Surgical Techniques Development

21 pages, 1292 KiB

Open AccessSystematic Review

Popliteal Artery Injury Following Knee Dislocation: Anatomy, Diagnosis, Treatment, and Outcomes

by Kunj C. Vyas, Michael Abaskaron, Mikaila Carpenter, Taylor Manes, Morgan Turnow, Daniel T. DeGenova and Benjamin C. Taylor

Surg. Tech. Dev. 2025, 14(1), 2; https://doi.org/10.3390/std14010002 - 13 Jan 2025

Abstract

Background/Objectives: Popliteal artery injury is a rare but devastating complication of knee dislocations, significantly increasing the risk of limb ischemia, amputation, and poor functional outcomes if not promptly managed. This systematic review primarily evaluates the functional outcomes associated with this injury but [...] Read more.

Background/Objectives: Popliteal artery injury is a rare but devastating complication of knee dislocations, significantly increasing the risk of limb ischemia, amputation, and poor functional outcomes if not promptly managed. This systematic review primarily evaluates the functional outcomes associated with this injury but also reviews current research on diagnostic modalities and treatment strategies to provide a comprehensive understanding of this severe orthopedic and vascular injury. Methods: A systematic search of PubMed, in accordance with PRISMA Guidelines, identified 144 studies, of which 13 full-text articles were assessed for eligibility after excluding 131 during the title and abstract screening. Six studies were excluded due to missing vascular injury or functional outcome data or being written in a foreign language, leaving seven studies for inclusion. These studies were predominantly retrospective, focusing on knee dislocations with popliteal artery injury and reporting validated functional outcomes such as the Lysholm and International Knee Documentation Committee (IKDC) scores. The data were synthesized narratively due to heterogeneity in the study designs, interventions, and outcome reporting. Results: Patients with vascular injuries consistently demonstrated poorer functional outcomes compared to those without, with mean or median Lysholm and IKDC scores consistently being lower than non-vascular injury patients. Increased BMI, delayed intervention, and multi-ligamentous injury were associated with worse outcomes, highlighting the importance of timely surgical management. Early repair and grafting techniques improved functional recovery, while diagnostic modalities such as Doppler ultrasound and CT angiography showed high sensitivity in detecting vascular injury. Complications included limb ischemia, prolonged rehabilitation, and amputation, often linked to delayed diagnosis. Conclusions: Knee dislocations with popliteal artery injury require rapid diagnosis and early surgical intervention to optimize functional outcomes and reduce complications. Standardized outcome measures and high-quality prospective research are needed to refine management strategies and address patient-specific factors like BMI. Full article

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10 pages, 421 KiB

Open AccessArticle

Impact of Severe Obesity on Outcomes in Single-Level Anterior Cervical Discectomy and Fusion (ACDF): A Large-Scale Comparative Study

by David Maman, Ofek Bar, Yaniv Steinfeld, Ali Sleiman, Arsen Shpigelman, Lior Ben Zvi and Yaron Berkovich

Surg. Tech. Dev. 2025, 14(1), 1; https://doi.org/10.3390/std14010001 - 9 Jan 2025

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical radiculopathy and myelopathy. Severe obesity (BMI ≥ 40 or BMI ≥ 35 with comorbidities) is associated with increased perioperative risks. This study examines the impact of severe obesity on outcomes [...] Read more.

Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical radiculopathy and myelopathy. Severe obesity (BMI ≥ 40 or BMI ≥ 35 with comorbidities) is associated with increased perioperative risks. This study examines the impact of severe obesity on outcomes in patients undergoing single-level ACDF. Methods: Data from the Nationwide Inpatient Sample (2016–2019) were analyzed, including 85,585 patients who underwent single-level ACDF. Patients were classified as severely obese (n = 4935) or non-obese (n = 80,650). Outcomes such as length of stay, complications, and in-hospital mortality were compared using SPSS and MATLAB, with a significance level of p < 0.05. Results: Severely obese patients were younger (54 vs. 55.7 years, p < 0.001) and had more comorbidities like type 2 diabetes (38% vs. 17.8%, p < 0.001) and obstructive sleep apnea (31.1% vs. 9.5%, p < 0.001). They experienced longer hospital stays (1.92 vs. 1.65 days, p < 0.001) but similar in-hospital mortality (0.1%, p = 0.506). Severe obesity was linked to higher odds of complications, including increased risks of dehiscence (OR 8.2), respiratory failure (OR 6.5), myocardial infarction (OR 5.5), Horner syndrome (OR 4.7), pulmonary edema (OR 4.5), and dural tears (OR 4.1). Risks of acute kidney injury, pulmonary embolism, and dysphonia were also elevated in severely obese patients. Conclusion: Severe obesity is associated with higher complication rates and longer hospital stays following ACDF. Tailored perioperative management is essential to mitigate these risks and improve outcomes in this high-risk population. Full article

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17 pages, 517 KiB

Open AccessSystematic Review

Transanal Irrigation in Patients with Low Anterior Resection Syndrome After Rectal-Sphincter-Preserving Surgery for Oncological and Non-Oncological Disease: A Systematic Review

by Andrea Morini, Massimiliano Fabozzi, Magda Zanelli, Francesca Sanguedolce, Andrea Palicelli, Alfredo Annicchiarico, Candida Bonelli and Maurizio Zizzo

Surg. Tech. Dev. 2024, 13(4), 409-425; https://doi.org/10.3390/std13040033 - 22 Dec 2024

Abstract

Background/Objectives: Transanal irrigation (TAI) has been recognized as a safe and effective treatment for neurological bowel dysfunction, chronic constipation or fecal incontinence and has also been proposed for patients with low anterior resection syndrome (LARS). The aim of the present systematic review was [...] Read more.

Background/Objectives: Transanal irrigation (TAI) has been recognized as a safe and effective treatment for neurological bowel dysfunction, chronic constipation or fecal incontinence and has also been proposed for patients with low anterior resection syndrome (LARS). The aim of the present systematic review was to evaluate the feasibility and effectiveness of TAI in patients with significant LARS symptoms. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and guidelines in addition to the Cochrane Handbook for Systematic Reviews of Interventions. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023436839). The risk of bias was assessed using a modified version of the Downs and Black checklist. The main outcome was improvement in low anterior resection syndrome after TAI assessed by change in LARS score. Results: After an initial screening of 3703 studies, 9 were included and underwent qualitative synthesis (among them, 3 were randomized clinical trials). All studies recorded an improvement in LARS score following TAI procedure and almost all studies showed an improvement in other bowel function outcomes (Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC BFI, ), Cleveland Clinic Incontinence Score (CCIS), visual analog scale (VAS), Cleveland Clinic Florida Fecal Incontinence Score (CCFFIS), fecal incontinence score (FI score), Obstructed Defecation Syndrome (ODS) score) and quality of life (QoL) scores. The discontinuation rate ranged from 0% to 41%. The rate of adverse events was high (from 0 to 93%); moreover, no uniformity was found in the various protocols used among the different studies. Conclusions: The results of this review show that TAI is effective in the treatment of LARS, improving the LARS score, the other bowel function outcomes and the QoL scores. The absence of a treatment protocol validated by the scientific community is reflected in the high disparity in terms of adverse events and discontinuation of therapy, in addition to representing an intrinsic limitation to the study itself. Full article

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7 pages, 1646 KiB

Open AccessCase Report

Osteochondral Allograft Transplant in a Young Patient with a Traumatic Hip Fracture Dislocation: A Case Report

by Morgan Turnow, Trent Davis, Thomas Seebacher, Grant Chudik, Taylor Manes, Hunter Pharis, Daniel Degenova and Sanjay Mehta

Surg. Tech. Dev. 2024, 13(4), 402-408; https://doi.org/10.3390/std13040032 - 13 Dec 2024

Abstract

Background: Femoral head fractures with osteochondral defects are rare injuries often resulting from traumatic hip dislocations. These injuries create a significant risk for post-traumatic osteoarthritis. Various surgical methods for repair have been utilized to restore these osteochondral defects, including mosaicplasty, autologous cartilage implantation, [...] Read more.

