Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery

BACKGROUND

Pilonidal sinus disease (PSD) is a common surgical disease. Multiple surgical methods exist in the literature, without clear consensus regarding which should be the first-line treatment. Minimally invasive methods such as the Gips procedure are gaining popularity in recent years. The aim of our study was to assess recurrence rates following the Gips procedure and to determine whether using the same surgical approach during re-operation is efficient and successful.

METHODS

This is a single-center retrospective observational study of pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022.

RESULTS

565 pediatric patients underwent an elective surgery for PSD in the study period. Recurrence rate was 8.1% (n = 46). In all the patients with recurrence, re-operation took place on average 9 months following the first surgery and using the same surgical method. Following the second surgery, only 8 patients (1%) had multiple recurrences.

CONCLUSIONS

We found a relatively low recurrence rate in the pediatric population using the Gips method, and nearly 100% success rate following the second operation. Our findings set a new benchmark for pediatric recurrence following PSD operation, with clear recommendation to use the same method of surgery upon further recurrences as well.

Evaluation of a Novel Drilling Approach for Dynamic Navigation-Aided Endodontic Microsurgery: A Surgical Simulation Comparison Study

INTRODUCTION

This study investigated the feasibility of a novel drilling approach that integrates a pilot trephine into dynamic navigation (DN) for guided osteotomy and root-end resection (RER) with unimanual operation in endodontic microsurgery.

METHODS

Two operators with varying levels of DN experience performed guided osteotomy and RER using 2 unimanual drilling methods with DN-aided operation on 3-dimensional printed jaw models. Method 1 (M1) involved drilling with a conventional trephine. Method 2 (M2) involved drilling with a pilot trephine, followed by drilling with a conventional trephine. Accuracy, time, and safety of M1 and M2 were compared. Accuracy measurements included platform deviation (PD), end deviation (ED), angular deviation (AD), resection length deviation (RLD), and resection bevel angle (RBA). Additional parameters included osteotomy and RER time (OT) and bur slippage number (BSN). Statistical analyses were conducted using a 2-sample t-test or Mann-Whitney U test, with the significance level set at .05.

RESULTS

The PD, AD, RBA, and BSN in the M2 group were significantly less than in the M1 group (P < .05). For M1, the novice operator (NO) exhibited significantly higher values of PD, ED, OT, and BSN than the experienced operator (EO) (P < .05). For M2, the NO exhibited significantly higher value of ED only (P < .05), and drilling depth >7 mm was significantly associated with a longer OT (P < .05).

CONCLUSION

In this surgical simulation comparison study, the incorporation of a pilot drill improved the accuracy and safety of DN-aided endodontic microsurgery.

Foraminoplasty Performed with a Trephine and a New Tool in Transforaminal Endoscopic Lumbar Discectomy: A Single-Center Retrospective Study

OBJECTIVE

Foraminoplasty is an important step in transforaminal endoscopic lumbar discectomy (TELD). A trephine is widely used in foraminoplasty. However, foraminoplasty using a trephine alone sometimes fails to remove the resected bone, resulting in the bone remaining in the foramen or spinal canal, which can potentially cause neurological irritation or injury. The objective of this study is to introduce a self-designed tool, referred to as an anchoring drill, for use with a trephine in foraminoplasty in TELD and to evaluate its advantages.

METHODS

A retrospective review was performed to identify patients who underwent L4-5 TELD between January 2019 to January 2022. Foraminoplasty was performed in all patients. Depending on whether the anchoring drill was used or not, patients were divided into two groups. Surgery-related parameters and complications were reviewed. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores were also assessed for all patients. SPSS statistical software was used for statistical calculation.

