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Churakova Sidorova OV, Siegwolf RTW, Zharkov MS, Saurer M. Dual carbon and oxygen isotopes in Siberian tree rings as indicator of millennia sunshine duration changes. Sci Total Environ 2024; 927:172042. [PMID: 38554976 DOI: 10.1016/j.scitotenv.2024.172042] [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] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
The current lack of information on past summer sunshine duration variability from annually resolved palaeoclimatological archives is hindering progress in the understanding and modelling of the earth climate system. We show that a combination of tree-ring carbon and oxygen isotopes from Siberia provides robust information on summer sunshine duration, which we use for an annual 1505-year reconstruction of July sunshine duration variability (1,5K-SIB-JSDR). We found that the Medieval maximum is 56 % higher than the average over 1505 years. Rapid and drastic decreases in sunshine duration up to 60 % correspond to major stratospheric volcanic eruptions. Grand Solar Minima and total sunspot numbers are also well preserved in the 1,5K-SIB-JSDR. Coherency with a global air temperature composite and spring Arctic Oscillation indicate that a large-scale climate signal is retained in our sunshine reconstruction.
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Affiliation(s)
- Olga V Churakova Sidorova
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zürcherstrasse 111, CH-8903 Birmensdorf, Switzerland.
| | - Rolf T W Siegwolf
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zürcherstrasse 111, CH-8903 Birmensdorf, Switzerland
| | - Mikhail S Zharkov
- Siberian Federal University Krasnoyarsk, 660041 Svobodny 79, Russian Federation
| | - Matthias Saurer
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zürcherstrasse 111, CH-8903 Birmensdorf, Switzerland
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Gardner C, Wu S, Zahir J, Dong O, Raji O, Leasure J, McGahan P. Femoral interference screw divergence as a result of anteromedial portal insertion and outside-in FlipCutter femoral tunnel drilling: A cadaveric study. J Orthop 2024; 52:138-142. [PMID: 38600978 PMCID: PMC11001622 DOI: 10.1016/j.jor.2024.03.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
Aims and objectives To investigate whether interference screw fixation through an anteromedial portal into an outside-in drilled femoral tunnel via a flip cutter results in acceptable hardware position. Materials & methods 10 cadaveric knees underwent ACL-reconstruction with patellar BTB autograft. Femoral tunnel drilling was performed utilizing an outside-in flip cutter drill and interference screws for femoral fixation. Lateral and anterior-posterior (AP) fluoroscopic images were taken to measure screw divergence within the femoral tunnel. The means of AP and lateral divergence angles were compared using two-tailed t-tests. Results Using the flip cutter, the AP and lateral divergence angles were 7.3° ± 4.5° and 9.3° ± 9.3°, respectively, while the total divergence angles were 16.6° ± 11.8°. Divergence angles using a cannulated reamer were found to be 14.4° ± 2.5° and 6.8° ± 2.8° for AP and lateral, respectively and 21.1° ± 5.2° for the total divergence. The AP divergence angles using the flip cutter were significantly less than those reported using a cannulated reamer (p = 0.001). Conclusions The flip cutter method resulted in significantly reduced divergence angle between the screw and graft when compared to previous cadaveric studies in the coronal plane. There was no significant difference in divergence angle in the sagittal plane. Both methods appear to result in divergence angles below the threshold which would be considered to significantly decrease pull-out strength. Large standard deviations also reflect limited sample size but may also suggest more variability in divergence when compared to historical control set. This study clearly establishes the outside-in technique using a retrograde reamer as a viable independent femoral drilling solution for ACL reconstruction when using a BTB autograft with a femoral interference screw.
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Affiliation(s)
- Carson Gardner
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Samuel Wu
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Jamal Zahir
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Oliver Dong
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Oluwatodimu Raji
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Jeremi Leasure
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Patrick McGahan
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
- Advanced Orthopaedics and Sports Medicine, San Francisco, CA, USA
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3
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Vongsachang H, Chiou CA, Azad AD, Lin LY, Yoon MK, Lefebvre DR, Stagner AM. Periorbital necrotizing sweet syndrome: A report of two cases mimicking necrotizing soft tissue infections. Am J Ophthalmol Case Rep 2024; 34:102033. [PMID: 38487334 PMCID: PMC10937104 DOI: 10.1016/j.ajoc.2024.102033] [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: 12/03/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Purpose Two cases are described of necrotizing Sweet syndrome (nSS), a rare variant of acute febrile neutrophilic dermatosis that mimics necrotizing soft tissue infections. Observation A 74-year-old female with myelodysplastic syndrome (MDS) presented with isolated periorbital nSS that closely mimicked necrotizing fasciitis (NF); she displayed pathergy to debridement, was exquisitely responsive to corticosteroids, and underwent successful first-stage reconstruction of the eyelid with full-thickness skin grafting. A second 40-year-old female patient with relapsed acute myelogenous leukemia (AML) presented with multifocal nSS most prominently involving the eyelid. Positive herpes zoster virus (HSV) PCR and bacterial superinfection complicated the diagnosis. She improved with chemotherapy for AML and corticosteroid therapy. Conclusion nSS is rare and a high level of clinical suspicion as well as an understanding of its distinguishing features is necessary to avoid undue morbidity. Identification of pathergy, histopathology, microbiology, and clinical context are critical to avoid misdiagnosis of infection.
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Affiliation(s)
- Hursuong Vongsachang
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carolina A. Chiou
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Amee D. Azad
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lisa Y. Lin
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Michael K. Yoon
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Daniel R. Lefebvre
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anna M. Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Fujima N, Nakagawa J, Ikebe Y, Kameda H, Harada T, Shimizu Y, Tsushima N, Kano S, Homma A, Kwon J, Yoneyama M, Kudo K. Improved image quality in contrast-enhanced 3D-T1 weighted sequence by compressed sensing-based deep-learning reconstruction for the evaluation of head and neck. Magn Reson Imaging 2024; 108:111-115. [PMID: 38340971 DOI: 10.1016/j.mri.2024.02.006] [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: 07/18/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess the utility of deep learning (DL)-based image reconstruction with the combination of compressed sensing (CS) denoising cycle by comparing images reconstructed by conventional CS-based method without DL in fat-suppressed (Fs)-contrast enhanced (CE) three-dimensional (3D) T1-weighted images (T1WIs) of the head and neck. MATERIALS AND METHODS We retrospectively analyzed the cases of 39 patients who had undergone head and neck Fs-CE 3D T1WI applying reconstructions based on conventional CS and CS augmented by DL, respectively. In the qualitative assessment, we evaluated overall image quality, visualization of anatomical structures, degree of artifacts, lesion conspicuity, and lesion edge sharpness based on a five-point system. In the quantitative assessment, we calculated the signal-to-noise ratios (SNRs) of the lesion and the posterior neck muscle and the contrast-to-noise ratio (CNR) between the lesion and the adjacent muscle. RESULTS For all items of the qualitative analysis, significantly higher scores were awarded to images with DL-based reconstruction (p < 0.001). In the quantitative analysis, DL-based reconstruction resulted in significantly higher values for both the SNR of lesions (p < 0.001) and posterior neck muscles (p < 0.001). Significantly higher CNRs were also observed in images with DL-based reconstruction (p < 0.001). CONCLUSION DL-based image reconstruction integrating into the CS-based denoising cycle offered superior image quality compared to the conventional CS method. This technique will be useful for the assessment of patients with head and neck disease.
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Affiliation(s)
- Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan.
| | - Junichi Nakagawa
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Yohei Ikebe
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan; Center for Cause of Death investigation, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroyuki Kameda
- Faculty of Dental Medicine Department of Radiology Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - Taisuke Harada
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Yukie Shimizu
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Nayuta Tsushima
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo 060-8638, Japan
| | - Jihun Kwon
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo 108-8507, Japan
| | - Masami Yoneyama
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo 108-8507, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan; Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan; Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan; Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
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Schmidt A, Mohareri O, DiMaio S, Yip MC, Salcudean SE. Tracking and mapping in medical computer vision: A review. Med Image Anal 2024; 94:103131. [PMID: 38442528 DOI: 10.1016/j.media.2024.103131] [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: 10/16/2023] [Revised: 02/08/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
As computer vision algorithms increase in capability, their applications in clinical systems will become more pervasive. These applications include: diagnostics, such as colonoscopy and bronchoscopy; guiding biopsies, minimally invasive interventions, and surgery; automating instrument motion; and providing image guidance using pre-operative scans. Many of these applications depend on the specific visual nature of medical scenes and require designing algorithms to perform in this environment. In this review, we provide an update to the field of camera-based tracking and scene mapping in surgery and diagnostics in medical computer vision. We begin with describing our review process, which results in a final list of 515 papers that we cover. We then give a high-level summary of the state of the art and provide relevant background for those who need tracking and mapping for their clinical applications. After which, we review datasets provided in the field and the clinical needs that motivate their design. Then, we delve into the algorithmic side, and summarize recent developments. This summary should be especially useful for algorithm designers and to those looking to understand the capability of off-the-shelf methods. We maintain focus on algorithms for deformable environments while also reviewing the essential building blocks in rigid tracking and mapping since there is a large amount of crossover in methods. With the field summarized, we discuss the current state of the tracking and mapping methods along with needs for future algorithms, needs for quantification, and the viability of clinical applications. We then provide some research directions and questions. We conclude that new methods need to be designed or combined to support clinical applications in deformable environments, and more focus needs to be put into collecting datasets for training and evaluation.
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Affiliation(s)
- Adam Schmidt
- Department of Electrical and Computer Engineering, University of British Columbia, 2329 West Mall, Vancouver V6T 1Z4, BC, Canada.
| | - Omid Mohareri
- Advanced Research, Intuitive Surgical, 1020 Kifer Rd, Sunnyvale, CA 94086, USA
| | - Simon DiMaio
- Advanced Research, Intuitive Surgical, 1020 Kifer Rd, Sunnyvale, CA 94086, USA
| | - Michael C Yip
- Department of Electrical and Computer Engineering, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Septimiu E Salcudean
- Department of Electrical and Computer Engineering, University of British Columbia, 2329 West Mall, Vancouver V6T 1Z4, BC, Canada
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Zhang X, Liao H, Tan P, Zhang Y, Zhou B, Liu M, Pan J. Voltage activation induced MoO 42- dissolution to enhance performance of iron doped nickel molybdate for oxygen evolution reaction. J Colloid Interface Sci 2024; 661:772-780. [PMID: 38325175 DOI: 10.1016/j.jcis.2024.02.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Transition metal-based precatalysts are typically voltage-activated before electrochemical testing in the condition of alkaline oxygen evolution reaction. Nevertheless, the impact of voltage on the catalyst and the anion dissolution is frequently disregarded. In this study, Fe-doped NiMoO4 (Fe-NiMoO4) was synthesized as a precursor through a straightforward hydrothermal method, and MoFe-modified Ni (oxygen) hydroxide (MoFe-NiOxHy) was obtained via cyclic voltammetry (CV) activation. The effects of voltage on Fe-NiMoO4 and the dissolved inactive MoO42- ions in the process were examined in relation to OER performance. It has demonstrated that the crystallinity of the catalyst is reduced by voltage, thereby enhancing its electrocatalytic activity. The electron distribution state can be adjusted during the application of voltage, leading to the generation of additional active sites and an acceleration in the reaction rate. Additionally, MoO42- exhibits potential dependence during its dissolution. In the OER process, the dissolution of MoO42- enhances the reconstruction degree of Fe-NiMoO4 into the active substance and expedites the formation of active Ni(Fe)OOH. Hence, the optimized MoFe-NiOxHy exhibited exceptional electrocatalytic performance, with a current density of 100 mA cm-2 achieved at an overpotential of only 256 mV. This discovery contributes to a more comprehensive understanding of alkaline OER performance under the influence of applied voltage and the presence of inactive oxygen ions, offering a promising avenue for the development of efficient electrocatalysts.
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Affiliation(s)
- Xiaoqing Zhang
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China
| | - Hanxiao Liao
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China; School of Metallurgy and Environment, Central South University, Changsha 410083, PR China
| | - Pengfei Tan
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China.
| | - Yi Zhang
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China
| | - Binhua Zhou
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China
| | - Meihuan Liu
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China.
| | - Jun Pan
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha 410083, PR China.
