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Breast-cancer-related lymphedema (BCRL) is a common consequence of oncological treatment. Its management is a complicated, chronic, and arduous process. Therapeutic options can be divided on non-surgical and surgical methods, although there is still no clear consensus about their effectiveness in preventing or stopping the disease. That brings problems in everyday practice, as there are no guidelines about proper time for starting therapy and no agreement about which management will be beneficial for each patient. The aim of this review is to summarize current knowledge about possible treatment choices, non-surgical so as surgical, indicate knowledge gaps, and try to direct pathways for future studies.

The presence of postoperative complications may have a significant impact on the outcome of the breast reconstruction. The aim of this study was to investigate early postoperative complications and the risk factors for their occurrence. A prospective analysis was carried out to evaluate surgical outcomes after breast reconstructive surgeries performed over a 2-year period. Procedures included expander/implant (TE/IMP), pedicle transverse rectus abdominis musculocutaneous (pTRAM), and latissimus dorsi (LD) techniques. All adverse events which occurred within 6 weeks of surgery were ranked according to severity based on the contracted Accordion grading system. Outcomes were assessed for their association with surgical, demographic, and clinical variables. Sixty-one consecutive breast reconstruction procedures were analyzed. The overall complication rate was 60.7% (n = 37), and 8 patients (13.1%) required reoperation. The lowest complication rate was observed in implant-based reconstructions (TE/IMP, 18.8%; pTRAM, 72.7%; LD, 78.3%; p = 0.008). Mild complications occurred significantly more often after LD reconstructions (LD, 60.9%; pTRAM, 22.7%; TE/IMP, 12.5%; p = 0.031), while severe complications were significantly more frequent after the pTRAM procedures (pTRAM, 27.3%; TE/IMP, 6.2%; LD, 8.7%; p = 0.047). Severe complications were associated with higher rehospitalization rate (p = 0.010) and longer hospital stay. Study revealed a significant impact of the operative method on the incidence and severity of early complications after breast reconstruction procedures with little effect from other demographic and clinical factors.

Background Deregulation of signal transducer and activator of transcription (STAT) signaling is known to participate in the pathogenesis of cutaneous T-cell lymphomas (CTCLs). However, published results regarding STAT expression in different stages of CTCLs are conflicting. The aim of the study was to define the pattern of STAT expression in skin and detect any differences between pruritic and nonpruritic patients but also different stages of disease. Methods Thirty-nine skin biopsies from CTCL patients and 24 biopsies from healthy volunteers were taken. Immunohistochemical staining for STAT 3, 5a, 5b, and 6 was performed in formalin-fixed paraffin-embedded sections of mycosis fungoides (MF) and Sezary syndrome (SS) specimens. Results We found increased expression of STAT proteins in CTCL: MF and SS skin in comparison to the control group. STAT5 but also STAT6 and to a lesser extent STAT3 seems to be constitutively activated in MF and SS. Moreover, also downregulation of STAT5b protein in advanced-stage CTCL appears to contribute to its pathogenesis. There were no significant associations between expression of STATs and pruritus severity. Conclusions Our results confirm the possible pathogenetic role of STATs in CTCL. STATs seem to be a promising target for new effective therapeutic agents in CTCL.

Breast reconstruction is increasingly being considered as the next step in breast cancer treatment. There are many ways to recreate a new breast mound. In current times, the trend for breast reconstruction is reconstruction microsurgery which is the method of choice, but newcomers should know the alternative traditional methods. Since 1982 the pedicled TRAM (trans rectus abdominal myocutaneous) flap has become one of the most popular autologous tissue breast reconstruction procedures. It has also been debated for many years which method of transferring the tissue island is more reliable and has fewer complications—IPSI vs CONTRA [1]. The reasons for complications are the manner of twisting the nourishing blood supply and the tension due to the distance of the pedicle in both procedures [2]. Static thermography and dynamic thermography seem to provide the solution. In our experiment, we measured the medial surface temperature of flaps using static thermography and active dynamic thermography. The results were compared against the number of flap failures in each type of reconstruction. The study was conducted on a group of 20 female patients who underwent breast reconstruction.

