scholarly journals A modified technique for nipple-areola complex reconstruction

2011 ◽  
Vol 44 (01) ◽  
pp. 076-080
Author(s):  
Shoeib A. Mohamed ◽  
Peir Camillo Parodi
Keyword(s):  
Patient Satisfaction ◽  
Nipple Reconstruction ◽  
Modified Technique ◽  
Composite Grafts ◽  
Areola Complex ◽  
Classical Technique ◽  
Minimal Complication ◽  
Implant Reconstruction ◽  
Reconstructed Breast

ABSTRACT Background: From a historical perspective, many techniques of nipple reconstruction have been performed, including a graft from the contralateral nipple, composite grafts such as toe pulp or earlobe tissue and even an intra-dermal tattoo alone. This is the final stage of breast reconstruction, and is carried out only when the surgeon is confident that acceptable symmetry and shape of the reconstructed breast has been achieved. The technical challenges of nipple reconstruction include correcting position, maintaining adequate projection and creating an inconspicuous scar. An alternative to a surgically reconstructed nipple is the use of silicone prosthetic nipples. Materials and Methods: From August 2006 until September 2007, 80 cases of nipple/areola reconstruction were performed in our department (UDINE UNIV.) following mammary reconstruction or conservative breast surgery. Forty cases were carried out with the classical technique and another 40 cases with the introduction of our modification in the form of deepithelization of a semicircular area of the adjacent skin at the base of the flap. Postoperative follow-up as regards the nipple size, site, projection, symmetry and donnar scar were assessed. Patient satisfaction was also addressed and evaluated. Results: There were good to excellent results as regards nipple size, symmetry and projection. The technique is suitable for different autologous and implant reconstruction. The technique is an outpatient procedure, is easy and is not consuming time. Areolar graft from the contra-lateral areola is colouur matching and shows nearly no deference from the opposite one. Conclusions: Simple technique and not time consuming. Maintains the consistency and projection of the new nipple. Patient satisfaction. Minimal complication.

scholarly journals Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 373-378 ◽  
Author(s):  
Zoran Radovanovic ◽  
Milan Ranisavljevic ◽  
Dragana Radovanovic ◽  
Ferenc Vicko ◽  
Tatjana Ivkovic-Kapicl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Complications ◽  
Late Complication ◽  
Oncological Outcome ◽  
Primary Implant ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Implant Reconstruction

Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m2, and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

Submucosal Anoderm-Preserving Hemorrhoidectomy Revisited: A Modified Technique for the Surgical Management of Hemorrhoidal Crisis

2013 ◽  
Vol 79 (11) ◽  
pp. 1191-1195
Author(s):  
George E. Theodoropoulos ◽  
Nikolaos V. Michalopoulos ◽  
Dimitrios Linardoutsos ◽  
Ioannis Flessas ◽  
Dimitrios Tsamis ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Morbidity ◽  
Mucosal Prolapse ◽  
Tissue Preservation ◽  
Modified Technique ◽  
Long Term Follow Up ◽  
Hemorrhoidal Crisis ◽  
High Degree

Submucosal hemorrhoidectomy (Parks’ procedure) is a recognized method for treating acute hemorrhoidal crisis. Anoderm preservation has been stressed in various techniques described for elective or emergency excisional hemorrhoidal management. Mucopexy techniques have been proven useful as an adjunct to minimally resectional techniques. A modified submucosal technique with anoderm preservation and mucopexy was applied to 45 patients who presented on an emergency basis with hemorrhoidal crisis. External piles were minimally removed, the minimum possible amount of diseased mucosa was excised, a linear incision was used at the anoderm to enter the subanodermal/mucosal plane to achieve the submucosal excision, and a mucopexy was added at the approximation of the mucosal flaps. Postoperative morbidity was minimal and pain after the procedure remained at acceptable levels. This technique allows for an excision limited to the pathology with important anatomic tissue preservation. This results in conservation of the sensitive and useful anoderm, a decreased risk of stenosis, and addresses the mucosal prolapse. The level of postoperative pain with this technique is acceptable and long-term follow-up reveals a high degree of patient satisfaction.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

