Surgical Techniques Development

10 pages, 486 KB

Open AccessEditor’s ChoiceArticle

Predictive Factors for Union Time in Adult Diaphyseal Forearm Fractures

by Shai Factor, Ron Gurel, Gilad Eisenberg, Daniel Tordjman, Yishai Rosenblatt, Tamir Pritsch and Franck Atlan

Surg. Tech. Dev. 2023, 12(3), 135-144; https://doi.org/10.3390/std12030013 - 9 Aug 2023

Cited by 1 | Viewed by 4357

Abstract

Purpose: Although open reduction and internal fixation (ORIF) by plating are the treatment of choice for diaphyseal fractures of the forearm, delayed union and non-union remain as existing complications. This study aimed to analyze predictive factors for the union time in diaphyseal fractures [...] Read more.

Purpose: Although open reduction and internal fixation (ORIF) by plating are the treatment of choice for diaphyseal fractures of the forearm, delayed union and non-union remain as existing complications. This study aimed to analyze predictive factors for the union time in diaphyseal fractures of the forearm. Methods: A retrospective study was conducted on all adult patients with diaphyseal forearm fractures who underwent surgical treatment with plate fixation between 2007 and 2016 at a tertiary care referral center. The patients were divided into two groups based on their union times: ≤3 months or >3 months. They were then compared for demographics, fracture pattern and characteristics, associated injuries, type of fixation, and quality of postoperative reduction. Results: Eighty-six diaphyseal forearm bone fractures (radius, ulna, or both) were observed in 55 adults. Out of these fractures, 55 (65.1%) achieved union within ≤3 months, 26 (30.3%) took more than 3 months to achieve union, and 4 (4.6%) resulted in nonunion. The use of a locking plate in open reduction and internal fixation of diaphyseal forearm fractures significantly increased the likelihood of union within ≤3 months (p = 0.043). The parameter of gap width at the fracture site, as observed on postoperative X-rays, showed a qualitative and quantitative correlation with union time (p = 0.028). Conclusion: The use of a locking plate, combined with reducing the gap width at the fracture site after reduction during open reduction and internal fixation (ORIF) of diaphyseal forearm fractures, is significantly correlated with an increased likelihood of achieving bone union within 3 months. Full article

► Show Figures

Figure 1

9 pages, 2508 KB

Open AccessEditor’s ChoiceCase Report

The Ileojejunal Bypass: The Forgotten Procedure

by Caroline Mercedes Sobotta, Emre Tanay, Shadi Sued, Christopher Kieninger, Jörg Köninger and Tobias Meile

Surg. Tech. Dev. 2023, 12(3), 126-134; https://doi.org/10.3390/std12030012 - 26 Jul 2023

Viewed by 5140

Abstract

Since its inception in the early 1970s, bariatric surgery has experienced remarkable advancements, leading to improved patient outcomes. However, amidst these developments, the once-popular ileojejunal bypass procedure has faded into obscurity, along with its associated risks and complications. In this particular case, we [...] Read more.

Since its inception in the early 1970s, bariatric surgery has experienced remarkable advancements, leading to improved patient outcomes. However, amidst these developments, the once-popular ileojejunal bypass procedure has faded into obscurity, along with its associated risks and complications. In this particular case, we present the medical history of a 68-year-old male who endured prolonged hospitalization due to a myriad of health issues, including malnutrition, kidney stones, chronic kidney disease, and persistent diarrhea following an ileojejunal bypass performed back in 1973. Troublingly, his symptoms were erroneously attributed to other causes for an extended period, overlooking the potential long-term effects of his prior surgery. This case emphasizes the importance of recognizing and monitoring the lasting impacts of historical surgical interventions, as well as the need for heightened vigilance in postoperative care. Full article

► Show Figures

Figure 1

7 pages, 1407 KB

Open AccessEditor’s ChoiceCase Report

Achalasia Post-Bariatric Surgery, Placement Roux-En-Y Gastric Bypass: Case Report

by Juan Pablo Landeros-Ruiz, Lourdes Marlene Zúñiga-Ramos, Daniela Cárdenas-Guerrero and Quitzia Libertad Torres-Salazar

Surg. Tech. Dev. 2023, 12(3), 119-125; https://doi.org/10.3390/std12030011 - 25 Jul 2023

Cited by 1 | Viewed by 3802

Abstract

Introduction: Achalasia is a pathology with an incidence of 1 in 100,000 inhabitants per year. There are very limited data on achalasia in the obese population, especially in those undergoing bariatric surgery. The approach of choice for cases of achalasia is the procedure [...] Read more.