The progress in translational cancer research relies on access to well-characterized samples from a representative number of patients and controls. The rationale behind our biobanking are explorations of post-zygotic pathogenic gene variants, especially in non-tumoral tissue, which might predispose to cancers. The targeted diagnoses are carcinomas of the breast (via mastectomy or breast conserving surgery), colon and rectum, prostate, and urinary bladder (via cystectomy or transurethral resection), exocrine pancreatic carcinoma as well as metastases of colorectal cancer to the liver. The choice was based on the high incidence of these cancers and/or frequent fatal outcome. We also collect age-matched normal controls. Our still ongoing collection originates from five clinical centers and after nearly 2-year cooperation reached 1711 patients and controls, yielding a total of 23226 independent samples, with an average of 74 donors and 1010 samples collected per month. The predominant diagnosis is breast carcinoma, with 933 donors, followed by colorectal carcinoma (383 donors), prostate carcinoma (221 donors), bladder carcinoma (81 donors), exocrine pancreatic carcinoma (15 donors) and metachronous colorectal cancer metastases to liver (14 donors). Forty percent of the total sample count originates from macroscopically healthy cancer-neighboring tissue, while contribution from tumors is 12%, which adds to the uniqueness of our collection for cancer predisposition studies. Moreover, we developed two program packages, enabling registration of patients, clinical data and samples at the participating hospitals as well as the central system of sample/data management at coordinating center. The approach used by us may serve as a model for dispersed biobanking from multiple satellite hospitals. Our biobanking resource ought to stimulate research into genetic mechanisms underlying the development of common cancers. It will allow all available “-omics” approaches on DNA-, RNA-, protein- and tissue levels to be applied. The collected samples can be made available to other research groups.

Background: Informed consent is important in clinical practice, as a person’s written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. Methods: Our assessment of a Polish-language plastic surgery informed consent form used the Polish-language comprehension analysis program (jasnopis.pl, SWPS University) to assess the readability of texts written for people of various education levels, and this enabled us to modify the form by shortening sentences and simplifying words. The form was re-assessed with the same software and subsequently given to 160 adult volunteers to assess the revised form’s degree of difficulty or readability. Results: The first software analysis found the language was suitable for people with a university degree or higher education, and after revision and re-assessment became suitable for persons with 4–6 years of primary school education and above. Most study participants also assessed the form as completely comprehensible. Conclusions: There are significant benefits possible for patients and practitioners by improving the comprehensibility of written informed consent forms.

IntroductionAlthough breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is infrequent, with less than 1000 noted cases worldwide, patients consenting for breast implant surgery should be aware of its risk. We describe the first Polish multicenter case-series data on BIA-ALCL patients and present diagnostic and treatment recommendation for breast surgeons.Material and methodsIn cooperation with the Polish Society of Surgical Oncology and Polish Lymphoma Research Group, we collected BIA-ALCL cases in Poland.ResultsWe retrospectively reviewed clinical data of seven BIA-ALCL patients, diagnosed between July 2013 and November 2019. The median time from implant placement to the first BIA-ALCL symptoms was 65 months (range: 33–96 months). All the patients were exposed to textured implants at presentation. Capsulectomy with implant removal was performed in all the patients with immediate reimplantation in 2 cases. In a median follow-up of 19 months (range 5-81 months), there was no recurrence and all the patients stayed alive. Between 2013 and 2019, the incidence of BIA-ALCL in Polish female population age 30 and above ranged from 0 to 0.021/100 000/year.ConclusionsBIA-ALCL is scarce in the Polish population. In a short-term follow-up, patients’ prognosis remains excellent. Due to the withdrawal of roughly textured implants from the market and the exclusion of likely the most potent etiologic factor, it might be expected that the incidence of BIA-ALCL will become even rarer.

