Background and Objective: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a technique of local anesthesia commonly used in the surgical treatment of a wide variety of conditions affecting the upper extremity, including Carpal Tunnel Syndrome (CTS). The recent retrospective studies investigated patient experiences in a wide variety of hand disorder-related cases. The aim of our study is to evaluate patient satisfaction regarding open surgical treatment for CTS using the WALANT technique. Material and Methods: we enrolled 82 patients with CTS without medical record of surgical treatment for CTS. For WALANT, a hand surgeon used a combination of 1:200,000 epinephrine, 1% lidocaine, and 1 mL 8.4% sodium bicarbonate solution without tourniquet application and sedating the patient. All patients were treated in a day-care setting. For assessment of patient experience, Lalonde’s questionnaire was adapted. Participants completed survey twice: one month and six months after the surgical treatment was performed. Results: the median pre-operative pain score for all patients was 4 (range 0–8) after one month and 3 (range 1–8) after six months. The median intraoperative pain score for all patients was 1 (range 0–8) after one month and 1 (range 1–7) after six months. The median post-operative pain score for all patients was 3 (range 0–9) after one month and 1 (range 0–8) after six months. More than half (61% after one month and 73% after six months) of the patients responded by stating that their real experience of WALANT was better than their initial expectations. An absolute majority of patients (95% after one month and 90% after six months) would recommend WALANT treatment to their relatives. Conclusions: overall, patient satisfaction with treatment for CTS using WALANT is high. Furthermore, complications related to the performed treatment and persistent post-operative pain could be associated with more reliable patient recall of this healthcare intervention. A longer period of time between intervention and assessment of patient experience could possibly be a reason for recall bias.

In Caucasians, basal cell carcinoma, the predominant non-melanoma skin cancer type, poses challenges for surgeons due to anatomical and aesthetic concerns, particularly when located on the nose. The study aimed to evaluate tumor distribution, size, morphological subtypes, surgical outcomes, radicality levels, and their correlation with recurrence rates. A retrospective analysis encompassed 343 cases of nasal skin cancer over a four-year period from 1 January 2019 to 31 December 2022. The research cohort comprised 252 female and 91 male participants, averaging 75.2 years old. Tumors were most found on the left sidewall of the nose (25.4%) and the dorsum (24.8%). The infiltrative morphological subtype was predominant (70.8%). Standard surgical excision with fasciocutaneous plastic was the preferred surgical procedure. Radical excision, defined by the absence of tumor cells in a resection margin, was accomplished in 79.0% of lesions, whereas 16.9% demonstrated incomplete excision, signifying the presence of tumor cells in the resection margin. Non-radically excised tumors exhibited a significantly higher recurrence rate (24.1%) compared to those with radical excision (6.3%). In nasal reconstruction, diverse surgical techniques are essential for precise adaptation based on factors like tumor characteristics and patient needs. Despite surgeons’ careful adherence to excision margin guidelines, the possibility of non-radical outcome cannot be eliminated.

Publishes scientific surgical articles written by Lithuanian and foreign authors.

Background: Botulinum toxin type A (BoNT-A) has been proposed as an adjunct to orthognathic surgery because its temporary neuromuscular effects may reduce muscular loading during postoperative healing and potentially influence fixation stability, skeletal relapse, and postoperative recovery. This systematic review aimed to evaluate the available clinical evidence regarding the adjunctive use of BoNT-A in orthognathic surgery. Methods: A systematic literature search was conducted in PubMed, the Cochrane Library, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies directly comparing orthognathic surgery with and without adjunctive BoNT-A administration and reporting outcomes related to mechanical stability, skeletal stability, or postoperative recovery were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials and ROBINS-I for the non-randomized study. Results: Three studies met the eligibility criteria, comprising two randomized controlled trials and one retrospective comparative study. Considerable heterogeneity was observed in surgical procedures, targeted muscles, BoNT-A doses, timing of administration, and evaluated outcomes. Individual studies reported associations between BoNT-A administration and a lower incidence of fixation plate fracture, reduced anteroposterior skeletal relapse at the Pogonion, or lower preanalgesic pain scores and postoperative opioid consumption. However, these findings were derived from different studies evaluating distinct interventions and outcomes and were not consistently demonstrated across comparable outcome measures. Conclusions: BoNT-A may represent a promising adjunct to orthognathic surgery, with potential benefits for fixation-related mechanical stability, selected parameters of skeletal relapse, and postoperative pain management. However, the limited number of studies, methodological limitations, and substantial clinical heterogeneity preclude definitive conclusions. Further well-designed randomized controlled trials with standardized injection protocols and longer follow-up are required before routine clinical use can be recommended.

In Caucasians, basal cell carcinoma, a type of non-melanoma skin cancer, is most often found on the nose. This presents challenges for surgeons due to anatomical, functional, and aesthetic concerns. The study aimed to evaluate the distribution of tumor localization, size, morphological subtypes, surgical outcomes, radicality levels, and their correlation with recurrence rates. The research utilized data from the Hygiene Institute Health Information Centre. A retrospective analysis encompassed 343 cases of nasal skin cancer over a four-year period from January 1, 2019, to December 31, 2022. The research cohort comprised 252 female and 91 male participants, averaging 75,2 years old. Tumors were most found on the left sidewall of the nose (25.4%) and the dorsum (24.8%). The infiltrative morphological subtype was predominant (70.8%). Standard surgical excision with fasciocutaneous plastic was the preferred surgical procedure. Radical excision was achieved in 79.0% of lesions, while 16.9% were incompletely excised. Non-radically excised tumors exhibited a significantly higher recurrence rate (24.1%) compared to those with radical excision (6.3%). In nasal reconstruction, diverse surgical techniques are essential for precise adaptation based on factors like tumor characteristics and patient needs. Despite surgeons' careful adherence to excision guidelines, the potential for non-radical procedures cannot be entirely eliminated.

Background and Objectives: Implant-based breast reconstruction following subcutaneous mastectomy is widely performed; however, the optimal strategy for implant support remains controversial. Absorbable synthetic meshes have emerged as lower-cost alternatives to acellular dermal matrix (ADM), yet their clinical and economic value remains incompletely defined. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. Studies evaluating implant-based breast reconstruction with absorbable synthetic meshes, ADM, or without mesh were included. Outcomes of interest comprised postoperative complications, operative time, material costs, aesthetic outcomes, and patient-reported satisfaction. Methodological quality and risk of bias were assessed using design-appropriate appraisal tools. Results: Absorbable synthetic meshes were associated with low complication rates, including infection (3–8%), seroma (0–5%), hematoma (1–4%), skin necrosis (4–6%), and implant loss (3–6%). Compared with ADM, complication rates appeared comparable, while shorter operative times were reported in comparative studies. Material cost reductions of up to 90% were reported in comparative studies. Several studies reported favorable aesthetic outcomes and high patient satisfaction, although assessment methods were not standardized. Most included studies were retrospective or single-arm observational studies, with substantial clinical and methodological heterogeneity and an overall moderate risk of bias. Conclusions: Available evidence, derived predominantly from studies of polyglactin mesh, suggests that absorbable synthetic meshes may represent a feasible option for selected implant-based breast reconstructions, with potential advantages in terms of material costs and operative time. Evidence regarding polydioxanone mesh remains very limited, and the methodological limitations of the available studies preclude definitive conclusions.