Reconstruction of Soft Tissues of the Postamputation Lower Leg Stump with a Free Anterolateral Thigh Flap for Optimal Prosthesis.

Patients without proper covering of the bone stump with soft tissues after below-knee amputation have limited opportunities for prosthesis. The resulting high degree of disability severely restricts their proper functioning in social and professional life. The commonly used significant reduction of the bone length for local coverage limits rehabilitative options to the less comprehensive prosthesis. We aimed to describe a delayed reconstruction with soft tissues of the lower leg stump using free anterolateral thigh flap as an alternative surgical method allowing for optimal prosthesis. A 20-year-old patient was consulted because of right lower leg stump, covered only with a skin graft following posttraumatic amputation. Previously, the patient had ineffective attempts of using a prosthesis. He asked to determine the possibility of recovering the functionality of the lower limb. We performed reconstruction of soft tissues of the stump with a free anterolateral thigh flap. Postoperatively, the patient achieved good coverage of the remaining part of the tibia with a thick layer of soft tissues, allowing the subsequent adequate forming of the stump. Therefore, a fixed prosthesis with the dynamic foot could be implemented. A significant increase in physical activity contributed to a full return to the patient's professional and private life. In conclusion, the free anterolateral thigh flap provides a robust amount of good-quality tissues for supportive function of the lower limb stump. The resulting adaptation of the stump to numerous modern prosthetic devices significantly increases the range of physical activity and contributes to the full return of the patient to their professional and private life.

Multiple Symmetrical Scrotal Lipomatosis: Diagnosis and Treatment with Comprehensive Summary of the Entity.

Multiple symmetrical lipomatosis is a rare diffuse presentation of the progressive accumulation of deposits of nonencapsulated masses of adipose tissue. The characteristic image of this disease is bilateral swelling in the neck, the upper part of upper limb, pelvic rim, back, and thighs. We report a case of unusual localization of benign scrotal symmetrical lipomatosis with ultrasound and histological appearances of the scrotal lipomatous masses, together with treatment. Scrotal lipomatosis should be considered as a rare differential diagnosis of scrotal swelling, and excisional lipectomy should be considered in preference over liposuction. Patients should be offered counseling for infertility.

Evaluation of polymorphisms and expression of PTPN22, NLRP1 and TYR genes in vitiligo patients.

Introduction: Vitiligo is a pigmentary disorder associated with a selective loss of melanocytes in the skin, its appendages and mucous membranes. Aim: The aim of the study was to evaluate the association between the rs2476601 polymorphism of the PTPN22 gene, the rs2670660 and rs6502867 polymorphisms of the NLRP1 gene and the rs1847134 and rs1393350 polymorphisms of the TYR gene and vitiligo. Another aim was to compare the gene expression in lesional and symmetrically non-lesional skin of vitiligo patients and healthy controls. Material and methods: The experimental group consisted of 42 patients and the control group consisted of 38 healthy volunteers. The polymorphisms of the genes were assessed with PCR-RFLP technique and gene expression with qRT-PCR technique. Results: We found that the CT genotype of the PTPN22 rs2476601 polymorphism is more frequent in vitiligo patients, in the case of the NLRP1 rs2670660 polymorphism it was the AG genotype, in the NLRP1 rs6502867 polymorphism they were the CT and CC genotypes and in the TYR rs1393350 polymorphism it was the AG genotype. There was no association between vitiligo and the TYR rs1847134 polymorphism. We found statistically significant differences in gene expression in the lesional and symmetrical non-lesional skin of vitiligo patients compared to the control group. Conclusions: Our analysis showed genotypes predisposing to vitiligo. We found that the gene expression is different not only in lesional but also in non-lesional skin of vitiligo patients, what may change the approach to treatment of the disease.

The use of local anaesthetics in dermatology, aesthetic medicine and plastic surgery: review of the literature.

The aim of the study is to present the latest information on local anaesthesia in plastic surgery, aesthetic medicine and dermatology based on the available literature. The aim of the work is to present a model of cooperation between an anaesthesiologist, dermatologist, and surgeon, so that the patients feel safe, and, above all, the procedure will be comfortable and painless for them. Regional blocks are an excellent tool to achieve this goal. Achieving this requires commitment and understanding by both the plastic surgeon and the anaesthesiologist.

Resveratrol as a factor preventing skin aging and affecting its regeneration.

