scholarly journals Extended experience in parieto-occipital expansion surgery by meander technique—clinical and radiological evaluation

2021 ◽  
Author(s):  
Valentina Pennacchietti ◽  
Matthias Schulz ◽  
Anna Tietze ◽  
Karin Schwarz ◽  
Ulrich-Wilhelm Thomale
Keyword(s):  
Treatment Options ◽  
Surgical Techniques ◽  
Early Mobilization ◽  
Asymmetry Index ◽  
Intracranial Volume ◽  
Expansion Technique ◽  
Age At Surgery ◽  
Perioperative Course ◽  
Tonsillar Descent

Abstract Introduction Brachycephaly and anterior and posterior plagiocephaly appear as an isolated entity or manifest in syndromic conditions. In severe cases, possible treatment options currently comprise either cranioplasty or osteogenetic distraction. The aim of this paper is to retrospectively review the perioperative course of a series of children treated by posterior meander expansion technique at our institution with focus on the course of postoperative intracranial volume and eventual tonsillar descent evolution. Methods Forty-two children received a posterior cranial vault remodeling by means of a posterior meander technique during a 7-year period. Hospital records were reviewed, and pre- and postoperative MRIs were analyzed for intracranial volume, cephalic and asymmetry index, and tonsillar position over time. Results Median age at surgery was 11.5 months (range 17 days–10 years). Nineteen children had a symmetrical cranial deformity, twenty-three an asymmetrical synostosis. Half of the cohort showed a syndromic condition. Transfusions were administered in the majority (92.2%) of the cases. A significant postoperative increase of intracranial volume was present from 1188.9 ± 370.4 cm3 to 1324.8 ± 352.9 cm3 (p < 0.001). The asymmetry index showed a significant improvement postoperatively: 0.86 ± 0.06 versus 0.91 ± 0.05 (p < 0.001), while the cephalic index showed a non-statistical change (0.91 ± 0.11 versus 0.88 ± 0.08). Tonsillar herniation, bilateral or homolateral, showed no significant changes at early control, while a nonsignificant amelioration of tonsillar descent was seen among children older than 12 months at late imaging follow-up. Conclusion Among the osteoplastic techniques, the posterior meander technique offers several advantages, such as early mobilization of the child, less bony defects, absence of implants, and a small complication rate. However, further comparative studies among different surgical techniques are needed.

scholarly journals Percutaneous Fixation by Internal Cemented Screw for the Treatment of Unstable Osseous Disease in Cancer Patients

2018 ◽  
Vol 35 (04) ◽  
pp. 238-247 ◽  
Author(s):  
Steven Yevich ◽  
Guillaume Gravel ◽  
Charles Roux ◽  
Antoine Hakime ◽  
Thierry de Baère ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Image Guidance ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Percutaneous Fixation ◽  
Added Resistance ◽  
Case Examples ◽  
Impending Fracture ◽  
Compression Resistance

AbstractInterventional radiology expertise in image guidance has expanded the treatment options for cancer patients with unstable osseous disease. Percutaneous fixation by internal cemented screw (FICS) describes the technique by which the interventional radiologist stabilizes a fracture or impending fracture with the percutaneous placement of a cannulated screw that is locked in position by polymethyl methacrylate cement. The durable metallic screws provide added resistance to torque and tension stresses that complement the axial compression resistance of cement. Compared with cementoplasty alone, the procedure has been advanced as a more durable and precise technique for stabilization of osseous disease for certain disease presentations in cancer patients. The application of advanced image guidance techniques improves upon existing percutaneous surgical techniques to facilitate approaches that would otherwise prove quite challenging, particularly with stabilization of the pelvic flat bones. This article examines the applications of percutaneous FICS procedures for the treatment of unstable osseous disease in cancer patients. Indications, techniques, and follow-up care are reviewed. Case examples in which FICS can be performed in unstable pathology are detailed.

The Efficacy of Local Flaps in the Treatment of Traumatic Scalp Defects

2021 ◽  
Author(s):  
Adam Stepniewski ◽  
Wolfgang Lehmann ◽  
Maximilian Schilderoth ◽  
Dominik Behringer ◽  
Nadine Emmerich ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Defect Size ◽  
Local Flaps ◽  
Scalp Defects ◽  
Additional Surgery ◽  
Age At Surgery ◽  
The Mean ◽  
Tissue Defects ◽  
Scalp Arteries

Abstract Background Scalp defects represent a therapeutic challenge. The aim of this study is to present our experience with local and regional flaps in the treatment of trauma-induced scalp defects. Furthermore, a comparison with other surgical techniques was performed. Methods A retrospective evaluation of patient records was performed. Only patients who underwent surgery using local flaps between January 2010 and September 2020 due to traumatic scalp defects were included in the study. Results In all, 10 cases were identified (3 females, 7 males, average age at surgery of 46.5 years [range: 18–82 years]). Six patients underwent surgery due to tissue defects and four due to scar keloids. Three patients experienced minor postoperative complications, one of which required additional surgery. The mean defect size was 35.75 cm2 (range: 4–79 cm2) among the four patients where the defect size could be determined retrospectively. The mean inpatient follow-up was 12.4 days (range: 2–34 days). Conclusions Local flaps can be widely used. In carefully selected cases, they have the fewest disadvantages of all surgical techniques. In our experience, large angiosomes of the main scalp arteries allow the treatment of defects larger than 30 cm2 with local flaps. Our experience also suggests that the dimensions of flap length to flap width can exceed a ratio of 2:1 in the scalp.

