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Abstract
PURPOSE We performed a systematic review and meta-analysis to compare the safety and efficacy of minimally invasive surgery (MIS) versus open ureteral reimplantation (OUR) in children. METHODS Literature searches were conducted to identify studies that compared MIS (laparoscopic ureteral reimplantation or robot-assisted laparoscopic ureteral replantation) and OUR in children. Parameters such as operative time, blood loss, length of hospital stay, success rate, postoperative urinary tract infection (UTI), urinary retention, postoperative hematuria, wound infection, and overall postoperative complications were pooled and compared by meta-analysis. RESULTS Among the 7,882 pediatric participants in the 14 studies, 852 received MIS, and 7,030 received OUR. When compared with the OUR, the MIS approach resulted in shorter hospital stays (I 2 = 99%, weighted mean difference [WMD] -2.82, 95% confidence interval [CI] -4.22 to -1.41; p < 0.001), less blood loss (I 2 = 100%, WMD -12.65, 95% CI -24.82 to -0.48; p = 0.04), and less wound infection (I 2 = 0%, odds ratio 0.23, 95% CI 0.06-0.78; p = 0.02). However, no significant difference was found in operative time and secondary outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and overall postoperative complications. CONCLUSION MIS is a safe, feasible, and effective surgical procedure in children when compared with OUR. Compared with OUR, MIS has a shorter hospital stay, less blood loss, and less wound infection. Furthermore, MIS is equivalent to OUR in terms of success rate and secondary outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and overall postoperative complications. We conclude that MIS should be considered an acceptable option for pediatric ureteral reimplantation.
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Affiliation(s)
- Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhechen Yu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yicheng Yang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yunli Bi
- Department of Pediatric Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jinjian Luo
- Department of Pulmonary and Critical Care Medicine (PCCM), Anji County People's Hospital, Huzhou, Zhejiang, China
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Sivakumar B, Thatcher K, Hughes I, Watson A, Schick B, Graham DJ. Comparison of Arterial and Venous Interposition Grafting for Arterial Defects in a Rat Model. J Reconstr Microsurg 2024; 40:329-333. [PMID: 38011855 DOI: 10.1055/s-0043-1776735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Interposition microvascular grafting may be required to bridge arterial defects during digital replantation or revascularization and has traditionally been performed utilizing a venous autograft. Arterial interposition grafting has been shown to be superior in maintaining patency in large vessel surgery; there are case reports of its use in microsurgery. METHODS Six fellowship-trained hand and microsurgeons performed arterial and venous interposition grafts on the femoral arteries of 40 Wistar rats. After sectioning one femoral artery a segment of the contralateral femoral artery or vein was obtained. The time was recorded per graft and patency tested 10 minutes following grafting by an independent assessor. Each surgeon also completed a questionnaire detailing regular microsurgical volume, technical ease, and conceptual preference for either graft. RESULTS Time for arterial interposition (median time 51.7 minutes) was longer than venous grafting (median time 45.9 minutes, p = 0.075). Arterial grafts were more likely to be patent or questionably patent (odds ratio [OR] = 6.77, p = 0.031). All surgeons found arterial interposition grafting technically easier and preferred it conceptually. Improvements were noted in patency rates (OR = 11.29, p = 0.018) and avoidance of anastomotic leak (OR = 0.19, p = 0.029) when surgeons performed moderate levels or greater of microsurgery within their regular practice. CONCLUSION Greater immediate patency was noted with arterial interposition grafting in a rodent model when compared to venous grafting, although procedural time was greater. All surgeons found arterial grafting technically easier. Arterial microvascular grafting may be useful in the setting of digital replantation or revascularization with an arterial defect.
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Affiliation(s)
- Brahman Sivakumar
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Australia
- Discipline of Surgery, Sydney Medical School, the Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW, Australia
- Department of Orthopaedic Surgery, Northern Beaches Hospital, Frenchs Forest, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
| | - Keely Thatcher
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ian Hughes
- School of Medicine, University of Queensland, Herston, QLD, Australia
- Office for Research Governance and Development, Gold Coast Health, Southport, QLD, Australia
| | - Anna Watson
- Department of Orthopaedic Surgery, Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Bernard Schick
- Department of Hand Surgery, Sydney Hospital, Sydney Hospital Hand Unit, Sydney, NSW, Australia
| | - David J Graham
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Australia
- School of Medicine, University of Queensland, Herston, QLD, Australia
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Lin S, Xu H, He Y, Xu X, You G, Chen J, Xu D. Single-port-plus-one robot-assisted laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation in pediatric primary obstructive megaureter, comparing to laparoscopic cohen. Eur J Med Res 2024; 29:274. [PMID: 38720334 PMCID: PMC11077742 DOI: 10.1186/s40001-024-01862-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To compare the effects of a single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple approach and traditional laparoscopic Cohen in treating pediatric primary obstructive megaureter. MATERIALS AND METHODS The clinical data of 24 children with primary obstructive megaureter from January 2021 to November 2021 were analyzed retrospectively. Among them, 12 children (8 boys and 4 girls, the average age were 17.17 ± 6.31 months) treated with the laparoscopic Cohen method were defined as group C. The remaining 12 children (7 boys and 5 girls, the average age was 17.33 ± 6.99 months) underwent single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation were defined as group L. The parameters of pre-operation, intraoperative and postoperative were compared. RESULTS There were no differences in the patient characteristics and average follow-up time between the two groups (P > 0.05).The obstruction resolution rate was 100% in both groups. The total operation time in group L is slightly longer than that in group C(P < 0.001),but the intraperitoneal operation time of the two groups was comparable(P > 0.05). The postoperative parameters included blood loss, gross haematuria time, indwelling catheterization time and hospitalization time in group L is shorter than group C(P < 0.05). One year post-operation, decreasing in ureteral diameter and APRPD, and increasing in DRF were remarkably observed in both two groups(P < 0.05). Ureteral diameter, APRPD, and DRF were not significantly different both in pre-operation and post-operation between Group L and Group C(P > 0.05). CONCLUSION Single-port-plus-one robot-assisted laparoscopic-modified Lich-Gregoir direct nipple approach and traditional laparoscopic Cohen are both dependable techniques for ureteral reimplantation in the treatment of pediatric primary obstructive megaureter. Since Lich-Gregoir can preserve the physiological direction of the ureter and direct nipple reimplantation enhances the effect of anti-refluxing, this technique is favorable for being promoted and applied in robot surgery.
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Affiliation(s)
- Shan Lin
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001
| | - Huihuang Xu
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001
| | - Yufeng He
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001
| | - Xinru Xu
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001
| | - Guangxu You
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001
| | - Jianglong Chen
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China.
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001.
| | - Di Xu
- Shengli Clinical Medical College of Fujian Medical University, 1 North Xuefu Road, Fuzhou, 350122, Fujian, China.
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, China, 134 Dongjie Road ,Gulou District, 350001.
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Baroni M, Preda A, Carbonaro M, Fortuna M, Guarracini F, Gigli L, Mazzone P. Coronary venous lead reimplantation vs. left bundle branch area pacing crossover following cardiac resynchronization therapy defibrillator extraction: a single-centre experience. Europace 2024; 26:euae101. [PMID: 38666452 DOI: 10.1093/europace/euae101] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
Abstract
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Affiliation(s)
- Matteo Baroni
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Alberto Preda
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Marco Carbonaro
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Matteo Fortuna
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Fabrizio Guarracini
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Lorenzo Gigli
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Patrizio Mazzone
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
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Kuwahara Y, Hara T, Kurahashi T, Takeshige H, Urata S, Oguchi T. Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap Using Nail Bed Graft for Fingertip Amputation with Replantation. Plast Reconstr Surg 2024; 153:1086-1092. [PMID: 37253041 DOI: 10.1097/prs.0000000000010760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF. METHODS Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa subzone II or III) at the authors' hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test, Fingertip Injuries Outcome Score, and Hand20 score. RESULTS Overall, in 74 analyzed cases (40 replantation, 34 DAF), the median operative time and the median length of hospital stay were longer with replantation than with DAF (188 versus 126 minutes; P < 0.01; 15 versus 4 days; P < 0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening with replantation was significantly lower than with DAF (42.5% versus 82.4%; P < 0.01). There were fewer nail deformities with replantation than with DAF (45.0% versus 67.6%; P = 0.06). The proportion of patients who achieved excellent or good Fingertip Injuries Outcome Score and median Hand20 score were not significantly different between the groups (89.5% versus 85.3%, P = 0.61; 8.0 versus 13.5, P = 0.42, respectively). Median postoperative Semmes-Weinstein monofilament test values were similar between the groups (3.61 versus 3.61; P = 0.23). CONCLUSION In this retrospective study, compared with replantation, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stays, but resulted in inferior cosmetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | | | | | - Shiro Urata
- From Orthopedic Surgery, Anjo Kosei Hospital
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Bevans S. Management of Traumatic Nasal Avulsion Injuries. Facial Plast Surg Clin North Am 2024; 32:315-325. [PMID: 38575289 DOI: 10.1016/j.fsc.2024.01.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Soft tissue injuries to the midface (and nose) are common causes for seeking trauma care. As trauma patients, observing advanced trauma life support protocols is warranted given the risk of concomitant injuries. Here, options for optimizing tissue preservation, microvascular replantation, non-microvascular tissue replacement, and wound stabilization are discussed. Included in this discussion are data-driven predictors for successful replantation as well as technique descriptions with anatomic references to guide surgeons in choosing optimal donor vessels. In both partial and complete avulsion injuries, venous congestion is common. Several postoperative wound care protocols to maximize tissue perfusion and long-term viability are discussed.
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Affiliation(s)
- Scott Bevans
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, HI 96818, USA.
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Rivetti G, Marzuillo P, Guarino S, Di Sessa A, La Manna A, Caldamone AA, Papparella A, Noviello C. Primary non-refluxing megaureter: Natural history, follow-up and treatment. Eur J Pediatr 2024; 183:2029-2036. [PMID: 38441661 PMCID: PMC11035438 DOI: 10.1007/s00431-024-05494-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
Primary non-refluxing megaureter (PMU) is a congenital dilation of the ureter which is not related to vesicoureteral reflux, duplicated collecting systems, ureterocele, ectopic ureter, or posterior urethral valves and accounts for 5 to 10% of all prenatal hydronephrosis (HN) cases. The etiology is a dysfunction or stenosis of the distal ureter. Most often PMU remains asymptomatic with spontaneous resolution allowing for non-operative management. Nevertheless, in selective cases such as the development of febrile urinary tract infections, worsening of the ureteral dilatation, or reduction in relative renal function, surgery should be considered. CONCLUSION Ureteral replantation with excision of the dysfunctional ureteral segment and often ureteral tapering is the gold-standard procedure for PMU, although endoscopic treatment has been shown to have a fair success rate in many studies. In this review, we discuss the natural history, follow-up, and treatment of PMU. WHAT IS KNOWN • PMU is the result of an atonic or stenotic segment of the distal ureter, resulting in congenital dilation of the ureter, and is frequently diagnosed on routine antenatal ultrasound. WHAT IS NEW • Most often, PMU remains asymptomatic and clinically stable, allowing for non-operative management. • Nevertheless, since symptoms can appear even after years of observation, long-term ultrasound follow-up is recommended, even up to young adulthood, if hydroureteronephrosis persists. • Ureteral replantation is the gold standard in case surgery is needed. In selected cases, however, HPBD could be a reasonable alternative.
