Search

Background/Aim. Despite all innovations in medicine, melanoma still has a rising incidence and high mortality and thus represents a significant challenge for the healthcare system. The pandemic of the coronavirus dis-ease 2019 (COVID-19), spanning three years, redirected healthcare resources, suspended preventive programs, and strained the healthcare system, significantly impacting melanoma management. The aim of this study was to assess the influence of the COVID-19 pandemic on the treatment of melanoma patients. Methods. This retrospective study analyzed melanoma patients treated at a single tertiary care center over two distinct three-year periods: pre-COVID period (2017–2020) and the COVID-19 pandemic period (2020–2022). The following data were collected and compared: patient demographics, melanoma characteristics, time intervals from biopsy to surgery, and the share of thin and thick melanoma. Results. During the COVID-19 pandemic period, there was a 3 0% reduction in melanoma patients compared to the pre-COVID- 19 period. The decline was most pronounced in 2020 when the state of emergency was introduced in the country. Thin melanoma percentage as a measurement of successful screening programs decreased significantly during the COVID-19 pandemic (11.57% vs. 24.01%), while median Breslow thickness remained stable. The distribution of different histological types was consistent across both periods. The average time from biopsy to surgery remained similar between the two periods, around 40 days. Conclusion. Despite challenges posed by the COVID-19 pandemic, melanoma remains a critical healthcare issue. This study emphasized the significance of prioritizing melanoma care in emergencies, ensuring patient identification and timely treatment in order to optimize survival and minimize treatment costs.

Background/Aim. Radial artery perforator flap (RAPF) is a type of fasciocutaneous or adipofascial reverse pedicle flap, which proved to be a versatile flap for the reconstruction of small and moderate size soft tissue defects of the forearm, wrist, and hand. RAPF provides suitable skin coverage with elastic subcutaneous tissue thus enabling the protection of exposed or damaged functional structures and their simultaneous repair. The aim of this study was to summarize and analyze the results of the treatment of patients with upper extremity soft tissue defects caused by trauma, infection, burn, or tumor removal, which were re-constructed with RAPF. Methods. This retrospective study included 20 consecutive patients with skin and soft tissue defects of the hand and wrist, treated at the University Clinical Center of Vojvodina from 2012 to 2022. The design of the flaps and length of the pedicles were determined by the recipient site. Tourniquet-induced exsanguination was used during surgery for better visualization. The flaps were elevated and placed at the site of the defect. Data on patients and flaps were summarized upon their collection. Results. Distally based fasciocutaneous RAPF was used in all cases. The average age of the patients was 48 years, predominantly (64%) males. Defects were most often localized on the dorsal part of the hand (60%) and wrist (20%). The most common indications for surgery were trauma (45%) and tumor resection (25%). A satisfactory coverage of the defect was achieved in all 20 patients with no flap loss. Venous congestion was noted in 4 (20%) patients, which resulted in partial necrosis of the flap in 3 (15%) patients. Wound healing was achieved upon conservative treatment by secondary intention in two patients and with a secondary suture in the last one. A surgical site infection occurred in 2 (10%) patients who withdrew after proper local and systemic therapy. Conclusion. RAPF proved to be a workhorse flap for soft tissue reconstruction of the upper limb. This surgical solution led to an excellent functional and aesthetic outcome in the majority of patients. Complex surgical procedures could be done simultaneously, together with the reconstruction of tendons, joints, or fracture stabilization. The reliability and safety of these flaps are confirmed through our clinical data.