Introduction: Achalasia is a pathology with an incidence of 1 in 100,000 inhabitants per year. There are very limited data on achalasia in the obese population, especially in those undergoing bariatric surgery. The approach of choice for cases of achalasia is the procedure partial fundoplication to correct the reflux; however, lacking a fundus due to a previous gastrectomy, an alternative that offers optimal results should be chosen. Here, we present the surgical approach in a case of esophageal achalasia and a history of vertical sleeve gastrectomy, where we performed a simultaneous Heller’s cardiomyotomy and laparoscopic Roux-en-Y gastric bypass, as well as the results obtained. Case Presentation: A 44-year-old woman with no chronic degenerative diseases, who had a vertical sleeve gastrectomy carried out 5 years ago. Her first symptoms manifested 17 months before, and they were dysphagia to liquids and then to solids, in addition to weight loss of 10 kg in 4 months. Her body mass index before the vertical sleeve gastrectomy was 32 kg/m²; her body mass index at the time of admission was 20 kg/m²; she also presented regurgitation and generalized weakness. After analyzing the surgical options, it was decided to perform a Heller cardiomyotomy and a Roux-en-Y gastric bypass. Discussion and Conclusions: The procedure turned out to be safe and successful in treating achalasia symptomatology, in addition to completely resolving the reflux symptoms. Full article

► Show Figures

Figure 1

12 pages, 2565 KB

Open AccessEditor’s ChoiceArticle

Pediatric Supracondylar Fracture of the Humerus with Sideward Displacement

by Michael Zaidman, Mark Eidelman, Khaled Abu-Dalu and Pavel Kotlarsky

Surg. Tech. Dev. 2023, 12(3), 107-118; https://doi.org/10.3390/std12030010 - 30 Jun 2023

Cited by 1 | Viewed by 9189

Abstract

Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this [...] Read more.

Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this study was to calculate the incidence of this fracture subtype and suggest a modification to the standard operative technique, to achieve the desired fracture alignment and fixation. Methods: We reviewed the clinical records and radiographs of all pediatric patients with supracondylar humeral fractures surgically treated in our institution between the years 2006 and 2014. The fracture types, fixation configuration and any complications were recorded. Results: Overall, 263 consecutive patients were included. The incidence of supracondylar fracture of the humerus with solely sideward displacement was 6%. The fracture was characterized clinically and radiographically. We proposed a modification to the standard operative technique for this fracture subtype for successful closed reduction and percutaneous pinning. Conclusions: Special attention to this fracture subtype, including appropriate operating room setup and the application of a suitable reduction and pinning technique, has the potential to achieve successful results and avoid the need for open reduction. Full article

► Show Figures

Figure 1

8 pages, 2116 KB

Open AccessEditor’s ChoiceCase Report

Minimally Invasive Peritoneal Dialysis Catheter Insertion with Intraoperative Ultrasound-Doppler Measurement of Rectus Muscle Width and Inferior Epigastric Artery Localization

by Jurij Janež and Jan Grosek

Surg. Tech. Dev. 2023, 12(2), 99-106; https://doi.org/10.3390/std12020009 - 9 Jun 2023

Cited by 1 | Viewed by 4455

Abstract

Laparoscopic peritoneal dialysis catheter insertion is an established method for peritoneal dialysis catheter placement. One critical aspect of this procedure is rectus sheath tunneling. Proper peritoneal dialysis catheter incorporation within the abdominal wall is important for reducing pericatheter leaks and for proper peritoneal [...] Read more.

Laparoscopic peritoneal dialysis catheter insertion is an established method for peritoneal dialysis catheter placement. One critical aspect of this procedure is rectus sheath tunneling. Proper peritoneal dialysis catheter incorporation within the abdominal wall is important for reducing pericatheter leaks and for proper peritoneal dialysis functioning. Particularly, accurate positioning of the internal cuff within the rectus muscle sheath is crucial to prevent potential dialysate fluid leakage. In the present report, we describe the utilization of intraoperative ultrasound as a valuable tool for determining the ideal location of the internal cuff and assessing the course of the inferior epigastric artery during rectus sheath tunneling. This technique aims to optimize the position of the internal cuff and minimize complications such as vessel injury and pericatheter leaks. Furthermore, we demonstrate that post-catheter insertion, ultrasound imaging offers valuable insights into evaluating the appropriate placement of the internal cuff, external subcutaneous cuff, and potential bleeding within the abdominal wall. Full article

► Show Figures

Figure 1

12 pages, 4870 KB

Open AccessEditor’s ChoiceTechnical Note

Old but Gold: The Surgeon’s Affair to Manage Inguinal Hernia

by Mario Giuffrida, Gabriela Elisa Nita and Federico Biolchini

Surg. Tech. Dev. 2023, 12(2), 87-98; https://doi.org/10.3390/std12020008 - 25 May 2023

Viewed by 7884

Abstract

Purpose: Inguinal hernia repair is a common surgical procedure. It was widely reported worldwide during the COVID-19 pandemic. To manage the lack of anesthesiologists, we have introduced a new protocol to manage inguinal hernia repair. Methods: This protocol is the result of a [...] Read more.

