Olga Gutkowska | Wroclaw Medical University (original) (raw)

Papers by Olga Gutkowska

Research paper thumbnail of Case report Multiple schwannomas of the digital nerves and superficial radial nerve: two unusual cases of segmental schwannomatosis

Folia Neuropathologica, 2015

Two cases of segmental sporadic schwannomatosis characterized by unusual location of multiple sch... more Two cases of segmental sporadic schwannomatosis characterized by unusual location of multiple schwannomas in digital nerves (case 1) and the superficial radial nerve (case 2) are described in this paper. In the first of the described cases, 6 tumours located at the base of the middle finger and in its distal portion were excised from both digital nerves. In the second case, 3 tumours located in the proximal 1/3 and halfway down the forearm were removed from the superficial radial nerve. In both cases, symptoms such as palpable tumour mass, pain, paraesthesias, and positive Tinel-Hoffman sign resolved after operative treatment. Final diagnoses were made based on histopathological examination results. In the second of the described cases, the largest of the excised lesions had features enabling diagnosis of a rare tumour type-ancient schwannoma.

Research paper thumbnail of Volar retinacular ganglions (flexor tendon sheath ganglions) The results of surgical treatment

PubMed, Dec 1, 2018

Volar retinacular ganglions are the third most common group of all ganglions located in the hand ... more Volar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications which were observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.

Research paper thumbnail of Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve

Folia Neuropathologica, 2015

The objective of this paper is to present a case of rare location of schwannoma in the medial cut... more The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.

Research paper thumbnail of Results of Surgical Treatment of Schwannomas Arising from Extremities

BioMed Research International, 2015

Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experie... more Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

Research paper thumbnail of Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

Medical Science Monitor, Jul 15, 2017

Self financing Anterior glenohumeral dislocation affects about 2% of the general population durin... more Self financing Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17-96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2-3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available. The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation. A comprehensive literature search and review was performed using the keywords "glenohumeral dislocation", "shoulder dislocation", "immobilization", "external rotation", and "recurrent dislocation" in PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar databases from their inceptions to May 2016. Three cadaveric studies, 6 imaging studies, 10 clinical studies, and 4 meta-analyses were identified. The total number of 734 patients were included in the clinical studies. Literature analysis revealed better coaptation of the labrum on the glenoid rim in external rotation in cadaveric and imaging studies. However, this tendency was not confirmed by lower redislocation rates or better quality of life in clinical studies. On the basis of the available literature, we cannot confirm the superiority of immobilization in external rotation after glenohumeral dislocation when compared to internal rotation. A yet-to-be-determined group of patients with specific labroligamentous injury pattern may benefit from immobilization in external rotation. Further studies are needed to identify these patients.

Research paper thumbnail of Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up

World Neurosurgery, Sep 1, 2017

Results of operative treatment of brachial plexus injury resulting from shoulder dislocationa stu... more Results of operative treatment of brachial plexus injury resulting from shoulder dislocationa study with a long-term follow up Running title: Brachial plexus injury after shoulder dislocation

Research paper thumbnail of Peripheral nerve tumours: 30-year experience in the surgical treatment

