Surgical Techniques Development

Background/Objectives: Epidermolysis bullosa (EB) comprises a heterogeneous group of rare inherited skin-fragility disorders in which even minimal trauma can cause blistering, chronic wounds, scarring, and functional impairment. After surgical release of EB hand deformities, wound coverage is challenging because autologous split-thickness skin grafting creates an additional donor-site wound in already fragile tissue. This preliminary case series reports our single-center pediatric experience using intact fish skin grafting (iFSG) as an adjunct after EB hand surgery. Methods: We conducted an observational case series of five pediatric patients with dystrophic EB, including eight operated hands, treated between December 2022 and December 2025. iFSG was applied after the release of contractures and/or pseudosyndactyly. Primary outcomes were time to complete re-epithelialization, need for re-application, need for autologous grafting, and early complications. Secondary outcomes included dressing-related pain assessed with an age-appropriate visual analog scale during awake dressing care, dressing burden, and early recurrence signals. Results: The iFSG application was feasible in all cases. One localized second application was required, and no patient required autologous split-thickness skin grafting. Mean dressing-related pain was 1.6 on the visual analog scale, and mean time to complete re-epithelialization was 47.6 days. No allergic reactions occurred. Healing was slower in the two most severe bilateral mitten-hand cases, and one patient developed limited dorsal disepithelialization attributed to prolonged dressing contact on extremely fragile skin. One partial recurrence of pseudosyndactyly was observed during follow-up without the need for revision surgery. Conclusions: iFSG was feasible in this small preliminary pediatric dystrophic EB hand surgery series and may provide a biologically active scaffold that supports secondary closure while avoiding autologous donor-site creation. Because of the rarity of the disease, the limited sample size, the absence of a comparator group, and the limited follow-up, these findings should be interpreted cautiously. Larger multicenter studies with standardized functional, pain, recurrence, and caregiver-reported outcomes are needed to define the role of iFSG in EB hand reconstruction. ABILHAND-Kids was also administered to patients/caregivers and suggested encouraging perceived improvement in postoperative hand use and independence in daily activities. Full article

The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery as there are a number of participants, over 400, and an international team of invited speakers chosen for their renowned scientific value. The 12th meeting was held in Rimini (Italy) from 6 to 8 June 2025. The scientific issues concerned new advancements in aesthetic surgery. This book of abstracts contains research related to facial surgery, body contouring, breast surgery, and rhinoplasty, also including aesthetic medicine, AI’s impact on the medical profession, and forensic medicine. For the first time, the AICPE established an award in memory of Flavio Saccomanno for the best paper presented by a young surgeon with the endorsement of Surgical Techniques Development by MDPI. Full article

Background: Laparoscopic partial splenectomy (LPS) is a technically demanding procedure. The main difficulty when considering LPS is the bleeding risk. With advancements in technology and a deeper understanding of spleen vascular distribution, LPS has emerged as a feasible and safe procedure. Methods: There are many techniques used in order to prevent bleeding; in our case, we performed LPS using transient main splenic artery clamping. Our case represents a 65-year-old man who was diagnosed with a space-occupying lesion in the lower pole of the spleen and underwent LPS by temporary non-selective occlusion of the splenic artery. Results: The LPS was successfully performed. The surgery length was about 105 min, and it took about 48 min from placement of the bulldog on the splenic artery (warm ischemia), transecting the splenic parenchyma and release of the bulldog. The estimated blood loss was less than 50 mL. The recovery was smooth and uneventful, and the patient was discharged on the third postoperative day. Conclusions: LPS with temporary occlusion of the main trunk of splenic artery is shown to be an effective, practicable and reliable method that is associated with minor operative blood loss. Full article

