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The Limberg Flap Procedure in the Treatment of Pilonidal Cyst Disease of the Sacrum – Initial Report

100%
Spychała A., Murawa D.
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vol. 86
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issue 6
257-262
EN
Pilonidal cyst disease mainly concerns young people, aged between 16 and 25 years. The disease causes significant pain, considerable discomfort and impairs daily functioning, often resulting in an inability to work and study. Many techniques have been introduced in the treatment of pilonidal cysts, but till today no gold standard has been established. The aim of the study was to present initial results considering the treatment of pilonidal cyst disease with the use of a skin flap by means of Limberg’s method. Material and methods. During the period between January, 2012 and March, 2013, 10 patients were operated due to pilonidal cysts using the Limberg flap procedure. All patients presented with the chronic form of the disease and were after previous surgical incisions. Pain considering patients was evaluated using the visual pain scale (VAS), one and 10 days after the operation. Patients reported for control 10 days, one month, and 6 months after the surgical procedure. Results. The planned procedure was safely performed in all cases. There were no complications during the procedure, nor late postoperative complications. We observed no wound infection or dehiscence in all operated patients. The mean follow-up time of the presented group was 13.32 months (ranging between 7.53‑21.57). During the follow-up period there was no episode of recurrence. Conclusions. The use of the skin flap by means of Limberg’s method after excision of the pilonidal cyst in the sacrum area is a good method, which provides a very low percentage of recurrences and complications. Fast return to daily activities, no significant pain in patients, and an acceptable cosmetic result are strong reasons in favor of the above-mentioned method. Preliminary observations and experience enable to recommend this method for the treatment of pilonidal cysts in the vicinity of the sacrum
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Melanoma of Unknown Primary as a Cause of Intestinal Obstruction - a Case Description

100%
Murawa D., Spychała A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 8
415-419
EN
Melanoma of unknown primary applies to 1-8% of all diagnosed melanomas, whereas primary melanoma of the small intestine is a extremely rare case. One of the melanoma characteristics is its capability of forming metastases in the small intestine which very often are diagnosed during autopsy.We present a case report of diagnosed melanoma of unknown primary, whose first symptom was intestinal obstruction. Before admission to the hospital cause of intestinal obstruction, the patient didn't present any signs and symptoms. All typical localizations of primary melanoma were excluded during diagnostic procedure. Palliative right hemicolectomy and segmental small intestine resection were performed. There were no complications in the postoperative course. On the ninth day the patient was discharged from hospital.Quick identification and radical resection of melanoma metastases in the alimentary tract may improve the survival rate in this group of patients. Resection, even if it is palliative by assumption, is not only the best method of elimination of persistent symptoms but it also gives hope for longer survival.
3
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Sentinel Lymph Node Biopsy in Cutaneous Melanoma - Analysis of 227 Cases

71%
Spychała A., Murawa D., Połom K., Gracz A., Murawa P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 5
241-247
EN
The aim of the study was to evaluate the experience of the centre in carrying out and assessing the use of sentinel node biopsy in skin melanoma.Material and methods. From 2000 to 2004, a sentinel node biopsy was carried out on 227 patients being treated for skin melanoma. In all the patients, the sentinel node was subjected to a standard histological evaluation with the application of H+E staining. If no melanoma cells were visualised within the sentinel node, the material was subjected to an immunohistochemical investigation. The patients whose sentinel node included metastases found in the H+E examination or micrometastases identified by means of the immunohistochemical investigation were subjected to a supplementary lymphadenectomy.Results. The sentinel node was identified in all the patients. In a group of 28 patients (12.3%), the presence of metastases within the sentinel node was visualised by means of H+E examination. A group of 199 patients (87.66%) with a metastases-negative sentinel node (H+E staining) was subjected to immunohistochemical evaluation, which revealed the presence of micrometastases in 45 patients (19.82%). Supplementary lymphadenectomy was carried out in patients who screened positive, and metastases were identified in other regional lymph nodes in 11 (4.8%) patients.Conclusions. 1. After finishing the learning curve, the sentinel node biopsy is a simple and effective method, enabling precise assessment of the lymphatic system in patients with skin melanoma. 2. The application of immunohistochemical investigation enabled the identification of micrometastases in 19.8% of the patients, where these were not found in the H+E examination. 3. The application of sentinel node biopsy allowed lymphadenectomy to be avoided in 154 (67.8%) patients.
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