Neurosurgical Review, Mar 3, 2015

Peripheral nerve tumours are relatively rare type of soft tissue tumours. The aim of this work is... more Peripheral nerve tumours are relatively rare type of soft tissue tumours. The aim of this work is to present our experience with surgical treatment of this type of lesions. Clinical material consists of 94 patients (56 females, 38 males), in whom 101 tumours deriving from peripheral nervous system were removed. The patients underwent surgical treatment between 1983 and 2012. Tumours occurred mainly in the upper extremity (72 tumours), less often in the lower extremity (25 tumours). Lesions developed in major peripheral nerves (51 tumours) and small nerve branches (50 tumours). The most common symptoms reported before surgery included presence of tumour mass (100 %), positive Hoffmann-Tinel sign (95.6 %) and paraesthesia (93.4 %). Less often sensory deficit (89.1 %) and pain (71.7 %) were observed. Motor deficit was the least common manifestation (41.3 %). Benign tumours prevailed in presented material (94 tumours). In 7 cases, malignant peripheral nerve sheath tumour (MPNST) was identified. As a result of surgical treatment in the group of tumours deriving from major peripheral nerves, in 87.8 % of the patients, pain relief was achieved; in 84 %, Hoffmann-Tinel sign was negative; and in 79 %, paraesthesia resolved. Sensory function improvement was observed in 51.2 % of the patients while motor function improved in 26.3 % of the patients. None of the patients experienced tumour relapse. In the group of tumours deriving from small nerve branches, 47 patients had no signs of tumour recurrence. One female patient diagnosed with MPNST suffered a relapse. Obtaining satisfactory results of peripheral nerve tumour treatment requires both careful differential diagnosis and well thought-out strategy at every stage of therapeutic management.

Research paper thumbnail of Chemical Substances Used in the Treatment of Ganglions Located in the Hand and Wrist

Polimery w medycynie, 2016

Methods of treatment for ganglions located in the hand and wrist region include observation, surg... more Methods of treatment for ganglions located in the hand and wrist region include observation, surgical removal of the lesion and aspiration, which may or may not be followed by an injection of a chemical substance into the cyst cavity [1-4]. Historical methods, such as causing the rupture of a ganglion by applying pressure to it with a golden coin, smashing the lesion with a heavy book (including the Bible) or applying digital pressure to the cyst are no longer in use [1, 3]. This article discusses the range of chemical substances most commonly used in the treatment of ganglion cysts located in the hand and wrist region in clinical practice. Chemical Substances Hyaluronidase Hyaluronidase is a protein enzyme from the family of hydrolases that depolymerizes hyaluronic acid. It also causes an increase in the permeability of connective tissue. Due to these properties, hyaluronidase is used in medicine to augment the dispersion and absorption of other injected substances and liquids. However, decreases in tissue viscosity may facilitate the spread of microorganisms, thus increasing the risk of infection. A variety of hyaluronidase preparations are commercially available: Hydase™ (Prima-Pharm Inc.), Vitrasse (Bausch + Lomb Inc./Valeant Pharmaceuticals International Inc.), Amphadase (Amphastar Pharmaceuticals Inc.) and Hyason (Organon Pharmaceuticals). These products are available in 1-1.2 mL vials containing 150-200 international units (IU) of the enzyme per milliliter. Synthetic human hyaluronidase containing 150 IU/mL, named Hylenex (Halozyme Therapeutics), was approved for use in 2005. The administration of hyaluronidase is associated with the risk of an allergic reaction. Subjects who are allergic to bee or wasp venom have a higher risk of developing an allergic reaction. Complications and side effects observed after the administration of hyaluronidase include edema and erythema at the injection site, hypotonia, seizures, dizziness, shivers, nausea, vomiting and tachycardia [5]. A skin allergy test is recommended before hyaluroni

Research paper thumbnail of Benign nerve tumours of the hand (excluding wrist)

Archives of Orthopaedic and Trauma Surgery, Sep 21, 2015

Hand tumours of neural origin are rare in clinical practice. The aim of this work is to present o... more Hand tumours of neural origin are rare in clinical practice. The aim of this work is to present our experience in operative treatment of benign nerve tumours located in the hand. Special emphasis has been put on determining the occurrence rates of particular tumour types characterized by their unique histopathological patterns and describing detailed location of the lesions. The obtained results of treatment were assessed. The study comprised of 26 patients, both female (19) and male (7). The mean age and age range of the female and male patients were 44.8 years (range, 21-73 years) and 39.6 years (range, 21-74 years), respectively. The patients underwent operative treatment for tumours of neurogenic origin located in the hand between the years 1990 and 2013. In total, 31 tumours in 26 patients were removed. The most common site of tumour origin was small cutaneous branches and only exceptionally the tumours arose from common digital nerves (2 patients). No patient was lost to postoperative follow-up. The shortest period of postoperative follow-up covered 1 year. No tumour recurrence was detected during postoperative follow-up examinations. The patients reported neither pain nor presence of paraesthesias. Neurofibromas (17 tumours) predominated in the gathered clinical material, while the second most common group of tumours were schwannomas (12 tumours). (1) Benign nerve tumours of the hand are rare. Neurofibromas and schwannomas predominate among them. Tumours having other histopathological patterns are extremely uncommon. (2) The prognosis after resection of benign nerve tumours located in the hand is good and the risk of postoperative complications and recurrence is low.