Background: Total knee arthroplasty in patients with hemophilia remains the most effective surgical intervention for end-stage hemophilic arthropathy, yet it poses unique surgical and perioperative challenges that are rarely encountered in standard osteoarthritis cases. This article synthesizes technical, anatomical, and perioperative considerations specific to hemophilic patients and integrates prospective clinical data derived exclusively from the hemophilic cohort of our long-term study (twenty patients, twenty knees; 2015–2024). Emphasis is placed on deformity correction, bone loss management, implant selection, hemostatic strategies, transfusion patterns, and perioperative pitfalls. The objective is to provide a comprehensive narrative reference for surgeons managing complex hemophilic knees, consolidating both evidence-based recommendations and practical perioperative “tips and tricks” accumulated across more than a decade of clinical experience. Methods: This prospective observational study evaluated twenty consecutive male patients with hemophilia who underwent primary total knee arthroplasty for advanced hemophilic arthropathy between 2015 and 2024 at our institution. The following variables were collected: operative time measured from skin incision to skin closure, postoperative transfusion requirement, length of hospitalization measured in days, early postoperative complications, and functional recovery as assessed by the Knee Society Score. Early complications included postoperative bleeding or hematoma, superficial or deep infection, and stiffness requiring intensive physiotherapy or manipulation under anesthesia. Results: The mean age at the time of surgery was 44.8 years with a standard deviation of 7.2 years, ranging from 31 to 59 years. The mean operative time in the hemophilic cohort was 154.54 min with a standard deviation of 18.36 min. The range of operative time was from 120 to 180 min. Nine of the twenty patients, representing 45 percent, required postoperative blood transfusion. The mean length of hospital stay in the hemophilic cohort was 12.3 days with a standard deviation of 2.38 days, ranging from 9 to 17 days. The mean Knee Society Score improved from 38 points preoperatively to 82 points at final follow-up, representing a mean increase of 44 points. Conclusions: Total knee arthroplasty in hemophilic patients is safe and effective when specialized surgical techniques, comprehensive synovectomy, precise deformity correction, optimized hemostasis, and structured postoperative coagulation factor replacement are implemented. Functional outcomes and prosthetic survival are excellent in experienced centers. Full article

Background/Objectives: Tonsillectomy remains one of the most frequently performed procedures in pediatric otolaryngology. This study compared the clinical efficacy and postoperative morbidity of coblation tonsillectomy (Group A) versus traditional cold dissection (Group B), focusing on postoperative pain, recovery time, and hemorrhagic complications. Methods: A prospective, randomized, single-blinded study was conducted involving 100 pediatric patients (n = 50 per group) aged 3 to 17 years. Patients were monitored for 10 days postoperatively. The primary outcome was pain intensity, measured twice daily using the Wong–Baker FACES Pain Rating Scale. Secondary outcomes included operative time, analgesic consumption, time to return to a normal diet, and secondary hemorrhage rates. Results: The mean operative time for Group A was significantly shorter (18.5 ± 4.2 min) compared to Group B (24.1 ± 5.6 min; p < 0.05). Pain assessment showed significantly lower mean pain scores for the Coblation group during the critical first week. For instance, on Post-op Day 1, the mean pain score was 3.2 for Group A vs. 5.8 for Group B (p < 0.001). Patients in Group A returned to a normal solid diet significantly earlier (mean day 5.2 ± 1.1) than those in Group B (mean day 7.4 ± 1.5; p < 0.01). Secondary hemorrhage occurred in 1 case (2%) in Group A and 1 case (2%) in Group B (p = 1.00). Conclusions: Coblation tonsillectomy significantly reduces postoperative pain and accelerates recovery without compromising the safety profile. The clinical benefits, despite the higher procedural cost, justify its preference in modern pediatric surgical practice due to improved quality of life for the patient. Full article

Introduction: Plantar fasciitis is a common cause of heel pain in adults, with a significant impact on quality of life and athletic performance. While conservative treatments are effective in most cases, a subset of patients remains symptomatic and may require surgical intervention. Minimally invasive techniques, such as bipolar radiofrequency (RF) coblation using the TOPAZ system, have emerged as promising alternatives to traditional open or endoscopic procedures. Methods: This retrospective study evaluated the clinical outcomes of 49 consecutive patients (20 males and 29 females; mean age 54.3 ± 11.4 years; mean BMI 25.3 ± 3.2, range 21.5–34.7) with chronic plantar fasciitis unresponsive to at least six months of conservative treatment. The affected side was left in 24 patients and right in 25, and 35 patients were regularly engaged in sports prior to symptom onset. All patients underwent percutaneous bipolar RF coblation using the TOPAZ device between July 2019 and November 2024. Patient-reported outcome measures—including the Visual Analog Scale (VAS), AOFAS Ankle–Hindfoot Score, SF-36, and Tegner Activity Scale—were collected at the final follow-up (mean 41.7 ± 18.3 months, range 6–71). Results: Statistically significant improvements were observed in pain and function: mean VAS decreased from 8.5 to 3.1 (p < 0.001), and American Orthopaedic Foot and Ankle Society (AOFAS) pain and function scores improved from 2.5 and 12.75 to 28.75 and 38.75, respectively (p < 0.001). The mean Tegner score increased from 1.3 to 4.1 (p < 0.001), with 100% of previously active patients returning to sport. No major complications or reoperations were reported. Conclusions: Percutaneous bipolar RF coblation appears to be a safe and effective treatment for recalcitrant plantar fasciitis, offering significant pain relief, functional improvement, and a high return-to-sport rate with minimal morbidity. This technique may represent a valuable intermediate option between conservative care and open surgery. Full article

