1
|
Yang XJ, Wang WH, Zou JY, Wang J, Yang ZQ. Triplane technique for breast reconstruction after breast cancer surgery: A case series report. Medicine (Baltimore) 2024; 103:e37559. [PMID: 38552090 PMCID: PMC10977549 DOI: 10.1097/md.0000000000037559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. PATIENT CONCERNS The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. DIAGNOSES The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. INTERVENTIONS The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. OUTCOMES No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. LESSONS The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.
Collapse
Affiliation(s)
- Xiao-Juan Yang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Wen-Huan Wang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Jie-Ya Zou
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Ji Wang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Zhuang-Qing Yang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| |
Collapse
|
2
|
Pitoulias GA, Pitoulias AG, Chatzelas DA, Zampaka T, Loutradis C, Potouridis A, Tachtsi MD. Early Results of Elective Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms With the Minos TM Stent-Graft System. J Endovasc Ther 2023:15266028231172379. [PMID: 37166154 DOI: 10.1177/15266028231172379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE A variety of last-generation endografts are currently available for standard endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs). The purpose of this study is to report the preliminary clinical outcomes of the Minos trimodular stent-graft system, which was recently introduced to the European market. MATERIALS AND METHODS Between February 2020 and 2022, we treated 41 consecutive AAA patients (mean age 72.2±8.5, 37 males) with elective standard EVAR using the Minos. The mean maximum diameter of AAAs was 54.7±6.6 mm, the mean proximal neck's (PN) diameter was 24.8±2.7 mm, while the relevant length and angulation were 16.0 mm and 21.7°, respectively. Overall, 22 (53.6%) patients presented with shorter and angulated PN, according to the stent-graft's instructions of use, and in 6 (14.6%) patients the PN angulation >60° was combined with concomitant iliac angulation >60°. Eleven (26.8%) EVARs were performed with concomitant enormous iliac artery narrowing and tortuosity. Finally, in 19 (46.3%) AAAs, the distal iliac landing zone was aneurysmatic and they were treated with the bell-bottom technique in 17 patients and with limb extension to the external iliac artery in two cases. We evaluated technical and clinical success of the index procedures, which was based on the combination of five factors: freedom from EVAR-related mortality, from graft-related endoleak of any type, from migration at any part of graft as well the absence of notable increase AAA's sac maximum diameter and the patency of bifurcated stent-graft and of access vessels. RESULTS Primary technical and clinical success of index procedures was 100%. During a median 12-month radiological follow-up the clinical success remained 100%. No type I or III endoleak, stent-graft migration, EVAR-related death, AAA rupture, or graft-related adverse events or reinterventions were documented. Four (9.8%) type II endoleaks were detected with stable AAA sac diameter. The overall incidence of sac regression was 34.1% (n=14). CONCLUSION The preliminary results of our series showed that Minos provided excellent feasibility and safety features even through angulated and tortuous iliac vessels and in short and angulated PNs. The overall clinical success at 1 year suggests that performance of Minos follows very high standards. Further validation of these promising results with long-term data is acquired to complete the evaluation of this recently introduced stent-graft system. CLINICAL IMPACT The current study explored the clinical performance of a new in market ultra-low profile bifurcated abdominal aortic stent-graft, the MINOS. The early and 12-month results of study suggest that implantation of this stent-graft in standard EVAR, even in hostile proximal aortic neck and iliac vessels conditions, follows very high clinical standards and encourage the further clinical use of MINOS.