Research paper thumbnail of Dorsal and volar wrist ganglions: The results of surgical treatment

Advances in Clinical and Experimental Medicine, Aug 2, 2018

Background. The wrist, especially its dorsal surface, is the most common location of ganglion cys... more Background. The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. Objectives. The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. Material and methods. A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. Results. Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12. 1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. Conclusions. Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.

Research paper thumbnail of Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases

Advances in Clinical and Experimental Medicine, Mar 1, 2017

Background. Ganglions constitute the most common tumor type of the hand and wrist region. They ha... more Background. Ganglions constitute the most common tumor type of the hand and wrist region. They have a non-neoplastic character and affect patients of all ages. Objectives. The purpose of this work was to analyze the epidemiological data of a representative group of patients diagnosed with ganglions of the hand and wrist. Material and methods. Five-hundred-and-twenty patients operated on for ganglions of the hand and wrist between the years 2000 and 2014 were included in the study. For the statistical analysis, STATISTICA v. 10 was used. Categorical data was analyzed using the χ 2. The distribution of two and more independent samples was compared through the Mann-Whitney U test and Kruskal-Wallis test followed by pairwise comparisons for significant test statistics, respectively. Results. In the studied group of patients, ganglions affected females more often than males, with a 2.8 : 1 ratio. No statistically significant differences in age distribution between women and men (median age 38 vs. 40 years) were found. Ganglions affected both sides of the body with comparable equality. Wrist ganglions predominated (76%). The patients diagnosed with hand ganglions were statistically significantly older (p < 0.001), and the right hand was affected more often (p = 0.003). A statistically significant difference in age distribution between the patients with DWG (dorsal wrist ganglions) and VRG (volar retinacular ganglions) was observed (p < 0.001). DWG affected the left side (p = 0.003) and VRG the right side (p = 0.005) of the body more often. Conclusions. Statistical analysis of our patients confirmed much of the previously published data. Although the diagnosis and treatment of ganglions of the hand and wrist are relatively uncomplicated, the pathophysiology of their formation is still waiting to be thoroughly explained.

Research paper thumbnail of The role of chitin and chitosan in peripheral nerve reconstruction

Polimery w medycynie, Oct 2, 2017

Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacety... more Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacetylated derivative. The properties of both biopolymers allow their wide use in medicine and various industries. This paper presents the possibilities offered by chitin and chitosan for the creation of neurotubes utilized in peripheral nerve repair procedures. In the initial part of this manuscript, experimental studies on both polysaccharides carried out by numerous authors have been presented and their results have been discussed. Further, basic information on Reaxon® Nerve Guide, being the first chitosan tube approved for clinical use, is provided. Finally, existing limitations in the optimal use of chitosan tubes in peripheral nerve reconstruction have been pointed out. It is expected that modification of the properties of chitosan itself as well as enriching neurotubes with components of extracellular matrix, cells, growth factors and filaments will further improve the results of nerve regeneration obtained with chitosan-based nerve conduits.

Research paper thumbnail of Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve

Folia Neuropathologica, 2015

The objective of this paper is to present a case of rare location of schwannoma in the medial cut... more The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.