Cutaneous T-cell lymphomas (CTCL) are malignant lymphoproliferative disorders accompanied by persistent pruritus. Pruritogenic role of interleukin-31 (IL-31) has been studied extensively and was proven in atopic dermatitis (AD), while its role in CTCL is still rather vague.To investigate IL-31 serum level along with IL-31, IL-31 receptor α (IL-31RA) and oncostatin M receptor β (OSMR) skin expression in CTCL and compare it to controls: AD and healthy volunteers.The level of IL-31 in serum was measured using ELISA, while IL-31 and receptors' expression in the skin were measured using immunohistochemistry and correlated with the stage of disease and pruritus severity.Expression of IL-31 and IL-31 receptor in serum and skin were significantly higher in CTCL and AD in comparison to healthy controls. No significant correlation between the IL-31 serum level and pruritus severity in CTCL patients was found. There was also no correlation between IL-31/IL-31RA/OSMR expression in the skin and CTCL pruritus, while IL-31 and IL-31RA in CTCL skin negatively correlated with the stage of disease.Our data indicate that IL-31 does not play a crucial role in pruritus in CTCL but it is rather involved in the pathogenesis of the disease. It seems that IL-31 plays an essential role in the pruritus pathomechanism that is unique to AD.

Background: The aim of this study was to evaluate whether Accordion Severity Grading System can serve as a tool for classification, and severity assessment in reporting postoperative complications after breast reconstructive surgery. Methods: A retrospective analysis covered 88 breast reconstruction surgeries following mastectomy and prophylactic breast amputation with simultaneous reconstruction conducted from January 2015 to December 2017. All registered postoperative complications were evaluated using the Accordion Severity Grading System. The time horizon selected was 6 weeks after surgery. Results: Eighty-two adverse events which met the criteria for complications according to the Accordion classification were observed in 53.4% (n = 47) of the patients. The highest percentage of complications was observed in the group where reconstruction involved using autologous tissues (pedicled transverse rectus abdominis myocutaneous), which were associated with 77.4% risk of complications. In patients with combined methods (latissimus dorsi + prosthesis), complications occurred in half of the cases (51.4%). In patients who underwent reconstructive procedures with artificial materials (expander/prosthesis), complications occurred in 20% of cases. A high γ correlation coefficient of 0.7 ( P < .001) was observed between the Accordion degree assigned to the patient and the length of hospital stay. A moderately strong correlation was found between the degree of Accordion system and rehospitalization rate (r = 0.54; P < .0001) and cost of hospital care (r = 0.65; P < .001). Discussion: Based upon the presented study, Accordion Severity Grading System is a workable, intuitive and universal scale for classifying and assessing the severity of postoperative complications and may be recommended for documenting complications in breast reconstructive procedures.

The skin barrier defect in cutaneous T-cell lymphomas (CTCL) was recently confirmed to be similar to the one observed in atopic dermatitis (AD). We have examined the expression level of cornified envelope (CE) proteins in CTCL, AD and healthy skin, to search for the differences and their relation to the courses of both diseases. The levels of FLG, FLG2, RPTN, HRNR, SPRR1A, SPRR1B, SPRR3 and LELP-1 mRNA were determined by qRT-PCR, while protein levels were examined using the ELISA method in skin samples. We have found that mRNA levels of FLG, FLG2, LOR, CRNN and SPRR3v1 were decreased (p &le, 0.04), whereas mRNA levels of RPTN, HRNR and SPRR1Av1 were increased in lesional and nonlesional AD skin compared to the healthy control group (p &le, 0.04). The levels of FLG, FLG2, CRNN, SPRR3v1 mRNA increased (p &le, 0.02) and RPTN, HRNR and SPRR1Av1 mRNA decreased (p &le, 0.005) in CTCL skin compared to the lesional AD skin. There was a strong correlation between the stage of CTCL and increased SPRR1Av1 gene expression at both mRNA (R = 0.89, p &le, 0.05) and protein levels (R = 0.94, 0.05). FLG, FLG2, RPTN, HRNR and SPRR1A seem to play a key role in skin barrier dysfunction in CTCL and could be considered a biomarker for differential diagnosis of AD and CTCL. SPRR1Av1 transcript levels seem to be a possible marker of CTCL stage, however, further studies on a larger study group are needed to confirm our findings.