Collapse
Affiliation(s)
- Georgios A Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Apostolos G Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Dimitrios A Chatzelas
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Theodosia Zampaka
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Charalampos Loutradis
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Anastasios Potouridis
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Maria D Tachtsi
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| |
Collapse
|
3
|
Sowa D, Guzik G, Bronisz M, Merkiel D, Biega P. Functional and Surgical Outcomes of Corpectomy in Patients with Unstable Spinal Fractures. Ortop Traumatol Rehabil 2023; 25:61-71. [PMID: 37345629 DOI: 10.5604/01.3001.0053.6159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Unstable fractures of the spine should be managed surgically. An anterior approach allows for precise decompression of the vertebral canal and reconstruction of the fractured vertebral body. The aim of the study was to evaluate the functional and surgical outcomes of anterior surgical approaches for vertebral body removal and prosthetic reconstruction. MATERIAL AND METHODS The objectives of this paper were accomplished by reviewing the course of treatment and treatment outcomes of patients operated on at the Orthopaedic Oncology Department in Brzozw and the Department of Orthopaedics and Traumatology in District Hospital in Stalowa Wola in the years 2020-2021. In total, the treatment of 54 patients was analyzed. The study only included patients with traumatic and pathological fractures who underwent a single-level corpectomy. A total of 18 patients with fractures of the cervical spine, 15 of the thoracic spine and 21 of lumbar spine were treated. Before and after treatment, patients' neurological status was assessed according to the Frankel classification, performance was assessed with the Karnofsky score and pain intensity was analyzed with a VAS. The vertebral wedge angle (alpha), the ratio of the anterior height of the fractured vertebral body to the anterior height of the upper adjacent vertebral body (a/c), the ratio of the anterior height to the posterior height of the fractured vertebra (a/b) and the distance between the vertebral endplates adjacent to the fractured vertebra, measured between their anterior edges (A-B) were assessed. The most common general medical and surgical complications were also evaluated. RESULTS After the surgery, significant pain relief measured using a VAS was noted (the median was 7 preoperatively and 4 postoperatively) and an improvement in performance according to the Karnofsky score was observed (the median was 50 preoperatively and 70 postoperatively). Out of the 14 patients with neurologic deficits 11 improved, while 5 regained the ability to walk. In four patients, the implant migrated into an adjacent vertebra and three patients suffered a fracture of the upper adjacent vertebra. The correction of the spine deteriorated in all 7 patients. There was no postoperative neurological deterioration of patients and no infectious complications. During the surgery, three patients suffered dura mater injury, which was identified intraoperatively and repaired. CONCLUSIONS 1. Corpectomy followed by vertebral body replacement is an effective and safe method that enables the restoration of the shape of the vertebra, restoration of the physciological spinal curvature and direct neural decompression. 2. The treatment outcomes are good. Pain significantly decreases and performance improves in most patients. 3. Treatment complications are rare. The most often observed complication was migration of the implant into an adjacent vertebral endplate, fractures above the place of fixation and dura mater injury.
Collapse
Affiliation(s)
- Dariusz Sowa
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola. Poland
| | - Grzegorz Guzik
- Odział Ortopedii Onkologicznej Szpitala Specjalistycznego w Brzozowie - Podkarpacki Ośrodek Onkologiczny, Brzozów, Polska / Orthopaedic Oncology Department, Subcarpathian Oncology Centre in Brzozów, Rzeszów University of Technology, Brzozów, Poland
| | - Michał Bronisz
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola. Poland
| | - Dawid Merkiel
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola. Poland
| | - Piotr Biega
- Odział Ortopedii Onkologicznej Szpitala Specjalistycznego w Brzozowie - Podkarpacki Ośrodek Onkologiczny, Brzozów, Polska / Orthopaedic Oncology Department, Subcarpathian Oncology Centre in Brzozów, Rzeszów University of Technology, Brzozów, Poland
| |
Collapse
|
4
|
Abstract
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
Collapse
Affiliation(s)
| | - Musaab Yassin
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Ankit Desai
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Tharu Tharakan
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | | | - Martina Zurli
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Suks Minhas