Purpose: Inguinal hernia repair is a common surgical procedure. It was widely reported worldwide during the COVID-19 pandemic. To manage the lack of anesthesiologists, we have introduced a new protocol to manage inguinal hernia repair. Methods: This protocol is the result of a strong collaboration between surgeons and anesthesiologists. It was based on EHS recommendations and the well-described percutaneous ilioinguinal–iliohypogastric and genitofemoral nerves block. Results: More than 400 patients have been treated at our institution. The application of the protocol has led to a sensible reduction in initially planned spinal anesthesia. The complications traditionally related to spinal anesthesia have not been reported in 80% of the patients. Only three patients required the infusion of atropine or flumazenil without the need to involve anesthesiologist. Conclusion: The application of our protocol seems promising. Preliminary results have shown the safety and efficacy of percutaneous ilioinguinal–iliohypogastric and genitofemoral nerves block. The combination of this kind of anesthesia with wound protector and adequate postoperative pain control can lead to a reproducible system avoiding the not strictly necessary presence of an anesthesiologist. The changes that have occurred in the healthcare system in recent years should be new opportunities for the improvement of resources and results. Full article

► Show Figures

Figure 1

7 pages, 9373 KB

Open AccessEditor’s ChoiceTechnical Note

Posterior Cervical Unilateral Biportal Endoscopic One-Block Resection Technique for Cervical Ossified Ligamentum Flavum

by Rajeesh George and Pang Hung Wu

Surg. Tech. Dev. 2023, 12(2), 80-86; https://doi.org/10.3390/std12020007 - 9 May 2023

Viewed by 3071

Abstract

Background: There is sparse literature on the technique of single-stage anterior discectomy fusion and posterior decompression and flavectomy using the biportal endoscopic technique. Methods: Single-stage anterior discectomy fusion and posterior biportal endoscopic decompression and flavectomy apply to cervical myelopathy at a single level [...] Read more.

Background: There is sparse literature on the technique of single-stage anterior discectomy fusion and posterior decompression and flavectomy using the biportal endoscopic technique. Methods: Single-stage anterior discectomy fusion and posterior biportal endoscopic decompression and flavectomy apply to cervical myelopathy at a single level with an anterior disc and posterior ossified ligamentum flavum complex. Anterior discectomy and fusion were performed in the usual fashion in the supine position, and subsequently, posterior biportal endoscopic decompression was carried out after turning the patient prone. Conclusion: Single-stage anterior discectomy fusion and posterior biportal endoscopic decompression and flavectomy are good alternatives for circumferential decompression with myelopathy Full article

► Show Figures

Figure 1

12 pages, 1167 KB

Open AccessEditor’s ChoiceArticle

Analysis of Facial Nerve Functionality and Survival Rates of Patients with Parotid Salivary Gland Carcinoma Submitted to Surgery, Facial Nerve Reconstruction, and Adjuvant Radiotherapy

by Wilber Edison Bernaola-Paredes, Franco Novelli, Estefani Albuja-Rivadeneira, Adriana Aparecida Flosi, Anna Victoria Garbelini Ribeiro, Helena Rubini Nogueira, Hugo Fontan Köhler, Clóvis Antonio Lopes Pinto, Kleber Arturo Vallejo-Rosero and Antonio Cassio Assis Pellizzon

Surg. Tech. Dev. 2023, 12(2), 68-79; https://doi.org/10.3390/std12020006 - 18 Apr 2023

Viewed by 4809

Abstract

Background and Objectives: Parotid cancer (PC), when treated surgically, may have associated damage to the functionality of the facial nerve. The role of radiotherapy in the recovery of facial motricity remains controversial. This study aimed to evaluate the impact of radiotherapy (RT) on [...] Read more.

Background and Objectives: Parotid cancer (PC), when treated surgically, may have associated damage to the functionality of the facial nerve. The role of radiotherapy in the recovery of facial motricity remains controversial. This study aimed to evaluate the impact of radiotherapy (RT) on facial nerve functionality in patients who underwent parotidectomy and facial nerve microsurgical reconstruction. Materials and Methods: Four groups of patients were composed: (a) those who underwent parotidectomy without facial nerve reconstruction and RT; (b) those with nerve reconstruction and without RT; (c) those without nerve reconstruction and RT; and (d) those with nerve reconstruction and RT. Results: 49 patients were male, and 43 were female. A total of 89 underwent parotidectomy, 45 partials, and 44 total. Thus, in nine patients, the sural nerve was used for microsurgical reconstruction. Moreover, 48 patients had a normal facial pattern, 15 with paresthesia, and 29 with permanent paralyses after the House–Brackmann (HB) scale evaluation. Conclusions: The evaluation of nerve functionality after parotidectomy by the House–Brackmann scale is a feasible way to evaluate facial motricity that has already decreased in these patients. Finally, longitudinal studies must be performed to clarify the role of each therapy in the multimodal approach and their clinical impact in facial nerve function. Full article