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Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anthony A Caldamone
- Division of Urology, Warren Alpert School of Medicine at Brown University/Hasbro Children's Hospital, Providence, RI, USA
| | - Alfonso Papparella
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Carmine Noviello
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
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Gao T, Bao B, Lin J, Tian M, Xia L, Wei H, Cai Q, Zhu H, Zheng X. Development and external validation of a prediction model for digit replantation failure after traumatic amputations based on a prospective multicenter cohort. Int J Surg 2024; 110:2701-2707. [PMID: 38349211 DOI: 10.1097/js9.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Failure of digit replantation after traumatic amputation is difficult to predict. The authors aimed to develop a prognostic model to better identify factors that better predict replantation failure following traumatic digit amputation. MATERIALS AND METHODS In this multicenter prospective cohort, the authors identified patients who had received digit replantation between 1 January 2015 and 1 January 2019. Univariable and multivariable analyses were performed successively to identify independently predictive factors for failure of replanted digit. To reduce overfitting, the Bayesian information criterion was used to reduce variables in the original model. Nomograms were created with the reduced model after model selection. This model was then internally validated with bootstrap resampling and further externally validated in validation cohort. RESULTS Digit replantation was failed in 101 of 1062 (9.5%) digits and 146 of 1156 digits (12.6%) in the training and validation cohorts, respectively. The authors found that six independent prognostic variables were associated with digit replantation failure: age, mechanism of injury, ischemia duration, smoking status, amputation pattern (complete or incomplete), and surgeon's experience. The prediction model achieved good discrimination, with concordance indexes of 0.81 (95% CI: 0.76-0.85) and 0.70 (95% CI: 0.65-0.74) in predicting digit failure in the training and validation cohorts, respectively. Calibration curves were well-fitted for both training and validation cohorts. CONCLUSIONS The proposed prediction model effectively predicted the failure rate of digit replantation for individual digits of all patients. It could assist in selecting the most suitable surgical plan for the patient.
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Affiliation(s)
- Tao Gao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Bingbo Bao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Junqing Lin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Maoyuan Tian
- Department of Orthopaedic Surgery, 80 PLA Hospital Shandong
| | - Lei Xia
- Department of Hand Surgery, Xi'an Honghui Hospital, Nanshaomen, Xi'an, Shaanxi, People's Republic of China
| | - Haifeng Wei
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Qianying Cai
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Hongyi Zhu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xianyou Zheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
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Ziewers S, Dotzauer R, Thomas A, Brandt MP, Haferkamp A, Frees S, Zugor V, Kajaia D, Labanaris A, Kouriefs C, Radu C, Radavoi D, Jinga V, Mirvald C, Sinescu I, Surcel C, Tsaur I. Robotic-assisted vs. open ureteral reimplantation: a multicentre comparison. World J Urol 2024; 42:194. [PMID: 38530438 DOI: 10.1007/s00345-024-04875-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/09/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Open ureteral reimplantation is considered the standard surgical approach to treat distal ureteral strictures or injuries. These procedures are increasingly performed in a minimally invasive and robotic-assisted manner. Notably, no series comparing perioperative outcomes and safety of the open vs. robotic approach are available so far. METHODS In this retrospective multi-center study, we compared data from 51 robotic ureteral reimplantations (RUR) with 79 open ureteral reimplantations (OUR). Both cohorts were comparatively assessed using different baseline characteristics and perioperative outcomes. Moreover, a multivariate logistic regression for independent predictors was performed. RESULTS Surgery time, length of hospital stay and dwell time of bladder catheter were shorter in the robotic cohort, whereas estimated blood loss, postoperative blood transfusion rate and postoperative complications were lower than in the open cohort. In the multivariate linear regression analysis, robotic approach was an independent predictor for a shorter operation time (coefficient - 0.254, 95% confidence interval [CI] - 0.342 to - 0.166; p < 0.001), a lower estimated blood loss (coefficient - 0.390, 95% CI - 0.549 to - 0.231, p < 0.001) and a shorter length of hospital stay (coefficient - 0.455, 95% CI - 0.552 to - 0.358, p < 0.001). Moreover, robotic surgery was an independent predictor for a shorter dwell time of bladder catheter (coefficient - 0.210, 95% CI - 0.278 to - 0.142, p < 0.001). CONCLUSION RUR represents a safe alternative to OUR, with a shorter operative time, decreased blood loss and length of hospital stay. Prospective research are needed to further define the extent of the advantages of the robotic approach over open surgery.
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Affiliation(s)
- Stefanie Ziewers
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Frees
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Vahudin Zugor
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | - David Kajaia
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | | | | | - Cosmin Radu
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Daniel Radavoi
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Viorel Jinga
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Mirvald
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Ioanel Sinescu
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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10
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Larson EL, Lieb MW, Pysick HE, Mehdi M, Hoben GM. Postoperative Interventions in Pediatric Digital Replantation: A Tertiary Referral Center Case Review. J Hand Surg Am 2024; 49:276.e1-276.e9. [PMID: 35985864 DOI: 10.1016/j.jhsa.2022.06.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/22/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Although a few case series have been published describing the excellent outcomes of replantation and revascularization operations in children, there has been limited study of the hospital course that these patients experience and the number of potentially harmful interventions and treatments that occur. The purpose of this study was to detail the results of various postoperative interventions, including anticoagulation, transfusion, leeching, sedation, and additional anesthetic exposures. METHODS Twenty-nine patients aged less than 18 years had 34 digital revascularizations or replantations performed between January 2000 and May 2020. The details of each patient's presentation, surgery, and postoperative care were analyzed. RESULTS Nine of 29 children underwent repeat anesthetics, including 6 revision amputations. No demographic, surgical, or postoperative variables consistently preceded revision amputation or additional anesthetic procedures. Only 5 patients had >1 hemoglobin (Hb) measurement. Two patients received blood transfusions; the average drop in Hb was 3.5 g/dL from before surgery to the lowest after surgery. Four patients underwent leech therapy. Only patients receiving leech therapy required postoperative transfusions. Anticoagulation regimens were prescribed on the basis of demographic and surgical factors, although no medication or regimen seemed to affect outcomes. CONCLUSIONS Although the experience of digital replantation is essentially the same in pediatric patients as adults, there may be different ramifications for children. Specifically, postoperative management of pediatric digital replantation or revascularization can involve multiple interventions that carry their risks. Parents should be counseled about the risks of anticoagulants, transfusions, and repeat anesthetics, and clinicians should monitor Hb closely when using leech therapy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ellen L Larson
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | | | | | - Maahum Mehdi
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Gwendolyn M Hoben
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI.
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Xiao C, Bao G, Zhang G, Guan Y, Wang Q, Li H. Application of Digital Artery Transposition in the Replantation of Severed Fingers with Vessel Defects and its Influence on Nerve Function and Joint Function Recovery. J Musculoskelet Neuronal Interact 2024; 24:90-96. [PMID: 38427373 PMCID: PMC10910204] [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] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To investigate the application of digital artery transposition in replanting severed fingers with vascular defects and its impact on nerve and joint function recovery. METHODS 200 patients who received replantation of severed fingers were randomly divided into artery transposition group (n = 100) and vein transplantation group (n = 100). The digital artery transposition technique was used in the artery transposition group, and the autologous vein bridging technique was used in the vein transplantation group. The clinical efficacy and survival rate of severed fingers were compared between the two groups. RESULTS The clinical excellent and good rate in artery transposition group was significantly higher than that in vein transplantation group (P < 0.05). CONCLUSION The transposition of digital artery is effective and safe in replantation of severed fingers with vascular defects.
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Affiliation(s)
- Chunlai Xiao
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, China
| | - Genqiang Bao
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, China
| | - Guohui Zhang
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, China
| | - Yulong Guan
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, China
| | - Quan Wang
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, China
| | - Hua Li
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, China
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Chen C, Chen J, Liu WC, Tuaño KR. Overview and management of complications after digital replantations. J Hand Surg Eur Vol 2024; 49:167-176. [PMID: 38315131 DOI: 10.1177/17531934231212394] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The main complications after digital replantation are discussed in this review article. These complications include vascular compromise, infection, partial necrosis, delayed union or nonunion, atrophy and so on. The countermeasures for these complications are reviewed and the authors' methods are also introduced and discussed.
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Affiliation(s)
- Chao Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, China
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Krystle R Tuaño
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Tian Z, Yang Y, Zhang P, Wang X, Yao W. Inactivation and replantation of the knee joint: an infeasible surgical method. World J Surg Oncol 2024; 22:33. [PMID: 38273344 PMCID: PMC10809503 DOI: 10.1186/s12957-024-03311-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/13/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The inactivation and replantation of autologous tumor bones are important surgical methods for limb salvage in patients with malignancies. Currently, there are few reports on the inactivation and replantation of the knee joint. In this study, we aimed to evaluate the feasibility of our surgical approach. METHODS This is a retrospective case series study. We retrospectively collected the clinical data of patients with sarcoma treated with knee joint inactivation and replantation and analyzed the efficacy of this surgical method. The bone healing and complications in these patients after inactivated autograft replantation were assessed. RESULTS This study included 16 patients. Fifteen patients had osteosarcoma, and one had Ewing's sarcoma. The average length of the inactivated bone is 20.2 cm (range 13.5-25.3 cm). All the patients underwent internal plate fixation. The average follow-up duration was 30 months (range 8-60 months). Before the data deadline of this study, eight (50%) patients were still alive, and eight (50%) died of sarcoma metastasis. Eight (50%) patients achieved bone healing at the diaphysis site of the inactivated tumor bone, with an average bone healing time of 21.9 months (range, 12-36 months). Five (31%) patients died due to metastases and did not achieve bone healing. Two (12.5%) patients did not achieve bone healing because of infection, and one (6.3%) patient underwent amputation due to tumor recurrence. Ten (62.5%) patients experienced fractures around the joint ends of the inactivated replanted bone, and eight of these ten patients were combined with joint dislocation. CONCLUSION The incidence of joint deformities after the knee-joint inactivation and replantation is extremely high and is not recommended for use.
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Affiliation(s)
- Zhichao Tian
- Department of Sarcoma, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China.
| | - Yang Yang
- Modern Educational Technology Center, Henan University of Economics and Law, Zhengzhou, 450046, Henan Province, China
| | - Peng Zhang
- Department of Sarcoma, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Xin Wang
- Department of Sarcoma, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Weitao Yao
- Department of Sarcoma, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
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Kubík M, Molitor M, Zálešák B. Microsurgical replantation after forehead avulsion - success or failure? A case report. Acta Chir Plast 2024; 66:16-21. [PMID: 38704232 DOI: 10.48095/ccachp202416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.
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Hayashi K, Hattori Y, Chia DSY, Sakamoto S, Sonezaki S, Doi K. Fingertip Replantation: Surgical Technique, Tips, and Tricks. Plast Reconstr Surg 2024; 153:168-171. [PMID: 37036316 DOI: 10.1097/prs.0000000000010521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
SUMMARY Replantation of fingertip amputations restores the original tissue and is the ideal treatment to provide the best aesthetic and functional outcome. However, successful fingertip replantation is considered challenging because it requires supermicrosurgery techniques. This article provides a detailed surgical technique for fingertip replantation and the authors' preferences and recommendations. In the authors' experience, the most important factors for successful fingertip replantation are meticulous vascular dissection, reliable arterial repair, and venous anastomosis to avoid postoperative venous congestion. Proximal arterial dissection until pulsatile bleeding is encountered avoids the zone of vascular injury, and is particularly important in crush or avulsion amputations. Distal arterial dissection is performed until undamaged intima is identified. The authors believe anastomosis to the central artery is reliable even in a Tamai zone II amputation. When an arterial defect is present, the authors recommend using a vein graft to anastomose to the central artery. In addition, the authors highly recommend at least one venous anastomosis to avoid postoperative venous congestion. In Tamai zone I, available veins can be found on the palmar side of the pulp. It is important to search directly below the dermis and remove adipose tissue around the vessels to secure space for anastomosis. The authors consider nerve suture in Tamai zone I and II replantations inessential, because spontaneous sensory recovery can be expected. Postoperative management of venous congestion, spasm in artery, and arterial thrombosis are as important as surgery.
