Search Results (70)

Background/Objectives: Acute bacterial endocarditis (ABE) is a frequent situation and continues to be a challenge. Mitral valve involvement during acute bacterial endocarditis is often the result of the spread of the endocarditic process from the adjacent aortic valve. Mitral involvement, on the other hand, could also be an expression of the initial localization of the bacteria. The best option for treating mitral ABE is still a matter of debate. Recent reports have shown satisfactory results with mitral reconstructive techniques in the treatment of mitral ABE. In this study, we present a comprehensive review of our 10-year institutional experience in the surgical management of acute mitral endocarditis with a focus on technical considerations, outcomes, and the durability of mitral valve repair in this high-risk population. Methods: We queried the institutional database, cross-referencing patients admitted with a diagnosis of “acute bacterial endocarditis” with patients undergoing surgical procedures for “valvular disease” at our division. Out of 1136 valvular procedures listed in our PACS database, 180 patients were admitted with a diagnosis of active acute endocarditis, and 46 included treatment of the mitral valve. We analyzed and compared short- and long-term follow-up (ranging from 3 to 141 months with a mean of 42 ± 38 months) of these 46 patients, dividing them into two groups: mitral valve repair (MVr) and mitral valve replacement (MVR). Results: 18 (40%) patients underwent reconstructive treatment of the mitral valve, and 28 (60%) underwent mitral valve replacement. Cumulative in-hospital mortality was 10% (5 pts, all from the MVR group), however, with no difference between the two groups. A shorter time gap from diagnosis to surgery (<10 days) was the only predictive factor for early mortality. A further 11 patients died during follow-up (2 from group A and 9 from group B). Long-term survival, on the other hand, was negatively influenced by MV surgical replacement (p = 0.0178), older patients’ age (>60 years), and urgent surgical procedures. Finally, patients with MVr also experienced a favorable postoperative event-free curve for endocarditis recurrence (p = 0.0260) and time elapsed before recurrence (p = 0.0438). Conclusions: Mitral valve repair in the case of active endocarditis could be a treatment associated with more favorable outcomes, providing that a complete eradication of infective tissue can be accomplished. Conservative treatment, when feasible, seems to offer favorable cumulative long-term outcomes. Full article

Background: Glioblastoma (GBM), IDH-wildtype, is one of the most aggressive primary brain malignancies, and maximal safe resection is consistently recognized as a significant prognostic factor. Intraoperative adjuncts including functional mapping, neuronavigation, and fluorescence-guidance are not always present in many centers around the world. The aim is not to suggest equivalence to adjunct-assisted resections, but rather to illustrate the feasibility of anatomy-guided surgery in carefully selected cases and to contribute to the broader discussion on safe operative strategies in resource-limited environments. Methods: We present the case of a 54-year-old right-handed male who presented with progressive non-fluent aphasia, seizures, and signs of intracranial hypertension. Pre-operative MRI showed a heterogeneously hyperintense, frontobasal intra-axial mass involving the dominant inferior frontal gyrus, extending toward the corpus callosum and orbitofrontal cortex, and early subfalcine shift. Surgery was performed via a left frontobasal craniotomy, using subpial dissection and cortical–sulcal anatomical landmarks while aiming to preserve eloquent subcortical tracts (frontal aslant tract, superior longitudinal fasciculus). Nueronavigation, functional mapping or fluorescence was not used. We defined our outcomes by the extent of resection, functional preservation, and early radiological stability. Results: The procedure achieved a subtotal-near-total resection (>95% estimated volume) while maintaining functional motor function from prior to surgery and the patient’s baseline expressive aphasia, with no new neurological deficits. Early post-operative CT showed decompression of the resection cavity without hemorrhage or shift. At three months post-operative, CT showed stability of the cavity and resolution of the most perilesional edema with no evidence of recurrence. Clinically, the patient showed gradual improvement in verbal fluency, he remained seizure free, and maintained independence, which allowed for timeliness of the initiation of adjuvant chemoradiotherapy. Conclusions: We intend for the case to illustrate that, in selected dominant frontal GBM, following microsurgical anatomical principles closely may provide a high extent of resection with the preservation of function, even without advanced intraoperative adjuncts. We hope that our experience may support our colleagues who practice in resource-limited settings and contribute to our shared goal of both oncological outcomes and the quality of life of our patients. Full article

