Faculty of Medicine
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Item type:Publication, Methods for tissue perfusion assessment after Dellon decompression of tarsal tunnels in diabetic neuropathy: key to effective management—a narrative review(Wolters Kluwer Health, 2025-01-02); ; ; Background and Objective Diabetic neuropathy significantly elevates the risk of foot ulceration and lower-limb amputation, underscoring the need for precise assessment of tissue perfusion to optimize management. This narrative review explores the intricate relationship between sympathetic nerves and tissue perfusion in diabetic neuropathy, highlighting the important role of autonomic neuropathy in blood flow dynamics and subsequent compromises in tissue perfusion. The consequences extend to the development of diabetic peripheral neuropathy and related foot complications. By analyzing both non-invasive diagnostic methods and surgical interventions, such as tarsal tunnel decompression, the paper seeks to highlight their effectiveness in improving tissue perfusion, preventing ulcers, and reducing the risk of amputations in patients with diabetic peripheral neuropathy. Methods We reviewed current literature on both non-invasive diagnostic tools and surgical techniques for assessing and improving tissue perfusion in diabetic neuropathy. Methods discussed include transcutaneous oxygen pressure (TcPO2), Doppler ultrasound, Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI, and the SPY Laser Angiographic System. Key Content and Findings Emphasizing the critical importance of surgical interventions, such as tarsal tunnel decompression and neurolysis of the posterior tibial nerve, the article underscores their efficacy in enhancing tissue perfusion and preventing ulcers and amputations. Additionally, it addresses the significance of precise blood flow measurement and timely intervention in the management of diabetic neuropathy and foot ulcers. The non-invasive techniques for assessing tissue perfusion and blood flow in diabetic neuropathy such as TcPO2, Doppler ultrasound and Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI are explained. Also, this review introduces the SPY Laser Angiographic System, which employs near-infrared fluorescence imaging to assess blood flow and perfusion in tissues. This advanced tool generates real-time microvascular blood flow images and proves instrumental in diagnosing and monitoring diabetic foot ulcers. Conclusions In conclusion, surgical interventions, both vascular and peripheral nerve are pivotal for optimizing patient care. Early identification of foot ulcers and peripheral arterial disease is imperative, and an understanding of blood flow dynamics, combined with effective surgical techniques, constitutes key elements in managing diabetic neuropathy, healing and preventing ulcers, and limb salvage. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease(Multidisciplinary Digital Publishing Institute (Switzerland), 2025-02-12); ; ; Jovanovska, KaterinaBackground: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is revolutionizing surgery by providing a bloodless field without tourniquet use, reducing risks, costs, and enhancing patient comfort. While extensively used in hand surgery, its application in foot and ankle procedures, particularly for high-risk patients with diabetic neuropathy and peripheral artery disease (PAD), remains underexplored. This study evaluates the safety, efficacy, and outcomes of WALANT for tarsal tunnel decompression in such patients. Methods: Between March 2022 and April 2024, 32 patients with diabetic neuropathy and PAD underwent Dellon decompression of the tarsal tunnel. Five received spinal anesthesia with a tourniquet, while 27 underwent WALANT. Outcomes assessed included operative time, Visual Analogue Scale (VAS) pain scores, posterior tibial artery blood flow (via Doppler ultrasonography), and complications. Data were collected preoperatively, immediately postoperatively, and at six and nine months. Results: WALANT reduced operative time (40 ± 8 min vs. 65 ± 10 min) and required fewer personnel (four vs. six). VAS scores improved significantly in the WALANT group (from 8.65 ± 0.84 preoperatively to 1.21 ± 0.24 at nine months). Posterior tibial artery blood flow also showed superior improvements with WALANT (5.30 ± 0.65 cm3/s vs. 2.50 ± 0.45 cm3/s). Minor wound healing delays were noted in two WALANT cases; no major complications occurred. Conclusion: WALANT offers a safe, efficient alternative to spinal anesthesia for tarsal tunnel decompression in high-risk patients, minimizing ischemic risks, enhancing vascular outcomes, and reducing postoperative pain. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Platelet-rich plasma as a promising bioscaffold for enhancing peripheral nerve regeneration: An experimental study in a rat sciatic nerve model(Journal of Biological Methods, 2025); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries(Elsevier Ltd., 2022-11-05) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Clinical Applications of Keystone Design Perforator Island Flap: A Single-Center Experience(SciTeMed Publishing Group, 2023); ; ; Objective: The field of microsurgery is constantly striving for innovative reconstructive techniques that offer optimal outcomes. Among these techniques, the keystone design perforator island flap (KDPIF) has emerged as a prominent solution, garnering substantial attention from surgeons worldwide. Its versatility and simplicity make it a preferred choice for soft tissue reconstruction, regardless of the underlying etiology. In this study, we aimed to share our clinical experience and report on the outcomes of the KDPIF reconstruction process, thereby contributing valuable insights to the existing knowledge base. Methods: This retrospective study analyzed 115 adult patients who underwent KDPIF reconstruction at our clinic over a 40-month period. Patients included elective cases of soft tissue malignancies and chronic wounds, as well as emergency cases due to trauma-inflicted wounds. The surgical technique involved meticulous flap planning based on the defect's orientation, adhering to relaxed skin tension lines. Outcome measures included flap survival rate, postoperative complications, donor site morbidity, and scar assessment using the Manchester scar scale. By evaluating these parameters, we aimed to assess the