Research paper thumbnail of Results of Surgical Treatment of Schwannomas Arising from Extremities

BioMed Research International, 2015

Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experie... more Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

Research paper thumbnail of Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

Medical Science Monitor, Jul 15, 2017

Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime.... more Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17-96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2-3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available. The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation. A comprehensive literature search and review was performed using the keywords "glenohumeral dislocation", "shoulder dislocation", "immobilization", &quo...

Research paper thumbnail of Volar retinacular ganglions (flexor tendon sheath ganglions) The results of surgical treatment

Acta orthopaedica Belgica, 2018

Volar retinacular ganglions are the third most common group of all ganglions located in the hand ... more Volar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications which were observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.

Research paper thumbnail of Dorsal and volar wrist ganglions: The results of surgical treatment

Advances in Clinical and Experimental Medicine

Background. The wrist, especially its dorsal surface, is the most common location of ganglion cys... more Background. The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. Objectives. The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. Material and methods. A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. Results. Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12. 1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. Conclusions. Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.

Research paper thumbnail of Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

BioMed Research International

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character... more Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% ...

Research paper thumbnail of Brachial plexus injury after shoulder dislocation: a literature review

Neurosurgical Review

Brachial plexus injuries are among the rarest but at the same time the most severe complications ... more Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.

Research paper thumbnail of The role of chitin and chitosan in peripheral nerve reconstruction

Polimery w medycynie

Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacety... more Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacetylated derivative. The properties of both biopolymers allow their wide use in medicine and various industries. This paper presents the possibilities offered by chitin and chitosan for the creation of neurotubes utilized in peripheral nerve repair procedures. In the initial part of this manuscript, experimental studies on both polysaccharides carried out by numerous authors have been presented and their results have been discussed. Further, basic information on Reaxon® Nerve Guide, being the first chitosan tube approved for clinical use, is provided. Finally, existing limitations in the optimal use of chitosan tubes in peripheral nerve reconstruction have been pointed out. It is expected that modification of the properties of chitosan itself as well as enriching neurotubes with components of extracellular matrix, cells, growth factors and filaments will further improve the results of nerve...

Research paper thumbnail of Case report Multiple schwannomas of the digital nerves and superficial radial nerve: two unusual cases of segmental schwannomatosis

Folia Neuropathologica, 2015

Two cases of segmental sporadic schwannomatosis characterized by unusual location of multiple sch... more Two cases of segmental sporadic schwannomatosis characterized by unusual location of multiple schwannomas in digital nerves (case 1) and the superficial radial nerve (case 2) are described in this paper. In the first of the described cases, 6 tumours located at the base of the middle finger and in its distal portion were excised from both digital nerves. In the second case, 3 tumours located in the proximal 1/3 and halfway down the forearm were removed from the superficial radial nerve. In both cases, symptoms such as palpable tumour mass, pain, paraesthesias, and positive Tinel-Hoffman sign resolved after operative treatment. Final diagnoses were made based on histopathological examination results. In the second of the described cases, the largest of the excised lesions had features enabling diagnosis of a rare tumour type-ancient schwannoma.

Research paper thumbnail of Volar retinacular ganglions (flexor tendon sheath ganglions) The results of surgical treatment

PubMed, Dec 1, 2018

Volar retinacular ganglions are the third most common group of all ganglions located in the hand ... more Volar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications which were observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.

Research paper thumbnail of Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve

Folia Neuropathologica, 2015

The objective of this paper is to present a case of rare location of schwannoma in the medial cut... more The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.

