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Type III transforming growth factor beta receptor (TGFbrIII) modulates TGFbeta superfamily signaling. Its tutor tissue expression is downregulated in human breast cancer. We assumed that its soluble form (sTGFbrIII) could be detectable in plasma with potential use in diagnostics/follow-up of breast cancer patients. For this purpose, we aimed to develop an indirect ELISA for its quantification and test its utility in a cohort of women with breast cancer. Our data suggest a high potential of plasma sTGFbrIII as a vowel diagnostic and prognostic biomarker in breast cancer.

Prikazani rezultati kirurškog liječenja dekubitusa na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju KB Dubrava u vremenu od 2011. do 2016. nisu bitno različiti u odnosu na rezultate kirurškog liječenja iste patologije u studiji iz vreme- na 2003.-2008., što dokazuje i dalje odličnu planiranost i izvedivost kirurških zahvata, odgovarajuću pripremu bolesnika i adekvatnu postoperacijsku skrb. Unatoč manjem broju hospitaliziranih bolesnika s dekubitusom u studiji 2011.-2016. (31 bolesnik ; 42 rekonstrukcijska zahvata) i dalje je učinjen sličan broj rekonstrukcijskih zahvata uspoređujući sa studijom 2003.-2008. (47 bolesnika ; 57 rekonstrukcijskih zahvata). Kod rekonstrukcije dekubitusa na sakralnoj regiji kod naših bolesnika najbolje rekonstrukcijske rezultate postigli smo i dalje kliznim fasciokutanim, odnosno mišićnokutanim režnjevi- ma. Kada je god to moguće, ovisno o kliničkoj slici defekta trebalo bi dati prednost mišićnokutanim režnjevima, posebno u slučajevima recidiva dekubitusa. Kod rekonstrukcije dekubitusa u području ishijadičnih zona vrlo dobri rezultati postignuti su uporabom mišićnih režnjeva semimembranozusa i /ili semitendinozusa koji se mobiliziraju u defekt, dok za područje trohan- terne regije koristimo transpozicijski režanj fascije late. Liječenje bolesnika s dekubitusom je multidisciplinarno s naglaskom na kirurško liječenje koje se sastoji od radikalnog debridmana, ostektomije i egzaktno planirane i učinjene rekonstrukcije. Konzervativno liječenje mora biti podrška kirurškom liječenju s naglaskom na njegu i visoke higijenske mjere bolesnika. U novije vrijeme (studija 2011.-2016.) sve kvalitetnija uporaba konzervativnog načina tretmana dekubitalnih rana realno je dovela do smanjenja potrebe za hospitalizacijom i kirurškim liječenjem. Daljnjim edukacijama medicinskih sestara u smislu „wound care“-a u zdravstvenim učilištima i bolnicama trebalo bi dati posebno značenje što bi dovelo do prevencije, ali i pravodobnog početka liječenja bolesnika s dekubitusom.

Potkoljenični vrijed je učestala bolest u općoj populaciji koja ima za posljedicu znatan morbiditet. Poseban problem je široka diferencijalna dijagnoza što se etiologije tiče tako da uzrok može biti metabolički, imunološki, vaskularni, onkološki ili miješani. Pristup liječenju je multidisciplinaran. Uz niz uključenih medicinskih struka kirurgija je bitan faktor u liječenja komplikacija vrijeda, postoji niz učinkovitih zahvata koji uz pravu indikaciju imaju za ishod cijeljenje . Uz plastično rekonstrukcijske metode postoji i niz komplementarnih metoda uglavnom iz domene vaskularne kirurgije kojima se optimizira lokalno i regionalno stanje te poboljšava rezultat liječenja., Lower leg ulcers have a high in incidence in general population and are associated with a significant morbidity rate. Wide differential diagnosis considering their etiology poses considerable problem, as the causes are diverse including metabolic, immune, oncologic, vascular and mixed ones. Approach to treatment should be multidisciplinary, and among various medical specialties surgery plays an important role. There are numerous efficient procedures that require proper indication to be successful. Along with reconstructive methods, there are complementary methods, mainly from the field of vascular surgery; when combined, they produce good results.