RESULTS

A total of 100 patients were included (55 in the anchoring drill group and 45 in the trephine group). The incidence of residual bone fragments after foraminoplasty of the anchoring drill group was 9.09%, which was lower than that of the trephine group, at 33.33% (p < 0.05). The mean endoscopic operation time of the anchoring drill group was shorter than that of the trephine group (p < 0.05). The mean fluoroscopy time and duration of foraminoplasty showed no significant differences between the two cohorts. The total perioperative complication incidence was lower in the anchoring drill group, in which the neural irritation incidence showed a significant difference (anchoring drill group: 3.64%, trephine group: 17.78%, p < 0.05). VAS and JOA scores were significantly improved after the operation for all patients (p < 0.001), however, no statistical differences were found between the two groups at each follow-up visit.

CONCLUSION

The combination of a trephine with an anchor drill was demonstrated to be safe and effective in foraminoplasty in TELD, improving the success rate of foraminoplasty and reducing neurological complications compared to using trephine alone.

Variability of bone marrow biopsy reporting affects accuracy of diagnosis of myeloproliferative neoplasms: data from the ALLG MPN01 registry

The Philadelphia-negative myeloproliferative neoplasms (MPN) are a heterogeneous group of overlapping bone marrow disorders defined by characteristic peripheral blood counts and bone marrow morphological findings in conjunction with recurrent somatic mutations. The accurate diagnosis and subclassification of MPN relies upon careful reporting of bone marrow morphology combined with ancillary information in an integrated pathology report. This co-operative trial group study ALLG MPN01 (ANZCTR:12613000138785), led by the Australasian Leukaemia & Lymphoma Group (ALLG), aimed to describe the current approach to diagnosis of MPN in routine practice. Specifically, we assessed the frequency with which bone marrow biopsies were performed, and the adherence of reporting pathologists to recommendations contained in the revised 2016 WHO classification pertaining to MPN. We reviewed the diagnosis of 152 patients from eight institutions who were enrolled in a national MPN registry of the ALLG between 2010 and 2016. The ALLG MPN01 registry is now closed to recruitment. Key features were extracted from pathology reports provided to the registry. Bone marrow biopsies were performed in 112/152 cases (74%). The pathological information entered was concordant with the stated clinical diagnosis in 75/112 cases (67%). The main reasons for discordant results were incomplete descriptions of megakaryocyte topography and morphology, inconsistent grading of reticulin fibrosis, and failure to integrate the available morphological and ancillary clinicopathological information. In this retrospective audit, 26% of MPN patients did not undergo a diagnostic bone marrow biopsy. In those who did, the specific MPN subtype may not have been reported correctly in 33% of cases, as evidenced by inconsistent features reported or insufficient information to assess. A more standardised approach to bone marrow reporting is required to ensure accuracy of MPN diagnoses and consistent reporting to cancer registries and clinical trials.

Use of a Trephine to Extract a Fractured Corail Femoral Stem During Revision Total Hip Arthroplasty: Tips From Our Case Report

Despite the significant advancements in the field of total hip arthroplasty (THA) and prosthesis designs, fracture of the modular femoral stem after THA can occur rarely and needs attention. Orthopaedic surgeons face a daunting task when it comes to the removal of a broken stem. The use of a trephine reamer has been evaluated for extracting the distal femoral stem, and this case report tries to address some key tips for the same. A 67-year-old obese male, without any major medical comorbidities, presented to the Royal Lancaster Infirmary orthopaedic outpatient department with a complaint of acute-on-chronic right anterior thigh pain that worsened over a few weeks. He had a history of bilateral staged uncemented THA done around 12 years ago. The plain radiological images confirmed the presence of a fracture of the Corail femoral stem. A posterior approach was used to dislocate the hip and the distal broken part of the stem was removed using trephines. Reamers were used and care was taken to prevent thermal necrosis by using intermittent saline lavage. After the removal of the fractured femoral stem, a cemented femoral revision THA was performed, which was uneventful. The patient walked without any aid or thigh pain postoperatively during his last follow-up. Using trephines to remove broken femoral stems is an effective and safe method. Intraoperative measures can help in avoiding heat necrosis while using a trephine reamer for extracting the fractured femoral stem. Regular follow-up and counselling are important after THA, to avoid a delayed diagnosis of non-traumatic femoral stem fractures.

