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Surgeries, Volume 5, Issue 4 (December 2024) – 9 articles

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13 pages, 1441 KiB  
Review
Towards Standardized, Safe, and Efficacious Screening Approaches to Patients with Lower Extremity Peripheral Arterial Disease in the Setting of Lower Extremity Arthroplasty
by Adam Pearl, Katherine O’Neil, Souhil Jaafil, Zaina Khoury, Ahmad Hasan and Khaled Saleh
Surgeries 2024, 5(4), 997-1009; https://doi.org/10.3390/surgeries5040080 (registering DOI) - 4 Nov 2024
Viewed by 132
Abstract
Introduction: Peripheral arterial disease (PAD) impedes the ability to recover from lower extremity arthroplasties (LEA) while simultaneously increasing risks of peri- and postoperative complications, morbidity, and mortality. Despite the known risks that PAD presents, there are currently no standards outlining how practitioners should [...] Read more.
Introduction: Peripheral arterial disease (PAD) impedes the ability to recover from lower extremity arthroplasties (LEA) while simultaneously increasing risks of peri- and postoperative complications, morbidity, and mortality. Despite the known risks that PAD presents, there are currently no standards outlining how practitioners should screen patients prior to undergoing LEA. The purpose of this manuscript is to facilitate the improved diagnosis of PAD, leading to appropriate vascular surgery consultation prior to undergoing orthopedic surgeries. Recommendations for Preoperative Assessment: Screening begins with a succinct history and physical exam, looking for signs and symptoms of diminished vascular integrity. A heightened suspicion for PAD should prompt the immediate enactment of an ankle brachial index, or alternatively, a pressure volume recording or the skin perfusion pressure technique. Full article
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11 pages, 976 KiB  
Article
Racial Differences in Incidence of Anxiety and Depression Among Mastectomy and Breast Reconstruction Patients Using the All of Us Database
by Stuti P. Garg, Namrata V. Chintalapati, Kirtana Sandepudi, Sammer Marzouk, Kelly C. Ho, Jason H. Ko and Robert D. Galiano
Surgeries 2024, 5(4), 986-996; https://doi.org/10.3390/surgeries5040079 - 30 Oct 2024
Viewed by 250
Abstract
Background: Breast reconstruction after mastectomy may improve psychological sequelae for patients. The objective of this study is to characterize differences in depression and anxiety rates for mastectomy and breast reconstruction (BR) patients by race. Methods: The All of Us database was utilized for [...] Read more.
Background: Breast reconstruction after mastectomy may improve psychological sequelae for patients. The objective of this study is to characterize differences in depression and anxiety rates for mastectomy and breast reconstruction (BR) patients by race. Methods: The All of Us database was utilized for patients who underwent mastectomy and BR post-mastectomy. Anxiety and depression rates and self-identified race were extracted from DatasetV7. Results: Of mastectomy patients, 2398 were White and 472 were Black. Black patients had the greatest difference in depression rates between mastectomy (44.5%) and BR patients (28.8%) (OR = 0.46, 95% CI 0.26–0.82). White patients had lower depression rates (40.4%) for mastectomy than Black patients. Asian patients had the lowest rates of depression for mastectomy (OR = 0.43, 95% CI 0.22–0.84) and for mastectomy and BR (OR = 0.35). Black patients had a decrease in anxiety rates from mastectomy (49.4%) to BR (40.9%) (OR = 0.67). Conclusions: Anxiety and depression varied significantly by race for mastectomy and BR patients. Black mastectomy patients had the highest rates of depression and anxiety, which decreased after receiving BR. Lower rates of anxiety and depression were found amongst Asian mastectomy patients. These data highlight the need to identify and treat races vulnerable to depression and anxiety before and after mastectomy/BR. Full article
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16 pages, 1161 KiB  
Systematic Review
Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis
by Muhammad Ikhlas Abdian Putra, Mirnasari Amirsyah, Budiman Budiman, Shakira Amirah, Seba Talat Al-Gunaid and Muhammad Iqhrammullah
Surgeries 2024, 5(4), 970-985; https://doi.org/10.3390/surgeries5040078 - 28 Oct 2024
Viewed by 482
Abstract
Open total cranial vault reconstruction (CVR) is the common procedure in managing craniosynostosis, yet more techniques have been introduced as alternatives, namely endoscopic suturectomy (ES), endoscopy-assisted craniectomy (EC), spring-assisted surgery (SAS), strip craniectomy with helmet (SC), Pi craniectomy (PiC), Pi plasty (PiP), and [...] Read more.