Potkoljenični vrijed je učestala bolest u općoj populaciji koja ima za posljedicu znatan morbiditet. Poseban problem je široka diferencijalna dijagnoza što se etiologije tiče tako da uzrok može biti metabolički, imunološki, vaskularni, onkološki ili miješani. Pristup liječenju je multidisciplinaran. Uz niz uključenih medicinskih struka kirurgija je bitan faktor u liječenja komplikacija vrijeda, postoji niz učinkovitih zahvata koji uz pravu indikaciju imaju za ishod cijeljenje . Uz plastično rekonstrukcijske metode postoji i niz komplementarnih metoda uglavnom iz domene vaskularne kirurgije kojima se optimizira lokalno i regionalno stanje te poboljšava rezultat liječenja.

Breast cancer is the most common cancer in women. It can be diagnosed in early stage through screening, early detection and educational programs, and when diagnosed early it can be efficiently treated. Treatment modalities include surgery, chemotherapy, radiotherapy, hormonal therapy and targeted biologic therapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis, management, treatment and monitoring of patients with breast cancer in the Republic of Croatia.

Rak dojke najčešći je zloćudni tumor u žena koji se može probirom, redovitim kontrolama i zdravstvenim odgojem otkriti u ranim stadijima bolesti i uspješno liječiti. Metode liječenja uključuju kirurgiju, kemoterapiju, radioterapiju, hormonsku terapiju i ciljanu biološku terapiju ovisno o stadiju bolesti, biološkim obilježjima tumora i općem stanju bolesnice. Odluku o liječenju donosi multidisciplinarni tim. S obzirom na važnost ove bolesti, potrebno je definirati i provoditi standardizirani pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu koji slijedi iznesene su kliničke smjernice s ciljem implementacije standardiziranih postupaka u radu s bolesnicama s rakom dojke u Republici Hrvatskoj.

Type III TGFβ receptor (TGFβrIII) modulates TGFβ superfamily signaling. Its tumor tissue expression is downregulated in human breast cancer. We determined (indirect ELISA) plasma levels of the soluble receptor (sTGFβrIII) in 47 women with breast cancer (AJCC stage 0 to IIB) (cases) pre- surgery and over two months after the surgery, and in 36 healthy women (controls). Plasma sTBFβrIII was lower in cases than in controls (age-adjusted difference -29.7 ng/mL, P

Breast carcinoma falls into a heterogeneous group of diseases which can be determined by various prognostic factors. The identification of clinical and histopathologic factors is of great value in predicting the progression of tumor growth and survival outcome. Due to a high degree of cell proliferation in breast tumors and high genetic instability of these tumors, as a consequence of defective DNA repair mechanisms, chemotherapy as a treatment option often renders very successful results. During our scientific study of the expression of genes responsible for mismatch repair of DNA in cells of invasive ductal carcinoma we also compared the patient survival rate with the major prognostic factors. This study included 108 patients who were surgically treated for invasive breast cancer at the Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava". The overall survival rate was compared to factors such as initial tumor stage, regional lymph node involvement and distant metastasis. The overall five year survival rate of our patients was 78.7%. Patients without the presence of distant metastasis, a lower rate of local lymph node involvement and a lower. tumor stage statistically had a longer overall survival period. It is important that physicians recognize the various clinico-pathohistological factors in patients with breast carcinoma. This study confirms that this prognostic factors determine the type of treatment required and most important, the patient overall survival period.

Breast carinoma falls into a heterogeneous group of diseases which can be determined by various prognostic factors. The identification of clinical and histopathologic factors is of great value in predicting the progression of tumor growth and survival outcome. Due to a high degree of cell proliferation in breast tumors and high genetic instability of these tumors, as a consequence of defective DNA repair mechanisms, chemotherapy as a treatment option often renders very successful results. During our scientific study of the expression of genes responsible for mismatch repair of DNA in cells of invasive ductal carcinoma we also compared the patient survival rate with the major prognostic factors. This study included 108 patients who were surgically treated for invasive breast cancer at the Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital »Dubrava«. The overall survival rate was compared to factors such as initial tumor stage, regional lymph node involvement and distant metastasis. The overall five year survival rate of our patients was 78, 7%. Patients without the presence of distant metastasis, a lower rate of local lymph node involvement and a lower tumor stage statistically had a longer overall survival period. It is important that physicians recognize the various clinico- pathohistological factors in patients with breast carcinoma. This study confirms that this prognostic factors determine the type of treatment required and most important, the patient overall survival period.

