A minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions: Nose ring drainage technique

Pelvic leak points (PLP) may be responsible for vulvar, perineal and lower limb varicose veins, in women during and/or after pregnancy. The accurate anatomical and hemodynamic assessment of these points, the perineal (PP), inguinal (IP) and clitoral points (CP) and their surgical treatment under local anesthetics as defined by Claude Franceschi is a new therapeutic option. The aim of this study was to assess the reliability and durability of the PLP reflux ablation using a minimally-invasive surgical disconnection at the PLP level in women with varicose veins of the lower limbs fed by the PLP. In this open-label trial 273 pelvic leak points free of pelvic congestion syndrome, with at least a 12-month follow- up, were assessed. 273 PLP treated: PP (n=177), IP (n =91) and CP (n=5). Followup: Period =12 to 92 months (mean =30.51 months). Age from 29 to 77 years (mean=45). The only 3 patients over 70 years (71, 74, 77) showed a high-speed reflux from a I point that fed symptomatic varicose veins of the lower limb. Exclusion criteria: pelvic congestion syndrome, BMI>24, venous malformations, a post thrombotic varicose vein. Diagnosis was performed using echo duplex and PLPs selected for treatment when refluxing at Valsalva + Paraná + squeezing maneuvers. A surgical skin marking of the PLP had been performed using echo duplex before surgery. Surgery consisted of minimally invasive dissection and selective division and ligation with non-absorbable suture of the refluxing veins and fascias at the PP, IP and CP pelvic escape points, under local anesthesia in a single center. The follow-up consisted of an echo duplex ultrasound, searching for reflux at the PLP treated thanks to the Valsalva maneuver, within 2 weeks, after 6 and 12 months and then yearly. The main endpoint of the study was the immediate elimination of the reflux at the PLP treated. The second endpoint was the long-term durability of the reflux ablation at the PLP treated. 267 (97.8%) without PLP reflux redo. 6 (2.2%) PLP reflux recurrences (PP=4, IP=1, CP 1). 3 patients with PLP reflux recurrence undergo a redo surgery (1.1%) where PP=2 (0.7%) and IP=1 (0.3%). This study shows the feasibility and durability of reflux ablation at the PLP level thanks to a minimally-invasive surgical treatment of the PLP and it demonstrates that there is no need for pelvic varicose embolization in patients without clinical signs of pelvic congestion syndrome. The accurate ultrasound assessment of each specific pelvic leak as well as a special surgical technique (vein division, non-absorbable suture of veins and fascias) seems to be the key for satisfactory outcomes.

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MIPO For Complex Comminuted Bone Fractures in the Floating Knee IIC According Fraser: a Case Report

10.21203/rs.3.rs-841367/v1 ◽

2021 ◽

Author(s):

Chuangang Peng ◽

Guangkai Ren ◽

Minghan Dou ◽

Baoming Yuan ◽

Dankai Wu

Keyword(s):

Minimally Invasive ◽

Lower Limb ◽

Bone Structure ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Full Weight Bearing ◽

Minimally Invasive Plate Osteosynthesis ◽

Intraarticular Fracture ◽

Limited Mobility

Abstract Objective:Floating knee type IIC according to Fraser’s classification is an uncommon severe injury that typically occurs in polytrauma. In this case, mainly due to both intraarticular fracture and the high degree of comminution and malformation on the femoral mid-distal segments, fixation was challenging. The purpose of this study was to prove that minimally invasive plate osteosynthesis (MIPO) technology can simplify complex problems and improve prognosis. Case Presentation:A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly on the anterior aspect of the mid-distal thigh. Physical examination and lower limb computed tomography angiography (CTA) confirmed that the neurovascular status was normal. The clinical diagnosis were closed intraarticular fracture of the proximal tibia, open intraarticular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee.In this case, a locking plate system characterized by minimally invasive plate osteosynthesis (MIPO) technology was used as the treatment. Results and Conclusion:Postoperative evolution was satisfactory, with immediate functional exercise, full weight bearing after three months, and return to daily activity without pain. Final follow-up taken at 3 years showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.

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Foam sclerotherapy

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515589536 ◽

2015 ◽

Vol 30 (2_suppl) ◽

pp. 18-23 ◽

Cited By ~ 10

Author(s):

Glen Alder ◽

Tim Lees

Keyword(s):

Minimally Invasive ◽

Lower Limb ◽

Varicose Veins ◽

Current Evidence ◽

Clinical Consequence ◽

Complication Rates ◽

Foam Sclerotherapy ◽

Invasive Treatment ◽

Nice Guidelines ◽

Endovenous Ablation

Foam sclerotherapy is a minimally invasive treatment for lower limb varicose veins. Current evidence indicates that its efficacy may not be as high as surgery or endovenous ablation. The minimally invasive nature of the treatment however means that it has a wide application, and it can be particularly useful in patients who are not suitable for other types of treatment. NICE guidelines recommend its use as a second line after endovenous ablation. Complication rates are low and most of these are of little clinical consequence.