Background: Femoral head fractures with osteochondral defects are rare injuries often resulting from traumatic hip dislocations. These injuries create a significant risk for post-traumatic osteoarthritis. Various surgical methods for repair have been utilized to restore these osteochondral defects, including mosaicplasty, autologous cartilage implantation, osteochondral allograft transplant (OAT), and demineralized bone matrix (DBM). Methods: We present a case of a 21-year-old male who sustained a fracture-dislocation of the left femoral head with impaction of the weight-bearing surface due to a motor vehicle collision. Due to the patient’s relatively young age, OAT plugs from a fresh-frozen proximal humerus with DBM supplementation during fracture fragment fixation were chosen to reduce the likelihood of post-traumatic arthritis. Results: The patient regained subjective function and full strength on exam with no pain at 2 years postoperatively. Conclusions: We propose that a proximal humerus allograft is a suitable alternative in an urgent setting when a femoral head allograft is not available. Full article

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9 pages, 461 KiB

Open AccessSystematic Review

Minimally Invasive Distal Metatarsal Osteotomies for Metatarsalgia Treatment: A Review

by Mario Suárez-Ortiz, Sofía Mora-Pardo, Miguel López-Vigil, Francisco Muñoz-Piqueras and Alfonso Martínez-Nova

Surg. Tech. Dev. 2024, 13(4), 393-401; https://doi.org/10.3390/std13040031 - 3 Dec 2024

Abstract

Introduction: Metatarsalgia is a very common pathology in podiatric consultations, whose main aetiological factor is biomechanical alterations. Given the failure of conservative treatments, minimally invasive osteotomies of the distal metatarsal are becoming more popular, providing comparable results to open surgical techniques and with [...] Read more.

Introduction: Metatarsalgia is a very common pathology in podiatric consultations, whose main aetiological factor is biomechanical alterations. Given the failure of conservative treatments, minimally invasive osteotomies of the distal metatarsal are becoming more popular, providing comparable results to open surgical techniques and with a lower rate of complications. Objectives: To determine clinical improvement and patient satisfaction after minimally invasive distal metatarsal osteotomy (DMMO) as a surgical treatment for central metatarsalgia at present. Methodology: The databases used for this systematic review were PubMed, Scielo, Cochrane Library, WOS and Scopus. We included articles that studied the efficacy of DMMO for primary metatarsalgia and excluded studies whose patients had more than one pathology or used other surgical techniques. Results: We identified 10 articles, 5 prospective studies, 4 retrospective studies and 1 cross-sectional, non-randomized, analytical study published between 2015 and 2021. The total number of subjects was 366, with a mean age of 61 years. The majority of subjects were women. They presented with symptomatology compatible with primary metatarsalgia for a minimum of 6 months and had failed conservative treatment. Conclusions: DMMO osteotomies for central metatarsals offer excellent post-surgical results for the treatment of central metatarsalgia in the assessment scales (AOFAS, MOXFQ etc.) of the articles analyzed and therefore an evident clinical improvement with benefits in terms of MTF mobility and reduction of surgical time, as well as a high degree of satisfaction in the patients who received this intervention that can be considered as excellent. Full article

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11 pages, 9455 KiB

Open AccessTechnical 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

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

Open AccessArticle

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

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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Graphical abstract

12 pages, 3785 KiB

Open AccessEditor’s ChoiceArticle

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

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

Open AccessEditor’s ChoiceArticle

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

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

Open AccessEditor’s ChoiceArticle

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

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

Open AccessTechnical 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

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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12 pages, 2705 KiB

Open AccessEditor’s ChoiceArticle

The Use of Cryopreserved Umbilical Tissue as an Adjunctive Therapy in Immediate Breast-Reconstruction Patients at High Risk for Wound-Healing Complications: Case-Report Series and Preliminary Results

by Kyle M. Ockerman, Nhan Trieu, Sabrina H. Han, Markos Mardourian, Lisa Spiguel, Kalyan Dadireddy and Sarah Sorice Virk

Surg. Tech. Dev. 2024, 13(3), 313-324; https://doi.org/10.3390/std13030024 - 20 Sep 2024

Abstract

Introduction: Mastectomy skin necrosis (MSN) is a common complication occurring in up to 50% of patients. In patients with risk factors for poor wound healing such as immunosuppression, prior radiotherapy (XRT), and high body mass index (BMI > 30.0), this number is even [...] Read more.