Background/Aim. Upper blepharoplasty is one of the most often performed aesthetic operations and is indicated for periorbital rejuvenation or correction of some functional problems. The aim of the study was to evaluate the outcome of this procedure and to assess patients’ satisfaction and possibilities of objective measurement of operative results. Methods. A two-year prospective observational study was conducted among female patients who had upper blepharoplasty done by the same surgeon. Data were collected from medical documentation, questionnaire, and objective measurements conducted via standardized digital photographs taken before and two months after surgery. Tarsal platform show (TPS) and brow fat span (BFS) were measured at three points (P1, P2, P3) before and two months after the surgery. A questionnaire conducted before surgery and two months after it included general complaints considering upper eyelids (visual field narrowing, fallen eyelids, the sensation of heavy eyelids, raising head backward in order to enhance vision, headache), patientsʼ assessment of eyelid asymmetry and an additional questionnaire after surgery included questions for the surgeon and patients concerning satisfaction with treatment outcome. Results. This study involved 50 female patients aged be-tween 33 and 67 years (49.98 ± 8.6 years). There was a statistically significant difference in all points for TPS and BFS measurements before and after the operation. No significant asymmetries were noticed between eyes neither before nor after surgery. There was a statistically significant difference in operation success among 3 age categories in TPS-P1 (χ2 = 13.089, df = 2, p = 0.001) and TPS-P2 (χ2 = 8.386, df = 2, p = 0.015) with best results achieved in older patients (> 55 years). There was strong positive, statistically significant correlation between patient’s and surgeon’s satisfaction (r= 0.704, p = 0.002), as well as between patients’ satisfaction and their age (r = 0.704, p = 0.002). Conclusion. Realistic expectations, adequate information about the surgery and possible complications, are essential to satisfied patients. Objective measurements correlate with patientsʼ satisfaction and together with photographs can be a useful tool in communication with them.

Background/Aim. Hand injuries are one of the most common injuries seen in emergency departments. Inadequate treatment can lead to prolonged healing, complications, significant morbidity, and serious disability. The aim of this study was to evaluate the epidemiology, risk factors, and treatment of hand injuries in one tertiary care level clinical center. Methods. This study was designed as a descriptive retrospective epidemiological study that involved all patients with hand injuries treated at the University Clinical Center of Vojvodina, Novi Sad, Serbia for seven years. The authors collected sociodemographic and clinical data such as age, gender, mechanism of injury, type of injury, days of hospitalization, type of defect reconstruction, the time of in-jury, the timing of surgery, and reasons for operative treatment delay. For every hospitalized patient the Modified Hand Injury Severity Score (MHISS) was calculated. All data were analyzed using SPSS IBM 21.0 software. Results. From 2012 to 2018, 34,796 patients were treated for hand injury at the University Clinical Center of Vojvodina, with 554 (1.6%) hospitalized patients. The mean age of patients was 43.2 years; the majority of them (87.55%) were men, and most (47.2%) were injured at home. Most injuries occurred during knife handling. The average length of stay for hospitalized patients was 4 days. MHISS score for most patients was over 50 and was classified a s severe. It was noticed that the waiting time for operation became shorter throughout the selected years. Conclusion. Hand injuries present a complex problem that can sometimes be underestimated by patients. The requirement of highly specialized hand surgeons, sometimes special equipment (e.g., microscope), multiple operations, prolonged rehabilitation, possible invalidity, and high cost of treatment calls for careful evaluation of the problem and the development of proper strategies in order to be able to lower the costs and obtain better medical care for all people with higher injury risk.

Background/Aim. When it comes to anesthesia, patient satisfaction (PS) is more difficult to assess than in any other medical specialty. The aim of this study was to construct a tool for assessing PS with anesthesia and then examine the effects of postoperative care provided by anesthesiologists on PS. Methods. The study included patients undergoing general anesthesia due to the reconstruction of the anterior cruciate knee ligament who were considered the American Society of Anesthesiologists (ASA) 1 and ASA 2 classes. Patients were divided into three groups: group 1 included 74 patients who had a postoperative visit performed by an attending anesthesiologist; group 2 included 70 patients who had a postoperative visit performed by a nurse anesthetist after surgery; group 3 included 74 patients who did not have postoperative visit during postoperative care by an anesthesiologist nor a nurse anesthetist. The tools used in the research were the Anesthesia Patient Satisfaction questionnaire specially designed for this study and the Post Anesthetic Recovery Scoring System (PAS). ANOVA and Pearson’s correlation coefficient were used to estimate the statistical significance of the obtained results between the groups. Results. Association between an objective assessment of the postoperative status of patients on day zero and satisfaction with the anesthesiologist’s patient management showed statistical significance (p < 0.05). Patients who had a postoperative visit by an anesthesiologist tolerated better preoperative and postoperative physical symptoms. Patients visited by an anesthesiologist were most satisfied with postoperative care (p < 0.05). Conclusion. The use of a highly reliable questionnaire for the evaluation of PS with anesthesia could improve the postoperative condition of patients and enable faster recovery during the postoperative period.