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Chronic Knee and Ankle Pain Treatment through Selective Microsurgical Approaches: A Minimally Invasive Option in the Treatment Algorithm for Refractory Lower Limb Pain

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1717100 ◽

2020 ◽

Author(s):

Giorgio Pietramaggiori ◽

Gianluca Sapino ◽

Giorgio De Santis ◽

Franco Bassetto ◽

Saja Scherer

Keyword(s):

Chronic Pain ◽

Minimally Invasive ◽

Peripheral Nerve ◽

Lower Limb ◽

Treatment Algorithm ◽

Ankle Pain ◽

Limb Pain ◽

Lower Limb Pain ◽

Significant Difference ◽

Nerve Surgery

Abstract Background Injury or compression of a sensory nerve is an under-reported source of disabling pain in the lower limb. It is known that peripheral nerve microsurgeons can reconstruct and rewire injured nerves to relieve chronic pain but this option remains not completely understood and ignored by most orthopaedic surgeons, neurologists, and pain therapists. In this paper, we describe our experience with knee and ankle peripheral nerve surgery to improve the condition of patients suffering from chronic, posttraumatic lower limb pain. Patients and Methods Between 2015 and 2018, a retrospective investigation was performed including patients who underwent ankle and knee nerve surgery for posttraumatic chronic pain with at least 1 year of follow-up. Previous surgeries or type of trauma, pain location and characteristics, type of operation (reconstruction, decompression, or denervation), and number of nerves operated were listed. Selective neuropathy was confirmed by ultrasound-guided nerve blocks. Outcome was assessed combining the visual analogue scale (VAS) score at rest and during movement, functional indexes, drug use, and ability to work. Results A total of 34 patients (14 knee and 20 ankle) were included in this study. A statistically significant difference (p < 0.05%) in postoperative pain at rest and during activity was seen in both groups of patients. Good to excellent outcomes were recorded in 92 and 80% of patients treated, respectively, at the knee and the ankle levels. No major complications occurred, while a secondary procedure due to neuroma recurrence was necessary in seven patients (three knees and four ankles). Conclusion Peripheral nerve microsurgery is a useful and minimally invasive tool to be added in the algorithm of treatment of chronic knee and ankle pain. Physicians should be trained to suspect a neuropathic origin of pain in absence of musculoskeletal signs of pathology, especially following trauma or surgeries.

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A New Venous Drainage Technique in Minimally Invasive Redo Tricuspid Surgery: Vacuum-Assist Venous Drainage via a Single Femoral Venous Cannula

Heart Lung and Circulation ◽

10.1016/j.hlc.2016.06.1219 ◽

2017 ◽

Vol 26 (2) ◽

pp. 201-204 ◽

Cited By ~ 5

Author(s):

Runsheng Peng ◽

Jun Ba ◽

Chunsheng Wang ◽

Hao Lai ◽

Kejian Hu ◽

...

Keyword(s):

Minimally Invasive ◽

Venous Drainage ◽

Venous Cannula ◽

Drainage Technique

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Ultrasound-guided foam sclerotherapy for severe chronic venous insufficiency

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912017005014 ◽

2017 ◽

Vol 44 (5) ◽

pp. 511-520 ◽

Cited By ~ 3

Author(s):

Guilherme Camargo Gonçalves de-Abreu ◽

Otacílio de Camargo Júnior ◽

Márcia Fayad Marcondes de-Abreu ◽

José Luís Braga de-Aquino

Keyword(s):

Minimally Invasive ◽

Lower Limb ◽

Chronic Venous Insufficiency ◽

Thermal Ablation ◽

Venous Insufficiency ◽

Varicose Veins ◽

Venous Hypertension ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

New Techniques

ABSTRACT Chronic venous insufficiency is characterized by cutaneous alterations caused by venous hypertension; in severe forms, it progresses to lower limb ulcers. Lower limb varicose veins are the main cause of chronic venous insufficiency, and the classic treatment includes surgery and compressive therapy. Minimally invasive alternative treatments for varicose veins include new techniques such as venous thermal ablation using laser or radiofrequency. The use of different methods depends on clinical and anatomical factors. Ultrasound-guided foam sclerotherapy is the venous injection of sclerosing foam controlled by Doppler ultrasound. Sclerotherapy is very useful to treat varicose veins, and probably, is cheaper than other methods. However, until the present, it is the less studied method.

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