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Biomedical subjects

Z M Arnez

Publications and source records attributed to Z M Arnez.

At least 19 recordsLinked to original sources
PubMed2006

Breast reconstruction following mastectomy for invasive breast cancer by free flaps from the abdomen is oncologically safe.

AIMS: To report the long-term results of oncological safety of breast reconstruction by autologous tissue following mastectomy for invasive breast cancer. METHODS: One-hundred-fifty-six consecutive patients with invasive breast cancer treated with mastectomy and reconstruction by autologous tissue were reviewed throughout (from 1987 to 2003 with median follow up time of 66 months). RESULTS: Median patient age was 45.9 years (range 26-68). The 157 observed tumors had mean diameter of 25+/-19 mm, 70 of them were poorly differentiated, and 137 were invasive ductal carcinoma. Multifocal disease was present in 44 patients. Breast reconstruction was carried out only by autologous tissue (free flaps were used in 95% and free TRAM flap transfer was the most common reconstructive procedure). There was only one local recurrence as first site of recurrence, thus yielding a local recurrence rate of 0.6%. CONCLUSIONS: Breast reconstruction by autologous tissue following mastectomy for invasive breast cancer is an oncologically safe procedure.

Abdominal Muscles↗
PubMed2006

Factors predicting free flap complications in head and neck reconstruction.

In this retrospective study, all free flap transfers used for reconstruction following ablation of head and neck tumors in University Medical Centre Ljubljana between the years 1989 and 1999 were analysed. The data taken from the patients' charts covered the demographic profile, the tumor and free flap details (44 variables for each patient). Logistic regression model was used to identify factors associated with free flap failure and complications. One hundred and sixty-two patients with head and neck tumors underwent microsurgical reconstruction. One hundred and ninety-four free flaps were performed with an overall success rate of 85%. Two significant predictors of free flap complication were identified: diabetes and salvage free flap transfer. Patients with diabetes were five times more likely to develop complications associated with free flaps (p = 0.02). Free flap complications were four times more likely to develop after salvage free flap transfer (p = 0.04). In addition, two significant factors predicting free flap failure were identified: salvage free flap transfer (p = 0.019) and use of interposition vein grafts (p = 0.032). After this study we changed our strategy of free flap selection and preoperative evaluation of the patients with head and neck tumors requiring free tissue transfer. Between January 2000 and January 2005 we performed additional 105 free flaps for head and neck reconstruction after tumor resection in 101 patients and our success rate improved to 94.3%.

Adult↗
PubMed2004

Breast reconstruction by the free transverse gracilis (TUG) flap.

The transverse upper gracilis (TUG) flap is a free musculocutaneous (type II) flap consisting of a segment of the proximal gracilis muscle and a 25x10 cm skin paddle oriented transversely. The vascular pedicle of the TUG flap is the ascending branch of the medial circumflex femoral artery with two venae comitantes. The pedicle length is 6 cm and the diameter of the artery is 1.6 mm. In the year 2002, seven patients had breast reconstruction by the free TUG flap. There were three primary and four secondary reconstructions. Five flaps totally survived, two flaps were lost (in the same patient).TUG flap is indicated in women who seek primary autologous reconstruction after a skin sparing mastectomy, have small or moderately large breasts, do not accept scars on the abdomen, back or gluteal region, who are large in hips and thighs and want a thigh lift. The vascular pedicle although short, permits easy anastomosis of matching vessel diameters to the internal mammary vessels. The main possible complication, other than thrombosis at the anastomosis, is wound dehiscence on the thigh with secondary wound healing. This can happen when the flap is wider than 10 cm.

Female↗
PubMed2003

Nerve fibre composition of the palmar cutaneous branch of the median nerve and clinical implications.

