Isolated ureteral injury from multiple stab wounds: A case report

This is a case report about a 44-year-old woman who sustained multiple stab wounds, resulting in an isolated right ureteral injury. Despite a precise diagnosis from an urgent CT scan showing contrast material extravasation, the patient's stable vital signs allowed for a thorough surgical exploration, leading to an accurate diagnosis. Immediate surgical repair of the right ureter using an end-to-end anastomosis following precise surgical principles achieved complete restoration of the initial injuries. The case highlights the accuracy of CT scan assessment, the unreliability of hematuria in diagnosing ureteral injuries, and the need for a high index of suspicion during surgical exploration to avoid overlooking such cases.

An anatomical study of 16 cases

INTRODUCTION

Post-traumatic lesions of the carpus (scapholunate rupture, scaphoid non-union) frequently evolve into disabling osteoarthritis (scapholunate advanced collapse or scaphoid non-union advanced collapse: SLAC or SNAC wrist). Proximal row carpectomy (PRC) is a reliable option but with poorer prognosis in case of osteoarthritis of the distal radius or capitate head. In such situations, radiocarpal arthrodesis may be necessary, sacrificing wrist motion. To circumvent this limitation, we propose a new procedure consisting in arthroscopic PRC and replacing the proximal row by tendon graft.

METHODS

This was a study on 16 cadaver specimens. A scapholunate pin was introduced via an approach into the anatomical snuffbox and used as a guide for a cannulated drill bit (9mm) to create a tunnel through the proximal row. The arthroscope and a reamer were introduced into the tunnel via its radial and ulnar ends. PRC was performed under arthroscopic control. The gracilis and semitendinosus tendons were harvested and folded so as to obtain a graft with the same length and diameter as the proximal row. The graft was threaded through the radial approach and fixed to the capsule.

RESULTS

Mean procedure time was 68min. There was no pre- to postoperative difference in joint motion or carpal height. On radiocinematography, the graft was stable between the radius and the second row of the carpus. The radial and ulnar sensory branches, median nerve and radial artery were intact at end of procedure.

DISCUSSION

This technique could be a solution in SLAC or SNAC wrist with osteoarthritis of the capitate head or radial glenoid. It also conserves carpal height. Being arthroscopic, the procedure avoids the major edema observed after a dorsal approach of the carpus, and also ensures graft stability, since the radiocarpal ligaments are conserved. Harvesting from a second anatomical site and the in vivo fate of the transplant are two issues that need to be discussed.

CONCLUSION

This anatomical study paves the way for clinical experimentation.

LEVEL OF EVIDENCE

IV.

Overlapping-plasty technique for pulmonary artery aneurysm

Massive pulmonary artery aneurysms, while extremely rare, might require surgical intervention. Most previous cases have been repaired either by pulmonary artery plication or synthetic graft replacement. We report a case of massive pulmonary artery aneurysm that was successfully repaired using an 'overlapping-plasty' technique with the help of 3D image simulation. This specially designed procedure might be useful as a surgical option for pulmonary artery aneurysms.

Use of neocords in the treatment of mitral valve prolapse: about 6 cases

INTRODUCTION AND IMPORTANCE

Mitral insufficiency is a common valve disease with a prevalence of 2% and increases after the age of 65. This is the second valvulopathy operated after aortic stenosis. The surgical management of mitral insufficiency has been completely changed in recent years. The mitral valvular replacement with was the gold standard; is currently preceded by conservative surgery thanks to the emergence of reproducible and durable surgical techniques. The aim of our study is to highlight the place of Neogortex in the treatment of mitral valvular prolapse.

METHODS

This is a retrospective study that includes 6 adult patients operated on for mitral insufficiency by prolapse of the large valve between October 2016 and June 2018 in the Cardiovascular Surgery Department A of the Ibn Sina Hospital in Rabat, Morocco.