Background/Aim. Treatment options for metastatic melanoma in Serbia are limited due to the lack of newly approved biologic agents and the lack of clinical studies. Also, there is a paucity of data regarding the treatment approaches in different tertiary centers and efficacy of available chemotherapy protocols. The aim of this study was to obtain more detailed data about treatment protocols in Serbia based on structured survey in tertiary oncology centers. Methods. Data about the melanoma patients treated in 2011 were analyzed from hospital databases in 6 referent oncology centers in Serbia, based on the structured survey, with the focus on metastatic melanoma patients (unresectable stage IIIC and IV). Results. A total of 986 (79-315 in different centers) patients were treated, with 320 (32.45%) newly diagnosed patients. There were 317 patients in stage IIIC/IV, 77/317 aged < 50 years. At the time of diagnosis 47.3% of patients were < 60 years of age (24.2% < 40 years, 23% 50-59 years, 52.6% > 60 years). At initial diagnosis 12.5% of patients were in stage III and 4.5% in stage IV. The most common type was superficial spreading melanoma (50-66%), followed by nodular melanoma (23.5-50%). Apart from the regional and distant lymph node metastases, the most frequent organs involved in stage IV disease were distant skin and soft tissues (12-55%), lungs (19-55.5%), liver (10-60%), and bones (3-10%). The first line therapy in stage IV metastatic melanoma was dacarbazine (DTIC) dimethyl-triazeno-imidozole-carboxamide in 61-93% of the patients, while the second line varied between the centers. Disease control (complete response + partial response + stable disease) was achieved in 25.7% of the patients treated with the first line chemotherapy and 23.1% of the patients treated with the second line therapy, but the duration of response was short, in first-line therapy 6.66 ± 3.36 months (median 6.75 months). More than 90% of patients were treated outside the clinical trials. Conclusion. Based on this survey, there is a large unmet need for the new treatment options for metastatic melanoma in Serbia. The development of national guidelines, and greater involvement in international clinical studies could lead to widening of treatment options for this chemotherapy resistant disease.

Background/Aim. Necrotizing fasciitis (NF) is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012) were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81%) were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%). The majority of our patients were male (164 - 75.92%). Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%), followed by obesity (38 - 17.59%) and diabetes mellitus (31 - 14.35%). Trauma was most common etiological factor (22 - 10.8%) in infected wounds, followed by abdominal (15 - 6.94%) and orthopedic (11 - 5.09%) surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18%) patients and more than one etiological factor were diagnosed in 20 (9.25%) patients. The majority of our patients had type I acute NF (172 - 79.62%) with Streptococcal species as the most common microorganism (125 - 71.02%). The most common localization was an extremity (151 - 69.90%). The minority of our patients had head and neck localization of infection (7 - 3.24%). Surgical treatment was performed in all the patients and most of them (183 - 84.72%) received the first surgery within 24 h. Other patients (23 - 10.64%) received operation after stabilization of general status or after getting the diagnosis of acute NF (unclear diagnosis on admission). During hospitalization, the most common complication among our patients was sepsis (156 - 72.22%). The mortality rate was 14.35%. Conclusion. Acute NF is a rare but very difficult and sometimes life-threatening disease of superficial fascia and around soft tissue. If acute NF is suspected, early radical excision of all the affected tissue with exploration and excision of superficial fascia with pathological and microbiological assessment are most significant for treatment. Appropriate antibiotics and intensive care setting to manage other organ failure of NF are recommended at the same time with surgery.

Background/Aim. Hand injuries comprise up to one fourth of all injuries and require excellent skills and aggressive physical therapy with still a high potential to cause long term physical and functional disability which affects one’s quality of life. The aim of this study was to evaluate disability and quality of life in patients with different degrees of hand and forearm injuries using the two different scoring systems and to examine the correlation between them. Methods. This retrospective study was performed among patients operated on at our clinic due to acute hand and forearm trauma during the period of two years. Four groups of patients were made according to the Modified Hand Injury Severity Score (MHISS). One year after the treatment, phone interviews were made with those patients to answer to the Disability of Arm Shoulder and Hand (quick-DASH) score for estimating disability and to the World Health Organization Quality of Life BREF (WHOQoL-BREF) score to estimate the quality of life regerding four domains: physical, social, environmental and psychological. Results. Out of 182 patients who satisfied the inclusion criteria, only 60 completely answered to the questionnaires, 46 (17%) men and 14 (23%) women. Most of the patients were in the group with moderate injuries according to the MHISS, followed by the group with major and severe injuries. A weak correlation was found between the MHISS and quick DASH score in the group with minor injuries, compared to no correlation between these parameters in other groups. The lowest quality of life was registered in the physical domain, while the highest in the social one. A negative correlation was found among the four domains of the WHOQoL BREF score and quick- DASH score in all the groups. Conclusion. Severity of hand and forearm injuries does not necessarily correlate with patient’s perception of disability. The quality of life was less affected by severity of injury than by the patient’s perception of disability.

