Surgical correction of coarctation in early infancy: Does surgical technique influence the result?

Object Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly. Methods The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction. Results The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case). Conclusions Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.

Download Full-text

Evaluation of the Surgical Treatment for Congenital Blepharoptosis Using Mustarde’s Modified Method

Polish Journal of Surgery ◽

10.1515/pjs-2016-0044 ◽

2016 ◽

Vol 88 (3) ◽

Author(s):

Aleksandra Iljin ◽

Andrzej Zieliński ◽

Edward Lewandowicz ◽

Bogusław Antoszewski ◽

Tomasz Zieliński

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Surgical Technique ◽

Surgical Correction ◽

Small Range ◽

Modified Method ◽

Aesthetic Results ◽

Low Rate

AbstractThe aim of the study was evaluation of the results of surgical treatment of congenital blepharoptosis (CBP) using Mustarde’s modified method.Material and methods. Between 2005-2014 forty eight children with CBP underwent surgical correction of CBP by Mustarde’s modified method. Basing on the results of ophthalmic and orthoptic examination, and standard measurements, we estimated postoperative difference in the position and symmetry of the upper eyelids, and postoperative complications in our patients.Results. Very good results were obtained in all cases with mild, in 89.5% with moderate, and in 85.7% with severe unilateral CBP after correction by Mustarde’s modified method. Lagophthalmos was seen in 6.25%, and undercorrection in 12.5% of cases.Conclusions. 1. Mustarde’s modified method allows for obtaining very good functional and aesthetic results in CBP patients. 2. Mustarde’s modified method is a valuable supplemental surgical technique in CBP, and contributes to a low rate and small range of lagophthalmos.

Download Full-text

Congenital Megaprepuce: Literature Review and Surgical Correction

Case Reports in Urology ◽

10.1155/2019/4584609 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Zachary Werner ◽

Ali Hajiran ◽

Osama Al-Omar

Keyword(s):

Surgical Technique ◽

Literature Review ◽

Surgical Correction ◽

Positive Outcomes ◽

Wide Range ◽

Buried Penis ◽

Aged Eleven

Congenital megaprepuce (CMP) is a type of buried penis characterized by extensive redundancy and ballooning of the inner prepuce as a result of preputial stenosis and phimosis. The malformation typically presents with difficulty voiding, often requiring manual expression of stagnant urine. Multiple techniques have been reported for the treatment of CMP with varying levels of positive outcomes. The authors provide a review of published literature, in addition to describing the procedure and results of our surgical technique in three children aged eleven months, two years, and twelve years. The literature review was conducted using PubMed with keywords “congenital megaprepuce,” “megaprepuce,” “buried penis,” “CMP,” and “correction.” Results were then differentiated based on presence or absence of true congenital megaprepuce and the surgical correction thereof. Regarding our cases, all patients completed the procedure with excellent cosmesis and without complication. Our technique is shown to provide consistent, excellent esthetic outcome across a wide range of ages and may be replicated by others.

Download Full-text

Neurovascular Complications of Knee Arthroscopy

The American Journal of Sports Medicine ◽

10.1177/03635465020300042501 ◽

2002 ◽

Vol 30 (4) ◽

pp. 619-629 ◽

Cited By ~ 72

Author(s):

Tae Kyun Kim ◽

Richard M. Savino ◽

Edward G. McFarland ◽

Andrew J. Cosgarea

Keyword(s):

Surgical Technique ◽

Knee Joint ◽

Minimally Invasive ◽

Knee Arthroscopy ◽

Invasive Procedure ◽

Surgical Correction ◽

Minimally Invasive Procedure ◽

Intraoperative Planning ◽

Neurovascular Anatomy ◽

Arthroscopic Procedures

During the last 3 decades, arthroscopy has revolutionized the way knee surgery is performed. The indications and the applications of arthroscopic procedures in the knee joint have enormously increased with the improvement in surgical technique and advent of new arthroscopic equipment. The use of arthroscopic techniques has led to a significant decrease in morbidity for the patient with intraarticular abnormalities, in terms of both diagnosis and surgical correction. Even though knee arthroscopy is a minimally invasive procedure with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. The reported incidence of neurovascular complication is low, but it may be underestimated. Many neurovascular complications that occur are preventable with a thorough understanding of neurovascular anatomy, good preoperative and intraoperative planning, and attention to the details of basic techniques and the equipment used for the procedure. It is imperative that the surgeon who is performing arthroscopy be aware of these neurovascular complications, recognize them as early as possible, and initiate further evaluation and treatment as expeditiously as possible. In this article, the causes, management, prevention, and medicolegal implications of neurovascular complications of knee arthroscopy are reviewed.