Research paper thumbnail of Results of Surgical Treatment of Schwannomas Arising from Extremities

BioMed Research International, 2015

Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experie... more Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

Research paper thumbnail of Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

Medical Science Monitor, Jul 15, 2017

Self financing Anterior glenohumeral dislocation affects about 2% of the general population durin... more Self financing Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17-96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2-3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available. The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation. A comprehensive literature search and review was performed using the keywords "glenohumeral dislocation", "shoulder dislocation", "immobilization", "external rotation", and "recurrent dislocation" in PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar databases from their inceptions to May 2016. Three cadaveric studies, 6 imaging studies, 10 clinical studies, and 4 meta-analyses were identified. The total number of 734 patients were included in the clinical studies. Literature analysis revealed better coaptation of the labrum on the glenoid rim in external rotation in cadaveric and imaging studies. However, this tendency was not confirmed by lower redislocation rates or better quality of life in clinical studies. On the basis of the available literature, we cannot confirm the superiority of immobilization in external rotation after glenohumeral dislocation when compared to internal rotation. A yet-to-be-determined group of patients with specific labroligamentous injury pattern may benefit from immobilization in external rotation. Further studies are needed to identify these patients.

Research paper thumbnail of Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up

World Neurosurgery, Sep 1, 2017

Results of operative treatment of brachial plexus injury resulting from shoulder dislocationa stu... more Results of operative treatment of brachial plexus injury resulting from shoulder dislocationa study with a long-term follow up Running title: Brachial plexus injury after shoulder dislocation

Research paper thumbnail of Peripheral nerve tumours: 30-year experience in the surgical treatment

Neurosurgical Review, Mar 3, 2015

Peripheral nerve tumours are relatively rare type of soft tissue tumours. The aim of this work is... more Peripheral nerve tumours are relatively rare type of soft tissue tumours. The aim of this work is to present our experience with surgical treatment of this type of lesions. Clinical material consists of 94 patients (56 females, 38 males), in whom 101 tumours deriving from peripheral nervous system were removed. The patients underwent surgical treatment between 1983 and 2012. Tumours occurred mainly in the upper extremity (72 tumours), less often in the lower extremity (25 tumours). Lesions developed in major peripheral nerves (51 tumours) and small nerve branches (50 tumours). The most common symptoms reported before surgery included presence of tumour mass (100 %), positive Hoffmann-Tinel sign (95.6 %) and paraesthesia (93.4 %). Less often sensory deficit (89.1 %) and pain (71.7 %) were observed. Motor deficit was the least common manifestation (41.3 %). Benign tumours prevailed in presented material (94 tumours). In 7 cases, malignant peripheral nerve sheath tumour (MPNST) was identified. As a result of surgical treatment in the group of tumours deriving from major peripheral nerves, in 87.8 % of the patients, pain relief was achieved; in 84 %, Hoffmann-Tinel sign was negative; and in 79 %, paraesthesia resolved. Sensory function improvement was observed in 51.2 % of the patients while motor function improved in 26.3 % of the patients. None of the patients experienced tumour relapse. In the group of tumours deriving from small nerve branches, 47 patients had no signs of tumour recurrence. One female patient diagnosed with MPNST suffered a relapse. Obtaining satisfactory results of peripheral nerve tumour treatment requires both careful differential diagnosis and well thought-out strategy at every stage of therapeutic management.

Research paper thumbnail of Chemical Substances Used in the Treatment of Ganglions Located in the Hand and Wrist

Polimery w medycynie, 2016

Methods of treatment for ganglions located in the hand and wrist region include observation, surg... more Methods of treatment for ganglions located in the hand and wrist region include observation, surgical removal of the lesion and aspiration, which may or may not be followed by an injection of a chemical substance into the cyst cavity [1-4]. Historical methods, such as causing the rupture of a ganglion by applying pressure to it with a golden coin, smashing the lesion with a heavy book (including the Bible) or applying digital pressure to the cyst are no longer in use [1, 3]. This article discusses the range of chemical substances most commonly used in the treatment of ganglion cysts located in the hand and wrist region in clinical practice. Chemical Substances Hyaluronidase Hyaluronidase is a protein enzyme from the family of hydrolases that depolymerizes hyaluronic acid. It also causes an increase in the permeability of connective tissue. Due to these properties, hyaluronidase is used in medicine to augment the dispersion and absorption of other injected substances and liquids. However, decreases in tissue viscosity may facilitate the spread of microorganisms, thus increasing the risk of infection. A variety of hyaluronidase preparations are commercially available: Hydase™ (Prima-Pharm Inc.), Vitrasse (Bausch + Lomb Inc./Valeant Pharmaceuticals International Inc.), Amphadase (Amphastar Pharmaceuticals Inc.) and Hyason (Organon Pharmaceuticals). These products are available in 1-1.2 mL vials containing 150-200 international units (IU) of the enzyme per milliliter. Synthetic human hyaluronidase containing 150 IU/mL, named Hylenex (Halozyme Therapeutics), was approved for use in 2005. The administration of hyaluronidase is associated with the risk of an allergic reaction. Subjects who are allergic to bee or wasp venom have a higher risk of developing an allergic reaction. Complications and side effects observed after the administration of hyaluronidase include edema and erythema at the injection site, hypotonia, seizures, dizziness, shivers, nausea, vomiting and tachycardia [5]. A skin allergy test is recommended before hyaluroni