This paper presents the new method of the transverse rectus abdominis musculocutaneous flap blood perfusion mapping based on the active dynamic thermography. The method is aimed at aiding a surgeon during breast reconstruction procedure. A pair of dTnorm and t90_10 parameters were used as parametric image descriptors of the flap blood perfusion. The method was tested on 38 patients that were subjected to breast reconstruction procedure. This showed that, comparing to the static thermography, this is potentially an objective and effective method of skin flap perfusion assessment that can be performed in the operating room.

Tocopherols and tocotrienols have been extensively studied owing to their anticancer potential, especially against breast cancer. Therefore, the aim of this study was to quantitatively determine tocochromanols in human breast adipose tissue with the use of HPLC-FLD. The sample preparation procedure included homogenization and solvent extraction with isopropanol-ethanol-0.1% formic acid mixture prior to solid-phase extraction. After implementation of central composite design, satisfactory separation of all eight target compounds was achieved within 10.5 min. Chromatographic runs were carried out with the use of a naphthylethyl chromatographic column with methanol-water mixture (89:11, v/v) as the mobile phase. Fluorescence detection of tocochromanols was performed with excitation and emission wavelengths 298 and 330 nm, respectively. The method was validated in terms of linearity, carryover, recovery, precision, accuracy and stability. Extraction yield was also determined for accurate evaluation of vitamin E content in human breast adipose tissue samples. Finally, concentrations of particular tocochromanols compounds were assessed in human breast adipose tissue samples obtained from 99 patients, including women with breast cancer, healthy volunteers and deceased women who had died as a result of accidents. The raw data was transformed according to the newly developed equation for accurate estimation of the concentrations of tocochromanols in breast adipose tissue samples. Results obtained in the study indicated that the proposed analytical assay could be useful in breast cancer research.

The number of breast reconstruction procedures has been increasing in recent years. One of the suggested treatment methods is breast reconstruction with a pedicled skin and muscle TRAM flap (transverse rectus abdominis muscle – TRAM). Surgical incisions performed during a cholecystectomy procedure may be located in the areas significant for flap survival. The aim of this paper is to present anatomical changes in abdominal walls secondary to pedicled skin and muscle (TRAM) flap breast reconstruction, which influence the planned access in cholecystectomy procedures. The authors present 2 cases of cholecystectomy performed due to cholelithiasis in female patients with a history of TRAM flap breast reconstruction procedures. The first patient underwent a traditional method of surgery 14 days after the reconstruction due to acute cholecystitis. The second patient underwent a laparoscopy due to cholelithiasis 7 years after the TRAM procedure. In both cases an abdominal ultrasound scan was performed prior to the operation, and surgical access was determined following consultation with a plastic surgeon. The patient who had undergone traditional cholecystectomy developed an infection of the postoperative wound. The wound was treated with antibiotics, vacuum therapy and skin grafting. After 7 weeks complete postoperative wound healing and correct healing of the TRAM flap were achieved. The patient who had undergone laparoscopy was discharged home on the second postoperative day without any complications. In order to plan a safe surgical access, it is necessary to know the changes in the anatomy of abdominal walls following a pedicled TRAM flap breast reconstruction procedure.

Despite intraoperative clinical evaluation, development of post-breast reconstruction surgery flap necrosis is not uncommon. This results in prolonged healing or the need for a secondary corrective procedure to remove the necrosis part. In the present study, to predict the post-operative necrosis risk (within 24 h), novel passive and active dynamic thermography-based quantitative parameters were tested. Thirty-two patients, undergoing breast reconstruction surgery, were recruited, on whom, post-surgery passive and active infrared (IR) thermography examinations were performed. Using the resultant quantitative parameters, a cut-off value-based classification model was tested that resulted in a highest sensitivity, specificity, and accuracy of 89%, 87%, and 88%, respectively, for the passive thermography examination performed just after the surgery.