Introduction: Mastectomy skin necrosis (MSN) is a common complication occurring in up to 50% of patients. In patients with risk factors for poor wound healing such as immunosuppression, prior radiotherapy (XRT), and high body mass index (BMI > 30.0), this number is even higher. MSN can lead to infection, loss of reconstruction, poorer aesthetics, and most ominously, delay in adjuvant cancer therapy. Instead of forgoing reconstruction in these patients, adjunctive therapies to optimize wound healing are necessary. The purpose of this study is to introduce the use of cryopreserved umbilical tissue (vCUT) as an adjunct therapy for high-risk-wound-healing immediate breast reconstruction (IBR) patients. Methods: All patients who underwent breast reconstruction with vCUT as an adjunctive therapy were identified and retrospectively analyzed. Results: Seven patients who underwent breast reconstruction with vCUT placement were identified. These patients had risk factors for delayed healing, such as obesity, immunosuppression, and/or prior XRT. The mean post-operative follow-up was 252 days (range 183–287). Four out of seven patients demonstrated post-operative complications: two out of seven developed seromas, two out of seven developed wound dehiscence, two out of seven developed infection, two out of seven developed MSN, and two out of seven lost their reconstruction. Conclusion: As undergoing IBR leads to improved mental health and superior aesthetic outcomes, efforts to expand current indications for safe IBR to traditionally poorer reconstructive candidates are imperative. The results of this case series demonstrate vCUT as a promising novel adjunctive tool in the reconstructive surgeons’ armamentarium in managing the less ideal reconstructive breast candidate. Full article

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12 pages, 272 KiB

Open AccessEditor’s ChoiceReview

Is Chronic Pelvic Inflammatory Disease an Exclusively Medical Gynecological Disease, or It May Be a Surgical Challenge?

by Mihai-Daniel Dinu, Bashar Haj Hamoud, Mihaela Amza, Romina-Marina Sima, Ileana-Maria Conea, Gabriel-Petre Gorecki and Liana Pleș

Surg. Tech. Dev. 2024, 13(3), 301-312; https://doi.org/10.3390/std13030023 - 3 Sep 2024

Abstract

Pelvic inflammatory disease is an infectious condition affecting women’s upper genital tract, including the uterus, fallopian tubes, and ovaries. It primarily arises from an infection that spreads upward from the lower genital area. The relationship between chronic pelvic pain and coexisting conditions is [...] Read more.

Pelvic inflammatory disease is an infectious condition affecting women’s upper genital tract, including the uterus, fallopian tubes, and ovaries. It primarily arises from an infection that spreads upward from the lower genital area. The relationship between chronic pelvic pain and coexisting conditions is a key focus in its diagnosis and treatment. This type of pain is also considered a form of reflex dystrophy, involving both neurological and psychological components, the first line treatment consists in antibiotherapy. For patients with complex or severe pelvic abscesses, surgical intervention may be considered in selected cases. The primary surgical techniques employed are open and laparoscopic surgery, both aimed for abscess removal. MRI or Doppler ultrasonography may be employed when there is a suspicion of adnexal torsion, adenomyosis or deep pelvic endometriosis, especially if the ultrasound results are unclear or inconclusive Laparoscopic surgery has increasingly become favored by both healthcare professionals and patients. Moreover, laparoscopy has emerged as the most valuable tool for diagnosing chronic pelvic pain. The approach to treating pelvic abscesses in women of reproductive age depends greatly on clinical assessments, individual patient factors, and the desire to preserve fertility. However, laparoscopy may present technical difficulties in patients with severe pelvic abscesses, particularly those with extensive adhesions or a closed-off pelvic area, requiring advanced surgical expertise. Women with associated conditions such as endometriosis often experience a more severe form of pelvic inflammatory disease, which is less responsive to antibiotics and more frequently requires surgical resolution. The surgical treatment should be performed individualized to the clinical condition of the patient and the time of intervention must be carefully chosen. Full article