Resveratrol, a compound belonging to polyphenols, besides its action on the cardiovascular system, affects also wound healing, regeneration, and photoaging of the skin. By interactions with numerous substances and pathways, e.g. MAPK, MAPKK, FOXO3, TGF or metalloproteinase 1, it protects the skin against the harmful effects of type B ultraviolet radiation, which is the main factor in the skin aging processes. It also enhances collagen synthesis by activating the oestrogen receptor and reduces wrinkles. In damaged tissues, it accelerates skin regeneration and healing by activating, among others, VEGF. Based on the review of the literature, there is no doubt that resveratrol has the potential to be used in cosmetology, dermatology and plastic surgery. It can be used as a compound of anti-aging products or as a topical treatment of scars and wounds. In the future this polyphenol might be applied in pharmacotherapy of many dermatoses.

A new heterotropic vascularized model of total urinary bladder transplantation in a rat model.

This study developed a new procedure of urinary bladder transplantation on a rat model (n = 40). Heterotopic urinary bladder transplantation (n = 10) in the right groin vessels was performed. Direct urinary bladder examination, microangiography, histological analysis, and India ink injection were performed to evaluate the proposed method's functionality. Observation time was four weeks. One week after the procedure, the graft survival rate was 80%, two urinary bladders were lost due to anastomosis failure. The rest of the grafts survived two weeks without any complications. Lack of transitional epithelium or smooth muscle layer loss and lack of inflammatory process development were observed. This study was performed in order to obtain the necessary knowledge about urinary bladder transplantation. The proposed technique offers a new approach to the existing orthotropic models.

Another face of dermal fillers.

Potential complications related to dermal fillers depend on the type of the fillers and the site of their application. The classification of dermal filler complications can be divided into early and late, and into minor and major events. According to their mechanism, they can be divided into non-ischaemic and ischaemic complications. The aim of this study is to present possible complications related to dermal fillers, to explain their aetiology and to propose preventive management and treatment. Non-ischaemic complications can be technique-dependent and include the reactions at the site of the injection, contour irregularities, and inflammatory and infectious reactions. They are usually resolved as a matter of course after 2-7 days. Arterial or venous occlusion leads to ischemia, with subsequent necrosis of the skin and/or vision loss.

The whole truth about botulinum toxin - a review.

Treatment with botulinum toxin is widely viewed as safe, effective and largely devoid of serious side effects. There are two classes of Botox-related adverse events - transient and benign events, and potentially serious events. The aim of this study was to provide an overview of Botox-related side effects and advise potential management and preventive strategies. Benign side effects are well-localized, reversible and self-limited complications which develop within a few days of the injection, and they usually disappear without any treatment. The aesthetic and functional adverse effects are associated with different muscle responses to botulinum toxin or with misplacement of botulinum toxin. The serious events are sequelae due to the systemic spread of toxin leading to botulism.

Salivary levels and immunohistochemical expression of selected angiogenic factors in benign and malignant parotid gland tumours.

OBJECTIVES: Angiogenesis underlies tumour growth and metastasis through hepatocyte growth factor (HGF), epithelial growth factor (EGF), and vascular endothelial growth factor (VEGF). The aim of this study was to determine the levels of VEGF, EGF, HGF, HGFR (hepatocyte growth factor receptor), and SRSF1 (serine-rich protein splicing factor-1) in patients with parotid gland tumours and in healthy controls via ELISA in parotid saliva. Immunohistochemical expression of anti-angiogenic isoform of VEGF165b subunit, VEGFR1, VEGFR2, and microvessel density (CD34) were assessed in the tumour tissue and in the non-tumorous surrounding margins. MATERIALS AND METHODS: The study included 48 patients with benign and malignant parotid gland tumours and 15 healthy controls. RESULTS: Comparison of VEGF, EGF, and HGF in tumour and non-tumorous tissues showed no significant differences and no correlations with tumour stage. The salivary VEGF concentration was significantly higher in patients with pleomorphic adenoma and Warthin's tumour. No significant correlation was found between expression of VEGF165b and VEGFR2 in tumours and non-tumor surgical margins. CONCLUSIONS: The increased salivary VEGF reflects changes in affected parotid glands, but it cannot be used as a prognostic and differentiative factor for parotid tumours. CLINICAL RELEVANCE: Reciprocal relations between growth factors suggest an overlapping pathway of secretion and activity.

Benign tumours and tumour-like lesions in the oral cavity: a retrospective analysis.