Topping-off technique for stabilization of lumbar degenerative instabilities in 322 patients

2020 ◽  
Vol 32 (3) ◽  
pp. 366-372
Author(s):  
Sandro M. Krieg ◽  
Nele Balser ◽  
Haiko Pape ◽  
Nico Sollmann ◽  
Lucia Albers ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Interbody Fusion ◽  
Smooth Transition ◽  
Lumbar Pain ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Rod System ◽  
Reoperation Rates ◽  
Topping Off

OBJECTIVESemi-rigid instrumentation (SRI) was introduced to take advantage of the concept of load sharing in surgery for spinal stabilization. The authors investigated a topping-off technique in which interbody fusion is not performed in the uppermost motion segment, thus creating a smooth transition from stabilized to free motion segments. SRI using the topping-off technique also reduces the motion of the adjacent segments, which may reduce the risk of adjacent segment disease (ASD), a frequently observed sequela of instrumentation and fusion, but this technique may also increase the possibility of screw loosening (SL). In the present study the authors aimed to systematically evaluate reoperation rates, clinical outcomes, and potential risk factors and incidences of ASD and SL for this novel approach.METHODSThe authors collected data for the first 322 patients enrolled at their institution from 2009 to 2015 who underwent surgery performed using the topping-off technique. Reoperation rates, patient satisfaction, and other outcome measures were evaluated. All patients underwent pedicle screw–based semi-rigid stabilization of the lumbar spine with a polyetheretherketone (PEEK) rod system.RESULTSImplantation of PEEK rods during revision surgery was performed in 59.9% of patients. A median of 3 motion segments (range 1–5 segments) were included and a median of 2 motion segments (range 0–4 segments) were fused. A total of 89.4% of patients underwent fusion, 73.3% by transforaminal lumbar interbody fusion (TLIF), 18.4% by anterior lumbar interbody fusion (ALIF), 3.1% by extreme lateral interbody fusion (XLIF), 0.3% by oblique lumbar interbody fusion (OLIF), and 4.9% by combined approaches in the same surgery. Combined radicular and lumbar pain according to a visual analog scale was reduced from 7.9 ± 1.0 to 4.0 ± 3.1, with 56.2% of patients indicating benefit from surgery. After maximum follow-up (4.3 ± 1.8 years), the reoperation rate was 16.4%.CONCLUSIONSThe PEEK rod concept including the topping-off principle seems safe, with at least average patient satisfaction in this patient group. Considering the low rate of first-tier surgeries, the presented results seem at least comparable to those of most other series. Follow-up studies are needed to determine long-term outcomes, particularly with respect to ASD, which might be reduced by the presented approach.

scholarly journals Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

2021 ◽  
Author(s):  
Ciro Esposito ◽  
Ernesto Montaruli ◽  
Giuseppe Autorino ◽  
Mario Mendoza-Sagaon ◽  
Maria Escolino
Keyword(s):  
Patient Satisfaction ◽  
Laser Therapy ◽  
Pilonidal Sinus ◽  
Pediatric Population ◽  
Treatment Protocol ◽  
Pilonidal Sinus Disease ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clavien Grade

AbstractThis paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

scholarly journals Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110111
Author(s):  
Anthony J. Ignozzi ◽  
Zane Hyde ◽  
Scott E. Dart ◽  
David R. Diduch
Keyword(s):  
Patient Satisfaction ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Trochlear Groove ◽  
Thick Shell ◽  
Absorbable Sutures ◽  
Postoperative Dislocation ◽  
A Prospective Study ◽  
Patellar Stability

Background: Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty. Indications: Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination. Technique Description: The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur. Results: A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10. Discussion/Conclusion: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.

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