Comprehensive Care for Bariatric Surgery Patients

2017 ◽  
Vol 28 (3) ◽  
pp. 263-274
Author(s):  
Aura Petcu
Keyword(s):  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Treatment Options ◽  
Surgical Care ◽  
The United States ◽  
Bariatric Patients ◽  
Technical Simplicity ◽  
Perioperative Course

Obesity is a worldwide epidemic, and those suffering from obesity have increased morbidity and mortality rates. There are various causes of obesity and many treatment options for patients suffering from obesity, including nonsurgical treatments. However, bariatric surgery is often the best choice for optimal weight loss and the attenuation of comorbidities. Currently, laparoscopic sleeve gastrectomy is the most common type of bariatric surgery in the United States due to its technical simplicity, feasibility, and overall positive outcomes. This article discusses bariatric surgical criteria and selection, expected perioperative course, potential complications after surgery, and nursing implications for the care of bariatric patients. A case report is used to exemplify stages of surgical care and follow-up treatment for patients who undergo laparoscopic sleeve gastrectomy.

scholarly journals New Agents, Emerging Late Effects, and the Development of Precision Survivorship

2018 ◽  
Vol 36 (21) ◽  
pp. 2231-2240 ◽  
Author(s):  
Eric J. Chow ◽  
Zoltan Antal ◽  
Louis S. Constine ◽  
Rebecca Gardner ◽  
W. Hamish Wallace ◽  
...  
Keyword(s):  
Late Effects ◽  
Treatment Options ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Adaptive Immune System ◽  
Host Susceptibility ◽  
Cell Surface Antigens ◽  
New Agents

Incremental improvements in the treatment of children and adolescents with cancer have led to 5-year survival rates reaching nearly 85%. In the past decade, impressive progress has been made in understanding the biology of many pediatric cancers. With that understanding, multiple new agents have become available that offer the promise of more-effective and less-toxic treatment. These include agents that target various cell surface antigens and engage the adaptive immune system, as well as those that interfere with key signaling pathways involved in tumor development and growth. For local control, surgery and radiation techniques also have evolved, becoming less invasive or featuring new techniques and particles that more precisely target the tumor and limit the dose to normal tissue. Nevertheless, targeted agents, like conventional chemotherapy, radiotherapy, and surgery, may have off-target effects and deserve long-term follow-up of their safety and efficacy. These include injury to the endocrine, cardiovascular, and immunologic systems. New radiation and surgical techniques that theoretically reduce morbidity and improve long-term quality of life must also be validated with actual patient outcomes. Finally, with advances in genomics, information on host susceptibility to late effects is beginning to emerge. Such knowledge, coupled with improved metrics that better describe the spectrum of potential late effects across the entire lifespan, can lead to the development of decision models that project the potential long-term health outcomes associated with various treatment and follow-up strategies. These developments will help extend the current focus on precision medicine to precision survivorship, where clinicians, patients, and families will have a better grasp of the potential risks, benefits, and tradeoffs associated with the growing number of cancer treatment options.

scholarly journals Management of Adult Unilateral TMJ Ankylosis with Temporalis Muscle and Fascia Flap: Review of 51 Cases

2012 ◽  
Vol 3 (3) ◽  
pp. 133-136
Author(s):  
Sobhan Mishra ◽  
Ramanupam Tripathy ◽  
Samrat Sabhlok ◽  
Ritesh Roy
Keyword(s):  
Treatment Options ◽  
Mouth Opening ◽  
Early Mobilization ◽  
Functional Results ◽  
Temporalis Muscle ◽  
Tmj Ankylosis ◽  
Study Support ◽  
Cosmetic Outcomes ◽  
Fascia Flap

