Kęstutis Maslauskas

Measurement of melanoma thickness ― comparison of two methods: Ultrasound versus morphology

OBJECTIVE The aim of our study was to investigate the association between non-invasive ultrasound examination and morphologic test results in the measurement of cutaneous melanoma thickness influencing surgical treatment strategy. METHODS Our prospective clinical study has been conducted in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital (KUMH) since January 2004 until October 2008. A total of 100 patients with a clear clinical diagnosis of stage I-II cutaneous melanoma were enrolled in this study. Melanoma depth was measured using a linear 14-MHz frequency ultrasound sensor (Toshiba Xario XG). Surgically removed fragments of skin-subcutaneous tissue were fixated using 10% formalin solution in the operating theatre, and sent to KUMH Clinic of Pathological Anatomy. The most informative sections were analysed for tumour thickness, according to Breslow, as well as tumour type, vascular and lymphatic invasion and dissemination. A comparative data analysis of melanoma thickness measured by ultrasound (T) preoperatively and histologically estimated cutaneous melanoma (CM) thickness according to Breslow (pT) using the Bland-Altman method was performed. RESULTS Higher mean difference of melanoma thickness (60 μm) between T and pT measurements was found when tumour thickness matched pT1 and pT2 categories. In cases of CM depth exceeding 2mm, mean difference of measurements between CM thickness determined by ultrasound and histological examination was lower (30 μm). Data regression analysis showed that correlation between T and pT measurements was lower when CM was thinner (1-2 mm) (Pearsons correlation coefficient, r: 0.283). In cases of thicker melanoma (>2 mm), strong and statistically significant (p<0.0001) correlation (r: 0.869) was observed. CONCLUSIONS Correlation between melanoma thickness measured using a linear 14-MHz frequency ultrasound sensor and histologically estimated melanoma thickness according to Breslow was lower if melanoma was thinner (1-2 mm). However, in cases of thicker melanoma (>2 mm), very strong correlation between measurements was observed.

Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: Analysis of recurrence-free survival.

BACKGROUND AND AIM Cutaneous squamous cell carcinoma (CSCC) is a malignant epithelial cell tumor. CSCC has a tendency to spread via lymphogenic pathway. Metastases are found in 2%-6% of cases. Prognosis of patients with CSCC is directly related to the morphology and localization of primary tumor. The aim of this study was to evaluate the recurrence-free survival of patients with CSCC after tumor excision and SLNB as well as to analyze morphologic CSCC features related to patient recurrence-free survival. MATERIALS AND MATERIALS A retrospective analysis of 51 patients with CSCC, who underwent surgical treatment between January 1, 2012, and December 31, 2014, in the Clinic of Plastic and Reconstructive Surgery, Hospital of the Lithuanian University of Health Sciences, was done. The diagnosis of CSCC was verified on a histological examination, and all patients had no clinical evidence of nodal or distant metastases on a physical examination or imaging studies. Sentinel lymph node biopsy (SLNB) was performed for low- and high-risk CSCC patients. RESULTS A total of 51 patients were enrolled into the study (34 women and 17 men). Total of 68 lymph nodes were removed during sentinel lymph node biopsy. No micrometastases were identified. Until April 1, 2015, no relapse event was documented. The mean time after operation was 27.5 months. During the follow-up period, no distant metastases were identified. CONCLUSIONS No patient who had no micrometastases in sentinel lymph nodes developed local and distant CSCC metastases during the follow-up period. Our report supports the concept that SLNB can be applied for CSCC. It is obvious that larger prospective studies with longer follow-up period are needed to establish the efficacy of SLNB and define the optimal treatment of occult nodal metastasis for CSCC.

Assessment of the Data of Pre-Operation Ultrasound Research of Hand and Arm Blood Vessels Before the Formation of the Arteriovenous Link

Ultrasound research of the blood vessels of hand and arm before the operation of the formation of the arteriovenous link is gradually becoming a necessity as it provides multiple useful information for the planning of the operation. Hospital of Lithuanian University of Health Sciences Kaunas clinics (LSMUL) is performing a prospective research based on the pre-operation ultrasound evaluation of hand and arm blood vessels. 182 patients with terminal deficiency of the renal function were researched; they were treated in LSMUL Department of Nephrology in 2008 to 2010. Before the formation of the primary arteriovenal link in the forearm, vena cephalica end to arteria radialis side (end-to-side anostomosis), the patients had hand and arm blood vessels ultrasound research performed. The age average of the patients was 64,62 ±2,31 (18-91) years, of whom males constituted 92 (50,5%). 137 patients (75,3%) underwent the operation of the left arm. Internal diameter of a. radialis and v. cephalica were being measured together with the amount of blood flowing through a. radialis as well as the state of the blood vessels (a.radialis atherosclerosis, v. cephalica thrombosis). During the operation, blood vessels were observed directly (atherosclerosis plates and calcinosis in the arteries) as well as measured. The diameter of the blood vessels when assessing in terms of gender usually was 2.01-3.00 mm regarding the arm under operation. A. radialis and v. cephalica average diameter of the crosssection area in dependence of the patient gender and the hand/ arm under operation ranged within 2.08±0.126 to 2.58±0.136 mm and 2.11±0.17 to 2,49±0,33. In different age groups, blood vessels also dominated (both a. radialis and v. cephalica) with the cross-section of 2.01 to 3.00 mm. The most frequent amount of blood flow in a. radialis was 0.01 l/min. A. radialis atherosclerosis was found in senior patients with the age average of 65.63±14.648 years. V. cephalica thrombosis was encountered in 41 patients (14 males, 27 females). The gender, age and the arm under operation do not influence the results of the operation. Patients of the senior age group who have atherosclerosis more commonly necessitate pre-operation ultrasound research in order to discover a more favourable location for the arteriovenous link. doi:10.5200/sm-hs.2012.066