There are still a lot of contradictory reports about single or bilateral, pedicled or skeletonized internal mammary artery (IMA) harvesting and its implication on sternal microcirculation and wound complications even in diabetic patients. We present the case of excessive breast skin necrosis after single IMA harvesting in a diabetic patient with necrosis progression far from the acute phase that finally has demanded for breast amputation., {"references":["Wouters R, Wellens F, Vanermen H, De Geest R, Degrieck I, De Meerleer F. Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors. Tex Heart Inst J 1994;21:183-8.","Carrier M, Grégoire J, Tronc F, Cartier R, Leclerc Y, Pelletier LC. Effect of internal mammary artery dissection on sternal vascularization. Ann Thorac Surg. 1992;53:115-9.","Seyfer AE, Shriver CD, Miller TR, Graeber GM. Sternal blood flow after median sternotomy and mobilization of the internal mammary arteries. Surgery 1988;104:899-904.","Knobloch K, Lichtenberg A, Pichlmaier M, Mertsching H, Krug A, Klima U, Haverich A. Microcirculation of the sternum following harvesting of the left internal mammary artery. Thorac Cardiovasc Surg. 2003;51:255-9.","Lorberboym M, Medalion B, Bder O, Lockman J, Cohen N, Schachner A, Cohen AJ. 99mTc-MDP bone SPECT for the evaluation of sternal ischaemia following internal mammary artery dissection. Nucl Med Commun. 2002;23:47-52.","Behranwala AA, Raja SG, Dunning J. Is skeletonised internal mammary harvest better than pedicled internal mammary harvest for patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg. 2005;4:577-82.","Medalion B, Katz MG, Lorberboym M, Bder O, Schachner A, Cohen AJ. Decreased sternal vascularity after internal thoracic artery harvesting resolves with time: an assessment with single photon emission computed tomography. J Thorac Cardiovasc Surg. 2002;123:508-11."]}

This report describes a chondromyxoid fibroma of the second metacarpal bone in a 32-year-old female patient. Chondromyxoid fibroma is a rare, benign, slow-growing bone tumor of cartilaginous origin. Tumor has a high recurrance rate. Our aim was to show successful treatment of a metacarpal chondromyxoid fibroma with wide resection and implantation of finger join endoprosthesis.

Najčešće vrste kroničnih rana su rane na donjim ekstremitetima dijabetičara (dijabetičko stopalo), ulkusi u bolesnika sa smetnjama venske odnosno arterijske cirkulacije (venski i arterijski ulkusi), rane zbog pritiska (dekubitus), kronične postraumatske rane, odnosno kronične rane nakon kirurških zahvata, te kronični postiradijacijski ulkusi. Najčešći uzrok kroničnog potkoljeničnog ulkusa je kronična venska insuficijencija i periferna arterijska bolest. Komplicirano dijabetičko stopalo je najveći uzrok netraumatskih amputacija. Uz poznavanje dijagnostike i odgovarajućeg kirurškog liječenja uzroka kronične rane, potrebno je i poznavanje rekonstrukcijskih modaliteta defekta koji nastaje nakon obavezno učinjenog debridmana. U obzir dolazi pokrivanje defekta slobodnim kožnim transplantatom, lokalnim fasciokutanim i mišićnim režnjevima, kao i slobodnim fasciokutanim, kutanim i mišićno-kutanim, odnosno mišićnim režnjevima. Postoje i drugi oblici tretiranja defekata primjenom negativnog tlaka, posebnih obloga, rasteretne obuće, hiperbarične oksigenoterapije kao i primjene zamjenskih oblika kožnog pokrova (faktori rasta, matične stanice). S ciljem maksimalnih funkcionalnih i rekonstrukcijskih rezultata, multidisciplinarni i «holistički» pristup ima vodeću ulogu u modernom konceptu liječenja kroničnih rana.

