Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

2021 ◽  
Author(s):  
Valeria P. Bustos ◽  
Joseph M. Escandón ◽  
Eric Santamaría ◽  
Pedro Ciudad ◽  
Antonio J. Forte ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Scoping Review ◽  
Surgical Techniques ◽  
Research Strategy ◽  
Human Studies ◽  
Abdominal Wall Defects ◽  
Complication Rates ◽  
Vascularized Composite Allotransplantation ◽  
Level Of Evidence ◽  
Scoping Reviews

Abstract Background Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with intestinal transplantation (ITx) or multivisceral abdominal transplantation (MVTx). Since the introduction of this procedure, several studies have been published reporting their experience. This study aims to present a scoping review looking at all available evidence-based medicine information to understand the most current surgical techniques and clinical outcomes. Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for scoping reviews checklist. A comprehensive research strategy of several databases was conducted. Results A total of 31 studies were included in this review, which comprised animal, cadaveric, and human studies. In human studies, four surgical techniques with high flap survival rates and low complication rates were found. In cadaveric studies, it was shown that the use of iliofemoral cuff-based flaps provided adequate tissue perfusion to the abdominal wall graft. Also, the use of thoracolumbar nerves have been described to provide functionality to the AW-VCA and prevent long-term muscle atrophy. Conclusion AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. The future holds a promising evolution of a functional AW-VCA, though surgeons must face and overcome the challenge of distorted anatomy frequently present in this population. Forthcoming studies with a better level of evidence are required to evaluate functionality and differences between surgical techniques.

scholarly journals Diagnosing Overtraining Syndrome: A Scoping Review

2021 ◽  
pp. 194173812110447
Author(s):  
Justin Carrard ◽  
Anne-Catherine Rigort ◽  
Christian Appenzeller-Herzog ◽  
Flora Colledge ◽  
Karsten Königstein ◽  
...  
Keyword(s):  
Scoping Review ◽  
Sports Medicine ◽  
Female Athletes ◽  
Data Extraction ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Exercise Tests ◽  
Overtraining Syndrome ◽  
Scoping Reviews ◽  
Study Characteristics

Context: Overtraining syndrome (OTS) is a condition characterized by a long-term performance decrement, which occurs after a persisting imbalance between training-related and nontraining-related load and recovery. Because of the lack of a gold standard diagnostic test, OTS remains a diagnosis of exclusion. Objective: To systematically review and map biomarkers and tools reported in the literature as potentially diagnostic for OTS. Data Sources: PubMed, Web of Science, and SPORTDiscus were searched from database inception to February 4, 2021, and results screened for eligibility. Backward and forward citation tracking on eligible records were used to complement results of database searching. Study Selection: Studies including athletes with a likely OTS diagnosis, as defined by the European College of Sport Science and the American College of Sports Medicine, and reporting at least 1 biomarker or tool potentially diagnostic for OTS were deemed eligible. Study Design: Scoping review following the guidelines of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews (PRISMA-ScR). Level of Evidence: Level 4. Data Extraction: Athletes’ population, criteria used to diagnose OTS, potentially diagnostic biomarkers and tools, as well as miscellaneous study characteristics were extracted. Results: The search yielded 5561 results, of which 39 met the eligibility criteria. Three diagnostic scores, namely the EROS-CLINICAL, EROS-SIMPLIFIED, and EROS-COMPLETE scores (EROS = Endocrine and Metabolic Responses on Overtraining Syndrome study), were identified. Additionally, basal hormone, neurotransmitter and other metabolite levels, hormonal responses to stimuli, psychological questionnaires, exercise tests, heart rate variability, electroencephalography, immunological and redox parameters, muscle structure, and body composition were reported as potentially diagnostic for OTS. Conclusion: Specific hormones, neurotransmitters, and metabolites, as well as psychological, electrocardiographic, electroencephalographic, and immunological patterns were identified as potentially diagnostic for OTS, reflecting its multisystemic nature. As exemplified by the EROS scores, combinations of these variables may be required to diagnose OTS. These scores must now be validated in larger samples and within female athletes.