Background/Aim. The lack of effective therapy for advanced stages of melanoma emphasizes the importance of preventive measures and screenings of population at risk. Identifying individuals at high risk should allow targeted screenings and follow-up involving those who would benefit most. The aim of this study was to identify most significant factors for melanoma prediction in our population and to create prognostic models for identification and differentiation of individuals at risk. Methods. This case-control study included 697 participants (341 patients and 356 controls) that underwent extensive interview and skin examination in order to check risk factors for melanoma. Pairwise univariate statistical comparison was used for the coarse selection of the most significant risk factors. These factors were fed into logistic regression (LR) and alternating decision trees (ADT) prognostic models that were assessed for their usefulness in identification of patients at risk to develop melanoma. Validation of the LR model was done by Hosmer and Lemeshow test, whereas the ADT was validated by 10-fold cross-validation. The achieved sensitivity, specificity, accuracy and AUC for both models were calculated. The melanoma risk score (MRS) based on the outcome of the LR model was presented. Results. The LR model showed that the following risk factors were associated with melanoma: sunbeds (OR = 4.018; 95% CI 1.724- 9.366 for those that sometimes used sunbeds), solar damage of the skin (OR = 8.274; 95% CI 2.661-25.730 for those with severe solar damage), hair color (OR = 3.222; 95% CI 1.984-5.231 for light brown/blond hair), the number of common naevi (over 100 naevi had OR = 3.57; 95% CI 1.427-8.931), the number of dysplastic naevi (from 1 to 10 dysplastic naevi OR was 2.672; 95% CI 1.572-4.540; for more than 10 naevi OR was 6.487; 95%; CI 1.993-21.119), Fitzpatricks phototype and the presence of congenital naevi. Red hair, phototype I and large congenital naevi were only present in melanoma patients and thus were strongly associated with melanoma. The percentage of correctly classified subjects in the LR model was 74.9%, sensitivity 71%, specificity 78.7% and AUC 0.805. For the ADT percentage of correctly classified instances was 71.9%, sensitivity 71.9%, specificity 79.4% and AUC 0.808. Conclusion. Application of different models for risk assessment and prediction of melanoma should provide efficient and standardized tool in the hands of clinicians. The presented models offer effective discrimination of individuals at high risk, transparent decision making and real-time implementation suitable for clinical practice. A continuous melanoma database growth would provide for further adjustments and enhancements in model accuracy as well as offering a possibility for successful application of more advanced data mining algorithms.

Background/Aim. There are various opinions regarding the factors motivating women to undergo breast augmentation. The aim of this study was to estimate motivation for augmentation mammaplasty (AM), self-esteem and body image perception in breast augmentation patients. Methods. This prospective study involved AM patients operated in the Clinical Center of Vojvodina during a 3-year period. A total of 45 patients responded to our package of questionnaires designed to assess motivation for surgery, self-esteem level and body image perception. Those patients were compared to the control group of women who did not want to change their breast size, and who were similar in their age, social status and education level. Our package of questionnaires included a general questionnaire, Photographic Figure Rating Scale (PFRS) and Rosenberg’s Self-Esteem Scale. Results. Differences in marital status, educational level, habitation and employment status were statistically insignificant, but there was a significantly lower body mass index (BMI) in the operated women. Considering motives for surgery, a few factors were distinguished: desire to feel more feminine (82.2%), confident (75.5%) and attractive (73.3%), to feel less shy with men (64.4%), to improve their sex life (46.5%), teasing history (42.2%) and easier to find a partner (11.1%) and job (2.2%). Both groups demonstrated a high self-esteem level, but in the AM group results were lower than in the control group. The mean current self-rating by the PFRS in the group AM was lower than in the control group (4.28 ± 1.3 vs 5.12 ± 1.23, respectively) and this coincided with lower BMI in the AM group. The women in the AM group had chosen significantly smaller body size as maximally attractive, and had chosen a narrower attractive body size range than the women in the control group. Conclusion. Preoperative evaluation of patients’ motives for surgery can help surgeons to exclude woman with unrealistic expectations and different psychological problems.