► Show Figures

Graphical abstract

8 pages, 1602 KB

Open AccessEditor’s ChoiceTechnical Note

An Innovative Surgical Technique to Obtain an Adipose-Derived Stromal Cell-Rich Graft for the Treatment of Osteoarthritis: Technical Note

by Luca Ambrosio, Fabrizio Russo, Simone Catapano, Giuseppe Francesco Papalia, Gianluca Vadalà, Rocco Papalia and Vincenzo Denaro

Surg. Tech. Dev. 2023, 12(2), 60-67; https://doi.org/10.3390/std12020005 - 25 Mar 2023

Viewed by 3605

Abstract

Osteoarthritis (OA) is one of the main causes of disability worldwide and is caused by the progressive degeneration of joint tissues, ultimately leading to chronic pain and loss of function. Intraarticular delivery of mesenchymal stromal cells, such as adipose-derived stromal cells (ASCs), is [...] Read more.

Osteoarthritis (OA) is one of the main causes of disability worldwide and is caused by the progressive degeneration of joint tissues, ultimately leading to chronic pain and loss of function. Intraarticular delivery of mesenchymal stromal cells, such as adipose-derived stromal cells (ASCs), is being actively investigated due to their trophic properties observed in both preclinical and clinical studies. However, cell expansion and handling involve costly and time-consuming processes that limit their application. Recently, several devices and kits have been developed to isolate and process the stromal vascular fraction (SVF), a high biologically active compound of the adipose tissue, right at the patient’s bedside. In this study, we introduce a novel technique to obtain an SVF graft with a high content of ASCs for intraarticular injection directly from liposuction and with minimal equipment. In this technical note, we describe in detail the steps of the surgical technique as well as strategies to avoid common pitfalls and complications. Full article

► Show Figures

Figure 1

7 pages, 470 KB

Open AccessEditor’s ChoiceCase Report

RETRACTED: Lacrimal Gland Prolapse: Case Report

by Ei Ei Naing, Khin Thandar Myint and Roberto Roddi

Surg. Tech. Dev. 2023, 12(1), 53-59; https://doi.org/10.3390/std12010004 - 8 Mar 2023

Cited by 2 | Viewed by 17451

Abstract

Lacrimal gland prolapse is an important diagnosis to consider in patients with lateral upper eyelid fullness. Prolapse of the lacrimal gland is the descent of the lacrimal gland into the upper eyelid. It can result in blepharoptosis and a bulging “frog-eyed” appearance. This [...] Read more.

Lacrimal gland prolapse is an important diagnosis to consider in patients with lateral upper eyelid fullness. Prolapse of the lacrimal gland is the descent of the lacrimal gland into the upper eyelid. It can result in blepharoptosis and a bulging “frog-eyed” appearance. This is a case report of lacrimal gland prolapse in a 19-year-old female patient treated by suture repositioning of the glands in an outpatient surgical setting. We report on non-recognition of the prolapse and in the absence of essential surgical correction, in addition to the aesthetic disorders often reported, worsening of functional symptoms such as epiphora with major discomfort. Prolapse in young patients has not been reported in the international literature consulted, E&OE. Full article

10 pages, 945 KB

Open AccessEditor’s ChoiceSystematic Review

Hyperbaric Oxygen Therapy in Plastic, Aesthetic, and Reconstructive Surgery: Systematic Review

by Mariana Ríos-Gómez, Viviana Gómez-Ortega, Cesar Cardona and Jose A. De la Hoz-Valle

Surg. Tech. Dev. 2023, 12(1), 43-52; https://doi.org/10.3390/std12010003 - 20 Feb 2023

Cited by 5 | Viewed by 10687

Abstract

Introduction: Hyperbaric oxygen therapy (HBOT) has been used over the past six decades to treat multiple conditions. This systematic review aims to identify and evaluate the clinical outcomes of hyperbaric oxygen therapy in the field of plastic, reconstructive, and aesthetic surgery, found in [...] Read more.