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Affiliation(s)
- Kota Hayashi
- From the Department of Orthopaedic Surgery, Ogori Daiichi General Hospital
| | - Yasunori Hattori
- From the Department of Orthopaedic Surgery, Ogori Daiichi General Hospital
| | | | - Sotetsu Sakamoto
- From the Department of Orthopaedic Surgery, Ogori Daiichi General Hospital
| | - Shicho Sonezaki
- From the Department of Orthopaedic Surgery, Ogori Daiichi General Hospital
| | - Kazuteru Doi
- From the Department of Orthopaedic Surgery, Ogori Daiichi General Hospital
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Tawaranurak N, Attawettayanon W, Boonchai S, Chalieopanyarwong V, Chungsiriwattana W, Kongpanichkul L. Successful Pediatric Penile Replantation Following Amputation During Ritual Circumcision: A Case Report and Literature Review. Am J Case Rep 2023; 24:e942448. [PMID: 38130044 PMCID: PMC10750800 DOI: 10.12659/ajcr.942448] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. CASE REPORT We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. CONCLUSIONS Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes.
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Affiliation(s)
- Niti Tawaranurak
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Worapat Attawettayanon
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Sarayuth Boonchai
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Virote Chalieopanyarwong
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Wanchalerm Chungsiriwattana
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Laliphat Kongpanichkul
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
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Elbakry AA, Abdelhalim A, Al-Omar O. Tips and tricks for the extravesical robotic-assisted laparoscopic ureteral reimplantation for pediatric vesicoureteral reflux. J Pediatr Urol 2023; 19:816-817. [PMID: 37524572 DOI: 10.1016/j.jpurol.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
Over the past few years, robotic-assisted laparoscopic ureteral reimplantation (RALUR) has gained popularity as an acceptable alternative for the traditional open approach if surgery is elected for children with vesicoureteral reflux (VUR). We present our technique including the tips and tricks for both male and female patients, including a stepwise approach for ureteral identification in female patients depending on the level of technical difficulty. Our series include 30 patients who represent a spectrum in which we presented the different tips and tricks included in this video.
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Affiliation(s)
- Amr A Elbakry
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA.
| | - Ahmed Abdelhalim
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Osama Al-Omar
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
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Comez I, Ucar T, Telli O, Gunaydin B, Silay MS. Does previous endoscopic subureteric injection (STING) effect the outcomes of robot-assisted laparoscopic ureteral reimplantation surgery (RALUR) in children? J Pediatr Urol 2023; 19:800.e1-800.e6. [PMID: 37607849 DOI: 10.1016/j.jpurol.2023.07.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND There is lack of evidence on the success of robot-assisted laparoscopic ureteral reimplantation (RALUR) for the treatment of vesicoureteral reflux (VUR) who had prior intervention. OBJECTIVE This study aimed to evaluate the effect of previous unsuccessful STING on the outcomes of RALUR in children. STUDY DESIGN A total of 67 children treated with RALUR by a single surgeon for the treatment of VUR were scanned between February 2018 and April 2022. Two patients were excluded from the final data analysis due to the presence of a megaureter. Patients were divided into two groups: those with a history of STING (Group A - n:14) and those without STING (Group B - n:51). Patient characteristics, previous numbers of injections, console time, total operative time, perioperative and postoperative complications and clinical success data were collected. Clavien Dindo and Satava complication scales were used as the standard record of peri and postoperative complications. Radiographic success was defined as absence of reflux detected on postoperative voiding cystourethrography, whereas clinical success was defined as the absence of a febrile urinary tract infection during the follow-up. Mann-Whitney U and Chi-square tests and Fisher exact test were used where appropriate. RESULTS A total of 36 (55.3%) female versus 29 (44.6%) male patients were operated for 96 refluxive ureters. Nearly half of the patients were with bilateral VUR (n = 31). The mean follow-up was 20.2 ± 15.4 months. The median age of patients was 59 ± 31 (range: 28-132 months) versus 46 ± 33.1 (range: 7-206 months) for groups A and B respectively (p = 0.22). Gender, age, peri- and postoperative complication rates, and clinical success were comparable between the two groups. The median operative time and the console time was significantly higher in children with history of STING (op time: 142.5 ± 27.4 versus 120 ± 24.9 min (p = 0.008), console time: 117.5 ± 28.2 versus 100 ± 24.5 min (p = 0.011) for groups A and B, respectively. A total of six complications (9.2%) occurred with none of them were greater than Clavien grade 3b. The overall clinical success rate was 97%, with 2 cases of clinical failure. In both cases, VCUG demonstrated absence of VUR. DISCUSSION The outcomes of our study provided that RALUR is effective with more than 95% success rates despite failed endoscopic injection procedures. CONCLUSION The previous history of STING neither changes the success nor the complication rates of RALUR. However, this can lead to more challenging surgery by increasing the total operative times.
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Affiliation(s)
- Ilker Comez
- Memorial Hospitals Group, Urology, Istanbul; Uskudar University, Medical Faculty, Department of Urology, Istanbul, Turkey
| | - Taha Ucar
- Nigde Omer Halis Demir University Research and Training Hospital, Department of Urology, Turkey
| | - Onur Telli
- Memorial Hospitals Group, Urology, Istanbul
| | - Bilal Gunaydin
- Nigde Omer Halis Demir University, Department of Urology, Turkey
| | - M Selcuk Silay
- Memorial Hospitals Group, Urology, Istanbul; Biruni University, Department of Urology, Istanbul, Turkey.
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Davis E, Hinkley D, Quiring ME, Hamby T, Reyes KJ, Pinto K. Utility of preoperative urine cultures and cystoscopies before ureteral reimplantation in pediatrics. Urologia 2023; 90:709-714. [PMID: 37002702 DOI: 10.1177/03915603231166722] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Ureteral reimplantation remains the primary surgical method used for patients with vesicoureteral reflux (VUR). Cystoscopy is commonly performed first to visualize anatomy and rule out possible abnormalities. Urine cultures may also be obtained. The objective of this study is to evaluate the prudency of preoperative urine cultures and cystoscopies in pediatric patients undergoing ureteral reimplantation. METHODS Pediatric urologists were surveyed regarding collecting urine cultures in asymptomatic patients and cystoscopies before reimplantation. A retrospective review was also conducted of patients who underwent ureteral reimplantation for VUR between March 2018 and April 2021 at Cook Children's Medical Center. RESULTS When physicians were asked the frequency they obtain urine cultures before reimplantation on asymptomatic patients, 36% said "never" and 38% said "always." Regarding cystoscopy, 53% said "never" and 32% said "always." Inclusion criteria were met by 101 patients. Cystoscopies were performed in 46 patients and never altered the reimplantation. There were 20 preoperative, 90 intraoperative, and 61 postoperative urine cultures. Complications were associated with positive cultures of urine collected intraoperatively and postoperatively only. CONCLUSION Cystoscopies and asymptomatic urine cultures obtained before ureteral reimplantation provide no additional benefit while increasing cost for patients' families. Further research is needed to thoroughly identify the prudency of such practices in ureteral reimplantation for VUR.
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Affiliation(s)
- Erin Davis
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Dawson Hinkley
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Mark E Quiring
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tyler Hamby
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Research Operations, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Kristy J Reyes
- Department of Research Operations, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Kirk Pinto
- Department of Urology, Cook Children's Medical Center, Fort Worth, TX, USA
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Favede C, Bradshaw C, Sethia R, Kramer S, Jatana K, Elmaraghy C, Grischkan J. Near-Total Ear Avulsion Repaired With Primary Closure and Hyperbaric Oxygen: A Case Series and Review of the Literature. Ann Otol Rhinol Laryngol 2023; 132:1265-1270. [PMID: 36541620 DOI: 10.1177/00034894221142934] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Near-total ear avulsion is a rare and challenging problem to repair with many techniques described; primary repair is an attractive option but is not always successful. Healing may be augmented with postoperative hyperbaric oxygen therapy (HBOT), but this technique is under-reported, and an ideal regimen is not known. The study objective is to discuss the role of HBOT in the management of ear avulsion by reviewing 2 unique cases. METHODS Case report and review of the literature. A Pubmed search using the terms ear avulsion and postoperative hyperbaric oxygen was performed. RESULTS Two pediatric patients presented with near-total avulsion of the auricle after suffering a dog bite. Various management options were discussed including observation, primary repair, post-auricular cartilage banking, graft reconstruction with periauricular tissue or rib cartilage, or microsurgical replantation. The decision was made to perform primary reattachment, followed by adjuvant hyperbaric oxygen therapy (HBOT). The patients achieved favorable esthetic results and continue to maintain the function of the reattached ear. Photo documentation was obtained throughout the process. DISCUSSION There is no consensus on the management of near-total ear avulsion. Primary repair is ideal from a cosmetic and ease-of-operation standpoint but does not always yield viable tissue. The use of postoperative HBOT is an attractive option that may boost success rates, but the ideal HBOT regimen is unknown. These cases represent a successful application of this innovative technique in a pediatric patient.
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Affiliation(s)
- Cecelia Favede
- Prisma Health Children's Hospital, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Charles Bradshaw
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rishabh Sethia
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Kramer
- Ohio ENT & Allergy Physicians, Columbus, OH, USA
| | - Kris Jatana
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan Grischkan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
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Persitz J, Khan S, Kim G, Alhujayri AK, Lorquet E, Baltzer H. Functional and patient-reported outcomes following single digit replantation: A systematic literature review. Hand Surg Rehabil 2023; 42:379-385. [PMID: 37453715 DOI: 10.1016/j.hansur.2023.07.002] [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] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Finger amputations can involve different levels of injury complexity, and the success of a finger replantation is further shaped by a variety of factors, including patient characteristics, surgical technique, and postoperative rehabilitation. These variables may interact in complex ways and contribute to heterogeneity that makes it challenging to guide management for individual patients. As such, this systematic review seeks review the outcomes of isolated single digit replantation and compare patient reported outcomes following revision amputation to guide decision making. METHODS The United States National Library of Medicine (PubMed/Medline), EMBASE and CINAHL were systematically searched to identify publications relevant to this systematic review. Related articles that were published from database inception to October 15, 2022 were extracted. The inclusion criteria consisted of English language clinical trials and observational studies reporting any functional or patient-reported outcome following single digit replantation. RESULTS From the initial 1050 titles and abstracts that were eligible for screening, six studies representing 550 single digit replantations were included. There were 162 replanted thumbs (162/550), as reported in three studies, and 388 replanted fingers (388/550), as reported in all six studies. Overall, all six studies concluded that non-thumb single digit replantation can provide satisfactory outcomes. Five studies suggested that single digit replantation proximal to flexor zone II can have reasonable outcomes in select cases. Two of the comparative studies (Zhu et al. [1], Chung et al. [2]) showed a statistically significant increase in MHQ score in the non-thumb replant group in comparison to the revision amputation group (87.6 versus 84.6 respectively). CONCLUSION When technically feasible, replantation is recommended, even in select index finger zone II amputations. Single digit replantation does not restore pre-injury hand function but does result in acceptable hand function when successful. Further study is needed to better inform risk-stratification of patients, and guide patient, and surgeon expectations for post-operative recovery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonathan Persitz
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada.
