Biomechanical Nasal Anatomy Applied to Open Preservation Rhinoplasty

2021 ◽  
Author(s):  
Abdulkadir Goksel ◽  
Yves Saban ◽  
Khanh Ngoc Tran
Keyword(s):  
Soft Tissue ◽  
Functional Result ◽  
Open Approach ◽  
Anatomical Structures ◽  
Surgical Safety ◽  
Soft Tissue Envelope ◽  
Nasal Anatomy ◽  
Tip Plasty ◽  
Safety Knowledge ◽  
Preservation Technique

AbstractPreservation rhinoplasty is a new way to reshape the nose by preserving the dorsum, nasal ligaments, soft tissue envelope, and muscles. This new concept provides the opportunity to achieve a more natural aesthetic and functional result. To achieve a good aesthetic and functional outcome while maintaining surgical safety, knowledge of the relevant anatomy is key. This is especially true for the preservation rhinoplasty technique, where a firm grasp of the anatomy of the nasal soft tissue and bony–cartilaginous framework is critical. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose and the dorsum. Furthermore, tip plasty is easier to perform under direct vision, which is an advantage of the open approach. The goal of this article is therefore to make clear all the important anatomical structures and their relevance to the surgical steps taken when performing the open preservation rhinoplasty technique.

Comprehensive Diagnosis and Planning for the Difficult Rhinoplasty Patient: Applications in Ultrasonography and Treatment of the Soft-Tissue Envelope

2017 ◽  
Vol 33 (05) ◽  
pp. 509-518 ◽  
Author(s):  
Aaron Kosins
Keyword(s):  
Soft Tissue ◽  
Preoperative Planning ◽  
Early History ◽  
Diagnosis And Treatment ◽  
Open Approach ◽  
Secondary Surgery ◽  
Soft Tissue Envelope ◽  
Comprehensive Diagnosis ◽  
History Of ◽  
Closed Approach

AbstractRhinoplasty is one of the most complicated operations that a plastic surgeon will encounter. In the early history of rhinoplasty, operations were done with a closed approach, and the structures were shrouded in mystery while surgeons relied on surface aesthetics for diagnosis and treatment. Finally, with the advent of the extended open approach, power tools, and piezosurgery, the whole bony pyramid can be directly visualized, shaped, and sculpted. Osteotomies can be done under direct vision with high precision. Using this approach, every part of the osseocartilaginous vault and nasal tip can now be directly observed, diagnosed, and surgically treated. However, this only occurs once the patient is in the operating room. This article will detail the diagnosis and treatment of the difficult soft-tissue envelope of the nose. It will also describe the use of ultrasonography for preoperative planning as well as postoperatively for diagnosis and treatment during the healing period and for planning possible revision and secondary surgery.

scholarly journals Differences in soft tissue damage using a percutaneous versus open approach for antegrade straight humeral nailing: a quantitative and qualitative anatomical study

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110105
Author(s):  
Christian Fang ◽  
Dennis KH Yee ◽  
Tak Man Wong ◽  
Evan Fang ◽  
Terence Pun ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Humeral Head ◽  
External Rotation ◽  
Biceps Tendon ◽  
Anatomical Study ◽  
Percutaneous Technique ◽  
Open Approach ◽  
Entry Site ◽  
Intramedullary Canal ◽  
Percutaneous Insertion

Background: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. Materials and Methods: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. Results: The percutaneous technique produced greater latitudinal tearing ( p = 0.002) and less longitudinal tearing ( p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area ( p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. Conclusions: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.

Late Stage Decomposition of Embalmed Cadavers

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Pilar Mata Tutor ◽  
Catherine Villoria Rojas ◽  
María Benito Sánchez
Keyword(s):  
Soft Tissue ◽  
Late Stage ◽  
Good Condition ◽  
Experimental Studies ◽  
The Body ◽  
Health Law ◽  
External Appearance ◽  
Intrinsic Factors ◽  
Preservation Technique ◽  
Extrinsic And Intrinsic Factors

Decomposition is a natural process that begins approximately four minutes after death and continues until the body is degraded to simpler biochemical components which are gradually recycled back to the environment. This process is dependent on extrinsic and intrinsic factors. Embalming is a chemical preservation technique that aims to preserve the external appearance of the body in good condition for an indeterminate period. In Spain, there is a lack of experimental studies carried out to analyse the variables that affect decomposition in embalmed bodies, therefore, in accordance with the conclusions reached by previous authors, it is hypothesised that embalmed bodies show quantifiable characteristics during the late stage decomposition which distinguish them from control, unembalmed, cadavers. An anthropological and statistical analysis was performed on 14 individuals from Cementerio Sur de Madrid exhumed after ten years according to the Mortuary Health Law of the Autonomous Region of Madrid. The preliminary results obtained showed that there is a qualitative and statistically significant relationship between the variables evaluated, being the presence or absence of soft tissue the most notable difference. The mortuary or thanatopraxy treatments performed before the burial and the microenvironmental conditions of the burial positively influence the soft tissue preservation on embalmed bodies. These results contribute to the understanding about the decomposition rate of an embalmed cadavers in cemeteries, and the related extrinsic variables.