A multidimensional analysis reveals distinct immune phenotypes and tertiary lymphoid structure-like aggregates in the bone marrow of pediatric acute myeloid leukemia

Because of the low mutational burden, children with acute myeloid leukemia (AML) are thought to have a 'cold' tumor microenvironment and consequently, a low likelihood of response to T cell-directed immunotherapies. Here, we provide a multidimensional overview of the tumor immune microenvironment in newly diagnosed pediatric AML. On a cohort level, we demonstrate wide variation in T cell infiltration with nearly one-third of cases harboring an immune-infiltrated bone marrow. These immune-infiltrated cases are characterized by a decreased abundance of M2-like macrophages, which we find to be associated with response to T cell-directed immunotherapy in adult AML. On an organizational level, we reveal the composition of spatially organized immune aggregates in pediatric AML, and show that in the adult setting such aggregates in post-treatment bone marrow and extramedullary sites associate with response to ipilimumab-based therapy. Altogether, our study provides immune correlates of response to T cell-directed immunotherapies and indicates starting points for further investigations into immunomodulatory mechanisms in AML.

The temporary resection of the cranial vault by Wilhelm Wagner (1848-1900) instead of trepanation: the cornerstone of the modern craniotomy

In this paper, the authors trace the history of cranial temporary resection, described by Wilhelm Wagner (1848-1900) in 1889, which changed the paradigm of the cranial opening from trephining to the craniotomy. The objective of the temporary resection was to obtain wide openings in the skull, keeping the cranial flap attached to the soft tissues to maintain bone vitality. The cranial temporary resection was reproduced by the authors in an anatomical study faithfully following the original technique, demonstrating the feasibility of the surgical procedure as described by Wagner. Surgical steps include a large omega-shaped skin incision and a beveled cut of the bone with the chisel and mallet until reaching the dura mater, lifting the bone flap en bloc along with all superficial soft tissues. A literature review shows that the temporary cranial resection became a great success at that time because it allowed physicians to improve a number of constraints of the cranial opening using the crown trephine: bone vitality; a wide cranial window; easy, safe, and quick surgery; and economy of surgical instruments. The crude, primitive proposal of the temporary resection was ameliorated to quickly build the successful model of the modern craniotomy.

Trephine-based foraminoplasty in PTED treatment of lumbar lateral recess stenosis

BACKGROUND

During minimally invasive spine surgery, nerve root decompression is challenging due to the anatomical division and uncertainty in lumbar lateral recess (LLR).

OBJECTIVES

To evaluate the outcome and safety of foraminoplasty using percutaneous transforaminal endoscopic decompression (PTED) (performed with an aid of a trephine) in the treatment of lumbar lateral recess stenosis (LLRS).

MATERIAL AND METHODS

All operations were performed under local anesthesia and in prone position. The puncture point was 10-14 cm away from the midline of the spinous process. One hundred eight individuals with LLRS who underwent PTED from September 2016 to December 2020 in our hospital were enrolled in the study. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were collected preoperatively after 1 day, 7 days, 1 month and at the final follow-up (June 2021). Low back pain and leg pain were measured using VAS score. Functional outcomes were assessed with ODI and modified Macnab criteria.

RESULTS

After the surgery, the VAS score and ODI were statistically significant at all follow-up points compared with the pre-surgery (both p < 0.05). Based on the modified Macnab scores at the final follow-up, the satisfaction rate at postoperative 1 month was 96.3% and the satisfaction rate at postoperative 7 days was 70.38%. A significant difference was observed between the 2 groups (p < 0.05).

CONCLUSIONS

Foraminoplasty using PTED performed with a trephine is one of the safe and effective, minimally invasive methods to treat LLRS.

