Search Results (462)

Background: Autologous fat grafting is increasingly used in daily clinical practice across various surgical fields, including the treatment of chronic wounds, scars, burns, and non-healing perianal fistulas. Recently, some studies have shown that non-enteric cutaneous fistulas can also benefit from adipose tissue injections, but the efficacy remains unclear. This study aims to systematically review the literature on fat grafting in the context of non-enteric cutaneous fistulas and to assess treatment outcomes. Methods: A comprehensive search of the PubMed/Medline database was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to January 2024 without restrictions on the time period or the language of publication. Results: Seven studies meeting the inclusion criteria were analyzed, encompassing 13 patients with non-healing cutaneous fistulas treated with injections of autologous fat. The mean age of the patients was 58 ± 3 years, of which 85% had comorbidities. Fat grafting resulted in complete healing in 92% of the cases, with a mean fistula persistence of 158 days before treatment. Treatment protocols varied among patients, including preparation of the fistulous tract, fat processing techniques, and suturing of the fistulous orifice. Conclusions: The results highlight the potential of autologous fat grafting in promoting tissue regeneration and healing of non-enteric cutaneous fistulas. Standardized protocols are essential to confirm and optimize treatment efficacy and, eventually, improve patient outcomes. Further research with a larger sample size and standardization is needed to confirm fat graft efficacy. Full article

Background: Foreign bodies (FBs) within the masticatory space are a rare but significant complication of oral and maxillofacial procedures. Despite advancements in orthognathic surgery, instrument breakage and accidental loss can lead to challenging secondary procedures. Clinical experience with retained foreign bodies in the masticatory space following orthognathic surgery and related dental procedures is summarized. Methods: A retrospective search was conducted in the surgical and radiological database of a tertiary referral center for maxillofacial surgery, covering procedures from January 2017 to December 2024. Patients were included if they had undergone orthognathic surgery and presented with a retained FB in the masticatory space confirmed through imaging. Clinical records, operative notes, imaging studies, and follow-up data were reviewed. Results: Out of 2092 procedures, four patients (0.19%) were identified. Two FBs were related to broken surgical instruments during orthognathic surgery (a suture needle and a burr fragment), while two were fractured local anesthesia needles during third molar extraction under local anesthesia. All FBs were located in deep compartments of the masticatory space (paramandibular or pterygopalatine region). Surgical retrieval via transoral approach under general anesthesia was successful in all cases. One patient experienced transient facial nerve dyskinesia; no long-term complications or recurrences were noted. Conclusions: Retained foreign bodies in the masticatory space are infrequent yet warrant prompt recognition and surgical management to mitigate the risk of infection, nerve damage, and repeated procedures. Thorough instrument checks, proper technique, and advanced imaging modalities are crucial for minimizing these complications in orthognathic surgery. Full article

Osteosarcoma is one of the most common primary bone malignancies, typically occurring around the knee. However, the forearm is a rare site, with tumors in the proximal ulna being extremely uncommon. Primary sarcoma in this location presents a surgical challenge due to the complex anatomy and limited reconstructive options. We report a rare case of a 19-year-old female with non-metastatic, high-grade giant cell-rich osteosarcoma involving the right proximal ulna. To our knowledge, this is only the second reported adult case of this histological subtype in this location. The patient was treated at a specialized oncology center with neoadjuvant and adjuvant chemotherapy, along with wide intra-articular resection for local tumor control. Reconstruction was achieved using a novel, customized 3D-printed articulating cement spacer mold with plate osteosynthesis. Artificial elbow ligamentous reconstruction was performed using FiberTape and FiberWire sutures passed through drill holes, and the triceps tendon was reattached to the cement mold using an endobutton. This cost-effective and personalized surgical approach allowed successful joint reconstruction while maintaining elbow stability and function. Our case highlights a feasible reconstructive option for rare and anatomically challenging osteosarcoma presentations, contributing to the limited literature on proximal ulna giant cell-rich osteosarcoma. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article

Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. Methods: We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. Results: The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. Conclusions: In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients. Full article

Background and Objectives: Cyanoacrylate (CA) tissue adhesives have gained increasing attention as alternatives to sutures in oral surgery and periodontology. The objective of this scoping review is to assess their clinical applications and effectiveness in wound closure and postoperative management. Materials and Methods: The review was conducted following the JBI methodology and PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, Scopus, and Web of Science to identify randomized controlled trials published between 2015 and 2025 evaluating the use of CAs in oral surgery and periodontal procedures. Results: A total of 19 studies were included. Cyanoacrylate adhesives demonstrated comparable or superior outcomes to other wound healing strategies in terms of operative time, postoperative pain reduction, and early wound healing. Their use was particularly beneficial in free gingival grafts and palatal donor site management. However, the findings across studies were not always consistent, and some trials did not report statistically significant differences. The use of long-chain CA formulations is associated with minimal toxicological risk, though these adhesives demonstrate intrinsic hemostatic and antimicrobial effects. Conclusions: Cyanoacrylate tissue adhesives represent a valid alternative to sutures in several dental surgical contexts, especially in procedures involving mucogingival grafts. Further high-quality clinical studies are needed to clarify their long-term outcomes and broaden their indications in dentistry. Full article

Objectives: We aimed to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) in promoting wound healing after the surgical removal of inferior third molars. Methods: Patients in need of unilateral mandibular third molar extraction were randomly assigned to either a test or control group before surgery. During the test, a photoactive substance activated with laser light (20 mW, 660 nm) was applied to the post-extraction site for 60 s before suturing to promote healing and disinfection. The control group did not receive any laser applications after tooth removal. The probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), gingival recession (REC), and levels of clinical attachment loss (CAL) before surgery (T0), 14 days after surgery (T1), and after 3 months after surgery (T2) were evaluated for the adjacent second molar. Post-operative swelling, pain (VAS index), the number of painkillers taken, alveolar probing, and Landry’s healing index were recorded at T1. Results: Sixty-five patients, aged between 14 and 39 years, were assigned randomly to test (n = 32) or control (n = 33) groups. Five dropouts occurred. Post-operative swelling and the VAS index were significantly lower in the test group compared to the control (p = 0.002 and p = 0.04, respectively). All periodontal indexes except recession significantly worsened at T1 in both groups. After three months, a significant improvement for PPD, CAL, and PI was recorded in the test group compared to the control (p = 0.001). Conclusions: According to the results of this study, the use of aPDT seems to have a beneficial effect on post-operative swelling and pain, as well as the plaque index, in the short-term follow-up. Full article

Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the Garcia-Elias classification. Materials and Methods: A retrospective study was performed on ten patients treated with this novel technique. The technique involves a dorsal approach to the wrist through a 5–7 cm incision ulnar to Lister’s tubercle. After exposing the scapholunate joint, reduction is performed using Kirschner wires (K-wires) as joysticks, followed by stabilisation with three K-wires through the scapholunate, scapho-capitate, and radio-lunate joints. Two 2.3 mm suture anchors with double sutures are placed where the reduction K-wires were removed. One pair of sutures connects the anchors and any remaining SLIL tissue, while the second pair create a shoelace-like capsulodesis. Post-operative care includes staged K-wire removal at one and two months, with progressive rehabilitation before returning to weight-bearing activities at six months. Results: All patients improved in pain and function. The technique addresses SLIL injuries by restoring both coronal alignment through ligament repair and sagittal alignment via dorsal capsulodesis. The use of suture anchors and direct repair preserves the native tissue while reinforcing the dorsal capsule–scapholunate septum complex, avoiding the need for tendon grafts or extensive bone tunnelling. Conclusions: This ligament-sparing technique offers several advantages, including absence of donor site morbidity, minimal damage to carpal cartilage and vascularity, and preservation of surgical options should revision be necessary. The procedure effectively addresses both components of scapholunate instability while maintaining a relatively straightforward surgical approach. Full article

