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Surgical Techniques Development
Volume 13
Issue 4
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Surg. Tech. Dev., Volume 13, Issue 4 (December 2024) – 6 articles

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11 pages, 9455 KiB  
Technical Note
Direct Anatomical Reconstruction of the Achilles Tendon and Its Application for Surgical Treatment of Acute Achilles Tendon Ruptures
by Alessandro Pisano and Gaetano Caruso
Surg. Tech. Dev. 2024, 13(4), 382-392; https://doi.org/10.3390/std13040030 - 23 Nov 2024
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Abstract
Background/Objectives: Acute ruptures of the Achilles Tendon (AT) are common injuries in the active population, in particular among men aged 30 to 50. Full functional recovery after this kind of injury is long and challenging and nowadays there is no universal “gold standard” [...] Read more.
Background/Objectives: Acute ruptures of the Achilles Tendon (AT) are common injuries in the active population, in particular among men aged 30 to 50. Full functional recovery after this kind of injury is long and challenging and nowadays there is no universal “gold standard” strategy when dealing with them. Methods: When it comes to surgical treatment, various techniques have been described: in case of a typical lesion at the midportion of the tendon (which is the most common type), the basic principle of surgical repair is the end-to-end suture of the tendon stumps. The AT (“calcaneal tendon” according to the International Anatomical Terminology) is the strongest tendon of the human body, it is the conjunct tendon of the two Gastrocnemii Muscles and the Soleus Muscle and has a well-recognizable twisted structure: the subtendon from the Medial Head of the Gastrocnemius attaches postero-laterally on the calcaneal tendon footprint, the subtendon from the Lateral Head of the Gastrocnemius attaches antero-laterally and the subtendon from the Soleus attaches medially, therefore creating a 90° twist of the tendon structure. Results: the twisted structure of the human AT is of central importance to its biomechanics, since it gives the tendon a higher resistance to deformation and concurs in supination of the subtalar joint during gait. Conclusions: given the abovementioned anatomical and biomechanical premises, we believe that the restoration of the subtendons anatomy can lead to a better functional recovery of the Triceps Surae—Achilles Tendon complex, therefore we recently decided to adopt for open surgical repair the Direct Anatomical Reconstruction of the Achilles Tendon, which we describe in the present article. Full article
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11 pages, 4330 KiB  
Article
The Vascular Anatomical Basis for a Well-Designed Reconstruction of the Ala Nasi by a Microsurgical Preauricular Flap Technique
by Gianpaolo Faini, Alice Ferrari, Lena Hirtler, Lorena Giugno, Sergio Arleo and Barbara Buffoli
Surg. Tech. Dev. 2024, 13(4), 371-381; https://doi.org/10.3390/std13040029 - 1 Nov 2024
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Abstract
Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the [...] Read more.
Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the surgical flap. This study aimed to provide an anatomical and surgical guide for a well-designed reconstruction of the ala nasi using a free preauricular flap. Methods: In this study, three fresh-frozen and two formalin-fixed human head specimens injected with red silicone rubber to enhance the arterial facial system were used. The reconstruction of the full-thickness defect of the ala nasi was performed using a microsurgical auricular flap technique, with the dimensions of the ala nasi and the preauricular flap duly noted. In addition, anatomical dissections were conducted, during which the positions and diameters of the main donor and recipient vessels were measured. Results: A presurgical evaluation was performed to define the flap design. A comparison of the shape and mean dimensions of the ala nasi defect (height 9.66 ± 1.40 mm; thickness 3.52 ± 0.53 mm) and the preauricular flap (height 8.50 ± 2.68 mm; thickness 3.92 ± 1.29 mm) indicated that this flap was an optimal option for the reconstruction of the ala nasi. The surgical procedure involved the full-thickness removal of the ala nasi, and the harvesting and insertion of the preauricular flap. The anatomical measurements demonstrated that the facial artery and veins were the optimal recipient vessels, with a diameter of >1 mm (2.08 ± 0.56 and 2.85 ± 0.74 mm), suitable for anastomosis with the superficial temporal artery and vein (1.86 ± 0.58 and 1.66 ± 0.15 mm). In addition, the postsurgical evaluations indicated a slight mean difference in the thickness (1.14 ± 0.65 mm) and height (1.68 ± 1.18 mm) between the ala nasi and helix and a satisfactory VAS score (7.9 ± 0.57). Conclusions: Our surgical and anatomical data provide compelling evidence in favour of free preauricular flap reconstructions of the ala nasi. This procedure allows for the correct choice of recipient vessels and the creation of a well-designed surgical flap. Full article
(This article belongs to the Special Issue New Insights into Plastic Aesthetic and Regenerative Surgery)
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12 pages, 3785 KiB  
Article
Tourniquet Restriction of External Carotid Artery vs. Internal Maxillary Artery Ligation for Bleeding Control in Total Maxillectomy
by Yuan-Cheng Liu and Peir-Rong Chen
Surg. Tech. Dev. 2024, 13(4), 359-370; https://doi.org/10.3390/std13040028 - 14 Oct 2024
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Abstract
Background/Objectives: Temporary artery ligation or compression is commonly used to reduce intraoperative blood loss in various surgeries, including uterine procedures. In head and neck surgery, the external carotid artery (ECA) typically branches into eight vessels, supplying most of the head and neck except [...] Read more.