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Woo SJ, Park KH, Woo SH. Simultaneous or Delayed Free Tissue Transfer in Combination with Replantation Surgery. Hand Clin 2024; 40:301-313. [PMID: 38553101 DOI: 10.1016/j.hcl.2023.08.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
In hand and upper extremity replantation surgery, simultaneous free flap reconstruction restores the physiologic circulation to the amputated part, ensuring its survival, and promotes wound healing through anatomic restoration. Especially in digit replantation, an arterialized venous flap serves to reconstruct both vessel and soft tissue defects simultaneously. Delayed free flap reconstruction aims to enhance both functional improvement and cosmetic acceptance in a successfully replanted part using flaps that include functioning muscle, bone, joint, nerve, and soft tissue.
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Affiliation(s)
- Soo Jin Woo
- W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea
| | - Kwang Hyun Park
- W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea
| | - Sang Hyun Woo
- W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea.
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Couvercelle C, Bilger G, Simon E. [Case report: Great toe dorsal defect reconstruction by cross-toe flap]. ANN CHIR PLAST ESTH 2024; 69:228-232. [PMID: 37932174 DOI: 10.1016/j.anplas.2023.09.007] [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: 07/19/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023]
Abstract
Reconstruction of hallux soft-tissue defects is essential for the locomotor function. Some regional flaps are available and have to be preferred in case of small defect. Here, we present the case of a patient treated by a cross-toe flap in order to cover an exposed hallux proximal interphalangeal joint, after an open fracture. The functional outcome of this reliable and easy flap was very satisfying, with quick wound healing and resumption walk.
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Affiliation(s)
- C Couvercelle
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Service de chirurgie orthopédique traumatologique et arthroscopique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - G Bilger
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Service de chirurgie orthopédique traumatologique et arthroscopique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - E Simon
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Service de chirurgie orthopédique traumatologique et arthroscopique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
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Yubran AP, Pesquera LC, Juan ELS, Saralegui FI, Canga AC, Camara AC, Valdivieso GM. Presurgical perspective and postsurgical evaluation of acromioclavicular joint instability. Skeletal Radiol 2024; 53:847-861. [PMID: 38008754 DOI: 10.1007/s00256-023-04526-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
Acromioclavicular joint (ACJ) dislocations are a common cause of pain in patients of any age. Athletes who participate in contact sports, such as hockey, football, rugby, and soccer, are particularly susceptible to such injuries. The ACJ has an important role in the function of the upper limb, and its complexity of movement makes it susceptible to acute injuries and chronic dysfunction with debilitating effects that must be treated appropriately and promptly to preserve function. Recently, ACJ has received increasing attention due to the development of new surgical techniques for the restoration of normal function and stability. There is some agreement about the treatment of ACJ dislocations, but controversy remains about the treatment of Rockwood grade III dislocations, and a new approach to these injuries is suggested by ISAKOS. Overall, the paper summarizes new concepts in the anatomy of the ACJ and reviews the utility of imaging methods in ACJ dislocations as well as their treatment and complications.
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Affiliation(s)
- Alexeys Perez Yubran
- Department of Radiology, IBERORAD, 1893, Carrer Valencia 226, Principal, Primera, 08007, Barcelona, Spain.
| | | | | | | | - Alvaro Cerezal Canga
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Cruz Camara
- Department of Arthroscopic Surgery, Hospital Santa Clotilde, Santander, Spain
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Seo JB, Jung JW, Yoo JS. Combination of arthroscopic biologic tuberoplasty and bursal acromial reconstruction. J Orthop 2024; 51:1-6. [PMID: 38299060 PMCID: PMC10825636 DOI: 10.1016/j.jor.2023.10.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
Background Recently, among the various method for irreparable rotator cuff tears, the "tension-free allodermis graft technique" has been introduced as a method for arthroscopic biologic tuberoplasty(ABT) and bursal acromial reconstruction(BAR).The objective was to analyze the outcomes of ABT and BAR combination surgical technique. Methods Eighteen cases who underwent simultaneous ABT and BAR procedures were retrospectively recruited. Before the surgery and at one year post-surgery, the researchers assessed the patients' Visual Analog Scale(VAS), American Shoulder and Elbow Surgeons(ASES) scores, pain scores, range of motion(ROM), retear, and acromiohumeral distance (AHD). Results One year post-surgery, both the VAS pain scores, ASES scores, and ROM showed statistically significant improvement compared to before the surgery. Upon reviewing the radiological results, the AHD significantly improved from 4.3 ± 4.1 mm before surgery to 9.2 ± 1.9 mm at one year post-surgery (p < 0.001). Moreover, in the one year follow-up, there was no observed failure of the allodermis graft in any of the cases. Conclusion The combination of ABT and BAR demonstrated significantly improved clinical outcomes after surgery, showing a substantial increase in AHD and preventing graft failure effectively.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Wook Jung
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Narui K, Satake T, Ishikawa T, Muto M, Tsunoda Y, Yamada A, Kawashima K, Uenaka N, Fujiwara Y, Oshi M, Adachi S, Suzuki C, Wada T, Yamamoto S, Tanabe M, Maegawa J, Endo I. Endoscopic mastectomy followed by immediate breast reconstruction with fat grafting for breast cancer. Breast Cancer 2024; 31:476-484. [PMID: 38512534 DOI: 10.1007/s12282-024-01561-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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/24/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Although endoscopic mastectomy has been associated with good tolerance and enhanced patient satisfaction, limitations such as the implant or flap size for reconstruction with small incisions remain unresolved. Fat grafting (FG) can expand tissue volume with pinhole skin incisions. Herein, we evaluated the safety and efficacy of endoscopic mastectomy followed by immediate FG. METHODS Patients who underwent endoscopic mastectomy with immediate FG reconstruction from 2015 to 2021 were retrospectively evaluated to establish surgical outcomes and prognosis. RESULTS Twenty-three patients with clinical stage 0 or I breast cancer underwent unilateral endoscopic mastectomy with immediate FG. The median age was 45 years (41-55), and the median body mass index was 19.3 kg/m2 (15.8-26.6). Endoscopically performed procedures included skin-sparing mastectomies in 18 patients (78%) and nipple-sparing mastectomies in five patients (22%). The median procedure duration was 295 min (242-346). The median specimen weight was 133 g (71-334), and the median grafted fat volume was 200 mL (136-320). No patient required reoperation or additional procedures for complications. One patient experienced recurrence at a median follow-up of 56.1 months and underwent resection; the patient was alive without recurrence 54 months post-resection. CONCLUSION To the best of our knowledge, this is the first report of endoscopic mastectomy with immediate FG for reconstruction. When compared with other immediate autologous reconstructions, our strategy could minimize the skin incision and procedure duration, as well as limit complications. Further prospective investigations are needed to evaluate oncological safety, surgical outcomes, and patient satisfaction.
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Affiliation(s)
- Kazutaka Narui
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Toshihiko Satake
- Department of Plastic, Reconstructive and Aesthetic Surgery, Toyama University Hospital, Toyama, Toyama, Japan
| | - Takashi Ishikawa
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Tokyo, Japan
| | - Mayu Muto
- Department of Plastic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yui Tsunoda
- Department of Plastic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Akimitsu Yamada
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Kei Kawashima
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Natsuki Uenaka
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Tokyo, Japan
| | - Yoshie Fujiwara
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Masanori Oshi
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Shoko Adachi
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Chiho Suzuki
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Tomoko Wada
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Shinya Yamamoto
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Mikiko Tanabe
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Ng TP, Loo BYK, Yong N, Chia CLK, Lohsiriwat V. Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM. Ann Surg Oncol 2024; 31:3366-3376. [PMID: 38285304 DOI: 10.1245/s10434-024-14943-4] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. MATERIALS AND METHODS We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. RESULTS A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. CONCLUSIONS This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.
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Affiliation(s)
- Trina Priscilla Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Brandon Yong Kiat Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nicole Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clement Luck Khng Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Visnu Lohsiriwat
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Asad F, Adil M, Shahid S, Khan N, Huang R, Zhu H. Tree-ring based summer temperature variability since 1790 CE in the Hindu Kush region of northern Pakistan. Int J Biometeorol 2024:10.1007/s00484-024-02683-9. [PMID: 38656351 DOI: 10.1007/s00484-024-02683-9] [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] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
The Hindu Kush high-altitude regions of Pakistan are currently experiencing severe consequences as a result of global warming. In this sense, increasing soil erosion and the quick melting of glaciers are two particularly evident effects. In such a scenario, understanding long-term temperature changes is crucial for making accurate forecasts about how the Hindu Kush region may experience regional temperature changes in the future. In this study, the climate tree-ring width (TRW) analysis designated a positive and significant correlation (r = 0.622, p < 0.001) between the TRW chronology and the June to September (summer) mean maximum temperature (MMT). Using the tree-ring width of Pinus wallichiana A. B. Jackson, we reconstructed summer temperatures in the Hindu Kush region from 1790 CE. Statistical analysis showed that the reconstruction model has explained 38.7% of the climate variance during the instrumental period of 1967 to 2018 CE. Five extremely warm summer periods (≥ 4 years; before the instrumental period 1967-2018 CE) of 1804-1830, 1839-1862, 1876-1879, 1905-1910, 1923-1935 CE, and six cold summer periods of 1790-1803, 1832-1838, 1863-1875, 1880-1904, 1911-1922, and 1936-1945 CE have been observed during the past 229 years. Individually, the year 1856 CE experienced severe warmth (31.85 °C), whereas 1794 CE was relatively cooler (29.60 °C). The spectral multi-taper method (MTM) shows significant (p < 0.05) cycles, which take place about every 9.3, 5.7, 4.2, and 3.6 years. In particular, the 9.3-year cycle, which closely aligns with the 11-year solar activity cycle, suggests a potential correlation between solar activity and local temperature fluctuations. Moreover, our reconstruction demonstrates a significant degree of consistency when compared to actual climate data and regional temperature reconstruction series, reporting a strong logic of trust in the reliability and accuracy of our findings. This evidence reaffirms that our reconstruction shows significant and dependable regional temperature signals, notably being representative for the Hindu Kush region.
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Affiliation(s)
- Fayaz Asad
- Department of Chemical and Life Science, Qurtuba University of Science & Information Technology, Peshawar, KP, Pakistan.
| | - Muhammad Adil
- Department of Chemical and Life Science, Qurtuba University of Science & Information Technology, Peshawar, KP, Pakistan
| | - Sabrina Shahid
- Department of Chemical and Life Science, Qurtuba University of Science & Information Technology, Peshawar, KP, Pakistan
- Department of Botany, Women Campus Charbagh, University of Swat, Kp, Pakistan
| | - Nasrullah Khan
- Department of Botany, University of Malakand, Chakdara Dir Lower, Khyber Pakhtunkhwa, 18800, Pakistan
| | - Ru Huang
- State Key Laboratory of Tibetan Plateau Earth System, Environment and Resources (TPESER), Chinese Academy of Sciences, Beijing, 100101, China
- Department of Environment and Biodiversity, Paris-Lodron-University of Salzburg, Salzburg, 5020, Austria
| | - Haifeng Zhu
- State Key Laboratory of Tibetan Plateau Earth System, Environment and Resources (TPESER), Chinese Academy of Sciences, Beijing, 100101, China
- China Pakistan Joint Research Center on Earth Sciences, CAS-HEC, Islamabad, 45320, Pakistan
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Lin G, Zhang X, Song Z, Xu Y, Wang H, Zheng R, Fan F, You J. Clinical Application of Botulinum Toxin A on Nasal Reconstruction with Expanded Forehead Flap for Asian Patients. Aesthetic Plast Surg 2024:10.1007/s00266-024-04033-x. [PMID: 38653821 DOI: 10.1007/s00266-024-04033-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Because of its unique advantages, frontal expansion has become a common tool for Asian nasal reconstruction, but it has the limitations of prolonging the duration and pain in the expansion area. Based on the fact that the denervation effect of botulinum toxin type A (BTX-A) has been widely used in the reconstruction of superficial organs, we hypothesized that BTX-A would shorten the length of nasal reconstruction sequence and alleviate the discomfort of patients. METHODS A comparative retrospective study was conducted of consecutive patients underwent sequential treatment of nasal reconstruction between June 2010 and July 2012. Data on demographics, BTX-A injection plan and expansion duration were collected and analyzed. Phased pain intensity outcomes were evaluated by visual analogue scale (VAS). Photographs were collected during the follow-up period. RESULTS Thirty patients were enrolled in the study; 15 (50%) with and 15 (50%) without BTX-A pre-injection. Demographic data were homogeneous. The duration of the observation group (BTX-A pretreated) (133.87 ± 13.64 days) was significantly shortened versus the control group (164.27 ± 14.08 days, P<0.001). At the initial stage, no significant difference was found in the VAS scores (P=0.64). At the medium stage, the VAS score of the observation group (2.07 ± 0.80) was significantly lower than the control group (3.00 ± 0.53, P<0.01). At the terminal stage, the VAS score of the observation group (1.93 ± 0.59) was significantly lower than the control group (2.73 ± 0.70) but with a narrower disparity. CONCLUSION Pre-injection of BTX-A is effective in shortening the duration of the expansion phase, as well as relieving the pain associated with expansion. LEVEL OF EVIDENCE IV The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .
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Affiliation(s)
- Guangxian Lin
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Xulong Zhang
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zhen Song
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Yihao Xu
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Huan Wang
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Ruobing Zheng
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Fei Fan
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
| | - Jianjun You
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Cosset T, Tonnerre D, Gorphe P, Dupret-Bories A, Dufour X, Carsuzaa F. Free-flap reconstruction methods in head-and-neck oncologic surgery: A CROSS practice survey of members of the French GETTEC Head-and-Neck Tumor Study Group. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00053-X. [PMID: 38658260 DOI: 10.1016/j.anorl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To survey practices concerning the use of anticoagulants and antiplatelets in microvascular free-flap reconstruction following oncological surgery of the head and neck. METHODS A survey of practices was carried out between September 2022 and March 2023. An online questionnaire was sent to members of the French GETTEC Head-and-Neck Tumor Study Group in all French centers practicing head-and-neck cancer surgery with reconstruction using microvascular free-flaps. The questionnaire asked surgeons about their practices regarding the use of intra- and postoperative anticoagulants and antiplatelets, preoperative management of comorbidities, and prevention of postoperative complications. RESULTS Sixty-one percent of the 38 respondents (23/38) used intraoperative intravenous heparin injection, associated to flap irrigation with heparin for 76% of surgeons (29/38) and/or a heparin solution bath for 37% (14/38). Postoperative anticoagulation was used by 95% of surgeons (36/38), and antiplatelets by 40% (15/38). Postoperatively, 40% (15/38) carried out monitoring using an implantable micro-Doppler probe, associated to analysis of clinical characteristics of the flap. CONCLUSION Reconstructive surgery using microvascular free-flaps involves numerous factors that can influence success. Prospective studies, particularly concerning the management of anticoagulants, could enable a national consensus on methods for free-flap reconstruction.
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Affiliation(s)
- T Cosset
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - D Tonnerre
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - P Gorphe
- Département d'ORL et de chirurgie cervicofaciale, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Dupret-Bories
- Service ORL et chirurgie cervicofaciale et audiophonologie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - X Dufour
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - F Carsuzaa
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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16
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He J, Geng B, Xu P, Xia Y. Do Age and Timing Influence the Outcomes of Single-stage Reconstruction of Multiple Ligament Knee Injuries? 5-10 Years Follow Up. Orthop Surg 2024. [PMID: 38644618 DOI: 10.1111/os.14067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/21/2024] [Accepted: 03/30/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVES Multiple ligament knee injuries (MLKIs) are disruptive injuries, however, there are controversies in the results of acute and delayed reconstruction. Also, clinical outcomes between patients older or younger than 40 have not been compared in MLKIs. This study was designed to investigate the influence of age and timing of reconstruction on the outcomes of single-stage reconstruction of MLKIs. METHODS The patients who underwent reconstruction of multiple injured ligaments because of MLKIs between May 2013 and July 2019 were added to the cohort. The postoperative complications, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) 2000 score, Tegner activity level, patient satisfaction, and SF-36 score were compared between young (≤ 40 years old, n = 41) and old patients (n = 61); acute (≤ 3 weeks after injury, n = 75) and delayed reconstruction (n = 27), using Mann-Whitney U test or χ2 test. RESULTS A total of 102 MLKI patients managed by single-stage multi-ligament reconstruction were retrospectively reviewed. Patients were followed up after surgery for a mean of 7.3 years (5.2-10.7 years). At the last follow-up, no significant difference was found in knee ROM, functional scores, and patient-reported outcomes between patients older or younger than 40; acute and delayed reconstruction (p > 0.05). The rate of complications in the delayed reconstruction group was higher than that of the acute reconstruction group (22.2% vs 5.3%, p < 0.05). The IKDC objective scores reached grade A in 63.7%-80.4% of patients, and grade B in 11.8%-23.5% patients. CONCLUSION The single-stage reconstruction of MLKIs can obtain comparative long-term functional and objective outcomes regardless of patients older or younger than 40; acute and delayed reconstruction, however, delayed reconstruction is related to a high rate of postoperative complications.
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Affiliation(s)
- Jinwen He
- Department of Orthopaedics, Orthopaedics Clinical Medicine Research Center of Gansu Province, Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Bin Geng
- Department of Orthopaedics, Orthopaedics Clinical Medicine Research Center of Gansu Province, Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shanghai, China
| | - Yayi Xia
- Department of Orthopaedics, Orthopaedics Clinical Medicine Research Center of Gansu Province, Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
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Dayal D, Zalikha AK, El-Othmani MM. Evaluating the optimal management strategy for intraoperative iatrogenic injury to the medial collateral ligament during primary total knee arthroplasty: A systematic review. Knee 2024; 48:138-149. [PMID: 38642540 DOI: 10.1016/j.knee.2024.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/27/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Intraoperative iatrogenic MCL injuries during primary TKA are rare complications that lack a gold standard management protocol. This review aims to provide insight into various treatment modalities and evidence-based guidance for improved patient outcomes. METHODS A comprehensive search across five databases identified relevant randomized control trials and retrospective cohort studies with reported outcomes. A total of 17 studies were included, and variables such as patient demographics, injury type, management, and Knee Society Scores (KSS) were assessed. The quality of included studies was evaluated using the Critical Appraisal Skills Programme tool. RESULTS Mean age of included patients ranged from 60.0 to 71.4 years. The mean Body Mass Index ranged from 26.75 to 34.40 kg/m2. Among the included knees, 298 were categorized as MCL avulsion, and 167 as midsubstance/transection injuries. Primary repair with sutures or bone staples emerged as the most common management. Intraoperative MCL injury was correlated with reduced preoperative range of motion (ROM) and postoperative KSS clinical, functional, and pain scores compared to control groups. Postoperative ROM was comparable between MCL injury and control groups, ranging from 100.0° to 130.0° and 107.0° to 130.0°, respectively. CONCLUSION Current evidence supports primary repair as the preferred management for this complication. Factors such as extent of the tear, type of injury, and the surgeon's experience also help to guide treatment. While treatment modalities like allograft or autograft reconstruction show promise, further research with larger sample sizes is needed to enhance future outcomes.
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Affiliation(s)
- Dev Dayal
- Michigan State University College of Osteopathic Medicine, Detroit, MI, USA
| | - Abdul K Zalikha
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA.
| | - Mouhanad M El-Othmani
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Lattimore CM, Meneveau MO, Desai R, Camacho TF, Squeo GC, Showalter SL. Are There Disparities in Breast Reconstruction After Contralateral Prophylactic Mastectomy? J Surg Res 2024; 298:277-290. [PMID: 38636184 DOI: 10.1016/j.jss.2024.03.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/26/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Despite national guidelines against contralateral prophylactic mastectomy (CPM) in low- to moderate-risk breast cancer, CPM use continues to rise. Breast reconstruction improves health-related quality of life and satisfaction among women undergoing mastectomy. Given the lack of data regarding factors associated with reconstruction after CPM and the known benefits of reconstruction, we sought to investigate whether disparities exist in receipt of reconstruction after CPM. METHODS The 2004-2017 National Cancer Database was queried to identify women diagnosed with breast cancer who underwent unilateral mastectomy with CPM. Patients were divided into two groups: those who underwent planned reconstruction at any timepoint and those who did not. A secondary analysis comparing types of reconstruction (tissue, implant, combined) was conducted. Patient, tumor, and demographic characteristics were analyzed using chi-square test and odds ratios were calculated using generalized estimating equations. RESULTS The cohort included 1,73,249 women: 95,818 (55.3%) underwent reconstruction and 77,431 (45.7%) did not. Both the rate CPM and the proportion of women undergoing reconstruction after CPM increased between 2004 and 2017. Of the women who had reconstruction, 40,840 (51.7%) received implants, 29,807 (37.7%) had tissue, and 8352 (10.6%) had combined reconstruction. After adjusted analysis, factors associated with reconstruction were young age, Hispanic ethnicity, private insurance, and living in an area with the highest education and median income (P < 0.01). Patients who underwent reconstruction were less likely to have radiation (P < 0.01) and chemotherapy (P < 0.01), more likely to have stage I disease (P < 0.01), and to be treated at an integrated cancer center (P < 0.01). CONCLUSIONS Reconstruction after CPM is disproportionately received by younger women, Hispanics, those with private insurance, and higher socioeconomic status and education. While the rate of reconstruction after CPM is increasing, there remain significant disparities. Conscious efforts must be made to eliminate these disparities, especially given the known benefits of reconstruction after mastectomy.
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Affiliation(s)
- Courtney M Lattimore
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Max O Meneveau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Raj Desai
- Division of Translational Research & Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
| | - T Fabian Camacho
- Division of Translational Research & Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
| | - Gabriella C Squeo
- Department of Plastic and Maxillofacial Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Shayna L Showalter
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Wu M, Xu J, Dai H, Zhu J, Sun M, Xue C, Wang Y. Reconstruction of perianal skin defect using modified keystone flap after perianal tumor resection. Heliyon 2024; 10:e28254. [PMID: 38571588 PMCID: PMC10987925 DOI: 10.1016/j.heliyon.2024.e28254] [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: 03/05/2023] [Revised: 07/22/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose The large resection area of perianal tumor makes the skin defect hard to reconstruct. The keystone flap has demonstrated a growing application in skin defects. Herein, we aimed to explore the efficacy of keystone flap in the repair of skin defect after perianal tumor resection. Methods This study is a retrospective review of patients diagnosed with perianal tumor from January 2010 to November 2021. A standardized data collection template was used to collect variables. The detailed process of the reconstructive surgery is carefully described in this article. After surgery, the healing process was closely observed. Results Twenty patients underwent keystone flap repair. The average wound size before closure measured 3.5 × 4.9 cm2. Primary wound healing was achieved, and the flap survived during the follow up period, which ranged from 6 to 24 months. No severe complications occurred; slight edema was noticed in one patient. Conclusion The application of keystone flap is a promising way to repair skin defect after tumor removal, and the complications rate was low after surgery. It can be concluded that this method is an effective and reliable way to repair perianal skin defect.
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Affiliation(s)
| | | | | | - Ji Zhu
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Mengyan Sun
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Yuchong Wang
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
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Qaisi M, Al Azzawi T, Joseph F, Shah B, Murphy J. Osteo-cutaneous microvascular free-flaps are a viable option for reconstructing the temporomandibular joint. Heliyon 2024; 10:e28201. [PMID: 38571615 PMCID: PMC10987928 DOI: 10.1016/j.heliyon.2024.e28201] [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: 08/05/2023] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Background There are multiple reconstructive options after mandibular resection and disarticulation of the condyle. The purpose of this study was to assess the clinical outcomes and functionality of osteocutaneous free flaps in the reconstruction of mandibular defects that involve the Temporo-Mandibular Joint (TMJ). Methods Our study is a retrospective cohort study involving subjects who underwent mandibular resection and needed TMJ reconstruction with vascularized bony-free flaps from February 2016 to June 2018. Data gathered included patient demographics, post-operative function, maximum interincisal opening (MIO), occlusion status, deviation on opening, and TMJ symptoms. Data points collected from postoperative CT imaging included the following: position of the flap in relation to the glenoid fossa and articular eminence, and closest point of contact. Results Eight out of the nine patients who underwent free flap reconstruction of mandibular defects involving the TMJ qualified for the study. The mean age was 39.7 years old. In all 8 cases, virtual surgical planning (VSP) was used. The mean follow-up time was 18.75 months. The flap success rate was 100%. The mean MIO was 37.37 mm. Six patients resumed their premorbid diet, and one patient developed dysphagia and was peg tube dependent. In seven cases the occlusion was intact and reproducible, one case was without sufficient teeth for occlusion. On imaging, the mean distance from the neo-condyle to the glenoid fossa was 14 mm and to the articular eminence 8.68 mm. The point of closest contact in all cases appeared to be the articular eminence. Conclusion Vascularized Osteocutaneous-flaps such as FFFs and DCIA flaps provide a good option for the reconstruction of mandibular defects that involve the TMJ. Ipsilateral deviation on opening does not negatively affect clinical outcomes or function. Placing patients in Maxillomandibular fixation for 4-6 weeks may help to prevent condylar sag and provide stable post-operative occlusion.
