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Mazur M, Steelman K, Sayeed Z, Chen C, Darwiche H, Little B. Total Hip Arthroplasty in the Ultrayoung. Arthroplast Today 2023; 23:101181. [PMID: 37731593 PMCID: PMC10507074 DOI: 10.1016/j.artd.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 09/22/2023] Open
Abstract
Background Total hip arthroplasty (THA) procedures provide a surgical option for "ultrayoung" patients ≤30 years old with end-stage hip arthropathy. This has historically been coupled with concerns over early component failure and challenging surgical technique leading to increased risk of overall morbidity. The purpose of this study is to better elucidate the poorly defined indications and outcomes for THA in ultrayoung patients with end-stage hip disease. Methods A total of 40 THAs in 35 patients ≤30 years old performed at our institution from 2009 to 2016 were retrospectively followed for an average of 2 years (median 11 months, interquartile range 1-31.25). Primary outcome measure was THA revision. Patient demographics were compared against outcomes. The effects on revision rate of hip joint pathology and type of bearing surface were investigated. T-test, chi-square test, and bivariate correlation were performed to determine statistical significance (P < .05). Machine learning was used to determine the normalized important factor leading to THA revision. Results Fifteen male and 25 female patients were included. Median patient age was 23 (interquartile range 19-27) years, with an average body mass index of 27.0 ± 7.9. A majority of THAs were indicated for osteonecrosis (32) and bearing surface type was predominantly metal-on-highly cross-linked polyethylene (36). The overall revision rate was 7.5%, without a correlation between revision and demographic characteristics. Revision surgery was significantly correlated with bearing surface type (P = .028). Important factors for revision were age (100%), bearing surface type (84.7%), and body mass index (52.1%). Conclusions In patients ≤30 years old, THAs performed with the use of modern implants and surgical methods show satisfactory survivorship and functional outcomes with short-term follow-up.
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Affiliation(s)
- Matthew Mazur
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Kevin Steelman
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Zain Sayeed
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Chaoyang Chen
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Hussein Darwiche
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Bryan Little
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Mousavi SH, Radi M, Kazemi D, Izadpanah F, Shahrouzian A. Evaluation the results of anterior cruciate ligament reconstruction with or without using antibiotic solution during graft preparation. Eur J Orthop Surg Traumatol 2023; 33:3033-3036. [PMID: 36988698 DOI: 10.1007/s00590-023-03522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Joint infection after Anterior Cruciate Ligament (ACL) reconstruction is an uncommon infection which can affect joint movement and function. In this study, the impact of using antibiotic during graft preparation on the results of ACL reconstruction was investigated to examine the negative effects of antibiotic solution on graft and clinical symptoms after the surgery. METHODS In this randomized clinical trial study, 80 patients were enrolled. In one group, the graft was placed in vancomycin solution (500 mg of vancomycin powder in 100 ml of normal saline) for 10-15 min during the surgery. In other group, the surgery was performed routinely and the graft was not placed in antibiotic solution. Intravenous antibiotic was given to both groups and they underwent ACL reconstruction surgery through arthroscopic transportal technique using their hamstring tendon. Symptoms and examinations of patients were evaluated for one year after the surgery. RESULTS There was no difference between two groups in terms of knee dislocation, knee lock, pain, fever, positivity of Lachman test, Anterior drawer test and pivot-shift test, knee swelling, and movement restriction in flection and extension (P > 0.05). No infection was seen in patients. CONCLUSIONS Placing grafts in vancomycin solution does not have negative effects on graft quality and results of ACL surgery.
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Affiliation(s)
- Seyed Hamid Mousavi
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Radi
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davoud Kazemi
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fatemeh Izadpanah
- Food and Drug Laboratory Research Center and Food and Drug Reference Control Laboratories Center, Food and Drug Administration of Iran, MOH & ME, Tehran, Iran
| | - Abbas Shahrouzian
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran
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203
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Cain EL, Parker D. Open Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Injuries. Clin Sports Med 2023; 42:589-598. [PMID: 37716723 DOI: 10.1016/j.csm.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Open reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments results in excellent reduction of severely displaced AC dislocations, most commonly Grades III and V. Anatomic CC reconstruction through clavicular bone tunnels can prevent vertical instability, whereas the addition of an acromial limb of the graft can increase horizontal stability. Autograft tendon is preferred in the young athletic group of collision sports participants, although allograft has had acceptable results. Accessory fixation may be placed to protect the graft during healing, or for severe instability, especially for athletes involved in contact sports.
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Affiliation(s)
- E Lyle Cain
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA.
| | - David Parker
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA
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204
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Chang LS, Kim DK, Hwang KT, Kim YH, Kim SW. A modified induced membrane 2-stage technique using a thoracodorsal artery perforator free flap followed by vascularized or non-vascularized free fibular transfer for the treatment of complex bone infection with concomitant severe soft tissue lesion-A case series of 9 cases. Injury 2023; 54:110956. [PMID: 37542788 DOI: 10.1016/j.injury.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
Treatment of post-traumatic complex bone infection is very challenging. The two principal bone reconstruction approaches are the single-stage vascularized bone graft technique and the two-stage induced membrane technique (IMT). Here we introduce a modified 2-stage induced membrane technique (MIMT) for complex long bone infection with a major bone defect and a concomitant severe soft tissue lesion. The 2-stage procedure consists of bone debridement, placement of a PMMA spacer and soft tissue reconstruction with a thoracodorsal artery perforator free flap ("Tdap") at stage 1. At stage 2, the thoracodorsal artery perforator flap is elevated and a fibular strut graft (either vascularized of non-vascularized) is placed for bone reconstruction. We retrospectively analyzed the extents of lower extremity, long bone, post-traumatic bone infection treated via MIMT from 2008 to 2020. There were nine such cases (eight males) of mean age 59.8 (range 31 to 79) years. The osteomyelitis durations ranged from 3 to 360 months (mean 53 months). The cortical bone defect sizes was ranged from 9 to 14 cm (mean10.7 cm). All skin resurfacing employed Tdap. Vascularized fibular grafts were placed in six patients and non-vascularized grafts were placed in three. The fibular graft size ranged from 12.5 to 19 cm (mean 16.2 cm). Non-vascularized iliac bone grafts served as the fibula docking sites. Unfortunately, all patients suffered complications before bone union was achieved. One case of plate stress fracture and one case of screw fracture required plate and screw change. In three cases of cellulitis, one resolved by use of intravenous antibiotics, others required plate and screw removal. Wound disruption required re-suture and distal skin flap partial necrosis was covered by perforator-based island flap. One case of fibular stress fracture needed cast for 4 weeks. A peroneal nerve palsy patient recovered spontaneously. Bone union was achieved after 6 months in five patients and after 8 months in three (mean 6.9 months). All patients were able to walk unaided. The follow-up period ranged from 2 to 14 years (mean 6.2 years). MIMT saves the limbs in cases with difficult post-traumatic bone infection. It is valid treatment option for complex bone infections with severe soft tissue lesions. However, even with this technique potential complication must be considered.
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Affiliation(s)
- Lan Sook Chang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Dae Kwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyu Tae Hwang
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea.
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205
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Black SM, Maclean C, Barrientos PH, Ritos K, Kazakidi A. Reconstruction and Validation of Arterial Geometries for Computational Fluid Dynamics Using Multiple Temporal Frames of 4D Flow-MRI Magnitude Images. Cardiovasc Eng Technol 2023; 14:655-676. [PMID: 37653353 PMCID: PMC10602980 DOI: 10.1007/s13239-023-00679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Segmentation and reconstruction of arterial blood vessels is a fundamental step in the translation of computational fluid dynamics (CFD) to the clinical practice. Four-dimensional flow magnetic resonance imaging (4D Flow-MRI) can provide detailed information of blood flow but processing this information to elucidate the underlying anatomical structures is challenging. In this study, we present a novel approach to create high-contrast anatomical images from retrospective 4D Flow-MRI data. METHODS For healthy and clinical cases, the 3D instantaneous velocities at multiple cardiac time steps were superimposed directly onto the 4D Flow-MRI magnitude images and combined into a single composite frame. This new Composite Phase-Contrast Magnetic Resonance Angiogram (CPC-MRA) resulted in enhanced and uniform contrast within the lumen. These images were subsequently segmented and reconstructed to generate 3D arterial models for CFD. Using the time-dependent, 3D incompressible Reynolds-averaged Navier-Stokes equations, the transient aortic haemodynamics was computed within a rigid wall model of patient geometries. RESULTS Validation of these models against the gold standard CT-based approach showed no statistically significant inter-modality difference regarding vessel radius or curvature (p > 0.05), and a similar Dice Similarity Coefficient and Hausdorff Distance. CFD-derived near-wall hemodynamics indicated a significant inter-modality difference (p > 0.05), though these absolute errors were small. When compared to the in vivo data, CFD-derived velocities were qualitatively similar. CONCLUSION This proof-of-concept study demonstrated that functional 4D Flow-MRI information can be utilized to retrospectively generate anatomical information for CFD models in the absence of standard imaging datasets and intravenous contrast.
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Affiliation(s)
| | - Craig Maclean
- Research and Development, Terumo Aortic, Glasgow, UK
| | - Pauline Hall Barrientos
- Clinical Physics, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Konstantinos Ritos
- Department of Mechanical and Aerospace Engineering, Glasgow, UK
- Department of Mechanical Engineering, University of Thessaly, Volos, Greece
| | - Asimina Kazakidi
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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Lin J, Wu D, Sun YD, Wu LZ, Liu YW, Xu LW, Yang YY, Gao BW, Xie F, Hou CL, Li QF, Zhang YF, Liu CY. Successful replantation of amputated facial tissues by supermicrosurgery. J Plast Reconstr Aesthet Surg 2023; 85:26-33. [PMID: 37454547 DOI: 10.1016/j.bjps.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Although replantation of amputated facial segments remains challenging in reconstructive surgery, it offers excellent aesthetic and functional outcomes. METHODS From May 2004 to October 2019, 12 patients underwent replantation of amputated facial tissues by supermicrosurgery. The case details, such as the rationale for replantation, the operation method, and postoperative therapy, are described. Four cases are discussed to demonstrate the replantation of different facial parts. RESULTS Facial tissue replantation was successful in all 12 patients without secondary surgery. The cases included the nose (1 patient), ears (8 patients), lips (2 patients), and one of the soft tissue segments surrounding the lower jaw. Venous congestion occurred in three patients who received a solitary arterial repair and were treated with bloodletting. All patients expressed satisfaction with the cosmetic and functional results at the final follow-up. CONCLUSIONS Supermicrosurgical facial tissue replantation is a promising and effective procedure for providing patients with the best aesthetic and functional outcomes.