U retrospektivnoj studiji analizirali smo i usporedili faktore lokalne pro{; ; ; irenosti raka dojke, odnosno veli~inu tumora i status regionalnih limfnih ~vorova u razdoblju od 1997. do 2007. Tako|er smo uspore|ivali zastupljenost pojedinih dobnih skupina i prosje~nu dob bolesnica u promatranom razdoblju. Studijom su obuhva}; ; ; ene samo one bolesnice kod kojih je dijagnoza postavljena na otvorenoj kirur{; ; ; koj biopsiji, a bilo je mogu}; ; ; e odrediti lokalnu pro{; ; ; irenost tumora u vrijeme postavljanja dijagnoze (pT i pN stadij), ukupno 1202 bolesnice. Prosje~na veli~ina tumora u vrijeme postavljanja dijagnoze bila je 2, 2 cm, a kretala se izme|u 1, 7 cm (2005.) i 2, 4 cm (1997., 1999.). U~estalost metastaza u pazu{; ; ; nima limfnim ~vorovima varirala je izme|u 37% (2001.) i 50% (2000. i 2006.). Prosje~no u 6% svih slu~ajeva rak dojke dijagnosticiran je u neinvazivnom (in situ) stadiju. Srednja dob bolesnica bila je 56, 8 godina, a prema promatranim godinama kretala se izme|u 54, 3 (1999.) i 59, 1 (2004.) godina. Nije bilo statisti~ki zna~ajne razlike u odnosu prema stadiju bolesti ili dobi bolesnica u vrijeme postavljanja dijagnoze u cijelome promatranom razdoblju. Isto tako nije bilo statisti~ki zna~ajnih razlika u pro{; ; ; irenosti bolesti u vrijeme dijagnoze kod bolesnica mla|ih i starijih od 50 godina.

Defects of the scalp and calvaria most frequently occur as a result of invasive growth of intra- or extracranial malignant or benign tumors, or as a result of trauma. During a five-year period, from 2004 to 2008, 21 patients (12 men and 9 women) underwent reconstructive surgery for scalp and calvaria defects at the Department of Plastic Surgery, “Dubrava” University Hospital. The patients were divided into groups with regard to the etiology of the defect, size, depth, reconstruction technique, number of surgical procedures, complications and duration of hospitalization. Different local flaps were successfully used for reconstruction of small and medium-sized defects of the scalp and calvaria, while large defects were reconstructed using free microvascular flaps. Successful treatment of the scalp and calvaria defects depends on accurate indication and the choice of an appropriate reconstruction technique., Defekti skalpa i kalvarije najčešće su posljedica invazivnog rasta intra- ili ekstrakarnijalnih zloćudnih ili dobroćudnih tumora ili traume. Tijekom petogodišnjeg razdoblja, od 2004. do 2008. godine, u Klinici za plastičnu kirurgiju KB Dubrava 21 bolesnik (12 muškaraca i 9 žena, srednja dob - 61 godina) bio je podvrgnut rekonstrukcijskom kirurškom zahvatu zbog defekata sklapa i kalvarije. Bolesnici su podijeljeni u skupine s obzirom na etiologiju defekta, veličinu, dubinu, reksontrukcijski postupak, broj kirurških zahvata, komplikacije i trajanje hospitalizacije. Za male i srednje velike defekte skalpa i kalvarije uspješno su korišteni različiti lokalni režnjevi, a za velike defekte slobodni mikrovasularni režnjavi. Uspjeh zbrinjavanja ovih defekata skalpa i kalvarije ovisi o pravilnoj indikaciji i izboru adekvatne kirurške tehnike za rekonstrukciju.

Značajan napredak u kirurškom liječenju opeklina u drugoj polovici 20 st. omogućilo nam je bolje razumijevanje patofizioloških mehanizama nastanka opekline te sistemsko djelovanje koje prate takve ozljed. Opekline predstavljaju ozbiljan i javnozdravstveni problem. U modernom pristupu kirurškog liječenja dubokih opeklina, značajan doprinos daje razvoj tehnika plastične kirurgije - transplantacija kože. Kirurški plan pristupa liječenju opeklina mora biti prilagođen svakoj osobi posebno. Postoje brojne kirurške mogućnosti za liječenje opeklina u akutnoj fazi kao npr: privremena zamjena kože - aloplastični xenograft, sintetička i polusintetička zamjena kože i konačno najbolji autotransplantati kože. Kirurško liječene dubokih opeklina a koje uključuje ekscizije opečenog tkiva i pokrivanje sa slobodnim kožnim presadcima poboljšava i ubrzava izlječenje opečenih bolesnika uz smanjenje invaliditeta. Ovi rani kirurški postupci dovode i do smanjenja opće smrtnosti, poboljšanja estetske i funkcionalne razine opsežno opečenih bolesnika.