Introduction: Hyperbaric oxygen therapy (HBOT) has been used over the past six decades to treat multiple conditions. This systematic review aims to identify and evaluate the clinical outcomes of hyperbaric oxygen therapy in the field of plastic, reconstructive, and aesthetic surgery, found in the literature from the year 2000 to the present. Methods: A systematic review of the literature focused on the conceptual and methodological aspects of the PRISMA Declaration. The search for clinical trials focused on the results of hyperbaric therapy in plastic, reconstructive, and cosmetic surgery. The Newcastle–Ottawa scale suggested by the Cochrane manual was applied to each study. The study was carried out with a defined protocol and was registered in PROSPERO, with code CRD42022301261. Results: From the 170 articles identified, 6 were selected. Five of them showed that hyperbaric oxygen therapy favored the reduction of the size of skin ulcers and increased the formation of granulation tissue (two trials; p < 0.05), increased the partial pressure of transcutaneous oxygen in patients with free flaps (one trial; p < 0.001), reduced perfusion in keloid scarring disorder (one trial; p < 0.01), and accelerated both the fading of melanin pigmentation and the decrease in age spot size (one trial; p < 0.05). The methodological quality was moderate in all cases because there was no blinding method reported. One study failed to find differences in flap survival, time to resolution of venous congestion, resolution of edema, and postoperative recovery period (p > 0.05). Conclusions: Hyperbaric oxygen therapy has been increasingly used in the field of plastic and reconstructive surgery, and has shown potential benefits in promoting wound healing, reducing the risk of infection, and improving the survival of tissues used in reconstructive procedures. Further research with more rigorous clinical trials is needed to fully understand the efficacy and optimal use of this therapy in the field of plastic and reconstructive surgery. Full article

(This article belongs to the Special Issue At the Frontiers of Plastic and Aesthetic Surgery)

► Show Figures

Figure 1

33 pages, 76907 KB

Open AccessEditor’s ChoiceReview

Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer—Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction

by Geetu Bhandoria, Aditi Bhatt, Sanket Mehta and Olivier Glehen

Surg. Tech. Dev. 2023, 12(1), 1-33; https://doi.org/10.3390/std12010001 - 21 Dec 2022

Cited by 4 | Viewed by 11131

Abstract

Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60–70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer [...] Read more.

Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60–70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer survival compared, complete cytoreduction benefits overall survival, making upper-abdominal cytoreduction an essential component of CRS for advanced ovarian cancer. The upper abdomen constitutes several vital organs and large blood vessels draped with the parietal or visceral peritoneum, common sites of disease in ovarian cancer. A surgeon treating advanced ovarian cancer should be well versed in upper-abdominal cytoreduction techniques, including diaphragmatic peritonectomy and diaphragm resection, lesser omentectomy, splenectomy with or without distal pancreatectomy, liver resection, cholecystectomy, and suprarenal retroperitoneal lymphadenectomy. Other procedures such as clearance of the periportal region, Glisson’s capsulectomy, clearance of the superior recess of the lesser sac, and Morrison’s pouch are essential as these regions are often involved in ovarian cancer. This manuscript covers the surgical anatomy of the upper abdomen, the techniques and therapeutic rationale of upper-abdominal cytoreduction, and specific measures for perioperative management of these patients. The main focus is the description of various peritonectomies and regional lymphadenectomies. Full article

► Show Figures

Figure 1

9 pages, 1633 KB

Open AccessEditor’s ChoiceArticle

The Outcomes of Three Surgical Approaches for Acromioclavicular Dislocation Treatment: Findings from Vietnam

by Nguyen Xuan Thuy, Nguyen Manh Tien, Vu Truong Thinh, Pham Van Hieu, Hoang Huy Phan, Dam Minh Duc, Bui Tuan Nghia, Tran Minh Long Trieu and Duong Ngoc Le Mai

Surg. Tech. Dev. 2022, 11(3), 105-113; https://doi.org/10.3390/std11030010 - 15 Nov 2022

Cited by 2 | Viewed by 6884

Abstract

Background: Acromioclavicular (AC) dislocation, one of the most common shoulder joint injuries, can be treated by several surgical methods. However, there are still few records about the treatment quality. This study aims to describe the outcomes of three surgical methods for acromioclavicular [...] Read more.

Background: Acromioclavicular (AC) dislocation, one of the most common shoulder joint injuries, can be treated by several surgical methods. However, there are still few records about the treatment quality. This study aims to describe the outcomes of three surgical methods for acromioclavicular dislocation treatment at Viet Duc University Hospital, Vietnam. Methods: A cross-sectional study was conducted on 80 patients diagnosed with AC. We retrospectively collected data in the medical records and re-examined the patients. Results: There was no difference between the three groups of surgical approaches relating to the patient’s characteristics, except for the time from the accident to hospital admission. The median length of stay after surgery was highest in the Hook plate group (median (IQR) = 5(2) days), while it was lowest in the K-wire group (median (IQR) = 3(1) days) (p < 0.05). There is statistical significance in the difference of coracoclavicular distance between pre and post-operation in all three surgical method groups (p < 0.001). Conclusion: All of the methods—Hook plate, K-wire, and TightRope—were associated with optimistic outcomes and restored initial anatomy. While the three surgical methods are both safe and effective, the K-wire method is associated with a shorter length of stay and might be economical. Full article

► Show Figures

Figure 1

7 pages, 1723 KB

Open AccessEditor’s ChoiceCase Report

Custom-Made 3D Titanium Plate for Mandibular Reconstruction in Surgery of Ameloblastoma: A Novel Case Report

by Somangshu Chakraborty, Rajdeep P. Guha, Sukanya Naskar and Rajarshi Banerjee

Surg. Tech. Dev. 2022, 11(3), 98-104; https://doi.org/10.3390/std11030009 - 31 Oct 2022

Cited by 5 | Viewed by 10574

Abstract

Ameloblastoma is a benign yet locally invasive odontogenic neoplasm, characterised by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, with recurrence commonly occurring. The safety margin of resection is hence essential to avoid recurrence. Understanding [...] Read more.