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Affiliation(s)
- Jian Lin
- Department of Center for Orthopedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences (Shanghai Xinhua Hospital Chongming Branch), Shanghai 202150, China.
| | - Dan Wu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Yi-Dan Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Li-Zhi Wu
- Department of Microsurgery, Taizhou Hospital, Wenzhou Medical University, Taizhou 317000, China
| | - Yang-Wu Liu
- Department of Microsurgery, Xianning Central Hospital, Xiangyang 437100, China
| | - Lu-Wen Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yi-Yuan Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bo-Wen Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Feng Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chun-Lin Hou
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ying-Fan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Cai-Yue Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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Shekhar N, Jaiswal R, Joseph L, Jain S, Jain S, Kr A, Yashas N, Fernandes A, G C, S V, Reddy T, Reddy L, Kumar R. An Overview of Psychological Analysis of Breast Cancer Patients undergoing Modified Radical Mastectomy and Breast Conservation Surgery and its impact on Objectified Body Consciousness at a Tertiary Care Cancer Centre in South India. Clin Breast Cancer 2023; 23:e394-e400. [PMID: 37400311 DOI: 10.1016/j.clbc.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer among females, and surgery plays a central role in its treatment. Surgical treatments may have a negative psychological impact on women's mental health regarding their body image. The purpose of this study was to compare the psychological health insights pertaining to objectified body consciousness scores before and after the surgery and also to observe whether these scores were comparable across the surgery types. MATERIALS AND METHODS This retrospective analysis of prospectively maintained data included 706 breast carcinoma patients who underwent either Breast Conservation Surgery or Modified Radical Mastectomy at tertiary care Cancer Centre, between the years 2020 to 2021. A validated questionnaire of Objectified Body Consciousness was used to obtain responses at diagnosis and at 6 months postsurgery and final scores were calculated for both instances. Two sample t-tests/analysis of variance and Chi-square tests were used to compare continuous and categorical variables respectively. RESULTS Out of total 706 breast cancer patients, 402 patients underwent Breast Conservation Surgery and 304 underwent Modified radical mastectomy procedure. A statistically significant change was seen in the mean Objectified Body Consciousness Score (14.22 ± 15.44) for all patients when compared preoperatively(72.72 ± 11.38) and postoperatively(60.15 ± 17.58). This change was higher in the Modified Radical Mastectomy group(29.38 ± 11.53). Also, statistically significant rise in scores was seen with increasing age. CONCLUSION We could affirmatively conclude in our study that younger breast cancer patients and all patients who underwent a Modified Radical Mastectomy, had more psychological apprehension with the body image postsurgery, signifying these groups should be encouraged by healthcare professionals to reach out for counselling at the earliest.
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Affiliation(s)
- Neha Shekhar
- Department of Psychology, Vidyashilp Academy, Bengaluru, Karnataka, India
| | - Richa Jaiswal
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India.
| | - Leesha Joseph
- Department of Psychology, Vidyashilp Academy, Bengaluru, Karnataka, India
| | - Shraddha Jain
- Department of We Can Team, Manipal Hospitals Bengaluru, Karnataka, India
| | - Salil Jain
- Department of We Can Team, Manipal Hospitals Bengaluru, Karnataka, India
| | - Ashwin Kr
- Department of Surgical Oncology, Aster CMI Hospitals, Bangalore, Karnataka, India
| | - Nitin Yashas
- Department of Medical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Aaron Fernandes
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Chandana G
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Vanitha S
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Trupthi Reddy
- Department of Surgery, Manipal University, Tiger Circle Road, Manipal, Karnataka, India
| | - Lavanya Reddy
- Department of Surgery, St. Johns College Hospital, Bangalore, Karnataka, India
| | - Rohit Kumar
- Department of Surgical Oncology, Aster CMI Hospitals, Bangalore, Karnataka, India
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Çakır GH, Mutlu İ. A comparison of stress, contact pressure, and contact area on menisci in re-injury mechanisms after reconstruction of the anterior cruciate ligament with autograft and synthetic graft: a finite element study. Int Orthop 2023; 47:2487-2496. [PMID: 37449986 DOI: 10.1007/s00264-023-05881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The anterior cruciate ligament (ACL) is crucial in maintaining knee stability. Some motion mechanisms, which are common in sports, cause excessive load to be passed on the ACL. In non-contact ACL injuries, the ACL cannot sustain the high stress and becomes injured or ruptures in the valgus-external rotation mechanism (VERM) and varus-internal rotation mechanism (VIRM). The mechanical strength of the grafts used to repair the torn ligament varies. The purpose of this study is to look at the alterations in the menisci after anterior cruciate ligament repair with autografts and synthetic grafts in cases of non-contact re-injury mechanisms. METHODS In the finite element analysis, VERM and VIRM motions of the injury were simulated with different ACL graft materials. During the simulations of these mechanism motions with polyethylene terephthalate (PET) and patellar tendon (PT), the contact pressures, contact areas, and von mises stress values created in the medial and lateral meniscus were compared. RESULTS The peak contact pressures on the menisci during the VERM are higher than the peak contact pressures during the VIRM, except for one variation. The peak contact pressure of the medial meniscus is almost the same for both graft materials and mechanisms. Furthermore, the peak contact pressures in the menisci are higher than in the VERM. For all injury mechanisms, the peak contact stresses on the lateral meniscus are higher than on the medial meniscus. CONCLUSIONS The findings suggest that VERM can induce further knee joint injury. It was found that the PET will lessen the pressure on the menisci even more. It is also advantageous since it does not damage the anterior extremities and transmits less pressure to the menisci. In conclusion, using a high-strength ACL is healthier for the menisci. Even though synthetic grafts are not clinically preferred, the study demonstrates that enhancing the material properties of synthetic grafts will increase the chance of their use in the future, based on the current results.
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Affiliation(s)
- Gül Hilal Çakır
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey.
| | - İbrahim Mutlu
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey
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209
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Putman S, Lee SH. How to improve operative results in patients with meniscus and anterior cruciate ligament injuries? Orthop Traumatol Surg Res 2023; 109:103672. [PMID: 37527774 DOI: 10.1016/j.otsr.2023.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Sophie Putman
- Service d'orthopédie 2, hôpital Salengro, avenue du Professeur Émile-Laine, 59037 Lille, France; ULR 2694-METRICS, CERIM, Public Health Department, Lille University, 59000 Lille, France
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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210
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Rentea RM, Renaud E, Ricca R, Derderian C, Englum B, Kawaguchi A, Gonzalez K, Speck KE, Villalona G, Kulaylat A, Wakeman D, Yousef Y, Rialon K, Somme S, Lucas D, Levene T, Chang H, Baerg J, Acker S, Fisher J, Kelley-Quon LI, Baird R, Beres AL. Surgical Management of Ulcerative Colitis in Children and Adolescents: A Systematic Review from the APSA Outcomes and Evidence-Based Practice Committee. J Pediatr Surg 2023; 58:1861-1872. [PMID: 36941170 DOI: 10.1016/j.jpedsurg.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The incidence of ulcerative colitis (UC) is increasing. Roughly 20% of all patients with UC are diagnosed in childhood, and children typically present with more severe disease. Approximately 40% will undergo total colectomy within ten years of diagnosis. The objective of this study is to assess the available evidence regarding the surgical management of pediatric UC as determined by the consensus agreement of the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee (APSA OEBP). METHODS Through an iterative process, the membership of the APSA OEBP developed five a priori questions focused on surgical decision-making for children with UC. Questions focused on surgical timing, reconstruction, use of minimally invasive techniques, need for diversion, and risks to fertility and sexual function. A systematic review was conducted, and articles were selected for review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of Bias was assessed using Methodological Index for Non-Randomized Studies (MINORS) criteria. The Oxford Levels of Evidence and Grades of Recommendation were utilized. RESULTS A total of 69 studies were included for analysis. Most manuscripts contain level 3 or 4 evidence from single-center retrospective reports, leading to a grade D recommendation. MINORS assessment revealed a high risk of bias in most studies. J-pouch reconstruction may result in fewer daily stools than straight ileoanal anastomosis. There are no differences in complications based on the type of reconstruction. The timing of surgery should be individualized to patients and does not affect complications. Immunosuppressants do not appear to increase surgical site infection rates. Laparoscopic approaches result in longer operative times but shorter lengths of stay and fewer small bowel obstructions. Overall, complications are not different using an open or minimally invasive approach. CONCLUSIONS There is currently low-level evidence related to certain aspects of surgical management for UC, including timing, reconstruction type, use of minimally invasive techniques, need for diversion, and risks to fertility and sexual function. Multicenter, prospective studies are recommended to better answer these questions and ensure the best evidence-based care for our patients. LEVEL OF EVIDENCE Level of evidence III. STUDY TYPE Systematic review.
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Affiliation(s)
- Rebecca M Rentea
- Children's Mercy-Kansas City, University of Missouri- Kansas City, Department of Pediatric Surgery, Kansas City, MO, USA
| | - Elizabeth Renaud
- Division of Pediatric Surgery, Hasbro Children's Hospital, Alpert Medical School at Brown University, Providence, RI, USA
| | - Robert Ricca
- Division of Pediatric Surgery, Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Christopher Derderian
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Brian Englum
- Division of Pediatric Surgery, University of Maryland, Baltimore, MD, USA
| | - Akemi Kawaguchi
- Department of Pediatric Surgery. Children's Memorial Hermann Hospital, UTHealth, Houston, TX, USA
| | - Katherine Gonzalez
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - K Elizabeth Speck
- Division of Pediatric Surgery, C.S Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | | | - Afif Kulaylat
- Division of Pediatric Surgery, Penn State Hershey, Hershey, PA, USA
| | - Derek Wakeman
- Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA
| | - Yasmine Yousef
- Division of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Kristy Rialon
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sig Somme
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Donald Lucas
- Division of Pediatric Surgery, Naval Medical Center, San Diego, CA, USA
| | - Tamar Levene
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Henry Chang
- Division of Pediatric Surgery, Hopkins ALL Children's Hospital, St. Petersburg, FL, USA
| | - Joanne Baerg
- Division of Pediatric Surgery, Presbyterian Health Services, Albuquerque, NM, USA
| | - Shannon Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Jeremy Fisher
- University Surgical Associates, UT College of Medicine, Chattanooga, TN, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Robert Baird
- Division of Pediatric Surgery, BC Women's and Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alana L Beres
- St. Christopher's Hospital for Children, Drexel University School of Medicine, Division of Pediatric Surgery, Philadelphia, PA, USA.