Targeted Endodontic Microsurgery: A Retrospective Outcomes Assessment of 24 Cases

INTRODUCTION

Targeted endodontic microsurgery (TEMS) replaces freehand carbide or diamond bur osteotomy and root-end resection with a guided approach using an end-cutting trephine bur rotated within a guide tube. TEMS departs from traditional endodontic microsurgery in osteotomy size, control of resection level and bevel, surgical time, and resection method; yet, the impact of these departures on clinical outcomes has yet to be assessed. The aim of this study was to assess clinical outcomes of TEMS surgeries at least 1 year after treatment.

METHODS

Potential cases were retrospectively identified from a secure database of all patients who received TEMS in the Air Force Postgraduate Dental School from June 2017-May 2019 with a postsurgical follow-up examination at 1 year or beyond (23 patients with 24 teeth). Two board-certified endodontists completed a calibration exercise before assessing radiographs. A retrospective outcomes assessment was conducted considering follow-up clinical and radiographic findings to assign 1 of 3 healing designations: complete healing, reductive healing, or failure.

RESULTS

Combined clinical and radiographic data led to 20 designations of complete healing, 2 designations of reductive healing, and 2 failures (91.7% success rate). Considered alone, radiographic criteria for complete healing were met for 20 cases, reductive healing for 3 cases, and radiographic failure for 1 case.

CONCLUSIONS

This limited retrospective outcomes assessment is an early indication that TEMS-guided trephine bur root-end resection leads to similar success as is established for freehand carbide and diamond bur resection. Controlled clinical trials with long-term follow-up are warranted.

Targeted Endodontic Microsurgery: Implications of the Greater Palatine Artery

INTRODUCTION

Targeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS.

METHODS

Three endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS.

RESULTS

Palatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA.

CONCLUSIONS

Palatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.

Guided modern endodontic microsurgery by use of a trephine bur

Surgical guides and three-dimensional (3D) planning softwares used in everyday dental implantology open new possibilities in other fields of dentistry. While using the operation microscope in endodontic microsurgery provides more precise apicectomy, there is still no consent on the exact localisation and size of the bony window to be prepared for this surgery. Our aim is to describe a new, guided endodontic microsurgery method when osteotomy and apicectomy are planned in a 3D software and performed with a trephine bur. Based on data from Cone Beam Computed Tomography, planning of the surgical guide was performed with a 3D planning software (Smart Guide, dicomLAB, Hungary) in order to define the size of the bony window, the angulation and the depth of the trephine bur during the apicectomy. After preparing a mucoperiosteal flap, with the help of the dentally supported surgical guide, the trephine bur removes the cortical bone and the apex of the root simultaniously. Following the modern microsurgical protocol, after performing the ultrasonic retrograde preparation, mineral trioxide aggregate (ProRoot MTA; Dentsply Maillefer, Ballaigues, Switzerland) is placed as a retrograde filling to close the resected area. After the uneventful healing period, a complete bony regeneration can be seen on the 1-year follow up X-ray. The patient is symptom-free. This technique is considered to be faster and more precise than the non-guided endodontic microsurgery carried out without the utilization of a trephine bur. Orv Hetil. 2020; 161(30): 1260-1265.

Minimally invasive subtalar arthrodesis for traumatic subtalar arthritis

Objective

This study was performed to introduce a new method of minimally invasive subtalar arthrodesis (MISA) and assess its clinical effects on traumatic subtalar arthritis (TSA).

Methods

Fifteen patients (8 male and 7 female; age range, 36–56 years; mean age, 48.67 years) with TSA who underwent MISA were included. All patients were treated using a series instrument. The intraoperative and postoperative indexes were recorded.

Results

Among all patients, the mean operation time was 59.67 ± 16.31 minutes and the mean intraoperative blood loss was 43.33 ± 52.87 mL. Four patients underwent iliac crest bone graft surgery, and one patient developed a complication involving fat liquefaction of the iliac crest wound. The mean bony fusion time among all patients was 3.5 months. According to the American Orthopaedic Foot and Ankle Society standard, an excellent outcome was obtained in eight patients and a good outcome was obtained in seven patients. The operation time and intraoperative blood loss were significantly different between patients who did and did not undergo iliac crest bone graft surgery.