Ameloblastoma is a benign yet locally invasive odontogenic neoplasm, characterised by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, with recurrence commonly occurring. The safety margin of resection is hence essential to avoid recurrence. Understanding the three-dimensional anatomy for reconstruction of mandibular defects after tumour resection often poses problems for head and neck surgeons. Historically, various autografts and alloplastic materials have been used in the reconstruction of these types of defects. Over time, advances in technology with computed tomography scanners and three-dimensional images enhance the surgical planning and management of maxillofacial tumours. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is vital for the clinical outcome. The objective of this paper was to report a clinical case of employing these methodologies for reconstruction after an extensive mandibular resection. The clinical outcomes were observed. A case of follicular ameloblastoma of the mandible is depicted in the following paper, where a 3D biomodel was used throughout the surgery. A 3D printed patient-specific titanium implant was manufactured and placed intraoperatively for reconstruction. The treatment had satisfactory postoperative results without complications. Titanium implants being bioinert, customisable and easily workable, especially with the help of 3D virtual planning techniques, can be considered as ideal alloplastic materials for mandibular reconstruction. Full article

(This article belongs to the Special Issue At the Frontiers of Plastic and Aesthetic Surgery)

► Show Figures

Figure 1

8 pages, 2297 KB

Open AccessEditor’s ChoiceArticle

Clinical Application of 3D Visualization Technology in Pancreatoduodenectomy

by Yubo Zhang, Gang Yang, Peng Lei and Danyang Zhang

Surg. Tech. Dev. 2022, 11(3), 90-97; https://doi.org/10.3390/std11030008 - 24 Sep 2022

Cited by 3 | Viewed by 4468

Abstract

Objective: To explore the surgical effect of three-dimensional (3D) image reconstruction technology in pancreatoduodenectomy. Methods: The clinical records of 47 cases who underwent pancreatoduodenectomy between January 2018 and December 2019 at the department of hepatobiliary surgery of the General Hospital of Ningxia Medical [...] Read more.

Objective: To explore the surgical effect of three-dimensional (3D) image reconstruction technology in pancreatoduodenectomy. Methods: The clinical records of 47 cases who underwent pancreatoduodenectomy between January 2018 and December 2019 at the department of hepatobiliary surgery of the General Hospital of Ningxia Medical University were retrospectively examined, including 23 males and 24 females, with an average age of 55.00 ± 10.06 years. All patients underwent enhanced computed tomography (CT), and the 3D images were reconstructed by uploading the CT imaging data. The pre-operation evaluation and treatment strategy were planned according to CT imaging and 3D data, respectively. The change of treatment strategy based on 3D evaluation, actual surgical procedure, tumor volume measured by 3D model, actual tumor volume, variants of hepatic artery, operation time, intraoperative blood loss, post-operation hospital stay and post-operation complications was recorded. Results: The treatment strategies were changed after 3D visualization in 10 (21.3%) out of 47 patients because of blood vessel and organ invasion by tumor. The surgical procedure was changed in three cases, and the surgical procedure was optimized and improved in seven cases. All surgical plans based on 3D visualization technology were matched with the actual surgical procedures. Tumor volume measured by 3D model was 19.69 ± 23.47 mL, post-operation actual tumor volume was 17.07 ± 20.29 mL, with no significant difference between them (t = 0.54, p = 0.59). Pearson’s correlation analysis showed statistical significance (r = 0.766, p = 0.00). The average operation time was 4.85 ± 1.75 h, median blood loss volume was 447.05 (50–5000) mL, and post-operation hospital stay was 26.13 ± 11.13 days. Six cases had pancreatic fistula, two cases had biliary leakage, and four cases had delayed gastric emptying. Ascites and pleural effusion was observed in three cases. Conclusions: 3D visualization technology can offer a precise and individualized surgical plan before operation, which might improve the safety of pancreatoduodenectomy, and has application value in preoperative planning. Full article

► Show Figures

Figure 1

19 pages, 12650 KB

Open AccessFeature PaperEditor’s ChoiceArticle

Technical Note on Unilateral Biportal Lumbar Endoscopic Interbody Fusion

by Eugene Tze-Chun Lau and Pang Hung Wu

Surg. Tech. Dev. 2022, 11(2), 71-89; https://doi.org/10.3390/std11020007 - 15 Aug 2022

Cited by 5 | Viewed by 8961

Abstract

Unilateral biportal lumbar endoscopic interbody fusion is a relatively new technique in the field of minimally invasive spine surgery. It combines the benefits of preservation of the normal anatomy of the spine with direct visualization of the decompression of neural elements and endplate [...] Read more.

