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Piotr Wójcicki and Dariusz Rychlik

Analysis of Management and Outcome of Treatment of Late Results of Neck Burns in 321 Patients

The aim of the study was to evaluate respectively the effectiveness of therapy of late complications of neck burns in the form of scars and contractures in the material of one clinical centre in the past 31 years (1976-2007).

Material and methods. 321 patients aged from 1 to 69 (mean age: 8 years) years with late complications of neck burns were treated in the Plastic Surgery Hospital in Polanica Zdrój in the years 1976-2007. The majority of patients were children aged from 1 to 14 years - 276. In total 589 surgical procedures were performed.

The following therapeutic modalities were applied: scar excision followed by local reconstructive flap surgery - 434 cases; full thickness and split-thickness skin grafting - 124 cases; local flap reconstruction with the use of expander - 18 cases; transferred pedicle flap from adjacent tissues - 3 cases, flap from other body regions on microvascular anastomosis - 11 cases; and dermabrasion - 19 cases.

Results. 285 (89%) patients were satisfied with the treatment outcome and accepted the appearance of scars without complaints. The remaining 36 patients did not find their esthetic appearance after reconstructive surgery satisfactory and did not accept the deformities.

Conclusions. Deciding on the management and choosing a surgical modality in patients with postburn skin scarring, a plastic surgeon must take into consideration the kind and severity of the deformity. Surgical treatment of severe scarring is a complex and multi-stage procedure.

Open access

Karolina Wójcicka and Piotr Wójcicki

Epidemiology of Lip, Alveolar Process and Palate Clefts - Comparison of Own Studies with Data from Other Centres

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Kazimierz Kobus and Piotr Wójcicki

Gigant Facial Neurofibroma

In August 2003, a 15 year old male, with a giant tumor located on the whole left side of his face, was admitted for treatment. The changes in appearance first began to show in the 2nd month after birth and systematic enlargement lead to an overgrowth of the soft tissues and bones of the face. As a result of the pressure excerted by the tumor, the frontal bone and the surrounding protective structures became thickened and displaced posterio-inferiorly, causing a shrinking of the anterio-inferior part of the skull. Histological analysis indicated that the tumor was of neurological origin. The patient was operated on a year later because of the continued growth of the tumor. Another year later, the enlarged and protruding maxillar bone was filed down.

A radical approach is important in such cases, not only from an aesthetic point of view, but most of all because it is the best way of counteracting any regrowth of the tumour and is the most effective means of oncological prophylaxis.

Open access

Piotr Wójcicki and Karolina Wójcicka

Vascular tumours and malformations are revealed at birth and do not subside.

The aim of the study was to present the principles and outcomes of treatment of patients with arteriovenous malformations treated at the Clinic of Plastic Surgery in Polanica Zdrój in the years 2009- 2010.

Only one patient, who had not been treated previously, had the lesion on the cheek removed subtotally and the defect was closed by means of local repair. In the remaining patients, with primary lesions located in the auricle, scalp, and cheeks, the indications for operation included recurrent infections, ulcerations, and first of all, massive, life-threatening haemorrhages.

All the patients, treated for many years in other centres, had underwent numerous resection procedures, vessel ligations, embolizations and obliterations. The patients were followed up after the surgery every 6 months.

The therapy aim was achieved in all the patients. Vascular tumours were removed totally or subtotally, the lost structures were reconstructed and permanent healing of the wound was achieved. None of the patients developed recurrence of the disease, infection, or bleeding.

Open access

Piotr Wójcicki, Władysław Wojtkiewicz and Piotr Drozdowski

Severe Lower Extremities Degloving Injuries - Medical Problems and Treatment Results

Degloving injuries consist in detachment of skin and subcutaneous tissue from underlying fascia and muscles. They mostly address total surface of extremities or trunk, resulting in high morbidity and mortality. Their treatment, due to severity of the injury, high percentage of serious concomitant injuries and massive blood loss is time - consuming and its results are often unfavourable. The authors present results of treatment of three cases of patients with degloving injuries of the lower extremities and trunk. The patients presented poor healing prognosis connected with the extension of the injury. A complicated course of treatment was described. In all patients skin grafts healed well, resulting in acceptable aesthetic and functional outcome.

Open access

Karolina Wójcicka, Kazimierz Kobus and Piotr Wójcicki

Epidemiology of Lip, Alveolar Process and Palate Clefts in the Material of Hospital and Clinic of Plastic Surgery in Polanica Zdrój

The aim of the study was to determine the incidence rate of individual types of clefts, association with other congenital defects and family incidence of the disease as well as evaluation of the condition of neonates born with cleft.

Material and methods. Retrospective studies were performed in 2500 patients with cleft lip and palate treated at the Hospital and Clinic of Plastic Surgery in the years 1979-2003. There were examined 1650 patients with cleft lip with/without palate (CL±P) and 850 patients with isolated cleft palate (CP). In the group of 1650 cleft lip and palate subjects there were 775 patients with complete unilateral cleft lip and palate (UCLP), 250 patients with complete bilateral cleft lip and palate (BCLP) and 625 patients with cleft lip (CL).

Results. 1. The incidence rate of CLP: CL: CP was approximately as 5: 3: 4. Unilateral clefts were 3 times as common as bilateral clefts and they occurred twice more often on the left side. 2. CLP occurred predominantly in males- M:F ratio = 1.8 : 1; in CL- M:F = 1.3 : 1 while reverse proportions were observed in CP patients, F:M = 1.38 : 1.3. A relationship was found between the condition of the neonate as evaluated by Apgar score and the body mass and coexistence of a specific cleft. The lowest Apgar score and the lowest birth weight was observed in neonates with BCLP, while neonates with CL had the highest values. 4. There is a proportional relationship between the severity of cleft and the incidence of the defect in first degree relatives. 5. 11% of cleft patients also develop other congenital deformities, including defect syndromes, which account for 24% of all associated defects.