Clinical Outcome of a Modified Coracoid Tunnel-Free Coracoclavicular Sling Technique With Remnant Preservation for the Treatment of High-Grade Acromioclavicular Joint Separation: A Report of 48 Cases With 2 to 5 Years of Follow-up

2021 ◽  
pp. 036354652110021
Author(s):  
Fenglong Li ◽  
Yue Li ◽  
Yi Lu ◽  
Yiming Zhu ◽  
Chunyan Jiang
Keyword(s):  
Los Angeles ◽  
Surgical Techniques ◽  
Case Series ◽  
Complication Rates ◽  
High Grade ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Remnant Preservation ◽  
Joint Separation

Background: High-grade acromioclavicular (AC) joint separation injuries (Rockwood type IV or V) are surgically indicated because of complete disruption of the AC and coracoclavicular (CC) ligaments, leading to instability and pain. In surgical techniques that require a suspensory system, coracoid tunnel-related complications are not uncommon. Purpose: To report subjective and objective clinical outcomes and complication rates of a modified coracoid tunnel-free CC sling technique combined with CC ligament remnant preservation for a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Between January 2014 and January 2017, we prospectively enrolled patients who underwent a modified CC sling technique performed by 1 senior surgeon using the AC TightRope System in a coracoid tunnel-free fashion. The CC distance (CCD) and Rockwood AC joint classification were evaluated on radiographs preoperatively, immediately postoperatively, and at the final follow-up. The visual analog pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and University of California Los Angeles score were recorded preoperatively and at the final follow-up. Results: In total, 48 of 54 patients (88.9%) were included for the evaluation with a mean ± SD follow-up of 39.3 ± 8.9 months (range, 24.7-64.3 months). The CCD was significantly decreased from 22.7 ± 4.2 to 9.8 ± 2.3 mm ( P < .01) immediately after surgery and to 11.2 ± 1.8 mm ( P < .01) at final follow-up. At the final follow-up, the side-to-side difference of CCD was 3.5 ± 0.6 mm. Compared with the preoperative level, all subjective evaluations were significantly improved at the final follow-up. We observed that 4 of the 48 patients (8.3%) had a loss of reduction at the final follow-up, but no pain or instability was documented. Further, no coracoid-related complication or other complications were recorded. Conclusion: The coracoid tunnel-free CC sling technique using the AC TightRope System combined with CC ligament remnant preservation demonstrated significant improvement regarding both clinical and radiological outcomes, with a reduction loss rate of 8.3%. It is a safe method that could achieve satisfactory result without any coracoid drilling-related complications.

scholarly journals TECHNOSOCIALITY AND HEALTH PROMOTION IN THE DAILY LIVES OF PRIMARY CARE USERS: A SCOPING REVIEW

2021 ◽  
Vol 30 ◽  
Author(s):  
Leila Cristine do Nascimento ◽  
Amanda Morais Campos ◽  
Stephanie Botelho Figueiredo ◽  
Rosane Gonçalves Nitschke ◽  
Maria Josefa Arcaya Moncada ◽  
...  
Keyword(s):  
Health Care ◽  
Health Promotion ◽  
Scoping Review ◽  
The United States ◽  
Level Of Evidence ◽  
Daily Lives ◽  
Scoping Reviews ◽  
Meta Analyses ◽  
And Control ◽  
Behavioral Barriers

ABSTRACT Objective: to map available evidence on the use of technologies by Primary Health Care users in the context of health promotion. Method: this is a scoping review according to Joanna Briggs Institute, and the recommendations of the international guide Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were followed. The PCC strategy (participants, concept and context) was used. The search in the databases was carried out from January to April 2020. Results: a total of 5,267 studies were retrieved and 28 articles were selected for review. The article origin was diverse, with the largest number being from the United States of America (7), the predominant language is English, the year was 2018 and the level of evidence 2. Studies show that users obtain benefits in health care through the use of technologies. Conclusion: health interventions, using technology, positively impact people’s behavior and lifestyle, focusing on the prevention and control of chronic diseases. It is noteworthy that technologies used in isolation cannot overcome behavioral barriers and their use does not replace one-to-one care and monitoring.

scholarly journals Flap Surgical Techniques For Incisional Hernias Reccurences. A Swine Experimental Model