Rare case of angiofibroma presenting as perineal hernia

2021 ◽  
Vol 14 (1) ◽  
pp. e236661
Author(s):  
Ruchika Kumari ◽  
Cherring Tandup ◽  
Ambuj Agarwal ◽  
Anish Chowdhury
Keyword(s):  
Soft Tissue ◽  
Case Reports ◽  
En Bloc Resection ◽  
Perineal Hernia ◽  
Pathological Examination ◽  
Soft Tissue Tumour ◽  
Open Approach ◽  
En Bloc ◽  
Rare Tumour ◽  
Tissue Tumour

Angiofibroma is a benign soft tissue tumour presenting as a gradually progressive swelling in the vulvovaginal area in women and in the inguinoscrotal region in men. Being a rare tumour, there are only a few case reports in the literature, and among them, presentation as perineal herniation is very rare. En bloc resection of angiofibroma either via laparoscopic or open approach is the choice of treatment to avoid recurrence. Detailed pathological examination and immunohistochemistry workup are imperative to distinguish it from various mesenchymal tumours. Perineal hernia is itself rare and may occur spontaneously or following abdominoperineal resection, sacrectomy or pelvic exenteration. Surgical repair via open transabdominal and transperineal approaches has been described. Here, we report a case of a young woman who presented with spontaneous reducible perineal hernia with a soft tissue tumour as its content, which on histopathological investigation was found to be an angiofibroma.

Reconstruction of Large Palmar Defects of the Hand Using Free Flaps

1997 ◽  
Vol 22 (5) ◽  
pp. 623-630 ◽  
Author(s):  
M. M. NINKOVÍC ◽  
A. H. SCHWABEGGER ◽  
G. WECHSELBERGER ◽  
H. ANDERL
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Subcutaneous Tissue ◽  
Free Flaps ◽  
Difficult Problem ◽  
Glabrous Skin ◽  
Soft Tissue Reconstruction ◽  
Anatomical Structures ◽  
Tissue Reconstruction ◽  
Restoration Of Sensibility

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.

scholarly journals Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
In Vitro Study ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Iliotibial Band ◽  
Soft Tissue Envelope ◽  
Medial Side ◽  
Fresh Frozen

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.

scholarly journals What is a balanced knee replacement?

2018 ◽  
Vol 3 (12) ◽  
pp. 614-619 ◽  
Author(s):  
Lucy C. Walker ◽  
Nick D. Clement ◽  
Kanishka M. Ghosh ◽  
David J. Deehan
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Current Evidence ◽  
Soft Tissue Envelope ◽  
Total Knee ◽  
Uneven Wear ◽  
Definition Of ◽  
Revision Tka

For multifactorial reasons an estimated 20% of patients remain unsatisfied after total knee arthroplasty (TKA). Appropriate tension of the soft tissue envelope encompassing the knee is important in total knee arthroplasty and soft tissue imbalance contributes to several of the foremost reasons for revision TKA, including instability, stiffness and aseptic loosening. There is debate in the literature surrounding the optimum way to achieve balancing of a total knee arthroplasty and there is also a lack of an accepted definition of what a balanced knee replacement is. It may be intuitive to use the native knee as a model for balancing; however, there are many difficulties with translating this into a successful prosthesis. One of the foundations of TKA, as described by Insall, was that although the native knee has more weight transmitted through the medial compartment this was to be avoided in a TKA as it would lead to uneven wear and early failure. There is a focus on achieving symmetrical tension and pressure and subsequent ‘balance’ in TKA, but the evidence from cadaveric studies is that the native knee is not symmetrically balanced. As we are currently trying to design an implant that is not based on its anatomical counterpart, is it possible to create a truly balanced prosthesis or to even to define what that balance is? The authors have reviewed the current evidence surrounding TKA balancing and its relationship with the native knee. Cite this article: EFORT Open Rev 2018;3:614-619. DOI: 10.1302/2058-5241.3.180008.

scholarly journals Soft Tissue Sarcomas of Extremities - MRI Role in the Diagnostic Evaluation

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 45
Author(s):  
A.M. Bratu ◽  
I.A. Sălcianu ◽  
C. Zaharia ◽  
G. Iana ◽  
A.N. Marinescu
Keyword(s):  
Soft Tissue ◽  
Malignant Tumors ◽  
Soft Tissue Sarcomas ◽  
Oblique Muscle ◽  
Special Importance ◽  
Fatty Tissue ◽  
Anatomical Structures ◽  
Bony Pelvis ◽  
Female Predominance ◽  
The Relationship