Conclusion

MISA is a simple and effective method for the treatment of TSA.

Artifacts of the neurosciences: A resource guide to museums and collections

Medical museums and collections care for important artifacts relating to the history of the neurosciences across the United States, the United Kingdom, and Europe. This essay highlights the collections and galleries of greatest interest and worth a visit. It also provides a list of online directories of medical museums and bibliography of related publications.

Frank Clifford Rose Memorial Lecture: The tale of three trephines: Surgeons and their surgical-instrument makers in Britain, France, and America in the nineteenth century

Trephines and trepanning date to ancient times, but a "modern" form of instruments was codified by the seventeenth century. This did not preclude efforts to "improve" the trephine in the late-eighteenth and nineteenth centuries. Surgeons and instrument makers in Britain (Jardine and Savigny), France (Thomson and Charrière), and America (Galt and Otto & Reynders) endeavored to make the trephine safer and more precise. In exploring their interactions, this presentation shows the evolving role of the instrument makers not only as fabricators of tools, but as creative design collaborators of surgeons and physicians.

Comparative study to evaluate bone loss during osteotomy using standard drill, bone trephine, and alveolar expanders for implant placement

Statement of Problem:

Various osteotomy modalities seem to have an impact on the primary and secondary stability of the dental implant. The available literature lacks the comparison of various available osteotomy modalities used for the dental implant placement and its effects on the initial surgical bone removal.

Purpose:

The purpose of this study is to compare and evaluate the osteotomy sites created using standard drill, bone trephine, and alveolar expanders for dental implant surgery.

Materials and Methods:

The study was done on ten goat hemimandibles. Three osteotomy sites were prepared at the inferior border of the mandible using standard drill, trephine, and alveolar expander in each hemimandibles and the sites were subjected to cone-beam computed tomography (CBCT). The CBCT images obtained were compared for the amount of cortical bone and bone marrow loss at osteotomy sites in different techniques.

Results:

The mean and standard deviation of loss of cortical bone with standard drills, trephines, and alveolar expanders was 3.62 ± 4.216 × 10⁻², 3.6 ± 4.681 × 10⁻¹⁶ and 3.15 ± 7.071 × 10⁻². At the middle-third region, the loss of marrow bone was 3.38 ± 7.88 × 10⁻², 2.15 ± 8.498 × 10⁻² and 0.03 ± 9.487 × 10⁻², and at lower third region, it was 2.3 ± 4.714 × 10⁻², 0.02 ± 6.325 × 10⁻², and 0.0, respectively.

Conclusion:

CBCT images showed minimum bone loss with the use of alveolar expander which may be due to the lateral bone condensation rather the removal of the marrow. Trephine showed less marrow removal in comparison to the standard drill used for dental implant surgery.

Surgical Treatment of Corneal Ectasia with Motowa's Trephine and Selective Suturing Technique

A 40-year-old male presented with bilateral ectasia, contact lens intolerance, and astigmatism >10 D in both eyes. The patient had end-stage pellucid marginal degeneration that warranted surgical treatment. We present a unique surgical technique to stabilize the cornea, minimize astigmatism, improve vision and corneal status, and avoid penetrating keratoplasty.

Optimizing Safety of Iliac Bone Harvest Using an Acumed Drill: A Simulated Radiographic Study of 100 Patients

OBJECTIVE

To determine the potential risk of visceral injury during Acumed drill iliac crest cancellous bone graft harvest.

DESIGN

Radiographic iliac crest anatomic analysis with simulated drill course to measure cancellous bone available for harvest and proximity of vulnerable pelvic structures.

SETTING

Single institution, tertiary care university hospital.

PATIENTS AND PARTICIPANTS

One hundred pelvic computed tomography scans performed on children 8 to 12 years old without traumatic or neoplastic pathology.

INTERVENTIONS

Radiographic simulation of Acumed drill course within iliac bone.