Open total cranial vault reconstruction (CVR) is the common procedure in managing craniosynostosis, yet more techniques have been introduced as alternatives, namely endoscopic suturectomy (ES), endoscopy-assisted craniectomy (EC), spring-assisted surgery (SAS), strip craniectomy with helmet (SC), Pi craniectomy (PiC), Pi plasty (PiP), and Renier’s “H” technique (RH). The aim of this study was to compare the effectiveness of craniosynostosis surgeries in improving the cephalic index of the patients. Studies published until 7 March 2024 reporting CVR, ES, SAS, SC, RH, and PiP as definitive craniosynostosis management with the cephalic index as the outcome were included. Bayesian network meta-analysis and pair-wise meta-analysis were performed using a random-effects model based on standardized mean difference (SMD) and 95% confidence interval (CI). Nine studies published in 2008–2024 recruiting a total of 464 craniosynostosis patients (age: 18–61 months) were included in this meta-analysis. EC (SMD = 0.23 [95%CI: −5.47 to 5.63]; p = 0.935), PiP (SMD = −0.07 [95%CI: −9.27 to 8.79]; p = 0.988), ES (SMD = −0.59 [95%CI: −6.07 to 4.94]; p = 0.834), PiC (SMD = −1.16 [95%CI: −8.89 to 6.35]; p = 0.765), RH (SMD = −0.96 [95%CI: −6.62 to 4.53]; p = 0.736), SAS (SMD = −0.86 [95%CI: −8.25 to 6.18]; p = 0.815), and SC (SMD = −1.79 [95%CI: −9.05 to 5.28]; p = 0.624) were found to be as effective as CVR in improving the cephalic index. Network meta-analysis suggests that PiP is the most effective among these techniques (rank 1 probability = 0.273). According to the rank probabilities of our model the order of techniques from the most to the least effective is as follows: EC > CVR > PiP > ES > SAS > RH > PiC > SC. Full article
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14 pages, 299 KiB  
Review
Oral Wound Healing in Aging Population
by Claudia Florina Bogdan-Andreescu, Andreea-Mariana Bănățeanu, Oana Botoacă, Carmen Liliana Defta, Cristian-Viorel Poalelungi, Anca Daniela Brăila, Constantin Marian Damian, Matei Georgian Brăila and Laurențiu Mihai Dȋră
Surgeries 2024, 5(4), 956-969; https://doi.org/10.3390/surgeries5040077 - 8 Oct 2024
Viewed by 608
Abstract
Background: Oral wound healing in the aging population is a multifaceted issue requiring a comprehensive approach, considering the physiological changes that come with aging and the frequent presence of comorbidities. Methods: This descriptive review summarizes the factors influencing oral wound healing in aging [...] Read more.
Background: Oral wound healing in the aging population is a multifaceted issue requiring a comprehensive approach, considering the physiological changes that come with aging and the frequent presence of comorbidities. Methods: This descriptive review summarizes the factors influencing oral wound healing in aging patients, including age-related physiological changes, hormonal modifications, multimorbidities, polypharmacy, oralome alterations, and nutritional status. Results: The aging population encounters numerous challenges in oral wound healing due to intrinsic factors, such as biological aging and hormonal changes, and extrinsic factors, such as medication use and lifestyle. Conclusion: Understanding these factors and their combined impact is essential for effective clinical management and improved outcomes in older adults. Full article
8 pages, 2147 KiB  
Article
Efficacy of Using a Vessel Dilator during Surgery to Evaluate Vein Diameter and Predict Radiocephalic Arteriovenous Fistula Maturation and Patency
by Kanako Takai, Takehisa Nojima, Hidehiko Taguchi, Kosei Hasegawa and Takashi Yamauchi
Surgeries 2024, 5(4), 948-955; https://doi.org/10.3390/surgeries5040076 - 7 Oct 2024
Viewed by 443
Abstract
Background: We use vessel dilators to assess the diameter of the target vein during surgery for arteriovenous fistula (AVF) creation in hemodialysis patients. This study investigates the efficacy of using vein diameter as measured using dilators (surgical diameter; SD) versus that as measured [...] Read more.