Background: Varioaus methods are available to address fingertip injuries, which are becoming increasingly common. Coverage should ideally involve both functional and aesthetic improvements. The second toe pulp-free flap is useful because of its similarity to the fingertips in shape, texture, and sensation. Herein, we present our clinical experience and surgical methods for fingertip defect reconstruction using second toe pulp-free flaps. Materials and Methods: Between April 2022 and May 2023, 13 toe pulp-free flaps were used to reconstruct fingertip defects. The average patient age was 50.1 years (range, 35–67 years), and nine of the 13 patients were male. Nine patients were injured on the right hand, and four on the left hand. After complete debridement, a toe-pulp flap was harvested with a teardrop from the ipsilateral side. The cases included the reconstruction of four index fingers, seven middle fingers, and two little fingers. Functional and aesthetic assessments were performed postoperatively. Results: All flaps survived completely, with no partial necrosis. The average flap size was 1.5 × 2 cm (range, 0.8 × 1.5 to 2.0 × 3.0 cm). None of the patients had functional impairments. No emergency surgeries were required during the follow-up period. The median follow-up period was 28 months, and the median duration of surgery was 119 min (range, 100–140 min). The average static two-point discrimination score for the injured finger pulp was 3.7 mm (range, 2–5 mm), the Quick Dash score was 3.4 (range, 2.3–4.2), and the Vancouver scar scale was 1.5 (range, 0–2). Conclusions: The toe pulp-free flap is the optimal choice for surgical treatment of fingertip defects and injuries, with excellent functional and cosmetic results. Full article

Background: Huriez syndrome is a rare hereditary skin disorder marked by early-onset sclerodactyly, hyperkeratosis of the palms and soles, and nail dysplasia. A key concern is the early and aggressive development of cutaneous squamous cell carcinoma (SCC), typically affecting the dorsal aspects of the hands. Methods: This narrative review summarizes clinical features, genetic aspects, and oncologic implications of Huriez syndrome. A systematic search was conducted in PubMed and Scopus, including English-language articles published up to May 2025. Relevant case reports and small case series were analyzed. Results: Seven patients (58.3%) underwent multiple surgeries due to recurrent or bilateral disease. Six patients (50%) required amputations, including finger, hand, and arm amputations, with no foot amputations reported. Reconstruction after oncological resection was performed in six patients (50%) using skin grafts (3), pedicled flaps (2), or free flaps (1). Amputation was mainly for advanced disease, with radial forearm flaps used for reconstruction. All flaps remained disease-free. Five cases (41.6%) had a history of local recurrence. Conclusions: The early diagnosis of Huriez syndrome is crucial to enable the surveillance and timely treatment of SCC. A multidisciplinary team including dermatologists, oncologists, plastic surgeons, and geneticists is recommended. Further research is needed to clarify genetic mechanisms and develop early detection strategies to improve outcomes. Full article

Background/Objectives: Orthognathic surgery has evolved with digital advancements, improving precision and predictability. Traditional free-hand techniques rely on surgeon expertise, often leading to variable outcomes. Fully guided approaches integrate computer-assisted surgery, including virtual surgical planning (VSP), CAD/CAM, and dynamic navigation, enhancing accuracy and efficiency. This review compares these approaches, assessing their impact on surgical accuracy, efficiency, and patient outcomes. Methods: A scoping review was conducted across PubMed, MEDLINE, Scopus, Cochrane Library, and Embase databases, focusing on clinical trials and cohort studies. Key parameters analyzed include surgical precision, operative efficiency, complication rates, and functional/aesthetic results. Results: Fully guided techniques achieve sub-millimetric accuracy with mean length deviations ranging from 1.3 mm to 2.4 mm and mean angular deviations between 2.29° and 3.51°. Moreover, these approaches markedly reduce operative time, averaging between 34 min and 1.7 h, and postoperative complications. Digital tools streamline workflow, improving reproducibility and aesthetic outcomes. Free-hand methods remain cost-effective but require greater surgical expertise, often resulting in longer recovery periods and higher variability. Conclusions: Computer-assisted orthognathic surgery enhances precision and efficiency, outperforming free-hand techniques in accuracy and predictability. While free-hand methods remain viable for simpler cases, fully guided approaches optimize surgical execution. Future research should explore hybrid strategies combining digital precision with manual adaptability to further refine surgical techniques. Full article

