Andrzej Balcerowiak

Cena uzyskania wolnego płata przedramienia w rekonstrukcjach w obrębie jamy ustnej i gardła – powikłania miejsca donorowego

PURPOSE Evaluation of the donor site efficiency in patients after reconstructive surgery with use of free forearm flap. All patients were treated for oral cavity and larynx cancer. MATERIALS AND METHODS a group of 21 patients (16 men and 5 women) treated in 2007-2011. The retrospective analysis was conducted on the anamnesis, operating protocols, physical examination and a questionnaire, there was completed by patients during a routine ENT follow up examination. The PRWE (Patient Rated Wrist Evaluation) subjective questionnaire was used to estimate the rate of pain severity and wrist mobility. RESULTS In 59% of patients the wrist was healed primary, in 36% of patients by granulation. In all patients the wound was healed satisfactory in follow up examination, but 60% of patients revealed extensive scars formation. 62% of patients showed no local pain at rest, while in 38% of them worsening of symptoms was noticed--average 0.5/10 (median 1.0). Pain was more intense in patients who did basic motor activity of hands approximately 1/10 and lifting weights averaging 2.1/10. Dysfunction of the wrist was at the level of the average value of 4.2/50. CONCLUSIONS Surgical reconstruction with a use of the free forearm flap is associated with the formation of extensive wrist scars. The risk of local complications is low while preserving the qualification protocol, postoperative care and proper surgical management. Reconstructive surgery based on the free forearm flaps gives satisfactory functional results of the donor site. However, it requires surgical experience and practical knowledge of anatomy.

Przyczyny zwężeń krtaniowo-tchawiczych na podstawie przeglądu literatury i doświadczeń własnych

Summary Laryngo-tracheal stenosis (LTS) is a relatively rare disease, caused usually by iatrogenic reasons (intubation, tracheotomy, radiotherapy and surgery of the larynx and trachea) or by trauma. However they may be caused by another rare diseases effecting the wall of the larynx and trachea (primary stenosis) or by compression of pathological process near by (secondary stenosis). Among the primary stenosis except iatrogenic and posttraumatic there are also: congenital, postinfective (tuberculosis, syphilis, scleroma, diphtheria, histoplasmosis and the other), in connective tissue diseases (Wegeners granulomatosis, relapsing polychondritis), in blister diseases (pemphigoid cicarticans, epidermolysis bullosa hereditaria), in amyloidosis, in sarcoidosis and tracheobronchopathia osteochondroplastica. Secondary stenosis may be effected by thyroid diseases, diseases of the big blood vessels of the thorax, hypertrophic thymus, enlargement of the lymph nodes near by the trachea, tumors and cysts of the neck and mediastinium, retrotracheal abscess and cold abscess in vertebral column tuberculosis. If the reason of stenosis is unknown, the stenosis is called idiopathic. In this publication basing on the literature review the reasons of LTS were described in details. We also present our clinical experience concerning 124 patients. The authors underline, that in most of patients the reason of LTS can be find after taking the history of a patient. However, in the cases, when the reason is not clear, a lot of specific examination should be done to find another rare reason, and only after exclusion it the diagnosis of idiopathic LTS can be established.

Ewakuacja ropnia mózgowia pod kontrolą neuronawigacji

Summary Otogenic brain abscess remain a challenge for otosurgeons. The method of choice in treatment, is the operation of the middle ear and drainage of the abscess in one step procedure. Evacuation of the abscess under neuronavigation leeds to decrease the intraoperative injury of the brain and to improve the precision of the puncture. The paper describe the technique of drainage of the otogenic brain abscess under neuronavigation, step by step.

Evaluation of surgery and surgical results of Baha® Attract system implantations – single centre experience of hundred twenty five cases

INTRODUCTION Bone-anchored hearing aids are currently well-established solutions for treatment of hearing-impaired patients. OBJECTIVE To evaluate the surgery of the Baha® Attract system, healing process and soft tissue condition after the processor activation. METHODS 125 patients implanted with the Baha® Attract system during a 3 year period in a single ENT department were analysed. Evaluated parameters comprised: details of surgery, healing process and soft tissue condition at the time of the processor activation and on subsequent follow-up visits. RESULTS The implantation was conducted under local anaesthesia in 96% of patients. The mean surgery time was 42min. Soft tissue reduction was performed in 43.2% of cases; bone polishing in 23.2% and bipolar coagulation in all the cases. Healing was uneventful in 92.8%. 10 days after the surgery, pain was reported in 48% of cases. On subsequent follow-up visits, 1 month and 3 months after the surgery, pain was present in 18.4% and 2.4% of cases respectively. Similarly, numbness and paresthesia, initially reported in 84% and 15.2%, were present in 60% and 11.2% after a month, and in 17.6% and 1.6% after three months. After the processor attachment, no serious problems were observed in the analysed group during follow-up visits. However, mild redness and/or mild pain over the magnet were observed in 9.6% of patients. CONCLUSION Implantation of the Baha® Attract system is an easy and safe procedure. It can be performed under local anaesthesia in adults. There are no major surgical problems or complications, and the healing process proceeds efficiently in most patients. Postoperative pain is usually mild and gradually decreases in the following months. Numbness in the operated area is frequent, but as reinnervation occurs in time, the numb patch decreases in size and finally completely disappears in most cases.

Czy skleroterapia malformacji limfatycznych głowy i szyi może zastąpić leczenie chirurgiczne

Streszczenie Leczenie malformacji ukladu chlonnego rejonu glowy i szyi pozostaje wyzwaniem. Chirurgia ma ograniczone zastosowanie w przypadku zmian rozleglych, trudno dostepnych, zlokalizowanych w poblizu waznych struktur i narządow. Celem pracy jest zaprezentowanie wstepnych doświadczen zastosowania preparatu OK-432 (Picibanil) w leczeniu rozleglych malformacji limfatycznych glowy i szyi. W dwoch opisywanych przypadkach metoda okazala sie skuteczna i bezpieczna. Autorzy przedstawiają technike iniekcji i przegląd dostepnej literatury.