Background: We use vessel dilators to assess the diameter of the target vein during surgery for arteriovenous fistula (AVF) creation in hemodialysis patients. This study investigates the efficacy of using vein diameter as measured using dilators (surgical diameter; SD) versus that as measured by preoperative ultrasonography (ultrasonographic diameter; UD) to predict postoperative complications and patency. Methods: Sixty-three patients who underwent radiocephalic AVF creation and had measurements of UD and SD were retrospectively analyzed. Cutoff values for UD and SD regarding complications were used to dichotomize the patients into high and low groups for comparisons. Results: The 2-year primary and secondary patency rates overall were 66.5% and 88.9%, respectively. The optimal UD and SD cutoff values were 2.4 and 3.5 mm, respectively. The 2-year primary patency rate was higher in the high-SD group than the low-SD group (88.2% vs. 58.6%; p = 0.0426). The 2-year secondary patency rate was significantly higher in the high-UD/high-SD group than the low-UD/low-SD group (91.7% vs. 68.4%; p = 0.0067). Conclusions: Intraoperative measurement of vein diameter using dilators during AVF creation might be a useful method of predicting patency, particularly when SD is used in combination with UD. Full article
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19 pages, 803 KiB  
Review
Autogenous Tooth Graft Biomaterial in Guided Bone Regeneration: A Comprehensive Review
by Aurora Picone, Filipe Castro, Artur Falcão, Jesus Glez Medina, Elio Minetti, Juliana Campos Hasse Fernandes and Gustavo Vicentis Oliveira Fernandes
Surgeries 2024, 5(4), 929-947; https://doi.org/10.3390/surgeries5040075 - 3 Oct 2024
Viewed by 443
Abstract
Objective: This review evaluated the use of autogenous tooth as a bone graft material in guided bone regeneration (GBR). Moreover, it compared the results of GBR using autogenous demineralized dentin, partially demineralized dentin, and mineralized dentin with or without membrane to verify its [...] Read more.
Objective: This review evaluated the use of autogenous tooth as a bone graft material in guided bone regeneration (GBR). Moreover, it compared the results of GBR using autogenous demineralized dentin, partially demineralized dentin, and mineralized dentin with or without membrane to verify its clinical advantage, effectiveness, and safety. Methods: A search was conducted in PubMed/MEDLINE, Lilacs, Embase, Cochrane, and Scopus databases. Specific criteria were established for the inclusion and exclusion of studies, including types of studies considered, target population (clinical studies: humans), evaluated intervention (studies assessing and comparing autologous demineralized dentin, partially demineralized dentin, and mineralized dentin in GBR with or without resorbable membrane), and language and publication period of articles (English and published in the last 11 years). A detailed assessment of the methodological quality of the selected studies was conducted using the JBI critical appraisal tool. Results: Based on the analysis conducted, out of 174 potentially relevant articles obtained, only 19 publications met the inclusion criteria, with three papers showing medium quality/moderate risk of bias and the rest with high quality/low risk of bias. Comparison between groups revealed stability of the newly formed bone, low marginal bone loss, clinically acceptable primary and secondary implant stability quotient (ISQ) values, and high implant survival rates after using autogenous tooth biomaterial. Conclusions: The results of this review on the use of autogenous teeth as a bone graft material in guided bone regeneration indicated that the technique has the potential to be an effective and safe treatment option. Analysis of selected studies showed favorable evidence for the use of autogenous teeth in bone regeneration, suggesting clinical benefits, most for socket preservation. These results are relevant for guiding clinical practice and assisting dental professionals in having options for biomaterials for bone regeneration. Full article
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9 pages, 2411 KiB  
Case Report
Thoracic Extradural Psammomatous Meningioma on T6–T8: A Case Report and Literature Review
by Roberto Renan Albavera-Gutiérrez, Arturo Espíndola-Rodríguez, Carlos Alberto Castro-Fuentes, Ana Karen Aguayo Martínez, Omar Esteban Valencia-Ledezma, Juan Manuel Salgado-Camacho, Luis Bernal Mendoza and Ernesto Nuñez Nava
Surgeries 2024, 5(4), 920-928; https://doi.org/10.3390/surgeries5040074 - 1 Oct 2024
Viewed by 416
Abstract
Tumors of the spine are rare, with an incidence of 1.0 and 1.5 per 100,000 individuals. A 44-year-old female patient underwent emergency surgery for posterior decompression and tumor resection. A 3-level laminectomy was performed from T6 to T8 using the Medtronic Midas Rex [...] Read more.