Background: Cartilaginous exostoses of the scapula are rare and can cause symptoms such as pain and mechanical crepitus due to scapulothoracic bursitis. While open surgical resection remains the standard approach, it is associated with significant tissue disruption and longer rehabilitation. This technical note presents a minimally invasive arthroscopic technique for excising scapular exostoses. Methods: We report the case of a 22-year-old female patient with a symptomatic ventral scapular exostosis. After confirmation of a benign lesion, the exostosis was excised en bloc under continuous arthroscopic guidance. The surgical procedure, including patient positioning, portal placement, instrumentation, and specimen removal, is described in detail. Results: The lesion was successfully excised as a single piece for histopathological analysis. The patient experienced no intra- or postoperative complications. Postoperative rehabilitation included early passive motion, and full recovery was achieved within six weeks. At 24-month follow-up, the patient remained pain-free with complete restoration of shoulder function and no evidence of recurrence. Conclusions: Arthroscopic excision of scapular exostoses offers a viable alternative to open surgery. The technique minimizes soft tissue trauma, supports faster recovery, and may be safely performed in experienced hands with appropriate preoperative planning and imaging. Full article

Background: Upper extremity reconstruction poses a significant challenge due to the complex anatomical and functional requirements of the hand and forearm. While free flaps have become the gold standard, pedicled abdominal flaps remain a valuable alternative, especially in cases where microsurgical anastomosis is contraindicated or unfeasible. This study evaluates the efficacy and outcomes of free-style pedicled abdominal flaps in reconstructing complex upper limb defects. Methods: A retrospective review was conducted on 20 patients who underwent soft tissue reconstruction of the upper extremity using free-style pedicled abdominal flaps between January 2019 and June 2024. Patient demographics, injury mechanisms, flap design, postoperative complications, and clinical outcomes were analyzed. Flap design was customized to defect size and location, utilizing single, double, triple, and tunneled flap configurations where necessary. Results: Stable soft tissue coverage was achieved in all cases without the need for additional free flap procedures. Complications included surgical site infections (n = 2), marginal necrosis (n = 2), partial flap necrosis (n = 2), and complete necrosis (n = 2), with no cases requiring free flap conversion. Long-term follow-up revealed no finger stiffness or loss of hand function. Donor site morbidity was minimal, with only one case requiring a split-thickness skin graft for closure. Conclusions: Despite advancements in microsurgical techniques, free-style pedicled abdominal flaps remain a vital reconstructive option for upper limb defects, particularly in patients with complex, large, or circumferential injuries. Their versatility, reliable vascularity, and ability to conform to various defect shapes underscore their enduring relevance in modern reconstructive surgery. Full article

Background: Fractures of the distal radius are common, particularly among young men and elderly women, often leading to painful wrist arthritis, especially if the joint surface has been affected. Traditional treatments of the wrist, such as full or partial wrist fusion, limit movement, and common wrist prostheses have high complication rates. Regenerative medicine and 3D bioprinting offer the potential for personalized joint replacements. Methods: This study evaluates using the contralateral radius as a template for creating customized distal radius prostheses. Bilateral CT scans of healthy wrists were analyzed to assess the shape and symmetry of the distal radius using a landmark-free morphometric method. Instead of comparing defined landmarks, the entire surface of the radius is analyzed employing dense point- and deformation-based morphometry to detect subtle morphological differences, providing an unbiased and more accurate comparison of the overall deformations in the distal radii. Results: results show strong intraindividual symmetry in joint surfaces. Interindividual comparisons revealed significant morphological variations, particularly gender-specific differences. Conclusions: These findings support the use of the contralateral radius as a template for the replaced side. At the same time, the interindividual results endorse the approach of pursuing personalized prostheses as the optimal replacement for distal joint surfaces. The increasing improvement of 3D-printed prostheses promises new methods for better outcomes in distal radius arthrosis after intraarticular fractures. Further research into clinical applications and biocompatible 3D printing materials is recommended. Full article

Background: Lesions of the digital apices are common, and several treatment strategies can be considered for them. Among these, the free great toe pulp flap can be used. Methods: This is a retrospective report in which five patients undergoing hallux free flap surgery for loss of pulpal substance at the level of the hand were evaluated. They were re-evaluated by using both clinical testing to assess sensitivity and the use of questionnaires to estimate function. Results: None of the performed flaps failed. The mean follow-up was 36 months (range 16–66 months). With SW-MF, the mean value was 3.734 compared to 2.986 for the same contralateral finger. The S2-PD test attested a mean value of 6.8 mm (range 6–8 mm) in contrast to the contralateral finger, which showed a mean result of 3.2 mm (range 3–5 mm), while the D-2PD indicated lower values for both the operated finger, with a mean value of 6.4 mm (range 4–8 mm), and the healthy finger. Conclusions: When a dystrophic fingertip results from an inappropriate acute management, the GTP flap appears to be an excellent strategy to restore the specialized tissue of finger pulp and to bring supple tissue to the correct PIP flexion contracture or the small first web space contracture. It is mostly required for thumb and radial fingers’ reconstruction, especially in young patients or those who need high functional demands and/or present an extensive loss of substance that cannot be resolved with local flaps. Full article