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Affiliation(s)
- Mohammed Qaisi
- Oral & Maxillofacial Surgery, USA
- Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, 1950 W Polk Street, Suite 8302, Chicago, IL 60612, USA
| | - Thaer Al Azzawi
- Division of Oral and Maxillofacial Surgery Cook County Health 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
| | - Fanti Joseph
- Oral & Maxillofacial Surgery Resident, Division of Oral and Maxillofacial Surgery, Cook County Health, 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
| | - Biraj Shah
- Attending Physician Division of Oral and Maxillofacial Surgery Cook County Health 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
| | - James Murphy
- Attending Physician Division of Oral and Maxillofacial Surgery Cook County Health 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
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Shan S, Zhang C, Cheng M, Qi Y, Yu D, Wildgruber M, Ma X. SPFS: SNR peak-based frequency selection method to alleviate resolution degradation in MPI real-time imaging. Phys Med Biol 2024. [PMID: 38593815 DOI: 10.1088/1361-6560/ad3c90] [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] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The primary objective of this study is to address the reconstruction time challenge in Magnetic Particle Imaging (MPI) by introducing a novel approach named SNR-Peak-Based Frequency Selection (SPFS). The focus is on improving spatial resolution without compromising reconstruction speed, thereby enhancing the clinical potential of MPI for real-time imaging. APPROACH To overcome the trade-off between reconstruction time and spatial resolution in MPI, the researchers propose SPFS as an innovative frequency selection method. Unlike conventional SNR-based selection, SPFS prioritizes frequencies with Signal-to-Noise Ratio (SNR) peaks that capture crucial system matrix information. This adaptability to varying quantities of selected frequencies enhances versatility in the reconstruction process. The study compares the spatial resolution of MPI reconstruction using both SNR-based and SPFS frequency selection methods, utilizing simulated and real device data. MAIN RESULTS The research findings demonstrate that the SPFS approach substantially improves image resolution in Magnetic Particle Imaging, especially when dealing with a limited number of frequency components. By focusing on SNR peaks associated with critical system matrix information, SPFS mitigates the spatial resolution degradation observed in conventional SNR-based selection methods. The study validates the effectiveness of SPFS through the assessment of MPI reconstruction spatial resolution using both simulated and real device data, highlighting its potential to address a critical limitation in the field. SIGNIFICANCE The introduction of SNR-Peak-Based Frequency Selection (SPFS) represents a significant breakthrough in MPI technology. The method not only accelerates reconstruction time but also enhances spatial resolution, thus expanding the clinical potential of MPI for various applications. The improved real-time imaging capabilities of MPI, facilitated by SPFS, hold promise for advancements in drug delivery, plaque assessment, tumor treatment, cerebral perfusion evaluation, immunotherapy guidance, and in vivo cell tracking.
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Affiliation(s)
- Shihao Shan
- School of Control Science and Engineering, Shandong University, No.17923 Jingshi Road, Jinan Shandong, Jinan, Shandong, 250100, CHINA
| | | | - Min Cheng
- xintai hospital of traditional Chinese medicine, No. 860, Qingyun Road, Tai'an, 271200, CHINA
| | - Yafei Qi
- Qilu Hospital of Shandong University, Jinan, Jinan, Shandong, 250012, CHINA
| | - Dexin Yu
- Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan City, Jinan, Shandong, 250012, CHINA
| | - Moritz Wildgruber
- Department of Radiology, Ludwig-Maximilians-Universität München, Munich 81337, Munchen, Bayern, 80539, GERMANY
| | - Xiaopeng Ma
- School of Control Science and Engineering, Shandong University, No.17923 Jingshi Road, Jinan Shandong, Jinan, Shandong, 250100, CHINA
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Widarda IR, Soedjana H, Hasibuan LY, Lukito RS. Nasal reconstruction on supernumerary nostril: A rare case report. Int J Surg Case Rep 2024; 118:109627. [PMID: 38631195 PMCID: PMC11035025 DOI: 10.1016/j.ijscr.2024.109627] [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: 03/11/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION A supernumerary nostril is one of the rarest congenital nasal abnormalities. Recently we encountered a 16-months-old patient with 3 supernumerary nostrils that was located at left side of the nose and performed an operation on this case. We reported a rare case of three supernumerary nostril located at left side of the nose. CASE PRESENTATION A 14-month-old male baby was referred to our clinic for assessment of a nose deformity. Physical examination revealed an asymmetrical ala of nose with 3 supernumerary nostrils at left side and a normal right nostril. She was diagnosed with supernumerary rostril and underwent fistulectomy of the accessory nasal tract, followed by nostril reconstruction with primary closure of margin defect at 16-month-old. There was no complication and she was discharged the next day. One month after surgery triamcinolone was injected at scar. Nasal cavity retainer is still maintained in place as aftercare for at least 3-months-post-surgery. We obtained an event-free postoperative result with good function and aesthetic results. DISCUSSION Supernumerary nostril is an extremely rare case. It should not be confused with a double nose. Surgery should be performed at an early age. Nevertheless, we performed surgery at 16-month-old baby and still obtained satisfying result. CONCLUSION Surgical technique performed at this rare supernumerary nostril case was fistulectomy of the accessory nasal tract, followed by nostril reconstruction good functions, aesthetic results post operatively.
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Affiliation(s)
- Irra Rubianti Widarda
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Jalan (street) Prof. Dr. Eyckman 38, Bandung, West Java, Indonesia 40161
| | - Hardisiswo Soedjana
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Jalan (street) Prof. Dr. Eyckman 38, Bandung, West Java, Indonesia 40161.
| | - Lisa Y Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Jalan (street) Prof. Dr. Eyckman 38, Bandung, West Java, Indonesia 40161
| | - Ratnanggana Sistaparamita Lukito
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Jalan (street) Prof. Dr. Eyckman 38, Bandung, West Java, Indonesia 40161
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Schantz C, Coulibaly A, Faye K, Traoré D. Amazons in Mali? Women's experiences of breast cancer and gender (re)negotiation. Soc Sci Med 2024; 348:116874. [PMID: 38608482 DOI: 10.1016/j.socscimed.2024.116874] [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: 10/17/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
Breast cancer is the second most common cancer, with more than 2.31 million cases diagnosed worldwide in 2022. Cancer medicine subjects the body to invasive procedures in the hope of offering a chance of recovery. In the course of treatment, the body is pricked, burned, incised and amputated, sometimes shattering identity and often changing the way women perceive the world. In sub-Saharan Africa, incidence rates are steadily increasing and women are particularly young when they develop breast cancer. Despite this alarming situation, the scientific literature on breast cancer in sub-Saharan Africa is poor and largely dominated by medical literature. Using a qualitative approach and a theoretical framework at the intersection of the sociology of gender and the sociology of the body, we explore the discourse strategies of women with breast cancer in Mali regarding their relationship to the body and to others. Based on 25 semi-directive interviews, we analyse the experiences of these women. Using the image of the Amazon woman, whose struggle has challenged gender because of its masculine attributes, we explore whether these women's fight against their breast cancer could be an opportunity to renegotiate gender relations. The experience of these women is characterised by the deconstruction of their bodies, pain and suffering. The masculinisation of their bodies and their inability to perform certain typically female functions in society (such as cooking or sexuality) challenges their female identity. The resistance observed through the sorority, discreet mobilisation and display of their bodies does not seem to be part of a renegotiation of gender relations, but it does play an active role in women's acceptance of the disease and their reconstruction.
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Affiliation(s)
- Clémence Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France; Institut Convergences et Migrations - ICM, Aubervilliers, France.
| | | | - Kadiatou Faye
- Association Les Combattantes du Cancer, Bamako, Mali
| | - Drissa Traoré
- Faculty of Medicine and Odontostomatology (FMOS), Bamako, Mali
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24
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Kostretzis L, Pinto I, Katakalos K, Kazakos G, Cheva A, Papadopoulos P, Ditsios K. Intrasynovial autograft for reconstruction of chronic large rotator cuff tears in a rabbit model: biomechanical, computed tomography, and histological results. J Orthop Surg Res 2024; 19:224. [PMID: 38575992 PMCID: PMC10996304 DOI: 10.1186/s13018-024-04691-2] [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: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Rotator cuff (RC) tears are a common cause of shoulder dysfunction and pain, posing significant challenges for orthopedic surgeons. Grafts have been proposed as a solution to augment or bridge torn tendons, but optimal clinical outcomes are not always achieved due to poor graft integration, suboptimal mechanical properties, and immunological reactions. The aim of this study was to investigate the biomechanical, CT and histological results of RC reconstruction using an intrasynovial tendon autograft, in a chronic large tear subscapularis rabbit model. METHODS Twenty-six adult male Zealand white rabbits were used in this study. Large defects in the subscapularis tendons were produced bilaterally in 20 rabbits. After 6 weeks, secondary procedures were performed to the right shoulder of the rabbits, which were reconstructed with an intrasynovial interposition autograft (graft group). The left shoulder did not undergo any further treatment (defect group). The specimens were randomly divided into two equal time groups and underwent biomechanical testing, CT analysis, and histological evaluation at 6, and 12 weeks after reconstruction. In addition, 6 rabbits that were not operated, were used as a control group. RESULTS At 12 weeks post-repair, the graft group exhibited a significant increase in ultimate failure load compared to the defect group (p < 0.05). Furthermore, the 12-week graft group demonstrated comparable stiffness to that of the control group. CT analysis indicated no significant progression of intramuscular fat accumulation in both graft groups, in contrast to the 12-week defect group when compared to the control group. Finally, histological evaluation revealed a gradual integration of the graft with the host tissue at 12 weeks. CONCLUSION Our study suggests that intrasynovial flexor tendon autografts hold promise as an effective interposition graft for the reconstruction of chronic large RC tears, as they improve the biomechanical and biological properties of the repaired tendon. Nonetheless, further investigations in preclinical large animal models are warranted to validate and extrapolate these findings to human studies.
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Affiliation(s)
- Lazaros Kostretzis
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, General Hospital of Thessaloniki "G.Gennimatas", Thessaloniki, Greece.
| | - Iosafat Pinto
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, General Hospital of Thessaloniki "G.Gennimatas", Thessaloniki, Greece
| | - Konstantinos Katakalos
- Laboratory for Strength of Materials and Structures, Civil Engineering, Department of Aristotle, University of Thessaloniki, Thessaloniki, Greece
| | - George Kazakos
- School of Veterinary Medicine of Aristotle, University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, General Hospital of Thessaloniki "G.Gennimatas", Thessaloniki, Greece
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, General Hospital of Thessaloniki "G.Gennimatas", Thessaloniki, Greece
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Fischer VKS, Rothschild MA, Kneubuehl BP, Kamphausen T. Skin simulants for wound ballistic investigation - an experimental study. Int J Legal Med 2024:10.1007/s00414-024-03223-1. [PMID: 38570340 DOI: 10.1007/s00414-024-03223-1] [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: 10/12/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
Gunshot wound analysis is an important part of medicolegal practice, in both autopsies and examinations of living persons. Well-established and studied simulants exist that exhibit both physical and biomechanical properties of soft-tissues and bones. Current research literature on ballistic wounds focuses on the biomechanical properties of skin simulants. In our extensive experimental study, we tested numerous synthetic and natural materials, regarding their macromorphological bullet impact characteristics, and compared these data with those from real bullet injuries gathered from medicolegal practice. Over thirty varieties of potential skin simulants were shot perpendicularly, and at 45°, at a distance of 10 m and 0.3 m, using full metal jacket (FMJ) projectiles (9 × 19 mm Luger). Simulants included ballistic gelatine at various concentrations, dental silicones with several degrees of hardness, alginates, latex, chamois leather, suture trainers for medical training purposes and various material compound models. In addition to complying to the general requirements for a synthetic simulant, results obtained from dental silicones shore hardness 70 (backed with 20 % by mass gelatine), were especially highly comparable to gunshot entry wounds in skin from real cases. Based on these results, particularly focusing on the macroscopically detectable criteria, we can strongly recommend dental silicone shore hardness 70 as a skin simulant for wound ballistics examinations.
