scholarly journals The Revolving Door Flap: Revisiting an Elegant but Forgotten Flap for Ear Defect Reconstruction

2020 ◽  
Vol 53 (01) ◽  
pp. 064-070
Author(s):  
Anupam Golash ◽  
Sudipta Bera ◽  
Aditya V. Kanoi ◽  
Abhijit Golash
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Donor Site ◽  
Case Series ◽  
Senior Author ◽  
Revolving Door ◽  
Harvest Technique ◽  
Flap Design ◽  
Mean Dimension ◽  
The Mean

Abstract Background The revolving door flap, although well described in the literature, is not widely used in general plastic surgery practice. The flap has been used for anterior auricular and conchal defects and is considered elegant for its unique flap design and peculiarity of flap harvest. However, due to its use for a very specific purpose and unique flap harvest technique that may be difficult to grasp, the flap is not very popular in reconstructive practice. Objectives This study aims to evaluate the understanding and learning curve of the revolving door flap, assess surgical outcome, and reemphasize its utility and elegance in reconstruction of ear defects. Methodology This is a case series of nine surgeries performed between January 2014 and 2018. Three cases were performed by the senior author and six cases by two junior authors. Patients were observed for complications and aesthetic outcomes. Results The mean dimension of the flaps was 27.22 mm × 22.78 mm. The mean operative time was 56.56 minutes (standard deviation 22.50, standard error of the mean 7.5). Flap congestion was noted in three cases postoperatively which resolved completely by the second week. Major “pinning” of the ear was noted in four cases. Conclusion Though infrequently performed, the revolving door flap has an easy learning curve once the proper harvest technique and flap movement has been grasped. The flap harvest is convenient, safe, and yields predictable results. Not only is total or partial flap loss extremely rare, the flap is sensate, color match is good, auricular contour is maintained, and the donor site can be closed primarily and remains well hidden.

scholarly journals Radical prostatectomy outcomes in renal transplant recipients: a retrospective case series of Thai patients

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kun Sirisopana ◽  
Pocharapong Jenjitranant ◽  
Premsant Sangkum ◽  
Kittinut Kijvikai ◽  
Suthep Pacharatakul ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Renal Transplant ◽  
Operative Time ◽  
Case Series ◽  
Urinary Continence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background The incidence of prostate cancer in renal transplant recipients (RTR) is similar to the general population. Radical prostatectomy (RP) is the standard of care in the management of clinically localized cancer, but is considered complicated due to the presence of adhesions, and the location of transplanted ureter/kidney. To date, a few case series or studies on RP in RTR have been published, especially in Asian patients. This study aimed to evaluate the efficacy and safety and report the experience with RP on RTR. Methods We retrospectively reviewed data of 1270 patients who underwent RP from January 2008 to March 2020, of which 5 patients were RTR. All available baseline characteristics, perioperative and postoperative data (operative time, estimated blood loss (EBL), complications, length of hospital stay, complication), pathological stage, Gleason score, surgical margin status, and pre/postoperative creatinine were reviewed. Results Of the 5 RTR who underwent RPs (1 open radical prostatectomy (ORP), 1 laparoscopic radical prostatectomy (LRP), 2 robotic-assisted laparoscopic radical prostatectomies (RALRP), and 1 Retzius-sparing RALRP (RS-RALRP)) prostatectomy, the mean age (± SD) was 70 (± 5.62) years. In LRP and RALRP cases, the standard ports were moved slightly medially to prevent graft injury. The mean operative time ranged from 190 to 365 min. The longest operative time and highest EBL (630 ml) was the ORP case due to severe adhesion in Retzius space. For LRP and RALRP cases, the operative times seemed comparable and had EBL of ≤ 300 ml. All RPs were successful without any major intra-operative complication. There was no significant change in graft function. The restorations of urinary continence were within 1 month in RS-RALRP, approximately 6 months in RALRP, and about 1 year in ORP and LRP. Three patients with positive surgical margins had prostate-specific antigen (PSA) persistence at the first follow-up and 1 had later PSA recurrence. Two patients with negative margins were free from biochemical recurrence at 47 and 3 months after their RP. Conclusions Our series suggested that all RP techniques are safe and feasible mode of treatment for localized prostate cancer in RTR.

Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

2021 ◽  
Author(s):  
Jourdain D. Artz ◽  
Elisa K. Atamian ◽  
Clairissa Mulloy ◽  
Mark W. Stalder ◽  
Jamie Zampell ◽  
...  
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Imaging Study ◽  
Vessel Diameter ◽  
Pubic Tubercle ◽  
Computed Tomographic ◽  
Flap Design ◽  
Preoperative Magnetic Resonance ◽  
The Mean ◽  
Artery Perforator

Abstract Introduction While the originally described transverse profunda artery perforator (tPAP) flap is designed to capture the first profunda perforator, our group hypothesized the dominant perforator may not always be captured in this configuration. This study maps the location of dominant profunda perforators using imaging and cadaveric dissections to determine the probability of capturing dominant perforators with the transverse flap design versus the vertical PAP (vPAP) variant. Methods Fifty preoperative magnetic resonance angiogram or computed tomographic angiogram scans (100 total extremities) were examined from autologous breast reconstruction patients between 2015 and 2019. Profunda perforator characteristics that were examined included the distance from the pubic tubercle to the infragluteal fold (IGF), the distance of the perforators from the IGF, distance posterior to the gracilis, the diameter of the perforator at fascial exit, and total number of perforators present. Profunda perforator dissection was performed in 18 cadaveric extremities. Analysis included mean distance from pubic tubercle, distance posterior to the gracilis, diameter at fascial exit, and total number of perforators. Results In imaging analysis, the mean distance from the IGF to the fascial exit of all dominant perforators was 7.04 cm. The mean diameter of the dominant perforator at the fascial exit was 2.61 mm. Twenty-six thighs (26%) demonstrated dominant perforators that exited the fascia greater than 8 cm below the IGF. In cadaver dissections, the mean distance from the pubic tubercle to the fascial exit of all the dominant perforators was 10.17 cm. Nine cadaver specimens (50%) demonstrated perforators that exited the fascia greater than 8 cm below the estimated IGF. Conclusion The dominant perforator can often be missed in the traditional tPAP design. The vPAP incorporates multiple perforators with a long pedicle, excellent vessel diameter, and favorable donor-site.

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

2020 ◽  
Vol 134 (10) ◽  
pp. 875-881
Author(s):  
I D Erbele ◽  
M R Fink ◽  
G Mankekar ◽  
L S Son ◽  
R Mehta ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Senior Author ◽  
Retrospective Case ◽  
Closure Rate ◽  
Hearing Results ◽  
Middle Ear Cholesteatoma ◽  
Cartilage Tympanoplasty ◽  
The Mean ◽  
Clinically Significant

AbstractObjectiveThis study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications.MethodThis was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained.ResultsSixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3–71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4–9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring.ConclusionOver-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

2014 ◽  
Vol 151 (5) ◽  
pp. 791-796 ◽  
Author(s):  
Honda Hsu ◽  
Peir-Rong Chen ◽  
Sou-Hsin Chien ◽  
Jiunn-Tat Lee
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Tertiary Care ◽  
Case Series ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Recipient Site ◽  
The Mean

Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

scholarly journals Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series

2021 ◽  
Vol 10 (20) ◽  
pp. 4749
Author(s):  
Dvir Benshabat ◽  
Shai Factor ◽  
Eran Maman ◽  
Amal Khoury ◽  
Raphael Krespi ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Iliac Crest ◽  
Bone Marrow Aspirate ◽  
Donor Site ◽  
Clavicle Fracture ◽  
Case Series ◽  
Fracture Union ◽  
Retrospective Case ◽  
Fracture Nonunion ◽  
The Mean

Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pain related to the iliac crest donor site. Supplementary BMAC to ORIF in the treatment of clavicle fracture nonunion is a safe method, resulting in high rates of fracture union and good functional outcomes with minimal complications and pain.

scholarly journals Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

2021 ◽  
Vol 8 (1) ◽  
pp. 30-37
Author(s):  
Narottama Tunjung ◽  
Nandita Melati Putri
Keyword(s):  
Retrospective Study ◽  
Operative Time ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complete Healing ◽  
Type Iv ◽  
Pressure Injury ◽  
The Mean ◽  
The Right ◽  
Thorough Debridement

Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

scholarly journals Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Kazumi Goto ◽  
Yozo Katsuragawa ◽  
Yoshinari Miyamoto
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Operative Time ◽  
Case Series ◽  
Level Of Evidence ◽  
Ankle Angle ◽  
Total Knee ◽  
The Mean ◽  
Hip Knee Ankle Angle

