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Martić K, Vojvodić B, Gorjanc B, Budimir I, Tucaković H, Caktaš D, Žic R, Jaman J. Feet Salvage Using Anterolateral Thigh Flaps after Severe Frostbite Injury: A Case Report. J Pers Med 2024; 14:389. [PMID: 38673016 PMCID: PMC11051273 DOI: 10.3390/jpm14040389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. CASE REPORT The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient's progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. RESULTS The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient's feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient's ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. CONCLUSION This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management.
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Affiliation(s)
- Krešimir Martić
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
- Department of Surgery, School of Medicine, University of Zagreb, Šalata 2, 10000 Zagreb, Croatia
| | - Borna Vojvodić
- Clinic for Traumatology, Sestre Milosrdnice University Hospital Center, Draškovićeva 19, 10000 Zagreb, Croatia
| | - Božo Gorjanc
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Ivan Budimir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Hrvoje Tucaković
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Doroteja Caktaš
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Rado Žic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
- Department of Surgery, School of Medicine, University of Zagreb, Šalata 2, 10000 Zagreb, Croatia
| | - Josip Jaman
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
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Bilić M, Jaman J, Gorjanc B, Žic R. Massive dedifferentiated thigh liposarcoma growing for 10 years and extending into the retroperitoneum: a case report. Case Reports Plast Surg Hand Surg 2023; 10:2285051. [PMID: 38229695 PMCID: PMC10790800 DOI: 10.1080/23320885.2023.2285051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/13/2023] [Indexed: 01/18/2024]
Abstract
Liposarcomas are rare, malignant tumors of adipocyte differentiation. Surgery is the main treatment method. We are reporting a rare case of a 65- year- old female patient with a massive dedifferentiated thigh liposarcoma that was growing for 10 years and spread to the retroperitoneum.
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Affiliation(s)
- Miro Bilić
- Department of Plastic Surgery, University Hospital "Dubrava", Zagreb, Croatia
| | - Josip Jaman
- Department of Plastic Surgery, University Hospital "Dubrava", Zagreb, Croatia
| | - Božo Gorjanc
- Department of Plastic Surgery, University Hospital "Dubrava", Zagreb, Croatia
| | - Rado Žic
- Department of Plastic Surgery, University Hospital "Dubrava", Zagreb, Croatia
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Mužar RM, Eljuga D, Jaman J, Vlajčić Z, Žic R. Reconstruction of extensive thoracolumbar defect with perforator-based double Keystone Island flap. J Surg Case Rep 2023; 2023:rjad505. [PMID: 37701446 PMCID: PMC10493126 DOI: 10.1093/jscr/rjad505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open
Abstract
Sarcomas represent 1% of malignancies in adult population; thereby dermatofibrosarcoma protuberans is found in 1%-2% of all cases. A surgical approach in oncologic treatment is the standard of care; therefore, important is an extensive resection to achieve clear margins and prevent recurrence. Herein we report a case of recurrent dermatofibrosarcoma protuberans in the thoracolumbar region. As the adequate resection was to cause a huge defect, we have made a reconstruction plan for coverage, using a perforator-based double Keystone Island flap (Type III). The method was chosen as a reliant solution with low complication rates and without need for complex flap designs thereby giving good functional and esthetic results. Main aim of the case report was to show that Keystone Island flaps present a simple and technically straightforward method with low complication rates and good results.
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Affiliation(s)
- Rhea M Mužar
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital “Dubrava”, 10'000 Zagreb, Croatia
| | - Domagoj Eljuga
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital “Dubrava”, 10'000 Zagreb, Croatia
| | - Josip Jaman
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital “Dubrava”, 10'000 Zagreb, Croatia
| | - Zlatko Vlajčić
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital “Dubrava”, 10'000 Zagreb, Croatia
| | - Rado Žic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital “Dubrava”, 10'000 Zagreb, Croatia
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Budimir I, Tomasović-Lončarić Č, Kralik K, Čonkaš J, Eljuga D, Žic R, Gorjanc B, Tucaković H, Caktaš D, Jaman J, Lisek V, Vlajčić Z, Martić K, Ozretić P. Higher Expressions of SHH and AR Are Associated with A Positive Receptor Status and Have Impact on Survival in A Cohort of Croatian Breast Cancer Patients. Life (Basel) 2022. [DOI: https://doi.org/10.3390/life12101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Breast cancers (BC) are usually classified into four molecular subtypes according to the expression of estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptors and proliferation marker Ki-67. Despite available anti-hormonal therapies and due to the inherent propensity of some subtypes to develop metastasis, there is a permanent need to discover new prognostic and predictive biomarkers, as well as therapeutic targets for BC. In this study, we used immunohistochemical staining to determine the expression of androgen receptor (AR) and sonic hedgehog protein (SHH), the main ligand of the Hedgehog-GLI (HH-GLI) signaling pathway, in 185 archival primary BC tissue samples and correlated it with clinicopathological characteristics, molecular subtypes, receptors statuses, and survival in a cohort of Croatian BC patients. Results showed that higher SHH and AR expressions were associated with positive receptor status, but increased SHH expression had a negative impact on survival in receptor-negative BCs. On the contrary, higher AR expression was mostly protective. However, multivariate analysis showed that only higher AR expression could be considered as an independent prognostic biomarker for poorer overall survival in triple-negative breast cancer patients (TNBC) (HR 10.9, 95% CI 1.43–83.67; p = 0.021), what could be Croatian population-related. SHH could be a potential target for treating TNBCs and HER2-enriched BCs, in cases where HH-GLI signaling is canonical (SHH-dependent).