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Rehman U, Whiteman E, Sarwar MS, Brennan PA. Reconstruction of head and neck oncological soft tissue defects post-resection using robotic surgery: a systematic review of the current literature. Br J Oral Maxillofac Surg 2023; 61:514-521. [PMID: 37661537 DOI: 10.1016/j.bjoms.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
Head and neck cancer (HNC) resection often leaves soft tissue defects and exposure of vital structures. In recent years, there has been an increase in the use of robotic surgery for HNC resections. This allows for achieving smaller defects by using a tissue-sparing approach. However, this poses a challenge for reconstruction with less space available to perform microsurgery. We reviewed the efficacy of robotic surgery in the reconstruction of HNC defects by assessing the impact on flap success and complication rates. A literature search was conducted on Pubmed, Prospero, Dynamed, DARE, EMBASE, and COCHRANE databases. A total of 14 articles fulfilled the inclusion criteria with 96 patients aged mean (range) 60.7 (29-87) years, undergoing robotic reconstruction. The radial forearm flap was the most commonly used flap for robot-assisted reconstruction (n = 47). Robotic graft inset was performed in 94 cases and robotic assisted microvascular anastomoses for 25 vessels. One hundred per cent of flaps survived with a total of 25 (26.0%) complications (wound healing (n = 7), fistula formation (n = 2), haematoma (n = 4), dehiscence (n = 10), and wound infection (n = 2). Seven (12.2%) patients required additional surgery for managing complications and revision of the flap. Fewer complications were seen in patients undergoing robotic-assisted microvascular anastomoses compared with open anastomoses (4.0% versus 34.2%, p < 0.05). Robot-assisted reconstruction in HNC defects demonstrates 100% success rate with minor associated complications. Our results also support feasibility in both flap inset and microvascular anastomoses. Our results also demonstrate feasibility in both flap inset and microvascular anastomoses. Significantly fewer complications were seen with robotic-assisted microvascular anastomoses compared with open anastomoses.
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Affiliation(s)
- Umar Rehman
- Core Surgical Trainee, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Elena Whiteman
- Foundation Doctor, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Locum Clinical Fellow, Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Peter A Brennan
- Honorary Professor of Surgery, Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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212
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Bolia IK, Shontz EC, Dobitsch A, Mayfield CK, Bashrum BS, Weber AE. Female patient with bilateral distal biceps tendon reconstruction: A case report. Trauma Case Rep 2023; 47:100870. [PMID: 37383027 PMCID: PMC10293761 DOI: 10.1016/j.tcr.2023.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/30/2023] Open
Abstract
This is a case of a 57-year-old healthy woman with traumatic bilateral distal biceps tendon rupture with tendon retraction requiring reconstruction. The functional outcomes were recorded pre-operatively and at 3 months, 6 months, 1 year and 2 years postoperatively. Conclusion: Distal biceps tendon rupture usually occurs in male patients; however, this injury may occur in females. Delay in treatment may result in tendon degeneration precluding repair. Distal biceps tendon reconstruction with Achilles allograft yielded favorable outcome in a middle-aged female patient who sustained bilateral distal biceps tendon rupture.
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Affiliation(s)
| | | | | | | | | | - Alexander E. Weber
- Corresponding author at: USC Epstein Family center for Sports Medicine, Keck Medicine of USC, 1520 San Pablo st # 2000, Los Angeles, CA 90033, USA.
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Turner MT, Chung J, Noorkbash S, Topf MC, Hardman J, Holsinger FC, Paleri V. Complications following salvage transoral robotic surgery with and without reconstruction: A systematic review of the literature. Oral Oncol 2023; 145:106467. [PMID: 37454544 DOI: 10.1016/j.oraloncology.2023.106467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Transoral robotic surgery (TORS) has been used in the salvage setting for head and neck cancers both with and without reconstruction. The complications of salvage TORS and the effect of reconstruction on complications has not been studied. OBJECTIVE To study the complications of salvage TORS and examine the effect of reconstruction on complication rates. METHOD An electronic search of the English- language literature using PubMed, Medline, and the Cochrane database was conducted and a systematic review performed in accordance with PRISMA guidelines (CRD42020181057). RESULTS A total of 23 studies including 533 patients have been published on salvage TORS.The average patient age was 61.2 years.Prior treatment was described for 420 patients.205 (48.8%) underwent prior definitive radiotherapy (RT).160 (38.1%) underwent definitive chemoradiotherapy (CRT).Only 55 (13.1%) had prior surgery.Overall, there were 158 complications with a pooled rate of 33.6% (95%CI: 25.4-42.3%).77 were major complications requiring surgical intervention with a pooled rate of 18.9% (95% CI: 14.8-23.3%).The number of patients undergoing reconstruction among salvage cases in the literature is 59 (9.19%), with 24 local flaps and 25 microvascular free flaps.Reconstruction was associated with lower overall hemorrhage rates but had no impact on major hemorrhage rates. CONCLUSIONS The pooled incidence rates of major complications, major POH and emergency tracheostomy following salvage TORS are 18.9%, 10.5%, and 4.4%.The rate of death following salvage TORS is 3.6%. Reconstruction was associated with lower overall hemorrhage rate after salvage TORS but had no impact on major postoperative hemorrhage rates.
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Affiliation(s)
- Meghan T Turner
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA.
| | - Jeffson Chung
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Seth Noorkbash
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA
| | | | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
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214
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Liu B, Pan D, Gao Z, Duan P, Ou Q. Double-pivot proper digital artery perforator flap for fingertip reconstruction. J Orthop Surg Res 2023; 18:737. [PMID: 37770926 PMCID: PMC10540400 DOI: 10.1186/s13018-023-04231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Dorsal flap based on proper digital artery perforator has been commonly used in wound coverage of fingertip; yet a small diameter and short length poses a risk of pedicle kinking or occlusion. The present study aims to present our preliminary results of using a double-pivot perforator flap based on the end dorsal branch of proper digital artery to repair finger pulp defect. METHODS We designed a double-pivot flap based on the end-dorsal perforator branch of proper digital artery, raised from the dorsal aspect of the middle phalanx, with inclusion of both the perforator and a section of the trunk of the artery. This modified procedure forms a pedicle with a larger diameter and length than traditional designs. Twelve patients (12 fingers) each with a soft-tissue defect of the fingertip were successfully treated and followed up in this retrospective study. RESULTS All the flaps survived without showing any signs of necrosis; three cases presented with transient venous flow disorder, these self-resolving without requiring any additional treatment. At final follow-up (12-33 months, mean 20 months), mean static two-point discrimination on the flap was 7.0 mm (range, 6-9). CONCLUSION The double-pivot proper digital artery flap serves as a reliable option in fingertip reconstruction offering added benefits of having greater rotation flexibility, a lower risk of vessel kinking or occlusion, and good recovery of cutaneous sensation.
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Affiliation(s)
- Benquan Liu
- Department of Hand Surgery, Zhoukou Orthopedic Hospital, Taihao Road, Chuanhui District, Zhoukou City, Henan, China
| | - Ding Pan
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Kaifu District, Changsha, Hunan, China
| | - Zhiyu Gao
- Department of Hand Surgery, Zhoukou Orthopedic Hospital, Taihao Road, Chuanhui District, Zhoukou City, Henan, China
| | - Pengfei Duan
- Department of Hand Surgery, Zhoukou Orthopedic Hospital, Taihao Road, Chuanhui District, Zhoukou City, Henan, China
| | - Qifeng Ou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Kaifu District, Changsha, Hunan, China.
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215
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Ferrández MC, Golla SSV, Eertink JJ, de Vries BM, Wiegers SE, Zwezerijnen GJC, Pieplenbosch S, Schilder L, Heymans MW, Zijlstra JM, Boellaard R. Sensitivity of an AI method for [ 18F]FDG PET/CT outcome prediction of diffuse large B-cell lymphoma patients to image reconstruction protocols. EJNMMI Res 2023; 13:88. [PMID: 37758869 PMCID: PMC10533444 DOI: 10.1186/s13550-023-01036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Convolutional neural networks (CNNs), applied to baseline [18F]-FDG PET/CT maximum intensity projections (MIPs), show potential for treatment outcome prediction in diffuse large B-cell lymphoma (DLBCL). The aim of this study is to investigate the robustness of CNN predictions to different image reconstruction protocols. Baseline [18F]FDG PET/CT scans were collected from 20 DLBCL patients. EARL1, EARL2 and high-resolution (HR) protocols were applied per scan, generating three images with different image qualities. Image-based transformation was applied by blurring EARL2 and HR images to generate EARL1 compliant images using a Gaussian filter of 5 and 7 mm, respectively. MIPs were generated for each of the reconstructions, before and after image transformation. An in-house developed CNN predicted the probability of tumor progression within 2 years for each MIP. The difference in probabilities per patient was then calculated between both EARL2 and HR with respect to EARL1 (delta probabilities or ΔP). We compared these to the probabilities obtained after aligning the data with ComBat using the difference in median and interquartile range (IQR). RESULTS CNN probabilities were found to be sensitive to different reconstruction protocols (EARL2 ΔP: median = 0.09, interquartile range (IQR) = [0.06, 0.10] and HR ΔP: median = 0.1, IQR = [0.08, 0.16]). Moreover, higher resolution images (EARL2 and HR) led to higher probability values. After image-based and ComBat transformation, an improved agreement of CNN probabilities among reconstructions was found for all patients. This agreement was slightly better after image-based transformation (transformed EARL2 ΔP: median = 0.022, IQR = [0.01, 0.02] and transformed HR ΔP: median = 0.029, IQR = [0.01, 0.03]). CONCLUSION Our CNN-based outcome predictions are affected by the applied reconstruction protocols, yet in a predictable manner. Image-based harmonization is a suitable approach to harmonize CNN predictions across image reconstruction protocols.
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Affiliation(s)
- Maria C Ferrández
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
| | - Sandeep S V Golla
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Jakoba J Eertink
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart M de Vries
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Sanne E Wiegers
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Gerben J C Zwezerijnen
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Simone Pieplenbosch
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louise Schilder
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
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216
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Walatek J, Myśliwiec A, Krakowczyk Ł, Wolański W, Lipowicz A, Dowgierd K. Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review. Eur J Med Res 2023; 28:386. [PMID: 37770987 PMCID: PMC10536701 DOI: 10.1186/s40001-023-01386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Mandible tumors are very rare. One of the main methods of the treatments is resection of the tumor and then reconstruction of the mandible. The donor site is often distant tissue-fibula or ilium. Following this, it is necessary to improve the patient in two ways, on one hand restoring the function of the mandible, and on the other hand, improving the donor site area. For that reason, physiotherapy after tumor resection and reconstruction of the mandible is very complicated. The aim of this bibliographic review was to find the methods of the reconstruction of the mandible in the context of patients' functional assessment after surgeries to create effective physiotherapeutic procedures in the feature. METHODS PEDro, Medline (PubMed), Cochrane Clinical Trials were searched. RESULTS 767 articles were found. 40 articles were included to this literature review. CONCLUSIONS Authors showed different kinds of surgeries strategy for patients with tumors of the mandible. They also showed manners of patients' functional assessment in the localization of transplantation and donor site. It could be useful for physiotherapists during planning of comprehensive physiotherapy.
