Other procedures
Benign tumors of the skin
Mole (nevus)
A benign change on the skin and mucous membrane that can be of different colors, shapes and sizes. An adult man has about 15-20 moles - some are present from birth, and others appear later in life. Moles should not be removed, except in the case of inconvenient localization in the place of constant irritation (laundry, clothing, jewelry) or for aesthetic reasons, but they should be inspected periodically and attention should be paid to their growth, color, shape and accompanying phenomena such as itching, flaking or bleeding. They are removed by surgical excision, and the final diagnosis is verified histo-pathologically.
Papilloma
Benign change of the epithelium of the skin and mucous membrane of viral origin. It is most often found on the neck, upper arm, in the armpit, under the breast, on the stomach and groin. It is of different shapes, often stalked, elastic and usually skin-colored. It is removed by radioexcision or minor surgical excision.
Lipoma
Benign and fatty tissue tumor that usually occurs in the subcutaneous tissue of the neck, back, shoulders, abdominal wall. It has small dimensions, although sometimes it reaches gigantic proportions. A lipoma is a soft, elastic nodule that is not always well demarcated from the surrounding tissue, and is covered by skin of an unchanged appearance. It must be carefully removed as a whole, because any remnants of this tumor can be the cause of its reappearance.
Keratosis
A yellowish skin change of different sizes, localized usually on exposed parts of the body - face, neck, décolletage, arms, back. It does not appear on the palms and soles. Over time, it grows and acquires a dark, even black color. It is removed by radio waves.
Dermatofibroma
A skin change that can be single or multiple, hard or painless nodule. It occurs in adults, on the extremities, and sometimes on other parts of the body. It is reddish or yellowish-brown in color, ranging in size from a few millimeters to a few centimeters. It is removed by surgical excision.
Atheroma
is a skin change that represents a blocked sebaceous gland that has grown on the skin. It occurs on the face, head, earlobes, neck and back. An infection with signs of suppuration may develop. It must be removed as a whole, otherwise it can re-occur.
Malignant tumors of the skin
Basal cell carcinoma of the skin
is the most common skin tumor. It occurs in older age groups and appears on parts of the body exposed to the sun such as the face or hands. It can have a different shape and way of growth: flat or raised, erythematous even scaly surfaces, some appear as yellowish nodules while others are darkly pigmented. It very rarely metastasizes, but locally it can be very invasive and infiltrate local structures.
Squamous cell carcinoma of the skin
is the second most frequent malignant skin tumor. It can occur anywhere on the body, but very rarely occurs on intact skin. There are two forms of squamous cell carcinoma: the first resembles a small wound, covered with a scab, of round or irregular shape, while the second form of this tumor usually resembles a small protrusion that gradually penetrates into the deeper subcutaneous tissue. This tumor has all the characteristics of a true malignant disease: local-infiltrative growth, recurrence and frequent metastases.
Melanoma
is relatively rare, but the most aggressive of all malignant skin tumors. Youth, UV radiation, heredity, hormones, chemical factors are cited as risk factors. In most cases, malignant melanoma arises on the site of existing nevi, and very rarely from unchanged skin. A change is suspicious for malignant melanoma if it is asymmetrical, has changed color, has irregular edges, often bleeds or itches, and is larger than 6 mm in diameter. A wide incision is used in all cases to eliminate any possibility of local recurrence of the disease. In the event that one of the malignant skin tumors is located on the face, reconstruction of the postoperative defect is performed using an autograft or a local flap. The safest way to fight against these skin tumors is their prevention - if any change in growth, size, color, or bleeding nevus is noticed on the youngster, it must be surgically removed and histologically verified.
Other skin changes to be aware of
Two common types of skin changes are moles (nevi, marks) and keratoses. Moles are changes that consist of clusters of skin cells that are rich in the pigment melanin, at or above the skin level. Many moles are not dangerous, but some large ones present from birth or some that contain different colors and poorly defined borders can turn into malignant melanoma. Moles are most often removed for aesthetic reasons or if they are subject to chronic irritation (rubbing with clothing or jewelry). Such irritations can cause precancerous changes. Solar or actinic keratosis is a rough, red or brown growth on the skin. They are found, most often, in places that are exposed to the sun and can sometimes develop into squamous cell carcinoma.