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Affiliation(s)
- Victoria K S Fischer
- Institute of Legal Medicine, Faculty of Medicine, University of Cologne, Melatenguertel 60/62, 50823, Cologne, Germany.
| | - Markus A Rothschild
- Institute of Legal Medicine, Faculty of Medicine, University of Cologne, Melatenguertel 60/62, 50823, Cologne, Germany
| | | | - Thomas Kamphausen
- Institute of Legal Medicine, Faculty of Medicine, University of Cologne, Melatenguertel 60/62, 50823, Cologne, Germany
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Gadzhiagaev VS, Lasunin NV, Okishev DN, Konovalov AN, Golbin DA, Cherekaev VA, Serova NK, Grigorieva NN. One-step orbit reconstruction using PMMA implants following hyperostotic sphenoid wing meningioma removal: Evolution of the technique in short clinical series. World Neurosurg X 2024; 22:100281. [PMID: 38455245 PMCID: PMC10918255 DOI: 10.1016/j.wnsx.2024.100281] [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: 08/30/2022] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose To report our experience with patient specific implants for one-step orbit reconstruction following hyperostotic SWM removal and to describe the evolution of the technique through three surgical cases. Methods: Three cases of one-step SWM removal and orbit reconstruction are described. All cases are given consecutively to describe the evolution of the technique. Hyperostotic bone resection was facilitated by electromagnetic navigation and cutting guides (templates). Based on a 3D model, silicone molds were made using CAD/CAM. Then PMMA implant was fabricated from these molds. The implant was adjusted and fixed to the cranium with titanium screws after tumor removal. Results: Following steps of the procedure changed over these series: hyperostotic bone resection, implant thickness control, implant overlay features, anatomic adjustments, implant fixation. The proptosis resolved in all cases. In one patient the progressive visual acuity deterioration was recognized during the follow-up. No oculomotor disturbances and no tumor regrowth were found at the follow-up. Conclusion CAD/CAM technologies enable creation of implants of any size and configuration, and thereby, to increase the extent of bony resection and lower the risk of tumor progression. The procedure is performed in one step which decreases the risk of postoperative morbidity.
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Affiliation(s)
- Vadim S. Gadzhiagaev
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Nikolay V. Lasunin
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Dmitriy N. Okishev
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Anton N. Konovalov
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Denis A. Golbin
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Vasily A. Cherekaev
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Natalia K. Serova
- Burdenko Neurosurgical Center, Department of Neuro-ophthalmology, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Nadezhda N. Grigorieva
- Burdenko Neurosurgical Center, Department of Neuro-ophthalmology, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
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Chraibi O, Rajaallah A, Lamris MA, Aitlhaj N, El Kassimi CE, Rafai M. Rare case of chondrosarcoma of the manubrium sterni: Management challenges and insights (a surgical case report). Int J Surg Case Rep 2024; 117:109443. [PMID: 38458018 PMCID: PMC10937845 DOI: 10.1016/j.ijscr.2024.109443] [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: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Chondrosarcoma of the manubrium sterni is an exceedingly rare localization of chondrosarcoma. Its treatment poses a significant therapeutic challenge due to the tumor's proximity to the mediastinal organs and the clavicles. This challenge is magnified when the inner ends need to be resected due to tumor contact with the sternoclavicular joints and, more critically, during the reconstruction of the thoracic wall. CASE PRESENTATION We present the case of a 71-year-old female with a 45x42x51 mm chondrosarcoma of the manubrium sterni, extending to both sternoclavicular joints. The diagnosis was confirmed cytologically and histologically after an ultrasound-guided biopsy. A surgical strategy involving en bloc resection of the manubrium sterni, the internal ends of both clavicles, and the first two ribs, followed by sternal reconstruction using a synthetic manubrial plate and titanium costal staples without clavicular bridging, was indicated and executed. CLINICAL DISCUSSION This case outlines the surgical considerations and techniques adopted for this complex procedure, emphasizing the operative planning and interdisciplinary collaboration required for a successful outcome. CONCLUSION At 18 months post-surgery, the patient demonstrated favorable clinical and radiological progress, indicating a positive response to the treatment strategy employed.
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Affiliation(s)
- Omar Chraibi
- 32 pavilion of CHU Ibn Rochd of Casablanca, Morocco
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Varda BK, Levitt MA. How we select our surgical approach for cloacal reconstruction. J Pediatr Urol 2024; 20:320-322. [PMID: 38042687 DOI: 10.1016/j.jpurol.2023.11.007] [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: 09/24/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
During cloacal reconstruction, we consider both common channel (CC) and urethral length when deciding between total urogenital mobilization (TUM) and a urogenital separation (UGS). Our concern about TUM in the case of a short urethra is resultant bladder neck incompetence, while conversion to UGS after completing the TUM dissection may result in urethral injury. Use of an interposition flap harvested from the ischiorectal fossa is another measure we use to prevent potential complications.
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Affiliation(s)
- Briony K Varda
- Children's National Division of Colorectal and Pelvic Reconstruction, USA; Children's National Division of Urology, USA.
| | - Marc A Levitt
- Children's National Division of Colorectal and Pelvic Reconstruction, USA
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Singh K, Beniwal M, Sharma A, Singh P, Kumar A, Anshul. Reconstruction of Partial Defect of Ear in a Tertiary Care Institute. Indian J Otolaryngol Head Neck Surg 2024; 76:1825-1835. [PMID: 38566656 PMCID: PMC10982196 DOI: 10.1007/s12070-023-04420-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: 10/11/2023] [Accepted: 12/01/2023] [Indexed: 04/04/2024] Open
Abstract
Auricle is the outward visible part of ear and composed of skin and cartilage. Auricle due to its standout and projected position is more vulnerable to get injured and cause distortion of the facial aesthetics. Reconstruction of the ear defect should be individualized depending on the defect size, location, nearby skin, patient requirement and surgeon experience. To present the results of various reconstructive options for partial ear defect which will aid in decision making among reconstructive options available. Reconstruction was individualized considering the defect size, depth, location, surrounding skin. In upper 1/3 defect reconstructive options include Antia-Buch chondrocutaneous advancement flap, autogenous cartilage with temporoparietal fascial flap, for middle 1/3 defect options include retroauricular soft tissue tube flap, diefenbach procedure, Autogenous cartilage graft and temporoparietal fascial flap, for lower 1/3 defect reconstructive options include pre auricular flap, triangular repair method, Zenteno Alanis technique. Reconstruction with various techniques results in aesthetically good outcomes. There is no major complication seen in any patient. Reconstruction of ear defect with various options available has good outcome. Planning is important part in reconstruction process. Reconstructive option chosen for a ear defect should be individualized depending on patient characteristics, surgeon experience.
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Affiliation(s)
- Kuldeep Singh
- Department of Burns and Plastic Surgery, Pt. B.D.Sharma PGIMS Rohtak, 1150 Sector 1, Rohtak, Haryana 124001 India
| | - Meenu Beniwal
- Department of Burns and Plastic Surgery, Pt. B.D.Sharma PGIMS Rohtak, 1150 Sector 1, Rohtak, Haryana 124001 India
| | - Abhishek Sharma
- Department of Burns and Plastic Surgery, Pt. B.D.Sharma PGIMS Rohtak, 1150 Sector 1, Rohtak, Haryana 124001 India
| | | | - Akshay Kumar
- Department of Burns and Plastic Surgery, Pt. B.D.Sharma PGIMS Rohtak, 1150 Sector 1, Rohtak, Haryana 124001 India
| | - Anshul
- Department of Anaesthesia, Pt. B.D.Sharma PGIMS, Rohtak, India
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Knowles AJ. Advocating for Enhanced Patient Engagement in Breast Cancer Care: Impact of Residual Increased Lateral Adiposity and Consideration of the Pursuit of "Living Flat". Clin Breast Cancer 2024; 24:e186-e194. [PMID: 38326163 DOI: 10.1016/j.clbc.2024.01.003] [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: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
Breast cancer is a significant health concern, accounting for a substantial proportion of cancer cases. Despite improvements in cancer survivorship, many women still require mastectomy as part of their therapeutic treatment. Mastectomy alone or delayed breast reconstruction (DBR) are two options available to women not suitable for immediate breast reconstruction at initial mastectomy. However, the presence of increased lateral adiposity (ILA) following mastectomy, commonly referred to as ``dog-ears,'' can lead to discomfort and aesthetic concerns. This paper explores the benefits and harms of ILA postmastectomy and its impact on patient satisfaction when choosing between mastectomy alone or DBR. A literature search was completed within OVID Medline, 1946-current, with the following terms, filtered for relevance: "mastectomy," "autologous reconstruction," "scar," "body image/dysmorphia," "patient-reported outcomes," "reconstructive surgical procedures/excess skin," "surgical flaps/dog ear." The disparity between clinical support and educational resources available for patients considering DBR options compared to those choosing mastectomy alone or pursuit of "living flat" is discussed. A common theme from qualitative research was the reported feeling of lack of inclusion in reconstruction planning by the patient. There were instances reported of residual skin remaining postmastectomy, against patient wishes. The findings emphasized the importance of shared decision-making and comprehensive preoperative education to ensure that patients are well-informed and satisfied with their chosen treatment approach. Further research is needed to address the specific needs and preferences of patients opting for mastectomy and to improve surgical techniques and education regarding living-flat options.
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Affiliation(s)
- Aaron J Knowles
- Pioneer Wound healing and Lymphoedema Centres, Eastbourne, United Kingdom.
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Kolpan KE, Vadala J, Dhanaliwala A, Chao T. Utilizing augmented reality for reconstruction of fractured, fragmented and damaged craniofacial remains in forensic anthropology. Forensic Sci Int 2024; 357:111995. [PMID: 38513528 DOI: 10.1016/j.forsciint.2024.111995] [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: 09/05/2023] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Forensic anthropologists are often confronted with human remains that have been damaged due to trauma, fire, or postmortem taphonomic alteration, frequently resulting in the fracture and fragmentation of skeletal elements. The augmented reality (AR) technology introduced in this paper builds on familiar 3D visualization methods and utilizes them to make three dimensional holographic meshes of skeletal fragments that can be manipulated, tagged, and examined by the user. Here, CT scans, neural radiance fields (NeRF) artificial intelligence software, and Unreal Engine production software are utilized to construct a three-dimensional holographic image that can be manipulated with HoloLens™ technology to analyze the fracture margin and reconstruct craniofacial elements without causing damage to fragile remains via excessive handling. This allows forensic anthropologists a means of assessing aspects of the biological profile and traumatic injuries without risking further damage to the skeleton. It can also be utilized by students and professional anthropologists to practice refitting before reconstructing craniofacial fragments if refitting is necessary. Additionally, the holographic images can be used to explain complicated concepts in a courtroom without the emotional response related to using bony elements as courtroom exhibits.
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Affiliation(s)
- Katharine E Kolpan
- Department of Culture, Society and Justice, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844, USA.
| | - Jeffrey Vadala
- Penn Neurology Virtual Reality Laboratory, University of Pennsylvania, Richards Medical Laboratories, 3700 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Ali Dhanaliwala
- Department of Radiology, Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104, USA
| | - Tiffany Chao
- Department of Otorhinolaryngology - Head and Neck Surgery, Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104, USA
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Zhao J, Lu F, Dong Z. Strategies for Constructing Tissue-Engineered Fat for Soft Tissue Regeneration. Tissue Eng Regen Med 2024; 21:395-408. [PMID: 38032533 PMCID: PMC10987464 DOI: 10.1007/s13770-023-00607-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/17/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Repairing soft tissue defects caused by inflammation, tumors, and trauma remains a major challenge for surgeons. Adipose tissue engineering (ATE) provides a promising way to solve this problem. METHODS This review summarizes the current ATE strategies for soft tissue reconstruction, and introduces potential construction methods for ATE. RESULTS Scaffold-based and scaffold-free strategies are the two main approaches in ATE. Although several of these methods have been effective clinically, both scaffold-based and scaffold-free strategies have limitations. The third strategy is a synergistic tissue engineering strategy and combines the advantages of scaffold-based and scaffold-free strategies. CONCLUSION Personalized construction, stable survival of reconstructed tissues and functional recovery of organs are future goals of building tissue-engineered fat for ATE.