7 pages, 868 KiB

Open AccessEditor’s ChoiceCase Report

Fully Dual-Portal Robotic-Assisted Thoracic Surgery (F-DRATS) and Indocyanine Green-Navigated Segmentectomy

by Khrystyna Kuzmych, Carolina Sassorossi, Dania Nachira, Maria Teresa Congedo, Stefano Margaritora and Elisa Meacci

Surg. Tech. Dev. 2024, 13(3), 294-300; https://doi.org/10.3390/std13030022 - 19 Aug 2024

Abstract

Background: In the landscape of thoracic surgery, innovation continually drives progress, offering novel approaches to address complex pathologies while prioritizing patient well-being. Dual-port robotic-assisted thoracic surgery (DRATS) represents a new frontier in this evolution. In this report, we describe our experience with the [...] Read more.

Background: In the landscape of thoracic surgery, innovation continually drives progress, offering novel approaches to address complex pathologies while prioritizing patient well-being. Dual-port robotic-assisted thoracic surgery (DRATS) represents a new frontier in this evolution. In this report, we describe our experience with the fully dual-port robotic-assisted thoracic surgery (F-DRATS) approach for segmentectomy with the indocyanine green intersegmental plane identification. Methods: We define as F-DRATS the robotic thoracic surgery performed by two intercostal incisions without rib spreading, using the robotic camera, robotic dissecting instruments, and exclusively robotic staplers. We herein describe our F-DRATS approach in lingulectomy and lymphadenectomy of stations 5, 6, 7, and 10 using the da Vinci Surgical System. Results: The patient’s postoperative course was uneventful with the chest tube removed on the second postoperative day. The final pathological analysis confirmed a low-grade malignant potential adenocarcinoma, with a main diameter of 1.1 cm, at 3 cm from the lung margins. Conclusions: This is the first description in the literature of a F-DRATS lingulectomy with ICG intersegmental plane identification. Full article

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16 pages, 22963 KiB

Open AccessEditor’s ChoiceCase Report

Perioperative Benefits of a 3D Printed Spine Biomodel in the Setting of Congenital Scoliosis Surgery

by Dean C. Perfetti, Stanley Kisinde, Theodore A. Belanger and Isador H. Lieberman

Surg. Tech. Dev. 2024, 13(3), 278-293; https://doi.org/10.3390/std13030021 - 9 Aug 2024

Abstract

The spine community is continuously adding to its armamentarium of intraoperative techniques for visualization and instrumentation of the spine. Recently, three-dimensional printed spine models were introduced for use in preoperative planning, surgical simulation, and intraoperative guidance. We present a 14-year old African male [...] Read more.

The spine community is continuously adding to its armamentarium of intraoperative techniques for visualization and instrumentation of the spine. Recently, three-dimensional printed spine models were introduced for use in preoperative planning, surgical simulation, and intraoperative guidance. We present a 14-year old African male with congenital kyphoscoliosis, small stature, an obvious gibbus deformity and coronal imbalance, who underwent a three-staged posterior surgical correction procedure, during which a 3D-printed spine biomodel was utilized for better appreciation of his complex spinal deformity patho-anatomy. During the first stage of the procedure, he developed diminished lower extremity motor strength bilaterally and bowel/bladder control, but, following his third stage procedure and with focused rehabilitation efforts, he has regained full control of his bowel and bladder function, and is able to ambulate and perform activities of daily living independently, albeit still requiring intermittent walking support with a single forearm crutch due to residual left leg weakness. The 3D spine biomodel functioned successfully as a valuable tool and surrogate anatomic blueprint for the surgeons, enabling adequate appreciation of the complex bony anatomy which could not be easily resolved on the conventionally available imaging modalities, intraoperative navigation or robotic platform. Theoretically, up to $2900 USD in savings, translated from the mean estimated time saved per procedure with the use 3D-printed spine models has been proposed in some studies. Therefore, 3D-printed spine models have utility in complex spinal deformity correction surgery. Full article