Komplicirano dijabetičko stopalo je najveći uzrok netraumatskih amputacija što dovodi do značajnog morbiditeta i mortaliteta osoba oboljelih od dijabetesa. Osnovno je u liječenju razumijevanje patofiziologije razvoja ulkusa na dijabetičkom stopalu Antibiotska terapija, kao i revaskularizacija ekstremiteta uz odgovarajući tretman defekta, nema smisla bez dobro regulirane osnovne bolesti. Nakon odgovarajuće pripreme bolesnika i nekrektomije svih nek rozom zahvaćenih struktura u obzir dolazi direktno zatvaranje bataljka (amputacija), ali i rekonstrukcija defekata slobodnim kožnim transplantatom, lokalnim kožnim i mišićnim režnjevima, a u pojedinačnim slučajevima i slobodnim režnjevima. Ostali modaliteti liječenja kao što je terapija negativnim tlakom, hiperbarična oksigenoterapija, rasteretna terapija raznim udlagama kao i terapija faktorima rasta također ima važno mjesto u liječenju samog defekta.

Najčešći uzrok kroničnog vrijeda potkoljenice je kronična venska insufi cijencija i periferna arterijska bolest. Kronična venska insufi cijencija podrazumijeva valvularnu inkompetenciju s opstrukcijom venskog odtoka ili bez nje, koja zahvaća površinski ili duboki venski sustav zajedno s perforantnim venama. Periferna arterijska bolest je opstruktivno-okluzivna bolest donjih ekstremiteta koja značajno reducira normalan protok krvi. Oba patološka supstrata dovode do promjena mikrocirkulacije s posljedičnim kroničnim potkoljeničnim vrijedom. Razumijevanje patofi ziologije koja dovodi do pojave vrijeda potkoljenice čini okosnicu liječenja bez obzira na etiološki čimbenik. Atraumatski striping površinskih vena uz mikrofl ebektomiju standardni je postupak liječenja kronične venske insufi cijencije. Okluzijski postupci kao što su RFA, EVLT, te endoskopsko podvezivanje perforantnih vena (SEPS) čine novije zahvate na površinskom venskom sustavu. Dobrom selekcijom bolesnika i pravilnim odabirom supraingvinalnih i infraingvinalnih oblika revaskularizacije moguće je postići višegodišnju prohodnost revaskulariziranih krvnih žila. Uz poznavanje dijagnostike i odgovarajućeg kirurškog liječenja uzroka vrijeda potrebno je i poznavanje rekonstrukcijskih modaliteta defekta koji nastaje nakon obavezno učinjenog debridmana. U obzir dolazi pokrivanje defekta slobodnim kožnim transplantatom, lokalnim fascio-kutanim i mišićnim režnjevima, kao i slobodnim fasciokutanim, kutanim i mišićno-kutanim odnosno mišićnim režnjevima. Postoje i drugi oblici tretiranja defekata primjenom negativnog tlaka, posebnih obloga, hiperbarične oksigenoterapije kao i primjene zamjenskih oblika kožnog pokrova.

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BACKGROUND: The sentinel lymph node (SLN) procedure is a method for ascertaining the axillary lymph node status in patients with breast cancer. Intraopearative examination of the SLN is important because a positive result directs surgery to a complete axillary lymph node dissection (ALND) and negative result avoids unnessesary lymphadenectomy. The purpose of this study was to evaluate the utility and accuracy of intraoperative touch imprint cytology (ITIC) in patients undergoing SLN for metastatic breast cancer. METHODS: Within three years (2003 – 2006) a total of 79 SLNs from 63 patients (62 female and one male) with T1 to T2 breast carcinoma were examined by ITIC. SLNs were identified by technetium-labelled sulphur colloid and blue dye. They were bisected along the long axis or sliced into 3 mm sections. Imprints were made of each cut surface, stained with Hemacolor rapid staining and reviewed by a cytologist. Later SLNs were submitted for paraffin embedding and serial sectioning. They were stained with HE and immunohistochemical staining for cytokeratin. Intraoperative imprint cytology results were compared with final histological diagnosis. RESULTS: Definitive histology revealed metastases in 17/63 patients (27%) in 20/79 SLNs (25%). Intraoperative cytology showed a sensitivity of 70%, a specificity of 94.9%, a negative predictive value of 90.3%, a positive predictive value of 82.4% and an accuracy of 88.6% per sentinel node basis. There were 6 false-negative cases due to micrometastases in the SLN and 3 “ false positives” in the group with 59 negative SLNs in 46 patients. CONCLUSION: Intraoperative touch imprint cytology of SLN in breast carcinoma patients is a simple, quick and accurate method for detecting metastatic disease in the SLN. Despite its limitations, ITIC evaluation of SLN could spare a second operation to a large number of patients with breast cancer. Results may be improved by an appropriate enlargement of the surface sampled and the use of rapid immunocytochemistry on the touch imprint smears