| | - Shawn Khan
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Grace Kim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Abdulaziz K Alhujayri
- Division of Plastic Surgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Etienne Lorquet
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Heather Baltzer
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
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22
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Lin J, Wu D, Sun YD, Wu LZ, Liu YW, Xu LW, Yang YY, Gao BW, Xie F, Hou CL, Li QF, Zhang YF, Liu CY. Successful replantation of amputated facial tissues by supermicrosurgery. J Plast Reconstr Aesthet Surg 2023; 85:26-33. [PMID: 37454547 DOI: 10.1016/j.bjps.2023.06.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Although replantation of amputated facial segments remains challenging in reconstructive surgery, it offers excellent aesthetic and functional outcomes. METHODS From May 2004 to October 2019, 12 patients underwent replantation of amputated facial tissues by supermicrosurgery. The case details, such as the rationale for replantation, the operation method, and postoperative therapy, are described. Four cases are discussed to demonstrate the replantation of different facial parts. RESULTS Facial tissue replantation was successful in all 12 patients without secondary surgery. The cases included the nose (1 patient), ears (8 patients), lips (2 patients), and one of the soft tissue segments surrounding the lower jaw. Venous congestion occurred in three patients who received a solitary arterial repair and were treated with bloodletting. All patients expressed satisfaction with the cosmetic and functional results at the final follow-up. CONCLUSIONS Supermicrosurgical facial tissue replantation is a promising and effective procedure for providing patients with the best aesthetic and functional outcomes.
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Affiliation(s)
- Jian Lin
- Department of Center for Orthopedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences (Shanghai Xinhua Hospital Chongming Branch), Shanghai 202150, China.
| | - Dan Wu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Yi-Dan Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Li-Zhi Wu
- Department of Microsurgery, Taizhou Hospital, Wenzhou Medical University, Taizhou 317000, China
| | - Yang-Wu Liu
- Department of Microsurgery, Xianning Central Hospital, Xiangyang 437100, China
| | - Lu-Wen Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yi-Yuan Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bo-Wen Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Feng Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chun-Lin Hou
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ying-Fan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Cai-Yue Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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Chang TNJ, Hsu CC, Dafydd H, Sachanandani NS, Chen LWY, Chen YC, Lin YT, Lin CH, Lin CH. Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review. J Reconstr Microsurg 2023; 39:573-580. [PMID: 36720252 PMCID: PMC10411093 DOI: 10.1055/s-0043-1761288] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reconstruction of the mutilated hand is one of the most difficult challenges for hand microsurgeons. When multiple digits are amputated, orthotopic digital replantation of the available remnants may not adequately restore the hand function. In such cases, heterotopic digital replantation may provide a more functional reconstruction. METHODS Between 1997 and 2018, 53 patients with mutilating hand injuries were treated with heterotopic digital replantation at our institution. A retrospective chart review was conducted to determine the details of the injury, indications for heterotopic digital replantation, and functional outcomes. RESULTS In total, 173 digits were amputated from 53 patients (one patient suffered from bilateral hand injuries, so totally 54 hands). Sixty-eight digits underwent heterotopic digital replantation, 30 digits had orthotopic digital replantation, and 75 stumps were terminalized. The survival rate of digits treated by heterotopic digital replantation and orthotopic digital replantation was 83.8% (57/68) and 86.7% (26/30), respectively (p = 1). Tripod grip was achieved in 83.3% (45/54) of patients following replantation and optional secondary reconstructive surgeries. CONCLUSION Heterotopic digital replantation is a practical and reliable method for achieving optimal hand function following mutilating hand injuries. The basic principles are to restore a functional thumb in the first instance, followed by at least two adjacent fingers against which the thumb can oppose. This method is particularly indicated when orthotopic digital replantation of the available amputated parts would yield a suboptimal result.
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Affiliation(s)
- Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Hywel Dafydd
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Neil S. Sachanandani
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chieh Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
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24
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Peng C, Lee CH, Liao CH, Hsieh CH, Fu CY. Effect of multiple-digit replantation in patients with amputated digits. J Plast Reconstr Aesthet Surg 2023; 84:626-633. [PMID: 37467694 DOI: 10.1016/j.bjps.2023.06.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The replantation of multiple amputated digits is a technically challenging procedure for reconstructive surgeons that requires more time than the replantation of a single digit. We evaluated the effect of multiple-digit replantation on the success of digital replantation. METHODS Patients who experienced digital amputation and underwent digital replantation from January 2018 to December 2021 were studied retrospectively. Patients who experienced successful and failed replantation were compared, as were digits that survived or became necrotic after replantation. A multivariate logistic regression (MLR) analysis was performed to evaluate the independent factors of replanted digit survival. RESULTS There were 378 patients with 497 amputated digits who underwent digital replantation. Of all 378 patients, 298 underwent single-digit replantation, and the other 80 patients underwent multiple-digit replantation. A total of 83.3% of the replanted digits survived (414 of 497). Compared with patients with surviving replanted digits, significantly more patients with necrotic replanted digits underwent multiple-digit replantation (37.7% vs. 17.5%, p < 0.001). On the other hand, a digit that developed necrosis after replantation was more likely to have been involved in the replantation of three or more digits (16% vs. 29%, p = 0.005). The subsequent MLR analysis revealed that the likelihood of necrosis was 2.355 (p = 0.003) times higher in the replantation of three or more digits than in the replantation of one or two digits. CONCLUSION Patients who underwent multiple-digit replantation exhibited a higher incidence of necrosis in the replanted digits. In cases involving patients with multiple-digit amputation, it is crucial to prioritize and perform selective replantation based on the amputated digits.
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Affiliation(s)
- Chi Peng
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University
| | - Che-Hsiung Lee
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University.
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25
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Ahn IY, Ha MS, Kim WJ, Bae TH, Kim SM, Choi SY, Kang SH. Rare Case of Managing and Evaluating Viability after Replantation of a Serial Self-Amputated Bilateral Testis by a Patient with Schizophrenia: A Case Report. Urol Int 2023; 107:827-834. [PMID: 37544287 PMCID: PMC10614563 DOI: 10.1159/000531149] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/28/2023] [Indexed: 08/08/2023]
Abstract
Amputation of the testis is very rare in clinical situations; therefore, most surgeons have no experience with an amputated testis. In this case, a 31-year-old male with schizophrenia amputated both testes due to self-mutilation. We performed replantation surgery via microscopy. On postoperative day 1, he removed his right testis by using his hand, even though his hands were restrained. The second attack disrupted the viability of the right testis. However, after proper management, we checked the normal sex hormone level by preserving the replanted left testis. We evaluated the viability of the replanted testis by performing five examinations, namely, intraoperative indocyanine green injection, testicular scan with technetium pertechnetate, contrast-enhanced computerized tomography, Doppler ultrasonography, and serum testosterone level. In this report, we aimed to describe our rare experience about management with replantation of the amputated testes and evaluation of their viability.
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Affiliation(s)
- Il Young Ahn
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Moon Soo Ha
- Department of Urology, Hyundae General Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Tae Hui Bae
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Shin Hyuk Kang
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Chen Z, Li M, Huang S, Wu G, Zhang Z. Is Prolonged Use of Antibiotic Prophylaxis and Postoperative Antithrombotic and Antispasmodic Treatments Necessary After Digit Replantation or Revascularization? Clin Orthop Relat Res 2023; 481:1583-1594. [PMID: 36795073 PMCID: PMC10344486 DOI: 10.1097/corr.0000000000002578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Ensuring the patency of repaired vessels is pivotal in improving the success rate of digit replantation. There is no consensus on how to best approach postoperative treatment for digit replantation. The influence of postoperative treatment on the risk of failure of revascularization or replantation remains unclear. QUESTIONS/PURPOSES (1) Is there an increased risk of postoperative infection with early discontinuation of antibiotic prophylaxis? (2) How are anxiety and depression affected by a treatment protocol consisting of prolonged antibiotic prophylaxis and administration of antithrombotic and antispasmodic drugs and by the failure of a revascularization or replantation procedure? (3) Are there differences in the risk of revascularization or replantation failure based on the number of anastomosed arteries and veins? (4) What factors are associated with failure of revascularization or replantation? METHODS This retrospective study was conducted between July 1, 2018, and March 31, 2022. Initially, 1045 patients were identified. One hundred two patients chose revision of amputation. In all, 556 were excluded because of contraindications. We included all patients in whom the anatomic structures of the amputated part of the digit were well preserved, and those with an ischemia time for the amputated part that did not exceed 6 hours. Patients in good health without any other serious associated injuries or systemic diseases and those without a history of smoking were eligible for inclusion. The patients underwent procedures that were performed or supervised by one of four study surgeons. Patients were treated with antibiotic prophylaxis (1 week); patients treated with antithrombotic and antispasmodic drugs were categorized into the prolonged antibiotic prophylaxis group. The remaining patients treated with antibiotic prophylaxis for less than 48 hours and no antithrombotic and no antispasmodic drugs were categorized into the nonprolonged antibiotic prophylaxis group. Postoperative follow-up was for a minimum of 1 month. Based on the inclusion criteria, 387 participants with 465 digits were selected for an analysis of postoperative infection. Twenty-five participants with a postoperative infection (six digits) and other complications (19 digits) were excluded from the next stage of the study, in which we assessed factors associated with the risk of failure of revascularization or replantation. A total of 362 participants with 440 digits were examined, including the postoperative survival rate, variation in Hospital Anxiety and Depression Scale scores, the association between the survival rate and Hospital Anxiety and Depression Scale scores, and the survival rate based on the number of anastomosed vessels. Postoperative infection was defined as swelling, erythema, pain, purulent discharge, or a positive bacterial culture result. Patients were followed for 1 month. The differences in anxiety and depression scores between the two treatment groups and the differences in anxiety and depression scores based on failure of revascularization or replantation were determined. The difference in the risk of revascularization or replantation failure based on the number of anastomosed arteries and veins was assessed. Except for statistically significant variables (injury type and procedure), we thought that the number of arteries, number of veins, Tamai level, treatment protocol, and surgeons would be important. A multivariable logistic regression analysis was used to perform an adjusted analysis of risk factors such as postoperative protocol, injury type, procedure, number of arteries, number of veins, Tamai level, and surgeon. RESULTS Postoperative infection did not appear to increase without prolonged use of antibiotic prophylaxis beyond 48 hours (1% [3 of 327] versus 2% [3 of 138]; OR 2.4 [95% confidence interval (CI) 0.5 to 12.0]; p = 0.37). Intervention with antithrombotic and antispasmodic therapy increased the Hospital Anxiety and Depression Scale scores for anxiety (11.2 ± 3.0 versus 6.7 ± 2.9, mean difference 4.5 [95% CI 4.0 to 5.2]; p < 0.01) and depression (7.9 ± 3.2 versus 5.2 ± 2.7, mean difference 2.7 [95% CI 2.1 to 3.4]; p < 0.01). In the analysis based on the failure of revascularization or replantation, the Hospital Anxiety and Depression Scale scores for anxiety (11.4 ± 4.4 versus 9.7 ± 3.5, mean difference 1.7 [95% CI 0.6 to 2.8]; p < 0.01) and depression (8.5 ± 4.6 versus 7.0 ± 3.1, mean difference 1.5 [95% CI 0.5 to 2.5]; p < 0.01) were higher in the failed revascularization or replantation group than in the successful revascularization or replantation group. There was no increase in the artery-related risk of failure (one versus two anastomosed arteries: 91% versus 89%, OR 1.3 [95% CI 0.6 to 2.6]; p = 0.53). For patients with anastomosed veins, a similar outcome was observed for the two vein-related risk of failure (two versus one anastomosed vein: 90% versus 89%, OR 1.0 [95% CI 0.2 to 3.8]; p = 0.95) and three vein-related risk of failure (three versus one vein anastomosed: 96% versus 89%, OR 0.4 [95% CI 0.1 to 2.4]; p = 0.29). Factors associated with failure of revascularization or replantation included the mechanism of injury (crush: OR 4.2 [95% CI 1.6 to 11.2]; p < 0.01, avulsion: OR 10.2 [95% CI 3.4 to 30.7]; p < 0.01). Revascularization had a lower risk of failure than replantation (OR 0.4 [95% CI 0.2 to 1.0]; p = 0.04). Treatment with a protocol of prolonged antibiotics, antithrombotics, and antispasmodics was not associated with a lower risk of failure (OR 1.2 [95% CI 0.6 to 2.3]; p = 0.63). CONCLUSION With proper wound debridement and patency of repaired vessels, prolonged use of antibiotic prophylaxis and regular antithrombotic and antispasmodic treatment may not be necessary for successful digit replantation. However, it may be associated with higher Hospital Anxiety and Depression Scale scores. Postoperative mental status is associated with digit survival. Well-repaired vessels, instead of the number of anastomosed vessels, could be critical to survival and decrease the influence of risk factors. Further research on consensus guidelines that compare postoperative treatment and the surgeon's level of expertise after digit replantation should be conducted at multiple institutions. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Zhiying Chen
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, PR China
| | - Muwei Li
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, PR China
| | - Shaogeng Huang
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, PR China
| | - Gong Wu
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, PR China
| | - Zhe Zhang
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, PR China
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Şener K, Çakır A, Ahmedov A, İpteç M, Hanoğlu ND, Altuğ E, Güven R, Avci A. Composite graft repair in distal finger injuries: emergency room or operating room? ULUS TRAVMA ACIL CER 2023; 29:764-771. [PMID: 37409917 PMCID: PMC10405035 DOI: 10.14744/tjtes.2023.96702] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms. METHODS Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level. RESULTS Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction. CONCLUSION Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.
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Affiliation(s)
- Kemal Şener
- Department of Emergence Medicine, Başaksehir Çam and Sakura City Hospital, İstanbul-Türkiye
| | - Adem Çakır
- Çanakkale Mehmet Akif Ersoy State Hospital, Çanakkale-Türkiye
| | - Anvar Ahmedov
- Department of Plastic, Reconstructive And Aesthetic Surgery, Başaksehir Çam and Sakura City Hospital, İstanbul-Türkiye
| | - Murat İpteç
- Department of Hand Surgery, Başaksehir Çam and Sakura City Hospital, İstanbul-Türkiye
| | - Nazife Didem Hanoğlu
- Department of Emergence Medicine, Başaksehir Çam and Sakura City Hospital, İstanbul-Türkiye
| | - Ertuğrul Altuğ
- Department of Emergence Medicine, Başaksehir Çam and Sakura City Hospital, İstanbul-Türkiye
| | - Ramazan Güven
- Department of Emergence Medicine, Başaksehir Çam and Sakura City Hospital, İstanbul-Türkiye
| | - Akkan Avci
- Health Science University, Adana City Research and Training Hospital, Adana-Türkiye
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28
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Lin J, Wei P, Wang Y, Song Q, Yang Z, Xu Y. Experience in Microsurgical Treatment of Complete Scalp Avulsion. Ann Plast Surg 2023; 90:331-333. [PMID: 36752491 DOI: 10.1097/sap.0000000000003468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction. METHODS Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed. RESULTS Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance. CONCLUSIONS Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.
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Affiliation(s)
| | - Peng Wei
- Ningbo First Hospital, Ningbo, China
| | | | | | | | - Yi Xu
- Ningbo First Hospital, Ningbo, China
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29
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Babajide R, Andolfi C, Kanabolo D, Wackerbarth J, Gundeti MS. Postoperative hydronephrosis following ureteral reimplantation: Clinical significance and importance of surgical technique and experience. J Pediatr Surg 2023; 58:574-579. [PMID: 35918238 DOI: 10.1016/j.jpedsurg.2022.07.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Though common, postoperative hydronephrosis (POHN) following ureteroneocystostomy raises concern for an underlying obstruction. We aimed to determine the clinical significance of POHN following open (OUR) or robotic (RALUR) ureteral reimplantation. METHODS We retrospectively reviewed pediatric patients who underwent ureteral reimplantation for vesicoureteral reflux (VUR) from 2008 to 2019 by a single surgeon. Baseline characteristics, operative outcomes, and trends in POHN were assessed. POHN was defined as new onset hydronephrosis or exacerbation of pre existing hydronephrosis. Renal ultrasounds were performed 1, 4, and 12 months postoperatively. Voiding cystourethrograms were performed 4 months postoperatively. Surgical experience for RALUR cases was defined as number of ureters operated over time. RESULTS Altogether, 93 patients (127 ureters) underwent RALUR and 19 patients (26 ureters) underwent OUR. POHN was found in 27.6% and 30.8% of ureters after RALUR and OUR, respectively. Rate and time to POHN resolution for RALUR (91.4%, 112 days) and OUR (75%, 211 days) were statistically similar. Odds of POHN after RALUR were directly related with preoperative VUR grade (Range OR: 2.82[2.26-3.52]) and surgical experience (Range OR: 8.88[7.16-11.02]). Surgical experience was inversely related with odds of VUR recurrence (Range OR: 0.41[0.32-0.54]). Rates of VUR resolution were comparable for OUR and RALUR patients. No patient required additional intervention for POHN. CONCLUSIONS Incidence and resolution rate of POHN after OUR and RALUR were similar. Higher VUR grades were associated with increased odds of POHN after RALUR. Increasing RALUR experience improved VUR resolution rate but increased odds of POHN. Surgical success rates were similar for RALUR and OUR. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rilwan Babajide
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Ciro Andolfi
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Diboro Kanabolo
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Joel Wackerbarth
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Mohan S Gundeti
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States; Director Pediatric Urology, Comer Children's Hospital: The University of Chicago Medicine & Biological Sciences, 5841 S. Maryland | P- 217 | MC 7122, Chicago, IL 60637, United States.
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30
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David TE, Seidman MA, David CM, Lafreniere-Roula M. Outcomes of Reimplantation of the Aortic Valve in Patients With Aortic Cusp Fenestration. Ann Thorac Surg 2023; 115:106-111. [PMID: 35122724 DOI: 10.1016/j.athoracsur.2021.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Aortic cusp fenestrations are common in patients with aortic root aneurysm, and their management during aortic valve repair remains controversial. We believe that fenestrations in the area of the commissures may rupture after reimplantation of the aortic valve because this operation increases the mechanical stress on the cusps. For this reason we have reinforced the free margin of the aortic cusp with fenestration with fine Gore-Tex sutures (WL Gore). This study examines the outcomes of reimplantation of the aortic valve in patients who had cusp fenestration reinforced with Gore-Tex sutures. METHODS A review of all patients who had reimplantation of the aortic valve for aortic root aneurysm disclosed 111 patients who had at least 1 cusp fenestration reinforced with a double layer of a fine Gore-Tex suture. The outcomes of these patients were examined and compared with a group of patients without fenestration using propensity score analysis. All patients were followed prospectively with images of the heart. RESULTS The median follow-up was 8.3 years. Overall the cumulative incidence of aortic valve reintervention at 15 years was 4.8% and the cumulative incidence of aortic insufficiency of moderate or severe degree was 9.2%. Comparison of outcomes of patients with and without fenestrations showed similar results up to 15 years of follow-up. CONCLUSIONS Reinforcement of the free margins of cusps with fenestrations using Gore-Tex sutures is safe and does not seem to adversely affect the durability of reimplantation of the aortic valve.
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Affiliation(s)
- Tirone E David
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada.
| | - Michael A Seidman
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Carolyn M David
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
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Mattioli G, Lena F, Fiorenza V, Carlucci M. Robotic ureteral reimplantation and uretero-ureterostomy treating the ureterovesical junction pathologies in children: technical considerations and preliminary results. J Robot Surg 2022; 17:659-667. [PMID: 36287349 DOI: 10.1007/s11701-022-01478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022]
Abstract
Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) and robotic ureteroureterostomy (RUU) are two mini-invasive surgical techniques that have begun to be performed in pediatric urology in recent years. RALUR has been employed especially for VUR treatment, while RUU is considered principally in case of complex doubled ureteral systems. Our aim is to discuss the safety and feasibility of these approaches in children, focusing on technical considerations and supporting their use in different anomalies and pathologies of the ureterovesical junction. We retrospectively collected data about 58 patients who underwent 44 dismembered RALUR (D-RALUR), 28 non-dismembered RALUR (ND-RALUR) and 5 RUU between May 2020 and December 2021. Indications for surgery were primary or secondary vesicoureteral reflux, megaureter, secondary UVJ obstructions, complicated doubled ureteral systems. Mean age was 3.5 years (range 0.6-12.9) and mean weight 17.1 (range 7.2-80). No intraoperative complications occurred nor conversion to open approach were reported. Major postoperative complications were reported in 11.7% of cases with a higher incidence for ND-RALUR. Mean hospital stay was 2.14 days (range 1-8). Success rate at the short-term follow-up was 91.9% for D-RALUR, 96.3% for ND-RALUR and 100% for RUU. RALUR and RUU are two feasible and safe procedures to perform in children. RALUR represents the most required and adequate technique in the treatment of UVJ pathologies, however, in selected cases RUU could represent an effective alternative that has to be considered.
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Affiliation(s)
- G Mattioli
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - F Lena
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - V Fiorenza
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Marcello Carlucci
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
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Chen G, Wang W, Wang P, Zhang N, Xiu X, Zhao J. Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children. Comput Math Methods Med 2022; 2022:9631858. [PMID: 35813429 PMCID: PMC9262523 DOI: 10.1155/2022/9631858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
Objective After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children's anxiety, so as to reduce the occurrence of vascular crisis. Methods The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time. Results Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant (P < 0.05). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups (P > 0.05). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children's postoperative crying and is conducive to children's postoperative recovery.
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Affiliation(s)
- Guangxian Chen
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Wei Wang
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Ping Wang
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Ning Zhang
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Xiaolei Xiu
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Jianyong Zhao
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
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Kogan MI, Sizonov VV. [Bradis anti-reflux ureterocysto-anastomosis in children with recurrent obstructive megaureter]. Urologiia 2022:5-10. [PMID: 35485808] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research. PURPOSE Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradis technique for children with recurrent obstructive megaureter (OM). MATERIALS AND METHODS The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradis extravesical reimplantation. RESULTS During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the pre-surgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings. CONCLUSIONS The simplicity of Bradis extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradis surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.
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Affiliation(s)
- M I Kogan
- Rostov State Medical University of the Russian Federation Ministry of Public Health, Rostov-on-Don, Russia
- Rostov Regional Childrens Clinical Hospital, Rostov-on-Don, Russia
| | - V V Sizonov
- Rostov State Medical University of the Russian Federation Ministry of Public Health, Rostov-on-Don, Russia
- Rostov Regional Childrens Clinical Hospital, Rostov-on-Don, Russia
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Rudin YE, Marukhnenko DV, Galitskaya DA, Aliev JK, Lagutin GV, Vardak AB. Pneumovesicoscopic ureteral reimplantation with intravesical tailoring of obstructive megaureter in pediatric patient. J Pediatr Urol 2022; 18:224.e1-224.e8. [PMID: 34991990 DOI: 10.1016/j.jpurol.2021.12.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/06/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION According to available data, there are only few articles describing pneumovesicoscopic (PNV) ureteral reimplantation (UR) for obstructive megaureter without tailoring and with ex vivo tailoring in children. AN OBJECTIVE To present our experience of the PNV UR using intravesical ureteral tailoring for symptomatic primary obstructive megaureter in children. STUDY DESIGN Between 2014 and 2020, 42 patients (mean age: 3.1 years) underwent a correction of primary obstructive megaureter (POM) via a vesicoscopic approach. Nine of them with the megaureter (diameter > 25 mm) underwent the intravesical ureteral tailoring. The analysis included only 9 patients who underwent intravesical tailoring of the ureter using the original technique. The dilated ureter is fixed intravesical by the loop in extended position. This simplifies the tailoring step of the ureter. The tailoring is performed by continuous suture (Star). RESULTS 43 UR were analyzed (1 bilateral, 1 with diverticulum, 1 with ureterocele). The mean operative time was 142 min (83-235 min). The mean manipulation time for intravesical tailoring of the megaureter was 18 min. After the surgery, the average kidney function doesn't reduce. We observed an increase in renal function by an average of 7% in three patients after the surgery. One patient required a conversion. It was in the early stages of mastering the technique. All patients underwent US 1-3 weeks 3-6-12 months after the operation, the size of the pelvic system and ureter decreased. Eight patients are asymptomatic, and only one has the clinical changes (a persistent leukocyturia, the size of the pelvic-ureteric segment, and the ureter remain unchanged or increased). According to the VCUG vesicoureteral reflux was detected in this case. An endoscopic correction used successful. DISCUSSION This possibility of applying our technique is confirmed according to folow-up data and should be used in other researches. The drainage of the ureter with an external stent for 1 month helps to form properly the neo-ureterovesical anastomosis and to prevent episodes of ureteral obstruction as a result the incidence of urinary tract infections reduces in the postoperative period. CONCLUSIONS The use of the Tuohy needle with the loop simplifies the fixation of the ureter. This helps to make the intravesical tailoring of the megaureter easier and faster. It is original and less traumatic for the ureter than existing methods.
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Affiliation(s)
- Yu E Rudin
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - D V Marukhnenko
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - D A Galitskaya
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation.
| | - J K Aliev
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - G V Lagutin
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - A B Vardak
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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Tian Y, Li N, Wang W, Liu L. Preoperative Cryopreservation Promotes Digital Survival after Digit Replantation. Comput Math Methods Med 2022; 2022:2003618. [PMID: 35295200 PMCID: PMC8920615 DOI: 10.1155/2022/2003618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Abstract
Cryopreservation has been applied in the replantation of limbs with a minimal amount of muscle tissue replanted. And small composite tissues have also been reported to be successfully replanted by preoperative cryopreservation. In this study, we aimed to study the effect of preoperative cryopreservation on digital survival after digit replantation. Accordingly, we collected and compared the demographic and clinicopathological characteristics of patients with digit injury of patients, and we observed no significant difference between the NT and CP patients of digital injury. We also investigated the records of successful digit replantation and other parameters which influenced the odds of digital survival of all recruited patients. Accordingly, we found that the number of survived digits was remarkably increased in patients in the CP group compared with that in patients in the NT group. And the number of patients requiring blood transfusion and the mean length of hospital stay were notably decreased in the CP group. And compared with other patient characteristics, the mechanism of injury (blade, crush, or avulsion) showed a remarkable difference between the two groups of digital failure. Moreover, we analyzed the correlations between patient characteristics and the odds of digit survival and found that compared with other basic characteristics of patients and their injury, the preservation temperature, especially cryopreservation, could significantly promote digital survival after replantation.
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Affiliation(s)
- Yu Tian
- Department of Hand & Foot Surgery, First Hospital of Qinhuangdao, Qinhuangdao, 066000 Hebei, China
| | - Nan Li
- Department of Ophthalmology, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, 066000 Hebei, China
| | - Wei Wang
- Department of Hand & Foot Surgery, First Hospital of Qinhuangdao, Qinhuangdao, 066000 Hebei, China
| | - Lei Liu
- Department of Plastic Surgery, Shanhaiguan People's Hospital, Shanhaiguan, 066200 Hebei, China
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36
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Yim N, Hacquebord J. Replantation Surgery Why Aren't We Getting Better at This? Bull Hosp Jt Dis (2013) 2022; 80:31-36. [PMID: 35234584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The first digital replantation was performed over 50 years ago, and soon after surgeons in countries around the world were finding great success in their outcomes. The initial wave of success, however, has been followed by somewhat disappointing results in the United States in recent years. The steadily declining number of attempts at replantation and diminishing viability rates can be attributed to several factors, many of which can be addressed with centralization of care and the modification of our own indications and contraindications. While other regions of the world still enjoy good outcomes, the United States must make a concerted effort to improve their results for these devastating injuries.
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Abstract
BACKGROUND Digit replantation under wide-awake local anesthesia is a challenging method, and there are only a few works of literature on this procedure. This article describes the authors' clinical experience in finger replantation under wide-awake local anesthesia compared to general anesthesia. METHODS Fifty-one patients who received single finger replantation after initial sharp amputation were included in the study, of whom 16 received wide-awake local anesthesia and 35 general anesthesia treatment. The indications for wide-awake local anesthesia were sharp amputation injury, estimated operation time less than 3 hours, and cooperative patients. The wide-awake local anesthesia was performed with 1% or 2% lidocaine infiltrated at the volar midpoint of the metacarpophalangeal joint of the affected digit without sedation medications. Demographic data included surgical outcome, waiting time, operation time, and hospital stay. RESULTS A total of 51 consecutive patients were included in this study. There were significantly shorter waiting times and operation times in the wide-awake local anesthesia group. The other parameters showed no significant differences. The overall success rate was 76.47 percent, with a mean overall operation time of 207 minutes. CONCLUSIONS In selected patients, finger replantation can be successfully performed under wide-awake local anesthesia, which has lower anesthesia risk and fewer medical expenses than general anesthesia. The method is feasible for single-digit replantation. Therefore, the finger replantation under wide-awake local anesthesia is a practicable alternative to general anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Hui-Fu Huang
- From the Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine; National Taiwan University Hospital; and University Hospital "Carl Gustav Carus" Dresden
| | - Jan Matschke
- From the Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine; National Taiwan University Hospital; and University Hospital "Carl Gustav Carus" Dresden
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Nafatalewa DK, Mukakala AK, Mujinga IMW, Lubosha NA, Yumba SN, Banza MI, Kaoma VDP, Katambwa PM, Musapudi EM, Misenga JB, Mukaz PM. Amputation totale du gland lors de la circoncision en milieu non hospitalier: à propos de deux cas. Pan Afr Med J 2022; 42:214. [PMID: 36258900 PMCID: PMC9569146 DOI: 10.11604/pamj.2022.42.214.28325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/02/2022] [Indexed: 11/11/2022] Open
Abstract
L´amputation du gland au cours de la circoncision est une complication tragique dont la responsabilité incombe à l´opérateur. Le traitement de référence de cette lésion repose sur la réimplantation microchirurgicale par anastomose vasculaire et nerveuse. Nous rapportons deux cas d´amputation totale du gland chez deux enfants: le premier âgé de cinq ans admis en urgence à la suite d´une circoncision et dont la réimplantation a été faite dans l´heure suivant l´accident, sans anastomose microchirurgicale; et le second était âgé de 11 ans reçu 3 ans après l´accident, géré psychologiquement jusque-là; il est en attente d´une chirurgie plastique. Le résultat obtenu après prise en charge du premier avait été jugé bon tant sur le plan urinaire, sur le plan de la sensibilité, de l´aspect cosmétique du gland et sur le plan érectile.
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Affiliation(s)
- Dimitri Kanyanda Nafatalewa
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
- Corresponding author: Dimitri Kanyanda Nafatalewa, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo.
| | - Augustin Kibonge Mukakala
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
- Département de Chirurgie, Cliniques Universitaires de Bukavu, Faculté de Médecine, Université Officielle de Bukavu, Bukavu, République Démocratique du Congo
| | - Igor Mujinga wa Mujinga
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Nasser Amisi Lubosha
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Serge Ngoy Yumba
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Manix Ilunga Banza
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Vincent de Paul Kaoma
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Prince Muteba Katambwa
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Eric Mbuya Musapudi
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Jeff Bukasa Misenga
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Pitchou Mbey Mukaz
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
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Mokashi SA, Rosinski BF, Desai MY, Griffin BP, Hammer DF, Kalahasti V, Johnston DR, Rajeswaran J, Roselli EE, Blackstone EH, Svensson LG. Aortic root replacement with bicuspid valve reimplantation: Are outcomes and valve durability comparable to those of tricuspid valve reimplantation? J Thorac Cardiovasc Surg 2022; 163:51-63.e5. [PMID: 32684389 DOI: 10.1016/j.jtcvs.2020.02.147] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess intermediate-term outcomes of aortic root replacement with valve-sparing reimplantation of bicuspid aortic valves (BAV), compared with tricuspid aortic valves (TAV). METHODS From January 2002 to July 2017, 92 adults underwent aortic root replacement with BAV reimplantation and 515 with TAV reimplantation at the Cleveland Clinic. Balancing-score matching based on 28 preoperative variables yielded 71 well-matched BAV and TAV pairs (77% of possible pairs) for comparison of postoperative mortality and morbidity, longitudinal echocardiogram data, aortic valve reoperation, and survival. RESULTS In the BAV group, 1 hospital death occurred (1.1%); mortality among all reimplantations was 0.2%. Among matched patients, procedural morbidity was low and similar between BAV and TAV groups (1 stroke in TAV group; renal failure requiring dialysis, 1 patient each; red cell transfusion, 25% each). Five-year results: Severe aortic regurgitation was present in 7.4% of the BAV group and 2.9% of the TAV group (P = .7); 39% of BAV and 65% of TAV patients had none. Higher mean gradients (10 vs 7.4 mm Hg; P = .001) and left ventricular mass index (111 vs 101 g/m2; P = .5) were present in BAV patients. Freedom from aortic valve reoperation was 94% in the BAV group and 98% in the TAV group (P = .10), and survival was 100% and 95%, respectively (P = .07). CONCLUSIONS Both BAV and TAV reimplantations can be performed with equal safety and good midterm outcomes; however, the constellation of higher gradients, less ventricular reverse remodeling, and more aortic valve reoperations with BAV reimplantations raises concerns requiring continued long-term surveillance.
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Affiliation(s)
- Suyog A Mokashi
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vidyasagar Kalahasti
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Abstract
IMPORTANCE Risk-adjusted variation in surgeon outcomes has been traditionally explained by surgeon volume and hospital infrastructure, yet it is unclear how a surgeon's operative proficiency directly contributes to their patients' outcomes. OBJECTIVE To assess the variation of surgeons' operative proficiency and investigate its association with surgical outcomes. DESIGN, SETTING, AND PARTICIPANTS This case series was a retrospective analysis of all digit replantations and revascularizations at a single US university medical center between January 2000 and August 2020. Surgeons were assigned a proficiency score based on the expected procedure difficulty and outcomes from a sample of their cases. Surgeon proficiency scores were then used to determine associations with outcomes from subsequent cases. The expected difficulty of each case was calculated using a novel scoring system that applied pooled relative risks from a meta-analysis of risk factors for replantation and revascularization failure. EXPOSURES Digit replantation and revascularization. MAIN OUTCOMES AND MEASURES Digit survival at 1-month follow up (case success) and number of complications. RESULTS A total of 145 patients and 226 digits were treated by 11 surgeons with training in hand or microsurgery (mean [SD] age, 41.9 [15.2] years; 204 [90%] men); there were 116 replantations and 110 revascularizations. Surgeon proficiency scores ranged from 1.3 to 5.7, with a mean (SD) of 3.4 (1.4). Case success rates among surgeons varied from 20.0% to 90.5%, with a mean (SD) of 64.9%. Higher proficiency scores were associated with fewer case failures: each point increase was associated with 40% decreased odds of failure (odds ratio, 0.60; 95% CI, 0.38-0.94). Every 3-point increase in proficiency score was associated with 1 less complication (effect estimate, -0.29; 95% CI, -0.56 to 0.02). Surgeon proficiency score had a greater association with case failure than surgeon volume (16.7% vs 12.0%). The final model's association with case failure had an area under the receiver operating characteristics curve of 0.93. CONCLUSIONS AND RELEVANCE Operative proficiency varied widely among practicing surgeons and accounted for 17% of estimative ability for success of digit replantation and revascularization. Greater surgeon proficiency was associated with better outcomes, indicating that the value of surgical care may be optimized by improving surgeon proficiency.
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Affiliation(s)
- Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Robert L. Kane
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Leyi Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Lu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Pertea M, Ciobanu P, Velenciuc N, Poroch V, Filip A, Moraru DC, Lunca S, Veliceasa B. Utility of "reposition-flap" in the reconstruction of the avulsed thumb. Medicine (Baltimore) 2021; 100:e27290. [PMID: 34559139 PMCID: PMC8462580 DOI: 10.1097/md.0000000000027290] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to "sacrifice" another anatomical region for thumb reconstruction, the "reposition-flap" technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using "reposition-flap" with an O'Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.
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Affiliation(s)
- Mihaela Pertea
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Petru Ciobanu
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Natalia Velenciuc
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- 2nd Surgical Clinic, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Vladimir Poroch
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Palliative Care Department, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Alexandru Filip
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Orthopaedics and Traumatology Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţeinr. 1, Iaşi, Romania
| | - Dan Cristian Moraru
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Sorinel Lunca
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- 2nd Surgical Clinic, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Bogdan Veliceasa
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Orthopaedics and Traumatology Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţeinr. 1, Iaşi, Romania
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Ascione T, Balato G, Mariconda M, Smeraglia F, Baldini A, De Franco C, Pandolfo G, Siciliano R, Pagliano P. Synovial Cell Count Before Reimplantation Can Predict the Outcome of Patients with Periprosthetic Knee Infections Undergoing Two-stage Exchange. Clin Orthop Relat Res 2021; 479:2061-2068. [PMID: 33944811 PMCID: PMC8373579 DOI: 10.1097/corr.0000000000001788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/31/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although synovial fluid can be used to diagnose periprosthetic joint infections (PJI) effectively, only the cutoff values adopted at the time of PJI diagnosis have been standardized, and few data are currently available about effectiveness of synovial fluid examination before definitive reimplantation. QUESTIONS/PURPOSES We asked: (1) What are the most appropriate thresholds for synovial fluid leukocyte counts (WBC) and neutrophil percentage (PMN percentage) in a patient group undergoing definitive reimplantation after an uninterrupted course of antibiotic therapy for chronic PJI? (2) What is the predictive value of our synovial WBC and PMN percentage threshold compared with previously proposed thresholds? METHODS In all, 101 patients with PJI were evaluated for inclusion from January 2016 to December 2018. Nineteen percent (19 of 101) of patients were excluded because of the presence of a chronic inflammatory disease, acute/late hematogenous infection, low amount of synovial fluid for laboratory investigations or infection persistence after spacer placement, and adequate antibiotic therapy. Finally, 81% (82 of 101) of patients with a median (range) age of 74 years (48 to 92) undergoing two-stage revision for chronic TKA infection, who were followed up at our institution for a period 96 weeks or more, were included in this study. The patients did not discontinue antibiotic treatment before reimplantation and were treated for 15 days after reimplantation if intraoperative cultures were negative. No patient remained on suppressive treatment after reimplantation. Synovial fluid was aspirated aseptically with a knee spacer in place to evaluate the cell counts before reimplantation. Thirteen percent (11 of 82) of patients had persistent or recurrent infection, defined as continually elevated erythrocyte sedimentation rate or C-reactive protein levels coupled with local signs and symptoms or positive cultures. The synovial fluid WBC counts and PMN percentage from the 11 patients with persistent or recurrent PJI were compared with the 71 patients who were believed to be free of PJI. Receiver operating characteristic (ROC) curve analyses assessed the predictive value of the parameters, and the areas under the curves (AUCs) were evaluated. The sensitivities, specificities, and positive and negative predictive values were determined for the WBC count and PMN percentage. Patients with persistent or recurrent infection had higher median WBC counts (471 cells/µL versus 1344 cells/µL; p < 0.001) and PMN percentage (36% versus 61%; p < 0.001) than did patients believed to be free of PJI. RESULTS ROC curve analysis identified the best threshold values to be a WBC count of 934 cells/µL or more (sensitivity 0.82 [95% CI 0.71 to 0.89], specificity 0.82 [95% CI 0.71 to 0.89]) as well as a PMN percentage of at least 52% (sensitivity 0.82 [95% CI 0.71 to 0.89] and specificity 0.78 [95% CI 0.67 to 0.86]. We found no difference between the AUCs for the WBC count and the PMN percentage (0.87 [95% CI 0.79 to 0.96] versus 0.84 [95% CI 0.73 to 0.95]. Comparing the sensitivities and specificities of the synovial fluid WBC count and PMN percentage proposed by other authors, we find that a PMN percentage more than 52% showed better predictive value than previously reported. CONCLUSION Based on our findings, we believe that patients with WBC counts of at least 934 and PMN percentage of 52% or more should not undergo reimplantation but rather a repeat debridement, as their risk of persistent or recurrent PJI appears prohibitively high. The accuracy of the proposed cutoffs is better than previously reported. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Tiziana Ascione
- Service of Infectious Diseases, Cardarelli Hospital, Naples, Italy
- Department of Infectious Diseases, D. Cotugno Hospital, AORN dei Colli - Naples
| | - Giovanni Balato
- Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Massimo Mariconda
- Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Francesco Smeraglia
- Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Andrea Baldini
- Orthopedic Unit, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Cristiano De Franco
- Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Giuseppe Pandolfo
- Department of Industrial Engineering, “Federico II” University, Naples, Italy
| | - Roberta Siciliano
- Department of Industrial Engineering, “Federico II” University, Naples, Italy
| | - Pasquale Pagliano
- Department of Infectious Diseases, D. Cotugno Hospital, AORN dei Colli - Naples
- Unit of Infectious Diseases, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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Zhang Q, Ding B, Wu J, Dong J, Liu F. Sonication fluid culture of antibiotic-loaded bone cement spacer has high accuracy to confirm eradication of infection before reimplantation of new prostheses. J Orthop Surg Res 2021; 16:377. [PMID: 34120643 PMCID: PMC8199841 DOI: 10.1186/s13018-021-02520-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/02/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sonication fluid culture of antibiotic-loaded bone cement spacer has been used to predict reinfection of two-stage revision, but its value remains disputable. This study aims to evaluate the association between the culture result of the sonicated spacer and the status of patients with periprosthetic joint infection receiving two-stage revision. MATERIALS AND METHODS A comprehensive electronic literature search was performed through four databases including PubMed, Embase/Ovid, and EBSCO, and the Cochrane Library to retrieve studies in which sonication fluid culture of the antibiotic spacer was conducted before reimplantation. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to assess the association between the culture result of sonicated spacer and prognosis of the two-stage revision. RESULTS Eleven eligible studies comprising 603 artificial joints with PJI (134 suffering a clinical failure of two-stage revision) were included in the quantitative analysis. The pooled incidences of positive culture of sonicated spacer and intraoperative tissue were 0.14 (95% confidence interval [CI] 0.08-0.21) and 0.14 (95% CI 0.08-0.20), respectively. A positive culture of sonicated antibiotic-loaded bone cement spacer illustrated moderate sensitivity (0.31, 95% CI 0.13-0.58) but high specificity (0.94, 95% CI 0.86-0.98) for the diagnosis of therapeutic failure of two-stage revision; the pooled DOR was 7.67 (95% CI, 3.63-16.22). Meanwhile, the pooled sensitivity, specificity, and DOR of intraoperative tissue culture during the two-stage revision to predict therapeutic failure were 0.32 (95% CI, 0.20-0.47), 0.96 (95% CI, 0.92-0.98), and 10.62 (95% CI, 4.90-23.01), respectively. CONCLUSIONS Sonication fluid culture of antibiotic-loaded bone cement spacer revealed high accuracy for confirming eradication of infection before reimplantation of new prostheses and therefore could be used as a supplement for assessing therapeutic effect for PJI. However, both sonication fluid culture and intraoperative tissue culture from antibiotic-loaded bone cement spacer showed restricted yield for the prediction of a septic failure after the two-stage revision of PJI. Large-scale, prospective studies are still needed to testify current findings.
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Affiliation(s)
- Qingyu Zhang
- Department of Orthopedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Baocong Ding
- Rehabilitation Department, Shandong University of Traditional Chinese Medicine Affiliated Hospital, No.16369, Road Jing Shi, Jinan, 250014, Shandong, China
| | - Jinglin Wu
- Basic Course Department, Weihai Vocational College, New Sci-Tech Park of Beihai, Weihai, 264200, Shandong, China
| | - Jun Dong
- Department of Orthopedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Regas I, Saizonou I, Pichonnat M, Menez C, Menu G, El Rifai S, Echalier C, Boyer E, Loisel F, Aubry S, Obert L, Feuvrier D, Pluvy I. Influence of the level of arterial resection on the replanting and revascularization results in hand surgery: prospective study over 22 months. Hand Surg Rehabil 2021; 40:660-669. [PMID: 34111576 DOI: 10.1016/j.hansur.2021.06.002] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.
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Affiliation(s)
- I Regas
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France.
| | - I Saizonou
- Service d'Anatomo-Pathologie, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - M Pichonnat
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - C Menez
- Service d'Orthopédie et de Traumatologie, Hôpital Chaumont, 17 Avenue des Etats Unis, 52000 Chaumont, France
| | - G Menu
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - S El Rifai
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - C Echalier
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - E Boyer
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - F Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - S Aubry
- Service d'Imagerie Ostéoarticulaire, Radiologie Interventionnelle, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - L Obert
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - D Feuvrier
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - I Pluvy
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France; Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
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Pertea M, Ciobanu P, Poroch V, Velenciuc N, Lunca S, Anghelina F, Palade DO. Arterial only anastomosis associated with modified Baudet technique in ear replantation: Case reports and literature review. Medicine (Baltimore) 2021; 100:e25357. [PMID: 33787638 PMCID: PMC8021351 DOI: 10.1097/md.0000000000025357] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump. METHODS This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added. RESULTS The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome. CONCLUSION Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.
