Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient’s age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon’s reliability in performing a particular procedure. Our study found no advantages of one procedure over the other.
Background/Aim. Neurocutaneous flaps (NF) are the type of fasciocutaneous flaps whose clinical application has increasingly grown over the years. They have become an indispensable step in the reconstructive ladder for the small and medium soft tissue defects of the lower leg and foot. The aim of this study was to analyse the results of the treatment of patients with lower extremity soft tissue defects caused by trauma, infection, tumour removal or unstable scar formation, which were reconstructed with a variety of NF. Methods. This retrospective study includes 32 consecutive patients with soft tissue defects of the lower limb, treated in the Clinical Centre of Vojvodina from January 2004 to April 2017. All the operations were performed in regional anaesthesia with pneumatic tourniquet. Design of the flap and length of the pedicle were determined by the size and position of the recipient site after necessary debridement. The flap was harvested, rotated and positioned in the defect region. The patients and flap data were summarized upon their collection. Results. The average age of the patients, mostly males (81.2%), was 46.7 years. Distally based sural flaps were used in a majority of patients (56.2%), followed by the distally based saphenous (21.9%), lateral sural (12.5%) and proximally based sural flaps (9.4%). Defects were most often localized on the distal third of the lower leg and on the ankle (53.1%). The most common indication for surgery were trauma (46.9%) and chronic infection (31.2%). A satisfactory coverage of the defect was achieved in all 32 patients with no flap loss. A partial necrosis of the flap due to prolonged venous congestion was noted in 3 (9.4%) patients, which were healed by second intention or with delayed skin grafting. Five (15.6%) patients developed a localised infection. The infection signs withdrew spontaneously in 2 cases and after a surgical revision in 3 cases, where osteitis of the tibia had persisted. One of them required the Ilizarov orthopaedic procedure after bone resection. Conclusion. NF proved to be a paramount alternative to free-flap reconstruction of the lower limb. Intensive clinical application can be explained by the fact that it is a less technically demanding and time consuming surgical procedure with no major source vessel sacrifice. The reliability and safety of their utilisation are confirmed by our clinical data.
Treatment is usually based on systemic antimycotic agents (Amphotericin B, Azoles: Fluconazole, Flucytosine). Prophylactic treatment is still a matter of debate. It is not routinely recommended in ICU, but is commonly used in transplant patients.
Background / Aim. Children with burns are submitted to multiple, painful and anxiety related procedures during wound dressing, treatment, and rehabilitation. The objective of analgesic treatments for procedural pain is the safe and efficient management of pain and emotional stress, which requires a careful, balanced, and systematic approach. The goal of this study was to determine the effectiveness of analgesic and/or local anestetic on relieving the intensity of procedural pain. Methods. In the study, 120 pediatric patients with second-degree burns were allocated into four groups of 30. During wound dressings, patients in the control group did not receive any analgesics, while in the remaining groups 30 minutes prior to wound dressing, oral nonsteroidal anti-inflammatory drug, local anesthetic, or both were administered. Results. The average visual analog scale (VAS) score in the control group was statistically significantly higher on all tested days in comparison with children in all groups who were treated. On the first test day, all children had high VAS values and the limit was 89.50/100. There was a remarkable difference on the fifth day of dressing with the limit of 57.50/100, and on the seventh day the limit was 43.50/100. Children who experienced the lowest intensity of pain during dressing changes of burn wounds for all test days were those in the group who recieved both systemic analgesic and local anesthetic. Conclusion. The study confirmed the importance of the introduction of complex polymodal protocol in the treatment of procedural pain in second degree burns. The protocol should include analgesics as well as anesthetics since they both contribute in achieving the best results in pain reduction and treatment outcome.
Background/Aim. Radial artery perforator flap (RAPF) as a type of fasciocutaneous or adipofascial reverse pedicle flap, proved to be a versatile flap for reconstruction of small and moderate size soft tissue defects of the forearm, wrist, and hand. It provides suitable skin coverage with elastic subcutaneous tissue to protect exposed or damaged functional structures. The aim of this study is to summarize and analyse the results of the treatment of our patients with upper extremity soft tissue defects caused by trauma, infection, burn or tumour removal which were reconstructed with RAPF. Methods. This retrospective study includes 20 consecutive patients with skin and soft tissue defects of the hand and wrist, treated in the University Clinical Centre of Vojvodina from 2012 to 2022. 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. Patient and flaps? data were summarized upon their collection. Results. Distally based radial artery fasciocutaneous perforator flaps were used in all of the cases. The average age of the patients was 48 years, mostly males (64%). 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 tumour resection (25%). A satisfactory coverage of the defect was achieved in all 20 patients with no flap loss. Venous congestion was noted in 4 patients (20%) which resulted in partial necrosis of the flap in 3 patients (15%). Wound healing was achieved upon conservative treatment by secondary intention in two patients and with secondary suture in the last one. A surgical site infection occurred in 2 patients (10%) which withdrew after proper local and systemic therapy. Conclusion. Radial artery perforator flap 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 reconstruction of tendons, joints, or fracture stabilisation. The reliability and safety of this flaps is confirmed through our clinical data.