Unilateral biportal lumbar endoscopic interbody fusion is a relatively new technique in the field of minimally invasive spine surgery. It combines the benefits of preservation of the normal anatomy of the spine with direct visualization of the decompression of neural elements and endplate preparation for fusion. This results in high union rates and excellent outcomes for patients with back pain and lumbar spinal stenosis from spondylolisthesis while reducing the risk of injuries to the neural elements, endplate fractures and the theoretical rate of adjacent segment disease from disruption of the musculature. In this paper, we describe the steps and technical pearls pertaining to this technique and methods to avoid common pitfalls and complications. In conclusion, this technique would be a good tool in the armamentarium of a spinal surgeon specializing in minimally invasive spinal surgery. Full article

► Show Figures

Figure 1

9 pages, 2714 KB

Open AccessEditor’s ChoiceCase Report

Surgical Ostioplasty of the Left Main Coronary Artery: An Alternative to Coronary Artery Bypass Grafting in the Treatment of Left Main Stem Isolated Ostial Stenosis—A Case Series

by Alvaro Perazzo, Pedro Rafael Vieira de Oliveira Salerno, Mariana Ferreira Paulino, Vitoria de Ataide Caliari, Isabella Martins Ribeiro, Roberto Lorusso, Ricardo de Carvalho Lima and Pedro Rafael Salerno

Surg. Tech. Dev. 2022, 11(2), 62-70; https://doi.org/10.3390/std11020006 - 20 Jul 2022

Cited by 2 | Viewed by 4814

Abstract

This study aims to demonstrate the use of surgical ostioplasty of the left main coronary artery as an alternative technique to the conventional use of coronary artery bypass grafting for the treatment of left main stem-isolated ostial stenosis. From 2002 to 2021, five [...] Read more.

This study aims to demonstrate the use of surgical ostioplasty of the left main coronary artery as an alternative technique to the conventional use of coronary artery bypass grafting for the treatment of left main stem-isolated ostial stenosis. From 2002 to 2021, five patients—three women (60%) and two men (40%)—presented with a history of angina pectoris and were diagnosed with isolated stenosis of the coronary ostia associated with normal distal coronary arteries. Pre-operative cardiac catheterization and echocardiography were performed to aid in the diagnosis. The patients were submitted to surgical ostioplasty with a posterior approach using a saphenous patch. There were no hospital deaths or myocardial infarctions during the post-operative period. The mean cardiopulmonary bypass time was 82 min (range, 70–95 min), and the mean aortic-clamp time was 62 min (range, 55–75 min). The average time of hospitalization was 6.2 days (range, 4–18 days). Patients with isolated stenosis of the coronary ostia associated with normal distal coronary arteries may be submitted to left main coronary artery ostioplasty as an alternative to coronary artery bypass grafting, the traditional surgical technique for this pathology. Full article

► Show Figures

Figure 1

8 pages, 1670 KB

Open AccessEditor’s ChoiceArticle

The Utility of Lesser Trochanter Version to Estimate Femoral Anteversion in Total Hip Arthroplasty: A Three-Dimensional Computed Tomography Study

by Mohamed Zaim bin Mohamed Thajudeen, Azhar Mahmood Merican, Muhammad Sufian Hashim and Abid Nordin

Surg. Tech. Dev. 2022, 11(2), 54-61; https://doi.org/10.3390/std11020005 - 28 Jun 2022

Cited by 2 | Viewed by 6873

Abstract

Objective: Femoral anteversion is an important parameter that can prevent complication following total hip arthroplasty (THA) caused by improper positioning of the implant. However, assessing the femoral anteversion can be challenging in situations with significant defect of the femoral neck. In this study, [...] Read more.

Objective: Femoral anteversion is an important parameter that can prevent complication following total hip arthroplasty (THA) caused by improper positioning of the implant. However, assessing the femoral anteversion can be challenging in situations with significant defect of the femoral neck. In this study, the lesser trochanter version was nominated as alternative parameter to femoral anteversion. So, the main objective of this study is to determine whether the femoral anteversion correlates with the lesser trochanter version. Design: Retrospective study. Methods: Three-dimensional images of 100 femora were generated and their femoral anteversion and lesser trochanter version was measured. Correlation between the parameters were calculated. Results: The mean lesser trochanter version was 38.54° ± 7.86° (mean ± SD), while the mean femoral anteversion was 11.84° ± 10.06°. The lesser trochanter version was inversely correlated with the femoral anteversion with a correlation coefficient of −0.72. Conclusions: The lesser trochanter should be considered as an additional bony landmark to assess proper implant positioning in THA. Full article