Abstract Purpose There are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes. Materials and methods Nineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip–knee–ankle angle, and femoral and tibial component angle were evaluated. Results The mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2° in group S and 114.2° in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip–knee–ankle angle, femoral component angle, or tibial component angle were observed. Conclusions Although operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed. Level of evidence IV (retrospective case series design).

scholarly journals Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880824 ◽  
Author(s):  
Clara Isabel de Campos Azevedo ◽  
Ana Catarina Leiria Pires Gago Ângelo ◽  
Susana Vinga
Keyword(s):  
Minimally Invasive ◽  
Donor Site ◽  
Case Series ◽  
Donor Site Morbidity ◽  
Fascia Lata ◽  
Rotator Cuff Tears ◽  
Shoulder Abduction ◽  
Open Approach ◽  
Superior Capsular Reconstruction ◽  
The Mean

Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity have discouraged surgeons from using this type of graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6 years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3; Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14 patients) underwent ASCR using a minimally invasive harvested fascia lata autograft. All patients completed preoperative and 6-month evaluations consisting of the Simple Shoulder Test (SST), subjective shoulder value (SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval (AHI), and magnetic resonance imaging. Twenty-one patients completed the 2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly ( P < .001): elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ± 31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months) and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0° ± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from 1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2 years). The mean functional shoulder scores improved significantly ( P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6 months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6 months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6 months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength improved significantly ( P < .001) from 0.0 to 1.1 ± 1.4 kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ± 3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years). This 0.7 ± 1.5–mm overall decrease was statistically significant ( P = .042). At 6 months, 20 of 22 patients (90.9%) had no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%) considered that the shoulder surgery’s end result compensated for the thigh’s changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.

Three-Hand Endoscopic Endonasal Transsphenoidal Surgery: Experience With an Anatomy-Preserving Mononostril Approach Technique

2017 ◽  
Vol 14 (2) ◽  
pp. 158-165 ◽  
Author(s):  
Chikezie I Eseonu ◽  
Karim ReFaey ◽  
Eva Pamias-Portalatin ◽  
Javier Asensio ◽  
Oscar Garcia ◽  
...  
Keyword(s):  
Learning Curve ◽  
Transsphenoidal Surgery ◽  
Operative Time ◽  
Surgical Techniques ◽  
Case Series ◽  
Postoperative Outcomes ◽  
Perioperative Outcomes ◽  
Early Group ◽  
Endoscopic Endonasal ◽  
Late Group

Abstract BACKGROUND Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. OBJECTIVE To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. METHODS Prospective case series and retrospective data analysis of patients who were treated with the 3-hand transsphenoidal technique between January 2007 and May 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. RESULTS Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3 min, P = .001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P = .846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. CONCLUSION We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized.

scholarly journals Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review

2015 ◽  
Vol 8 (3) ◽  
pp. 179-189 ◽  
Author(s):  
Michael Sosin ◽  
Arif Chaudhry ◽  
Carla De La Cruz ◽  
Branko Bojovic ◽  
Paul N. Manson ◽  
...  
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
The Elderly ◽  
Lessons Learned ◽  
Soft Tissue Coverage ◽  
Scalp Reconstruction ◽  
Tissue Transfer ◽  
The Mean

This article aims to demonstrate an individualized approach to an elderly patient requiring scalp reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of scalp reconstruction (E. D. R.) using free tissue transfer from 2005 to 2011, in patients older than 70 years, was completed. A total of eight patients met the inclusion criteria, five males and three females, with a mean age of 80.4 years (range, 73–92). Free tissue transfer achieved 100% soft tissue coverage. Six of the eight patients required cranioplasty. The mean size calvarial defect was 92 cm2 (range, 35–285 cm2). The mean flap size was 117.6 cm2 (range, 42–285 cm2). Free flaps included three ulnar, three anterolateral thigh, one latissimus dorsi, and one thoracodorsal perforator flap. The mean follow-up time was 18.4 months (range, 3–46 months). Donor site morbidity was minimal. Mortality was 0%. Immediate flap failure was 0%. Other complications occurred in six of the eight patients. Mean revisionary procedures were 1.25 procedures per patient. It was concluded that chronological age does not increase mortality or catastrophic flap complications; however, morbidity is increased in the elderly and revisionary surgery is likely.

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