Faculty of Medicine

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Author: search.filters.author.Jovanovska, KaterinaLanguage: search.filters.language.English

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    Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease
    (Multidisciplinary Digital Publishing Institute (Switzerland), 2025-02-12)
    Tusheva, Sofija
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    Jovanovska, Katerina
    Background: 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.
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    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)
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    Aleksovski, Boris
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    Tusheva, Sofija
    Despite advancements in surgical treatments, impairments persist after peripheral nerve injuries, prompting a shift in research toward the microenvironment of injured axons. Platelet-rich plasma (PRP), rich in growth factors and derived from autologous blood, emerges as a potential candidate to accelerate nerve healing.
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    IMPACT OF AWARENESS-RAISING CAMPAIGN ON PREVENTION OF PYROTECHNIC-RELATED HAND INJURIES IN NORTH MACEDONIA DURING CHRISTMAS HOLIDAYS
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023-04)
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    Kochoska, Renata
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    Aleksovski, Darko
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    Hadzitrifon, Sara
    Firecrackers and other pyrotechnic materials are used worldwide to celebrate national, religious, cultural festivals and holidays. In our country the use of firecrackers is usually during the holiday season, particularly during New Year's and Christmas days. The majority of users of firecrackers are adolescents who want to make the celebration more exciting, not being aware of the harmful effects and severe injures they can get by using pyrotechnics. The injuries caused by using pyrotechnics can vary from moderate such as first or second-degree burns to severe injuries like traumatic amputation of the fingers and hand, resulting in life-long mutilation. These injuries are expected to have long-term functional and psychological sequalae. Precisely because of that, our clinic started an awareness-raising campaign on prevention of pyrotechnic-hand injuries (PPH campaign) named "Don't let the firecrackers ruin your holidays”. The aim of this article is to present the impact of our PPH campaign in awareness raising against the use of pyrotechnic explosives and prevention of severe hand injuries by educating 15-16-year-old students about the dangers of using pyrotechnics and emphasizing the complexity of the hand and its importance in everyday life. In our study we used an anonymous questionnaire in order to see what was the impact of our presentation and discussions on students during the PPH campaign. From our 5-year experience with this type of campaign, we can see that awareness campaigns gave excellent results in decreasing the number of hand injuries. Therefore, our goal is this PPH awareness–raising campaign to be organized every year for generations to come.
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    SURGICAL TREATMENT OF PRIMARY LYMPHEDEMA COMPLICATIONS – A CASE REPORT
    (Macedonian Association of Anatomists and Morphologists, 2021)
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    Jovanovska, Katerina
    We present a case of a 28-year-old woman with primary lymphedema of the right leg, with tumor formations on her right foot, causing functional disabilities. Tumor formations were removed and histologically confirmed as dermatofibromas. Five years later, the patient was readmitted due to foot problems, keratosis of the heel, as well as increased edema of the dorsum of the foot and lower leg. Liposuction and excision of lymphoedematous tissue from the dorsum of the foot, release of the constrictive band at the level of the anterior surface of the ankle with "Z" plasty, as well as liposuction of lymphoedematous tissue of the lower leg and thigh were performed. The postoperative course was without complications, with a light seroma at the dorsum of the foot. During the 4-year follow-up period, the patient showed a noticeable improvement, with a slow increase in the volume of the lower leg and thigh, which did not reach the preoperative dimensions. Unfortunately, lymphedematous tissue increased again on the dorsum of the foot as prior to surgery.
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    WALANT as an Optimal Approach in Hand Surgery during Pandemics
    (Charles University in Prague, Karolinum Press, 2022-01)
    Georgieva, Gordana
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    Srbov, Blagoja
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    Tusheva, Sofija
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    Jovanovska, Katerina
    The emergence of the COVID-19 pandemic imposed fundamental changes in the field of surgery. Reorganization was made in order to adequately treat the patients during the pandemic. WALANT (Wide Awake Local Anesthesia No Tourniquet) approach was found to be a very convenient method in facilitating continuity in hand surgery with limited staff. A retrospective comparative study was performed between period of April 2020 till September 2021 at our clinic to evaluate advantages of WALANT approach. This study included 136 patients, from which 72 (53%) were operated with WALANT, compared to the control group of 64 (47%) patients without WALANT. Average hospital stay for the WALANT group was 2.2 days vs. 4.7 days for the control group. Average operating room personnel were 3.8 for WALANT and 6.2 for the control non-WALANT group. Intraoperative and postoperative VAS (visual analogue scale) score was evaluated. Due to its diversity, low cost and low complication rate, we recommend WALANT approach in acute and elective hand surgery.
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    Prophylactic Regenerative Peripheral Nerve Interfaces in Elective Lower Limb Amputations
    (Macedonian Academy of Sciences and Arts / Walter de Gruyter GmbH, 2022-04-22)
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    Srbov, Blagoja
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    Tusheva, Sofija
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    Jovanoski, Tomislav
    Regenerative peripheral nerve interface (RPNI) is a relatively new surgical technique to manage neuromas and phantom pain after limb amputation. This study evaluates prophylactic RPNI efficacy in managing post-amputation pain and neuroma formation in amputees compared with patients in which lower limb amputation was performed without this procedure. We included 28 patients who underwent above the knee amputation (AKA) or below the knee amputation (BKA) for severe soft tissue infection from July 2019 till December 2020. All patients had insulin-dependent diabetes. The patients were divided into two groups, 14 patients with primary RPNI and 14 patients without. We analyzed the demographic data, level of amputation, number of RPNIs, operative time, postoperative complications and functional outcome on the defined follow up period. The mean patient age was 68.6 years (range 49-85), 19 (67.9 %) male and 9 (32.1 %) female patients. In this study 11 (39.3 %) AKA and 17 (60.7 %) BKA were performed. Overall, 37 RPNIs were made. The mean follow-up period was 49 weeks. PROMIS T-score decreased by 15.9 points in favor for the patients with RPNI. The VAS score showed that, in the RPNI group, all 14 patients were without pain compared to the group of patients without RPNI, where the 11 (78.6 %) patients described their pain as severe. Patients with RPNI used prosthesis significantly more (p < 0.005). Data showed significant reduction in pain and high patient satisfaction after amputation with RPNIs. This technique is oriented as to prevent neuroma formation with RPNI surgery, performed at the time of amputation. RPNI surgery did not provoke complications or significant lengthening of operative time and it should be furthermore exploited as a surgical technique.
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    Platlet-Rich Plasma - Review of Literature
    (Macedonian Academy of Sciences and Arts / Walter de Gruyter GmbH, 2021-04-23)
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    Trajkova, Andrijana
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    Georgieva, Gordana
    Wound healing is a dynamic and physiological process for restoring the normal architecture and functionality of damaged tissue. Platelet-rich plasma (PRP) is an autologous whole blood product that contains a large number of platelets in a small volume of plasma with complete set of coagulation factors, which are in physiological concentrations. PRP has haemostatic, adhesive properties and acts supraphysiologically in the process of wound healing and osteogenesis. Platelets play a very important role in the wound healing process by providing growth factors that enhance the rate and quality of wound healing by many different mechanisms. The aim of this review is to describe: the biology of platelets and their role in the wound healing process, the terminology of platelet rich products, PRP preparation, activation and concentration of PRP, as well as the use of PRP in plastic surgery.