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| |
Collapse
|
5
|
Malalasekera A, Louie-Johnsun M, Wang A, van Diepen DC, Gottlieb T, Chan L. Is a 10-minute surgical scrub necessary in urologic prosthetic surgery? A randomized study of the effect of a 5- vs 10-minute surgical scrub on bacterial colony counts in the genital skin. Neurourol Urodyn 2019; 38:990-995. [PMID: 30801820 DOI: 10.1002/nau.23945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/21/2019] [Indexed: 12/30/2022]
Abstract
AIMS To determine the antiseptic efficacy on bacterial colony counts of a 5- vs 10-minute surgical site scrub in urologic surgery. METHODS A prospective cohort study was conducted in 101 patients presenting for elective urological procedures. Patients were randomized to a 5- or 10-minute groin scrub with Betadine (povidone-iodine). Skin swabs were taken immediately after skin clipping and following routine painting with Betadine. A third swab was taken after the betadine skin scrub. Bacterial colony counts were reported as a number of colony-forming units (CFUs). The primary outcome measure was a quantitative comparison of CFUs in the two arms. RESULTS Fifty-three patients were randomized to a 5-minute scrub and 48 to a 10-minute scrub. After Betadine painting, CFUs were present in 38% of patients in the 5-minute group (mean, 33.5 CFU) and in 27% of the 10-minute group (mean, 45.4 CFU). Following the surgical scrub, only 7.5% of the 5-minute group and 8.3% of the 10-minute group had a measurable CFU count of greater than or equal to 1, and colony counts were low in both groups (5- minute group: mean, 1.5 CFU; 10-minute group: mean, 2.0 CFU). There was no significant difference in CFUs following a 5- or 10-minute scrub (P = 0.28). CONCLUSIONS The addition of a surgical skin scrub leads to a fourfold reduction in the skin CFU count compared with Betadine painting. However, there is no difference between the antibacterial effects of a 5- and 10-minute scrub. A 5-minute scrub may be sufficient in urologic prosthetic surgery.
Collapse
Affiliation(s)
- Ashanya Malalasekera
- Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Mark Louie-Johnsun
- Department of Urology, Gosford Hospital and Gosford Private Hospital, Gosford, New South Wales, Australia
| | - Audrey Wang
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Danielle C van Diepen
- Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Sobreiro DI, Sampaio RO, Siciliano RF, Brazil CVA, Branco CEDB, Lopes ASDSA, Tarasoutchi F, Strabelli TMV. Early Diagnosis and Treatment in Infective Endocarditis: Challenges for a Better Prognosis. Arq Bras Cardiol 2019; 112:201-203. [PMID: 30785586 PMCID: PMC6371822 DOI: 10.5935/abc.20180270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 02/03/2023] Open
Affiliation(s)
- Daniely Iadocico Sobreiro
- Unidade Clínica de Cardiopatias Valvares do Instituto do
Coração do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Roney Orismar Sampaio
- Unidade Clínica de Cardiopatias Valvares do Instituto do
Coração do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Rinaldo Focaccia Siciliano
- Unidade de Controle de Infecção Hospitalar do
Instituto do Coração do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Calila Vieira Andrade Brazil
- Unidade Clínica de Cardiopatias Valvares do Instituto do
Coração do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Carlos Eduardo de Barros Branco
- Unidade Clínica de Cardiopatias Valvares do Instituto do
Coração do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Antônio Sergio de Santis Andrade Lopes
- Unidade Clínica de Cardiopatias Valvares do Instituto do
Coração do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Flávio Tarasoutchi
- Unidade Clínica de Cardiopatias Valvares do Instituto do
Coração do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Tânia Mara Varejão Strabelli
- Unidade de Controle de Infecção Hospitalar do
Instituto do Coração do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| |
Collapse
|
7
|
Pires RE, Waldolato G, Jr EOS, Wajnsztejn A, Labronici PJ, Giordano V. Calf Augmentation Implant Disruption Following a Tibial Plateau Fracture Fixation: An Extremely Rare Complication. J Orthop Case Rep 2019; 9:91-94. [PMID: 32548014 PMCID: PMC7276624 DOI: 10.13107/jocr.2250-0685.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Calf augmentation is a procedure to enhance leg contour, therefore, providing better aesthetic aspect. Patient satisfaction is extremely high, and reported complications following this procedure are rare. Case Report: The aim of this study is to report an as yet described complication related to calf implants: Prosthesis disruption in a 60-year-old female patient who fell downstairs and presented a closed bicondylar tibial plateau fracture on the right knee (Schatzker V). Conclusion: We believe this case report can alert orthopaedic surgeons to carefully evaluate leg images in traumatized extremities and look for calf augmentation implants, especially in unconscious patients.