Background/Objectives: Chronic otitis media with effusion (OME) is the primary cause of conductive hearing loss in children. High recurrence rates following conventional surgery are often linked to incomplete nasopharyngeal clearance or persistent adenotonsillar biofilms. This study evaluates the long-term impact of endoscopic coblation adenotonsillotomy on middle ear clearance and disease recurrence compared to conventional curettage adenoidectomy. Methods: We conducted a prospective comparative study on 142 pediatric patients with persistent OME. Participants were allocated into Group A (Endoscopic Coblation Adenotonsillotomy, n = 72) and Group B (Conventional Curettage Adenoidectomy, n = 70). Groups were homogeneous regarding age, gender, and baseline audiological parameters (p > 0.05), all presenting with moderate conductive hearing loss and Type B/C tympanograms. Primary outcomes included tympanometric normalization (Type A conversion), auditory gain (Air–Bone Gap closure), and the rate of secondary ventilation tube (VT) insertion, monitored at 1, 3, 6, and 12 months. Results: At the 1-month follow-up, Group A showed a higher normalization rate than Group B (75.0% vs. 60.0%), though this was near the threshold of statistical significance (p = 0.058). However, at 3, 6, and 12 months, the coblation group demonstrated significantly higher recovery rates (p < 0.05). By 12 months, 94.4% of Group A maintained a Type A tympanogram compared to 78.5% in Group B. Group A achieved a significantly lower mean ABG at 12 months (8.2 ± 3.1 dB vs. 12.6 ± 5.4 dB, p < 0.001), reflecting a superior auditory gain (20.2 dB vs. 15.3 dB). Furthermore, the recurrence rate was significantly lower in Group A (4.1% vs. 15.7%, p = 0.021), resulting in a substantially lower requirement for secondary VT insertion compared to the conventional group (2.7% vs. 12.8%, p = 0.018). Conclusions: Endoscopic coblation adenotonsillotomy provides significant long-term clinical advantages over conventional curettage. By ensuring precise, atraumatic clearance of the Fossa of Rosenmüller and addressing the tonsillar biofilm reservoir, this technique achieves more stable middle ear aeration and superior auditory recovery, significantly reducing the necessity for secondary surgical interventions at one year. Full article

Background/Objectives: This study aims to develop and validate a reproducible training model, built using common hospital items, for laparoscopic inguinal hernia repair with an intracorporeal suturing approach, specifically focusing on iliopubic tract redress in pediatric patients. Methods: Pediatric surgery residents and consultants were instructed on model building and engaged in training sessions. They practiced for four weeks with the handcrafted model and completed a post-simulation survey. The time taken to conclude the training task and the modified Objective Structured Assessment of Technical Skills score were compared between the initial and last sessions at the end of the training period. Additionally, the time required by consultants to perform the laparoscopic procedure in vivo, intraoperative complications, and recurrence rates were analyzed from the time they started the training. Results: A feasible model was created using a colostomy dressing support, Penrose drains, Foley catheters, feeding tubes, and surgical gloves to simulate. The sample involved a total of twelve residents and five consultants with an average age of 33 years old. All participants successfully completed the task during the session. Since the consultants started their training on the model, the operative results for laparoscopic inguinal hernia repair in the theater have improved. Conclusions: Training experience on this model led to improve laparoscopic skills such as cutting and dissection and intracorporeal tying and knotting. This study confirms that training outside clinical practice can significantly benefit laparoscopic proficiency and safety in vivo. Full article