Research paper thumbnail of Benign nerve tumours of the hand (excluding wrist)

Archives of Orthopaedic and Trauma Surgery, Sep 21, 2015

Hand tumours of neural origin are rare in clinical practice. The aim of this work is to present o... more Hand tumours of neural origin are rare in clinical practice. The aim of this work is to present our experience in operative treatment of benign nerve tumours located in the hand. Special emphasis has been put on determining the occurrence rates of particular tumour types characterized by their unique histopathological patterns and describing detailed location of the lesions. The obtained results of treatment were assessed. The study comprised of 26 patients, both female (19) and male (7). The mean age and age range of the female and male patients were 44.8 years (range, 21-73 years) and 39.6 years (range, 21-74 years), respectively. The patients underwent operative treatment for tumours of neurogenic origin located in the hand between the years 1990 and 2013. In total, 31 tumours in 26 patients were removed. The most common site of tumour origin was small cutaneous branches and only exceptionally the tumours arose from common digital nerves (2 patients). No patient was lost to postoperative follow-up. The shortest period of postoperative follow-up covered 1 year. No tumour recurrence was detected during postoperative follow-up examinations. The patients reported neither pain nor presence of paraesthesias. Neurofibromas (17 tumours) predominated in the gathered clinical material, while the second most common group of tumours were schwannomas (12 tumours). (1) Benign nerve tumours of the hand are rare. Neurofibromas and schwannomas predominate among them. Tumours having other histopathological patterns are extremely uncommon. (2) The prognosis after resection of benign nerve tumours located in the hand is good and the risk of postoperative complications and recurrence is low.

Research paper thumbnail of Dorsal and volar wrist ganglions: The results of surgical treatment

Advances in Clinical and Experimental Medicine, Aug 2, 2018

Background. The wrist, especially its dorsal surface, is the most common location of ganglion cys... more Background. The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. Objectives. The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. Material and methods. A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. Results. Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12. 1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. Conclusions. Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.

Research paper thumbnail of Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases

Advances in Clinical and Experimental Medicine, Mar 1, 2017

Background. Ganglions constitute the most common tumor type of the hand and wrist region. They ha... more Background. Ganglions constitute the most common tumor type of the hand and wrist region. They have a non-neoplastic character and affect patients of all ages. Objectives. The purpose of this work was to analyze the epidemiological data of a representative group of patients diagnosed with ganglions of the hand and wrist. Material and methods. Five-hundred-and-twenty patients operated on for ganglions of the hand and wrist between the years 2000 and 2014 were included in the study. For the statistical analysis, STATISTICA v. 10 was used. Categorical data was analyzed using the χ 2. The distribution of two and more independent samples was compared through the Mann-Whitney U test and Kruskal-Wallis test followed by pairwise comparisons for significant test statistics, respectively. Results. In the studied group of patients, ganglions affected females more often than males, with a 2.8 : 1 ratio. No statistically significant differences in age distribution between women and men (median age 38 vs. 40 years) were found. Ganglions affected both sides of the body with comparable equality. Wrist ganglions predominated (76%). The patients diagnosed with hand ganglions were statistically significantly older (p < 0.001), and the right hand was affected more often (p = 0.003). A statistically significant difference in age distribution between the patients with DWG (dorsal wrist ganglions) and VRG (volar retinacular ganglions) was observed (p < 0.001). DWG affected the left side (p = 0.003) and VRG the right side (p = 0.005) of the body more often. Conclusions. Statistical analysis of our patients confirmed much of the previously published data. Although the diagnosis and treatment of ganglions of the hand and wrist are relatively uncomplicated, the pathophysiology of their formation is still waiting to be thoroughly explained.