Collapse
Affiliation(s)
- Robinson E Pires
- Department of the Locomotor Apparatus, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Orthopaedic Surgery, FelicioRocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Gustavo Waldolato
- Department of Orthopaedic Surgery, FelicioRocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Egidio O Santana Jr
- Department of Orthopaedic Surgery, FelicioRocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - André Wajnsztejn
- Department of Orthopaedic Surgery, Albert Einstein Hospital, São Paulo, Brazil
| | - Pedro J Labronici
- Department of Orthopaedic Surgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Vincenzo Giordano
- Department of Orthopaedic Trauma, Miguel Couto Hospital, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Mohan S, Hernández IC, Wang W, Yin K, Sundback CA, Wegst UGK, Jowett N. Fluorescent Reporter Mice for Nerve Guidance Conduit Assessment: A High-Throughput in vivo Model. Laryngoscope 2018; 128:E386-E392. [PMID: 30098047 DOI: 10.1002/lary.27439] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Use of cell culture and conventional in vivo mammalian models to assess nerve regeneration across guidance conduits is resource-intensive. Herein we describe a high-throughput platform utilizing transgenic mice for stain-free axon visualization paired with rapid cryosection techniques for low-cost screening of novel bioengineered nerve guidance conduit performance. METHODS Interposition repair of sciatic nerve transection in mice expressing yellow fluorescent protein in peripheral neurons (Thy1.2 YFP-16) was performed with various bioengineered neural conduit compositions using a rapid sutureless entubulation technique under isoflurane anesthesia. Axonal ingrowth was assessed at 3 and 6 weeks using epifluorescent microscopy following cryosectioning. RESULTS Mean procedure time (incision-to-closure) was less than 2½ minutes. Direct operational costs of a 3-week experiment was calculated at $21.47 per animal. Tissue processing steps were minimized to aldehyde fixation, cryoprotection and sectioning, and rapid fluorescent dye staining for conduit visualization. Fluorescent microscopy readily resolved robust axonal sprouting at 3 weeks, with clear elucidation of ingrowth-permissive, semipermissive, or restrictive nerve guidance conduit environments. CONCLUSION A rapid and cost-efficient in vivo platform for screening of nerve guidance conduit performance has been described. LEVEL OF EVIDENCE NA. Laryngoscope, E392-E392, 2018.
Collapse
Affiliation(s)
- Suresh Mohan
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Iván Coto Hernández
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Wenjin Wang
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Kaiyang Yin
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, U.S.A
| | - Cathryn A Sundback
- Center for Regenerative Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ulrike G K Wegst
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, U.S.A
| | - Nate Jowett
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| |
Collapse
|
9
|
Abstract
Stents and tubes to maintain the patency of the airways are commonly used for malignant obstruction and are occasionally employed in benign disease. Malignant airway obstruction usually results from direct involvement of bronchogenic carcinoma, or by extension of carcinomas occurring in the esophagus or the thyroid. External compression from lymph nodes or metastatic disease from other organs can also cause central airway obstruction. Most malignant airway lesions are surgically inoperable due to advanced disease stage and require multimodality palliation, including stent placement. As with any other medical device, stents have significantly evolved over the last 50 years and deserve an in-depth understanding of their true capabilities and complications. Not every silicone stent is created equal and the same holds for metallic stents. Herein, we present an overview of the topic as well as some of the more practical and controversial issues surrounding airway stents. We also try to dispel the myths surrounding stent removal and their supposed use only in central airways. At the end, we come to the long-held conclusion that stents should not be used as first line treatment of choice, but after ruling out the possibility of curative surgical resection or repair.