MAIN OUTCOME MEASURES

(1) Potential for pelvic visceral injury. (2) Volume of cancellous bone safely available for harvest.

RESULTS

Superior and medial cortical thickness at the reference point remained stable across age groups; however, lateral cortical thickness increased with age (3.13 to 3.74 mm, P < .001). Cancellous bone width increased with age at all depths measured (P < .001). Through radiographic simulation, the drill could reach the bowel in 4% of cases and only through gross deviation (>30°) from the plane of the ilium. There were no cases of simulated bowel perforation within 3 cm of the reference point. The maximum cancellous volume safely harvested increased with age: 24 cc in 8-year-olds to 36 cc in 12-year-olds (P < .001).

CONCLUSIONS

Acumed assisted iliac crest bone graft harvest is a safe technique in which substantial amount of cancellous bone can be obtained. The low risk of bowel perforation can be further minimized by limiting the depth of drill bit penetration to less than 3 cm.

Accuracy of corneal trephination depth using the Moria single-use adjustable depth vacuum trephine system

Background

The Moria single-use adjustable depth trephine is a device that allows a goal trephination depth to be set prior to the surgical procedure.

Methods

Eleven fresh human cadaveric eyes were trephined using 8.0 mm Moria single-use adjustable vacuum trephines. Prior to trephination, the average corneal pachymetry in the peripheral 7–10 mm range was obtained using anterior segment optical coherence tomography. The trephination depth was set to 80% of that value. Light microscopy was used to image anteroposterior cross-sections of each corneal specimen. Digital protractor software was used to evaluate the trephination angle, depth, and length. All adequately processed specimens were included in the analysis. In addition, trephination angle data from a previous publication by Moshirfar et al were used as a comparison with those of this study.

Results

Trephination analysis of depth compared with pachymetry revealed a mean of 83.7%±6.53% (95% confidence interval 79.8–87.6). Maximum and minimum trephined depths were 95.35% and 71.3%, respectively. Trephination depth compared with angular corneal thickness yielded a mean of 66.2%±4.79% (95% confidence interval 63.0–69.4). Maximum and minimum depths were 73.7% and 59.7%, respectively. Analysis of trephination angle yielded a mean of 130.2±3.57 degrees (95% confidence interval 127.8–132.61). Maximum and minimum angles were 135.5 degrees and 126 degrees, respectively. The standard deviation of the trephination angle of the Moria trephine was found to be significantly less than that of Hessburg-Barron and Hanna trephines calculated in the previous study.

Conclusion

The Moria adjustable vacuum trephine is an accurate method of trephination when a specific depth is desired. Further investigation is needed to determine the relevance of this in relation to deep anterior lamellar keratoplasty.

Use of sonic instruments for implant biopsy retrieval

OBJECTIVE

To evaluate in vitro the quality of dental implant biopsies collected using trephines or a sonic instrument.

METHOD

Sixty implants, 4 mm long and 2.4 mm in diameter, were installed in twelve fresh bovine ribs. Biopsies were collected after using three different methods for retrieval, 20 biopsies representing each group: (A) A trephine used concentrically; (B) a trephine used eccentrically; and (C) a sonic device (Sonosurgery(®) ). The time used for biopsy collection was recorded, and an evaluation of the quality of the biopsies obtained was performed. The specimens were subsequently prepared for ground sections, and tissue-to-implant contact percentages (TIC%) were evaluated in a stereomicroscope.

RESULTS

Time needed for biopsy collection in Groups A and B was between 2 and 3 min, while in C, it amounted to 10-11 min. The differences between Group C and the other two groups were statistically significant (P < 0.00006). Group C showed significantly greater volumes of tissue around the apex of the implants compared with the other two groups (P < 0.027). Groups A and C showed biopsies with higher quality compared with Group B (P < 0.05). Group C presented a higher TIC% compared with the other two groups (P < 0.008).