Trabeculectomy with mitomycin C is a key surgical intervention for managing glaucoma when conservative treatments fail. The success of trabeculectomy is influenced by various factors, including preoperative ocular characteristics like conjunctival vascularity. This study aims to explore the relationship between the preoperative conjunctival vascular area and post-trabeculectomy outcomes in glaucoma patients. By analyzing the conjunctival vascular density, intraocular pressure (IOP), bleb morphology, laser suture lysis (LSL) frequency, and postoperative eye drops, this research sheds light on the impact of preoperative vascularity on surgical success. Results show that lower preoperative conjunctival vessel density is associated with favorable outcomes, such as better bleb formation and reduced need for postoperative interventions, while higher conjunctival vessel density correlates with complications like hyphema. These findings emphasize the importance of assessing preoperative conjunctival vascularity to optimize trabeculectomy outcomes and personalize treatment strategies for glaucoma patients. Full article

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods—including tacks, sutures, and glues—are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair. Full article

Background: Patellar resection is recommended in cases of massive cortical bone disruption or malignancies. Modern literature lacks a consensus surgical reconstruction after total patellectomy. Our study reviews the surgical techniques described in the literature and summarizes the reported functional outcomes and complication rates. Materials: We systematically reviewed the existing literature, searching the PubMed, Embase, and Scopus databases for articles published between 1950 and 2024. We recorded age, diagnosis, tumor size, Lodwick classification, soft tissue involvement, and pre-operative fractures for each case or case series. We also recorded the reconstructive approaches. Complications, local recurrences, MSTS scores, and knee range of motion (ROM) were considered when reported. Results: Twenty-eight articles met our inclusion criteria. Among these, 4 were case series and 24 were case reports. A total of 47 cases treated with total patellectomy were reviewed. Reconstruction was performed with direct suture in 8 cases, while 17 had local augments, including allograft (10 cases), muscle flaps or transportations (4), autologous bone (1), or a composite (2). Reconstruction was not mentioned in 22 cases. ROM was reported for 17 cases, and the MSTS score was reported for 9 cases. Conclusions: In cases of relatively small tissue defects, a direct suture of the extensor apparatus can allow adequate functional recovery. In cases of larger gaps, surgeons should use muscle flaps, transfers, or soft tissue augments. Massive bone and tendon allografts should mainly be considered in cases where the neoplasm was not confined to the patella but extensively involved the patellar ligament or the quadriceps tendon. Full article

Breast cancer-related lymphedema (BCRL) is a debilitating complication in breast cancer survivors, with axillary lymph node dissection (ALND) as the greatest independent risk factor. Beyond non-surgical therapies such as complete decongestive and compression therapy, there has been increased interest in immediate microsurgical reconstruction via immediate lymphatic reconstruction (ILR) anastomosing transected lymphatic vessels to a local venous recipient at the time of ALND to mitigate the risks of BCRL. This work provides a scoping review of the landscape surrounding ILR, spanning the updated literature investigating patient outcomes, current accepted best practices, and critical components of surgical techniques for a successful multidisciplinary approach. While limited by heterogeneity in the methods of lymphedema detection, a growing body of work demonstrates the protective effects of ILR. From the pioneering work by Boccardo et al. in 2009 and his introduction of Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) using an intussusception-type end-to-end microanastmosis, to the first randomized control trial by Coriddi in 2023, which importantly employed relative upper extremity volume change as an outcome measure to circumvent the confounding effects of body size and BMI, the current literature supports ILR following ALND in the prevention of BCRL. Collaboration between the oncologic breast surgeon and reconstructive microsurgeon are central to the success of ILR. Critical components for operative success include preoperative and intraoperative lymphatic mapping, preservation of suitable venous targets, availability of supermicrosurgical instruments and sutures, as well as aptitude with a variety of microsurgical anastomotic techniques. Full article