Collapse
Affiliation(s)
- Erik Folch
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen Keyes
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Abstract
BACKGROUND Malignant fibrous histiocytoma (MFH) of the bone is a rare tumor. Most studies comparing limb salvage and amputation have reported that limb salvage had no adverse effect on the long-term survival of patients. This study evaluates the oncological outcomes of limb salvage procedures that were used for 15 patients with MFH of the humerus. OBJECTIVES The aim of this study was to assess the functional and oncological outcomes of patients with malignant fibrous histiocytoma of the humerus after en bloc resection and prosthesis implantation. MATERIAL AND METHODS A retrospective review of the charts of 15 patients who had undergone resection of malignant fibrous histiocytoma of the humerus followed by reconstruction with prosthesis was used in this study. A functional evaluation was based on Enneking's modified system of the functional evaluation of surgical management for musculoskeletal tumors. Complications of the procedures were also analyzed. RESULTS Eight men and 7 women at an average age of 52.9 years were included in the study. The tumor involved the distal humerus in 3 patients, the proximal humerus in 8 patients and the mid-shaft humerus in 4 patients. Excellent results were achieved in 4 patients, good to fair in 10 and poor in 1. One patient had local recurrence. Pulmonary metastases occurred in 6 patients. CONCLUSIONS Limb salvage surgery with chemotherapy is a viable treatment option for patients with malignant fibrous histiocytoma of the humerus.
Collapse
Affiliation(s)
- Jun Sun
- Department of Orthopedics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ru-Ming Zhang
- Department of Orthopedics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Xin Zheng
- Department of Orthopedics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
11
|
Abstract
Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.
Collapse
Affiliation(s)
- Jacob W Lucas
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Kyle M Lester
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrew Chen
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| |
Collapse
|
12
|
Abstract
Pulmonary morphology, physiology, and respiratory functions change in both physiological and pathological conditions. Internal lung surface area (ISA), representing the gas-exchange capacity of the lung, is a critical criterion to assess respiratory function. However, observer bias can significantly influence measured values for lung morphological parameters. The protocol that we describe here minimizes variations during measurements of two morphological parameters used for ISA calculation: internal lung volume (ILV) and mean linear intercept (MLI). Using ISA as a morphometric and functional parameter to determine the outcome of alveolar regeneration in both pneumonectomy (PNX) and prosthesis implantation mouse models, we found that the increased ISA following PNX treatment was significantly blocked by implantation of a prosthesis into the thoracic cavity1. The ability to accurately quantify ISA is not only expected to improve the reliability and reproducibility of lung function studies in injured-induced alveolar regeneration models, but also to promote mechanistic discoveries of multiple pulmonary diseases.
Collapse
Affiliation(s)
- Zhe Liu
- Department of Life Sciences, Peking University; National Institute of Biological Sciences, Beijing
| | - Siling Fu
- National Institute of Biological Sciences, Beijing; Graduate School of Peking Union Medical College
| | - Nan Tang
- National Institute of Biological Sciences, Beijing;
| |
Collapse
|
13
|
Abstract
Despite increasing use of left ventricular devices for the surgical treatment of heart failure, there is limited experience with implantation of devices in the setting of challenging left apical anatomy. We report the case of a 68-year-old man with a chronic post-infarction calcified apical pseudoaneurysm, who underwent pseudoaneurysmectomy, ventricular myoplasty, and left ventricular assist device implantation. A review of the literature and operative strategies are presented.