Recognition of malignant skin diseases
Basal cell carcinoma and squamous cell carcinoma can vary considerably in appearance, i.e. there are many different forms. Cancer may initially be a small white or pink nodule or swelling, it may be smooth and shiny, waxy, or have a pitted surface. It can appear at the beginning as a red spot, and then as a row of dry uneven beads that are later covered with a crust, a group of crusts or nodules with visible capillaries on the surface, as an ulceration on the surface of the skin that does not heal at all, or as a whitish patch that looks like scar tissue. Malignant melanomas usually signal themselves by a change in size (most often by sudden growth), shape, color on an existing mole or a new one from normal skin. Watch out for "ABCD" signals when melanoma occurs (eng.) Asymmetry-asymmetrical growth; Border irregularity-uneven or cloudy I border changes; Color-change in color, brown, black, and sometimes a mixture of whitish, red and blue colors; Diameter- growth and size greater than 6 mm in diameter or any unusual and rapid growth. With all these forms of malignant skin diseases, which are common in our climate, the most important thing to remember is the following: Get to know and examine your skin from head to toe (don't forget your back!). If you notice any unusual change in any part of your body, don't hesitate to visit your doctor to get it checked out together. In our people, there is a belief that such changes (they are called marks), especially young people, should not be touched, and because of this, people often show up late with advanced stages of these diseases or not at all, which has disastrous consequences for their health. Such changes should not be touched in terms of irritation (piercing with red-hot needles, tying with silk thread or hair or treating with some herbal extracts) because this can lead to deterioration, but they should be professionally treated and sometimes removed by cutting the surrounding healthy skin, without touching the change.
Prevention of disease recurrence
After the surgical treatment of skin cancer, your doctor will recommend regular check-ups to make sure that the cancer does not recur. Your doctor will sometimes be able to prevent a recurrence. In order to reduce the risk of recurrence, it will sometimes be necessary to change your place of residence. The following measures are recommended for people who have not previously had a malignant skin disease:
1. Avoid prolonged exposure to the sun, especially between 10 a.m. and 2 p.m. and during the summer months. Remember that ultraviolent rays pass through water and clothing, and are reflected by sand and snow.
2. When going outside for a long period of time, protect yourself with clothing such as a hat or cap with a wide brim or long sleeves.
3. Apply sunscreen to all exposed parts of the body with an SPF (sun protection factor) of at least 15. Apply liberally one hour before going out into the sun and repeat several times, especially if you bathe or swim.
4. Finally, examine your own skin. If you find anything suspicious, consult your plastic surgeon or dermatologist as soon as possible.
Types of malignant skin diseases
The most common type of skin malignancy is basal cell carcinoma. Also, this type is the least dangerous solution, it grows slowly and extremely rarely spreads to distant places (metastasizes). It is extremely rarely life-threatening, and if left untreated, it can spread to deeper structures (subcutaneous tissue, muscles and bones) causing serious damage, especially if it is near the eye. Squamous cell carcinoma (squamous cell carcinoma) is the next most common malignancy of the skin, most often found on the lips, face or ears. It spreads (metastasizes) to distant places, regional lymph nodes of internal organs. It can be life-threatening if left untreated! The third form of malignant skin diseases is melanoma, which is the rarest, although its incidence has recently been growing rapidly, especially in sunny parts of the planet. Malignant melanoma is the most dangerous type of malignant skin disease. If detected early enough, a cure can occur. If not detected quickly and treated in time, it spreads very quickly throughout the body and is usually fatal.
How to choose a doctor?
If you suspect a malignant skin disease, contacting your family doctor (or general practitioner) is a good start. They will examine your skin and decide if a specialist is needed. If you notice any unusual growth, contact a dermatologist or plastic and reconstructive surgery specialist. Both specialists must be experienced enough to recognize and treat malignant skin diseases and other skin growths. Specialists in plastic and reconstructive surgery are a good choice if the change needs to be surgically removed, because they leave better aesthetic results after such a procedure, which is extremely important if the changes are in visible places. If additional treatment is required in addition to surgical deviation, the plastic surgeon will refer you to the appropriate specialist.
Diagnosis and treatment
The diagnosis of malignant skin diseases is established by removing the entire change or part of the change and sending it for pathohistological analysis (examination of the change under optical magnification-microscope, after special preparation). After that, the change can be treated with a number of methods, depending on the type of cancer, its stage and localization on the body. Most of the changes are removed surgically by a plastic surgeon. If the change is small, the operation can be simple and quick in outpatient conditions with the use of local anesthesia (a couple of needle punctures in the area of the change with injection of local anesthetic). The operation is usually ellipsoidal cutting of the change, which leaves behind a thin, barely visible scar. It may be possible to exfoliate the changes with a special instrument (a type of sharp spoon) and then treat the region with electric current in order to stop the bleeding or destroy the remaining malignant cells. This procedure leaves an oval whitish scar. Under normal circumstances, the risk of this type of surgery is very small. If the change is larger or has spread to the regional lymph nodes or to other places in the body, radical surgery is required, usually under general anesthesia with a hospital stay. Other possible methods of treatment are cryotherapy (freezing of malignant cells), radiation therapy (treatment of changes with x-ray radiation), local chemotherapy (treatment with ointments containing chemotherapeutic agent), Mohs surgical method (a special surgical method in which the cancer is shaved in one layer in one on occasion - requires specially trained personnel.) You should discuss all the possibilities with your doctor before the treatment. Find out which of the options is best for you, how effective it will be for your type of disease, possible side effects and risks, who performs the procedure best, what aesthetic and functional results can you expect? If you have any doubts, seek a second opinion, i.e. the opinion of another plastic surgeon, before deciding on the treatment. The various techniques used in the treatment of such changes can be life-saving, but can sometimes leave a less good aesthetic appearance or functional result. Depending on the localization and size of the change, it can leave a small but visible scar on your skin, but also permanent changes that affect your facial structure and aesthetic appearance, such as the nose, ears or lips. In such cases, regardless of who performs the primary surgery, the plastic surgeon must be part of the team. Reconstructive techniques from simple scar revisions to complicated procedures for moving tissue from adjacent or distant parts of the body (flap surgery) can often repair damaged tissue, reshape your body, and restore the appearance and function of that part.