INTRODUCTION: Oral lesions are divided into non-neoplastic lesions, potentially malignant lesions and neoplastic lesions. More clinical data are needed to determine their helpful clinical pattern. AIM: To present the epidemiological, clinical and histopathological characteristics of the oral lesions. MATERIAL AND METHODS: The retrospective study group comprised records of 208 patients which were reviewed according to selected epidemiological and clinical features. All the biopsy specimens were classified into: reactive lesions, precancerous lesions/potentially malignant lesions, salivary gland pathologies, benign and malignant tumours. RESULTS: The lower lip was the most common site involved followed by buccal and vestibular mucosa. The most frequent diagnoses were fibroma, mucocele and papilloma. The predominant pathomorphological forms were nodule and bulla. The most frequent salivary gland pathology was mucocele. Fibroma was the most frequent pathomorphological diagnosis, followed by mucocele and reactive lesions such as irritation fibroma (IF) and granuloma. CONCLUSIONS: In cases of oral mucosal lesions, we propose the following algorithm: the exclusion of all odontogenic and iatrogenic causes; the detection and elimination of harmful habits, parafunctions and irritants from the oral cavity especially from the vestibule of the oral cavity and from the lips; all surgical treatment should be performed only after the proper detection and elimination of causative factors to decrease the risk of recurrence; excisional biopsy or in more diffuse lesions incisional biopsy is recommended to confirm clinical diagnosis; and consideration of other factors that can modify the clinical pattern of oral lesions, such as oral hygiene, systemic diseases, and drugs.

Levels of EGF and VEGF in patients with primary and secondary Sjögren's syndrome.

BACKGROUND: Aberrant angiogenesis plays a role in the pathogenesis of Sjögren's syndrome (SS). OBJECTIVES: The aim of this study was to compare the levels of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) in stimulatory parotid saliva and in serum in healthy subjects (HS), patients with primary SS (pSS) and secondary SS (sSS) and to evaluate the expression of EGF, proangiogenic VEGF165 and antiangiogenic VEGF165 b mRNA isoforms. Additionally, we determined the salivary levels of serine/arginine splicing factor (SRSF1), which regulates VEGF165 and VEGF165 b expression. MATERIAL AND METHODS: The study comprised 34 women (16 with pSS and 18 with sSS) and healthy subjects for blood and saliva sampling. EGF and VEGF levels in saliva and serum and salivary SRSF1 levels were determined by enzyme-linked immunosorbent assay (ELISA). The expression of VEGF165 , VEGF165 b and EGF in peripheral blood mononuclear cells (PBMC) was evaluated by quantitative polymerase chain reaction (qPCR). RESULTS: There were no differences in the levels of EGF, VEGF, SRSF1 and in the expression of the EGF, VEGF165 and VEGF165 b between HS and SS patients, or between pSS and sSS patients. The salivary levels of VEGF165 and EGF were significantly higher in pSS, sSS and HS than serum levels. Levels of SRSF1 correlated positively with VEGF and EGF levels. Levels of EGF, VEGF and SRSF1 correlated with each other. CONCLUSIONS: The balance of VEGF isoforms is not disturbed in SS. Saliva is more sensitive for the detection of EGF and VEGF than serum, but salivary levels of those proteins are not representative for SS.

Selected presentations of lip enlargement: clinical manifestation and differentiation.

Lip enlargement may be an important symptom of either systemic or local diseases. On the basis of selected age-matched clinical cases we present the possible causes of lip swelling. We describe the most representative symptoms and recommend treatment of these pathologies. We differentiate lip swelling in Miescher syndrome, monosymptomatic form of Melkersson-Rosenthal syndrome, lip swelling in erythema multiforme and Stevens-Johnson syndrome and lip hemangioma and mucous extravasation cyst. We compare different causes of lip edema and indicate the most helpful diagnostic and treatment methods.

Expression of VEGF165b, VEGFR1, VEGFR2 and CD34 in benign and malignant tumors of parotid glands.

BACKGROUND: Vascular endothelial growth factor (VEGF) is an angiogenic factor and could be involved in the pathogenesis of salivary gland tumors. VEGF exerts its biological function by binding to its receptors, VEGFR1 and VEGFR2. An alternative splice variant of VEGF (VEGFxxxb) is an anti-angiogenic factor. Binding VEGF165b with VEGFR2 results in an impaired angiogenic response. The imbalance of VEGFxxx and VEGFxxxb isoforms can underpin pathological angiogenesis. OBJECTIVES: The purpose of this study was to evaluate and compare the expression of VEGF165b, VEGFR1, VEGFR2, and CD34 in benign and malignant parotid gland tumors and to explore the possible correlations between their expression and clinicopathological features of tumors. MATERIAL AND METHODS: The study was performed on archived paraffin-embedded tissue samples derived from 70 patients with benign and malignant parotid gland tumors (25 with malignant tumors, 23 with pleomorphic adenoma and 22 with Warthin's tumor). Immunohistochemical staining of selected tissue sections was performed using monoclonal antibodies. Immunohistochemical staining of selected molecules was used for evaluation of their expression in tissue sections. RESULTS: There were no statistically significant differences in the expression of the selected proteins localized in the tumor and surgical margin taken from the same patient. Expression of VEGFR2 correlated with VEGF165b in mixed tumors. There was a statistically significant difference in the expression of VEGFR1 in malignant tumors between females and males, and between the expression of VEGFR1 and the score of T classification in malignant tumors. CONCLUSIONS: VEGF165b cannot be treated as a prognostic factor. VEGF receptors correlated with selected clinicopathological data of malignant tumors, indicating their possible role as a prognostic marker. The balance of VEGF isoforms have a limited influence on the development of parotid glands tumors. The correlation between VEGF165b and VEGFR2 in mixed tumors suggests the existence of an additional antiangiogenic pathway in poorly vascularized mixed tumors.