efficacy and safety profile of the KDPIF technique, providing valuable insights into its clinical utility and outcomes. Results: In our study cohort of 115 patients, male individuals constituted 73% of the participants, with an average age of 55.7 years. Notably, our findings unveiled skin malignancies as the prevailing etiology for soft tissue defects. Localization analysis revealed that most defects were situated on the trunk (49.6%), followed by the lower extremity (23.5%). Among the various reconstructive options available, Type II KDPIF emerged as the predominant choice, employed in most cases (n=85), while type IV reconstruction was only required by two patients. Medium-sized defects, ranging from 16 to 50 cm², represented a significant proportion, accounting for 47.8% of cases. Operative procedures exhibited an average duration of 56 minutes, with no significant increase observed for larger defects. Postoperative complications occurred in 13.04% of patients, primarily manifesting as infections and partial flap necrosis, which were predominantly managed conservatively. The average hospital stay was 4.7 days, and at the 6-month follow-up, patients reported no incidences of flap sensitivity issues. Additionally, a mean Manchester scar scale score of 7.8 signified favorable results for the patient cohort. Conclusion: The KDPIF stands out as an efficient reconstructive technique, capable of addressing soft tissue defects in a single surgical procedure. Notably, its simplicity and expediency contribute to its widespread adoption. Our study reinforces the expanding indications for the use of the KDPIF, further emphasizing its clinical significance. The insights garnered from our clinical experience underscore the favorable outcomes associated with this versatile flap, establishing it as a reliable tool in the armamentarium of soft tissue reconstruction. Future research endeavors are warranted to explore and refine the application of the KDPIF in diverse clinical scenarios. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, BLEPHAROPLASTY - OUR EXPERIENCE(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2021); ; ; ; One of the most popular aesthetic surgery procedures is blepharoplasty. Preoperative planning and tissue resection can reduce complications and improve outcomes. Although some patients want blepharoplasty to address age-related changes in the skin of their eyelids, the procedure is more of a sculpture and contouring of the overall aesthetic unit. In this paper we present the history, basic anatomy, indications and surgical technique of upper and lower blepharoplasty. The importance of the preoperative patient evaluation for blepharoplasty has also been stated. We present our experience in blepharoplasty surgery done at the University Clinic for Plastic and Reconstructive Surgery in a three-year period, along with the complication rate and outcome. We have briefly described the techniques of standard upper and lower eyelid blepharoplasty. Practically, the rejuvenation of this complex anatomical area requires a combination of therapies including fat excision, repositioning or transfer, simultaneous brow or midface lift, and adjunctive treatment for skin resurfacing and periorbital hollows. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Starting from Scratch: Experiences from Developing the First Vascular Anastomotic Training Program in North Macedonia Using the Porcine Thigh as a Simulation Model(Georg Thieme Verlag KG, 2024-04-04); ; ; Stevanovski, GoranMicrosurgical reconstruction constitutes a fundamental part of plastic and reconstructive surgery. It demands high dexterity and intricate technical skills. Its steep learning curve benefits from thorough training throughout residency, where using realistic simulation models in the appropriate sequence of complexity progression is essential in ensuring patient safety prior to progressing to a clinical setting. Commencing training on microvascular-like small diameter vessels could prove unsuitable and ineffective for inexperienced surgeons, however, the larger diameter neurovascular structures in the porcine thigh can provide excellent anastomotic training without compromising the animal tissue training sought after by residents. We present the results from implementing the first vascular anastomotic course in our country, where reconstructive theory was combined with simulated anastomotic training on the porcine thigh. Junior plastic surgery residents described acquiring comprehensive knowledge of reconstructive techniques and could successfully complete anastomoses, despite none to minimal previous experience. Using the porcine thigh should be encouraged as a start-up vascular anastomotic training tool as it provides realistic conditions and tissue handling training, and could improve quality of further training on microvascular structures. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, NO PAIN IS A PATIENT’S GAIN – A REVIEW OF SURGICAL TECHNIQUES FOR PREVENTION AND TREATMENT OF POSTAMPUTATION PAIN(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022); ; ; Regardless of the cause, major lower limb amputation is a life-changing event and accompanied by pain it has a great impact on patients’ quality of life. Over the years many pharmacological and surgical treatments have been tried to manage residual limb pain and phantom limb pain, but they were either unsuccessful or did not apply to all patients. The aim of this review paper was to describe the current modalities of treatment of postamputation pain and the opportunity to use surgical techniques as prophylactic. More than 150 surgical interventions have been described in the literature: traction neurectomy, nerve capping, end-to-end nerve coaptation, nerve transposition, etc. New and efficient techniques are regenerative peripheral nerve interface and targeted muscle reinnervation initially described for bioprosthetic control. Results from recent studies have shown that these techniques can be used for treatment, but also in a prophylactic manner, which can only be of benefit for the patient. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, OPEN VS PERCUTANEOUS TENORRHAPHY IN TREATMENT OF “MALLET FINGER” INJURY – OUR EXPERIENCE(2023-11); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SAVING A HAND WHILE FIGHTING THE TICKING CLOCK – A REPLANTATION STORY(2023-11); ; ; Jovanovska, K.