Biomedical subjects

M Molski

Publications and source records attributed to M Molski.

At least 19 recordsLinked to original sources

PubMed2001

On the relationship between fractal geometry of space and time in which a system of interacting cells exists and dynamics of gene expression.

We report that both space and time, in which a system of interacting cells exists, possess fractal structure. Each single cell of the system can restore the hierarchical organization and dynamic features of the entire tumor. There is a relationship between dynamics of gene expression and connectivity (i.e., interconnectedness which denotes the existence of complex, dynamic relationships in a population of cells leading to the emergence of global features in the system that would never appear in a single cell existing out of the system). Fractal structure emerges owing to non-bijectivity of dynamic cellular network of genes and their regulatory elements. It disappears during tumor progression. This latter state is characterized by damped dynamics of gene expression, loss of connectivity, loss of collectivity (i.e., capability of the interconnected cells to interact in a common mode), and metastatic phenotype. Fractal structure of both space and time is necessary for a cellular system to self-organize. Our findings indicate that results of molecular studies on gene expression should be interpreted in terms of space-time geometry of the cellular system. In particular, the dynamics of gene expression in cancer cells existing in a malignant tumor is not identical with the dynamics of gene expression in the same cells cultured in the monolayer system.

Animals↗

PubMed2001

[Use of pedicled radial forearm flaps for covering of extensive soft tissue defects in the upper extremity].

Results of treatment of 13 patients with extensive defects of soft tissues in the upper extremities treated with pedicled radial forearm flaps are presented (11 fascio-cutaneous flaps and 2 adiposo-cutaneous). The group included 5 females and 8 males aged 9-85 years (mean age: 37 years). The defects followed trauma in 12 cases and in one case it was the result of oncological resection. The flap was used as a primary procedure in 4 cases after amputation of the finger or degloving of the hand. The flap appeared very useful in delayed reconstructions in older patients with extensive defects of soft tissues and bones, especially in the elbow region. Complete survival of all flaps with very good late results were obtained. Donor sites were covered with skin grafts and healed correctly in 11 patients. In two patients healing of the donor site prolonged in time for over 6 weeks. No other complications were observed using this method.

Adolescent↗

PubMed2001

[Evaluation of late results of reconstructions of the thumb by trimmed great toe method].

Twelve patients with posttraumatic defects of the thumb were treated in the years 1990-1999 by the trimmed great toe method. Eight of them had additional injuries or loss of long fingers (two patients lost all fingers). Reconstruction methods were chosen basing on the amputation level. A fragment of the trimmed great toe of an appropriate length was used distally to the distal part of the first metacarpal according to the technique described by Wei (9 patients). In cases of a more proximal amputation only a distal part of the great toe was used. Pollicisation of other elements of the index with simultaneous free transfer of the great toe distal part was carried out in two patients with index amputations. Bone stabilization was secured by K wires. Arthrodesis was performed in three patients. Tendons were sutured in eight patients In every case anastomosis of the dorsal pedis artery, saphenous vein and two toe digital nerves were performed (additionally the toe plantar artery was anastomosed in two patients and branches of the superficial peroneal nerve were anastomosed in seven patients). Immobilization was applied for four weeks on the foot and six weeks on the hand. All the transferred trimmed great toes survived completely. The hand wounds healed after two weeks, the foot wounds 2-7 weeks (twenty eight days on average). Late results were evaluated 1-9 years after reconstruction. 2PD was 6-14 mm. Thumb length was similar to the contralateral ones and the average range of motion in i.p. join was 3 degrees. According to the patients the results were very good.

Adolescent↗

PubMed2001

[One stage total thumb reconstruction using MP II joint pollicisation] and free transfer of distal part of great toe: report of two cases].

Indications, treatment and late results of thumb reconstruction in two males aged 28 and 29 are presented. The thumbs had been amputated on the level of the middle first metacarpal with concomitant amputation in the middle of proximal phalanx of the index. Besides, one of the patients lost all other fingers in this hand. Reconstructions of the thumbs were carried out in the third and sixth months after the injury using pollicisation of the index stump and transferring free distal part of the trimmed great toe. FHL and EHL tendons were left intact. Some complications were observed in one of the patients. The complications included: spasm of the vein in the recipient site on the second day after the operation, wound dehiscence on the foot on the tenth day and nonunion of the index phalanx. Another surgery using bone graft was necessary. Grip reconstruction in one patient with metacarpal hand needed additional two toes to hand transfer. Results of the treatment were evaluated 8 and 6 years after the reconstruction. The new reconstructed thumbs were very similar to those on the contralateral hands with good sensation and sufficient movement (40 and 60 degrees of the flexion) to obtain strong and precise grip.

Adult↗

PubMed2001

[A new method of thumb reconstruction using big and second toe elements].

