Surgical Techniques Development

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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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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8 pages, 3739 KiB

Open AccessEditor’s ChoiceCase Report

Fixation of Sacral Ala Fracture Using a Midfoot Mesh Plate as a Cannulated Screw Washer: A Case Report

by Daniel T. Degenova, Hunter Pharis, Mike Anderson, Morgan Turnow, Peter Spencer, Vishvam Mehta, Benjamin C. Taylor and Joseph Scheschuk

Surg. Tech. Dev. 2024, 13(3), 237-244; https://doi.org/10.3390/std13030016 - 22 Jun 2024

Abstract

Introduction: Sacral fractures are rare but are increasing in incidence among trauma patients. They are associated with a wide variety of complications, most commonly neurologic defects. Case Report: A 59-year old woman initially underwent open reduction internal fixation (ORIF) for a sacral fracture, [...] Read more.

Introduction: Sacral fractures are rare but are increasing in incidence among trauma patients. They are associated with a wide variety of complications, most commonly neurologic defects. Case Report: A 59-year old woman initially underwent open reduction internal fixation (ORIF) for a sacral fracture, after which the patient developed an infection, wound complications, and hardware failure. The revision of the iliosacral screws proved challenging in that the standard screw and washer could not achieve sufficient compression of the fracture. Therefore, a modified midfoot mesh plate was cut to size and used as a washer to gain more surface area, achieving fixation. The plate was applied laterally and cut to cover as much surface area as possible without unnecessary bony overhang. A trans-iliac trans-sacral screw was then inserted in the standard fashion, thus allowing the plate to act as a washer. This resulted in an excellent outcome with appropriate fracture healing. Conclusion: We describe the case of an iliosacral screw revision in which a modified midfoot mesh plate was used as a washer. This resulted in appropriate fixation in the revision settings. The principles described to achieve this fixation can be broadly applied in the setting of orthopedic fractures. Full article

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10 pages, 3779 KiB

Open AccessEditor’s ChoiceBrief Report

Modified Tension Band Wiring Using Only Non-Absorbable Braided Polyblend Sutures for the Treatment of Patellar Fractures

by Annalisa Itro, Annalisa De Cicco, Gianluca Conza, Luca Schiavo, Niccolò Garofalo, Adriano Braile, Francesco Nappi and Giuseppe Toro

Surg. Tech. Dev. 2024, 13(2), 227-236; https://doi.org/10.3390/std13020015 - 13 Jun 2024

Abstract

Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed [...] Read more.

Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed using tension band principles, through K-wires and metal cerclage. The tension band was conceived to transform the considerable tensile force applied to the patella into a compressive one to obtain a stable fixation. The use of metal implants might be associated with a significant discomfort, mostly related to the irritating action of K-wires and cerclage on the surrounding soft tissues, often leading to the need for implant removal. Therefore, we introduced an original technique for fix patellar fractures by using only a non-adsorbable braided polyblend suture. Postoperative care included progressive range of motion recovery using an articulated knee brace and a specific protocol. The suture-only tension band technique seems to be a useful technique in terms of complications and reoperation rate while allowing secure and early mobilization. Full article

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13 pages, 14834 KiB

Open AccessTechnical Note

The Method of 3D C-arm Navigated AC Joint Stabilization-Surgical Technique

by Alexander Böhringer, Carlos Pankratz, Alexander Eickhoff, Florian Gebhard and Konrad Schütze

Surg. Tech. Dev. 2024, 13(2), 214-226; https://doi.org/10.3390/std13020014 - 8 Jun 2024

Abstract

Background: The arthroscopically assisted stabilization of AC joint dislocations with a suture button system is an established procedure that is widely and successfully used in everyday practice. The main advantages of this one-step method are the minimally invasive procedure and the anatomical reconstruction [...] Read more.

Background: The arthroscopically assisted stabilization of AC joint dislocations with a suture button system is an established procedure that is widely and successfully used in everyday practice. The main advantages of this one-step method are the minimally invasive procedure and the anatomical reconstruction of the ruptured coracoclavicular ligaments with a permanent implant. With this technical note study, for the first time, the new method of navigated suture button implantation in everyday clinical practice is described with the future goal of further reducing invasiveness and increasing precision. Materials and Methods: The surgical technique is explained using precise descriptions and illustrations, photos, X-rays, and 3D reconstructions based on clinical cases. The step-by-step system setup and patient positioning, AC joint reduction and retention, 3D scan and drill tunnel planning, stab incision and Kirschner wire navigation, and cannulated drilling and implant positioning, as well as closure and documentation are described in detail. Results: The standard coracoclavicular stabilization of AC joint dislocations with the 3D C-arm navigated suture button method is described in detail. Furthermore, the feasibility of an additive horizontal acromioclavicular suture cerclage, the implantation of an additional coracoclavicular suture button system, and the single-stage cannulated screw fixation of non-displaced fractures is demonstrated. Conclusion: The navigated suture button method aims to be simple, safe, minimally invasive, and precise. Prospective clinical studies with a long follow-up should be carried out to determine the clinical and radiological outcome in comparison with current methods. Full article

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9 pages, 1211 KiB

Open AccessEditor’s ChoiceCase Report

Retrograde Endovascular Recanalization of the Superior Mesenteric Artery for the Treatment of Acute Bowel Ischemia: Case Report

by Pawel Latacz, Piotr Piekorz and Marian Simka

Surg. Tech. Dev. 2024, 13(2), 205-213; https://doi.org/10.3390/std13020013 - 24 May 2024

Abstract

Acute bowel ischemia is a life-threatening abdominal emergency. In many patients, percutaneous endovascular repair of visceral arteries in an antegrade direction across occluding lesions is challenging and sometimes not possible. We present the case of technically successful percutaneous retrograde recanalization of an occluded [...] Read more.