Background. Fibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytren` s disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhose`s disease or plantar fibromatosis is plantar equivalent of Dupuyten`s disease most often affecting middle- aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia. Case report. We presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhose`s disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytren`s contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP) joint. On the extensor side of the PIP joints there were Garrod`s nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture. Conclusion. Despite the fact that Dupuytren`s disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.

Background/Aim. Varicella is a common and benign disease of childhood. Complications are rare, but in some patients, even without risk factors, severe, life threatening complications could be seen. The aim of this study was to establish the type and frequency of varicella complications among hospitalized patients over an 8-year period. Methods. This retrospective analysis included medical charts of the patients hospitalized in the Infectious Disease Clinic, Belgrade, Serbia, from 2001-2008 (4.85% of all registered patients with varicella in Belgrade, 2001-2008). Among hospitalised patients dermografic characteristics were analyzed: hospitalisation lenght, presence and type of complications, presence of immunocompromising conditions and outcome of the disease. The diagnosis of varicella was made on clinical grounds, and in persons > 40 years, with negative epidemiological data of contacts, serological confirmation (ELISA VZV IgM/IgG BioRad®) and avidity of IgG antibodies were done to exclude the possibility of disseminated herpes zoster. Results. A total of 474 patient were hospitalized over an 8-year period. The age of patients was from 5 months to 75 years (mean 22.4 ± 16.1, median 23.5 years). The majority of patients were adults (n = 279; 58.9%) and 195 (41.1%) patients were ≤ 15 years old. Complications were found in 321/474 (67.7%) patients. The registered complications were: varicella pneumonia (n = 198; 41.38%), bacterial skin infections (n = 40; 8.4%), cerebelitis (n = 28; 5.9%), bacterial respiratory infection (n = 21; 4.4%), viral meningitis (n = 10; 2.31%), encephalitis (n = 9; 1.9%), thrombocytopenia (n = 2; 0.4%); 11 (2.3%) patients had more than one complication, among them were sepsis, myopericarditis and retinal hemorrhages. When complications were analyzed according to the age, there were no statistical significance, but when type of complication was analyzed statistical significance was found (p < 0.05). In adults, pneumonia was the most common complication: 173/279 (62%), followed by skin infections (2.9%), bacterial respiratory infections (2,2%), and more than one complication (2.3%). Pneumonia was more common in adults than in children (7 : 1). In children skin infections were the most common complications (16.4%), followed by cerebelitis (13.3%), viral pneumonia (12.8%), bacterial respiratory infections (7.7%), encephalitis (3.6%), and more than one complication (4.1%). Neuroinfections were more common in children than in adults (6:1), as well as bacterial skin infections (4 : 1). Two patients died (0,4%). Conclusion. There was no difference in the incidence of varicella complication in children and adults, but the type of complication differed. In children the most common complications were skin and neurological infections, while in adults it was varicella pneumonia. These data provide a baseline for estimating the burden of varicella in Belgrade and support the inclusion of varicella vaccine in childhood immunisation program in Serbia.

Background/Aim. Hand injuries in agriculture are characterized by massive destruction of all tissues, frequent amputations of finger, hand and often the whole extremity. These injuries are mutilant and can cause death. The aim of this paper was to show the specificities of hand injuries in agriculture in regard to hand injuries of other etiology. Methods. We analyzed patients that were treated in the Department for Plastic and Reconstructive Surgery, Clinical Center Vojvodina, during a five-year period (2003-2007) because of hand injuries. Results. In a five-year period there were 366 patients hospitalized because of hand injuries, out of whom 36 injuries were related to agricultural machinery use. In both groups the number of patients trended to increased, with male gender being dominant. Most of the patients were young or middle-aged men. In agricultural injuries most of the patients were in the group of 41-50-year old (30%), while in the other group, the patients were younger (21-30-year old). Hand injuries in agriculture resulted in finger amputation in 92%, while in the other group that number was much smaller (13%). Skin defect reconstruction in agricultural injuries required complex methods of skin grafting or skin flaps in more than 71%, while this was necessary in only 10% of other hand injuries. Conclusion. Hand injuries in agriculture are very mutilant and often result in conquassation and finger amputation. A possibility to preserve tissue damaged in this way is very limited, and skin closer usually requires complex methods.