Fifteen fresh human cadaver hands were dissected, using x2.8 loupe magnification, to study the subcutaneous innervation at the site of the incision (in the line with the radial border of the ring finger) for standard open carpal tunnel decompression. Subcutaneous nerve branches were detected and traced proximally to determine their origin. Morphometric analysis of nerve cross sections from the site of the incision and from the main nerve trunk proximal to cutaneous arborisation was performed using light and transmission electron microscopy and a computer-based image analysis system. At the site of the incision, the ulnar sub-branch (US) of the palmar cutaneous branch of the median nerve (PCBMN), which innervates the skin over the hypothenar eminence, was found in 10 of 15 cases. Branches from the ulnar side were not detected. The main trunk of PCBMN consisted on average of 1000 (SD 229) myelinated axons arranged in 1-4 fascicles. In the US of the PCBMN there were on average 620 (SD 220) myelinated axons, 80% of them smaller than 40 microm(2) i.e. thin myelinated axons, and on average 2037 (SD 1106) unmyelinated axons, arranged in 1-3 fascicles. The ratio of the number of myelinated axons in the US and the main trunk of the PCBMN was on average 63% (SD 19%). Frequency distribution of cross-sectional areas of myelinated axons shows no significant difference between the US and the main nerve trunk of the PCBMN. The importance of incision trauma to subcutaneous innervation of palmar triangle is emphasised and possible mechanisms of scar discomfort are discussed.

Adult↗
PubMed2001

External osteotomy in rhinoplasty.

OBJECTIVES: To compare external and internal lateral osteotomy in rhinoplasty. STUDY DESIGN: Retrospective review and study on cadavers. METHODS: One hundred forty-two patients who underwent aesthetic rhinoplasty were examined. The following criteria were taken into consideration: edema and ecchymosis around the eyes, the degree of closure of the roof, symmetry and level of fractures, solidity of the bone pyramid, and any scarring at the access point of the osteotome. In the last 25 patients who had surgery, a nasal endoscopy with optical fibers was carried out to evaluate any damage to the mucosa caused by the 2-mm osteotome. Furthermore, to compare the two routes in vivo, for five of these patients a lateral osteotomy was carried out externally for one side and internally for the other. Lateral osteotomy were performed on five cadavers by an external route on one side and by an internal one on the other. A midface degloving procedure was performed to expose the osteotomy sites. RESULTS: Edema and ecchymosis were always much less severe in patients who were treated with external osteotomy. The control of the fracture line was always excellent. Endoscopic evaluation and study on cadavers revealed damages to the mucosa caused from the internal osteotomy and a better control of fracture line in external osteotomy. CONCLUSIONS: External osteotomy is an easy and precise approach. Because the fracture is of a greenstick type, the bone stumps are stable. The reduced bleeding reduces the formation of edemas and ecchymosis around the eyes. The damage to the nasal mucosa is minimal, and the cutaneous scars are virtually invisible a month after surgery.

Adult↗
PubMed2000

Treatment of extensive bone and soft tissue defects of the lower limb by traction and free-flap transfer.

Twenty patients with extensive bone and soft tissue defects and posttraumatic osteomyelitis were treated between 1983 and 1995. In all cases an external fixator was used for bone fixation. Bone defects were managed with the Ilizarov intercalary bone transport. Two types of traction were used: the Ilizarov type and a 'new' Ljubljana type. The results of treatment were compared between the two types of traction. In all cases delayed bony union was observed. Osteomyelitis never reactivated. All patients were satisfied with treatment. They were all independent except for one amputee. The Ljubljana traction method was found to have the following advantages: no discrepancy in leg length, no orthopaedic support was needed, the aesthetic outcome was better, the traction time was reduced and there was less soft tissue damage during bone traction.

Adolescent↗
PubMed2000

Microvascular skin response to local cooling and body tilt early after digital replantation.

To elucidate the alteration in cutaneous microvascular reactivity early after replantation (14-21 days), laser Doppler (LD) flow changes evoked by direct and indirect local cooling and head-up body tilt were studied in the replanted digits (n = 10) and compared with those evoked in the healthy contralateral digits of the same patients (n = 10). During the first 3 minutes of direct cooling of the injured hand, LD flow increased significantly compared with the LD flow before cooling, which confirms that moderate vasodilation is the dominant component of the response to local cooling in skin microcirculation in the early period after replantation. During body tilt, LD flow in the healthy contralateral digit decreased significantly in only the first minute, while LD flow in the replanted digit started to decrease in the second minute after tilting; the decrease was significant from the third to the sixth minute. These results are consistent with the hypothesis that increased human skin alpha-adrenergic receptor sensitivity may be present as early as 2 to 3 weeks after replantation.