Acute bowel ischemia is a life-threatening abdominal emergency. In many patients, percutaneous endovascular repair of visceral arteries in an antegrade direction across occluding lesions is challenging and sometimes not possible. We present the case of technically successful percutaneous retrograde recanalization of an occluded superior mesenteric artery in a critically ill 82-year-old patient. The superior mesenteric artery was recanalized via the branches of the celiac trunk; the guidewires were navigated to the target artery through the gastroduodenal and pancreaticoduodenal arteries. Retrograde percutaneous recanalization of the superior mesenteric artery is technically feasible, even in hemodynamically unstable patients. Full article

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13 pages, 1749 KiB

Open AccessEditor’s ChoiceArticle

Locoregional vs. General Anaesthesia for Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) Using Propensity Score Matching Analysis: A Feasibility Study

by Francesco Pennestrì, Priscilla Francesca Procopio, Francesca Prioli, Pierpaolo Gallucci, Luca Sessa, Annamaria Martullo, Antonio Laurino, Luca Revelli, Cristina Modesti, Carmela De Crea and Marco Raffaelli

Surg. Tech. Dev. 2024, 13(2), 192-204; https://doi.org/10.3390/std13020012 - 11 May 2024

Abstract

Focused parathyroidectomy is the preferred surgical method for treating primary hyperparathyroidism (pHPT) sustained by the pre-operatively well-localized parathyroid adenoma. We aimed to compare the effectiveness, safety, and short-term clinical outcome of minimally invasive video-assisted parathyroidectomy (MIVAP) in locoregional anaesthesia (LA) vs. general anaesthesia [...] Read more.

Focused parathyroidectomy is the preferred surgical method for treating primary hyperparathyroidism (pHPT) sustained by the pre-operatively well-localized parathyroid adenoma. We aimed to compare the effectiveness, safety, and short-term clinical outcome of minimally invasive video-assisted parathyroidectomy (MIVAP) in locoregional anaesthesia (LA) vs. general anaesthesia (GA) by means of propensity score matching (PSM) analysis. Retrospective research of patients who underwent MIVAP between January 2014 and December 2022 was carried out. Patients were divided into two groups based on the anaesthesiologic procedure (LA vs. GA). Overall, 553 patients underwent MIVAP. After PSM, 115 patients in the LA group and 230 patients in the GA group were included. MIVAP under LA was associated with shorter median operative time (16 vs. 35 min, p < 0.001), shorter median operative room occupation time (44 vs. 73 min, p < 0.001), and lesser median post-operative visual analogue scale pain, with comparable post-operative hospital stay and complication rate. MIVAP under LA is a safe and feasible procedure with significant advantages over GA in terms of post-operative pain and operative room occupation time. This last step can finally result in more efficient utilisation of the operative room and the health care system’s resources. Full article

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14 pages, 1299 KiB

Open AccessEditor’s ChoiceArticle

Analysing Pre-Operative Gait Patterns Using Inertial Wearable Sensors: An Observational Study of Participants Undergoing Total Hip and Knee Replacement

by Pragadesh Natarajan, Ashley Lim Cha Yin, R. Dineth Fonseka, David Abi-Hanna, Kaitlin Rooke, Luke Sy, Monish Maharaj, David Broe, Lianne Koinis and Ralph Jasper Mobbs

Surg. Tech. Dev. 2024, 13(2), 178-191; https://doi.org/10.3390/std13020011 - 6 May 2024

Abstract

Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying [...] Read more.

Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying functional improvements with gait analysis. Our study therefore aims to characterise the disease-specific gait pattern of participants with knee and hip osteoarthritis undergoing total joint replacement using a single chest-based wearable sensor. Methods. Twenty-nine participants awaiting total hip replacement and 28 participants awaiting total knee replacement underwent three-dimensional motion analysis with inertial wearable sensors. These gait metrics were then compared with 28 healthy controls of similar ages. Differences in gait metrics were evaluated using a T-test. The participants were recruited through a single centre to participate in this cross-sectional observational study. Participants with osteoarthritis severity sufficient to warrant surgical intervention were considered for inclusion in our study. The participants were instructed to walk 15–120 m in a hospital environment while fitted with a chest-based wearable sensor. Results. In total, three domains were evaluated, including spatiotemporal, variability and asymmetry parameters. There were marked variations in the gait asymmetry parameters and step length variation in both the hip and knee osteoarthritis patients compared with the healthy controls. The magnitude of gait deterioration in terms of step length asymmetry was greater on average in the hip osteoarthritis group than the knee group. The hip osteoarthritis (+180%, p < 0.001) and knee osteoarthritis (+129%, p = 0.001) groups demonstrated marked differences in step length asymmetry. Discussion. A single chest-based sensor was found to be capable of detecting pathological gait signatures in osteoarthritis patients when compared with age-matched controls. Future studies should compare pre- and postoperative changes to disease-specific gait impairments to validate the use of wearable sensors as a clinical adjunct. Full article

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