Branko Suđecki

Background/Objectives: Cutaneous melanoma prognosis is largely determined at diagnosis, with Breslow thickness, subtype and other histopathological aspects being key prognostic indicators. Variations in healthcare organization and environmental factors may influence melanoma presentation. This study aimed to compare epidemiological, clinical, and histopathological characteristics of primary cutaneous melanoma between two national referral centers in Southeastern Europe. Methods: A multicenter retrospective cohort study was conducted at the University Clinical Center of Serbia (Belgrade) and the Clinical Center of Montenegro (Podgorica). Consecutive patients treated for primary cutaneous melanoma between January 2018 and December 2022 were included. Data of interest were extracted from medical records. Annual regional sunshine hours were obtained from publicly available climatological databases. Group comparisons were performed using appropriate parametric and non-parametric tests, followed by a multivariable ordinal logistic regression analysis. Results: A total of 412 patients were analyzed. Age and sex distributions were comparable between cohorts. Nodular melanoma predominated in Montenegro, whereas superficial spreading melanoma was most common in Belgrade (p < 0.001). Median Breslow thickness was significantly higher in Montenegro (p = 0.001), with a greater proportion of tumors >4 mm (p = 0.001). In multivariable analysis, increasing age (p < 0.001), male sex (p = 0.027), and treatment in Montenegro (p = 0.001) were independently associated with higher Breslow thickness categories. Conclusions: Patients treated in Montenegro presented with thicker melanomas and a higher proportion of nodular subtype. These differences may reflect multifactorial influences, including healthcare accessibility and diagnostic pathways. Further prospective studies incorporating other histopathological aspects, time-to-diagnosis and survival outcomes are warranted.

Background/Objectives: Integra Dermal Regeneration Template (IDRT) has emerged as a viable reconstructive option in exposed avascular structures, such as exposed bone devoid of periosteum. This systematic review aimed at examining success rates by comparing different wound types and their characteristics, as well as the surgical methods involved. Methods: A systematic review was conducted to identify studies using IDRT in the reconstruction of defects with exposed bone devoid of periosteum. Primary outcomes of interest were IDRT and skin graft success rates, followed by patient and wound characteristics, and different surgical methods used. The results were accompanied by an illustrative case report of IDRT-based hand reconstruction after a deep burn injury. Results: The review included 40 studies, with a total of 202 individual defects. The primary indication for IDRT-based reconstruction was post-oncologic defects in the elderly population. Although surgeons mostly used burring/fenestration as a bone preparation method prior to IDRT placement, decorticated bones showed faster grafting time (23.8 vs. 27.9 days). The average success rate of IDRT was 87.54% (±25.9), with an excellent IDRT take rate (100%) observed in more than 50% of cases. In the majority of cases (95.5%), the skin graft acceptance rate was deemed to be higher than 95%, with an average graft take of 98.8%. Conclusions: The results of this review support the use of IDRT in managing complex defects involving exposed bone, offering fast coverage with good functional restoration, without any donor site morbidity. Additionally, bone preparation methods also play an important role in IDRT-based reconstruction by shortening the grafting time.

Introduction/Aim: Prophylactic mastectomy may be performed in women with high genetic or familial risk, or unilaterally alongside therapeutic mastectomy. Although malignancy is not expected in prophylactic specimens, incidental contralateral breast cancer (CBC) may alter management and prognosis. The aim of this study is to present a clinical case of the incidental finding of CBC in a tissue specimen obtained through contralateral prophylactic mastectomy (CPM) in a 46-year-old patient who had been initially diagnosed with ductal carcinoma in situ (DCIS) in the opposite breast. Case report: We report a 46-year-old woman initially diagnosed with DCIS of the right breast. After declining adjuvant radiotherapy, she opted for bilateral nipple-sparing mastectomy with direct-to-implant reconstruction. Histopathology confirmed DCIS with a focal invasive component in the right breast and unexpectedly revealed three microscopic focuses of DCIS in the contralateral breast, alongside fibrocystic changes and atypical ductal hyperplasia. Conclusion: Although CPM does not consistently improve overall survival, it can contribute to individualized risk reduction, simplified surveillance, reduced anxiety in selected patients, as well as to improving the quality of life. This case underscores its diagnostic value in detecting occult contralateral malignancy and reinforces the need for personalized surgical planning within a multidisciplinary framework.