Research paper thumbnail of The role of chitin and chitosan in peripheral nerve reconstruction

Polimery w medycynie, Oct 2, 2017

Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacety... more Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacetylated derivative. The properties of both biopolymers allow their wide use in medicine and various industries. This paper presents the possibilities offered by chitin and chitosan for the creation of neurotubes utilized in peripheral nerve repair procedures. In the initial part of this manuscript, experimental studies on both polysaccharides carried out by numerous authors have been presented and their results have been discussed. Further, basic information on Reaxon® Nerve Guide, being the first chitosan tube approved for clinical use, is provided. Finally, existing limitations in the optimal use of chitosan tubes in peripheral nerve reconstruction have been pointed out. It is expected that modification of the properties of chitosan itself as well as enriching neurotubes with components of extracellular matrix, cells, growth factors and filaments will further improve the results of nerve regeneration obtained with chitosan-based nerve conduits.

Research paper thumbnail of Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve

Folia Neuropathologica, 2015

The objective of this paper is to present a case of rare location of schwannoma in the medial cut... more The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.

Research paper thumbnail of Results of Surgical Treatment of Schwannomas Arising from Extremities

BioMed Research International, 2015

Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experie... more Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

Research paper thumbnail of Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

Medical Science Monitor, Jul 15, 2017

Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime.... more Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17-96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2-3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available. The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation. A comprehensive literature search and review was performed using the keywords "glenohumeral dislocation", "shoulder dislocation", "immobilization", &quo...

Research paper thumbnail of Volar retinacular ganglions (flexor tendon sheath ganglions) The results of surgical treatment

Acta orthopaedica Belgica, 2018

Volar retinacular ganglions are the third most common group of all ganglions located in the hand ... more Volar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications which were observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.

Research paper thumbnail of Dorsal and volar wrist ganglions: The results of surgical treatment

Advances in Clinical and Experimental Medicine

Background. The wrist, especially its dorsal surface, is the most common location of ganglion cys... more Background. The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. Objectives. The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. Material and methods. A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. Results. Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12. 1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. Conclusions. Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.

Research paper thumbnail of Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

BioMed Research International

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character... more Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% ...

Research paper thumbnail of Brachial plexus injury after shoulder dislocation: a literature review

Neurosurgical Review

Brachial plexus injuries are among the rarest but at the same time the most severe complications ... more Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.

Research paper thumbnail of The role of chitin and chitosan in peripheral nerve reconstruction

Polimery w medycynie

Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacety... more Chitin is a natural polysaccharide commonly found in nature and chitosan is its partially deacetylated derivative. The properties of both biopolymers allow their wide use in medicine and various industries. This paper presents the possibilities offered by chitin and chitosan for the creation of neurotubes utilized in peripheral nerve repair procedures. In the initial part of this manuscript, experimental studies on both polysaccharides carried out by numerous authors have been presented and their results have been discussed. Further, basic information on Reaxon® Nerve Guide, being the first chitosan tube approved for clinical use, is provided. Finally, existing limitations in the optimal use of chitosan tubes in peripheral nerve reconstruction have been pointed out. It is expected that modification of the properties of chitosan itself as well as enriching neurotubes with components of extracellular matrix, cells, growth factors and filaments will further improve the results of nerve...