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Budimir I, Tomasović-Lončarić Č, Kralik K, Čonkaš J, Eljuga D, Žic R, Gorjanc B, Tucaković H, Caktaš D, Jaman J, Lisek V, Vlajčić Z, Martić K, Ozretić P. Higher Expressions of SHH and AR Are Associated with a Positive Receptor Status and Have Impact on Survival in a Cohort of Croatian Breast Cancer Patients. Life (Basel) 2022; 12:life12101559. [PMID: 36294994 PMCID: PMC9605052 DOI: 10.3390/life12101559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 02/05/2023] Open
Abstract
Breast cancers (BC) are usually classified into four molecular subtypes according to the expression of estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptors and proliferation marker Ki-67. Despite available anti-hormonal therapies and due to the inherent propensity of some subtypes to develop metastasis, there is a permanent need to discover new prognostic and predictive biomarkers, as well as therapeutic targets for BC. In this study, we used immunohistochemical staining to determine the expression of androgen receptor (AR) and sonic hedgehog protein (SHH), the main ligand of the Hedgehog-GLI (HH-GLI) signaling pathway, in 185 archival primary BC tissue samples and correlated it with clinicopathological characteristics, molecular subtypes, receptors statuses, and survival in a cohort of Croatian BC patients. Results showed that higher SHH and AR expressions were associated with positive receptor status, but increased SHH expression had a negative impact on survival in receptor-negative BCs. On the contrary, higher AR expression was mostly protective. However, multivariate analysis showed that only higher AR expression could be considered as an independent prognostic biomarker for poorer overall survival in triple-negative breast cancer patients (TNBC) (HR 10.9, 95% CI 1.43-83.67; p = 0.021), what could be Croatian population-related. SHH could be a potential target for treating TNBCs and HER2-enriched BCs, in cases where HH-GLI signaling is canonical (SHH-dependent).
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Affiliation(s)
- Ivan Budimir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Čedna Tomasović-Lončarić
- Clinical Department of Pathology and Cytology, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Kristina Kralik
- Department of Medical Statistics and Medical Informatics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Josipa Čonkaš
- Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia
| | - Domagoj Eljuga
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Faculty of Health Sciences, Libertas International University, 10000 Zagreb, Croatia
| | - Rado Žic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Božo Gorjanc
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Hrvoje Tucaković
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Doroteja Caktaš
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Josip Jaman
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Valentino Lisek
- Department of Abdominal Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Zlatko Vlajčić
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Krešimir Martić
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: (K.M.); (P.O.); Tel.: +385-98-752-178 (K.M.); +385-98-659-083 (P.O.)
| | - Petar Ozretić
- Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia
- Correspondence: (K.M.); (P.O.); Tel.: +385-98-752-178 (K.M.); +385-98-659-083 (P.O.)
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Jaman J, Martić K, Rasic N, Markulin H, Haberle S. Is the use of specific time cut-off or "golden period" for primary closure of acute traumatic wounds evidence based? A systematic review. Croat Med J 2021; 62:614-622. [PMID: 34981694 PMCID: PMC8771236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/28/2021] [Indexed: 09/19/2023] Open
Abstract
The time cut-off for primary closure of acute wounds is not clearly defined in the literature or in the surgical textbooks. It is even unclear whether the wound age increases wound infection rate. The scarcity of scientific evidence may explain the diverse wound management practices. To give guidance for further research in the field, this systematic review assessed recent evidence on the impact of wound age on the infection rate and on the selection of wound closure method. Using predefined criteria, we systematically searched Cochrane Central Register of Controlled Trials/CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Scopus, Web of Science Core Collection, Current Contents, SciELO Citation Index, KCI-Korean Journal Database, Russian Science Citation Index, BIOSIS Citation Index, Data Citation Index, LILACS/Latin American and Caribbean Health Sciences Literature, and African Index Medicus; as well as online trial registries: ClinicalTrials.gov, WHO International Clinical Trials Registry Platform/WHO ICTRP, and CenterWatch. Nine studies met the selection criteria and were included in the review. This review could not establish the time frame for primary closure of wounds. The time intervals mentioned in many surgical textbooks were supported by only a few low-quality studies. More important factors to be considered when delaying primary closure of acute wounds were the history of diabetes, wound location, wound length, and the presence of a foreign body.
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Affiliation(s)
- Josip Jaman
- Josip Jaman, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000 Zagreb, Croatia,
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Jaman J, Martić K, Rasic N, Markulin H, Haberle S. Is the use of specific time cut-off or “golden period” for primary closure of acute traumatic wounds evidence based? A systematic review. Croat Med J 2021. [PMID: 34981694 PMCID: PMC8771236 DOI: 10.3325/cmj.2021.62.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The time cut-off for primary closure of acute wounds is not clearly defined in the literature or in the surgical textbooks. It is even unclear whether the wound age increases wound infection rate. The scarcity of scientific evidence may explain the diverse wound management practices. To give guidance for further research in the field, this systematic review assessed recent evidence on the impact of wound age on the infection rate and on the selection of wound closure method. Using predefined criteria, we systematically searched Cochrane Central Register of Controlled Trials/CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Scopus, Web of Science Core Collection, Current Contents, SciELO Citation Index, KCI-Korean Journal Database, Russian Science Citation Index, BIOSIS Citation Index, Data Citation Index, LILACS/Latin American and Caribbean Health Sciences Literature, and African Index Medicus; as well as online trial registries: ClinicalTrials.gov, WHO International Clinical Trials Registry Platform/WHO ICTRP, and CenterWatch. Nine studies met the selection criteria and were included in the review. This review could not establish the time frame for primary closure of wounds. The time intervals mentioned in many surgical textbooks were supported by only a few low-quality studies. More important factors to be considered when delaying primary closure of acute wounds were the history of diabetes, wound location, wound length, and the presence of a foreign body.
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