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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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    COMPARATIVE STUDY OF ARTICLES ON DIFFERENT SURGICAL APPROACHES BY DIVERSE AUTHORS IN TREATMENT OF CUBITAL TUNNEL SYNDORME
    (Македонско Лекарско Друштво - Macedonian Medical Association/De Gruyter, 2019)
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    Introduction. Cubital tunnel syndrome is the second most common compressive neuropathy in the upper limb. The diagnosis of cubital tunnel syndrome is primarily clinical. A thorough history should include the onset of symptoms, presence of grip or pinch weakness, numbness and the chronicity of the condition. Methods. Depending on symptoms and clinical signs, the surgical methods of choice include in situ open decompression, submuscular transposition, intramuscular transposition, subcutaneous transposition and medial epicondylectomy. APubMed search was conducted and published articles were comparedusing predetermined criteria. Data collected showed the follow-up of patients’ surgical treatment with different surgical approaches. The percentage results are shown as combined good and excellent outcomes. Results. Despite the different scoring scales used and difficulty comparing studies directly, the bulk of single technique outcomes studies and multi-technique comparative studies demonstrate that all surgical techniques discussed are effective treatment methods for cubital tunnel syndrome, but fail to demonstrate one technique to be uniformly superior to another. Conclusion. The literature, articles and casereports, state that all of the techniques are generally effective. Comparative studies show no statistical difference in outcomes with any presentedtechnique. One conclusion is obvious that transposition should be performed only when subluxation of the nerve is present. In conclusion, there is no superior technique and no gold standard in treatment ofcubital tunnel syndrome.
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    Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries
    (Elsevier Ltd., 2022-11-05)
    NIHR Global Health Unit on Global Surgery
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    COVIDSurg Collaborative
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    Konjanoska, Maja
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    Kavain, Snezhana B.
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    The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs.
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    SAVING A HAND WHILE FIGHTING THE TICKING CLOCK – A REPLANTATION STORY
    (2023-11)
    Aleksovski, Darko
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    Jovanovska, K.
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    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)
    Dimovska, Eleonora O.F.
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    Stevanovski, Goran
    Microsurgical 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.
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    Clinical Applications of Keystone Design Perforator Island Flap: A Single-Center Experience
    (SciTeMed Publishing Group, 2023)
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    Tusheva, Sofija
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    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.
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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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    BLEPHAROPLASTY - OUR EXPERIENCE
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2021)
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    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.
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    Paget Schroetter syndrome
    (2023)
    Aleksovski, Darko
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    Hadjitrifon, Sara
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    Tusheva, Sofija
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