The author's modification of thumb reconstruction using the big and second toe elements is presented. Two separate parts were raised on one common pedicle to form future thumb. The main element including bones, tendons and soft tissues were taken from the second toe. The flap comprising nail radix, matrix and lateral fragment of the second toe pulp was prepared and left in situ. Similar flap was raised on the hallux. Winding of the hallux flap round the second toe part allowed to form nearly normal thumb. The nail radix and matrix were harvested subperiosteally without any bone fragments of distal phalanges. Harvesting of minimum of tissues from the hallux and covering the wound by similar flap from the second toe markedly limited the big toe deformation, typical for this type of procedure. The nail plate of the second toe looked acceptable on the slightly thinner hallux. Scares were localized out of the weight bearing surfaces. Best indications for this procedure include cases when the thumb is amputated on the proximal phalanx level. Rare anatomical variation of the toe vascularity may restrict application of this method. Individual length differences between the hallux and the second toe sometimes make it difficult to put the hallux flap in the proper position on the thumb. A small hallux valgity may appear when the second toe is too short.

Humans↗

PubMed2000

[Very distal finger replantation].

The paper presents the authors' experiences with very distal replantations of fingers. The results of surgical treatment in eleven cases of finger or thumb amputations at distal interphalangeal joint level or more distal are reviewed. There were 3 female and 8 male patients aged 13-45 years (mean age 25 years), with 7 amputations of the thumb and 4 amputations of other fingers. In 9 cases (82%)--8 complete amputations and 1 incomplete amputation--the replanted finger survived. In 2 failures cases, neuro-vascular flaps were used for pulp reconstruction (the authors' own modification). In 10 cases a very good functional and cosmetic result was achieved.

Adolescent↗

PubMed2000

[Use of reverse flow pedicled osteo-fascio-cutaneous radial forearm flap in reconstruction of the first ray in the hand].

A reverse flow pedicled osteo-fascio-cutanous radial forearm flap was applied in different clinical situations. Treatment of 1 female patient--age 28 years, and 3 male patient--age 17, 29 and 33 years is presented. Indications for treatment were: congenital malformation of the thenar region and thumb, deficit of the soft tissue, of the IMP joint and a segment of the first metacarpal bone, amputation of the thumb at IMP level and congenital total absence of the first ray of the hand. The author's modification of total thumb reconstruction is presented. Some steps of the procedure, using osteo-fascio-cutaneous radial flap differed from the original Biemer and Stock method. Donor site was located on the medial and radial part of the forearm. The flap was planned, elevated longitudinally and folded over the vascularized radial bone graft. In thumb reconstruction cases no implants were used for bone fixation. Part of the radius was directly nailed into the distal part of the first metacarpal. Bone healing was observed after 6 weeks and its remodeling took nearly 6 months. There were no complications at the donor site (one was closed directly and two by skin grafts). Two flaps were remodeled because of soft tissue abundance. Functional and cosmetic results were good in all four cases.

Adolescent↗

PubMed2000

[Osteosynthesis of infected and impaired growth of the femur with vascularized fibular graft].

The authors present the causes of difficulties arising during treatment of infected non-unions. Much attention was paid to the unique character of the infection in the thigh and the technical problems related to it. The role of vascularized bone grafts was emphasised. Different possibilities of surgical treatment of bone loss in different localisations were presented basing on clinical material of 7 patients. The authors used various osteosynthesis techniques, most frequently external fixators. Graft healing anf remodelling with different kind of fixators is discussed. The frequency of graft fractures was stressed. The differences in the healing of graft fractures and normal fractures was discussed. The need of suitable elasticity of the external fixator for the correct healing of the transplant and its remodelling was emphasised.

Adult↗

PubMed2000

[Tibia reconstruction using cross-leg pedicled fibular flaps: report of two cases].

The paper presents the results of treatment of two children with cross-leg pedicle fibular flaps. A boy (10 years old) was operated because of an extensive defect of the proximal tibial shaft (15 cm) and soft tissue deficit due to osteosarcoma. He had been previously operated several times: tumor resection with chemiotherapy, bone reconstruction using allografts and two other procedures because of inflammatory complications. The second case was a 9-year old girl who underwent an extensive excision of congenital pseudoarthrosis of the tibia due to neurofibroma and reconstruction of the further fragment of the tibia. Vascularized fibula was nailed deep into the tibial shaft, beyond the previously implanted metal elements. This allowed to maintain a correct axis of the limb, a firm stabilization of the transplant and probably evoked a quick periosteal reaction of the tibia. Plaster of Paris was used to immobilize the limb. Postoperative course showed no complications. The flap pedicle was cut off after 3-4 weeks. Progressive bone healing followed by bony hypertrophy was observed after 8 weeks. The children were able to fully load the operated extremities and ambulate without crutches (the boys 12 months post-surgery and the girl 6 months post-surgery).