Background: Burn wound dressing and debridement are excruciatingly painful procedures that call for appropriate analgesia—typically multimodal. Better post-procedural pain management, less opioid use, and consequently fewer side effects, which could prolong recovery and increase morbidity, are all benefits of this type of analgesia. Intravenously administered ketamine can be effective as monotherapy or in combination with opioids, especially with procedural sedation such as in burn wound dressing. Methods: This observational study investigated the effect of ketamine administered in subanesthetic doses combined with opioids during burn wound dressing. The study was conducted from October 2018 to October 2021. A total of 165 patients met the inclusion criteria. A total of 82 patients were in the ketamine group, while 83 patients were dressed without ketamine. The main outcome was the effect of ketamine on intraprocedural opioid consumption. The secondary outcome included the effect of ketamine on postprocedural pain control. Results: Patients dressed with ketamine were significantly older (p = 0.001), while the mean doses of intraoperatively administered propofol and fentanyl were significantly lower than in patients dressed without ketamine (150 vs. 220 mg, p < 0.001; and 0.075 vs. 0.150 mg, p < 0.001; respectively). Conclusions: Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management.

Introduction: Electrical burn injuries present a major public health issue in industrialized countries, and unlike electrical arc flash burns, they often result in deeper and more extensive injuries, especially in hands and feet. When choosing from the range of reconstructive modalities, prompt coverage of exposed defects is imperative, ensuring a better functional and cosmetic outcome. Patient review: A 26-year-old male was admitted into our facility's Burns Unit following a high-voltage electrical burn injuries sustained on the same day. After several debridement sessions, the left foot was left with a 100 square centimeter dorsal surface defect with the involvement of ankle joint region. The defect was covered using Integra® Dermal Regeneration Template (IDRT) with a 100% success rate both with the template and later split-thickness skin graft (STSG) application. There were no reported perioperative complications, with satisfactory cosmetic and functional results at the 6-month follow-up. Conclusion: IDRT can be considered a good surgical choice for effective defect coverage with satisfactory results. Nevertheless, the final outcome and patient recovery also often depend on a multitude of other factors, such as the defect size and the involvement of underlying structures.

Background and Objectives: The careful selection of adequate SLNB candidates not only aims at reducing the surgical risk while identifying SLN metastasis, but also plays a crucial role in identifying the patients eligible for adjuvant therapy. Objectives: The purpose of our study was to investigate the clinical and histologic aspects of primary melanomas that correlate with the likelihood of a positive SLNB result. Materials and Methods: A total of 101 primary melanoma patients who underwent sentinel lymph node biopsies were included in the study. General patient demographics were obtained as well as localization and melanoma-specific characteristics of primary melanoma from histologic reports in addition to data derived from SLNB melanoma histopathology reports. Results: The patients with positive SLN results had a statistically significant increased Breslow thickness (3.8 mm vs. 1.97 mm, p = 0.002), higher mitotic index rate (5/mm² vs. 2/mm², p = 0.009), as well as the presence of ulceration (68.4% vs. 31.6%, p = 0.007). Univariate regression analysis showed the Breslow thickness (p = 0.008), the mitotic index rate (p = 0.054), the presence of ulceration (p = 0.009), as well as the pT3-4 stage (p = 0.009) to be significant predictors of SLN positivity. The optimal cut-off values for Breslow thickness and the number of mitoses scores were determined based on ROC curve analysis. Using the Breslow thickness, mitotic index rate, presence of ulceration, and pT3-4 stage significant coefficients from the univariate regression model, a chance prediction score was developed. Conclusions: The newly developed and proposed scoring system can aid in patient selection for SLN biopsy by facilitating a more efficient risk assessment in the detection of lymph node metastases in melanoma patients.