Collapse
Affiliation(s)
- Richard V Ha
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Dipanjan Banerjee
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ahmad Y Sheikh
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
14
|
Abstract
Implants placed with high insertion torque (IT) typically exhibit primary stability, which enables early loading. Whether high IT has a negative impact on peri-implant bone health, however, remains to be determined. The purpose of this study was to ascertain how peri-implant bone responds to strains and stresses created when implants are placed with low and high IT. Titanium micro-implants were inserted into murine femurs with low and high IT using torque values that were scaled to approximate those used to place clinically sized implants. Torque created in peri-implant tissues a distribution and magnitude of strains, which were calculated through finite element modeling. Stiffness tests quantified primary and secondary implant stability. At multiple time points, molecular, cellular, and histomorphometric analyses were performed to quantitatively determine the effect of high and low strains on apoptosis, mineralization, resorption, and collagen matrix deposition in peri-implant bone. Preparation of an osteotomy results in a narrow zone of dead and dying osteocytes in peri-implant bone that is not significantly enlarged in response to implants placed with low IT. Placing implants with high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Using high IT to place an implant creates high interfacial stress and strain that are associated with damage to peri-implant bone and therefore should be avoided to best preserve the viability of this tissue.
Collapse
Affiliation(s)
- J Y Cha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA Orthodontic Department, College of Dentistry, Yonsei University, Seoul, South Korea
| | - M D Pereira
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - A A Smith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - K S Houschyar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - X Yin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - J B Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - J A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| |
Collapse
|
15
|
Mohite PN, Sabashnikov A, Zych B, Popov AF, Simon AR. Use of Foley catheter for insertion of ventricular assist device inflow cannula. Asian Cardiovasc Thorac Ann 2014; 22:1088-9. [PMID: 24887841 DOI: 10.1177/0218492313491584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ventricular assist devices are fast becoming an accepted alternative to treat end-stage heart failure, and are being implemented as a bridge to myocardial recovery, a bridge to heart transplantation, or as destination therapy. Positioning of the inflow cannula into the apex of the ventricle is a crucial step due to the risk of sucking in air. We describe an improved method of preparing the insertion site for the ventricular assist device inflow cannula, to minimize the chances of air embolism and blood spillage, which we applied in a 34-year-old man, as a bridge to transplantation.
Collapse
Affiliation(s)
- Prashant N Mohite
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, UK
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, UK
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, UK
| | - Aron F Popov
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, UK
| | - Andre R Simon
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, UK
| |
Collapse
|
16
|
Ihler F, Köhler S, Meyer AC, Blum J, Strenzke N, Matthias C, Canis M. Mastoid cavity obliteration and Vibrant Soundbridge implantation for patients with mixed hearing loss. Laryngoscope 2013; 124:531-7. [PMID: 23918587 DOI: 10.1002/lary.24180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/04/2013] [Accepted: 04/03/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the results of obliteration of a preexisting mastoid cavity with abdominal fat and Vibrant Soundbridge implantation in patients with mixed hearing loss (MHL) and to compare the data with results of Vibrant Soundbridge implantation in patients with MHL without mastoid cavity and with pure sensorineural hearing loss (SNHL). STUDY DESIGN Retrospective chart analysis of 10 patients (10 ears) with MHL and preexisting mastoid cavity, 18 patients (19 ears) with MHL alone and nine patients (10 ears) with SNHL treated in one tertiary referral center. METHODS Vibrant Soundbridge implantation and obliteration in case a mastoid cavity existed previously. Pure tone audiometry (average air-bone gap, average functional gain), speech audiometry (Freiburg Monosyllabic Test) and complication rate were main outcome measures. RESULTS Postoperative average air-bone gap was -15.1 ± 21.2 dB in patients with MHL with mastoid cavity obliteration, -7.2 ± 11.4 dB in patients with MHL without mastoid cavity, and -5.7 ± 11.2 dB in patients with SNHL. Average functional gain was 40.0 ± 23.5 dB, 39.7 ± 12.1 dB, and 9.5 ± 10.6 dB. Postoperative speech discrimination rate was 77.9 ± 20.8%, 83.3 ± 13.6%, and 83.6 ± 6.3%. No severe intraoperative or postoperative complications were noted. CONCLUSIONS Mastoid cavity obliteration during Vibrant Soundbridge implantation in patients with MHL and preexisting mastoid cavity is a safe procedure. The audiometric results are satisfying and comparable to those of other patient groups implanted with the same device. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Friedrich Ihler