Background/Objectives: Temporary artery ligation or compression is commonly used to reduce intraoperative blood loss in various surgeries, including uterine procedures. In head and neck surgery, the external carotid artery (ECA) typically branches into eight vessels, supplying most of the head and neck except for the brain. Severe and uncontrolled bleeding can occur if these branches are inadvertently damaged during surgery. However, limited research exists on temporary arterial ligation during head and neck surgeries. This study aimed to evaluate the effects of temporary ECA restriction and internal maxillary artery (IMA) ligation on minimizing intraoperative blood loss during head and neck surgery. Methods: This study involved 25 patients with terminal-stage maxillary tumors who underwent total maxillectomy. The effectiveness of IMA ligation and ECA restriction using a Rummel tourniquet in controlling intraoperative bleeding was compared. Results: The average blood loss was significantly lower in the ECA restriction (467 mL) and IMA ligation (461 mL) groups than in the control group (794 mL). However, no significant difference was observed between the IMA ligation and ECA restriction methods. Conclusions: Overall, our results suggest that either method is effective; however, ECA restriction is preferred for tumors involving the infratemporal fossa. Full article
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12 pages, 6455 KiB  
Article
In Vivo Validation of a Computer-Assisted Bowel Length Measurement System
by Benjamin F. B. Mayer, Sebastian Bodenstedt, Patrick Mietkowski, Rudolf Rempel, Lena M. Schulte, Stefanie Speidel, Hannes G. Kenngott and Karl F. Kowalewski
Surg. Tech. Dev. 2024, 13(4), 347-358; https://doi.org/10.3390/std13040027 - 10 Oct 2024
Viewed by 559
Abstract
(1) Background: The aim of this study was to investigate potential translational factors for optical 3D reconstruction in an in vivo setting using a newly developed computerized bowel length measurement system (BMS) as a real-time application. (2) Methods: The BMS was evaluated in [...] Read more.
(1) Background: The aim of this study was to investigate potential translational factors for optical 3D reconstruction in an in vivo setting using a newly developed computerized bowel length measurement system (BMS) as a real-time application. (2) Methods: The BMS was evaluated in an in vivo porcine experiment for the influence of light source power (Watt), laparoscope-to-bowel distance (cm), bowel rotation, image background, and surgical objects in the image. Endpoints were robustness, calculated as success rate (SR) in percent, and accuracy, defined as relative error (RE) in percent of BMS measurement result to ground truth. (3) Results: A total of 1992 bowel measurements were performed on n = 7 pigs using the BMS. Bowel measurements were robust and accurate regardless of light source power, at a laparoscope-to-bowel distance of 5 cm (SR 100%, RE 18 ± 38.5%), when the small bowel was aligned horizontally (SR 100%, RE 7.3 ± 36.2%) or in the image background (SR 100%, RE 15.2 ± 23.4%), and when no additional instruments were in the image. (4) Conclusions: Applications based on optical 3D reconstruction are feasible for intraoperative use and could enable quantitative laparoscopy. Full article
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10 pages, 1622 KiB  
Article
Trends and Factors Influencing Surgical Choices for Femoral Neck Fractures
by Hadar Gan-Or, David Maman, Assil Mahamid, Binyamin Finkel, Loai Ahmad Takrori, Eyal Behrbalk and Yaron Berkovich
Surg. Tech. Dev. 2024, 13(4), 337-346; https://doi.org/10.3390/std13040026 - 1 Oct 2024
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Abstract
Introduction: Femoral neck fractures pose significant health risks, particularly in the elderly population, leading to mortality, morbidity, and decreased quality of life. Surgery is the preferred treatment to restore function and alleviate pain, with options including total hip arthroplasty (THA) and hemiarthroplasty (HA). [...] Read more.