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Dupuytren’ s contracture (DC) Dupuytren’ s disease (DD) is a nodular palmar fibromatosis leading to flexion contractures of the fingers and loss of hand function. It is characterized by nodular fibroblastic proliferation and accumulation of myofibroblasts. Methods of treatment can be divided into conservative and operative, however high recurrence rates have not been solved by any means. Experimental chemotherapy, such as 5-fluorouracil (5-FU), proved to be useful in acting locally in the palm by inhibiting myofibroblasts proliferation. 5-FU was shown to inhibit both, proliferation and myofibroblast differentiation in DC’ s cell cultures. Therefore, we established primary fibroblasts/myofibroblasts cultures as a model for studying the effects of several newly synthesized chemical compounds on proliferation and differentiation of Dupuytren’ s fibroblasts/myofibrobalsts. Cells were characterized by MTT-proliferation assays and flow cytometric analysis of the cell cycle. Cells from the affected part (D) of fascia proliferated faster then the cells from non-affected part (ND). Also, the percentage of cells in the S-phase of the cell cycle was higher in the D than in the ND cells. The presence of myofibroblasts in culture was ascertained by immunocytochemistry and Western blot method, as we assed the quantity of α -smooth actin and p21 as markers for differentiated fibroblasts. We have further tested cytotoxic and antiproliferatve effects of 3 compounds (a N-sulfonylpyrimidine derivative, an amidino substituted benzimidazo(1, 2-a)quinoline derivative and an amido-substituted dithieno-kinolone derivative) by MTT-test and showed them all to have a strong antiproliferative effect on established cell lines.

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OBJECTIVE: Sentinel lymph nodes (SLNs) predict the axillary’ s status and may allow lymphadenectomy on a selective basis. The purpose of this study was to evaluate the usefulness and accuracy of intraoperative imprint cytology (IIC) in comparison with definitive histological evaluation of SLN in early breast cancer patients. METHODS: From February 2003 to March 2006 total of 79 SLNs from 63 patients with T1 – T2 breast carcinoma were examined by IIC. SLNs were identified by technetium-labelled sulphur colloid and blue dye and bisected along the long axis. Intraoperative imprints were made of each cut surface, stained with Hemacolor and reviewed by a cytologist. The time taken for procedure was recorded. Histological analysis of SLN involved serial sectioning of the whole node with HE and immunostaining for cytokeratin. RESULTS: Definitive histology revealed metastases in 17/63 patients in 20/79 SLNs. IIC identified metastases in 11 patients (sensitivity 64.7%) in 14 SLNs (sensitivity 70%). All 6 false-negative cases were due to micrometastases in the SLN. In the group with negative SLN (59) in 46 patients, 3 cases were &laquo ; false positives&raquo ; (specificity 94.9% per sentinel and 93.5% per patient basis). The average time to perform intraoperative analysis was 10 min (range: 5 – 20 min). CONCLUSION: Intraoperative imprint cytology of SLN in breast carcinoma patients is a simple, quick and accurate method for detecting metastatic disease in the SLN and enables the surgeon to determine whether or not an axillary lymph node dissection is necessary at the time of the initial surgery

