of postoperative pain relief and reacts quickly to the changing condition of the patient. The research results clearly indicate that the transfer of information at the nurse-patient level should be improved. Ensuring an appropriate environment for the patient to rest after surgery is not always possible for reasons beyond the control of the nursing staff.

PL

Wstęp. Laparoskopia jest jedną z najbardziej skutecznych metod leczenia operacyjnego. Głównymi korzyściami płynącymi z leczenia metodą laparoskopową jest szybszy powrót do zdrowia, mniejsza ilość powikłań, blizny niewielkich rozmiarów oraz zminimalizowanie odczuwanych dolegliwości bólowych. Cel. Celem pracy jest analiza oceny jakości leczenia bólu pooperacyjnego po zabiegach operacyjnych przeprowadzonych metodą laparoskopową. Materiał i metody. W pracy wykorzystano metodę sondażu diagnostycznego przy użyciu techniki ankietowania. Narzędziem badawczym służącym do przeprowadzenia badań była ankieta własna wraz z narzędziem standaryzowanym - Polska Wersja Skali Klinicznych Wskaźników Jakości Postępowania z Bólem Pooperacyjnym. Analizie badawczej poddano 100 pacjentów oddziału chirurgicznego Wojewódzkiego Szpitala Specjalistycznego we Włocławku leczonych metodą laparoskopową. Wyniki. Uzyskane wyniki są zbliżone do badań przeprowadzonych przez innych badaczy. Ogólna ocena jakości świadczonej opieki pielęgniarskiej w minimalizowaniu odczuwanych dolegliwości bólowych świadczy o konieczności poprawy opieki w sferze środowisko oraz komunikowanie. Wnioski. Personel pielęgniarski posiada wiedzę w zakresie uśmierzania bólu pooperacyjnego oraz szybko reaguje na zmieniający się stan chorego. Wyniki badań jednoznacznie wskazują, iż przekaz informacji na poziomie pielęgniarka – pacjent powinien ulec poprawie. Zapewnienie odpowiedniego otoczenia choremu do odpoczynku po operacji nie zawsze jest możliwe z przyczyn niezależnych od personelu pielęgniarskiego.

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What does a (general and abdominal) surgeon need to know on plastic surgery?

The characteristics of plantar flexors and dorsiflexors strength in patients after complete three-bundle Achilles tendon reconstruction

Elevated preoperative levels of CA 19-9 and CA 125 predicts overall survival time in the pancreatic adenocarcinoma. Single institution series.

Postoperative pain relief in general surgery – recommendations of the Association of Polish Surgeons, Polish Society of Anaesthesiology and Intensive Therapy, Polish Association for the Study of Pain and Polish Association of Regional Anaesthesia and Pain Treatment

Ocena jakości leczenia bólu pooperacyjnego u pacjentów oddziału chirurgicznego leczonych metodą laparoskopową