Browsing by Author "Stojičić, Milan (24554259500)"

Introduction/Objective A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or the combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and epidemiological and etiological aspects play a major role in their treatment. Methods A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated in our institution over a five-year period. Main data features used in the analysis were sex, age, principal diseases, comorbidities, and biochemical indicators of malnutrition. The patients’ data was obtained from the existing patients’ records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results A total of 72 patients with pressure ulcers were included in this study, with a mean age of 54.7 ± 16.1 years. Three times more patients injured in traffic accidents were male (75% vs. 25%), while most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of stage III or IV were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. Patients with stage IV pressure ulcer were usually treated with partial osteotomy. Conclusion Surgical reconstructive treatment with fasciocutaneous and myocutaneous flaps represents the gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures. © 2022, Serbia Medical Society. All rights reserved.

Purpose: This split-face study aimed to see whether different types of local anesthetics or their buffered/nonbuffered combinations produce lower pain scores in upper eyelid blepharoplasty. Methods: The study involved 288 patients, randomly divided into 9 groups: 1) 2% lidocaine with epinephrine - Lid + Epi; 2) 2% lidocaine with epinephrine and 0.5% bupivacaine (1:1) - Lid + Epi + Bupi; 3) 2% lidocaine with 0.5% bupivacaine (1:1) - Lid + Bupi; 4) 0.5% bupivacaine - Bupi; 5) 2% lidocaine - Lid; 6) 4% articaine hydrochloride with epinephrine - Art + Epi; 7) buffered 2% lidocaine/epinephrine with sodium bicarbonate (SB) in a 3:1 ratio - Lid + Epi + SB; 8) buffered 2% lidocaine with SB in a 3:1 ratio - Lid + SB; 9) buffered 4% articaine hydrochloride/epinephrine with SB in a 3:1 ratio - Art + Epi + SB. Following the injection of the first eyelid and a 5-minute period of soft pressure on the injection site, patients were asked to rate their pain level on the Wong-Baker Face Pain Rating Visual Analogue Scale. Rating of the pain level was repeated 15 and 30 minutes following anesthetic administration. Results: The lowest pain scores at the first time point were observed in Lid + SB when compared with all of the other groups (p < 0.05). At the final time point, significantly lower scores were also observed in Lid + SB, Lid + Epi + SB, and Art + Epi + SB when compared with the Lid + Epi group (p < 0.05). Conclusion: These findings could help surgeons select an appropriate combination of local anesthetics, particularly in patients with lower pain threshold and tolerance because buffered combinations of local anesthetics produce significantly lower pain scores compared with nonbuffered solutions. © 2023 Lippincott Williams and Wilkins. All rights reserved.

The appearance of cavum septi pellucidi (CSP) has been already connected with developmental disorders or with serious psychiatric diseases (schizophrenia, maniac-depressive disorder, aggressiveness or similar). During our investigation of CSP, group of alcoholics seemed to be interesting for investigation and comparison with the groups of schizophrenics and people with violent behavior. We obtained CSP in 205 out of 670 fixed brains (429 male and 241 female) of persons aged from 14 to 89 (mean ± SD: 53.28 ±16.57), 85 cava belonged to our group of interest. Prevalence of CSP in aforementioned groups was significantly higher than in the rest of examined population. Only in the group of 20 to 39 years of age all kinds of obtained pathologies were present. Alcoholics with CSP suffered from cardiovascular diseases and died accidentally and aggressive persons were the only drug addicts in our examined group and they had the shortest life span. 34 out of 41 schizophrenics had no data about prior diseases and disorders and they were the ones who committed suicide frequently. Intensive demyelinization of corpus callosum and transformation of potential space between laminae of septum pellucidum to the actual one could explain the CSP appearance among alcoholics. To our opinion, cavum septi pellucidi might be used as an additional marker of organic brain changes in long term alcohol abuse, as a consequence of demyelinization due to lipolytic effect of ethanol, and lower cerebral blood flow.