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Affiliation(s)
- Julia Walatek
- Department of Science, Innovation and Development, Galen-Orthopedics, 43-150 Bierun, Poland
| | - Andrzej Myśliwiec
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland
| | - Łukasz Krakowczyk
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Wojciech Wolański
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland
| | - Anna Lipowicz
- Department of Anthropology, Institute of Environmental Biology, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland
| | - Krzysztof Dowgierd
- Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury, 10-561 Olsztyn, Poland
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217
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Moura DL, Ribeiro PG. Anatomical reconstruction of complete burst vertebral fracture case report-combined reduction methods and armed kyphoplasty with stents filled with bone graft. J Spine Surg 2023; 9:357-368. [PMID: 37841779 PMCID: PMC10570634 DOI: 10.21037/jss-22-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/30/2023] [Indexed: 10/17/2023]
Abstract
Background Minimally invasive techniques used to augment the fractured vertebral body have acquired popularity thanks to their capacity to stabilize the anterior spine via the percutaneous posterior pathway. Case Description We present a clinical case of a 50-year-old male patient with a traumatic complete burst fracture of L1 vertebral body treated by L1 laminectomy, percutaneous pedicle instrumentation D11-D12-L2-L3 and indirect fracture reduction, followed by direct reduction by armed kyphoplasty with stents filled with bone graft. We describe the details of the surgical technique, as well as clinical and imaging outcomes. After 3-year follow-up, the patient is practically asymptomatic and control computed tomography demonstrates vertebral body fracture healing and maintenance of the vertebral heights recorded in the immediate postoperative period, without signs of loosening, migration or failure of intrasomatic stents or pedicle screws, as well as of bone graft resorption, which indicates its osseointegration and healing. We discuss the concepts of indirect and direct reduction and the rationale for anatomical vertebral restoration and for the use of intrasomatic bone graft. Conclusions We present a detailed description of a promising surgical technique combining indirect and direct reduction and vertebral body interior replacement with stents filled with bone graft, as a treatment that allows for a complete burst fracture to be anatomically restored by a posterior and minimally invasive approach. Also, we demonstrate a fast and full recovery, avoiding the morbidity and risk of serious complications of anterior approaches. Nevertheless, long-term prospective studies are necessary so as to prove the effectiveness and assets of this surgical option versus other common techniques in complete burst fractures.
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Affiliation(s)
- Diogo Lino Moura
- Spine Unit of Orthopedics Department, Coimbra University Hospital, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paulo Gil Ribeiro
- Orthopedics Department, Coimbra University Hospital, Coimbra, Portugal
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218
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Duraku LS, Esworthy GP, Nassimizadeh M, Kankam HKN, Power DM. Unusual Clinical Presentation of a Benign Peripheral Nerve Sheath Tumor of the Radial Nerve. Eplasty 2023; 23:e64. [PMID: 38045102 PMCID: PMC10690796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Diagnosis of simple benign peripheral nerve tumors (PNT) is usually based on imaging studies and in most cases, surgical excision leads to no significant functional deficit. The clinical presentation is often asymptomatic with incidental imaging findings. We present an unusual clinical presentation of a benign peripheral nerve sheath tumor of the radial nerve.
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Affiliation(s)
- Liron S Duraku
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Plastic, Reconstructive and Hand Surgery Department, Amsterdam UMC, Amsterdam, the Netherlands
| | - George P Esworthy
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- University of Leicester, Leicester Medical School, Leicester, United Kingdom
| | - Mohammad Nassimizadeh
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Hadyn KN Kankam
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dominic M Power
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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219
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Shukla V. Reconstruction of Sub-Total and Total Glossectomy Defects: An Arduous Challenge. Indian J Otolaryngol Head Neck Surg 2023; 75:2643-2644. [PMID: 37636731 PMCID: PMC10447842 DOI: 10.1007/s12070-023-03843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Varun Shukla
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, India
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220
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Gu L, Sun P, Pan B, Jiang H. Subtractive thinking: A novel combined application of antihelix reconstruction and outer helix reconstruction to treat mild cases of type I to II conchal microtia. J Plast Reconstr Aesthet Surg 2023; 84:462-468. [PMID: 37418845 DOI: 10.1016/j.bjps.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The management of mild cases of type Ⅰ to Ⅱ conchal microtia involves grafting cartilage to the affected ear to increase the cartilaginous area and transfer more skin to cover the larger cartilage. Herein, we performed a novel combined surgical procedure based on "subtractive thinking" that included antihelix reconstruction and outer helix reconstruction that was successful in patients with mild type I to II conchal microtia. METHODS From January 2018 to September 2022, 65 patients with mild, unilateral, type I to II conchal microtia were enrolled in this study. All patients were treated with a novel method at the Plastic Surgery Hospital of Peking Union Medical College. The perimeters, widths, and lengths of the healthy and affected ears were measured both preoperatively and postoperatively. Patients' levels of satisfaction were determined based on postoperative results. RESULTS The mean postoperative follow-up duration was 14.9 ± 2.65 months. All patients experienced no complications. Analysis revealed that our surgical method could effectively treat mild type I to II concha microtia irrespective of the auricular perimeter, width, and length (p < 0.0001). Furthermore, the patient satisfaction rate was 100%. CONCLUSION The combined surgical procedure, which includes antihelix and outer helix reconstructions, is a viable method of reconstructing type I to II auricular concha microtia.
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Affiliation(s)
- Luosha Gu
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bada Road, Shijingshan District, Beijing 100144, China
| | - Pengfei Sun
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bada Road, Shijingshan District, Beijing 100144, China
| | - Bo Pan
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bada Road, Shijingshan District, Beijing 100144, China.
| | - Haiyue Jiang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bada Road, Shijingshan District, Beijing 100144, China.
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221
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Rao A, Razzaq H, Agrawal A. Systematic review and meta-analysis of the effect of retraction techniques on the complication rate following mastectomy. J Plast Reconstr Aesthet Surg 2023; 84:187-190. [PMID: 37339543 DOI: 10.1016/j.bjps.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Ahsan Rao
- Cambridge University Hospitals, Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Humayun Razzaq
- Aneurin Bevan University Health Board, Headquarters, St Cadoc's Hospital, Lodge Road, Caerleon, Newport NP18 3XQ, UK.
| | - Amit Agrawal
- Cambridge University Hospitals, Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
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222
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De Vera E, Magliano J, Bazzano C. [Translated article] Large Cheek Defect Reconstruction With a Rhomboid Flap and Burow's Advancement Flap After Excision of a Basal Cell Carcinoma. Actas Dermosifiliogr 2023; 114:T722-T724. [PMID: 37453541 DOI: 10.1016/j.ad.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/06/2022] [Indexed: 07/18/2023] Open
Abstract
Reconstruction of large surgical defects on the cheek can be challenging for dermatologic surgeons. We describe using a modified rhomboid flap and Burow's advancement flap to close a surgical defect resulting from the excision of a basal cell carcinoma measuring 10cm×10cm in the buccomandibular area of the cheek.
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Affiliation(s)
- E De Vera
- Servicio de Dermatología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay.
| | - J Magliano
- Servicio de Dermatología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - C Bazzano
- Servicio de Dermatología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
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223
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Rauf Z, Zarif N, Khan A, Siddiqui S, Fatima S, Iqbal W, Amin H, Iqbal T, Arif M, Sattar S, Rauf MT. The Western Himalayan fir tree ring record of soil moisture in Pakistan since 1855. Int J Biometeorol 2023; 67:1477-1492. [PMID: 37464201 DOI: 10.1007/s00484-023-02517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
Data on historical soil moisture is crucial for assessing and responding to droughts that commonly occur in climate change-affected countries. The Himalayan temperate forests in Pakistan are particularly at risk of climate change. Developing nations lack the means to gather surface soil moisture (SSM) information. Tree rings are one way to bridge this gap. Here, we employed dendrochronological methods on climate-sensitive tree rings from Abies pindrow to reconstruct the SSM in the Western Himalayan mountain region of Pakistan from 1855 to 2020. December (r = 0.41), May (r = 0.40), and June (r = 0.65) SSMs were found to be the limiting factors for A. pindrow growth. However, only the June SSM showed reconstruction possibility (coefficient of efficiency = 0.201 and reduction of error = 0.325). Over the studied period, we found 6 years (wet year) when June SSM was above the threshold of 32.04 (mean + 2 δ) and 1 year (dry year) when June SSM was below the threshold of 21.28 (mean - 2 δ). It was revealed that 1921 and 1917 were the driest and wettest SSM of all time, with means of 19.34 and 36.49, respectively. Our study shows that winter soil moisture is critical for the growing season in the context of climate change. Climate change has broad impacts on tree growth in the Western Himalayas. This study will assist various stakeholders in understanding and managing local and regional climate change.
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Affiliation(s)
- Zahid Rauf
- Pakistan Forest Institute (PFI), Peshawar, 25000, Pakistan
- National Centre of Excellence Geology (NCEG), University of Peshawar, Peshawar, 25000, Pakistan
| | | | - Adam Khan
- University of Lakki Marwat, Lakki Marwat, 28420, Pakistan
| | - Samina Siddiqui
- National Centre of Excellence Geology (NCEG), University of Peshawar, Peshawar, 25000, Pakistan
| | - Seerat Fatima
- Pakistan Forest Institute (PFI), Peshawar, 25000, Pakistan
| | - Wahiba Iqbal
- Pakistan Forest Institute (PFI), Peshawar, 25000, Pakistan
| | - Hira Amin
- Department of Forestry Economics & Management, Northeast Forestry University, Harbin, 150040, People's Republic of China
| | - Tahir Iqbal
- Pakistan Forest Institute (PFI), Peshawar, 25000, Pakistan
| | - Muhammad Arif
- Biological Science Research Center, Academy for Advanced Interdisciplinary Studies, Southwest University, Chongqing, 400715, People's Republic of China.
| | - Shehla Sattar
- Department of Environmental Sciences, University of Swabi, Swabi, 23561, Pakistan
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224
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Kim MK, Shin SH, Han IW, Heo JS, Lee SJ, Lee KW, Park JB, Woo SY, Park YJ, Yang SS. Cryopreserved allografts versus end-to-end anastomosis for the reconstruction of a segment-resected portomesenteric vein during advanced pancreatic cancer surgery. Asian J Surg 2023; 46:3741-3747. [PMID: 36813675 DOI: 10.1016/j.asjsur.2023.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Porto-mesenteric vein (PMV) infiltration of pancreatic cancer is classified as borderline resectable cancer. For en-bloc resectability, the probability of PMV resection and reconstruction is the most decisive factor. The purpose of this study was to compare and analyze PMV resection and reconstruction during pancreatic cancer surgery using end-to-end anastomosis (EA) and a cryopreserved allograft (AG) and to verify the effectiveness of reconstruction using an AG. METHODS Between May 2012 and June 2021, 84 patients (65 underwent EA, and 19 received AG reconstruction) underwent pancreatic cancer surgery with PMV reconstruction. An AG is a cadaveric graft with a diameter of 8-12 mm and is obtained from a liver transplant donor. Patency after reconstruction, disease recurrence, overall survival, and perioperative factors were assessed. RESULTS The median age was higher in EA patients (p = .022) and neoadjuvant therapy (p = .02) was more in AG patients. Upon histopathological examination, the R0 resection margin did not show a significant difference by reconstruction method. During a 36-month survival analysis, primary patency was significantly superior in EA patients (p = .004), and there was no significant difference in recurrence-free survival (p = .628) or overall survival (p = .638) rates. CONCLUSION Compared with EA, AG reconstruction after PMV resection during pancreatic cancer surgery showed a lower primary patency, but there was no difference in recurrence-free or overall survival rates. Therefore, the use of AG can be a viable option for borderline resectable pancreatic cancer surgery if the patient is properly followed-up postoperatively.