Background Among the problems encountered by plastic surgeons is the reconstruction of defects following tumors. One of the reconstructive options is trans rectus abdominis (TRAM) flap. Despite that anatomy is well explored, marginal flap necrosis may develop. To minimize the complications, imaging examinations were designed to determine the degree of flap perfusion. One of them is the thermographic examination. Materials and methods We examined 38 patients who had undergone 10 reconstructive breast surgeries with a pedicled TRAM ipsilateral flap, 10 patients with a TRAM contralateral flap, and 18 patients with a TRAM supercharged flap. Each operated patient underwent a thermographic examination before the surgery, after the dissection of the skin-muscle flap, immediately after suturing flap, and during the first and seventh day after the surgery. The collected data were then processed to yield results in a numerical form and compared with clinical examination. The aim of this study is to evaluate the efficacy of new thermal model calculation of dT norm and t 90_10 in cold stress dynamic thermography in the in vivo assessment of intraoperative and postoperative skin blood supply in humans before ischemic lesions become clinically apparent. Results Of 38 patients participating in the study, nine patients developed marginal necrosis of the skin flap despite intraoperative clinical evaluation of blood supply. Explicit circulatory disorders apparent in a clinical examination developed after 24 h. Conclusions Cold stress t norm and t 90_10 dynamic thermography can be a helpful additional tool to assess and monitor the blood supply to the flap skin both intraoperatively and postoperatively. Active dynamic thermography; cold stress dynamic thermography, thermography; TRAM; flap necrosis; flap monitoring, breast reconstruction.

Since 1982 the pedicled TRAM flap has become the “gold standard” in breast reconstruction procedures. It has also been debated since then which way of transferring the tissue island is more reliable with less complications IPSI vs CONTRA [1]. The reasons for complications include the manner of twisting the nourishing blood supply and the tension due to the distance of the pedicle in IPSI or CONTRA procedures [2]. Static thermography seems to provide the solution. In our experiment we measure medial surface temperature of flaps using static thermography. The results were compared against the number of flap failures in each type of reconstruction. The study was conducted on a group of 20 female patients who underwent breast reconstruction.

This paper shows results of the static thermography for intraoperative and postoperative imaging of TRAM flap perfusion. The results were compared with the clinical examination of flap perfusion. The study was conducted on a group of 38 female patients who underwent breast reconstruction. One of the primary tasks of plastic surgery is the reconstruction of integumentary defects with the use skinfat or skin-muscle flaps. The flaps can be both pedicled and free, in which the flap vessels are connected with the recipient site vessels with microsurgical techniques. They involve surgical procedures with a high risk of complications, ranging from partial marginal necrosis with total necrosis of the flap. The consequences include a long hospitalization, increased risk of surgical site infection, necessity for subsequent operations, increased costs of treatment, and - finally - a poorer aesthetic and functional result.

Summary Aim The aim of this study was to evaluate results of our surgical treatment of advanced neoplasms of the floor of the mouth, treated from 2005–2011 in Department of Otolaryngology and Department of Plastic Surgery Medical University of Gdansk Material We analyzed group of 12 patients (aged 36 to 70 years, mean 55) treated by primary surgical excision of neoplasms of the floor of the mouth (with tracheotomy and mandibulotomy) and selective or radical neck dissection (uni- or bilateral) in combination with chemoradiotherapy. All patients referes with advancement of locoregional disease: primary tumors (T3 or T4) and neck metastases (N1 or N2b) Most of the patients required to use free microvascular reconstruction with free forearm skin flaps. Histological examinations revealed squamous cell carcinoma (11/12) and adenocarcinoma (1/12). Results Two patients die in 1 and 4 months after surgery. Three die from 2 to 3 years after surgery. Rest live from 6 month to 6 year after therapy. Conclusion Free forearm skin microvascular flap is good (anatomical and functional) for reconstruction for large defects after resection neoplasms of the floor of the mouth

Nipple-areola complex (NAC) is a unique part of the human body. Not only is it a functional structure, but it plays an aesthetic role as well. It offers the final touch to the convex shape of the breast. Its lack frequently leads to depression in patients. This paper describes the method used by the authors for reconstructing nipple mound projection in patients following an autologous breast reconstruction procedure. To reconstruct the nipple mound an adapted local C-V flap technique described by Losken was used, with a silicone rod to support the nipple. The new method is based on simple preparation of flaps, fixing the silicone rod at the nipple bottom and below the top, it is quick and efficient in terms of time and materials used. The procedure was conducted in 30 patients: 10 cases following LDf reconstruction and Becker prosthesis or expander prosthesis, 20 cases following body tissue reconstruction with TRAM flap (Transverse Rectus Abdominis Musculocutaneous flap). All the patients who had undergone the LDf procedure developed flap necrosis followed by rod removal. In the patients who had undergone TRAM flap reconstruction no necrosis or wound split was observed, healing progressed without complications. In this group durable nipple projection was achieved. The new method for reconstructing nipple projection may be applied both in simultaneous and staged procedures, only in patients who have undergone autologous breast reconstruction procedure.