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Introduction Skin sparing mastectomy, described by Toth and Lappert 1991, has been advocated as an oncologically safe approach for the management of patients with early-staged breast cancer that minimizes deformity and improves cosmetic result by preservation of the skin envelope of the breast. Verheyden 1998. described the nipple sparing total mastectomy for treating the premalignant lesions of the breast. Patients and methods Based on experiences of these and other authors, in past seven years we have treated 51 patients with premalignant breast lesions, DCIS and T1/T2 breast cancer with skin and nipple sparing mastectomy and immediate reconstruction. Pedicled deepithelized latissimus dorsi myocutaneus flap with or without breast implant was used in 23 patients and the deepitelized DIEP flap was used in 26 patients. Results Mean follow-up was 53 months. There were no local recurrences and the overall patient survival rate is 100%. The most frequent complication was partial areolar necrosis in 8 patients. In the patients reconstructed with DIEP flaps we had one total flap necrosis due to recurrent venous thrombosis. Conclusions According to our preliminary results from this ongoing study we can conclude that skin and nipple sparing mastectomy followed by immediate breast reconstruction is oncologically safe procedure in selected patients. Although the choice of reconstruction depends on various factors, in our opinion for majority of patients reconstruction with perforator flaps is a gold standard of breast reconstruction.

Introduction Repair of large bone defects can still be a problem. If we could prefabricate the needed bone size and shape in any standard flap we would greatly expand our reconstructive options and reduce the donor site morbidity thus improving the overall functional and aesthetic result. In this study we investigated the possibility of prefabrication of bone in the epigastric flap of the rat using Bone morphogenetic protein 7 (BMP7) and the usefulness of the prefabricated vascularized bone in reconstructing long bone defects of the rat femur. Material and Methods A hundred and eight male Wistar rats used in this study were divided into six groups. Collagen sponge or dematerialized bone was treated with a low (30µ g) or high (120 µ g) dose of BMP7 or with diluent only. The carrier was then inserted under the epigastric flap in the rat groin. After six weeks, when the new bone was formed, a gap of 0.8 cm was formed in the ipsilateral femur of each rat. This defect was reconstructed with the bone in the prefabricated epigastric flap. Eight weeks after the defect was reconstructed the animals were sacrificed. The healing in different groups was assessed by X-ray, examination and histology. Results BMP-7 stimulated bone formation in both the collagen sponge and demineralized bone implants irregardless of the dose. Histology of the femur specimens showed healing of bone defect reconstructed with the vascularized prefabricated bone in the high dose BMP-7 groups. Non-union was found in most femurs reconstructed with flaps that were prefabricated with low BMP-7 dose implants and all femurs reconstructed with flaps prefabricated with diluent treated implants. Conclusion The results of this study suggest bone can be successfully formed in a soft tissue flap using BMP7 and used to reconstruct long bone defects which would otherwise result in non union.

The sentinel lymph node (SLN) biopsy procedure for evaluation of metastatic tumour has revolutionized lymph node staging in patients with malignant melanoma.There are only few published papers about the use of intraoperative imprint cytology(IIC) to evaluate the SLN for malignant melanoma. The objective of the present study was to assess the value and the accuracy of IIC in patients undergoing SLN for melanoma.

Purpose: Fibula flap as a vascularized bone has an important place in reconstructive surgery for nearly 30 years. The flap is rised on peroneal artery. The posibility of taking proximal epiphysis with large part of fibula on single vascular pedicle for long bone replacement is quite contraversal. In this paper the authors present 5 years follow-up after using proximal epiphysis and large part of fibula on single vascular pedicle for long bone reconstruction after tumor resection in two young female patients. Material and method: Reconstruction of 16 cm long bone defect of proximal right humerus in 14 years old girl and 17 cm long bone defect of distal radius in 16 years old girl has been performed after resection of the osteosarcoma. Free singlepedicled vascularized proximal fibular flap was used to reconstruct a skeletal defect. The stability of the reconstructed sholder and wrist joint was maintained by suturing the fibular ligament to humeral capsula, or to palmar collateral ligament around the wrist. Results: The postoperative period was uneventful. X-rays and scintigram confirmed good bone healing and normal perfusion of the flap. On follow-up 5 years postoperatively, the functional result of the patient with humerus reconstruction was rated as very good. Excellent elbow and wrist-hand function were noted, but the shoulder abduction and anteflexion remained limited. Radiograps of the forarm showed absorption and collapse of the head of the fibula in second patient, but with no significant functional problems related to absorption. No instability of the knee joint was observed in both patients. Conclusion: After radical resection of the malignant tumors affecting upper humerus or distal radius singlepedicled proximal free fibula flap can be safetly included for long bone replacement with satisfactory local function and without any negative implications on knee function.