Wearable motion capture gloves enable the precise analysis of hand and finger movements for a variety of uses, including robotic surgery, rehabilitation, and most commonly, virtual augmentation. However, many motion capture gloves restrict natural hand movement with a closed-palm design, including fabric over the palm and fingers. In order to alleviate slippage, improve comfort, reduce sizing issues, and eliminate movement restrictions, this paper presents a new low-cost data glove with an innovative open-palm and finger-free design. The new design improves usability and overall functionality by addressing the limitations of traditional closed-palm designs. It is especially beneficial in capturing movements in fields such as physical therapy and robotic surgery. The new glove incorporates resistive flex sensors (RFSs) at each finger and an inertial measurement unit (IMU) at the wrist joint to measure wrist flexion, extension, ulnar and radial deviation, and rotation. Initially the sensors were tested individually for drift, synchronisation delays, and linearity. The results show a drift of 6.60°/h in the IMU and no drift in the RFSs. There was a 0.06 s delay in the data captured by the IMU compared to the RFSs. The glove’s performance was tested with a collaborate robot testing setup. In static conditions, it was found that the IMU had a worst case error across three trials of 7.01° and a mean absolute error (MAE) averaged over three trials of 4.85°, while RFSs had a worst case error of 3.77° and a MAE of 1.25° averaged over all five RFSs used. There was no clear correlation between measurement error and speed. Overall, the new glove design proved to accurately measure joint angles. Full article

Objectives: This study aimed to compare two surgical techniques—the free flap of the superficial palmar branch of the radial artery (SPBRA) and the free venous flap (FVF)—to evaluate their efficacy and aesthetic outcomes in repairing finger tissue defects. The goal was to determine which procedure offers faster healing curves and better overall patient outcomes, ultimately improving the quality of life for individuals undergoing these surgeries. Materials and Methods: A retrospective study was conducted using the clinical database of Sanliurfa Mehmet Akif Inan Education and Research Hospital, University of Health Sciences, from 1 January 2019 to 1 January 2022. A total of 44 patients with finger tissue defects, excluding thumb defects, were randomly divided into two groups: 21 patients underwent the SPBRA free flap procedure and 23 patients underwent the FVF procedure. Primary endpoints included flap survival rates, sensory recovery rates, aesthetic satisfaction scores, and complication rates. Data were collected during preoperative assessments and postoperative follow-ups at 1, 3, and 6 months. Results: The SPBRA group demonstrated a higher success rate (95% vs. 92%) and greater patient satisfaction in terms of restoring normal appearance and function. The SPBRA technique also showed superior sensory recovery with a lower two-point discrimination score (mean SPBRA = 6 mm vs. mean FVF = 8 mm). Functional outcomes, assessed by the Michigan Hand Outcomes Questionnaire, indicated higher scores for the SPBRA group (85/100) compared to the FVF group (80/100). Additionally, the SPBRA procedure was associated with fewer complications, highlighting its effectiveness and safety. Conclusions: The findings suggest that the SPBRA free flap technique offers better outcomes than the FVF procedure for repairing finger tissue defects. It provides superior functional restoration, enhanced cosmetic satisfaction, and a lower rate of complications. These results support the preference for the SPBRA technique in addressing complex finger tissue defects and improving patient outcomes. Full article

Multispectral imaging (MSI) enables non-invasive tissue differentiation based on spectral characteristics and has shown great potential as a tool for surgical guidance. However, adapting MSI to open surgeries is challenging. Systems that rely on light sources present in the operating room experience limitations due to frequent lighting changes, which distort the spectral data and require countermeasures such as disruptive recalibrations. On the other hand, MSI systems that rely on dedicated lighting require external light sources, such as surgical lights, to be turned off during open surgery settings. This disrupts the surgical workflow and extends operation times. To this end, we present an approach that addresses these issues by combining active illumination with smart background suppression. By alternately capturing images with and without a modulated light source at a desired wavelength, we isolate the target signal, enabling artifact-free spectral scanning. We demonstrate the performance of our approach using a smart pixel camera, emphasizing its signal-to-noise ratio (SNR) advantage over a conventional high-speed camera. Our results show that accurate reflectance measurements can be achieved in clinical settings with high background illumination. Medical application is demonstrated through the estimation of blood oxygenation, and its suitability for open surgeries is discussed. Full article