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9 pages, 10499 KiB

Open AccessEditor’s ChoiceCase Report

Three-Dimensional Computed Tomography-Assisted Complex Lung Segmentectomies for Challenging Oncological Cases

by Riccardo Orlandi, Lorenzo Gherzi, Michele Ferrari, Giovanni Mattioni, Marco Alifano and Alessandro Pardolesi

Surg. Tech. Dev. 2024, 13(3), 269-277; https://doi.org/10.3390/std13030020 - 1 Aug 2024

Abstract

Background: anatomic lung segmentectomies allow accurate resection of pulmonary lesions, maximizing healthy tissue preservation, and reducing unnecessary loss of lung function. In this setting, accurate preoperative planning is crucial. We present our early experience, detailing the successful use of 3D-CT models in tailoring [...] Read more.

Background: anatomic lung segmentectomies allow accurate resection of pulmonary lesions, maximizing healthy tissue preservation, and reducing unnecessary loss of lung function. In this setting, accurate preoperative planning is crucial. We present our early experience, detailing the successful use of 3D-CT models in tailoring therapeutic strategies for three patients undergoing complex anatomical lung resections due to neoplastic diseases. Case Presentation: (1) 60-year-old male patient with significant pulmonary functional impairment underwent successful right lower lobe bi-segmentectomy (S7–S8) for carcinoid, stage IA1. (2) 65-year-old female patient with previous left lung resection and functional impairment underwent uneventful right upper lobe bi-segmentectomy (S1–S2) for double lung adenocarcinoma, stage IIb. (3) 67-year-old male with previous ipsilateral lung resection underwent left lower lobe segmentectomy (S8) for metastatic colic adenocarcinoma without any complications. Conclusion: 3D-CT imaging, particularly through VP^TM platform, enhances the safety and precision of complex lung segmentectomy, providing a valuable surgical map for improved outcomes. Full article

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11 pages, 3000 KiB

Open AccessTechnical Note

Thoracic Fracture–Dislocation with Bilateral Locked Facet Joints: An Effective Reduction Technique

by Jure Pavešić, Mislav Jelić, Stjepan Dokuzović, Sathish Muthu, Ana Miletić, Stjepan Ivandić, Vide Bilić and Stipe Ćorluka

Surg. Tech. Dev. 2024, 13(3), 258-268; https://doi.org/10.3390/std13030019 - 29 Jul 2024

Abstract

Background and Objectives: Thoracolumbar fracture–dislocations (AO type C) are rare injuries that occur due to high-energy trauma, and the result is translational and rotational instability of the spinal column and neurological impairment. Several reduction maneuvers have thus far been published, each of which [...] Read more.

Background and Objectives: Thoracolumbar fracture–dislocations (AO type C) are rare injuries that occur due to high-energy trauma, and the result is translational and rotational instability of the spinal column and neurological impairment. Several reduction maneuvers have thus far been published, each of which can be of use in certain specific situations. We developed a modification to the previously described reduction technique. Materials and Methods: This is a case study on the management of thoracic AO type C fracture–dislocations managed with a modified reduction technique. The success of the reduction and intraoperative iatrogenic complications such as dural tear and screw pull out were the outcomes analyzed. Results: A total of four cases were successfully reduced with this described reduction technique. We did not note any complications such as a dural tear or screw failure with this modified reduction technique. Conclusions: A modification to the reduction technique employed in the management of thoracic fracture–dislocations resulted in a successful reduction without the risk of iatrogenic complications due to the reduction maneuver. Full article

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7 pages, 426 KiB

Open AccessEditor’s ChoiceArticle

Increased Postoperative Glycemic Variability Is Associated with Increased Revision Surgery Rates in Diabetic Patients Undergoing Hip Fracture Fixation

by Itay Ashkenazi, Nissan Amzallag, Shai Factor, Nadav Graif, Or Shaked, Yaniv Warschawski, Tomer Ben-Tov and Amal Khoury

Surg. Tech. Dev. 2024, 13(3), 251-257; https://doi.org/10.3390/std13030018 - 19 Jul 2024

Abstract

Background: An association between increased postoperative glycemic variability (GV) and inferior postoperative outcomes following hip arthroplasty procedures has been previously reported. However, the utilization of the GV to project surgical outcomes following the fixation of hip fractures has not been well established. The [...] Read more.