Adolescent↗
PubMed2000

Physiological differences for distinct somatic sensory modalities and sweating among the donor sites of cutaneous and fasciocutaneous free flaps.

Differences of sensation and sweating among the typical sites of cutaneous and fasciocutaneous flaps (scapular, lateral arm, radial forearm, groin and dorsalis pedis) were assessed in 30 healthy volunteers (20 males and 10 females) aged 17-62 years (mean 38.2 years). Standard clinical methods were used: Semmes-Weinstein monofilaments for testing light touch threshold, discriminator and blunt caliper for evaluation of static and dynamic two-point discrimination and the Marstock quantitative method for assessing the normative values of warm-cold difference limen and heat and cold pain thresholds. Spontaneous sweat secretion was observed and documented by the ninhydrin test. We established various physiological differences for distinct somatic sensory modalities and sweating among the body regions (donor sites of cutaneous and fasciocutaneous free flaps).

Adolescent↗
PubMed1999

Describing severe limb trauma.

Seventy-nine severe limb injuries were retrospectively reviewed to compare the AO/ASIF and the Gustillo classifications. Specifically, the suitability of these classifications with respect to prognosis and management of these cases was compared. A healed and stable wound was the ultimate outcome measure. Surrogate outcome measures used were: the time to healing; the number of anaesthetics until the wounds were healed; and the number of operations until the wounds were healed. Any change in lifestyle following the injury was also assessed. The primary healing rates of the AO/ASIF groups showed significant (P < 0.001) inter-group differences. However, when the injuries were classified using the Gustillo system, the primary healing rates did not show any differences between the groups. Also, differences in the other outcome measures were most pronounced when using the AO/ASIF system. Importantly, changes in lifestyle correlated with the injury score when using the AO/ASIF system (P < 0.05). Unlike the AO/ASIF system, the Gustillo system was not applicable in 100% of cases. A modified AO/ASIF scoring system is proposed which provides a good predictor of outcome.

Acute Disease↗
PubMed1999

Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity.

Reconstruction of the female breast following mastectomy has become commonplace. The number of donor sites have increased as the quest both for improving reconstruction and reducing morbidity continues. There are a number of donor sites which resemble breast tissue in terms of skin texture, suppleness and colour. The 'gold standard' for transfer in breast reconstruction, however, is the lower abdominal skin and fat. The tissue can be moulded into virtually any breast shape desired. The lower abdomen can provide enough material for total autologous reconstruction of small, moderate sized or even large breasts. This tissue can be transferred onto the chest wall for breast reconstruction using four vascular axes. These are the superior epigastric artery (SEA), the deep inferior epigastric artery (DIEA), a perforator of the deep inferior epigastric artery (DIEP) or the superficial inferior epigastric artery (SIEA). The main problem with the majority of these techniques is that they may be associated with significant donor site morbidity due to harvest of some or all of the rectus muscle. An order of decreased muscle harvest is as follows; pedicled TRAM > free TRAM > DIEP > SIEA. It is envisaged that morbidity will be reduced if the aponeurosis and musculature of abdominal wall is kept intact. This can be achieved in selected cases if the 'abdominoplasty' flap is harvested on the SIE vessels. We present a logical approach to harvesting the lower abdominal wall tissue in order to reduce donor site morbidity.

Abdomen↗
PubMed1999

Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap.

The lower abdominal wall has established itself as tissue that can mimic the breast to a high degree. Attention has, therefore, turned to harvesting and transferring this tissue, but with minimal donor site morbidity. We report on our experience with five transfers of this tissue based on the superficial inferior epigastric (SIE) vessels. This technique negates the harvest of any rectus muscle and thus its advantages become immediately obvious. The anatomy is reviewed as well as the techniques used. The limitations of this technique relate to the pedicle. The pedicle is shorter than the deep inferior epigastric (DIE) axis and presents itself on the anterior aspect of the tissue. However, these limitations can be overcome with simple adjustments.

Breast Neoplasms↗
PubMed1998

Salvage of a below knee amputation stump with a free sensate total sole flap preserving continuity of the posterior tibial nerve.