Introduction: Femoral neck fractures pose significant health risks, particularly in the elderly population, leading to mortality, morbidity, and decreased quality of life. Surgery is the preferred treatment to restore function and alleviate pain, with options including total hip arthroplasty (THA) and hemiarthroplasty (HA). However, clinical guidelines for selecting surgical procedures remain heterogeneous, prompting the need for further investigation into treatment trends and influencing factors. Methods: Data from the NIS database spanning 2016–2019 were analyzed, focusing on patients diagnosed with intracapsular femoral neck fractures and undergoing THA or HA as primary in-hospital surgeries. Advanced statistical analyses using SPSS and MATLAB were conducted to identify trends and factors influencing surgical choices. Results: Comorbidity profiles varied significantly between HA and THA patients, with specific conditions such as Alzheimer’s disease showing higher prevalence in HA patients. Demographic differences included a higher proportion of females and Medicare-insured individuals in the HA group. Racial disparities were observed, with differences in surgical preferences among various ethnic groups. THA adoption gradually increased over the study period, indicating a shift in surgical priorities. Additionally, THA patients tended to be younger on average compared with HA patients. Conclusions: This study highlights evolving trends in surgical management for femoral neck fractures and identifies factors influencing treatment decisions in our cohort. Understanding these trends and disparities is crucial for optimizing patient care and informing future clinical guidelines. Further research should focus on assessing different surgical approaches’ long-term outcomes and cost-effectiveness. Full article
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12 pages, 20321 KiB  
Technical Note
Novel Dural Opening Technique in Intradural Extramedullary Tumors at the Craniovertebral Junction: Three-Year Single-Center Experience
by Giovanni Federico Nicoletti, Francesca Graziano, Federica Paolini, Roberta Costanzo, Manikon Poullay Silven, Massimo Furnari, Domenico Gerardo Iacopino, Rosario Maugeri, Bipin Chaurasia, Gianluca Ferini, Giuseppe Emmanuele Umana and Gianluca Scalia
Surg. Tech. Dev. 2024, 13(4), 325-336; https://doi.org/10.3390/std13040025 - 24 Sep 2024
Viewed by 437
Abstract
Background/Objectives: The craniovertebral junction (CVJ) poses unique challenges in the surgical management of intradural extramedullary (IDEM) tumors due to its complex anatomy and proximity to critical neurovascular structures. This study presents a comprehensive review of a single center’s experience over three years in [...] Read more.
Background/Objectives: The craniovertebral junction (CVJ) poses unique challenges in the surgical management of intradural extramedullary (IDEM) tumors due to its complex anatomy and proximity to critical neurovascular structures. This study presents a comprehensive review of a single center’s experience over three years in managing IDEM tumors at the CVJ, emphasizing a novel approach to dural opening aimed at improving surgical access and patient outcomes. Materials and Methods: A retrospective analysis was conducted on patients with confirmed IDEM tumors involving the CVJ who underwent surgical intervention between January 2019 and December 2021 at the “ARNAS Garibaldi” Neurosurgical Department. The surgical technique involved a posterior midline approach with a modified dural opening technique, facilitating lateral dural incisions based on tumor location and size. Clinical, radiological, and surgical data were collected and analyzed, including patient demographics, tumor characteristics, surgical details, complications, and postoperative outcomes. Results: Eight patients (mean age: 53.87 ± 8.9 years) with diverse IDEM tumors (meningiomas, schwannomas, neurofibromas) at various locations, from the foramen magnum to the C2 vertebra, were included. Common symptoms included paresthesia (62.5%) and neck/head pain (62.5%). The modified dural opening technique enabled complete tumor resection in all cases, demonstrating favorable postoperative outcomes with no significant postoperative complications except for one case with CSF leak. Conclusions: This study highlights the complexity of managing IDEM tumors at the CVJ and introduces a novel modified dural opening technique aimed at optimizing surgical access while minimizing spinal cord retraction. Early outcomes suggest improved postoperative neurological status and reduced surgical complications. However, careful patient selection and meticulous technique are crucial. Further studies are warranted to validate the safety and efficacy of this approach, fostering advancements in the surgical management of IDEM tumors at the CVJ. Full article
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