Background and Objectives: Upper eyelid blepharoplasty is a surgical procedure that addresses both aesthetic and functional concerns, offering transformative potential for patients’ overall well-being. This study systematically evaluates the comprehensive impact of upper eyelid blepharoplasty on patients’ quality of life, employing rigorous methodologies and standardized assessment protocols. Materials and Methods: A prospective, randomized controlled trial was conducted, involving 348 patients aged 49 to 87 years. Patients were randomly assigned to receive either continuous or intradermal sutures following upper eyelid surgery. Validated FACE-Q questionnaires were used to assess various outcomes, including early-life impact, expectations, satisfaction with eyes, overall face satisfaction, satisfaction with the outcome, psychological function, social function, and adverse effects. Results: Results indicate significant improvements in multiple domains of patient-reported outcomes following upper eyelid blepharoplasty, including satisfaction with eyes, overall face satisfaction, satisfaction with the outcome, psychological function, and social function. Notably, no significant differences were observed between suturing techniques regarding patient satisfaction and well-being. Adverse effects were minimal and improved over time. Conclusions: The study underscores the transformative nature of upper eyelid blepharoplasty in enhancing patients’ quality of life, addressing both cosmetic and functional concerns. Utilizing standardized assessment tools like the FACE-Q questionnaire facilitates a comprehensive understanding of treatment outcomes and enables patient-centered care. Overall, this research contributes to the growing evidence supporting the positive impact of upper eyelid blepharoplasty on patients’ well-being, emphasizing the importance of continued research and standardized assessment protocols in advancing patient care in cosmetic surgery. © 2024 by the authors.

Most skin tumors are not fatal, but if not treated in a timely manner, they can lead to significant morbidity. Due to the COVID-19 pandemic and in order to create more capacities for the treatment of COVID-19-positive patients as well as to contain the spread of the virus, the healthcare system was reorganized worldwide, leading to decreased access to preventive screening programs. The aim of this study was to evaluate the impact of the pandemic on healthcare accessibility to cutaneous squamous cell carcinoma patients in Serbia. This retrospective study was conducted at the Clinic for Burns, Plastic, and Reconstructive Surgery, University Clinical Center of Serbia in Belgrade. Patient demographics and pathohistological findings of tumors of patients living in and outside the capital in the period before, during, and after the pandemic were compared. The two groups did not show any differences regarding the largest tumor diameter prior and during the pandemic; however, this difference became extremely noticeable after the pandemic (15 mm vs. 27 mm; p < 0.001). While cSCCs are commonly slow-growing tumors, the impact of the COVID-19 pandemic is not negligible. This study found a population at a significant risk of cSCC metastasis, with additional evidence likely to emerge in the upcoming years. © 2023 by the authors.

Most skin tumors are not fatal, but if not treated in a timely manner, they can lead to significant morbidity. Due to the COVID-19 pandemic and in order to create more capacities for the treatment of COVID-19-positive patients as well as to contain the spread of the virus, the healthcare system was reorganized worldwide, leading to decreased access to preventive screening programs. The aim of this study was to evaluate the impact of the pandemic on healthcare accessibility to cutaneous squamous cell carcinoma patients in Serbia. This retrospective study was conducted at the Clinic for Burns, Plastic, and Reconstructive Surgery, University Clinical Center of Serbia in Belgrade. Patient demographics and pathohistological findings of tumors of patients living in and outside the capital in the period before, during, and after the pandemic were compared. The two groups did not show any differences regarding the largest tumor diameter prior and during the pandemic; however, this difference became extremely noticeable after the pandemic (15 mm vs. 27 mm; p < 0.001). While cSCCs are commonly slow-growing tumors, the impact of the COVID-19 pandemic is not negligible. This study found a population at a significant risk of cSCC metastasis, with additional evidence likely to emerge in the upcoming years. © 2023 by the authors.

Cavum septi pellucidi (CSP), especially when longer than 6 mm, has been recognized as a neurodevelopmental anomaly associated with schizophrenia. The present post-mortem study was designed to determine the importance of linear parameters of CSP and to evaluate the possible differences of CSP in schizophrenic patients (n = 25 out of 110 CSP+ brains) and normal persons (n = 40 out of 110 CSP+ brains). According to our results, schizophrenia patients had significantly longer and wider CSP than normal individuals. Also, statistical analysis revealed a higher suicide rate in CSP-positive patients with schizophrenia.

Cavum septi pellucidi (CSP), especially when longer than 6 mm, has been recognized as a neurodevelopmental anomaly associated with schizophrenia. The present post-mortem study was designed to determine the importance of linear parameters of CSP and to evaluate the possible differences of CSP in schizophrenic patients (n = 25 out of 110 CSP+ brains) and normal persons (n = 40 out of 110 CSP+ brains). According to our results, schizophrenia patients had significantly longer and wider CSP than normal individuals. Also, statistical analysis revealed a higher suicide rate in CSP-positive patients with schizophrenia.