Novel laparoscopic optical forceps (OFs), developed and patented by the University of Bari Aldo Moro (EP4119030, Bari, Italy), were designed to enhance safety and efficiency during laparoscopic ovariectomy in dogs by enabling atraumatic ovarian suspension and surgical maneuvers. This study aimed to describe the design, prototyping, sterilization validation, and preliminary clinical evaluation of this instrument. Prototypes were fabricated using ABS-like Pro resin via LSPc 3D printing. EtOx (ethylene oxide) sterilization proved to be the only effective method ensuring both microbiological safety and material integrity after 25 cycles. A randomized clinical trial involving 36 female dogs compared the OFs with conventional extracorporeal suture (ES) suspension using two-port laparoscopic ovariectomy. Surgical performance was assessed via operative times and complication rates. The OF group demonstrated significantly reduced ovariectomy (7.5 ± 1.6 min vs. 23.7 ± 7.6 min, p < 0.01) and overall surgical (14.2 ± 1.7 min vs. 30.4 ± 7.4 min, p < 0.01) times. No intraoperative complications occurred in the OF group, while the ES group exhibited instances of needle breakage, multiple suture attempts, and increased bleeding. The OFs enabled surgical maneuvers and ovarian suspension without requiring additional incisions or complex techniques, offering ergonomic advantages and compatibility with standard optics. These findings support the OFs as a promising tool to simplify and improve minimally invasive ovariectomy in veterinary surgery. Full article

Background/Objectives: Complete rupture of the Achilles tendon is a common and challenging injury, specifically for individuals engaged in high-demand activities such as sports. Surgical repair is often required, but conventional methods, including direct suture repair, may fail to address the biological limitations associated with tendon healing, especially in cases involving chronic degeneration or extensive tissue damage. Methods: This case report explains how bioinductive implants, such as the Regeneten collagen-based scaffold, have gained attention as an innovative approach to augment tendon repair. Results: These implants not only provide mechanical stabilization but also promote the regeneration of tendon-like tissue by enhancing the biological healing environment. Conclusions: The use of bioinductive implants, such as the Regeneten scaffold, improves outcomes in tendon repair by augmenting both mechanical stabilization and biological healing. This approach represents a valuable alternative to improve clinical outcomes, particularly in patients with poor prognostic factors. Full article

Aim: To compare the three-year surgical outcomes among the Kahook dual blade (KDB), Tanito microhook (TMH), T-hook, and 360° suture trabeculotomy (S-lot) cohorts. Study design: Retrospective interventional comparative study conducted at a single eye center. Subjects and Methods: A total of 224 eyes that underwent combined cataract surgery with either KDB, TMH, T-hook, or S-lot procedures were retrospectively analyzed over the three-year period. Results: According to Tukey’s multiple comparison test, postoperative intraocular pressure (IOP) in the S-lot cohort was significantly lower than in the TMH cohort from 1 month to 3 years (p = 0.01 to <0.001), lower than in the KDB cohort between 6 months and 1 year (p = 0.026 to <0.001), and lower than in the T-hook cohort at 1 month (p = 0.012) and from 6 to 12 months (p < 0.001). The survival probability of achieving ≤15 mmHg and ≤18 mmHg in the S-lot cohort was significantly better than in others by p < 0.001 and 0.005, respectively. At 3 months, the T-hook cohort showed significantly lower IOP than the TMH cohort (p = 0.029), and at 1 week, IOP was marginally lower than in the KDB (p = 0.063) and TMH (p = 0.052) cohorts, based on Dunnett’s test. However, no significant differences in postoperative IOP were observed among the three sectorial canal-opening surgery (COS) groups beyond 6 months. Conclusions: Among the four MIGS cohorts, S-lot provided the most substantial mid-term postoperative IOP reduction. The T-hook cohort showed marginally superior IOP reduction at 1 week compared to the KDB and TMH groups. Full article