Tumors of the spine are rare, with an incidence of 1.0 and 1.5 per 100,000 individuals. A 44-year-old female patient underwent emergency surgery for posterior decompression and tumor resection. A 3-level laminectomy was performed from T6 to T8 using the Medtronic Midas Rex drill and a 5 mm diamond drill, with microsurgical resection of the lesion. A new resection was performed one week later to address a residual tumor located towards the rostral and cephalic levels. A sample of the extradural lesion was obtained and was sent to the Pathology Department of the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) for histopathological diagnosis, reporting Grade 1 psammomatous meningioma according to the WHO’s criteria. Our patient’s rehabilitation treatment consisted of two parts. The first part occurred during her hospital stay, before and after surgery, and upon her discharge. At the first outpatient consultation three weeks after surgery, the patient showed improved strength in the lower extremities, scoring 4/5 on the Daniel’s scale muscle strength test. After one year of follow-up, our patient has recovered muscle strength. This allows her to move freely, scoring 5/5 on the Daniel’s scale muscle strength test. Full article
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12 pages, 600 KiB  
Systematic Review
Return to Sport after Pediatric Osteochondral Lesions: A Systematic Review
by Omkar S. Anaspure, Shiv Patel, Anthony N. Baumann, Jake Lininger and Albert T. Anastasio
Surgeries 2024, 5(4), 908-919; https://doi.org/10.3390/surgeries5040073 - 1 Oct 2024
Viewed by 480
Abstract
Background: Evidence on return to sport (RTS) criteria and timelines for pediatric patients with osteochondral (OCD) lesions of the foot and ankle is limited. Methods: This systematic review evaluated RTS criteria and outcomes in this population by querying PubMed, Embase, Web of Science, [...] Read more.
Background: Evidence on return to sport (RTS) criteria and timelines for pediatric patients with osteochondral (OCD) lesions of the foot and ankle is limited. Methods: This systematic review evaluated RTS criteria and outcomes in this population by querying PubMed, Embase, Web of Science, CINAHL, and SPORTDiscus up to 30 May 2024. Inclusion criteria were retrospective or prospective studies that examined pediatric patients with osteochondral lesions of the foot and ankle and gave outcomes or criteria regarding RTS. Results: Five observational studies (n = 168 patients; n = 180 OCD lesions; mean age: 14.19 ± 0.47 years; mean follow-up: 42 ± 174 months) were included. Two studies (40%) used time-based criteria for RTS, two studies (40%) used mixed criteria, and the final study (20%) used milestone-based criteria. Across the mixed and milestone criteria, physical therapy (n = 3) and minimal partial weight-bearing prior to RTS (n = 4) were most frequently seen as the milestones used for assessing RTS readiness. RTS from the postoperative period ranged from 3 months to 6 months. At the final follow-up, 61.45% of patients (n = 110) were available to provide information regarding their ability to RTS. Of these patients, 80% (n = 88) achieved RTS. Conclusions: Results showed variability in RTS criteria, ranging from three to six months, with no clear patterns. Most patients returned to sport, suggesting that such individualized criteria may be effective to an extent. Future research should focus on larger, high-quality studies to develop consistent RTS protocols. Full article
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12 pages, 3010 KiB  
Article
Overcoming the Learning Curve in Robot-Assisted Spinal Surgery—How Does It Compare to O-Arm Navigation?
by Pirateb Paramasivam Meenakshi Sundaram, Mun Chun Lai, Arun-Kumar Kaliya-Perumal and Jacob Yoong-Leong Oh
Surgeries 2024, 5(4), 896-907; https://doi.org/10.3390/surgeries5040072 - 30 Sep 2024
Viewed by 482
Abstract
Background: Robotic systems have the potential to significantly enhance the accuracy and outcomes of spinal surgery. Adopting this new technology requires an examination of its learning curve and influencing factors. This study analyzes the learning curve associated with using the Mazor X Stealth [...] Read more.
Background: Robotic systems have the potential to significantly enhance the accuracy and outcomes of spinal surgery. Adopting this new technology requires an examination of its learning curve and influencing factors. This study analyzes the learning curve associated with using the Mazor X Stealth Edition system for pedicle screw placement and performs a matched-pair analysis to compare operative durations between robot-assisted and navigation-based surgeries, evaluating the efficiency of the robotic system. Methods: We collected retrospective operative data from patients who underwent robot-assisted pedicle screw placements between December 2020 and June 2024 and conducted a cumulative sum (CuSUM) analysis to assess the learning curve, focusing on the robotic system’s setup duration. Additionally, we compared a group of patients who underwent robot-assisted pedicle screw placements with a pair-matched group who underwent O-arm-based navigation-assisted pedicle screw placements. Results: There was a notable decrease in the robotic setup duration, with a significant shift in trend observed after the first 20 cases. While the initial setup time was 24 minutes, it reduced to 17 minutes in later cases, reflecting a marked improvement in efficiency as the surgeon gained more experience with the robot. Conclusion: Our findings indicate there were no added difficulties using the robotic system compared to the navigation system. Moreover, the learning curve for the robotic system can be quickly surmounted, and it offers clear advantages over previous systems, making it a valuable tool for pedicle screw application. Full article
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