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Affiliation(s)
- Min-Kyu Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In-Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su-Jeong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyo-Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Olvera-Yarza FA, Campos-Jiménez M, Téllez-Pallares F, Lara-Mejía A, Jiménez-Yarza M. Surgical management of axillary hidradenitis suppurativa with latissimus dorsi flap on a 24-year-old patient: A case report. Int J Surg Case Rep 2023; 110:108688. [PMID: 37611395 PMCID: PMC10470301 DOI: 10.1016/j.ijscr.2023.108688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with distinct characteristics: chronic nature, morphology, and location. It originates from occluded and ruptured follicles, releasing keratin and bacteria into the nearby dermis. This causes an inflammatory reaction, leading to the formation of abscesses and the destruction of the pilosebaceous junction. CASE PRESENTATION We present the case 24-year-old female with a severe, stage III case of HS who had a lesion (approx. 10 × 15 cm) on her right axilla spanning 4 years. Despite some response to medical treatment, she experienced recurrent symptoms, due to this, surgical intervention was decided, using a latissimus dorsi thoracodorsal artery perforator (TDAP) flap. The lesion was successfully removed, and the flap was placed, leading to proper postoperative healing, cicatrization, and sensitivity in the patient. DISCUSSION HS poses a challenge due to its recurring course. Treatment involves pharmacological and surgical approaches, with the former suited for mild to moderate cases and the latter for severe instances. Surgical options, like TDAP flaps, show lower recurrence rates than skin grafts. TDAP flaps also offer advantages such as reduced bulkiness and favorable aesthetic and functional outcomes compared to other latissimus dorsi flaps. CONCLUSION HS represents an obstacle in terms of systemic effects and aesthetic concerns. Lattisimus dorsi flaps have emerged as an effective treatment method due to the reliable vascular supply and adequate volume to the recipient site as demonstrated by our case, where the patient showed appropriate evolution with no morbidity associated with the procedure as well as adequate aesthetic results.
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Affiliation(s)
| | - Mario Campos-Jiménez
- Centro Médico Nacional Siglo XXI- Instituto Mexicano del Seguro Social, Department of Plastic Surgery, Mexico
| | - Fernando Téllez-Pallares
- Centro Médico Nacional Siglo XXI- Instituto Mexicano del Seguro Social, Department of Plastic Surgery, Mexico
| | - Aldo Lara-Mejía
- Centro Médico Nacional Siglo XXI- Instituto Mexicano del Seguro Social, Department of General Surgery, Mexico
| | - Miguel Jiménez-Yarza
- Hospital Regional Monterrey- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico.
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Omole D, Khatib B, Patel AA, Cheng A, Salama A, Brecht LE, Hirsch DL. Reconstructing the Mandible: Jaw-In-A-Day: Where We Were, Where We Are, and the Future. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:153-164. [PMID: 37500199 DOI: 10.1016/j.cxom.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- David Omole
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Baber Khatib
- Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR, USA; Trauma Service, Legacy Emanuel Medical Center, Portland, OR, USA; Head and Neck Institute, 1849 NW Kearney Street #300, Portland, OR 97209, USA
| | - Ashish A Patel
- Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR, USA; Trauma Service, Legacy Emanuel Medical Center, Portland, OR, USA; Head and Neck Institute, 1849 NW Kearney Street #300, Portland, OR 97209, USA
| | - Allen Cheng
- Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR, USA; Trauma Service, Legacy Emanuel Medical Center, Portland, OR, USA; Head and Neck Institute, 1849 NW Kearney Street #300, Portland, OR 97209, USA
| | - Andrew Salama
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - Lawrence E Brecht
- Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - David L Hirsch
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
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227
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Thuau F, Lancien U, Tiry E, Crenn V, Perrot P. Impact of surgical first excision delay on function for heat-press hand injury by the Quick-DASH questionnaire: Series over 20 years. Burns 2023; 49:1422-1431. [PMID: 36379823 DOI: 10.1016/j.burns.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Heat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. METHODS We carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). RESULTS Burns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures. We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0-52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17-42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = -0.46; r2 = 0.087; p = 0.053). CONCLUSION According to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.
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Affiliation(s)
- F Thuau
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - U Lancien
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France.
| | - E Tiry
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - V Crenn
- Orthopedic and Trauma Surgery department, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - P Perrot
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
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228
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De Vera E, Magliano J, Bazzano C. Large Cheek Defect Reconstruction With a Rhomboid Flap and Burow's Advancement Flap After Excision of a Basal Cell Carcinoma. Actas Dermosifiliogr 2023; 114:722-724. [PMID: 37150247 DOI: 10.1016/j.ad.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 05/09/2023] Open
Abstract
Reconstruction of large surgical defects on the cheek can be challenging for dermatologic surgeons. We describe using a modified rhomboid flap and Burow's advancement flap to close a surgical defect resulting from the excision of a basal cell carcinoma measuring 10×10cm in the buccomandibular area of the cheek.
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Affiliation(s)
- E De Vera
- Servicio de dermatología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay.
| | - J Magliano
- Servicio de dermatología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - C Bazzano
- Servicio de dermatología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
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229
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Saini A, Saroch M, Mehra R, Gargi G. Use of Paramedian Forehead Flap in an Octogenarian:A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:2342-2344. [PMID: 37636654 PMCID: PMC10447299 DOI: 10.1007/s12070-023-03646-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Increase in life expectancy has led to increased number of octogenarian and nonagenarians population. These old people have increased chances of developing skin tumours like slow growing basal cell carcinoma on the sun exposed parts of body. Many a times surgeons all over the world are bit conservative in managing these elderly patients and compromise on cosmetic aspects due to very advanced age of these patients. This report is about an 87-year-old female with BCC of nasal dorsum who underwent a major surgical procedure to maintain facial aesthetics.
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Affiliation(s)
- Amit Saini
- Department of ENT, Dr RKGMC, Hamirpur, H.P. India
| | - Munish Saroch
- Department of ENT, Dr RPGMC, Tanda, Kangra, H.P. India
| | - Richa Mehra
- Department of ENT, Zonal Hospital, Mandi, H.P. India
| | - Gaveshna Gargi
- Department of General Medicine, Dr RKGMC, Hamirpur, H.P. India
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230
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Martineau J, Scampa M, Viscardi JA, Giordano S, Kalbermatten DF, Oranges CM. Inferior gluteal artery perforator (IGAP) flap in autologous breast reconstruction: A proportional meta-analysis of surgical outcomes. J Plast Reconstr Aesthet Surg 2023; 84:147-156. [PMID: 37329748 DOI: 10.1016/j.bjps.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/30/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The inferior gluteal artery perforator (IGAP) flap is an alternative technique for autologous breast reconstruction. In contrast to other commonly used techniques, there is a paucity of literature on the safety and efficacy of the IGAP flap. The aim of this study was to perform a systematic literature review and meta-analysis of postoperative outcomes and complications associated with the IGAP in autologous breast reconstructions to validate its safety. METHODS A systematic review of literature was performed following PRISMA guidelines. Articles reporting post-operative outcomes of IGAP flaps in autologous breast reconstruction were included. A proportional meta-analysis of post-operative complications was performed to obtain their proportions with 95% confidence intervals (CIs). RESULTS Seven studies met the inclusion criteria, which represented a total of 239 IGAP flaps in 181 patients The total flap loss rate was 3% (95% CI 0-8%), partial flap loss rate was 2% (95% CI 0-4%), haematoma rate was 3% (95% CI 0-7%), overall donor-site complication rate was 15% (95% CI 5-28%), overall recipient-site complication rate was 24% (95% CI 15-34%), and the overall complication rate was 40% (95% CI 23-58%). CONCLUSIONS This meta-analysis provides comprehensive knowledge on the safety and efficacy of the IGAP flap in autologous breast reconstruction. It evidences the IGAP flap in autologous breast reconstruction's overall safety and validates its role as an effective option in breast reconstruction.
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Affiliation(s)
- Jérôme Martineau
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Matteo Scampa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Juan A Viscardi
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Salvatore Giordano
- Department of General and Plastic Surgery, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.
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231
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Hariyono DC, Wiramur A, Sungkar A, Yarso KY, Philo R. Reverse dorsoradial metacarpal artery flap for reconstruction of large finger skin defect: A case report. Int J Surg Case Rep 2023; 110:108610. [PMID: 37611402 PMCID: PMC10466908 DOI: 10.1016/j.ijscr.2023.108610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Plastic reconstructive surgery for defects of hand still pose a challenge to plastic surgeons. The skin envelope of the hand is a complex structure that not only covers the underlying tissues but also includes particular functional and sensory components. The main principle of therapy is to provide adequate and long-lasting coverage to minimize surgery scars. CASE PRESENTATION A 63 years old man was referred to our hospital from another facility with a soft tissue defect on his right index finger at the level of the interphalangeal joint. The injury occurred 4 hours prior when he was injured by a sickle while working in a rice field. The defect was measured 2 × 4 cm and the base was visible, exposing the underlying fascia with minimal contamination. The patient underwent treatment with a reverse dorsoradial metacarpal artery flap, which was elevated from the thumb. After one month, he returned to the hospital with complains of pain and drainage from the donor site over the past few days. Debridement was performed and the area was repaired with local anesthesia. Patient didn't complains about the functional impairment. CLINICAL DISCUSSION Compound defects of the hand need urgent surgical intervention and flap covering to prevent stiffness, improve the range of motion and facilitate early return to work. The reverse dorsoradial metacarpal artery flap is an excellent option for finger defects reconstruction. CONCLUSION This study showed that the reverse dorsoradial metacarpal artery flap is a viable flap for reconstructing finger defects.