The use of free TRAM flaps for clinical and experimental purposes has a number of advantages. The rat rectus muscle has a predictable “flow-through” axial vascular system with six to seven perforators. Anatomy-wise, it is a reliable model with clearly defined limits and stable orientation points. It offers reliable blood supply, it is multifunctional, easy to prepare without subsequent complications. Its vessels (superior epigastric, in particular) have a diameter which is sufficient for an expert microsurgeon to perform anastomoses. It may be used in a number of laboratory studies on microcirculation, biochemical or pharmacological laboratory studies.

The aim of this study was to evaluate results of our surgical treatment of advanced neoplasms of the floor of the mouth, treated from 2005-2011 in Department of Otolaryngology and Department of Plastic Surgery Medical University of GdańskWe analyzed group of 12 patients (aged 36 to 70 years, mean 55) treated by primary surgical excision of neoplasms of the floor of the mouth (with tracheotomy and mandibulotomy) and selective or radical neck dissection (uni- or bilateral) in combination with chemoradiotherapy. All patients referees with advancement of locoregional disease: primary tumors (T3 or T4) and neck metastases (N1 or N2b) Most of the patients required to use free microvascular reconstruction with free forearm skin flaps. Histological examinations revealed squamous cell carcinoma (11/12) and adenocarcinoma (1/12).Two patients die in 1 and 4 months after surgery. Three die from 2 to 3 years after surgery. Rest live from 6 month to 6 year after therapy.Free forearm skin microvascular flap is good (anatomical and functional) for reconstruction for large defects after resection neoplasms of the floor of the mouth.

As the most recognizable part of the body, the face has always interested, not only artists, but doctors as well. Each has had their own perception of facial beauty. The task for plastic and aesthetic surgery regarding the face is to reconstruct, not only traumatic lesions, but also to prevent the effects of facial tissue aging. It is also important to preserve the aesthetic values of the face in different emotional conditions. Those conditions are partially represented by mimetic or facial muscles. One might suggest that the perception of human beings portrayed by the artists could be very helpful in the realm of plastic and aesthetic surgery. Take, for example, Hans Memling, a fifthteenth century Flemish artist whose masterpiece ``Last Judgment'' is exhibited at Gdansk National Museum in Poland. The fortunate individuals on the left side of the painting are queuing at heaven's gate to receive their reward. Their faces are smooth with smiles, displaying blessings and happiness. The right-hand side of the painting exemplifies the expression of fear and the drama of the situation. These sinners have been damned and sentenced to hell by evil creatures. The fear, pain, and tragedy of condemnation fill their faces. For plastic and cosmetic surgeons, studying the works of great artists has not been as valuable as using the emotionless and intangible figures of an anatomy book. Undoubtedly, the only useful paintings and sculptures are those that are full of expression with the face displaying a plethora of emotions. In all surgical approaches where mimetic muscles are concerned, one has to remember and be conscious of the fact that the face is a very significant part of our body.

High-flow priapism is a relatively rare pathology. Thus, there are not many large studies evaluating its management. The article describes the case of a patient with high-flow priapism caused by an arterio-lacunar fistula resulting from a perineal trauma affecting the base of the left cavernous body. After unsuccessful selective embolization open direct excision of the vascular malformation was performed. The localization of the lesion was enabled by clinical examination and by Doppler ultrasound. The treatment was successful and erectile function fully recovered after one month. This simple method may be of value when modern minimally invasive techniques appear to be uneffective. fig. 1. Partial almost painless erection with small induration at the base of the left cavernous body. fig. 2. Arterio-lacunar fistula with high flow visible in color Doppler study.