Serum ICAM-1, VCAM-1 and E-selectin levels in patients with primary and secondary Sjögren's syndrome.

BACKGROUND: Typical features of Sjögren's syndrome (SS) are severe xerostomia and xerophthalmia which are basic diagnostic criteria. OBJECTIVES: The aim of this study was to compare the serum levels of soluble (s) intercellular adhesion molecule 1 (sICAM-1), vascular cell adhesion molecule 1 (sVCAM-1) and sE-selectin between primary (pSS), secondary (sSS) and healthy subjects (HS). We correlated these results with selected clinical parameters of disease activity and parameters of the severity of xerostomia and xerophthalmia. MATERIAL AND METHODS: The serum levels of sICAM-1, sVCAM-1 and sE-selectin were determined by enzyme-linked immunosorbent assay (ELISA) in 16 patients with pSS, 18 with sSS and 15 HS. Eye dryness and xerostomia were assessed by the Schirmer's test, the Fox test and the visual analogue scale (VAS). RESULTS: The levels of sICAM-1 in pSS and sVCAM-1 in sSS patients were significantly higher when compared to HS (p = 0.02 and p = 0.048, respectively). There were no differences between pSS and sSS. In pSS, sVCAM-1 correlated positively with VAS (rS = 0.52, p = 0.04) and the Fox test (rS = 0.66, p=0.01). In sSS, sE-selectin correlated positively with sICAM-1 (rS = 0.54, p = 0.01), the duration of the disease (rS = 0.51, p = 0.03) and negatively with the Schirmer's test (rS = 0.59, p = 0.04). sICAM-1 correlated positively with the erythrocyte sedimentation rate (ESR) value (rS = 0.59, p = 0.01). CONCLUSIONS: sVCAM-1 reflects xerostomia in pSS. sICAM-1 and sE-selectin may be additional parameters of sSS activity.

Autologous fat transfer to the subcutaneous tissue in the context of breast reconstructive procedures.

Autologous fat transfer (AFT) is an appropriate technique for aesthetic rejuvenation of the face, aesthetic enhancement of hands, correction of the facial appearance in various disorders and constitutes a surgical alternative of treatment of numerous breast deformities ranging from distorting posttraumatic scars, post-eczema lesions, post-burn deformities to partial or total breast reconstruction. Our work is aimed to familiarize dermatologists with the technique of harvesting and implanting the aspirate of adipose cells in patients consulted for deformities of the breast. In addition, the review summarizes the most common applications of AFT in the breast reconstructive procedures. In summary, AFT is an oncologically safe, relatively complication-free, minimally invasive surgical technique, which can be used to correct a wide range of deformities, which are commonly seen by dermatologists, in the area of the face, trunk and extremities. The procedure can correct a wide range of breast deformities, from contour or single quadrant deformities up to the state after mastectomy.

Oral mucosal manifestations in primary and secondary Sjögren syndrome and dry mouth syndrome.

INTRODUCTION: One of the most important symptoms of Sjögren syndrome is xerostomia. The oral cavity deprived of saliva and its natural lubricative, protective and antibacterial properties is prone to a number of unfavourable consequences. AIM: To present the most important lesions on the oral mucosa in primary and secondary Sjögren syndrome and in dry mouth syndrome. MATERIAL AND METHODS: The study group comprised 55 patients including 52 women and 3 men aged 20-72 years (average: 28.25 years). RESULTS: Basing on the accepted criteria, primary Sjögren syndrome was diagnosed in 22 (40%) patients, secondary Sjögren syndrome in 18 (32.7%) patients, and dry mouth syndrome in 15 (27.27%) patients. The physical examination and the examination of the mouth were performed and history was elicited from every patient. CONCLUSIONS: The most common pathologies appearing on the oral mucosa in primary and secondary Sjögren syndrome are angular cheilitis, cheilitis, increased lip dryness as well as non-specific ulcerations, aphthae and aphthoid conditions.