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Affiliation(s)
- Dedy Chandra Hariyono
- Department of Surgery, Moewardi General Hospital, Jl. Kol. Sutarto No. 132, Surakarta, Indonesia.
| | - Affandi Wiramur
- Department of Surgery, Moewardi General Hospital, Jl. Kol. Sutarto No. 132, Surakarta, Indonesia; Plastic Surgery Division, Deparment of Surgery, Moewardi General Hospital/Sebelas Maret University, Jl. Ir Sutami No. 36 a, Surakarta, Indonesia
| | - Amru Sungkar
- Department of Surgery, Moewardi General Hospital, Jl. Kol. Sutarto No. 132, Surakarta, Indonesia; Plastic Surgery Division, Deparment of Surgery, Moewardi General Hospital/Sebelas Maret University, Jl. Ir Sutami No. 36 a, Surakarta, Indonesia
| | - Kristanto Yuli Yarso
- Sebelas Maret University, Jl. Ir Sutami No. 36 a, Surakarta, Indonesia; Surgery Department, Oncology Division, Sebelas Maret University, Ir Sutami Street 46 (th) Solo Central Java, Indonesia
| | - Richard Philo
- Sebelas Maret University, Jl. Ir Sutami No. 36 a, Surakarta, Indonesia
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Melland-Smith M, Miller B, Petro C, Beffa L, Prabhu A, Krpata D, LaBelle M, Tamer R, Rosen M. Single-staged retromuscular abdominal wall reconstruction with mesh at the time of ostomy reversal: are we crossing the line? An ACHQC Analysis. Surg Endosc 2023; 37:7051-7059. [PMID: 37353652 DOI: 10.1007/s00464-023-10176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION The most appropriate method of reconstructing the abdominal wall at the site of a simultaneous stoma takedown is controversial. The contaminated field, concomitant GI procedure being performed and presence of a hernia all complicate decision-making. We sought to describe the surgical approaches, mesh type and outcomes of concomitant abdominal wall reconstruction during stoma takedown in a large hernia registry. METHODS AND PROCEDURES All patients who underwent stoma takedown with simultaneous hernia repair with retromuscular mesh placement from January 2014 to May 2022 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Patients were stratified by mesh type including permanent synthetic (PS), resorbable synthetic (RS) and biologic mesh. Association of mesh type with 30-day wound events and other complications and 1-year outcomes were evaluated. RESULTS There were 368 patients who met inclusion criteria. Eighty-nine patients had ileostomies, 276 colostomies and 3 had both. Two hundred and seventy-nine (75.8%) patients received PS mesh, 46 (12.5%) biologic, and 43 (11.7%) RS. Seventy percent (259/368) had a parastomal hernia, 75% (285/368) had a midline incisional hernia, and 48% (178/368) had both. All groups had similar preoperative comorbidities and the majority had a transversus abdominus release. All mesh groups had similar thirty-day SSI (13.2-14.3%), SSO (10.5-17.8%) and SSOPI (7.9-14.1%), p = 0.6. Three patients with PS mesh developed infected synthetic mesh and one PS mesh required excision. Four patients with PS developed an enterocutaneous fistula. Of these, only one patient was recorded as having both an enterocutaneous fistula and mesh infection. Thirty-day reoperation and readmission were similar across all mesh groups. Recurrence at 1-year was similar between mesh groups. Quality of life measured using HerQLes scores were higher at one year compared to baseline in all groups indicating improvement in hernia-specific quality of life. CONCLUSION Early complication rates associated with simultaneous stoma takedown and abdominal wall reconstruction are significant, regardless of mesh type utilized. Concomitant surgery should be weighed heavily and tailored to individual patients.
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Affiliation(s)
- Megan Melland-Smith
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA.
| | - Benjamin Miller
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Clayton Petro
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Lucas Beffa
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Ajita Prabhu
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - David Krpata
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | | | | | - Michael Rosen
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
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Choudhury A, Laxmidhar MI, Ahirwar N. Has the Pectoralis Major flap Really Become Obsolete? Indian J Otolaryngol Head Neck Surg 2023; 75:2172-2176. [PMID: 37636713 PMCID: PMC10447656 DOI: 10.1007/s12070-023-03842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 08/29/2023] Open
Abstract
Aim To evaluate the current role of pectoralis major (PM) flap including the reasons for selecting it over free flaps. Materials and methods All patients who underwent PM flap at Apollo Hospitals Ahmedabad during the 3-year period from January 2020 to December 2022 were included. Patient demographics, tumour characteristics and complications were studied and reasons for selecting pectoralis major flap were analyzed. Data was entered in Microsoft excel spreadsheet and analyzed using online statistical calculators. The p value of < 0.05 was considered statistically significant. Results 57 patients underwent reconstruction with PM flap while 154 patients underwent free flap reconstruction. 54 were male and 3 were female. Median age was 51 years. PM flap was used for intraoral lining in 25 patients, and it was bilobed in 26 patients with full thickness cheek defect. Most common complication was wound infection seen in 10 patients. 5 patients developed marginal necrosis of the flap and 5 had donor site wound dehiscence. No complete flap loss was seen. During the same period, 15/154 (9.74%) patients with free flaps developed complete flap necrosis and this was statistically significant (p = 0.012). Reasons for choosing PM flap were also analyzed. 14 patients had major comorbidities, 18 had extensive disease, in 5 patients it was used for salvage post free flap failure, while 10 previously treated patients had unavailability of suitable vessels for anastomosis. 12 patients underwent PM flap due to financial constraints. Conclusion Thus, PM flap is not obsolete and continues to maintain its place in head and neck reconstruction.
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Affiliation(s)
- Arpan Choudhury
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
| | - Murtuza I Laxmidhar
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
| | - Neelam Ahirwar
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
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Antal I, Szőke G, Szendrői M, Szalay K, Perlaky T, Kiss J, Skaliczki G. Functional outcome and quality of life following resection of the proximal humerus performed for musculoskeletal tumors and reconstruction done by four different methods. Musculoskelet Surg 2023; 107:351-359. [PMID: 36648636 PMCID: PMC10432350 DOI: 10.1007/s12306-022-00771-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The proximal humerus is a frequent site for both primary and secondary bone tumors. Several options are currently available to reconstruct the resected humerus, but there is no consensus regarding optimal reconstruction. The aim of this retrospective study was to compare the functional outcome, complications and patient compliance following four different types of reconstructive techniques. MATERIAL AND METHODS The authors performed 90 proximal humerus resections due to primary and secondary bone tumors over the past 21 years. Four different procedures were performed for reconstruction following the resection: fibula autograft transplantation, osteoarticular allograft implantation, modular tumor endoprosthesis (hemiarthroplasty) and reconstruction of the defect with a reverse shoulder prosthesis-allograft composite. A retrospective analysis of the complications and patient's physical status was performed. Functional outcome and life quality was evaluated by using the MSTS and SF-36 scores. RESULTS The best range of motion was observed following arthroplasty with a reverse shoulder prosthesis-homograft composite followed by a fibula autograft reconstruction. Revision surgery was required due to major complications most frequently in the osteoarticular allograft group, followed by the reverse shoulder prosthesis-allograft composite group, the autologous fibula transplantation group; the tumor endoprosthesis hemiarthroplasty group had superior results regarding revision surgery (40, 25, 24 and 14% respectively). MSTS was 84% on average for the reverse shoulder prosthesis-allograft composite group, 70% for the autologous fibula group, 67% for the anatomical hemiarthroplasty group and 64% for the osteoartricular allograft group. Using the SF-36 questionnaire for assessment no significant differences were found between the four groups regarding quality of life. DISCUSSION Based on the results of our study the best functional performance (range of motion and patient compliance) was achieved in the a reverse prosthesis-allograft combination group-in cases where the axillary nerve could be spared. The use of an osteoarticular allograft resulted in unsatisfying functional results and high complication rates, therefore we do not recommend it as a reconstructive method following resection of the proximal humerus due to either primary or metastatic bone tumors. Young patients who have good life expectancy but a small humerus or intramedullar cavity reconstruction by implantation of a fibula autograft is a good option. For patients with a poor prognosis (i.g. bone metastases) or in cases where the axillary nerve must be sacrificed, hemiarthroplasty using a tumor endoprosthesis was found to have acceptable results with a low complication rate. According to the MSTS and SF-36 functional scoring systems patients compliance was nearly identical following all four types of reconstruction techniques; the underlying cause may be the complexity of the shoulder girdle. However, we recommend the implantation of a reverse shoulder prosthesis-allograft whenever indication is appropriate, as it has been demonstrated to provide excellent functional outcomes, especially in young adults.
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Affiliation(s)
- I Antal
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
| | - G Szőke
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - M Szendrői
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - K Szalay
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - T Perlaky
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - J Kiss
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - G Skaliczki
- Department of Orthopedics, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
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235
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Xu B, Fan Y, Liu J, Zhang G, Wang Z, Li Z, Guo W, Tang X. CHSNet: Automatic lesion segmentation network guided by CT image features for acute cerebral hemorrhage. Comput Biol Med 2023; 164:107334. [PMID: 37573720 DOI: 10.1016/j.compbiomed.2023.107334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
Stroke is a cerebrovascular disease that can lead to severe sequelae such as hemiplegia and mental retardation with a mortality rate of up to 40%. In this paper, we proposed an automatic segmentation network (CHSNet) to segment the lesions in cranial CT images based on the characteristics of acute cerebral hemorrhage images, such as high density, multi-scale, and variable location, and realized the three-dimensional (3D) visualization and localization of the cranial lesions after the segmentation was completed. To enhance the feature representation of high-density regions, and capture multi-scale and up-down information on the target location, we constructed a convolutional neural network with encoding-decoding backbone, Res-RCL module, Atrous Spatial Pyramid Pooling, and Attention Gate. We collected images of 203 patients with acute cerebral hemorrhage, constructed a dataset containing 5998 cranial CT slices, and conducted comparative and ablation experiments on the dataset to verify the effectiveness of our model. Our model achieved the best results on both test sets with different segmentation difficulties, test1: Dice = 0.918, IoU = 0.853, ASD = 0.476, RVE = 0.113; test2: Dice = 0.716, IoU = 0.604, ASD = 5.402, RVE = 1.079. Based on the segmentation results, we achieved 3D visualization and localization of hemorrhage in CT images of stroke patients. The study has important implications for clinical adjuvant diagnosis.
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Affiliation(s)
- Bohao Xu
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Jingming Liu
- Emergency Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Guobin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhiping Wang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhili Li
- BECHOICE (Beijing) Science and Technology Development Ltd., Beijing, 100050, China
| | - Wei Guo
- Emergency Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Xiaoying Tang
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China.