Background/Objectives: Superior cluneal nerve entrapment syndrome (SCNES) is an underrecognized cause of chronic low back pain, particularly in adolescents where published experience is limited. This article describes a reproducible open surgical technique for superior cluneal nerve (SCN) decompression. Methods: We outline indications and relative contraindications, required instrumentation, key surface landmarks, and a stepwise operative approach. The nerve is identified where SCN branches traverse the thoracolumbar fascia and fibro-osseous tunnel near the posterior iliac crest. Decompression is performed via limited fasciotomy and release of surrounding soft tissues, with attention given to identifying additional branches requiring release. Results: The technique provides consistent exposure and decompression of the SCN branches using an approximately 5 cm oblique incision centered over the expected crossing point (about 7 cm lateral to the midline and roughly 4 cm lateral to the PSIS). Pearls and pitfalls are provided to reduce peri-incisional numbness and avoid thermal injury to the nerve. Conclusions: Open SCN decompression is a focused procedure that can be considered after confirmation of SCNES by clinical criteria and response to diagnostic block. Standardizing technique and postoperative care may facilitate broader adoption and future outcome studies in pediatric populations. Full article

Background: Cemented fixation remains the standard for total knee arthroplasty (TKA), with Palacos^® R considered the gold standard bone cement. However, more cost-efficient alternatives, like Biomet Bone Cement^® (BBC), require evaluation to confirm comparable outcomes. This retrospective 5-year study compares the clinical safety, performance, and radiographic outcomes of BBC versus Palacos-R in primary TKA, highlighting BBC’s potential as a comparable, cost-effective option amid the increasing cost of outpatient surgeries. Methods: This is a single-center, retrospective study of 128 consecutive patients undergoing primary TKA, evaluated over 5 years. The first 64 patients received Palacos-R, and the subsequent 64 patients received BBC. Radiographic outcomes, including cement gaps, radiolucency, periprosthetic osteolysis, and subsidence, were assessed using the Knee Society Radiographic scheme at immediate post-operative, 6-month, 1-year, 3-year, and 5-year intervals. Clinical outcomes were measured using the Knee Society Score (KSS) and the University of California Los Angeles Activity (UCLA) score. Statistical analyses included chi-square, Fisher’s exact tests, and t-tests (p < 0.05). Results: Cement gaps were significantly higher in the Palacos-R cohort at immediate postop (p = 0.0002) and 1-year (p = 0.0003), with no significant difference at 3 and 5 years. Radiolucency was non-progressive (<2 mm) in both cohorts. KSS was significantly higher in the Palacos-R group at 6 months, 1 year, and 3 years (p < 0.001), but equivalent at 5 years (p = 0.42). UCLA scores showed no differences. No revisions were required in either cohort. Conclusions: While BBC demonstrated comparable radiographic stability and clinical outcomes to Palacos at 5 years with no revisions in either cohort, the absence of preoperative KSS and UCLA scores is a major limitation that prevents adjustment for baseline function and limits interpretation of the early postoperative KSS differences. Full article

Background: Unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated compartment knee osteoarthritis, but it is associated with a higher risk of revisions. UKA-to-TKA conversions remain surgically challenging. In particular, the restoration of correct femoral rotation is difficult, mainly because of bone loss and altered anatomical landmarks. We describe a novel imageless robotic-assisted technique for UKA-to-TKA conversion using the ROSA™ robotic system and report a representative clinical case. Methods: After a standard medial parapatellar approach and joint exposure, the landmarks are registered with the UKA in situ, followed by the standard workflow for a robotic-assisted primary TKA according to the “inverse functional alignment” philosophy (virtual planning, tibial cut, planning adjustment, distal femoral cut and planning adjustment). At last, the femoral component rotation is defined using the FuZion^® tensioner, with the UKA femoral component being left in situ to compensate for the lateral posterior condyle bone loss. Results: A 72-year-old female patient underwent robotic-assisted lateral UKA-to-TKA conversion due to aseptic loosening of the tibial component. Accurate bone resection, restoration of alignment, and soft tissue balancing were achieved, avoiding the use of augments. Postoperative recovery was uneventful, with satisfactory clinical and functional outcomes at 3-month follow-up. Conclusions: Imageless robotic-assisted UKA-to-TKA conversion using the ROSA™ system seems a valuable aid in these complex scenarios. To our knowledge, this is the second report describing this procedure using the ROSA™ robot and the first presenting a distinct surgical technique. Further studies on larger cohorts are needed to confirm this technique efficacy and possible limitations. Full article