Download Full-text

Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

Sao Paulo Medical Journal ◽

10.1590/s1516-31801996000600004 ◽

1996 ◽

Vol 114 (6) ◽

pp. 1303-1308

Author(s):

José Luiz Martins ◽

José Pinus

Keyword(s):

Surgical Technique ◽

Fecal Incontinence ◽

Anorectal Manometry ◽

Anorectal Malformations ◽

Fecal Continence ◽

Surgical Correction ◽

Postoperative Evaluation ◽

The Relationship

PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.

Download Full-text

Catheter Break-in for Continuous Ambulatory Peritoneal Dialysisuniversity of Missouri Experience

Peritoneal Dialysis International ◽

10.1177/089686088400402s11 ◽

1984 ◽

Vol 4 (2_suppl) ◽

pp. 110-111 ◽

Cited By ~ 2

Author(s):

J. Zbylut ◽

Twardowski Leonor ◽

P. Ryan ◽

Juanita M. Kennedy

Keyword(s):

Peritoneal Dialysis ◽

Surgical Technique ◽

Retrospective Analysis ◽

Outpatient Clinic ◽

Small Volume ◽

Catheter Insertion ◽

Surgical Correction ◽

Tenckhoff Catheter ◽

Uremic Patients ◽

Clinic Visits

Retrospective analysis of the results of several break-in techniques in our institution revealed that a 10 day delay in CAPD initiation after a midline Tenckhoff catheter insertion is sufficient to prevent leakage in patients maintained on intermittent peritoneal dialysis. A leak or obstruction related to an insufficient surgical technique can be promptly diagnosed and corrected. An irrigation technique seems to be useful in non-uremic patients, but frequently fails to disclose a one-way obstruction with a consequent delay in a surgical correction. Recently we have introduced a modification of this technique in which the patency of the catheter is checked with one in and out exchange using a small volume of dialysate during outpatient clinic visits every 2– 3 days.

Download Full-text

Features of Surgical Treatment of Posttraumatic Lower Limbs of Different Lengths in Adult Patients

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-4-573-579 ◽

2021 ◽

Vol 9 (4) ◽

pp. 573-579

Author(s):

A. A. Artemiev ◽

A. N. Ivashkin ◽

A. M. Kashoob ◽

Yu. S. Solovyov ◽

G. G. Gululyan

Keyword(s):

Surgical Technique ◽

Negative Impact ◽

Lower Extremities ◽

Lower Leg ◽

Surgical Correction ◽

Lower Limbs ◽

Ilizarov Method ◽

Main Method ◽

Mechanisms Of Adaptation ◽

Post Traumatic

Relevance. Different lengths of the lower extremities have a negative impact on the position of the pelvis and spine and lead to secondary deformities. To prevent these consequences, early surgical correction of the shortening is necessary.Aim of study. Study of the features of post-traumatic shortening of the lower extremities, mechanisms of adaptation to this condition and, on the basis of this, optimization of surgical technique when performing reconstructive and restorative operations.Material and methods. A total of 276 patients with posttraumatic shortening of the lower extremities were examined, 102 of whom were operated on. Comparative radiography of both legs was used to diagnose different lengths. The Ilizarov method was used as the main method of surgical correction.Results. We studied the mechanisms of adaptation of patients to post-traumatic shortening of the hip and lower leg and optimized surgical technique. A method was developed for determining the optimal elongation value.Conclusion. The most effective and least traumatic method is external osteosynthesis according to Ilizarov. Distraction in the apparatus allows the formation of a regenerate of the required shape and length and the elongation of exactly the amount that is optimal for a given patient.

Download Full-text