We illustrate the use of a free sole flap with intact posterior tibial nerve in the coverage of a below knee amputation 6 months after an explosive injury to a 12-year-old child. We discuss the indications for lower leg amputation in children, modalities of reconstruction of the amputation stump and possible reason for the observed change of colour of the flap persisting for 14 days.

Amputation Stumps↗
PubMed1997

Regeneration of sudomotor and sensory nerve fibres after digital replantation and microneurovascular toe-to-hand transfer.

The end-stage sudomotor and sensory recovery in patients with replanted fingers and patients after microneurovascular toe-to-hand transfer was studied using quantitative electrophysiological investigations (recovery of sensory nerve action potentials and the sympathetic skin response), the ninhydrin test and clinical testing of sensory regeneration (light touch, pain, static and dynamic two-point discrimination). 13 adult patients with 22 replanted digits (11 males, 2 females) aged 21-58 years (mean 42.2 years) and 12 adults and adolescents (8 males, 4 females) aged 13-45 years, (mean 26.8 years) following 14 microneurovascular great and/or second toe-to-hand transfers were studied. The replanted fingers were examined 2-7 years after injury and replantation. The toe-to-hand transfers were examined 2-12 years after injury and transfer. The results show better end-stage recovery of sudomotor and sensory function following finger replantation when compared to microneurovascular toe-to-hand transfer.

Adolescent↗
PubMed1996

One hundred sixty-seven thumb replantations and revascularisations: early microvascular results.

One hundred sixty-seven thumb replantations and revascularisations were performed from 1977 to 1987 by the Ljubljana microsurgical team. Early microvascular results of thumb replantations and early reoperations were analysed retrospectively. Age of the patients, level of traumatic amputation, mechanism of injury, use of arterial grafts, severity (total-subtotal) of amputation and occurrence of thrombosis were potential survival factors analysed with logistic regression analysis. The overall success rate for this series was 66% (72% for failures to revascularise excluded). The most frequent cause of failure was venous thrombosis. The most critical time for failure was the first 4 days after the replantation. No microvascular complication occurred later than the seventh day and no reoperation was successful later than the third day after replantation. Survival factors were studied with logistic regression analysis which showed that the model was not statistically significant. However, estimation of relative risks gave us useful but statistically uncertain information regarding the survival factors inspected.

Adolescent↗
PubMed1996

Functional results of 46 thumb replantations and revascularisations.

The functional results of 46 patients with isolated thumb replantations and revascularisations were evaluated in the outpatient clinic. The modified system for evaluation of reattached parts proposed by Burton was used. The system for functional evaluation of hands consisted of three major fields: socioeconomic factors, objective assessment and subjective assessment. Certain potential factors which might have influenced the functional results were analysed using Kruskal-Wallis's and Wilcoxon's sum of ranks tests. Level of amputation (P < 0.01) and mechanism of amputation (P < 0.05) significantly influenced the functional result. Age of the patients and severity of amputation (total-subtotal) had no effect on the late results. Thirty-nine patients (85%) had the same employment as before injury. All the patients had economically suitable employment and 31 patients (67%) had the same manual work as before the injury. All but 8 patients experienced cold intolerance. Satisfaction with aesthetic appearance of injured hand differed between sexes: women not being pleased with the sight of their hands in 37% (3/8) and men in 8% (3/38). All patients but one would have the operation again.

Adolescent↗
PubMed1996

Measurement of sudomotor fibre regeneration by sympathetic skin response after complete division of peripheral nerves in children.

Sympathetic Skin Response (SSR) was measured in 14 paediatric patients (age range 3-15 years, mean 7.2 years) following repair of lacerated upper limb peripheral nerves (median, ulnar or both). All nerves had been completely divided and were repaired by primary epineural repair. Measurements of SSR were made at regular, 1-2 monthly, intervals during nerve regeneration in 6 patients. A further group of 7 patients had single SSR measurements at the end of nerve regeneration (21-63 months). A 4-year-old boy was also followed up from 10 to 21 months following replantation of a proximally amputated right upper limb. The method was first standardised in 16 healthy volunteers (age range 3-17 years, mean 9.4 years). Patients over 6 years of age were also clinically tested for return of sensation. The results show that the objective measurement of sudomotor nerve regeneration in children is possible with this method. They demonstrate its universal acceptance by children as young as 3 years old.

Adolescent↗