In the history of breast surgery, we have seen a lot of changes in orientation, position and localization of breast incisions. Most of the biopsy incisions have been made with no consideration of future mastectomy or reconstruction. Today wide acceptance of conservative breast surgery, skin-sparing mastectomy and reconstruction as an integral part of breast cancer therapy necessitates new consideration about the initial incisions used for breast biopsy. Patients and methods: During past two years we have preformed omega and inverted omega incision in 453 patients in different breast procedures: biopsy, lumpectomy, skin-sparing mastectoma(SSM) and skin and nipple-sparing mastectomy (SNSM). In 97% of patients that underwent SSM or SNSM, immediatereconstruction with autologous tissue was performed. Deepithelialized, pedicled latissimus dorsi flap and DIEP flap were used for reconstruction in majority of patients. Results: Using this type of incisions, seroma or hematomas have occured in 8% of lumpectomy cases, and 6% of SSM or SNSM cases, but only 1% needed surgical intervention. Infections were found in 1% of patients. About 15% of patients with SNSM showed partial thickness areolar necrosis, that healed spontaneously. patients have reported changes in nipple sensitivity in 5% of lumpectomy cases in the middle segment of the breast and in all cases where SNSM was performed. Untill now, we have had no full-thickness necrosis of the skin or nipples. Conclusions: Omega and inverted omega incisions are uniform incisions with good exposure of the breast or axilllary tissue, appropriate for different breast surgery procedures: biopsy, lumpectomy, SSM, SNSM, axillary dissection and all types of breast reconstruction. It avoids the "decollete" zone and preserves breast shape and projection.

Purpose: The cause for bilateral loss is seldom congenital, and usually destruction from trauma, particularly burn injury. Quite a similar problem is the creation of the NAC in female-to-male transsexuals and after correction of extreme bilateral gynaecomastia. As there are only few reports on anatomical approaches to contour a male chest such as the precise localisation of NAC, a prospective study on this question was carried out. Material and methods: A total of 100 healthy men aged 20-36 years were examined. The study was concentrated on the precise localisation of the NAC on the thoracic cage in relation to various measurements such as weight, height of the body, circumference of the thorax, length of sternum, position in the intercostal space and all the various distances such as the distance between sternal notch and nipples and, between midline of sternum and nipples. Results: Circumference of the thorax and length of the sternum were calculated as the best predictors of the NAC location. To localize the nipple-areola complex on the thoracic wall de novo, at least two reproducible measurements proved to be necessary, composed of two lines, in this study, two radius. The upper radius has a stating point in sternal notch, while stating point of another radius is in processus xiphoideus. Intersection point of these two radius is the position of the nipple. For the maximal simplifing the work sheet in Microsoft Excel has been created. A precision of this method has been proved on a control group (n = 52). Conclusion: The appropriate localization of the NAC in male, in cases of bilateral absence, can be calculated by means of this method derived from the circumference of the thorax and the length of the sternum of the patient.

IZHODIŠČA Rekonstrukcijski posegi na okončinah in njihovo reševanje po hudih poskodbah stari so tri desetletja čeprav so rekonstruktivni posegi na drugih delih telesa opisani već tisočlet prej. Obdobje rekonstrukcije kompleksnih poškodb okrajin z funkcionalnimi in estetskimi ishodi ki prej niso bili mogoči je pogojeno z boljšim poznavanjem anatomije, razvojem rekonstrukcijskih tehnik, mikrokirurgije, prostim prijenosom tkiv in rehabilitacijo. METODE. Autori predstavljajo pristop k bolniku z kompleksnimi poškodbami okrajin z hudimi organskimi i funkcijskimi okvarami, od sprejema bolnika, ocene poškodbe, preoperativne priprave rane i bolnika, do planiranja rekonstrukcijskega posega, z posebnim poudarkom na metode kirurške obdelave rane, izborom rekonstrukcijske metode odvisno o lokalizaciji i obsegu poškodbe in prostemu prenosu tkiva. Prikazan je pomen postoperativnoga nadzora rane i bolnika, nadzor cirkulacije, pomen infekta in njegovo zdravljenje, opomen zgodnje rehabilitacije, rednih kontrol ter dodatnih operativnih korekcij a funkcije i estetskoga izgleda poškodovane okončine. ZAKLJUČEK. Sodobne možnosti rekonstrukcije kompleksnih poškodb okončin nam omogočajo dobre funkcijske in estetske ishode, zmanjšanje invaliditeta in vračanje bolnika v normalno življenje.