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Vertical rectus abdominis myocutaneous flap inguinal reconstruction combined with lymphatic venous anastomosis after oncological resection – a case report and literature review

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Radziszewska J. , Krześniak N. , Radziszewski M. , Gierej P.

OncoReview

2023

tom 13

nr 4

103-108

Introduction: The vertical rectus abdominis myocutaneous (VRAM) flap is one of the possible solutions to cover large tissue defects after oncological resection in the inguinal region. Its efficacy can be impaired due to recipient site tissue damage following radiotherapy as well as due to lymphadenectomy, often resulting in lymphoedema and persistent lymphatic leakage. Case report: Contralateral VRAM reconstruction was performed in a 50-year-old male patient with a nonhealing inguinal wound following right thigh sarcoma excision and radiotherapy. To improve the flap performance, we combined VRAM surgery with lymphatic venous anastomosis (l VA) to the contralateral inferior epigastric vein. An immediate stoppage of the lymphatic leakage occurred as well as after the surgery a lower extremity edema reduction was observed (varying from 2 to 7 cm of leg circumference, depending on the level of the measurement). Discussion: It is possible that LVA enabled proper flap healing and improved lymphatic drainage; however, it is also probable that a similar effect could have been achieved with the VRAM flap alone. Conclusion: This case report indicates that l VA could improve VRAM flap performance in inguinal reconstruction procedures and reduce lymphedema and lymphorrhea; however, further research is needed.

Obustronna mastektomia redukująca ryzyko – procedura chirurgiczna, powikłania i zysk finansowy

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Gierej P. , Rajca B. , Górecki-Gomoła A.

Polish Journal of Surgery

2021

tom 93

nr 3

48-54

Mastektomia redukująca ryzyko jest uznanym postępowaniem profilaktycznym w grupie kobiet wysokiego i bardzo wysokiego ryzyka zachorowania na raka piersi w wielu krajach. W leczeniu chirurgicznym preferuje się mastektomię z równoczasową rekonstrukcją. Najczęściej wykonywana jest równoczasowa rekonstrukcja z użyciem implantów, ale równoważną metodą i o porównywalnym lub niższym odsetku powikłań jest równoczasowa rekonstrukcja tkankami własnymi, z uwzględnieniem wolnych płatów tkankowych. Należy poinformować pacjentkę o wysokim ryzyku powikłań, możliwym pogorszeniu jakości życia i wysokim odsetku ponownych zabiegów korekcyjnych. Aby taka forma najskuteczniejszej i wymiernej finansowo profilaktyki zdrowotnej była rzeczywiście realizowana, konieczna jest racjonalna wycena procedury i zróżnicowanie jej kosztów w zależności od rodzaju przeprowadzonej rekonstrukcji.

Bilateral risk-reducing mastectomy – surgical procedure, complications and financial benefit

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Gierej P. , Rajca B. , Górecki-Gomoła A.

Polish Journal of Surgery

2021

tom 93

nr 3

48-54

Risk-reducing mastectomy is a recognized prophylactic treatment for women at high and very high risk of breast cancer development in many countries. In surgical treatment, mastectomy with simultaneous reconstruction is preferred. The most common method is simultaneous reconstruction with the use of implants, but an equivalent method with a comparable or lower complication rate is simultaneous reconstruction with own tissues, taking into account free tissue flaps. The patient should be informed about the high risk of complications, possible deterioration of the life quality and high rate of corrective reoperations. In order for this form of the most effective and financially measurable health prophylaxis to be actually implemented, it is necessary to rationally evaluate the procedure and differentiate its costs depending on the type of reconstruction performed.

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results

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Krawczyk M. , Grąt M. , Barski K. , Ligocka J. , Antczak A. , Kornasiewicz O. , Skalski M. , Patkowski W. , Nyckowski P. , Zieniewicz K. , Grzelak I. , Pawlak J. , Alsharabi A. , Wróblewski T. , Paluszkiewicz R. , Najnigier B. , Dudek K. , Remiszewski P. , Smoter P. , Grodzicki M. , Korba M. , Kotulski M. , Cieślak B. , Kalinowski P. , Gierej P. , Frączek M. , Rdzanek Ł. , Stankiewicz R. , Kobryń K. , Nazarewski Ł. , Leonowicz D. , Urban-Lechowicz M. , Skwarek A. , Giercuszkiewicz D. , Paczkowska A. , Piwowarska J. , Gelo R. , Andruszkiewicz P. , Brudkowska A. , Andrzejewska R. , Niewiński G. , Kilińska B. , Zarzycka A. , Nowak R. , Kosiński C. , Korta T. , Ołdakowska-Jedynak U. , Sańko-Resmer J. , Foroncewicz B. , Ziółkowski J. , Mucha K. , Senatorski G. , Pączek L. , Habior A. , Lechowicz R. , Polański S. , Leowska E. , Pacho R. , Andrzejewska M. , Rowiński O. , Kozieł S. , Żurakowski J. , Ziarkiewicz-Wróblewska B. , Górnicka B. , Hevelke P. , Michałowicz B. , Karwowski A. , Szczerbań J.

Polish Journal of Surgery

2012

tom 84

nr 6

304-312

The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.