Objectives: To evaluate the short-term safety (30-day and in-hospital morbidity and mortality) and technical feasibility of uniportal video-assisted thoracic surgery (U-VATS) for anatomical lung resection in octogenarians (≥80 years) compared with younger patients (<80 years) at a single center. Methods: Ninety consecutive patients undergoing U-VATS anatomical lung resections between January 2020 and January 2024 were retrospectively analyzed. Patients were stratified by age: 60 patients < 80 years and 30 octogenarians ≥ 80 years. Propensity score matching (nearest-neighbor, 1:2 ratio, caliper 0.2 SD) yielded a matched cohort of 60 patients (40 younger, 20 octogenarians) for comparative analysis. Results: After matching, standardized mean differences (SMD) were <0.25 for most covariates, indicating good balance. Octogenarians demonstrated lower FEV1 (75.2 ± 15.3% vs. 87.5 ± 18.2%, p = 0.012) and DLCO (68.4 ± 12.1% vs. 78.5 ± 14.3%, p = 0.009), consistent with age-related pulmonary changes. Charlson Comorbidity Index was higher (5.3 ± 1.2 vs. 3.8 ± 1.4, p = 0.001). Surgical parameters were comparable: operative time (143.80 ± 42.3 vs. 136.55 ± 38.7 min, p = 0.524), blood loss (median 80 [IQR 50–120] vs. 95 [IQR 60–130] mL, p = 0.742). Zero conversions occurred. Major complications (Clavien–Dindo ≥ 3) occurred in 10% vs. 0% (absolute risk difference 10%, 95% CI: −3.2% to 23.2%). No 30-day mortality. 90-day mortality: 5% vs. 0% (p = 0.333); one-year: 15% vs. 0% (p = 0.035). Conclusions: U-VATS is technically feasible in carefully selected octogenarians with comparable intraoperative parameters to younger patients. Postoperative recovery differed meaningfully, with higher delirium rates, longer hospitalization, and greater rehabilitation needs. One-year mortality was higher in octogenarians, reflecting competing comorbid risk rather than surgical harm. Residual imbalance in comorbidity burden and pulmonary reserve after matching limits causal inference. These hypothesis-generating findings support U-VATS in selected octogenarians when comprehensive geriatric assessment and structured delirium prevention guide perioperative management; validation in larger multicenter prospective studies is required. Full article

(1) Background and introduction: High-demand lumbosacral fusions are often supplemented with sacral-alar-iliac (SAI) screws. The idealized SAI trajectory was estimated to traverse 35 mm of sacrum before crossing the sacroiliac (SI) joint. However, there is debate on how much osseous purchase SAI screws achieve. The goal of this study was to determine the amount of osseous engagement achieved using a porous fusion–fixation screw (PFFS) when placed in a stacked SAI configuration. (2) Materials and methods: We retrospectively reviewed 40 consecutive patients who underwent sacropelvic fixation with stacked PFFS at our institution from 1 June 2022 to 30 June 2023, using intraoperative computed tomography (CT)-based computer navigation. A snapshot of each screw was taken and the length of purchase within the sacrum and ilium was measured on the axial image along the anterior and posterior aspect of each screw. Nineteen patients did not have adequate images available for review and were excluded. (3) Results: The overall mean anterior sacral engagement was 38.6 mm (±8.2 mm), which was found to be statistically significantly greater than the hypothesized threshold of 35 mm (p < 0.001), while posterior sacral engagement was 28.1 mm (±8.6 mm), which was not found to be statistically significantly greater than the hypothesized threshold of 35 mm (p = 1). The mean difference in sacral engagement between the anatomical location for the cephalad screws was 10.3 mm (p < 0.001) and 10.6 mm (p < 0.001) for the caudal screws. The total sacral surface area available for bone ingrowth for bilateral stacked PFFS was calculated to be 3338.3 mm², while the total iliac surface area available for bone ingrowth was 4364.8 mm². A mean difference in surface area availability between anatomical locations was −689.5 mm² (p < 0.001) for the sacrum and 689.5 mm² (p < 0.001) for the ilium. (4) Discussion and conclusions: The SAI trajectory screws in this cohort of patients achieved approximately 39 mm of sacrum engagement anteriorly and 28 mm posteriorly. This is consistent with prior estimates based on the idealized SAI pathway through the sacrum. PFFSs allow for simultaneous sacropelvic fixation and SI joint fusion, which may reduce the incidence of de novo SI joint pain in patients with long fusion constructs. Full article