Introduction. Trichobezoars and gastric polyps are very rare conditions in children and may pose a diagnostic and therapeutic challenge. The purpose of this work is to present our successful experience using combined laparoscopic-endoscopic procedure for simultaneous treatment of a trichobezoar and gastric polyp in the same patient. Case outline. We present an unusual case of a 15-year-old girl whose symptoms included abdominal pain, non-bilious vomiting after feeding, including undigested food and sometimes hair. Positive history of trichophagia indicated that a trichobezoar could be the reason for her problems. Endoscopy and ultrasound examination revealed a trichobezoar occupying almost the entire capacity of the stomach, as well as one oval polyp in the prepyloric area of the antrum. Simultaneous combined laparoscopicendoscopic rendezvous procedure was performed. The trichobezoar (14 ? 6 cm) and the gastric polyp (2.2 ? 1.7 cm) were completely removed laparoscopically through anterior gastrotomy, with great support of an adequate endobag and mechanical fragmentation of trichobezoar. The postoperative course was uneventful. Conclusion. This case shows that diagnostic endoscopy is valuable and that the combined laparoscopicendoscopic technique is feasible, safe and recommended treatment for simultaneous removal of a gastric trichobezoar and gastric polypectomy.
Introduction/Objective Fibroadenoma, often called "breast mice tumors" due to their mobility, are the most common breast tumors in pediatric population. Considering that some tumors have a potential for rapid growth, breast tissue damage, and that an ideal diagnostic tool has yet to be found, complete mass extirpation might be the treatment of choice. The aim of the study was to present our clinical experience in treating children with breast masses. Methods A retrospective review (2011-2018) of patients treated for breast tumors at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad was conducted. Results In this study 29 girls (mean age 15.8 ± 1.8) were included. The majority of masses were located in the upper outer (27.6%) or lower inner (24.1%) breast quadrant. The mean mass diameter was 39.7 mm. It has been observed that the mean mass diameter in the group of girls with positive family history for breast diseases was significantly lower (p < 0.05) than in those with negative family history (27.5 vs. 43.2 mm). There were no proven malignant tumors and all tumors have been completely extirpated. The mean postoperative stay was 1.5 ± 1.02 days. Conclusion An appropriate radical operative technique dependent on mass size and localization is still the "gold standard" for treating breast masses in pediatric patients. Cooperation with experts in the field of oncologic breast surgery enables implementing these operative techniques in clinical practice of pediatric surgeons.
Introduction. Undescended testis is the most common congenital anomaly of the male urogenital tract. The main issues associated with this condition are decreased fertility and an increased risk for testicular cancer, which are minimized if early orchiopexy is performed. The objective of this study is to evaluate the age at orchiopexy at the Institute of Child and Youth Health Care of Vojvodina and to compare it to international guidelines (American Urological Association, Canadian Urological Association and European Association of Urology). Material and Methods. A retrospective study included 457 patients operated on between 2010 and 2015. The recorded data were analyzed by Microsoft Excel Office 365 using means, medians, minimums, maximums and standard deviations where appropriate. The patient age and current recommendations for timing of orchiopexy were analyzed as well. Results. The mean age at orchiopexy was 69.47 months, and the median age was 64 months. Considering each year separately, no significant differences between mean and median age at orchiopexy were found. The percentage of orchiopexies performed before 24 months was 29% and 5% were performed before 12 months of age. The mean age at orchiopexy was 51.47 months later than recommended by current international guidelines. Conclusion. This study confirmed that the age at orchiopexy in our sample was significantly delayed than recommended. It is necessary for all medical practitioners involved in child health care to share new information, trends and diagnostic-therapeutic algorithms about undescended testis and consequences of late treatment.
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