Hand surgery
Buntonier's lesion
It represents a rupture of the central part of the extensor tendon that attaches at the base of the medial phalanx. Deformity occurs in the form of flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint. Treatment is mostly conservative for 6 weeks or surgical.
Dupuytren's contracture
The basis of this pathological condition is a contracture of the palmar fascia, i.e. fibrodysplasia of the subcutaneous palmar connective tissue, which forms knots and bands, resulting in a flexion contracture of the affected fingers. Men between the ages of 40 and 60 are more often affected, and the IV and V fingers are most often affected. There are nodular thickenings on the palm, sometimes pain, and very often both hands are affected. The skin at the level of contractures is thick, firm and immobile due to the lack of subcutaneous fatty tissue. The treatment is operative when the pathologically altered palmar subcutaneous tissue that causes the contracture is removed by surgical excision.
Compression syndromes
Compressive neuropathies are pathological conditions in which the peripheral nerves of the upper extremities are compressed in the inextensible bone-connective and muscle-connective channels through which they pass. Increasing pressure in these channels leads to nerve damage and severe pain. Many reasons cause compressive neuropathies and can be anatomical, postural, developmental, inflammatory, traumatic and metabolic in nature. The resulting symptoms can be very different from transient paresthesia to complete impairment of nerve function. COMPRESSIONS OF THE N. MEDIANUS.
1. Carpal tunnel syndrome
Carpal tunnel syndrome occurs when there is pressure on the median nerve in the carpal tunnel. The slightest increase in tissue mass for a certain reason can cause nerve compression and ischemia. It is more common in women in menopause, pregnancy, patients with rheumatoid arthritis. Symptoms that arise as a result of compression of this nerve are pain, paresthesia and hypoesthesia’s in the area of the first three fingers. Treatment:
Carpal tunnel syndrome is treated surgically. In regional anesthesia, through an incision at the level of the wrist, the flexor retinaculum of the wrist is cut, which relieves pressure on the nerve and relieves symptoms. The operation lasts about 30 minutes, you leave the hospital the same day, the stitches are removed after ten days.
2. Pronator syndrome
In this syndrome, compression of the median nerve occurs at the level of the pronator teres, i.e. at the level of the elbow. The symptoms that characterize it are pain on the flexor side of the forearm, sensory deficit of the thumb and first three fingers, total or partial loss of flexion of the proximal interphalangeal joint of the thumb. Symptoms intensify with physical activity. Surgical therapy includes decompression of the nerve at the level of the pronator teres muscle. The elbow is immobilized in a slightly bent position for a week, after which physical therapy is started.
3. Anterior interosseous syndrome, compression of the branch of the median interosseus
The syndrome is characterized by mild, deep pain in the forearm that worsens with physical activity and subsides at rest. Sensory outbursts of the fingers may be absent, and the main characteristic is weakness of the flexor muscles of the thumb and index finger (flexor pollicis longus and flexor profundus indicis). The treatment is surgical, it involves releasing the nerve from compression. The improvement of function occurs already in the first two to three months.
Congenital anomalies of the hand
Congenital anomalies of the hand can appear in different forms - from disorders in the formation of parts or their differentiation, duplications, excessive or insufficient growth, as well as various generalized abnormalities of the skeleton. As much as 50% of congenital hand anomalies are polydactyly and syndactyly.
Polydactyly means the existence of a supernumerary finger, which most often occurs in the area of the little or 5th finger of the hand or in the area of the thumb. A supernumerary toe can be just a soft tissue appendage or it can contain all the bony, tendon and neurovascular structures like a normal toe. The treatment is surgical and is recommended in the first year of life in order to achieve optimal hand function.