Background: Limb-salvage surgery using extendable distal femoral endoprostheses has become the standard reconstruction following tumor resection in skeletally immature patients, allowing continued growth and improved function. However, mechanical complications, particularly tibial pain, remain challenging and poorly understood. This study aimed to identify radiographic predictors of tibial pain and evaluate their potential utility in early risk detection. Methods: A retrospective cohort study was conducted of 29 skeletally immature patients (mean age 10.4 years) who underwent expandable distal femoral endoprosthetic replacement between 2008 and 2018 at a tertiary orthopedic oncology center. Standardized radiographs were analyzed at 6 months and final follow-up (mean 75 months) to assess cortical thickness, stem-to-cortex distances, stem migration, stress shielding, pedestal formation, and periosteal reaction. Associations between radiographic parameters and tibial pain were assessed using multivariable logistic regression, t-tests, and chi-square analyses. Results: Seventeen patients (58.6%) developed activity-limiting tibial pain requiring analgesics, as documented during follow-up. Mean medial and lateral cortical thickness increased from 3.0 mm and 3.4 mm to 4.1 mm and 5.1 mm, respectively. The logistic regression model demonstrated strong explanatory power (Pseudo R² = 0.57, p = 0.004). Medial cortical thickness at last follow-up was the only significant independent predictor of tibial pain (p = 0.042), and was significantly associated with tibial pain. Patients with tibial pain exhibited greater medial cortical thickening (p < 0.001). Stem migration (φ = 0.421, p = 0.065), stress shielding (φ = 0.476, p = 0.044), pedestal formation (φ = 0.608, p = 0.004), and periosteal reaction (φ = 0.569, p = 0.008) were also associated with pain. Conclusions: Medial cortical hypertrophy emerged as a potential radiographic biomarker for tibial pain. after expandable distal femoral endoprosthesis in growing patients. The findings suggest that cortical remodeling, stress shielding, and pedestal formation collectively reflect stem micromotion and bone adaptation. Early radiographic surveillance of these parameters warrants further investigation in prospective studies to determine their clinical utility. Larger multicenter studies are warranted to validate these predictors and refine postoperative monitoring protocols. Full article

Background: In the last few decades, endoscopic endonasal approaches (EEA) have revolutionized surgical access to the sellar region and anterior cranial fossa (ACF). One technique, the endoscopic endonasal transethmoidal transcribriform approach (EETTA), offers distinct advantages over traditional open transcranial approaches, such as reduced morbidity, shorter hospital stays, faster recovery, and a reduced risk of neurological deficit due to less brain tissue manipulation. Methods: We present a comprehensive step-by-step description of the EETTA surgical technique, illustrated through four representative cases of varying pathologies treated at our institution. The anatomical boundaries—including the lamina papyracea, anterior and posterior ethmoidal arteries, and frontal sinus—and the surgical corridor are detailed alongside indications, technical nuances, limitations, and operative recommendations. Results: Four cases demonstrate the versatility of EETTA across diverse pathologies: two olfactory groove meningiomas (including one WHO grade 2 and one recurrent case with invasive skull base involvement), an esthesioneuroblastoma (ENB), and a recurrent inverted papilloma requiring combined transcranial and endoscopic resection. Near-total or gross-total resection was achieved in all cases. The indications, nuances, and limitations of this approach are discussed, along with tips for successful surgery. Conclusions: The EETTA represents an important minimally invasive option for ACF tumors extending into the nasal cavity, with midline involvement limited medially by the lamina papyracea. Success requires a thorough understanding of skull base anatomy, meticulous multilayer reconstruction techniques, and appropriate patient selection, based on the tumor location and lateral extension. While cerebrospinal fluid (CSF) leak remains the primary concern, contemporary techniques have substantially reduced this complication rate. Full article