Most skin tumors are not fatal, but if not treated in a timely manner, they can lead to significant morbidity. Due to the COVID-19 pandemic and in order to create more capacities for the treatment of COVID-19-positive patients as well as to contain the spread of the virus, the healthcare system was reorganized worldwide, leading to decreased access to preventive screening programs. The aim of this study was to evaluate the impact of the pandemic on healthcare accessibility to cutaneous squamous cell carcinoma patients in Serbia. This retrospective study was conducted at the Clinic for Burns, Plastic, and Reconstructive Surgery, University Clinical Center of Serbia in Belgrade. Patient demographics and pathohistological findings of tumors of patients living in and outside the capital in the period before, during, and after the pandemic were compared. The two groups did not show any differences regarding the largest tumor diameter prior and during the pandemic; however, this difference became extremely noticeable after the pandemic (15 mm vs. 27 mm; p < 0.001). While cSCCs are commonly slow-growing tumors, the impact of the COVID-19 pandemic is not negligible. This study found a population at a significant risk of cSCC metastasis, with additional evidence likely to emerge in the upcoming years.

Early melanoma diagnosis plays a key role in ensuring best prognosis with good survival rates. The ongoing global COVID-19 pandemic has greatly impacted global and national healthcare systems, thus making it a real challenge. The aim of this study was to evaluate the impact of the pandemic on diagnostic delay in melanoma patients in Serbia. In this retrospective study, we included patients treated at the university hospital in Serbia’s capitol over a period of five years and three months. We compared the prepandemic (01/JAN/17-14/MAR/20) and pandemic periods (15/MAR/20-31/MAR/22) by evaluating patient demographic data, melanoma subtype, Breslow thickness, Clark level, ulceration status, mitotic index rate and pT staging. We observed a significant reduction in the number of diagnosed patients (86.3 vs. 13.7%; p = 0.036), with melanomas having an increased median Breslow thickness (1.80 vs. 3.00; p = 0.010), a higher percentage of Clark IV–V level lesions (44.0% vs. 63.0%; p = 0.009), an increase in median mitotic index rate (2 vs. 5; p < 0.001) and a trend of increase in lesions thicker than 2 mm (37.8% vs. 53.7%; p = 0.026). We believe that this study can be a useful scenario guide for future similar events, highlighting the importance of preventive measures and timely diagnosis for the best patient outcomes.

Introduction: Percutaneous coronary interventions (PCI) in bifurcation lesions with more than 50% stenosis of both main and side branch remain challenging. These “true” bifurcation lesions (TBL) causing acute coronary syndrome (ACS) could pose an additional challenge for adequate treatment since there are no recommended strategies. We investigated the influence of the presence of TBLs as culprit lesions for ACS on the clinical outcomes after PCI. Methods: The study was retrospective and conducted in a high-volume university PCI centre. Study included 256 consecutive patients with native coronary artery bifurcation lesions causing an ACS. Patients with ACS caused by stent thrombosis were not included in the study. All patients underwent PCI of the culprit bifurcation lesion and afterwards were treated according to the appropriate guidelines. Results: Most of the bifurcations were located in left anterior descending 152/256 (59.3%), then in circumflex 66/256 (25.9%) and right coronary artery 38/256 (14.8%). The initial clinical presentation was STEMI in 144/256 (56.2%), then NSTEMI 59/256 (23.1%) and unstable angina in 53/256 (20.7%) patients. TBLs were present in 146/256 (57.0%) patients. TBLs were associated with longer PCI procedural time 48±24min vs. 31±28min (p<0.05) and greater contrast volume 177±73 vs. 149±48 ml (p=0.01), but not with larger myocardial infarction in terms of magnitude of troponin I release 47.35±73.73 vs 31.07±38.05 ng/ml (p=0.164) and LVEF 40±13 vs 42±13% (p=0.439), as compared to other bifurcations. The patients were followed for 405±377 days. MACCE (major adverse cardio-cerebral events: death, myocardial infarction, repeated revascularization and stroke) occurred in 55/256 (21.5%) patients. In univariate regression analysis, provisional PCI strategy was associated with fewer MACCE [OR 0.283 (95 % CI 0.089–0.898)]. However, in the multivariate regression analysis, that included recognized predictors of MACCE (diabetes, LVEF, chronic kidney disease, multivessel disease, provisional PCI strategy, use of ticagrelor, TBLs) only the presence of the multi-vessel coronary artery disease remained an independent predictor of MACCE [OR 5.147 (95 % CI 1.859–14.248)]. Conclusions: TBL in acute coronary syndrome are associated with longer PCI duration, but were not associated with larger myocardial infarction and adverse cardiovascular outcomes. The extent of the CAD at presentation is associated with future cardiovascular events.