CONCLUSION

Compared with the use of trephines, the use of a sonic device for harvesting biopsies resulted in higher-quality biopsies and generated smaller residual defects. However, the harvesting was more time-consuming and was limited to one aspect of the implants.

Utility of trephine reamers in revision hip arthroplasty

Powered trephines used over a femoral component to disrupt the bone component interface can yield acceptable clinical and radiographic outcomes while minimizing direct mechanical injury and indirect thermal necrosis. Thirty-six patients required trephining for fractured stems (16), infection (8), malposition (7), modular junction failure (4), and acetabular exposure (1). Harris Hip Scores (HHS), radiographic healing, and complications were assessed at a follow-up of 50.01 mo. Mean HHS increased from 46.61 preoperatively to 87.78 postoperatively (p<.0001). Two patients suffered spontaneous postoperative periprosthetic fractures in the region of the trephined bone at 3 mo and 4 mo postoperatively. Despite undergoing ORIF with locked plates, they both re-fractured with necrotic bone observed at the time of revision. There is a 5.6% incidence of femoral shaft fractures near the region of trephined bone within 1 year of surgery. Given the location of these fractures, thermal necrosis may have occurred and consideration should be given to distally bypassing the region of the femur that has been trephined.

Comparison of Hanna and Hessburg-Barron trephine and punch systems using histological, anterior segment optical coherence tomography, and elliptical curve fitting models

BACKGROUND

This study analyzes the characteristics of donor and recipient tissue preparation between the Hessburg-Barron and Hanna punch and trephine systems by using elliptical curve fitting models, light microscopy, and anterior segment optical coherence tomography (AS-OCT).

METHODS

Eight millimeter Hessburg-Barron and Hanna vacuum trephines and punches were used on six cadaver globes and six corneal-scleral rims, respectively. Eccentricity data were generated using measurements from photographs of the corneal buttons and were used to generate an elliptical curve fit to calculate properties of the corneal button. The trephination angle and punch angle were measured by digital protractor software from light microscopy and AS-OCT images to evaluate the consistency with which each device cuts the cornea.

RESULTS

The Hanna trephine showed a trend towards producing a more circular recipient button than the Barron trephine (ratio of major axis to minor axis), ie, 1.059 ± 0.041 versus 1.110 ± 0.027 (P = 0.147) and the Hanna punch showed a trend towards producing a more circular donor cut than the Barron punch, ie, 1.021 ± 0.022 versus 1.046 ± 0.039 (P = 0.445). The Hanna trephine was demonstrated to have a more consistent trephination angle than the Barron trephine when assessing light microscopy images, ie, ±14.39° (95% confidence interval [CI] 111.9-157.7) versus ±19.38° (95% CI 101.9-150.2, P = 0.492) and OCT images, ie, ±8.08° (95% CI 106.2-123.3) versus ±11.16° (95% CI 109.3-132.6, P = 0.306). The angle created by the Hanna punch had less variability than the Barron punch from both the light microscopy, ie, ±4.81° (95% CI 101.6-113.9) versus ±11.28° (95% CI 84.5-120.6, P = 0.295) and AS-OCT imaging, ie, ±9.96° (95% CI 95.7-116.4) versus ±14.02° (95% CI 91.8-123.7, P = 0.825). Statistical significance was not achieved.

CONCLUSION

The Hanna trephine and punch may be more accurate and consistent in cutting corneal buttons than the Hessburg-Barron trephine and punch when evaluated using elliptical curve fitting models, light microscopy, and AS-OCT.

Minimally invasive stomas

Traditionally, stoma creation and end stoma reversal have been performed via a laparotomy incision. However, in many situations, stoma construction may be safely performed in a minimally invasive nature. This may include a trephine, laparoscopic, or combined approach. Furthermore, Hartmann's colostomy reversal, a procedure traditionally associated with substantial morbidity, may also be performed laparoscopically. The authors briefly review patient selection, preparation, and indications, and focus primarily on surgical techniques and results of minimally invasive stoma creation and Hartmann's reversal.