Evaluation of Pain Following the Use of Scalpel Versus Electrosurgery for Skin Incisions in the Facial Regions.

INTRODUCTION: Postoperative pain presents a significant medical problem. It can create a considerable discomfort in the immediate postoperative period and thus increase patient's morbidity. Multiple mechanisms are involved in its' etiology, one of them being the method of tissue incision. The aim of this study is to compare the early postoperative pain following incision with two different methods, scalpel and electrosurgery in the facial regions. MATERIAL AND METHODS: Eighty patients with both benign and malignant skin lesions in the facial regions undergoing surgery were enrolled in this study. Patients were randomized in two groups. In group A, comprising 40 patients, cold steel surgical scalpel №15 was used for the surgical procedure. Electrosurgical microneedle with 0.06mm tip radius and generator unit KLS Martin Electrosurgical Unit ME MB 2 set on cutting mode, power 12 W was used for performing the surgery in group B including the same number of patients. After the surgery patients were given analgesics on their demand. The total number of on demand analgesics requirements was calculated. The patients were also asked to note the oral analgesics they were taking after being released from the hospital. RESULTS: Results of this study showed a statistically significant difference between the groups in the analgesics demand on the day of the operation (p=0.041). On the day of the operation 52.5% patients in the scalpel group and only 30% of the patents of the electrosurgery group received analgesics on demand. In all other analysed time points, the patients in the scalpel group received analgesics more often than the patients in the microneedle group, but with no statistically confirmed difference between the groups (p>0.05). Even more significant is the fact that patients treated with electrosurgery that needed analgesics, had significantly bigger excision area median 471 (rank 283-589) compared to the patients treated with the conventional method 289 (rank 177-432) (p=0.016). CONCLUSION: In accordance with previous studies our results suggested a significantly reduced postoperative pain in the electrosurgery group.

Tissue expansion in limbs vs other body regions.

INTRODUCTION: The development of tissue expansion technique as an important routine procedure in plastic and reconstructive surgery in the past two decades reflects the tendency of getting quality skin that would replace the defect. The aim of this study was to present our experience in the application of tissue expanders in the limbs, and to compare the complications of this procedure in limb and non-limb sites. MATERIAL AND METHODS: This retrospective study included 16 expanders in 14 patients. Indications for tissue expansion were post burn scarring and contractures, post mastectomy reconstruction and before excision of giant nevus. The expanders were placed in the following sites: scalp, breast, abdomen, leg and arm. RESULTS: Despite the fact that there were complications in 3 out of the 16 expanders used, failure occurred in 1 expander, which was removed. The remaining complications were managed either by immediate delivery whenever expansion approached full size or by salvage of the expander by exteriorizing the buried part in cases of infection.

Prognostic factors of primary cutaneus melanoma.

INTRODUCTION: The purpose of this study was to identify tumor characteristics of primary malignant melanoma predictive of sentinel lymph node positive status, and then to determine whether sentinel lymph node status has an impact on recurrence and survival. MATERIAL AND METHODS: A total of 100 patients with primary malignant skin melanoma were analyzed. The prospective melanoma database identified patients with histologically confirmed cutaneus melanoma, clinically negative and clinically positive regional lymph nodes with no evidence of distant disease, who had undergone surgery between April 2001 and May 2012. Univariate and multivariate analyses were performed to assess factors that predict sentinel lymph node positive status, recurrence and survival. RESULTS: We identified Breslow's thickness and lymphocytic response as independent predictors of sentinel lymph node status in cutaneous melanoma patients. Sentinel lymph node status was a significant predictor of disease free survival. CONCLUSION: Despite the limitation, this study confirms Breslow's thickness and tumor lymphocytic infiltration as two factors predictive of sentinel lymph node metastasis in cutaneous melanoma patients. We also found sentinel lymph node status to be the most significant independent predictor of disease free survival and identified sentinel lymph node status as an important variable to consider when estimating the risk of regional recurrence.