Background: An association between increased postoperative glycemic variability (GV) and inferior postoperative outcomes following hip arthroplasty procedures has been previously reported. However, the utilization of the GV to project surgical outcomes following the fixation of hip fractures has not been well established. The aim of this study is to assess the association between the postoperative GV of patients with diabetes mellitus (DM) and surgical outcomes following the fixation of a hip fracture. Methods: This is a retrospective analysis of 3117 consecutive cases of patients who underwent the fixation of hip fractures between 2011 and 2020. Patients with a DM diagnosis who had ≥3 postoperative glucose measurements during the first week after surgery and had a minimum of one-year follow-up were included. The coefficient of variation (the ratio of the standard deviation to the mean) was utilized to assess the GV. The final study population included 605 patients who were divided into three groups according to the extent of their GV. Short- and mid-term outcomes, including mortality, reoperations, readmissions, and postoperative infection rates were compared between the groups. Results: There was a non-significant trend towards increased rates of mortality (p = 0.06), readmissions (p = 0.22) and postoperative infections (p = 0.09) in the high GV group. The rate of revisions at the latest follow-up was significantly higher in the high GV group when compared to the two other groups (p = 0.04). Conclusion: For diabetic patients undergoing hip fracture fixation, a higher GV in the postoperative period was associated with increased rates of all-cause revision surgery and may be associated with increased mortality, readmission rates, and surgical site infections. Glucose levels of diabetic patients should be meticulously monitored and controlled in the postoperative period in an effort to contain the sequelae associated with elevated GV and to identify patients in need of closer observation and follow-up. Full article

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6 pages, 2698 KiB

Open AccessEditor’s ChoiceCase Report

Simultaneous Laparoscopic Surgery for Esophageal Achalasia Combined with Epiphrenic Diverticulum: A Case Report

by Koichi Okamoto, Jun Kinoshita, Hiroto Saito, Itasu Ninomiya, Noriyuki Inaki and Hiroyuki Takamura

Surg. Tech. Dev. 2024, 13(3), 245-250; https://doi.org/10.3390/std13030017 - 11 Jul 2024

Abstract

We report a case in which a 74-year-old man suffering from esophageal achalasia complicated with epiphrenic esophageal diverticulum was successfully treated with a simultaneous laparoscopic surgery. The gentleman was referred with symptoms suggestive of a passage disorder in the lower esophagus for the [...] Read more.

We report a case in which a 74-year-old man suffering from esophageal achalasia complicated with epiphrenic esophageal diverticulum was successfully treated with a simultaneous laparoscopic surgery. The gentleman was referred with symptoms suggestive of a passage disorder in the lower esophagus for the past 5 years. Esophagogastroduodenoscopy demonstrated an epiphrenic diverticulum at the left wall of the lower esophagus, and esophagography led to the suspicion of a combined esophageal achalasia. A simultaneous laparoscopic surgery with an abdominal approach was performed in which, following the opening of the esophageal hiatus, the diverticular wall was separated from the mediastinal organs and diverticulectomy was performed with linear staplers. After Heller’s myotomy, Dor’s fundoplication was subsequently performed in which both the incisional line of muscle layer and the suturing line of diverticulectomy were wrapped by the fornix of the stomach to make up for the wall strength and avoid the suture leakage. It was theoretically considered logical and effective to reinforce this vulnerable site with Dor’s fundoplication. He had an uneventful recovery and a rapid relief from symptoms following surgery. Full article

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