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Sanabria A, Olivera MP, Chiesa-Estomba C, Hamoir M, Kowalski LP, López F, Mäkitie A, Robbins KT, Rodrigo JP, Piazza C, Shaha A, Sjögren E, Suarez C, Zafereo M, Ferlito A. Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review. Adv Ther 2023; 40:3681-3696. [PMID: 37436593 PMCID: PMC10427525 DOI: 10.1007/s12325-023-02561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario. METHODS A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case-control, comparative cohort, or randomized controlled trial (RCT) studies were included. RESULTS A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8-20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce. CONCLUSION We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia.
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
| | - María Paula Olivera
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, and the Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan Pablo Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Elizabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Mark Zafereo
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125, Padua, Italy
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237
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Miloro M, Callahan N, Markiewicz MR. Neurosensory Reconstruction of the Mandible: Technical Aspects. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:129-136. [PMID: 37500196 DOI: 10.1016/j.cxom.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Michael Miloro
- Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Room 110, Chicago, IL 60611, USA.
| | - Nicholas Callahan
- Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Room 110, Chicago, IL 60611, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University of Buffalo, 3425 Main Street, 112 Squire Hall, Buffalo, NY 14214, USA
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238
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Panesar K, Markiewicz MR, Best D, Lee KC, Edwards S, Susarla SM. Pediatric Mandibular Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:177-186. [PMID: 37500201 DOI: 10.1016/j.cxom.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY, USA
| | - David Best
- Department of Oral and Maxillofacial Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Kevin C Lee
- Department of Oral and Maxillofacial Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Srinivas M Susarla
- University of Washington, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.
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239
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Wong AWJ, Sim NHS, Ooi A. Extramammary Paget's disease: Our 15-year experience in a Southeast Asian population. J Plast Reconstr Aesthet Surg 2023; 84:392-397. [PMID: 37399659 DOI: 10.1016/j.bjps.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
The treatment of choice for Extramammary Paget's disease (EMPD) is wide excision. However, owing to the tendency of microscopic spread and multi-centricity of the disease, resection margins are hard to determine. Despite the use of adjunctive methods such as mapping biopsy and Moh's micrographic surgery, recurrence rates remain high. We aim to establish treatment guidelines by determining the variables associated with recurrence and the optimal resection margin size. We reviewed 52 patients who underwent wide excision in our institution between 2002 and 2017. A retrospective review of patient demographics, disease characteristics, and resection margins was performed. Most patients were Chinese (n = 39, 75%) male (n = 38, 73.1%). The mean tumor size was 6.73 cm (SD=4.10; range, 1.50-21.0 cm). The mean resection margin was 2.5 cm (SD=1.21; range, 0.20-5.50 cm). Eleven patients (21.2%) had disease recurrence. Nodal involvement significantly correlated with disease recurrence or mortality related to disease (HR=4.645; 95% CI=1.539,14.018; p = 0.0064). Subgroup analysis showed a significant correlation between resection margin size and recurrence rates (p = 0.047). We observed that a smaller resection margin (<2 cm) is acceptable for smaller tumor sizes (<6 cm) to achieve the lowest possible recurrence rates (20%), whereas a larger resection margin (>2 cm) is required for larger tumor sizes (>6 cm) (p = 0.012). Our results suggest that a resection margin recommendation can be made in correlation to the tumor size. This serves as a guideline for surgeons to predict the defect size and provide options for reconstructive surgery while achieving low recurrence rates.
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Affiliation(s)
- Allen Wei-Jiat Wong
- Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore; Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | - Nadia Hui Shan Sim
- Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore.
| | - Adrian Ooi
- Polaris Plastic Surgery, Mount Elizabeth Medical Centre, 3 Mount Elizabeth #08-05, Singapore 228510, Singapore.
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240
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Natalwala I, Lee CYV, Kay S. The posterior approach to the thoracodorsal vessels for microsurgical free tissue transfer. JPRAS Open 2023; 37:77-81. [PMID: 37457992 PMCID: PMC10344685 DOI: 10.1016/j.jpra.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
The latissimus dorsi (LD) muscle is a workhorse flap in reconstructive surgery (e.g., breast reconstruction, chest wall defects, and lower limb trauma). The thoracodorsal artery and its venae comitantes supply this muscle. Recipient vessel options for microsurgical free flap reconstruction of the posterior thorax and lower back are limited. The thoracodorsal vessels are an excellent option due to their reliable anatomy and ease of access. In circumstances when the patient is best positioned prone, the posterior approach to access the thoracodorsal vessels is advantageous. We describe the technique to identify and isolate these vessels via a posterior approach.
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Affiliation(s)
- Ibrahim Natalwala
- Corresponding author at: Department of Plastic Surgery, Leeds Teaching Hospitals, Great George St., Leeds, West Yorkshire, LS1 3EX, United Kingdom.
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241
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Wang W, Shen H, Chen J, Xing F. MHAN: Multi-Stage Hybrid Attention Network for MRI reconstruction and super-resolution. Comput Biol Med 2023; 163:107181. [PMID: 37352637 DOI: 10.1016/j.compbiomed.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
High-quality magnetic resonance imaging (MRI) affords clear body tissue structure for reliable diagnosing. However, there is a principal problem of the trade-off between acquisition speed and image quality. Image reconstruction and super-resolution are crucial techniques to solve these problems. In the main field of MR image restoration, most researchers mainly focus on only one of these aspects, namely reconstruction or super-resolution. In this paper, we propose an efficient model called Multi-Stage Hybrid Attention Network (MHAN) that performs the multi-task of recovering high-resolution (HR) MR images from low-resolution (LR) under-sampled measurements. Our model is highlighted by three major modules: (i) an Amplified Spatial Attention Block (ASAB) capable of enhancing the differences in spatial information, (ii) a Self-Attention Block with a Data-Consistency Layer (DC-SAB), which can improve the accuracy of the extracted feature information, (iii) an Adaptive Local Residual Attention Block (ALRAB) that focuses on both spatial and channel information. MHAN employs an encoder-decoder architecture to deeply extract contextual information and a pipeline to provide spatial accuracy. Compared with the recent multi-task model T2Net, our MHAN improves by 2.759 dB in PSNR and 0.026 in SSIM with scaling factor ×2 and acceleration factor 4× on T2 modality.
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Affiliation(s)
- Wanliang Wang
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Haoxin Shen
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Jiacheng Chen
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Fangsen Xing
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
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242
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Heikkinen J, Bonde C, Oranges CM, Toia F, di Summa PG, Giordano S. Efficacy of breast reconstruction in elderly women (>60 years) using deep inferior epigastric perforator flaps: A comparative study. J Plast Reconstr Aesthet Surg 2023; 84:266-272. [PMID: 37356302 DOI: 10.1016/j.bjps.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The indications for microsurgical breast reconstruction remain debated, particularly concerning the safety of deep inferior epigastric perforator (DIEP) flaps in elderly women. Free tissue transfer still carries a risk of perioperative morbidity and mortality in elderly patients. We conducted this comparative study to clarify this issue. METHODS This retrospective cohort study included all unilateral DIEP breast reconstructions performed at a single institution. Patients were divided into two groups based on age: an elderly (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. The primary outcomes were complete flap loss, partial flap loss, and the need for flap re-exploration. The secondary outcomes included surgical site occurrences, such as wound healing-related complications, seroma, and others. RESULTS We included 214 flaps, 177 in the non-elderly and 37 in the elderly cohort. Elderly women had slightly higher comorbidity rates than those of non-elderly women, although these differences were not statistically significant. BMI was significantly lower in elderly women than in non-elderly women. The incidence of total or partial flap loss did not differ significantly between the two cohorts (2.7% vs 1.1%, p = 0.459% and 0.0% vs 5.1%, p = 0.161), nor did the flap re-exploration (8.1% vs 10.1%, p = 0.937). Similarly, postoperative complication rates did not differ significantly between the two groups (45.9% vs 61.8%, p = 0.074). On logistic regression, being elderly was not a risk factor for complete flap loss, nor for any complications. The overall success rate for the non-elderly cohort was 98.7%, whereas that for the elderly cohort was 97.3%. CONCLUSIONS Microsurgical breast reconstruction using DIEP is safe in elderly patients, as it achieves outcomes and complications rates comparable to those observed in a younger population. Patients should not be denied DIEP flaps because of their age alone.
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Affiliation(s)
- Jarna Heikkinen
- Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Christian Bonde
- Department of Plastic Surgery, Breast Surgery, and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Carlo M Oranges
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Department of Plastic Surgery, Breast Surgery, and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pietro G di Summa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Salvatore Giordano
- Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
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243
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Kocaman H, Alkan H, Yetİş M, Canli M, Kuzu Ş, Özüdoğru A. Five-times sit-to-stand test following anterior cruciate ligament surgery: a cross-sectional reliability study. Malawi Med J 2023; 35:177-182. [PMID: 38362290 PMCID: PMC10865063 DOI: 10.4314/mmj.v35i3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Aims Patients who have had anterior cruciate ligament reconstruction (ACL-R) should periodically have their muscle strength assessed. The five-times sit-to-stand test (FTSST) can evaluate the muscle strength and balance of the lower extremities. This study's primary purpose was to assess the validity and reliability of the FTSST in patients who have undergone ACL-R. Material and Methods Forty-three people who had undergone ACL-R surgery were included in the study. The study's primary outcome measure, the FTSST, was assessed by two different investigators. Secondary outcome measures were body balance, quadriceps muscle strength, Tegner activity score (TAS), and Lysholm score. Results The FTSST's test-retest and inter-rater reliability were both high (ICC: 0.99). The FTSST also showed a strong statistically significant correlation with all secondary outcome measures, including balance, quadriceps muscle strength, TAS, and Lysholm score (p<0.05). Conclusions According to the study results, the FTSST is a tool-free, simple method for assessing muscle strength and the body balance level, mobility level, and functional status of the knee in patients who have undergone ACL-R surgery.
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Affiliation(s)
- Hikmet Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Halil Alkan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Muş Alparslan University, Muş, Turkey
| | - Mehmet Yetİş
- Department of Orthopaedics and Traumatology Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Mehmet Canli
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Şafak Kuzu
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Anıl Özüdoğru
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Titan A, Mohan AT, Tokuyama M, Mirbegian J, Bean GR, Lee GK. Radiation-Induced Morphea of the Breast Treated With Wide Local Excision and Abdominal Free Flap Breast Reconstruction. Eplasty 2023; 23:e50. [PMID: 37664810 PMCID: PMC10472431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Radiation-induced morphea (RIM) associated with breast cancer treatment is a rare and underdiagnosed skin complication of radiotherapy that can lead to severe and painful contractures, resulting in disfigurement, failure of reconstruction, and poor quality of life in patients. The condition may present on a spectrum of local or more generalized forms involving skin over the breast and anterior chest wall. This diagnosis must be differentiated from post-radiation fibrosis, infection, cancer recurrence, inflammatory breast cancer, and other inflammatory conditions as the clinical course and treatment approaches differ. Various noninvasive and topical agents have been used; however, many cases are refractory to treatment. Surgery has been less commonly described in the management of generalized RIM. This report describes a case of RIM in a patient with breast cancer who experienced simultaneous resolution of symptoms as well as successful breast reconstruction using autologous free-tissue transfer.