Colon cancer (CC) is the third most frequent neoplasm, with a considerably high mortality rate. Due to the side effects of conventional forms of CC treatment (surgery, chemotherapy, and radiotherapy), several studies have focused on the use of medicinal plant derivatives to provide a green therapy for CC; although phytochemicals have shown promising results against CC, translating the results obtained in vitro and in vivo to the clinical setting remains a challenge. Indeed, like other orally applied medicines, medicinal plant derivatives have to cross different physiological barriers to reach the CC microenvironment, which considerably limits their dose-dependent therapeutic efficacy. On the other hand, phytocompounds are not free from biopharmaceutical drawbacks, so novel strategies using nanoparticles (NPs) have been proposed to overcome the physiological barriers of the body and provide controlled release of actives of interest. Accordingly, the current review provides an overview and discussion on the predisposing factors to CC and conventional treatment, the use of medicinal plants in CC treatment, and the advantages provided by NPs in the treatment of CC. Full article

Background and Objectives: The lateral arm flap has been a very useful choice for the reconstruction of small to medium-sized defects, such as in the hands, extremities, and oral head and neck area. Its versatile characteristics and surgical feasibility allow this flap to be widely applied, but its reconstructive potential in the facial subunit after tumor ablation procedures has never been reported. In this study, we aimed to utilize the advantages of this flap to carry out facial temple subunit defect reconstruction. Materials and Methods: Between 2020 and 2023, 12 patients underwent temple reconstruction with lateral arm free flaps after wide malignant tumor excisions. There were seven women and five men, and the mean patient age was 60.6 years. Among the patients with cancer, six had squamous cell carcinoma, five had basal cell carcinoma, and one had myxofibrosarcoma. All flaps were elevated under general anesthesia. Alprostadil (PGE1, Eglandin^®, Mitsubishi Tanabe Korea, Seoul, Republic of Korea) was administered postoperatively. Results: All flaps were the fasciocutaneous type, with sizes that varied from 3 cm × 4 cm to 5 cm × 7 cm (average size: 22.7 cm²). The average pedicle length was 6.1 cm. The versatility of the lateral arm flap enabled successful coverage in all cases, with no specific complications. Good functional outcomes and good ranges of motion in the donor arms were observed after surgery. Conclusions: The authors successfully verified the advantages of lateral arm flaps in the treatment of medium-sized facial temple subunit defects. Full article

Background/Objectives: Robot-assisted microsurgery (RAMS) has been introduced into the field of plastic surgery in recent years. It potentially offers enhanced precision and control compared to traditional methods, which is crucial for complex microvascular tasks in free flap reconstructions. We aim to analyze our experiences with robotic-assisted microsurgery in the field of upper extremity free flap reconstruction. Methods: This prospective study evaluated the efficacy and safety of the Symani Surgical System for free flap reconstructions in 16 patients with upper extremity defects at our institution from February 2023 to March 2024. Operating times were compared to a matched, historical cohort. We collected data on surgical outcomes, operative times, and complication rates, following strict adherence to the Declaration of Helsinki. Results: Our cohort primarily involved male patients (81%) with defects mostly located on the hand (81%). The anterolateral thigh flap was the most commonly used free flap (14/16, 88%). The average operative time was 368 ± 89 min (range: 216–550 min). No complete or partial flap losses were observed, but one flap required revision surgery due to arterial thrombosis. Major complications occurred in 13% of the cases. The average anastomosis time was 31 ± 12 min (range: 20–35 min) for arterial end-to-end anastomoses and 33 ± 13 min (range: 20–60 min) for arterial end-to-side anastomoses. Venous anastomoses required, on average, 20 ± 6 min. Operating times were not significantly longer when compared to the historical cohort (p = 0.67). Conclusions: We were able to show comparable outcomes to conventional microsurgery, while requiring more time for the microsurgical anastomoses. The study highlights the need for larger, controlled trials to better understand the benefits and limitations of robotic assistance in microsurgical reconstruction of the upper extremity. Full article