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Affiliation(s)
- Jing Zhao
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong, China
- Department of Plastic Surgery and Burn Center, Second Affiliated Hospital, Plastic Surgery Institute of Shantou University Medical College, Shantou, 515063, Guangdong, China
| | - Feng Lu
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong, China.
| | - Ziqing Dong
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong, China.
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Dzhuma K, De Win G, Mishra P, Biassoni L, Cherian A. Laparoscopic strategies in complex upper urinary tract obstruction. J Pediatr Urol 2024; 20:305-311. [PMID: 38000949 DOI: 10.1016/j.jpurol.2023.11.004] [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: 06/03/2023] [Revised: 10/22/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES We enumerate the various laparoscopic strategies to resolve upper urinary tract (UUT) obstruction in the context of variations in anatomy and report their outcomes. PATIENTS AND METHODS Retrospective review of primary laparoscopic UUT reconstructions performed between May 2012 and May 2021. Anomalies included: malrotated kidney (MRK), horseshoe kidney (HSK), duplex kidney (DK), pure intrarenal pelvis (IRP) and mid-ureteric stenosis (MUS). Success was defined by postoperative resolution of symptoms, improvement of anterior-posterior renal pelvic diameter (APD) on US and drainage on Mag3. Complications were categorised by Clavien-Dindo grading. Outcomes compared using the student's t-test with P < 0.05 considered statistically significant. RESULTS Of the 214 laparoscopic primary UUT reconstructions, 37 (17.2 %) were: 13-MRK, 12-HSK, 4-DK, 4-IRP and 4-MUS. Median age at surgery was 5-years (range 0.3-15). Dismembered pyeloplasty: 8; pyeloplasty with renal sinus dissection: 8; neo-PUJ anastomosis: 8; primary ureterocalycostomy: 7; pyeloureterostomy: 2; and uretero-ureterostomy: 4. Median follow-up was 43-months (range 8-108) with a success rate of 94.5 % (35/37). Complete resolution of symptoms in 20/21 patients; improvement of hydronephrosis on US in 35/37 patients (median pre-operative APD 27 mm vs. median postoperative APD 8 mm) [P < 0.001]; improvement of drainage on diuretic renogram in 32/34 kidneys and stable/improved DRF in 34/35 kidneys (median preoperative DRF - 45 % vs. median postoperative DRF - 47 %) [P > 0.05]. Postoperative complications managed medically (II Clavien) included urinary tract infections - 2 patients (5 %), stent-related symptoms in 2 (5 %) and umbilical port site collection in 1 patient (3 %). Recurrent pelvi-ureteric junction obstruction PUJO occurred in one patient (3 %) requiring redo surgery (IIIb Clavien), renal stones in 1 (3 %) which resolved with ESWL (IIIb Clavien); in 1 (3 %) patient with a HSK there was complete loss of ipsilateral kidney function but this was managed conservatively up to date (I Clavien). CONCLUSION Laparoscopic transperitoneal approach allows the prompt recognition of in-situ anatomical variants. UUT obstruction in such settings calls for a variety of strategies with excellent outcomes.
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Affiliation(s)
- Kristina Dzhuma
- Department of Urology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Gunter De Win
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Pankaj Mishra
- Department of Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
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Li Z, Lu M, Gong T, Zhou Y, Min L, Luo Y, Tu C. Revision for Solid-Body Breakage of the 3D-Printed Implant Following Joint-Sparing Surgery: A Technical Note. Orthop Surg 2024; 16:1010-1016. [PMID: 38316419 PMCID: PMC10984813 DOI: 10.1111/os.13983] [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: 09/07/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The advent of three-dimensional (3D)-printed custom-made implants has revolutionized orthopaedic surgery, particularly in limb- and joint-sparing surgeries. However, clinical experience in the revision for 3D-printed implant breakage is lacking, and the revision surgery remains challenging. This study reported the revision of proximal tibial prosthetic reconstruction necessitated by solid-body breakage of a 3D-printed implant, aiming to detail the surgical techniques and evaluate postoperative outcomes. CASE PRESENTATION A patient diagnosed with osteosarcoma underwent joint-sparing surgery with a 3D-printed implant, but implant breakage occurred during subsequent follow-up. The initial implant was broken into two parts: the proximal implant breakage part (IBP) integrated with the host bone and the distal IBP left in the prosthetic component. Four revision protocols were devised, each based on one of the four hypothesis results of taking out the initial implant. A new custom-made implant and a series of assistance devices ("positioning devices," "drill devices," "tap devices," and "separator devices") were specifically prepared for revision surgery. The proximal IBP was taken out from the host bone, but the distal IBP was not taken out from the initial prosthetic component. The patient received the new custom-made implant for reconstruction, with the knee joint preserved. The patient recovered uneventfully after revision surgery and achieved satisfactory function. The Musculoskeletal Tumor Society was 28 at the last follow-up. No complications were detected during the follow-up period. CONCLUSION Comprehensive preoperative planning and preparation, enabling the surgeon to effectively address intraoperative challenges, are crucial for the successful revision of 3D-printed implant breakage. It is feasible to re-implant a 3D-printed custom-made implant, demonstrating satisfactory clinical and functional results.
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Affiliation(s)
- Zhuangzhuang Li
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Minxun Lu
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Taojun Gong
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yong Zhou
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Li Min
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yi Luo
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Chongqi Tu
- Department of OrthopedicsOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
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Mosa H, Hughes C, Parr J, Anbarasan R, Kulkarni M, Mathur A. Correction of curvature in single stage hypospadias repair with foreskin reconstruction. J Pediatr Urol 2024; 20:334-335. [PMID: 38016835 DOI: 10.1016/j.jpurol.2023.11.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Many surgeons offer foreskin reconstruction (FR) as a routine part of hypospadias repair. We present a step-by-step video of the procedure of Tubularised Incised Plate (TIP) repair, FR and dorsal plication through a ventral skin incision. MATERIALS AND METHODS A ventral incision is made between the inner preputial mucosa and the outer skin extending below the meatus. Ventral degloving is carried out. The dissection is extended laterally around the corporal bodies. The point of maximal curvature (PMC) is marked on the dorsal midline. A vertical incision is made and closed transversely with 5-0 prolene suture in a Heineke- Mikulicz fashion. Urethroplasty is performed in 2 layers using 7-0 polydioxanone (PDS). Spongioplasty and ventral dartos are used as barrier layers. Glansplasty is performed in 2 layers.FR is carried out in 3 layers. DISCUSSION Curvature correction is key to good outcome. Dorsal degloving can be achieved through a ventral incision allowing exposure of the dorsal midline for plication sutures. RESULTS The patient had good cosmetic and functional outcome at 1 month follow up. CONCLUSION FR can be safely performed during TIP repair for distal hypospadias repair. Curvature of less than 30° can be corrected through a ventral incision only.
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Affiliation(s)
- Hazem Mosa
- Paediatric Urology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich, UK.
| | - Charlotte Hughes
- Paediatric Urology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich, UK
| | - Joanne Parr
- Paediatric Urology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich, UK
| | - Ravindar Anbarasan
- Paediatric Urology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich, UK
| | - Milind Kulkarni
- Paediatric Urology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich, UK
| | - Azad Mathur
- Paediatric Urology, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich, UK
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Huang W, Hu X, Cai W, Cheng M, Fang M, Sun Z, Hu T, Yan W. Soft-tissue reconstruction with pedicled vertical rectus abdominis myocutaneous flap after total or high sacrectomy for giant sacral tumor. J Plast Reconstr Aesthet Surg 2024; 91:173-180. [PMID: 38417394 DOI: 10.1016/j.bjps.2024.02.011] [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: 09/03/2023] [Revised: 12/23/2023] [Accepted: 02/01/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The large soft-tissue defect after total or high sacrectomy for giant sacral tumor induces high incidence of wound complications. It remains a huge challenge to reconstruct the soft-tissue defect and achieve the preferred clinical outcome. METHODS A total of 27 patients undergoing one-stage total or high sacrectomy for giant sacral tumors between 2016 and 2021 in a tertiary university hospital were retrospectively reviewed. Participants were divided into two groups. Thirteen patients underwent a pedicled vertical rectus abdominis myocutaneous (VRAM) flap reconstruction, whereas 14 patients underwent a conventional wound closure. Patient's clinical characteristics, surgical duration, postoperative complications, and outcomes were compared between the two groups. RESULTS Patients in VRAM and non-VRAM groups were similar in baseline characteristics. The mean tumor size was 12.85 cm (range: 10-17 cm) in VRAM group and 11.79 cm (range: 10-14.5 cm) in non-VRAM group (P = 0.139). The most common giant sacral tumor is chordoma. Patients in VRAM group had a shorter length of drainage (9.85 vs 17.14 days), postoperative time in bed (5.54 vs 17.14 days), and total length of stay (19.46 vs 33.36 days) compared with patients in non-VRAM group. Patients in the VRAM group had less wound infection and debridement than patients in non-VRAM group (15.4% vs 57.1%, P < 0.001). CONCLUSIONS This study demonstrates the advantages of pedicled VRAM flap reconstruction of large soft-tissue defects after high or total sacrectomy using the anterior-posterior approach. This choice of reconstruction is better than direct wound closure in terms of wound infection, length of drainage, and total length of stay.
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Affiliation(s)
- Wending Huang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xianglin Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiluo Cai
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Mo Cheng
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Meng Fang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhengwang Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tu Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Üstün GG, Kaplan GO, Sert G, Uzun H. Flap loss in head and neck reconstruction: Is there a singular cause for failure? J Plast Reconstr Aesthet Surg 2024; 91:353-359. [PMID: 38442516 DOI: 10.1016/j.bjps.2024.02.050] [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: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
Despite the high success rates reported in head and neck reconstruction, free flap failures continue to persist. Understanding the factors associated with flap loss and improving overall success are paramount. This study aimed to comprehensively assess the factors influencing flap revision and free tissue transfer survival in head and neck reconstruction. The study included 70 patients with defects in the lower two-thirds of the head and neck region and underwent reconstruction using free flaps. Patient age, gender, smoking status, comorbidities and data on the location and aetiology of the defect, the specific type of flap employed, the recipient artery and vein chosen, instances of revision and the overall success of the flap were collected. The investigation aimed to establish correlations between these variables as well as flap success and revision rates. No statistically significant differences were observed in arterial and venous anastomosis revision rates, or flap survival, in relation to variables such as age, gender, flap type, smoking status, comorbidities, recipient artery or vein and the number of vein anastomoses. The malignant tumour group exhibited a lower requirement for arterial revision and a higher flap survival rate compared to the benign tumour group. This study underscores the comparable safety profiles of perforator-based and conventional flaps in head and neck reconstruction. Furthermore, it reveals that patient characteristics are not contraindications for free tissue transfer. Additionally, the quantity of the veins and choice of recipient vessels are flexible and do not significantly impact flap success. The higher rates of flap success in patients with malignant aetiology requires further investigation.
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Affiliation(s)
- Galip Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey.
| | - Güven Ozan Kaplan
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| | - Gökhan Sert
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| | - Hakan Uzun
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
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Dubron K, Yang LH, Jacobs R, Politis C, Willaert R, Shaheen E. Symmetry recovery in zygomaticomaxillary complex fractures compared to normal unfractured population: A new reliable 3D evaluation. J Stomatol Oral Maxillofac Surg 2024:101857. [PMID: 38556166 DOI: 10.1016/j.jormas.2024.101857] [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] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes. MATERIAL AND METHODS Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed. RESULTS The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99). CONCLUSIONS This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.