Child↗

PubMed2000

[Evaluation of donor site morbidity after radial flap harvesting].

Donor sites of 58 radial forearm flaps in 56 patients were analysed and evaluated on the basis of documentation and follow-up examination. In 2 patients 2 radial flaps were harvested. There were 25 females and 31 males aged 9-85 (mean age: 35 years). 35 free flaps (31 on to feet, 2 on to tibial stumps and 2 on to contralateral forearm) and 4 pedicled flaps (on to the head) were transferred to distal body regions. Two of them included a part of the vascularized radius. The same upper extremity was covered with 19 pedicled radial forearm flaps (13 with retrograde blood flow). Six of them were osteo-fascio-cutaneous flaps. After harvesting 52 flaps (in 50 patients), the donor sites were covered with full or split thickness skin grafts. In 5 cases the donor sites were sutured, and in one case local V-Y plasty was used. In 11 cases the following complications were observed at the donor sites: delayed healing of the wound for more than 6 weeks in 4 cases;--chronic vascular insufficiency in 1 case;--dysesthesias on the dorsal part of the hand in 3 cases;--periodical pain and oedema of the hand in 2 cases;--unacceptable hypertrophic scar in 1 case. No acute ischemia of the hand, no fracture of the radial bone, and no neuroma of the sensory branch of the radial nerve were observed at the donor site.

Adolescent↗

PubMed2000

[Use of pedicled cutaneous groin flaps in distal reconstruction of the upper extremity].

In the years 1981-1997 at the Department of Plastic Surgery Medical Centre for Postsgraduate Education in Warsaw 116 patients were treated surgically using groin flaps and 97 patients using a pedicled cutaneous groin flap. This paper reports the results of the later technique. Reconstructions were performed in 10 female patients aged 18-58 (mean age 37.5 years) and 87 male patients aged 15-67 (mean age 33.8 years). The tissue defects or acquired deformations were caused by: crush injuries (26 cases), scalping injuries (23 cases), rugged injuries (18 cases), avulsion trauma (15 cases), explosion injuries (8 cases) and electric burns (7 cases). Flap size depended upon extent of the tissue defect and the from flaps were 7-26 cm long and 4-12 cm wide. Flap area ranged from 35 to 260 square centimetres. Emergency procedures were performed in 59 patients (61%). Secondary reconstructions were carried out in 38 cases (39%). Operative technique was based on the rules described by McGregor and Jackson. The donor site was sutured primarily tubulizing its basis--as in tube flap. The flap pedicle was cut off during a one stage procedure in 41 patients 21-30 days (mean 23 days) after surgery or during a two-stage procedure in 56 cases. The two-stage procedure consisted of an incision of part of the pedicle after 15-45 days post-op (mean 21 days) followed by a complete dissection after a few days (mean 4 days). In 44 cases the flap required modelling i.e. excision of excessives kin and/or thinning of subcutaneous tissue. The flap healed in 96 patients (99%). Complications at different stages of the treatment were observed in 40 patients (41%). In 3 cases wound ischemia was observed because of too tight suturing. Removal of skin sutures lead to normalization of blood supply. In 7 patients cyanotic skin of the distal part with no significant consequences was observed. In 27 patients (28%) necrosis of the marginal tissues surrounding the operation wound after cutting of the pedicle was noted. Besides supported necrectomy a conservative treatment was also applied by putting dressings soaked with antiseptics and 0.5% neomycine solution on a daily basis. This prolonged treatment by further several weeks. No significant complications were observed at the donor site.

Adult↗

PubMed2000

[Results of treating septic non-unions of the tibia with vascularized bone grafts and the Zespol stabilizer].

The authors present their experiences with various applications of the Zespol stabilizer and different kinds of vascularized bone transfers used in the treatment of septic non-unions of the tibia. The clinical material consisted of 24 patients with infections of the lower extremities treated with different vascularized bone transplants. The Zespol method was used in 23 cases. Compression osteosynthesis was applied every time with the stabilizer placed over the skin. The necessity of mounting the stabilizer far from the bone did not influence the stability of the osteosynthesis. Depending on the length of the transplant single or multiple plare supports were used. Additional plaster cast was applied only during wound healing. No loosening of the stabilizer was observed. The importance of early weight bearing in order to achieve bone union and remodelling of the bone graft is strongly emphasized by the authors. The described treatment allows bone union within 8 months on average. The advantages of the Zespol stabilizer in treatment of complicated disturbances of bone union are presented.