Plaštakų nudegimų gydymo metodų lyginamoji studija

Kestutis Maslauskas 1 , Rytis Rimdeika 1 , Jolita Rapolienė 3 , Tarvilas Norkus 1 , Žilvinas Saladžinskas 2 , Paulius Karcauskas 3 1 Kauno medicinos universiteto klinikų Chirurgijos klinikos Plastinės ir rekonstrukcinės chirurgijos skyrius 2 Kauno medicinos universiteto klinikų Chirurgijos klinika 3 Kauno medicinos universitetas, Eivenių g. 2, LT-50009, Kaunas El pastas: m.kestas@one.lt Įvadas KMUK Chirurgijos klinikos Plastinės chirurgijos ir nudegimų skyriuje (2001 01–2004 06) atliktas randomizuotas atsitiktinių imcių tyrimas, kuriuo lyginti du gydymo metodai. Ligoniai ir metodai Traukiant vokus pacientai suskirstyti į grupes. Patekusiems į A grupe pacientams per 7 paras nuo nudegimo atliekama nekrektomija ir dalies storio autodermoplastika. Pacientams, patekusiems į B grupe, atliekami perrisimai vartojant sidabro sulfadiaziną, o atsidalijus negyvybingiems audiniams, – autodermoplastika. Is stacionaro pacientai israsomi sugijus >95% žaizdų. Kontrolės metu tiriami pirstų ir rieso aktyvūs ir pasyvūs judesiai, matuojama pirstų ir plastakos jėga. Tirta 71 nudegusios plastakos funkcija (44 pacientai). Rezultatai Lygindami minėtų grupių pacientų rieso judesius nustatėme, kad rieso judesių amplitudė atliekant fleksinius, ekstenzinius judesius, radialinis ir ulnarinis nuokrypis buvo didesni A grupės. Palyginus nykscio metakarpofalanginių ir interfalanginių sąnarių fleksinių judesių amplitude bei ekstenziją per interfalanginius sąnarius, taip pat nykscio atitraukimą ir opoziciją issiaiskinome, kad statistiskai reiksmingai geresnė funkcija buvo A (ankstyvos plastikos) grupės. Nustatėme statistiskai reiksmingą skirtumą lygindami visų pirstų fleksinius judesius per metakarpofalanginius, proksimalinius interfalanginius ir distalinius interfalanginius sąnarius. Lygindami ekstenzinius judesius per sąnarius, statistiskai reiksmingo skirtumo negavome. Pirstų ir plastakų jėga buvo didesnė ankstyvos nekrektomijos ir plastikos, t. y. A, grupėje. Isvados Plastakų nudegimą gydant ankstyva nekrektomija ir plastika, žaizdos sugyja greiciau, atkuriama didesnė rieso ir pirstų judesių amplitudė, plastakos jėga, sutrumpėja paciento gydymo ligoninėje trukmė ir sumažėja gydymo islaidos. Reiksminiai žodžiai: plastakų sužalojimas, nudegimas, nekrektomija, plastika Comparative study of hand burn treatment Kestutis Maslauskas 1 , Rytis Rimdeika 1 , Jolita Rapolienė 3 , Tarvilas Norkus 1 , Žilvinas Saladžinskas 2 , Paulius Karcauskas 3 Objective During the period 01.2001–06.2004 in the Unit of Plastic Surgery and Burns of Kaunas Medical University Hospital a prospective randomised clinical trial was performed to compare two methods of treatment. Patient and methods Patients were selected into two groups by the envelope method. For patients in group A, necrectomy and immediate split thickness skin grafting were performed during the first 7 days after burn injury. In group B, daily local applications of silversulfadiazine and escharectomy with delayed split thickness skin grafting were performed. Patients were discharged from hospital when wound healing more than 95% was achieved. During the control, measurement of movements of all wrist and finger joints was performed. Also, the power of fingers and of all hand was measured. We examined 71 burned hands (44 patients). Results Comparing wrist flexion, extension, ulnar and radial deviation we found that the amplitude of movements was statistically significantly better in group A. Thumb flexion, extension, abduction and opposition were also better in the early necrectomy group. Conclusions The amplitude of movements of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints as well as the strength of fingers and hands were statistically better in group of early necrectomy with immediate split thickness skin grafting. Keywords: hand burns, hand injuries, grafting, early grafting