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Affiliation(s)
- Ashley Titan
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California
| | - Anita T Mohan
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California
| | - Minami Tokuyama
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Jacob Mirbegian
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Gordon K Lee
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California
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245
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Wang Y, Lee H, Kuhl BA. Mapping multidimensional content representations to neural and behavioral expressions of episodic memory. Neuroimage 2023; 277:120222. [PMID: 37327954 PMCID: PMC10424734 DOI: 10.1016/j.neuroimage.2023.120222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Abstract
Human neuroimaging studies have shown that the contents of episodic memories are represented in distributed patterns of neural activity. However, these studies have mostly been limited to decoding simple, unidimensional properties of stimuli. Semantic encoding models, in contrast, offer a means for characterizing the rich, multidimensional information that comprises episodic memories. Here, we extensively sampled four human fMRI subjects to build semantic encoding models and then applied these models to reconstruct content from natural scene images as they were viewed and recalled from memory. First, we found that multidimensional semantic information was successfully reconstructed from activity patterns across visual and lateral parietal cortices, both when viewing scenes and when recalling them from memory. Second, whereas visual cortical reconstructions were much more accurate when images were viewed versus recalled from memory, lateral parietal reconstructions were comparably accurate across visual perception and memory. Third, by applying natural language processing methods to verbal recall data, we showed that fMRI-based reconstructions reliably matched subjects' verbal descriptions of their memories. In fact, reconstructions from ventral temporal cortex more closely matched subjects' own verbal recall than other subjects' verbal recall of the same images. Fourth, encoding models reliably transferred across subjects: memories were successfully reconstructed using encoding models trained on data from entirely independent subjects. Together, these findings provide evidence for successful reconstructions of multidimensional and idiosyncratic memory representations and highlight the differential sensitivity of visual cortical and lateral parietal regions to information derived from the external visual environment versus internally-generated memories.
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Affiliation(s)
- Yingying Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China; Department of Psychology, University of Oregon, Eugene, OR 97403, USA
| | - Hongmi Lee
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Brice A Kuhl
- Department of Psychology, University of Oregon, Eugene, OR 97403, USA.
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246
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Maimaitiming ABLT, Mulati YLSD, Apizi ART, Li XD. Self-strangulation induced penile partial amputation: A case report. World J Clin Cases 2023; 11:5373-5381. [PMID: 37621600 PMCID: PMC10445066 DOI: 10.12998/wjcc.v11.i22.5373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Traumatic amputation of the penis is a rare surgical emergency, usually caused by self-mutilation, accidents, circumcision, assault and animal attacks. This study aimed to summarize our treatment experience involving penile reconstruction in a rare case of a self-strangulation induced chronical penile partial amputation. CASE SUMMARY A 22-year-old man presented with self-strangulation induced chronical penile partial amputation for 3 mo where the penile proximal part was 1 cm far from the pubis. Reconstruction methods included end-to-end anastomosis of the urethral mucosa, proximal anastomosis of the corpus cavernosum and tunica albuginea of the penis, anastomosis of the deep dorsal vein, dorsal artery, and superficial dorsal vein. Patient urinated smoothly after the catheter was removed on day 21. 3 mo after the surgery, the patient's penile preliminary cosmetic appearance was satisfactory, with occasional morning erections. Distal penile sensation was preserved, yet erection hardness of the distal penis was not satisfactory. CONCLUSION Complete preoperative assessment and prompt surgical intervention decreases loss of residual penile functions.
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Affiliation(s)
- A-Bu-Lai-Ti Maimaitiming
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ye-Li-Su-Dan Mulati
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ai-Re-Ti Apizi
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Dong Li
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
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247
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Maimaitiming ABLT, Mulati YLSD, Apizi ART, Li XD. Self-strangulation induced penile partial amputation: A case report. World J Clin Cases 2023; 11:5367-5375. [DOI: 10.12998/wjcc.v11.i22.5367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Traumatic amputation of the penis is a rare surgical emergency, usually caused by self-mutilation, accidents, circumcision, assault and animal attacks. This study aimed to summarize our treatment experience involving penile reconstruction in a rare case of a self-strangulation induced chronical penile partial amputation.
CASE SUMMARY A 22-year-old man presented with self-strangulation induced chronical penile partial amputation for 3 mo where the penile proximal part was 1 cm far from the pubis. Reconstruction methods included end-to-end anastomosis of the urethral mucosa, proximal anastomosis of the corpus cavernosum and tunica albuginea of the penis, anastomosis of the deep dorsal vein, dorsal artery, and superficial dorsal vein. Patient urinated smoothly after the catheter was removed on day 21. 3 mo after the surgery, the patient's penile preliminary cosmetic appearance was satisfactory, with occasional morning erections. Distal penile sensation was preserved, yet erection hardness of the distal penis was not satisfactory.
CONCLUSION Complete preoperative assessment and prompt surgical intervention decreases loss of residual penile functions.
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Affiliation(s)
- A-Bu-Lai-Ti Maimaitiming
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ye-Li-Su-Dan Mulati
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ai-Re-Ti Apizi
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Dong Li
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
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248
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Verhagen S, Dietvorst M, Delvaux E, van der Steen MC, Janssen R. Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients - a systematic review. BMC Musculoskelet Disord 2023; 24:630. [PMID: 37537529 PMCID: PMC10401849 DOI: 10.1186/s12891-023-06749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Different types of grafts can be used for anterior cruciate ligament reconstruction (ACLR). There is little published data regarding skeletally immature patients. The purpose of this systematic review was to assess the clinical outcomes and complications for different autograft types used in all-epiphyseal, transphyseal and partial epiphyseal/hybrid ACLR in skeletally immature children and adolescents. METHODS PubMed, Embase and Cochrane databases were systematically searched for literature regarding ACLR using hamstrings, quadriceps or bone-patellar-tendon-bone (BPTB) autografts in skeletally immature patients. Studies were included if they examined at least one of the following outcomes: graft failure, return to sport(s), growth disturbance, arthrofibrosis or patient reported outcomes and had a minimum follow-up of 1 year. Case reports, conference abstracts and studies examining allografts and extra-articular or over-the-top ACL reconstruction techniques were excluded. Graft failure rates were pooled for each graft type using the quality effects model of MetaXL. A qualitative synthesis of secondary outcomes was performed. RESULTS The database search identified 242 studies. In total 31 studies were included in this review, comprising of 1358 patients. Most patients (81%) were treated using hamstring autograft. The most common used surgical technique was transphyseal. The weighted, pooled failure rate for each graft type was 12% for hamstring tendon autografts, 8% for quadriceps tendon autografts and 6% for BPTB autografts. Confidence intervals were overlapping. The variability in time to graft failure was high. The qualitative analysis of the secondary outcomes showed similar results with good clinical outcomes and low complication rates across all graft types. CONCLUSIONS Based on this review it is not possible to determine a superior graft type for ACLR in skeletally immature. Of the included studies, the most common graft type used was the hamstring tendon. Overall, graft failure rates are low, and most studies show good clinical outcomes with high return to sports rates.
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Affiliation(s)
- S Verhagen
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands.
| | - M Dietvorst
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands
| | - Ejlg Delvaux
- MMC Academy, Máxima, Veldhoven, MC, The Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, PO box 1350, Eindhoven, 5602 ZA, The Netherlands
| | - Rpa Janssen
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Chair Value‑Based Health Care, Department of Paramedical Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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249
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Park-Simon TW, Müller V, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Wuerstlein R, Janni W, Thill M. Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:289-305. [PMID: 37900552 PMCID: PMC10601667 DOI: 10.1159/000531578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
Background Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023. Key Messages This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.
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Affiliation(s)
- Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für diagnostische und Interventionelle Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld GmbH, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Andreas D. Hartkopf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Joerg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth und Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Wiesbaden, Germany
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz (Buckow) & Immanuel Klinik Rüdersdorf/Medizinische Hochschule Brandenburg Theodor Fontane (Rüdersdorf), Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Köln, Cologne, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Rachel Wuerstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Oktar T, Selvi I, Kart M, Dönmez Mİ, Çetin B, Boyuk A, Ziylan O. Lower Urinary Tract Reconstruction for Ectopic Ureterocele: What Happens in the Long-term Follow-up? J Pediatr Surg 2023; 58:1566-1572. [PMID: 36241446 DOI: 10.1016/j.jpedsurg.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/19/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to analyze the long-term clinical and lower urinary tract function outcomes in children with duplex system ectopic ureterocele who underwent ureteroneocystostomy and ureterocelectomy. METHODS Fifty-one patients (28 females, 23 males) who underwent a series of surgical interventions including lower urinary tract reconstruction in childhood for duplex system ectopic ureterocele in our center between 1998 and 2019, were retrospectively reviewed. The demographic and clinical data, surgical history, and the indication for ureterocelectomy were noted. Lower urinary tract dysfunction (LUTD) status was assessed through dysfunctional voiding symptom scores (DVSS) and uroflowmetry in all patients at the last follow-up. The clinical outcomes, and LUTD were evaluated. RESULTS At the last visit at a mean follow-up of 117.18 ± 57.87 months after ureterocelectomy, ipsilateral persistent lower pole VUR was detected in 5.6% (3/54 renal units, 2 females and 1 male) of the cases, who were treated using the subureteric injection. Abnormal DVSS (median 11, range 9-15) was detected in 27.4% (14/51 pts) of the patients. Out of these, 57.1% (8/14 pts) had storage symptoms, 35.7% (5/14 pts) had voiding symptoms, and 7.1% (1/14 pts) had both storage and voiding symptoms while 71.4%(10/14 pts) had abnormal uroflowmetry findings (plateau shaped flow curve in 2, staccato shaped curve with sustained EMG activity in 3, tower shaped curve in 2, interrupted shaped curve in 3 patients). Five patients had elevated residual volume. Anticholinergics were administered to six patients who had overactive bladder symptoms. In addition, two girls required open bladder neck reconstruction due to stress incontinence caused by bladder neck insufficiency. CONCLUSIONS Our findings showed that clinical success was achieved using the lower urinary tract reconstruction with no need for re-operation in 90.2% of patients with duplex system ectopic ureterocele. However, LUTD was present in 27.4% of our patients in the long-term follow-up. Therefore, LUTD should be carefully assessed in the long-term follow-up of these patients.
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Affiliation(s)
- Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey; Koç University, School of Medicine, Department of Urology, Istanbul, Turkey.
| | - Ismail Selvi
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Mücahit Kart
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Bilal Çetin
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Abubekir Boyuk
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
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