Abstract Introduction. Soft tissue sarcomas (STS) are rare entities of soft tissue cancers. Their incidence is low, of only 1% of the malignant tumors. In terms of localization, most of the STS affect the extremities, and their incidence is much higher in children than in adults. Material and method. The present paper is a retrospective study that includes tumors with lower limb localizations, including the bony pelvis, over a 3-year period (2013-2016). The study group consisted of 29 patients who, following the MRI examination, were diagnosed with softtissue tumors. Of the 29 patients, 17 patients had a MRI (magnetic resonance imaging) and an anatomopathological diagnosis of leiomyosarcoma. The location of the tumor, its characteristics, and the relationship with the adjacent anatomical structures were analyzed in all cases. Results. The ages of the final group of 17 patients ranged between 28 and 84 years, with female predominance. In terms of localization, one showed a muscle tumor in the pelvis, namely left oblique muscle, other cases being located in the thigh and knee. A special importance was given to the superficial and profound location. In 5 cases, the tumor was localized in subcutaneous fatty tissue, thus superficial. In terms of the contours of the tumor, well-defined margins were present in 11 cases, and poorly defined contour in 6 cases. Regarding the size, the leiomyosarcomas in our study had dimensions between 5.2 cm and 18 cm, and their structure was inhomogeneous, with the presence of necrosis and calcifications. Necrosis was found in 14 cases, and calcifications were present in 68%, being more frequent than necrosis. Except for the necrotic areas, the contrast enhancement was intense. Conclusions. Although the diagnosis is always histopathological, the MRI plays an important role in defining a precise localization and tumor characteristics.

scholarly journals HUBUNGAN TINGKAT PENGETAHUAN PATIENT SAFETY TERHADAP KEPATUHAN PERAWAT DALAM PENERAPAN SURGICAL SAFETY CHECKLIST DI RUANG PRE OPERASI INSTALASI KAMAR OPERASI RSD MANGUSADA BADUNG

2021 ◽  
Vol 16 (2) ◽  
pp. 352-357
Author(s):  
Putu Ayu Mega Agnihortry ◽  
I Made Dwie Pradnya Susila ◽  
A.A. Ngurah Nara Kusuma
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Health Workers ◽  
P Value ◽  
Cross Sectional ◽  
Operation Room ◽  
Significance Level ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Safety Knowledge

Patient safety has now become a global issue and a critical component of hospital quality management. One of the components in patient safety that must be carried out in the operating room is the application of the surgical safety checklist. Adherence in implementing the surgical safety checklist is influenced by several factors such as the knowledge of patient safety that nurses have. This study aims to determine the relationship between the level of patient safety knowledge and the compliance of nurses in implementing the surgical safety checklist in the Pre-Operation Room, the Operation Room, RSD Mangusada Badung. This study used a quantitative observational method with a cross sectional design. The sample was all nurses in the operating room installation room RSD Mangusada Badung who were selected by a total sampling of 41 people. The research was conducted from 01-31 October 2020. The results of data analysis using the rho Spearman nonparametric statistical test at a significance level of ? 0.05, the p value was 0.000 <0.05. This shows that there is a significant relationship between the level of patient safety knowledge on nurses' compliance in implementing the surgical safety checklist in the Pre-Operation Room for the Operation Room, RSD Mangusada Badung. It is hoped that health workers, especially nurses in the operating room, can increase knowledge about patient safety and be more obedient in implementing the surgical safety checklist.

scholarly journals Internal and External Radiofrequency Assisted Lipo-Coagulation (RFAL) in the Control of Soft Tissue Contraction during Liposuction: Part 2 “Outside In” RFAL Thermal Tissue Tightening

2021 ◽  
Author(s):  
Robert Stephen Mulholland
Keyword(s):  
Soft Tissue ◽  
Invasive Procedure ◽  
Thermal Stimulation ◽  
Thermal Coagulation ◽  
Soft Tissue Envelope ◽  
Non Invasive ◽  
Tissue Contraction ◽  
Contraction Effect ◽  
Positively Charged ◽  
Coated Electrodes

The new Morpheus8 is a novel external RFAL device that uses the proven soft tissue contraction of BodyTite in an external, non-invasive procedure. This external RF applicator, which is also powered by BodyTite, inserts up to 40 positively charged, coated electrodes 8 mm into the subcutaneous, soft tissue envelope. A monopolar ablative lesion is generated from the tip of the electrode, stimulating contraction of the FSN and adipose coagulation. The RF then flows up to the distant negative, return electrodes on the surface of the skin, providing a non-ablative thermal stimulation to the papillary dermis. The “burst” feature of the Morpheus8, delivers simultaneous multiple levels of internal coagulation in a single one second pulse, amplifying the adipose ablation and contraction effect. Studies, show, that the combination of BodyTite internal thermal coagulation and external Morpheus8 at the time of liposuction can result in 60–70% area skin contraction, greatly improving the soft tissue contours and Body shaping outcomes following lipo-contouring procedures.

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