Background and objectives: Bullous pemphigoid (BP), the most common subepidermal autoimmune skin blistering disease (AIBD) has an estimated annual incidence of 2.4 to 42.8 new cases per million in different populations, designating it an orphan disease. Characterized by disruption of the skin barrier combined with therapy-induced immunosuppression, BP could pose a risk for skin and soft tissue infections (SSTI). Necrotizing fasciitis (NF) is a rare necrotizing skin and soft tissue infection, with a prevalence of 0.40 cases per 100,000 to 15.5 cases per 100,000 population, often associated with immunosuppression. Low incidences of NF and BP classify them both as rare diseases, possibly contributing to the false inability of making a significant correlation between the two. Here, we present a systematic review of the existing literature related to the ways these two diseases correlate. Materials and methods: This systematic review was conducted according to the PRISMA guidelines. The literature review was conducted using PubMed (MEDLINE), Google Scholar, and SCOPUS databases. The primary outcome was prevalence of NF in BP patients, while the secondary outcome was prevalence and mortality of SSTI in BP patients. Due to the scarcity of data, case reports were also included. Results: A total of 13 studies were included, six case reports of BP complicated by NF with six retrospective studies and one randomized multicenter trial of SSTIs in BP patients. Conclusions: Loss of skin integrity, immunosuppressive therapy, and comorbidities commonly related to BP patients are risk factors for necrotizing fasciitis. Evidence of their significant correlation is emerging, and further studies are deemed necessary for the development of BP-specific diagnostic and treatment protocols. © 2023 by the authors.

Introduction: Aesthetic surgery procedures are generally done in a relatively healthy population and carry a rather low risk compared to other surgical specialties. The incidence of complications in aesthetic surgery varies greatly depending on the type, wound cleanliness regarding the anatomical site, complexity of the surgery, patient’s age, and comorbidities but is generally considered low. The overall incidence of surgical site infections (SSIs) in all aesthetic surgical procedures is around 1% in most of the literature while cases of necrotizing soft tissue infections are mostly found as individual reports. In contrast, treating COVID-19 patients is still challenging with many diverse outcomes. Surgical stress and general anesthesia are known mediators of cellular immunity impairment while studies regarding COVID-19 infection unquestionably have shown the deterioration of adaptive immunity by SARS-CoV-2. Adding COVID-19 to the modern surgical equation raises the question of immunocompetence in surgical patients. The main question of the modern post-lockdown world is: what could be expected in the postoperative period of perioperatively asymptomatic COVID-19 patients after aesthetic surgery? Case report: Here, we present a purulent, complicated, necrotizing skin and soft tissue infection (NSTI) after gluteal augmentation most likely triggered by SARS-CoV-2-induced immunosuppression followed by progressive COVID-19 pneumonia in an otherwise healthy, young patient. To the best of our knowledge, this is the first report of such adverse events in aesthetic surgery related to COVID-19. Conclusion: Aesthetic surgery in patients during the incubation period of COVID-19 or in asymptomatic patients could pose a significant risk for surgical complications, including severe systemic infections and implant loss as well as severe pulmonary and other COVID-19-associated complications. © 2023 by the authors.

Background and Objectives: The careful selection of adequate SLNB candidates not only aims at reducing the surgical risk while identifying SLN metastasis, but also plays a crucial role in identifying the patients eligible for adjuvant therapy. Objectives: The purpose of our study was to investigate the clinical and histologic aspects of primary melanomas that correlate with the likelihood of a positive SLNB result. Materials and Methods: A total of 101 primary melanoma patients who underwent sentinel lymph node biopsies were included in the study. General patient demographics were obtained as well as localization and melanoma-specific characteristics of primary melanoma from histologic reports in addition to data derived from SLNB melanoma histopathology reports. Results: The patients with positive SLN results had a statistically significant increased Breslow thickness (3.8 mm vs. 1.97 mm, p = 0.002), higher mitotic index rate (5/mm2 vs. 2/mm2, p = 0.009), as well as the presence of ulceration (68.4% vs. 31.6%, p = 0.007). Univariate regression analysis showed the Breslow thickness (p = 0.008), the mitotic index rate (p = 0.054), the presence of ulceration (p = 0.009), as well as the pT3-4 stage (p = 0.009) to be significant predictors of SLN positivity. The optimal cut-off values for Breslow thickness and the number of mitoses scores were determined based on ROC curve analysis. Using the Breslow thickness, mitotic index rate, presence of ulceration, and pT3-4 stage significant coefficients from the univariate regression model, a chance prediction score was developed. Conclusions: The newly developed and proposed scoring system can aid in patient selection for SLN biopsy by facilitating a more efficient risk assessment in the detection of lymph node metastases in melanoma patients. © 2023 by the authors.