ABSTRACT Purpose This study is aimed to determine the efficacy of temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. Treatment of TMJ ankylosis has been a topic of debate and the treatment options are multidimensional. Achieving good postoperative mouth opening and functional and cosmetic outcomes of surgery, depends on the method of reconstruction. The need of study is to give the best possible solutions with minimal morbidity to the underlying deformity. Materials and methods A retrospective study was done on 51 patients to evaluate the postoperative results for unilateral TMJ ankylosis. Parameters such as etiology, postoperative mouth opening on 1st, 2nd, 6th week and 6 months and intraoperative and postoperative complications were recorded. The operative protocol for unilateral TMJ ankylosis entailed: (1) Resection of the ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF) and (6) early mobilization and aggressive physiotherapy. Results The results were encouraging and functional results of interpositional arthroplasty were satisfying with minimal complications. Early postoperative initial aggressive exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions. Conclusion The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. How to cite this article Mishra S, Tripathy R, Sabhlok S, Roy R. Management of Adult Unilateral TMJ Ankylosis with Temporalis Muscle and Fascia Flap: Review of 51 Cases. Int J Head and Neck Surg 2012;3(3):133-136.

scholarly journals Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age—technical note

2021 ◽  
Author(s):  
Y. S. Kang ◽  
V. Pennacchietti ◽  
M. Schulz ◽  
K. Schwarz ◽  
U-W. Thomale
Keyword(s):  
Surgical Treatment ◽  
Subjective Experience ◽  
Growth Dynamics ◽  
Technical Note ◽  
Sagittal Suture ◽  
Head Shape ◽  
Expansion Technique ◽  
Age At Surgery ◽  
Active Reconstruction ◽  
Perioperative Course

Abstract Objective Sagittal suture synostosis (SSS) is the most common form of craniosynostosis. For older patients, the strategy for surgical correction needs to consider diminished growth dynamics of the skull and an active reconstruction cranioplasty aims to sustain stability for the active child. We describe our technique of biparietal meander expansion (BME) technique for SSS for patients older than 1 year and retrospectively reviewed the perioperative course as well as the subjective experience of patients and caregivers during follow-up. Methods The BME technique incorporates bilateral serpentine craniotomies and fixation of the consecutively expanded bone tongues with crossing sutures for patients with SSS older than 12 months of age at surgery. We reviewed patients undergoing this surgical technique for correction of SSS and collected data about the clinical course and performed a patients reported outcome measure (PROM) for patients or caregivers to evaluate subjective experience and outcome after surgical treatment. Results BME was performed in 31 patients (8 females; median age: 43 months; range 13–388). The mean length of operation was 172.7±43 minutes (range 115–294). Patients experienced no immediate complications or neurological morbidity after surgery. Considering a total of 21 completed PROM questionnaires, the head shape after surgery was evaluated as either “better” (57%) or “much better” (43%) compared to preoperatively. Eighty-one percent of patients or caregivers answered that the patient experiences no limitation in daily activities. Although 42.8% perceived the hospital as strenuous, 90.5% would choose to undergo this treatment again. Conclusion BME is a feasible technique for older SSS patients resulting in immediate stability of the remodelled calvarium with a more normal head shape. The survey among caregivers or patients revealed a favourable subjectively experienced outcome after this type of surgical treatment of SSS in the more complex context of an older patient cohort.

scholarly journals Hemispherectomy for the Control of Intractable Epilepsy in Childhood: Comparison of 2 Surgical Techniques in a Single Institution

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons429-ons436 ◽  
Author(s):  
Allison Kwan ◽  
Wai Hoe Ng ◽  
Hiroshi Otsubo ◽  
Ayako Ochi ◽  
O. Carter Snead ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Intractable Epilepsy ◽  
Class I ◽  
Clinical Criteria ◽  
Patient Demographics ◽  
Initial Surgery ◽  
Age At Surgery ◽  
Second Procedure ◽  
Catastrophic Epilepsy

ABSTRACT BACKGROUND: Hemispherectomy is an established neurosurgical procedure for catastrophic epilepsy in childhood. However, the technique used to achieve an optimum outcome remains to be determined. OBJECTIVE: We examined the influence of hemidecortication (HD) vs peri-insular hemispherotomy (PIH) on patient outcome. METHODS: The medical records of 41 children undergoing hemispherectomy were reviewed for patient demographics, clinical criteria, and surgical outcomes. RESULTS: HD and PIH were performed in 21 and 20 children, respectively. The mean age at surgery for HD was 54 months and 61 months for PIH. The median durations of surgery for HD and PIH were 5 hours and 7 hours, respectively (P &lt; .001). For HD, 6 patients required a second surgery and 3 required a third. One PIH patient required a second procedure. Postoperative shunting was required in 5 HD patients, but only 1 PIH patient. All patients had increased hemiparesis after surgery. The overall mean follow-up time was 72 months. Engel class I or II outcomes after initial surgery were better after PIH (85%) compared with HD (48%) (P &lt; .02). After subsequent surgeries for seizure control, 4 HD patients and 1 PIH patient improved to Engel class I or II. CONCLUSION: Hemispherectomy is an effective surgical procedure for childhood intractable catastrophic epilepsy. In patients with diffuse hemispheric disorder, PIH tends to have fewer major complications, more favorable seizure outcomes, and a decreased need for subsequent surgical procedures, including shunting for hydrocephalus, compared with HD.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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