Syndactyly is a congenital anomaly that indicates joined, fused fingers in a child. It occurs in 1 in 1,000 live births, and is twice as common in boys. It can be incomplete or complete, and most often the 3rd and 4th toes are fused. It is treated surgically at the age of 6 months to 4 years, depending on the type of syndactyly. In the first surgical procedure, only one side of the finger is freed, and the plastic-reconstruction procedure includes multiple Z-plasties and the application of free skin grafts of the full thickness of the skin in order to reconstruct the hand as a whole.
Adactyly is a congenital lack of fingers, while aphalangia is a lack of phalanges. It is treated by lengthening the fingers or by transplanting (microsurgical) a finger from the foot to the hand.
Excessive growth (gigantism) represents a pathological expansion of the skeleton and soft tissue covering of the fingers, while hypoplasia (insufficient growth) most often affects the thumb, which is reduced and insufficiently developed. The treatment is surgical and it is necessary to create a new thumb by polycization (transposition of one of the fingers to the place of the thumb).
Mallet finger
It is most often caused by a rupture at the distal attachment of the extensor tendon with the resulting hammertoe deformity. It is treated by immobilization with the finger in mild hyperextension for 8 weeks or surgically if the first therapy does not give results.
Hand injuries
Hand injuries can be roughly divided into:
- bone injuries - fractures,
- joint and ligament injuries,
- tendon injuries.
The most common mechanism of bone fractures occurs after a fall or a blow to the hand. Direct blows often cause a fracture of one or more metacarpal bones, and the fractures are usually transverse, and extremely spiral. A large number of fractures are treated conservatively - by placing a plaster cast for three weeks. If the dislocation is larger, operative treatment is necessary. A "boxer's fracture" or a "bad street fighter's" fracture is the most common fracture that occurs in fights. There is a fracture of the neck of the V metacarpal bone due to an inadequate blow. It is treated with immobilization for 3 to 4 weeks, or repositioning of the fracture is required in case of greater angulation. Fractures of the bones of the fingers, especially the proximal and medial phalanges, are also common. Fractures are mainly treated by repositioning and fixation. For the diagnosis of all these fractures and further therapy, it is necessary to take an appropriate X-ray of the injured hand. Carpometacarpal, metacarpophalangeal and interphalangeal dislocations can occur in the hand. The diagnosis is established by clinical examination with radiographic confirmation. Most injuries are easily repaired and immobilized with a protective sling.
Trigger finger - snappy fingers
Trigger finger (digital stenosing tenovaginitis) is the occurrence of difficult extension (stretching) of the fingers accompanied by a sound phenomenon of clicking. It is caused by a disproportion between the flexor tendons and the tendon sheath. It occurs more often in women, and the third and fourth fingers are most often affected. Operative treatment is effective and leads to a permanent cure.
Tumors of the hand
- GIANT CELLULAR TUMOR of tendon sheaths is of benign origin, but has a high rate of recurrence. It most often occurs on the palmar side of the fingers, and is a slow-growing tumor.
- GLOMUS TUMORS are often found in the nail bed and give a classic triad of symptoms – pain, palpation sensitivity and sensitivity to cold.
- ENCHONDROMAS represent the most destructive benign bone tumors that usually affect the proximal phalanx of the finger. They often cause a pathological fracture.
- LIPOMAS usually occur in women between the ages of 30 and 60. They are mobile and painless and when enlarged can lead to compressive neuropathy.
Tumor-like formations
- GANGLIONS-HYGROMAS are the most common swellings on the hand. These changes are soft and painless. The treatment consists in aspiration of the contents, but with a 50% occurrence of recurrence or surgical removal, after which recurrence is also possible, but in a smaller percentage.
- MUCUS CYSTS occur on the dorsum of the distal interphalangeal joint, and are often associated with osteoarthritis.
Reconstructive surgery
Reconstructive operations are performed with the aim of correcting functional defects caused by traumatic injuries of various causes, burns, as well as reconstruction of defects by removing large tumor changes on the skin. Reconstructive surgery also removes congenital anomalies such as cleft palate or cleft lip, various bone fractures, developmental abnormalities, consequences of infections, etc. The primary goal of reconstructive surgery is to improve the functionality of a part of the body, but also to adapt it to a more natural appearance. Plastic surgery includes many types of reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, as well as the treatment of burns and the repair of their scars. Plastic surgeons are guided by microsurgery procedures to transfer tissue and fill in certain parts of the body where it is missing. In preparation for surgery, there are specific anatomical regions of the body according to which various plastic-reconstructive operations are planned and performed, such as reconstruction of the proximal, middle or lower part of the lower leg, upper leg, neck, head, upper arm, etc. A well-planned surgical procedure and trained and safe the operative technique gives a good result of the reconstructive operative procedure.