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Affiliation(s)
- K Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - L H Yang
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - R Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
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Bouzaiene H, Saadallah F, Bouaziz H, Jaidane O, Ben Hassouna J, Dhieb T, Rahal K. Inflammatory breast cancer: As surgical oncologists, what can we do? Int Rev Cell Mol Biol 2024; 384:113-124. [PMID: 38637095 DOI: 10.1016/bs.ircmb.2024.02.004] [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] [Indexed: 04/20/2024]
Abstract
Breast cancer surgery is the primary treatment for early-stage breast cancer. However, inflammatory breast cancer (IBC), with its specific presentation characterized by skin invasion, is unfit for primary surgery. According to the different guidelines, the management of IBC is trimodal with the coordination of oncologists, surgeons, and radiation therapists. Advances in breast cancer imaging and the development of more targeted therapies make new challenges for this aggressive cancer. This chapter aims to provide an update on the role of surgery in IBC. Radical surgery is still considered the standard surgical treatment in IBC. Some authors suggest a conservative surgery in patients with a clinical response to chemotherapy without affecting survival. For lymph node surgery, the sentinel lymph node biopsy (SLNB) is not feasible in IBC patients, according to the existing studies. However, prospective studies on SLNB are needed to verify its reliability after chemotherapy for a specific group of patients. In the metastatic IBC, surgery can be considered if there is a good response after chemotherapy or for uncontrolled symptoms. Existing studies showed that surgery may impact survival for these patients. Prospective studies are mandatory to optimize IBC management, considering factors such as tumor's molecular profile.
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Affiliation(s)
- Hatem Bouzaiene
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Fatma Saadallah
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hanen Bouaziz
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Olfa Jaidane
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Jamel Ben Hassouna
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tarak Dhieb
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Khaled Rahal
- Department of Surgical Oncology, Salah Azaiez Institute, Bab Saadoun, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Mantelakis A, McKean AR, Biju NE, Shet AS, Geh JLC. Evolutions in the use of Integra® and MatriDerm® in excision and reconstruction of cutaneous malignancies. J Plast Reconstr Aesthet Surg 2024; 93:24-27. [PMID: 38608534 DOI: 10.1016/j.bjps.2024.03.011] [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: 09/17/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Angelos Mantelakis
- Department of Plastic Surgery, Guy's, King's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Andrew R McKean
- Department of Plastic Surgery, Guy's, King's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Noel E Biju
- Faculty of Life Sciences and Medicine, School of Medicine, King's College London, Guy's Campus, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Aryan S Shet
- Faculty of Life Sciences and Medicine, School of Medicine, King's College London, Guy's Campus, Great Maze Pond, London SE1 1UL, United Kingdom.
| | - Jenny L C Geh
- Department of Plastic Surgery, Guy's, King's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
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Litsi-Mizan V, Kalantzi I, Tsapakis M, Pergantis SA, Karakassis I, Apostolaki ET. Trajectories of trace element accumulation in seagrass (Posidonia oceanica) over a decade reveal the footprint of fish farming. Environ Sci Pollut Res Int 2024:10.1007/s11356-024-32910-0. [PMID: 38532209 DOI: 10.1007/s11356-024-32910-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/10/2024] [Indexed: 03/28/2024]
Abstract
To evaluate the effect of trace element (TE) release from fish farms on seagrass Posidonia oceanica, we compared TE concentrations (As, Cd, Co, Cu, Mn, Mo, Ni, Pb, V, Zn) in shoots near fish cages (Station 'Cage') with those away from them (Station 'Control') in two fish farm facilities (Site 1 and Site 2, North Aegean Sea, Greece). We assessed the present (i.e., 2021, year of sampling) and past (reconstructed period 2012-2020) accumulation of TEs using the living compartments (leaf blades, sheaths, rhizomes, roots, epiphytes) and the dead sheaths, respectively. We also assessed possible seagrass degradation by reconstructing past rhizome production. P. oceanica rhizome production at the 'Cage' stations was up to 50% lower than at the 'Control' stations. Most TE concentrations were higher at 'Cage' stations, but the differences often depended on the seagrass living compartment. Significant differentiation between 'Cage' and 'Control' stations was observed based on the TE concentrations of the dead sheaths during 2012-2020. The contamination level at the 'Cage' stations was mostly moderate in Site 1 and low in Site 2, during the reconstructed period, while an increasing contamination trend was found for certain potential phytotoxic TEs (As, Cu, Cd, Mo, V). Our results emphasize the need for the aquaculture industry to work towards a more ecologically aware approach.
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Affiliation(s)
- Victoria Litsi-Mizan
- Biology Department, University of Crete, Voutes University Campus, P.O. Box 2208, 70013, Heraklion, Crete, Greece
- Institute of Oceanography, Hellenic Centre for Marine Research, P.O. Box 2214, 71003, Heraklion, Crete, Greece
| | - Ioanna Kalantzi
- Institute of Oceanography, Hellenic Centre for Marine Research, P.O. Box 2214, 71003, Heraklion, Crete, Greece
| | - Manolis Tsapakis
- Institute of Oceanography, Hellenic Centre for Marine Research, P.O. Box 2214, 71003, Heraklion, Crete, Greece
| | - Spiros A Pergantis
- Department of Chemistry, Environmental Chemical Processes Laboratory, University of Crete, Voutes University Campus, P.O. Box 2208, 70013, Heraklion, Crete, Greece
| | - Ioannis Karakassis
- Biology Department, University of Crete, Voutes University Campus, P.O. Box 2208, 70013, Heraklion, Crete, Greece
| | - Eugenia T Apostolaki
- Institute of Oceanography, Hellenic Centre for Marine Research, P.O. Box 2214, 71003, Heraklion, Crete, Greece.
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Zan K, Duan Y, Zhao M, Li H, Cui X, Chai L, Cheng Z. Performance of the Iterative OSEM and HYPER Algorithm for Total-body PET at SUVmax with a Low 18F-FDG Activity, a Short Acquisition Time and Small Lesions. Curr Med Imaging 2024:CMIR-EPUB-139356. [PMID: 38532604 DOI: 10.2174/0115734056274225240109112413] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/16/2023] [Accepted: 12/30/2023] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The primary objective of this comparative investigation was to examine the qualitative attributes of image reconstructions utilizing two distinct algorithms, namely OSEM and HYPER Iterative, in total-body 18F- FDG PET/CT under various acquisition durations and injection activities. METHODS An initial assessment was executed using a NEMA phantom to compare image quality engendered by OSEM and HYPER Iterative algorithms. Parameters such as BV, COV, and CRC were meticulously evaluated. Subsequently, a prospective cohort study was conducted on 50 patients, employing both reconstruction algorithms. The study was compartmentalized into distinct acquisition time and dosage groups. Lesions were further categorized into three size-based groups. Quantifiable metrics including SD of noise, SUVmax, SNR, and TBR were computed. Additionally, the differences in values, namely ΔSUVmax, ΔTBR, %ΔSUVmax, %ΔSD, and %ΔSNR, between OSEM and HYPER Iterative algorithms were also calculated. RESULTS The HYPER Iterative algorithm showed reduced BV and COV compared to OSEM in the phantom study, with constant acquisition time. In the clinical study, lesion SUVmax, TBR, and SNR were significantly elevated in images reconstructed using the HYPER Iterative algorithm in comparison to those generated by OSEM (p < 0.001). Furthermore, an amplified increase in SUVmax was predominantly discernible in lesions with dimensions less than 10 mm. Metrics such as %ΔSNR and %ΔSD in HYPER Iterative exhibited improvements correlating with reduced acquisition times and dosages, wherein a more pronounced degree of enhancement was observable in both ΔSUVmax and ΔTBR. CONCLUSION The HYPER Iterative algorithm significantly improves SUVmax and reduces noise level, with particular efficacy in lesions measuring ≤ 10 mm and under conditions of abbreviated acquisition times and lower dosages.
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Affiliation(s)
- Keyu Zan
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yanhua Duan
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Minjie Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiao Cui
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Leiying Chai
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhaoping Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Aman M, Zimmermann KS, Glaser JJ, Daeschler SC, Boecker AH, Harhaus L. Revealing digital nerve lesions-A comprehensive analysis of 2084 cases of a specialized center. Injury 2024:111514. [PMID: 38555200 DOI: 10.1016/j.injury.2024.111514] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Finger nerve injuries have a significant impact on hand function and can result in reduced sensation, pain and impaired coordination. The socioeconomic implications of these injuries include decreased workplace productivity, reduced earning potential, and financial burdens associated with long-term medical treatment and rehabilitation. However, there is a lack of comprehensive literature regarding the incidence, mechanisms, and associated injuries of finger nerve lesions. METHODS A retrospective analysis was conducted on patients treated at our institution from January 2012 to July 2020. Cases of peripheral finger nerve lesions were identified using the digital hospital information system and ICD-10 Classification. Exclusion criteria included injuries to the median nerve at the carpal tunnel level or superficial branch of the radial nerve. Data were collected using a pseudonymized approach, and statistical analyses were performed using SPSS Statistics (Version 27). RESULTS A total of 2089 finger nerve lesions were analyzed, with a majority of cases occurring in men. Most injuries97.4 % were caused by trauma, predominantly cut/tear injuries. Isolated finger nerve injuries were more common than multiple nerve injuries, with the index finger being the most frequently affected. Concomitant tendon and vascular injuries were observed in a significant proportion51.7 % of cases. Surgical management included direct nerve coaptation, interposition grafting and neurolysis. DISCUSSION Finger nerve injuries are the most prevalent type of nerve injury, often resulting from small lacerations. These injuries have substantial societal costs and can lead to prolonged sick leave. Understanding the epidemiology and etiology of finger nerve injuries is crucial for implementing effective preventive measures. Accompanying tendon injuries and the anatomical location of the nerve lesions can impact sensory recovery and treatment outcomes. Proper management of peripheral finger nerve lesions is essential for optimizing functional outcomes and minimizing the impact on daily activities. Treatment options should be tailored to the severity and underlying cause of the nerve injury.
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Affiliation(s)
- Martin Aman
- Department of Hand-, Peripheral Nerve Surgery and Rehabilitation, Department of Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Kim S Zimmermann
- Department of Hand-, Peripheral Nerve Surgery and Rehabilitation, Department of Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julia J Glaser
- Department of Hand-, Peripheral Nerve Surgery and Rehabilitation, Department of Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Simeon C Daeschler
- Department of Hand-, Peripheral Nerve Surgery and Rehabilitation, Department of Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arne H Boecker
- Department of Hand-, Peripheral Nerve Surgery and Rehabilitation, Department of Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Harhaus
- Department of Hand-, Peripheral Nerve Surgery and Rehabilitation, Department of Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
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Smith JD, Sridharan SS, Contrera KJ, Richmon JD, Feng AL, Chinn SB, Heft-Neal ME, Spector ME. Use of the spider limb positioner for fibular free flap reconstruction of head and neck bony defects. Oral Oncol 2024; 152:106757. [PMID: 38520757 DOI: 10.1016/j.oraloncology.2024.106757] [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: 01/11/2024] [Revised: 02/24/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Osseous and osteocutaneous fibular free flaps are the workhorse of maxillomandibular reconstruction over 30 years after the initial description. Since 2019, we have routinely used the Spider Limb Positioner, adapted from its use in shoulder orthopedic procedures, for fibular free flap harvest. Herein, we describe this novel technique in our cohort. METHODS We describe our intraoperative setup and endorse the versatility and utility of this technique in comparison to other reported fibular free flap harvest techniques. RESULTS The Spider Limb Positioner was used 61 times in 60 different patients to harvest osseous or osteocutaneous fibular free flaps. Median (range) tourniquet time for flap harvest was 90 (40-124) minutes. No iatrogenic nerve compression injuries or complications related to lower extremity positioning occurred. CONCLUSION We describe a novel approach to fibular free flap harvest utilizing the Spider Limb Positioner, which affords optimal ergonomics, visibility, and patient repositioning. There were no nerve injuries or complications related to positioning in our series.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin J Contrera
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Molly E Heft-Neal
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Liao Y, Zhou Z, Wang J, Li H, Zhou B. Fascia lata autografts achieve interface healing with the supraspinatus muscle histologically and mechanically in a rat supraspinatus tendon reconstruction model for massive irreparable rotator cuff tears. Arthroscopy 2024:S0749-8063(24)00235-4. [PMID: 38521207 DOI: 10.1016/j.arthro.2024.02.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To evaluate the histologic healing process and mechanical characteristics of the interface between a fascia lata autograft and supraspinatus muscle by establishing a supraspinatus tendon reconstruction model for chronic massive, irreparable rotator cuff tears (MIRCTs). METHODS A total of 40 rats were studied. Eight rats were sacrificed to establish an intact control group, and the other rats were first established as the chronic MIRCTs model and then developed as the supraspinatus tendon reconstruction model. Histology, fatty infiltration, mechanics and the open field test for the interface between the fascia lata autograft and muscle were assessed at 2, 4, 8 and 16 weeks postoperatively. RESULTS Histologically, the interface between the fascia lata autograft and muscle gradually regenerated structural similarities to the normal muscle-tendon interface by 16 weeks postoperatively. The amounts of collagen I and III were both increased significantly during the healing time and stabilized at 8 weeks postoperatively. Fatty infiltration was obvious in the supraspinatus muscle 4 weeks after the MIRCTs model. However, the degree of fatty infiltration in the supraspinatus muscle gradually decreased after supraspinatus tendon reconstruction and stabilized at 8 weeks postoperatively. The ultimate failure force and the ultimate stress gradually increased from 2 to 16 weeks and reached the level of the intact control tendon at 16 weeks postoperatively (P=0.086). The movability of the forepaw returned to normal in the open field test (P=0.907). CONCLUSIONS In this rat supraspinatus tendon reconstruction model, fascia lata autografts showed good interface healing with the supraspinatus muscle, and fatty infiltration in the supraspinatus muscle was histologically decreased. The interface between the fascia lata autograft and muscle can sustain mechanical strength similar to the anatomical muscle-tendon interface. CLINICAL RELEVANCE The supraspinatus tendon reconstruction technique using fascia lata autografts might be a good histological and biomechanical option for treating MIRCTs.