► Show Figures

Figure 1

7 pages, 605 KB

Open AccessEditor’s ChoiceArticle

Inframammary Fold Banking of the Non-Dominant Superficial Epigastric Vein (SIEV) in Unilateral Autologous Breast Reconstruction: A Simple and Helpful Backup Option for Revision Surgery

by Christoph Hirche, Ulrich Kneser and Sebastian Fischer

Surg. Tech. Dev. 2022, 11(1), 47-53; https://doi.org/10.3390/std11010004 - 19 May 2022

Cited by 1 | Viewed by 3650

Abstract

Free flaps from the lower abdomen represent the workhorses of modern autologous, microvascular breast reconstruction. Rare signs of venous congestion often become evident during the primary index operation, but a secondary shift of the initially dominant drainage of the DIEV system to the [...] Read more.

Free flaps from the lower abdomen represent the workhorses of modern autologous, microvascular breast reconstruction. Rare signs of venous congestion often become evident during the primary index operation, but a secondary shift of the initially dominant drainage of the DIEV system to the SIEV system with consequent malperfusion is a feared, rare event requiring urgent decision, and complex skill using vein grafts and additional anastomosis to restore a sufficient venous outflow. For secondary anastomosis of the SIEV, especially in stacked flaps, a vein graft to the DIEV or retrograde IMV may be necessary, but this requires an additional donor site, thus prolonging procedure time during the emergency operation and resulting in additional scars of the graft’s donor site. We report on a versatile, easy technique of scheduled inframammary fold banking of the dissected, flushed, and clipped non-dominant superficial epigastric vein (SIEV) in unilateral autologous breast reconstruction during the index operation. The banked graft may service as an easy and convenient accessible vein graft in the rare event of secondary shifting of the initial dominant drainage of the DIEV to the SIEV system with the need for urgent re-operation. We retrospectively evaluated the management and outcome of all suitable patients receiving autologous breast reconstruction with a unilateral abdominal DIEP or MS-Tram flap accompanied by banking of the SIEV in the breast pocket between 2017 and 2020 in the present study. In two out of 42 patients (4.8%) receiving autologous breast reconstruction with an abdominal DIEP or MS-TRAM flap with banking of the SIEV in the breast pocket, secondary malperfusion of the flap with progressive venous congestion occurred during the first 48 h perioperatively, between 2 and 37 (mean: 19.5) hours after skin closure. In both cases malperfusion was due to secondary SIEV system dominance, and the banked vein was used as an interpositional graft to the retrograde IMV (case 1) or the DIEV (case 2). Revision surgery lasted between 95 and 121 (mean: 108) minutes without the need for further vein graft harvesting, and further healing was uneventful. Based on the limited cases, inframammary fold banking of the non-dominant SIEV is a versatile, beneficial, and feasible concept with scarce additional dissection time and can be done in all unilateral breast reconstructions to have a reliable graft for emergency re-exploration. It is a useful approach in the context of spare part surgery and tissue banking to safeguard against the rare instance of venous congestion and need for an interpositional graft. Full article

(This article belongs to the Special Issue At the Frontiers of Plastic and Aesthetic Surgery)

► Show Figures

Figure 1

2 pages, 328 KB

Open AccessEditor’s ChoiceArticle

Successful Surgical Treatment of Intractable Post-Radiation Rectal Bleeding

by Rezvan Mirzaei, Bahar Mahjoubi, Jalil Shoa, Roozbeh Cheraghali and Zahra Omrani

Surg. Tech. Dev. 2021, 10(1), 9125; https://doi.org/10.4081/std.2021.9125 - 13 Jan 2022

Viewed by 2622

Abstract

Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8–12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. [...] Read more.

Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8–12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. Here we present a 64 year old female with metastatic breast cancer, who was referred to us for intractable rectal bleeding. Total colonoscopy and rigid rectosigmoidoscopy revealed proctitis, rectal and sigmoidal telangiectasis, multiple necrotic ulcers between 15 to 30 cm from the anal verge, and also huge ishemic ulcer with patchy necrotic areas about 10 cm from the anal verge. This abnormal irradiated part was resected and then mucosectomy of the remnant rectum, both transabdominally and transanally was done. We performed pull-through technique of normal proximal colon to anal region through the remnant rectal wall and finally did coloanal anastomosis. Diverting stoma was not made because of anastomosis in anal region. With this technique we can achieve benefits such as avoidance of harsh dissection in a frozen pelvis and its consequences, we can avoid intra-abdominal anastomosis, there is no need to a diverting stoma and, most important of all, definite bleeding control. Full article

Journal Menu

Journal Browser

Editor’s Choice Articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI