scholarly journals Microvascular myocutaneous and cutaneous free flap reconstruction in patients with terminal esophagostomy after complicated oncological esophagus resection

2021 ◽  
Author(s):  
Lukas Poelsler ◽  
Oliver Koch ◽  
Alexander Gaggl ◽  
Jaroslav Presl ◽  
Joerg Hutter ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Free Flap ◽  
Treatment Options ◽  
Graft Function ◽  
Case Series ◽  
Artificial Nutrition ◽  
Severe Problem ◽  
Promising Alternative ◽  
Surgical Department ◽  
Alternative Treatment Option

Summary Background Persisting anastomotic leakage after oncological esophagectomy is a severe problem associated with high mortality and morbidity. Unfortunately, treatment options with promising results are scarce, especially when conventional operative and endoscopic methods have failed. Due to limitation of oral intake and the need for artificial nutrition, quality of life (QOL) is reduced. Microvascular myocutaneous and cutaneous free flap (MFF) reconstruction could be a promising alternative. Methods This retrospective case series presents 7 patients treated between March 2017 and November 2020 at our surgical department, with persisting postoperative anastomotic leakage without further feasible treatment options. All patients received anastomotic MFF reconstruction; used flaps and important intraoperative factors like microvascular anastomosis were evaluated. Complications and patient contentment was assessed. Results The included 7 male patients had median age of 65.15 years (range: 48–75). MFF function was adequate in 6/7 patients, one flap necrosis was encountered. Whereas 5 patients initially had good results, surgical revision was performed in 1 patient to ensure graft function. Postoperative complications appeared in 6/7 patients. Mean duration of inpatient care was 63 days (range: 24–156). At the time of evaluation, 1 patient has died of his malignant disease. No more additional nutrition was needed in 3/6 patients with adequate graft function. Most patients reported improved QOL after MFF. Conclusion MFF free flap can be an alternative treatment option for patients with terminal esophagostomy after complicated oncological esophagus resection without further treatment options. The renewed ability of oral food intake results in a significant improvement of QOL.

scholarly journals 662 MICROVASCULAR MYOCUTANEOUS AND CUTANEOUS FREE FLAP RECONSTRUCTION FOR PATIENTS WITH TERMINAL ESOPHAGOSTOMY AFTER COMPLICATED ONCOLOGICAL ESOPHAGUS RESECTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Lukas Pölsler ◽  
Jaroslav Presl ◽  
Christian Brandtner ◽  
Alexander Gaggl ◽  
Jörg Hutter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Free Flap ◽  
Treatment Options ◽  
Graft Function ◽  
Oral Intake ◽  
Artificial Nutrition ◽  
Severe Problem ◽  
Promising Alternative ◽  
Number Of Patients

Abstract   Persisting anastomotic leak after oncological esophagectomy is a severe problem associated with high mortality and morbidity. Unfortunately, treatment options with promising results are scarce especially when conventional operative and endoscopic methods have failed. Due to limitation of oral intake and need for artificial nutrition quality of life is reduced. Microvascular myocutaneous and cutaneous free flap (MFF) reconstruction could be a promising alternative. Methods This retrospective cohort study presents seven patients treated between March 2017 and November 2020 at our surgical department, with terminal esophagostomy after complicated oncological esophagus resection without further feasible treatment options. All Patients received anastomotic MFF reconstruction. We have examined postoperative outcomes, complications according to Clavien-Dindo-Classification and patient contentment with a questionnaire. Additionally, we described important procedure related facts. Results The included seven male patients had median age of 65.15 years (range: 48–75). MFF function was adequate in six out of seven patients, graft rejection appeared in one patient. Five patients initially had good results, surgical revision was performed in one patient to ensure graft function. Postoperative complications appeared in 6/7 patients (Table 1). Mean duration of inpatient care was 63 days (Range: 24–156). At time of evaluation, one patient has died cancer related. No more additional nutrition was needed in 3/6 patients with adequate graft function. The majority of patients reported an improved quality of life compared to preoperatively. Conclusion MFF free flap can be a safe and feasible treatment option for patients with terminal esophagostomy after complicated oncological esophagus resection without further treatment options or in patients with complicated postoperative course with complex combined defects. The renewed ability of oral food intake results in a significant improvement of quality of life for the patients. No procedure related mortality was observed. Number of patients with regained ability of oral intake is encouraging.

scholarly journals Amelioration of lower limb pain and foot drop with 10 kHz spinal cord stimulation: A case series

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110059
Author(s):  
Honghui Feng ◽  
Patrick Doherty ◽  
Anand Rotte ◽  
Christopher Bovinet
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Case Series ◽  
Foot Drop ◽  
Leg Pain ◽  
Opioid Use ◽  
Promising Alternative ◽  
Lower Back ◽  
Lower Limb Pain

There are limited treatment options for patients with foot drop and associated lower back and/or leg pain. We present a case series of three patients who received permanent implantation of 10 kHz spinal cord stimulation (10 kHz SCS) devices. Following treatment, all patients reported sustained improvements in lower back and leg pain, foot mechanics and function which resulted in increased mobility and cessation of opioid use for pain management. Patients were followed up for approximately four years. Treatment with 10 kHz SCS may be a promising alternative to other interventional procedures commonly used for these patients.

In-block lateralization as a new technique for mobilization of the inferior alveolar nerve: a technique case series

2020 ◽  
Author(s):  
Marcos Augusto Tomazi ◽  
Alexandre da Silveira Gerzson ◽  
Angelo Menuci Neto ◽  
André Luciano Pasinato da Costa
Keyword(s):  
Treatment Options ◽  
Inferior Alveolar Nerve ◽  
Case Series ◽  
New Technique ◽  
Autogenous Bone ◽  
Minimal Risk ◽  
Short Implants ◽  
Bone Atrophy ◽  
A New Technique ◽  
Number Of Treatment

The edentulous atrophic posterior mandible is often a great challenge for implant rehabilitation. Although a number of treatment options have been proposed, including the use of short implants and surgical grafting techniques, in cases of severe bone atrophy, techniques for mobilization of the inferior alveolar nerve (IAN) have been shown to be efficient, with good results. Four female patients underwent IAN lateralization for prosthetic rehabilitation of the posterior mandible from 2013 to 2019, with 1 year to 5 years and 4 months of follow-up. This case series describes a new technique for mobilization of the IAN, named in-block lateralization, to facilitate access to the IAN and to reduce nerve manipulation. The implant is immediately installed (allowing nerve lateralization in unitary spaces) and the original mandibular anatomy is restored with autogenous bone from the original bed during the same surgical procedure. When well indicated and well performed, this new approach provides better and easier visualization of the IAN as well as safer manipulation aiming to achieve good results for implant stability and minimal risk of neurosensory disturbances, allowing rehabilitation even in unitary spaces.

scholarly journals The Evolution and Role of the Bursal Acromial Reconstruction

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542110013
Author(s):  
Daniel M. Curtis ◽  
W. Michael Pullen ◽  
Kevin Helenius ◽  
Michael T. Freehill
Keyword(s):  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Treatment Options ◽  
Clinical Problem ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Promising Alternative ◽  
Diagnostic Arthroscopy ◽  
Superior Capsular Reconstruction

Background: Massive, irreparable rotator cuff tears (RCTs) remain a challenging clinical problem with numerous described treatment options. Bursal acromial reconstruction (BAR) represents a promising and evolving technique for a subset of patients with irreparable RCTs. Indications: BAR is indicated for patients with massive, irreparable RCTs with a primary complaint of pain, well-compensated shoulder function, and minimal radiographic degenerative changes of the glenohumeral joint as an alternative to reverse total shoulder arthroplasty or superior capsular reconstruction. Technique Description: Positioning per surgeon preference and diagnostic arthroscopy is performed. Subacromial decompression with a minimal and gentle acromioplasty is performed, followed by assessment of RCT repairability. If the tear is deemed irreparable, acromial measurements in the medial-lateral and anterior-posterior dimensions are obtained. Two pieces of acellular dermal allograft are cut to the acromial dimensions and affixed together using fibrin glue. The reactive side (facing the acromion), medial, and anterior sides of the graft are labeled. Two suture tapes are passed through the corners of the graft and self-locked and run diagonally in a cruciate configuration using an antegrade suture passer. Medial and lateral #2 fiberwire sutures are placed in a luggage-tag configuration. Neviaser (posterior), middle, and anterior acromioclavicular joint portals are created for medial sided suture passage. Medial graft sutures are shuttled through the respective medial portals and the graft is pulled into the subacromial space. The lateral sutures are then removed from percutaneous posterolateral, middle lateral, and anterolateral portals along the acromial edge. Medial sutures are retrieved using a suture grasper subcutaneously on top of the acromion through the percutaneous lateral portals. The sutures are tied through the lateral portals, starting with the medial-lateral sutures, and the knots are buried. Postoperatively, patients are progressed through passive, active-assisted, and active range of motion between weeks 2 and 6 and strengthening is progressed at 6 weeks. Results: Clinical results are lacking in the literature, but anecdotal results in our institution have demonstrated promising early outcomes. Discussion/Conclusion: BAR represents a promising alternative in the array of surgical options for treatment of irreparable RCTs.

scholarly journals NPWTi allows safe delayed free flap repair of Gustilo IIIb injuries: A prospective case series

2021 ◽  
Vol 18 ◽  
pp. 82-87
Author(s):  
Hajime Matsumine ◽  
Giorgio Giatsidis ◽  
Hiroshi Fujimaki ◽  
Nobuyuki Yoshimoto ◽  
Yuma Makino ◽  
...  
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Flap Repair ◽  
Prospective Case Series

scholarly journals Aztreonam Lysine Increases the Activity of Phages E79 and phiKZ against Pseudomonas aeruginosa PA01

2021 ◽  
Vol 9 (1) ◽  
pp. 152
Author(s):  
Carly M. Davis ◽  
Jaclyn G. McCutcheon ◽  
Jonathan J. Dennis
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Morphological Changes ◽  
Burst Size ◽  
Type Iv Pili ◽  
Biofilm Growth ◽  
Promising Alternative ◽  
Type Iv ◽  
Alternative Treatment Option ◽  
One Step ◽  
Step Growth

Pseudomonas aeruginosa is a pernicious bacterial pathogen that is difficult to treat because of high levels of antibiotic resistance. A promising alternative treatment option for such bacteria is the application of bacteriophages; the correct combination of phages plus antibiotics can produce synergistic inhibitory effects. In this study, we describe morphological changes induced by sub-MIC levels of the antibiotic aztreonam lysine (AzLys) on P. aeruginosa PA01, which may in part explain the observed phage–antibiotic synergy (PAS). One-step growth curves for phage E79 showed increased adsorption rates, decreased infection latency, accelerated time to lysis and a minor reduction in burst size. Phage E79 plus AzLys PAS was also able to significantly reduce P. aeruginosa biofilm growth over 3-fold as compared to phage treatment alone. Sub-inhibitory AzLys-induced filamentation of P. aeruginosa cells resulted in loss of twitching motility and a reduction in swimming motility, likely due to a reduction in the number of polar Type IV pili and flagella, respectively, on the filamented cell surfaces. Phage phiKZ, which uses Type IV pili as a receptor, did not exhibit increased activity with AzLys at lower sub-inhibitory levels, but still produced phage–antibiotic synergistic killing with sub-inhibitory AzLys. A one-step growth curve indicates that phiKZ in the presence of AzLys also exhibits a decreased infection latency and moderately undergoes accelerated time to lysis. In contrast to prior PAS studies demonstrating that phages undergo delayed time to lysis with cell filamentation, these PAS results show that phages undergo accelerated time to lysis, which therefore suggests that PAS is dependent upon multiple factors, including the type of phages and antibiotics used, and the bacterial host being tested.

scholarly journals Open Appendicectomy under Spinal Anesthesia—A Valuable Alternative during COVID-19

2021 ◽  
Vol 07 (02) ◽  
pp. e69-e72
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Stated Preference ◽  
Case Series ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department ◽  
The United Kingdom

Abstract Introduction Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from March 25th, 2020 until the surgical department reverted to the laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (four-sevenths) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) postoperative events. Two patients suffered minor postoperative complications. Two experienced intraoperative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days, respectively. Although four stated preference in hindsight for GA, the majority (five-sevenths) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe and feasible in the United Kingdom. The technique could be a valuable contingency for COVID-suspected cases and patients with high-risk respiratory disease.

scholarly journals Sclerosing Mesenteritis: Diverse clinical presentations and dissimilar treatment options. A case series and review of the literature

2011 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Konstantinos Vlachos ◽  
Fotis Archontovasilis ◽  
Evangelos Falidas ◽  
Stavros Mathioulakis ◽  
Stefanos Konstandoudakis ◽  
...  
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Sclerosing Mesenteritis ◽  
Review Of The Literature ◽  
Clinical Presentations

Midcarpal instability

2015 ◽  
Vol 41 (1) ◽  
pp. 86-93 ◽  
Author(s):  
D. G. Hargreaves
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Case Series ◽  
Definite Diagnosis ◽  
Stress Tests ◽  
Functional Instability ◽  
Painful Wrist ◽  
Relative Rarity ◽  
Passive Stress

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

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