Background: The extent to which bone marrow aspiration technique affects the biological quality of bone marrow aspirate and its clinical relevance in knee osteoarthritis remains uncertain. This study compares the efficacy of the traditional aspiration method and the Snap Back technique at two anatomical harvest sites, the posterior iliac crest and the proximal tibia. Methods: This ancillary post hoc analysis was conducted within a randomized trial comparing posterior iliac crest and proximal tibia harvest sites in 60 patients with unicompartmental knee OA. Aspiration technique (traditional vs. Snap Back) was selected intraoperatively and not randomized. BMA samples were analyzed for MSCs, mononuclear cells (MNCs), platelet concentration, and marrow purity. Clinical outcomes were assessed at baseline and six months using the Visual Analog Scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Results: The posterior iliac crest yielded significantly higher MSC and MNC concentrations compared to the tibia, with superior purity and PLT counts observed using the Snap Back technique. Within each anatomical site, Snap Back aspiration provided improved cellular recovery over the traditional method. However, differences in clinical outcomes between groups were modest and did not consistently reach statistical significance. Conclusions: Both harvest site and aspiration technique were associated with substantial differences in the cellular composition of BMA. The withdrawal from posterior iliac crest combined with the Snap Back technique optimizes MSC yield and marrow purity, though clinical improvements appear independent of cellular concentration in the short term. These findings suggest that standardized aspiration protocols may be relevant for the biological efficacy of orthobiologic therapies in knee OA. Full article

Background/Objectives: Deltoid ligament injury has been reported in up to 40% of ankle fractures, as confirmed by arthroscopy. Despite the frequency of this injury, there are multiple methods of fixation, including use of sutures, anchors and grafts, with no consensus in the field on a gold standard of operative technique for deltoid ligament injuries identified in bimalleolar equivalent ankle fractures. This manuscript aims to describe a novel surgical technique for deltoid ligament repair in the setting of bimalleolar equivalent ankle fractures. Surgical Technique: In this technique, following fixation of the fibula in bimalleolar equivalent ankle fractures, barbed polydioxanone (PDS) suture is utilized for direct repair of the deltoid ligament. This technique can be completed with the patient either prone or supine, uses standard fluoroscopy for evaluation of the competency of the deltoid ligament, and utilizes a familiar anteromedial approach to the medial malleolus. When compared to using anchors for repair of the deltoid ligament, barbed PDS suture seems to provide an equivalent and cost-effective strategy for repair. Conclusions: Repair of the deltoid ligament using suture anchors is a widely accepted method that has been demonstrated to provide successful repair. However, these anchors can be costly and rely on appropriate fixation in the bone to provide long-term fixation. This suture technique seems to offer a reliable, cost-effective technique for deltoid ligament repair. Full article

Background/Objectives: Recurrence after curative gastrectomy for gastric cancer remains common, and treatment options are limited. In selected patients with isolated locoregional relapse, salvage re-gastrectomy may provide durable disease control. This study compared outcomes of salvage re-gastrectomy and chemotherapy for isolated locoregional recurrence. Methods: We reviewed 500 consecutive gastrectomies performed between 2010 and 2024. In total, 66 patients (12.8%) developed isolated locoregional recurrence after previous R0 resection: 25 underwent salvage re-gastrectomy, and 41 received chemotherapy. Propensity-score matching (intended 1:2) was used to balance clinical and pathologic variables, yielding 42 patients (17 surgery, 25 chemotherapy). The primary endpoint was overall survival (OS) from recurrence diagnosis; secondary endpoints included perioperative outcomes and patterns of treatment failure. Results: There were no 30-, 60-, or 90-day deaths after salvage re-gastrectomy. Overall mortality was lower in the surgical group (41.2%) compared with chemotherapy (80.0%; p = 0.010). Salvage re-gastrectomy was independently associated with better OS (HR 0.15, 95% CI 0.02–0.87, and p = 0.035). A longer disease-free interval correlated strongly with survival (ρ = 0.80 and p < 0.001). Surgical patients experienced fewer local (0% vs. 52%) and peritoneal (0% vs. 20%) recurrences. Conclusions: For carefully selected patients with late, isolated locoregional recurrence, salvage re-gastrectomy is feasible and associated with longer survival and improved local control compared with chemotherapy alone. Larger prospective studies are warranted. Full article