Bacterial Infections↗

PubMed1999

Application of Deformational Self-Consistent Procedure and New Potential Expansion to Effective Reduction of Wavenumbers of Rotational and Vibration-Rotational Transitions of GeS X1Sigma+

A deformationally self-consistent procedure and new expansion of the internuclear potential energy are applied to reduce the wavenumbers of 727 pure rotational and vibration-rotational transitions of nine isotopic variants of GeS to seven radial parameters with varsigma; = 1.048, varsigma = 0.00015 cm-1 and F = 1.32 x 10(15). A potential energy is expanded into a series of the variable xi = (R - R0)/[aR + (1 - a)R0] with a treated as a free-fitted parameter. For GeS, we evaluated a = 1.09255(81). This new expansion includes those of Dunham, Simons-Parr-Finlan, and Ogilvie as special cases corresponding to a = 0, 1, 12. Copyright 1999 Academic Press.

Journal Article↗

PubMed1999

[Stress fracture of free vascularized bone grafts].

Three cases of stress fracture within free vascularized bone graft were found among 35 patients with completed treatment. In 32 years old male stress fracture of free vascularized fibular graft used for tibial reconstruction occurred after a dozen of one (operated) leg hops. In 29 years old female operated due to tibial pseudoarthrosis with free vascularized iliac wing graft the fracture appeared after couple of days of intense walking. In both cases fracture occurred after incorporation of the graft, several months after removal of the external fixator. Pain and swelling of the limb increased over couple of days. In the last case of 25 years old male vascularized fibula transferred to the femur fractured in the presence of external fixator one year after surgery in the course of remodeling of the graft. In all cases X-ray revealed transverse fracture line in the middle of the graft. Plaster cast immobilization has been used in one case only. Graft remodeling with marked hypertrophy was found 4 month later.

Adult↗

PubMed1999

[Distal digital replantation after guillotine amputation].

Results of 8 distal digital replantations in 4 patients (2 females, 2 males) aged 13-45 (mean 32.5 years) are presented. Treatment was successful in 7 cases. Regional or local Oberst anesthesia was employed at surgery. Various modifications of the procedure were attempted to improve it and shorten operating time. Mean time of one digit replantation was 4 hours. At 6 months follow-up results were excellent.

Adolescent↗

PubMed1999

[Preliminary evaluation of the results of thumb replantation in the material of Plastic Surgery Clinic CMKP in Warsaw in 1983-1996].

Forty-four patients underwent thumb replantation (after complete amputation) at Department of Plastic Surgery, Medical Center for Postgraduate Education at Warsaw between 1983 and 1996. There were 41 males and 3 females aged 13-58 years (mean 29 years). In 16 patients other fingers were also amputated. Circular saw wounds prevailed (27 patients--61%). Replantation time ranged from 3 hours to almost 12 hours (mean 6.5 h). In 38 cases (86%) the replanted thumb survived. Half of the failures occurred before 1988. In all types of amputation including avulsion good results were achieved with reversed vein grafts and vessels rerouting from the index finger (from among 7 avulsed thumbs 6 survived). Surgical technique modification according to the injury type has been discussed.

Academic Medical Centers↗

PubMed1999

[Thumb replantation after 22 hours of ischemia: a case report and review of literature].

Contemporary views on ischemia time role on finger replantations within the hand are presented. Numerous cases of successful replantations after prolonged warm ischaemia (up to 42 hours) and cold ischaemia (up to 94 hours) are cited. A case of 17 year old male with thumb amputation in zone V who had successful replantation done after 22 hours of ischemia is described in details. At 4 months follow-up reinervation is progressing and prognosis is good. Intraoperative problems and pharmacotherapy are discussed.

Adolescent↗

PubMed1999

[Cross-leg pedicled fibular graft--a new reconstructive method with vascularized bone graft].

Theoretical foundations for cross-leg pedicled fibular graft, a new method for reconstruction within lower extremity with vascularized bone graft is presented. The flap can be raised in two fashions depending on blood flow direction in the pedicle. In case of regular flow up to 18 cm of fibula is available; in reversed pedicular flow over 20 cm of fibula can be harvested. An arch of rotation of the flap reaches mid-thigh and peripheral part of the lower extremity. Cross-leg pedicled fibular graft can be used for concomitant soft tissue defect reconstruction as well. Crossing and immobilization of both lower extremities is necessary for 4 weeks. No microsurgical procedure is required. Skin island of the fibular flap or narrow muscular cuff left around fibular vessels is sufficient to protect the pedicle. Main indication for cross-leg pedicled fibular flap include patients with major lower extremity injury with axial vessels damage or with history of previous trauma and thrombosis, and patients after bone tumor resection who had chemotherapy and/or radiotherapy. The indications may be markedly broadened especially in centers with no access to microsurgery. The results of this method are very encouraging so far.

Bone Transplantation↗