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Affiliation(s)
- Yatao Liao
- Department of sports medicine, First affiliated hospital of Army Medical University
| | - Zhou Zhou
- Department of sports medicine, First affiliated hospital of Army Medical University
| | - Jun Wang
- Department of sports medicine, First affiliated hospital of Army Medical University
| | - Huaisheng Li
- Department of sports medicine, First affiliated hospital of Army Medical University
| | - Binghua Zhou
- Department of sports medicine, First affiliated hospital of Army Medical University.
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Krijgh DD, List EB, Beljaars B, Qiu Shao SS, de Jong T, Rakhorst HA, Verheul EM, Maarse W, Coert JH. Patient-reported esthetic outcomes following lower extremity free flap reconstruction: A cross-sectional multicenter study. J Plast Reconstr Aesthet Surg 2024; 93:1-8. [PMID: 38598993 DOI: 10.1016/j.bjps.2024.03.007] [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: 01/22/2024] [Revised: 03/01/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The goal of lower-extremity reconstructions is primarily to salvage the leg; however, esthetic outcomes are also important. This study aimed to assess the impact of a lower extremity free tissue transfer regarding social functioning, patient-reported esthetic outcomes, and possible differences between fasciocutaneous vs. muscle flaps. MATERIAL AND METHODS For this cross-sectional multicenter study, patients operated between 2003 and 2021, with a minimum follow-up of 12 months, were identified. Outcomes were obtained from 89 patients. Patient-reported outcomes were assessed using a questionnaire containing 5-point Likert scale questions grouped in three groups: aspect of the reconstructed leg, the aspect of the donor site, and the negative impact on social functioning. Physical functioning and mental health were assessed with the Short-Form-36. RESULTS The overall score for negative impact on social functioning was 22.2. This was 46.7 for the esthetic satisfaction of the reconstructed leg and 57.1 for the donor site. No significant differences were seen between patients who underwent a reconstruction with a fasciocutaneous flap compared to a muscle flap. Secondary surgical procedures for improving the esthetic aspect were performed in 12% of the patients in the fasciocutaneous group and 0% in the muscle group. CONCLUSION Our results show that the most optimal esthetic outcome is not defined by the type of flap. We found a strong correlation between physical functioning and the negative impact on social functioning that a reconstructed lower extremity may have. The result of this study can be taken into consideration during the shared decision-making process of choosing the most optimal reconstruction.
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Affiliation(s)
- David D Krijgh
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands.
| | - Emile B List
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | - Brent Beljaars
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | - Shan S Qiu Shao
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tim de Jong
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Elfie M Verheul
- Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Wiesje Maarse
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
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Viegas V, Freton L, Richard C, Haudebert C, Khene ZE, Hascoet J, Verhoest G, Mathieu R, Vesval Q, Zhao LC, Bensalah K, Peyronnet B. Robotic YV plasty outcomes for bladder neck contracture vs. vesico-urethral anastomotic stricture. World J Urol 2024; 42:172. [PMID: 38506927 DOI: 10.1007/s00345-024-04814-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To compare the outcomes of patients undergoing robotic YV plasty for bladder neck contracture (BNC) vs. vesico-urethral anastomotic stricture (VUAS). METHODS A retrospective study included male patients who underwent robotic YV plasty for BNC after endoscopic treatment of BPH or VUAS between August 2019 and March 2023 at a single academic center. The primary assessed was the patency rate at 1 month post-YV plasty and during the last follow-up visit. RESULTS A total of 21 patients were analyzed, comprising 6 in the VUAS group and 15 in the BNC group. Patients with VUAS had significantly longer operative times (277.5 vs. 146.7 min; p = 0.008) and hospital stay (3.2 vs. 1.7 days; p = 0.03). Postoperative complications were more common in the VUAS group (66.7% vs. 26.7%; p = 0.14). All patients resumed spontaneous voiding postoperatively. Five patients (23.8%) who developed de novo stress urinary incontinence had already an AUS (n = 1) or required concomitant AUS implantation (n = 3), all of whom were in the VUAS group (83.3% vs. 0%; p < 0.0001). The proportion of patients improved was similar in both groups (PGII = 1 or 2: 83.3% vs. 80%; p = 0.31). Stricture recurrence occurred in 9.5% of patients in the whole cohort, with no significant difference between the groups (p = 0.50). Long-term reoperation was required in three VUAS patients, showing a statistically significant difference between the groups (p = 0.05). CONCLUSION Robotic YV plasty is feasible for both VUAS and BNC. While functional outcomes and stricture-free survival may be similar for both conditions, the perioperative outcomes were less favorable for VUAS patients.
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Affiliation(s)
- Vanessa Viegas
- Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | | | | | | | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Quentin Vesval
- Department of Urology, University of Rennes, Rennes, France
| | - Lee C Zhao
- Department of Urology, New York University, New York, USA
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
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D'Ascanio L, Gostoli E, Ricci G, De Luca P, Latini G, Brenner MJ, Di Stadio A. Modified Valente Technique for Cauliflower Ear: Outcomes in Children at Two-Year Follow-Up : New Surgical Technique for Cauliflower Ear. Aesthetic Plast Surg 2024:10.1007/s00266-024-03914-5. [PMID: 38499875 DOI: 10.1007/s00266-024-03914-5] [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: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Cauliflower ear deformity, a common sequela of auricular trauma, presents an esthetic and reconstructive challenge. Existing surgical techniques have limitations, including complexity, donor site morbidity, and variable long-term outcomes. MATERIALS AND METHODS In this case series, we present a novel and minimally invasive surgical approach for the correction of cauliflower ear deformity that adapts the Valente otoplasty technique; it combines cartilage debulking with helical rim release and Mustardé mattress stitches to restore ear contour and reduce the risk of recurrence. The procedural steps include bielliptic post-auricular skin and soft tissue incision, release of the cartilaginous spring, removal of excess fibrocartilaginous tissue, cartilage reshaping with suture to restore contour, and tissue redistribution to promote adherence of skin to the cartilage framework. RESULTS Outcomes were evaluated in 7 patients (9 ears) with cauliflower ear deformity, assessing surgical duration, complications, patient satisfaction, and esthetic outcomes at two years after surgery. The mean surgical duration per patient was 52 ± 17 minutes, including 2 bilateral procedures. Follow-up at 24 months showed favorable esthetic outcome in all patients with sustained improvements in auricular contour and symmetry with neither loss of the shape nor recurrence of deformity. Patients reported high satisfaction and improved quality of life, with mean Glasgow Children Benefit Questionnaire scores of 99.3 ± 6.3. CONCLUSIONS This technique thus demonstrated lasting correction of cauliflower ear with favorable cosmetic outcomes, low risk of complications, and high patient satisfaction. Further investigations and longer-term follow-up are warranted to validate the technique's durability and expand its application to older and more diverse patient populations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Luca D'Ascanio
- Department of Otolaryngology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Eleonora Gostoli
- Department of Otolaryngology, University of Perugia, Perugia, Italy
| | - Giampietro Ricci
- Department of Otolaryngology, University of Perugia, Perugia, Italy
| | - Pietro De Luca
- 3Department of Otolaryngology, Isola Tiberina Hospital - Gemelli Isola, Rome, Italy
| | - Gino Latini
- Department of Otolaryngology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Michael J Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Ortner G, Honis HR, Böhm J, Konschake M, Tokas T, Nagele U. Improved early continence following laparoscopic radical prostatectomy: the urethral hammock technique. World J Urol 2024; 42:168. [PMID: 38492077 DOI: 10.1007/s00345-024-04857-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 03/18/2024] Open
Abstract
PURPOSE To introduce and illustrate a novel urethral reconstruction technique-the 'urethral hammock-technique'-and to assess its impact on early postoperative continence following laparoscopic radical prostatectomy (LRP). METHODS 119 patients who underwent LRP between January 2020 and May 2022 (hammock group: n = 43, control group: n = 76) were included in the study. The primary outcome was continence (zero pads or max. one security pad) at 1, 3, and 6 months following surgery. Secondary outcomes were operative time, complications, and histological findings. Univariate and multivariate regression analyses were performed to reveal predictors for continence. p values < 0.05 with a two-sided 95%-confidence interval were considered statistically significant. RESULTS Baseline characteristics were comparable among both groups. The number of patients achieving complete continence in both the hammock and control groups at various time intervals was: 4 weeks 37.2% (16/43) vs. 19.2% (14/73) (p = 0.047); 3 months 60.5% (26/43) vs. 37.3% (28/75) (p = 0.021) and 6 months 72.1% (31/43) vs. 60.3% (44/73) (p = 0.23), respectively. Adjusting for bladder neck preservation status and age, the hammock technique was a significant predictor for continence for the 4-week (OR 0.33, 95% CI 0.13-0.83, p = 0.019) and 3-month (OR 0.28, 95% CI 0.12-0.66, p = 0.004) interval but not for the 6-month interval (OR 0.64, 95% CI 0.27-1.5, p = 0.31). Operative time, complication rates, time till catheter extraction and histological findings were comparable between both groups (all p > 0.05). CONCLUSIONS The hammock technique is a simple and reproducible technique to improve early postoperative continence for at least 3 months following surgery. However, these promising results warrant confirmation through a randomized controlled trial.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Hanne-Rose Honis
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Julia Böhm
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
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Yang HJ, Kim D, Lee WS, Oh SH. Malignant triton tumor in the abdominal wall: A case report. World J Clin Cases 2024; 12:1467-1473. [PMID: 38576801 PMCID: PMC10989446 DOI: 10.12998/wjcc.v12.i8.1467] [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: 11/24/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Malignant triton tumors (MTTs) comprise a subgroup of malignant peripheral nerve sheath tumors (MPNSTs) that exhibits rhabdomyosarcomatous differentiation and follow an aggressive course. MTTs are primarily located along peripheral nerves. Cases of MTTs in the abdominal wall have not been reported. MTT has a poorer prognosis than classic MPNSTs, and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies. Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical. CASE SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdominal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation. She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation. Abdominal computed tomography (CT) showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle. There was no sign of metastasis (T1N0M0). An incisional biopsy identified sporadic MTT of the lower abdomen. A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed. Subsequently, the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique. The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect. No complications arose, and annual follow-up CTs did not show signs of recurrence or metastasis. CONCLUSION An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction, eliminating the need for postoperative radiotherapy.
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Affiliation(s)
- Ho Jik Yang
- Department of Plastic and Reconstructive Surgery, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
| | - Donghyun Kim
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Won Suk Lee
- Department of Emergency, Eulji University Hospital, Daejeon 35233, South Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, South Korea
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