- Department for Otolaryngology, University of Göttingen Medical Center, Germany
| | | | | | | | | | | | | |
Collapse
|
17
|
Zhu P, Sun Y, Yang Q, Qiu F. Intraoperative device closure of atrial septal defects with minimal transthoracic invasion: a single-center experience. Tex Heart Inst J 2013; 40:256-260. [PMID: 23914014 PMCID: PMC3709217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial septal defect is one of the most common congenital heart defects. Open-heart repair via midline sternotomy or right thoracotomy and cardiopulmonary bypass has been considered the standard treatment for the closure of atrial septal defects, but transcatheter closure with the Amplatzer septal occluder has recently become a viable option. We have adopted a 3rd alternative: intraoperative device closure with minimal transthoracic invasion. From May 2007 through June 2011, 250 patients with secundum atrial septal defect underwent cardiac surgery at our institution. Open-heart repair with cardiopulmonary bypass was performed in 72 patients, and intraoperative device closure was performed in 178 patients. This minimally invasive approach, which required a full evaluation of the atrial septal defect by transthoracic echocardiography, was performed by deploying the device through the delivery sheath to occlude the atrial septal defect. The approach was successful in 175 of the 178 patients. The size of the implanted occluder ranged from 12 to 46 mm in diameter. Minor complications included transient arrhythmias (n=7) and pleural effusion (n=25). After complete release, the intraoperative occluder device dislodged in the right atrium in 3 patients, who then underwent immediate surgical repair with cardiopulmonary bypass. All discharged patients were monitored for 2.3 years to 5 years. As monotherapy, intraoperative device closure of atrial septal defect with minimal transthoracic invasion is a safe and feasible technique. It is particularly beneficial for elderly patients or patients with pulmonary hypertension and is associated with better cosmetic results and less trauma than is surgical closure.
Collapse
Affiliation(s)
- Peng Zhu
- Department of Cardiothoracic & Vascular Surgery, Xiamen Heart Centre, Zhongshan Hospital, Xiamen University, Xiamen 361004, People's Republic of China.
| | | | | | | |
Collapse
|
18
|
Frazier OH, Tuzun E, Narin C, Cohn WE. Right ventricle-sparing left ventricular resection and replacement with a continuous-flow rotary blood pump: an in vivo experiment. Tex Heart Inst J 2010; 37:276-279. [PMID: 20548801 PMCID: PMC2879189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Despite recent advances in left ventricular assist device and total artificial heart technologies, these devices are still so large that they pose a significant problem in small patients with refractory heart failure. Excising the left ventricle while preserving the right ventricle--and then replacing the left ventricle with a mechanical pump--has been proposed as an alternative approach to this problem. We conducted a pilot study to evaluate possible surgical techniques and the hemodynamic effects of right ventricle-sparing left ventricular resection and replacement with a continuous-flow rotary blood pump in a healthy bovine model.
Collapse
Affiliation(s)
- O H Frazier
- Cardiovascular Surgical Research Laboratories, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
| | | | | | | |
Collapse
|
19
|
Patel SH, Patel R. Inferior vena cava filters for recurrent thrombosis: current evidence. Tex Heart Inst J 2007; 34:187-94. [PMID: 17622366 PMCID: PMC1894721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Inferior vena cava filters are often used as alternatives to anticoagulant therapy for the prevention of pulmonary embolism. Many of the clinical data that support the use of these devices stem from relatively limited retrospective studies. The dual purpose of this review is to examine the incidence of thrombotic complications associated with inferior vena cava filters and to discuss the role of anticoagulant therapy concurrent with filter placement. Device-associated morbidity and overall efficacy can be considered only in the context of rates of vena cava thrombosis, insertion-site thrombosis, recurrent deep venous thrombosis, and recurrent pulmonary embolism.
Collapse
Affiliation(s)
- Salil H Patel
- Department of Medicine, The Methodist Hospital and Christus St. Joseph Hospital, Houston, Texas 77002, USA.
| | | |
Collapse
|