Introduction Primary malignant tumors of the sternum are rare, with chondrosarcoma being the most common primary malignant tumor of the chest. The gold standard in treatment is surgical treatment with wide resection margins, where the rigidity of the chest wall must be ensured, with protection of internal organs with satisfactory lung function. Case outline We present a 67-year-old patient in whom previous computed tomography and magnetic resonance imaging examinations confirmed a tumor mass involving the sternum with the associated ribs, with involvement of the soft tissues above. First, sternum resection was performed with partial resection of the associated ribs and soft tissues. Reconstruction and stabilization of the chest wall were achieved with two layers of polypropylene mesh and methyl methacrylate bone cement with antibiotics. We reconstructed the primary soft tissue defect with a combination of a large local fasciocutaneous flap raised from the abdomen and a smaller sliding flap from the chest. The secondary defect was reconstructed by wide undermining of the skin in the area of the anterior abdominal wall and a small Thiersch-type free skin graft. In the postoperative period, the flaps were vital, but there was necrosis of the free skin graft. That defect was closed secondary thanks to bandaging. Respiratory function was preserved. Conclusion Surgical treatment is the main treatment for sternal chondrosarcoma. With an adequate preoperative and intraoperative approach, it is necessary to enable good postoperative oncological outcomes with the achievement of chest rigidity and satisfactory respiratory status. © 2024, Serbia Medical Society. All rights reserved.

Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients. © 2023 by the authors.

Background: Burn wound dressing and debridement are excruciatingly painful procedures that call for appropriate analgesia—typically multimodal. Better post-procedural pain management, less opioid use, and consequently fewer side effects, which could prolong recovery and increase morbidity, are all benefits of this type of analgesia. Intravenously administered ketamine can be effective as monotherapy or in combination with opioids, especially with procedural sedation such as in burn wound dressing. Methods: This observational study investigated the effect of ketamine administered in subanesthetic doses combined with opioids during burn wound dressing. The study was conducted from October 2018 to October 2021. A total of 165 patients met the inclusion criteria. A total of 82 patients were in the ketamine group, while 83 patients were dressed without ketamine. The main outcome was the effect of ketamine on intraprocedural opioid consumption. The secondary outcome included the effect of ketamine on postprocedural pain control. Results: Patients dressed with ketamine were significantly older (p = 0.001), while the mean doses of intraoperatively administered propofol and fentanyl were significantly lower than in patients dressed without ketamine (150 vs. 220 mg, p < 0.001; and 0.075 vs. 0.150 mg, p < 0.001; respectively). Conclusions: Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management. © 2024 by the authors.

Background/Aim. Radial artery perforator flap (RAPF) is a type of fasciocutaneous or adipofascial reverse pedicle flap, which proved to be a versatile flap for the reconstruction of small and moderate size soft tissue defects of the forearm, wrist, and hand. RAPF provides suitable skin coverage with elastic subcutaneous tissue thus enabling the protection of exposed or damaged functional structures and their simultaneous repair. The aim of this study was to summarize and analyze the results of the treatment of patients with upper extremity soft tissue defects caused by trauma, infection, burn, or tumor removal, which were reconstructed with RAPF. Methods. This retrospective study included 20 consecutive patients with skin and soft tissue defects of the hand and wrist, treated at the University Clinical Center of Vojvodina from 2012 to 2022. The design of the flaps and length of the pedicles were determined by the recipient site. Tourniquet-induced exsanguination was used during surgery for better visualization. The flaps were elevated and placed at the site of the defect. Data on patients and flaps were summarized upon their collection. Results. Distally based fasciocutaneous RAPF was used in all cases. The average age of the patients was 48 years, predominantly (64%) males. Defects were most often localized on the dorsal part of the hand (60%) and wrist (20%). The most common indications for surgery were trauma (45%) and tumor resection (25%). A satisfactory coverage of the defect was achieved in all 20 patients with no flap loss. Venous congestion was noted in 4 (20%) patients, which resulted in partial necrosis of the flap in 3 (15%) patients. Wound healing was achieved upon conservative treatment by secondary intention in two patients and with a secondary suture in the last one. A surgical site infection occurred in 2 (10%) patients who withdrew after proper local and systemic therapy. Conclusion. RAPF proved to be a workhorse flap for soft tissue reconstruction of the upper limb. This surgical solution led to an excellent functional and aesthetic outcome in the majority of patients. Complex surgical procedures could be done simultaneously, together with the reconstruction of tendons, joints, or fracture stabilization. The reliability and safety of these flaps are confirmed through our clinical data. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.