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Affiliation(s)
- Mihaela Pertea
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency Hospital
| | - Petru Ciobanu
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency Hospital
| | - Vladimir Poroch
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Palliative Care
| | - Natalia Velenciuc
- University of Medicine and Pharmacy “Grigore T Popa”
- Second Surgical Oncologic Clinic, Regional Institute of Oncology
| | - Sorinel Lunca
- University of Medicine and Pharmacy “Grigore T Popa”
- Second Surgical Oncologic Clinic, Regional Institute of Oncology
| | | | - Dragos Octavian Palade
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Otorhinolaringology, “Sf. Spiridon” Emergency Hospital, Iasi Romania
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Abstract
This article discusses the contributions of the two pioneers of the surgical procedure of replantation-Ronald Malt in the US and Chen Zhongwei in China. Ronald Malt performed the reattachment surgery on a boy who had an accident in 1962, but he published his case report two years later in 1964. Chen Zhongwei performed a similar surgery on a worker who cut off his forearm in 1963, but he published his case report the same year. There is some debate about which one of these reputed surgeons should be given credit for being the first one to perform this breakthrough surgery, because although Malt was the first to perform the procedure, Zhongwei was the first to report it. To shed light on this controversy, criteria for scientific priority suggested by Ronald Vale and Anthony Hyman were applied. Although the criteria mainly favored Zhongwei as the pioneer of this procedure, he did not entirely fulfill one of the criteria. Therefore, the article could not present a definitive answer to the question, and it concludes by pointing out the highly commendable achievements and contributions of both Ronald Malt and Chen Zhongwei.
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Affiliation(s)
- Ka-Wai Fan
- Department of Chinese and History, City University of Hong Kong, Hong Kong
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Güntürk ÖB, Kayalar M, Bali U, Özaksar K, Toros T, Gürbüz Y. Clinical outcomes of salvage revision surgery following finger replantation with vascular insufficiency: A retrospective study. Acta Orthop Traumatol Turc 2020; 54:577-582. [PMID: 33423987 DOI: 10.5152/j.aott.2020.19016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the outcomes of revision surgery following replantation of single digital amputations. METHODS In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single finger replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only finger replantations into account, one finger (0.8%) was nail distal third, 70 fingers (56%) were nail distal third to lunula, 43 fingers (34.4%) were lunula to distal phalanx basis, 10 fingers (8%) were distal interphalangeal (DIP) joint, and one finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) fingers. The need for operative revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately. RESULTS After the replantations, according to survival analysis, while 342 (84.9%) fingers were operated upon successfully, 61 (15.1%) fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level. CONCLUSION The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted fingers with vascular insufficiency. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Özgün Barış Güntürk
- Clinic of Orthopaedics, Traumatology and Hand Surgery, Emot Hospital, İzmir, Turkey
| | - Murat Kayalar
- Clinic of Orthopaedics, Traumatology and Hand Surgery, Emot Hospital, İzmir, Turkey
| | - Ulaş Bali
- Department of Plastic and Reconstructive Surgery, Manisa Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Kemal Özaksar
- Clinic of Orthopaedics, Traumatology and Hand Surgery, Emot Hospital, İzmir, Turkey
| | - Tulgar Toros
- Clinic of Orthopaedics, Traumatology and Hand Surgery, Emot Hospital, İzmir, Turkey
| | - Yusuf Gürbüz
- Clinic of Orthopaedics, Traumatology and Hand Surgery, Emot Hospital, İzmir, Turkey
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Yontar NS, Aslan L, Can A, Öğüt T. Mid-term results of open debridement and reattachment surgery for insertional Achilles tendinopathy: A retrospective clinical study. Acta Orthop Traumatol Turc 2020; 54:567-571. [PMID: 33423985 DOI: 10.5152/j.aott.2020.18426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effects of age and body mass index (BMI) on the functional outcomes, satisfaction rates, and recovery time after open debridement and reattachment surgery in non-athletic patients with insertional Achilles tendinopathy (IAT). METHODS In this retrospective study, 33 non-athletic patients (34 ankles) in whom open debridement and reattachment surgery was performed for IAT from 2006 to 2016 were included. Change in pain intensity was assessed using a Visual Analogue Scale (VAS) preoperatively and at the final follow-up. Functional assessment was done by preoperative and postoperative American Orthopaedics Foot and Ankle Score (AOFAS) and final follow-up Victorian Institute of Sport Tendon Study Group-Achilles Tendinopathy score (VISA-A). Patient satisfaction was evaluated by Roles - Maudsley score (RMS). The recovery time was defined as the time interval from the first appearance to postoperative relief of symptoms and recording. In addition, the recurrent Haglund's deformity was determined by postoperative control radiographs. RESULTS The mean age at the time of the operation was 51.19 years. The mean follow-up was 61.75±8.49 months. According to BMI, 5 patients were determined as morbid obese, 19 as obese, 3 as overweight, and 6 as normal. The mean VAS score significantly decreased from 8.5 preoperatively to 1.3 postoperatively (p<0.001). The mean AOFAS score significantly improved from 55.8 preoperatively to 92 postoperatively (p<0.001). Postoperative VISA-A score was 86% (range=32%-100%). According to RMS, 22 patients reported the result as excellent, 8 as good, 2 as fair, and 1 as poor. The mean recovery time was 11.8 (range=2-60) months, but one patient did not reach a symptom free status and thus was not included in the recovery time analysis. Postoperative control radiographs revealed signs of recurrence deformity in four patients. Recovery time showed a negative correlation with the age of the patients (r=-0.65). Postoperative scores and BMI showed no significant correlations with the recovery time on the basis of Spearman's rho test (p=0.196). CONCLUSION The results of this study have shown that open debridement and reattachment surgery may be an effective surgical method in relieving pain and improving functional status with high satisfaction rate and acceptable recovery time in the management of non-athletic patients with IAT. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Necip Selçuk Yontar
- Department of Foot-Ankle Surgery, Nişantaşı Orthopaedics Center, İstanbul, Turkey
| | - Lercan Aslan
- Department of Orthopaedics and Traumatology, Koç University Hospital, İstanbul, Turkey
| | - Ata Can
- Department of Orthopaedics and Traumatology, Nişantaşı Orthopaedics Center, İstanbul, Turkey
| | - Tahir Öğüt
- Department of Foot-Ankle Surgery, Nişantaşı Orthopaedics Center, İstanbul, Turkey
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Rappaport YH, Kord E, Noh PH, Koucherov S, Gaber J, Shumaker A, Zisman A, Stav K, Chertin B, Dubrov V, Bondarenko S, Neheman A. Minimally Invasive Dismembered Extravesical Cross-Trigonal Ureteral Reimplantation for Obstructed Megaureter: A Multi-Institutional Study Comparing Robotic and Laparoscopic Approaches. Urology 2020; 149:211-215. [PMID: 33122054 DOI: 10.1016/j.urology.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/04/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare 2 minimally invasive surgical options for the treatment of obstructed megaureter: robot assisted dismembered extravesical cross-trigonal ureteral reimplantation (RADECUR) and laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation (LDECUR). METHODS A 2 arm retrospective comparative study, including all pediatric patients who underwent ureteral reimplantation of unilateral obstructed megaureter, either by RADECUR or LDECUR. Patient demographics, perioperative surgical data, complications, and results are described. The surgical technique in both arms was similar: dismembering of the ureter, performing an extravesical cross-trigonal detrusorotomy, and intracorporeal tailoring of the ureter when indicated, were the pivotal maneuvers utilized. RESULTS The study included 95 patients (48 and 47 in the RADECUR and LDECUR arms, respectively) operated between the years 2016 and 2019. Overall, median age at surgery was 24 months (IQR 12-48) and median weight was 14 kg (IQR 11-21). Median operative time was 93 minutes (IQR 90-120) for RADECUR and 130 minutes (IQR 105-160) for LDECUR (P< 0.001). Intracorporeal excisional tapering was performed in 11 of the RADECUR patients and 19 LDECUR patients. Grade 1-2 Clavien-Dindo complications occurred in 7 patients, and grade 3 complication in 1 patient in the RADECUR arm. In the LDECUR arm, grade 1-2 complications occurred in 2 patients, and 2 had a grade 3 complications. Surgical success was achieved in 97% and 94% in the RADECUR and LDECUR groups, respectively. CONCLUSION Unilateral robotic extravesical cross-trigonal ureteral re-implantation for treatment of obstructed megaureter in the pediatric population is safe and effective both for RADECUR and LDECUR. Operative time is significantly shorter for RADECUR.
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Affiliation(s)
| | - Eyal Kord
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Paul H Noh
- University Urology, 3290 Dauphin Street, Mobile, AL
| | - Stanislav Koucherov
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jaudat Gaber
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Andrew Shumaker
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Boris Chertin
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Vitaly Dubrov
- Department of Pediatric Urology, Children's City Clinical Hospital, Minsk, Republic of Belarus
| | - Sergey Bondarenko
- Department of Pediatric Urology, Municipal Hospital, Volgograd, Russia
| | - Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel
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Hung CC. Endoscopic transaxillary capsulectomy with immediate reimplantation performed as a single-operator outpatient procedure. J Plast Reconstr Aesthet Surg 2020; 73:2225-2231. [PMID: 32674909 DOI: 10.1016/j.bjps.2020.05.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/24/2020] [Accepted: 05/15/2020] [Indexed: 01/09/2023]
Abstract
Capsulectomy is a standard treatment for capsular contracture after breast augmentation. Incision via the endoscopic transaxillary approach is generally preferred by Asian women, but relevant literature addressing endoscopic transaxillary capsulectomy is limited. This study described the techniques of endoscopic transaxillary capsulectomy with reimplantation performed as a single-operator outpatient procedure. This retrospective study included patients with diagnosis of capsular contracture underwent endoscopic transaxillary capsulectomy with immediate reimplantation between January 1, 2013 and December 31, 2017. Data regarding history, implant type, operation time, duration of postoperative drainage, and complications were collected and analyzed. A total of 42 patients with a mean age of 36 years were included (11 unilateral and 31 bilateral capsulectomy). Total capsulectomy was performed on four (10%) patients for previous subglandular augmentation, and anterior capsulectomy was performed on 38 (91%) patients for previous submuscular augmentation. Mean sizes of previous and new (or reused) implants were 268 ml (median 283 ml, SD 57) and 317 ml (median 307 ml, SD 49), respectively. Mean operation time for unilateral and bilateral procedures were 4 h 15 min and 6 h 28 min, respectively. Postoperatively, mean duration of wound drainage was 10 (SD 3) days. Six (14%) patients experienced complications, including two (5%) patients with seroma, two (5%) with hematoma, one (2%) with infection, and four (10%) with recurrent capsular contracture. The four recurrent cases underwent repeat endoscopic transaxillary capsulectomy. All of the 42 patients had satisfactory clinical and esthetic outcomes. This study demonstrated the feasibility of endoscopic transaxillary capsulectomy with immediate reimplantation performed as an ambulatory surgery by a single surgeon who is in a stable and comfortable sitting position without the aid of a surgical assistant.
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Affiliation(s)
- Chih-Cheng Hung
- Chimay Plastic Surgery Clinic, 2F, No. 50, Section 4, Ren'ai Road, Da'an District, Taipei 106, Taiwan; School of Health Care Administration, Taipei Medical University, Taiwan.
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