RESULTS

We collected 6 patients. The average age is 56 years. The clinical presentation was made of dyspnea in the 6 patients. On the echocardiographic level, all patients had mitral insufficiency due to prolapse of the large mitral valve in 2 patients and a restriction of the play of the valve by shortening of the ropes in 2 patients. The 6 patients were operated. The technique was the installation of a prosthetic ring with neogortex fixation between the free edge and the abutment and a tricuspid plasty type Devega. The operative sequences were simple.

CONCLUSION

Mitral valve repair gives satisfactory results in terms of survival and symptomatic improvement with a low operative risk.

[Introduction to tissue movements - Principles of flaps]

The practice of surgical dermatology allows the dermatologist to take overall management of patients, particularly in the domain of skin cancer. It is the dermatologist who makes a diagnosis based on his expertise and his understanding, determines the tumour edges and the surgical margins to be applied, carries out the excision and repair procedures, and performs monitoring. Such comprehensive management requires knowledge of fundamental principles that allow for repair procedures suited to specific sites. Normally, simple repair involving direct suture can be performed using the intrinsic elasticity and plasticity of skin. However, depending on the site and the extent of substance loss, it may be necessary to perform a more complex repair by recruiting adjoining skin to create a flap. Skin flaps follow certain shared general rules. Their primary purpose is to fill in for surgically removed tissue that cannot be corrected by suturing by simply moving them from their current anatomical placement, creating a second and different shaped tissue loss at a point where simple wound closure may be effected thanks to looseness of the skin. In this article, we lay the groundwork for reflection on the practice of autoplasty, we set out the rules required to ensure optimal results, and we explain the various types of flaps using a classification based on tissue mobilization including advancement, rotation and transposition flaps.

Percutaneous transluminal plasty: a novel approach for refractory anastomotic stricture after esophagectomy

Anastomotic stricture is often observed after esophagectomy. Surgical treatment is considered for refractory stricture to conservative treatments. However, it is not established what type of surgery is safe and effective. In this report, we present a novel approach, percutaneous transluminal plasty, for refractory anastomotic stricture reconstructed via the subcutaneous route in esophagectomy. We believe that the effectiveness and safety of this technique is considerably good and can become a good alternative for refractory stricture after esophagectomy.

Distal quadricepsplasty in children: 88 cases of retractile fibrosis following intramuscular injections treated in Benin

INTRODUCTION

Retractile fibrosis of the quadriceps (RFQ) is a physical and social handicap in children, and often results from a past history of quadriceps intramuscular injection. The aim of this study was to evaluate the therapeutic results of RFQ treated by distal quadricepsplasty using a modified Thompson-Payr procedure (DQPMTP).

HYPOTHESIS

Functional recovery will be good with DQPMTP.

PATIENTS AND METHODS

This is a descriptive retrospective 10-year study from 2002 to 2011, including 74 children (88 knees) less than 15 years old, admitted for RFQ and treated in Benin. The types of RFQ were: knee flexion loss of motion 16 cases (18.2%), lag of extension 54 cases (61.4%) and associated genu recurvatum, 18 cases (20.5%). Wasting of the thigh was found in all cases. An associated distal femoral osteotomy was performed to correct a bone deformity in 18 cases (20.5%).

RESULTS

There were 16 cases (18.2%) of poorly looking postoperative scars and 2 cases (2.3%) of fracture during physical therapy. Mean flexion ROM after surgery was 77.7°. Mean flexion increased from 77.7° to 108.5° following postoperative rehabilitation or a mean gain of 30.7°. The quadriceps muscle testing scores were at least 3/5. Results of DQPMTP were good in 80.7% of cases, as shown by mean active knee flexion of 108.5° with normal active extension. The results were satisfactory in 17 cases (19.3%).

DISCUSSION

DQPMTP has the advantage of cutting a minimum of blood vessels, thus limiting the risk of hematoma. Laterally placed incisions create less tension reducing the risk of skin necrosis. The clinical and radiological results of this series confirm those in the literature. Treatment of RFQ by DQPMTP provides satisfactory functional rehabilitation in patients, which confirms our hypothesis.

LEVEL OF EVIDENCE

Level IV, retrospective study without comparison.