2017 ◽  
Vol 90 (2) ◽  
pp. 203-211
Author(s):  
Florina Popa ◽  
Filip Ardelean ◽  
Cosmin Pestean ◽  
Robert Purdoiu ◽  
Oana Rosca ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Mesh Repair ◽  
Surgical Techniques ◽  
Careful Examination ◽  
Large Animal ◽  
Abdominal Wall Defects ◽  
Flap Surgery ◽  
Abdominal Wall Repair ◽  
Large Animal Models ◽  
The University

Background and aims. In the age of synthetic prostheses most of hernia studies include a careful examination of the various types of prosthesis, their characteristics and their repair indications. Biological prostheses are also beginning to draw attention. But in terms of recurrence especially for poor or developing countries, the discussion is different, due to their high cost which makes them difficult to afford. In this article we present new flap reconstruction techniques for the reconstruction of the abdominal wall versus mesh repair, applied on swine models, outline the results of each technique, and specify the indications for their use.Methods. An experimental protocol using four swine models (PIC-FII-337 hybrid breed pigs), five months old, was conducted. All animal care and operative procedures were studied following the protocol approved by the Ethics Committee of the University of Medicine and Pharmacy resolution no. 281/2014 of the Department of Surgery of the University of Agricultural Sciences and Veterinary Medicine); the study was carried out between November 2015 and February 2016. The primary objective was to compare the effect of surgical strategies in the treatment of the abdominal wall defect using variable flaps versus mesh repair in a large-animal models. Physical examination and ultrasound imaging of the abdominal wall repair were done on determined periods, during one month. The complications occurring after the abdominal wall repair were edema, collections, superficial dehiscence an recurrences.Results. No recurrences were reported at one month results, all seromas reported were solved over time by natural drainage. Superficial necrosis appeared in two swine models and superficial dehiscence occurred in one model, the perforator ”plus” flap. Mesh infection was detected in the “onlay” swine model.Conclusions. In terms of recurrences, contaminated abdominal wall defects or other contraindications to the use of prosthetic materials, biological mesh repair or flap surgery are the only surgical options. Based on our findings and considering the high cost reported by the biological meshes use, flap surgery becomes the suitable treatment for such cases, allowing a good reconstruction of the abdominal wall.

Surgical Techniques for Revascularization in Abdominal Wall Transplantation

2020 ◽  
Vol 36 (07) ◽  
pp. 522-527
Author(s):  
Andrew Atia ◽  
Andrew Hollins ◽  
Ronnie Shammas ◽  
Brett T. Phillips ◽  
Kadiyala V. Ravindra ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Organ Transplantation ◽  
Abdominal Wall Reconstruction ◽  
Solid Organ Transplantation ◽  
Surgical Techniques ◽  
Solid Organ ◽  
Vascularized Composite Allotransplantation ◽  
Ischemia Time ◽  
Feasible Option ◽  
Surgical Field

Abstract Background Abdominal wall vascularized composite allotransplantation (AW-VCA) can be considered as a technically feasible option for abdominal wall reconstruction in patients whose abdomen cannot be closed using traditional methods. However, successful initial abdominal wall revascularization in the setting of visceral organ transplantation can pose a major challenge as graft ischemia time, operating in a limited surgical field, and variable recipient and donor anatomy must be considered. Several techniques have been reported to accomplish abdominal wall revascularization. Methods A literature review was performed using PubMed for articles related to “abdominal wall transplantation (AWT).” The authors of this study sorted through this search for relevant publications that describe abdominal wall transplant anatomy, technical descriptions, and outcomes of various techniques. Results A total of four distinct revascularization techniques were found in the literature. Each of these techniques was described by the respective authors and reported varying patient outcomes. Levi et al published a landmark article in 2003 that described technical feasibility of AWT with anastomosis between donor external iliac and inferior epigastric vessels with recipient common iliac vessels in end-to-side fashion. Cipriani et al described a microsurgical technique with anastomosis between donor and recipient inferior epigastric vessels in an end-to-end fashion. Giele et al subsequently proposed banking the abdominal wall allograft in the forearm to reduce graft ischemia time. Recently, Erdmann et al described the utilization of an arteriovenous loop for synchronous revascularization of abdominal wall and visceral transplants for reduction of ischemia time, operative time, while eliminating the need for further operations. Conclusion Vascularized composite allotransplantation continues to advance with improving immunotherapy and outcomes in solid organ transplantation. Optimizing surgical techniques remains paramount as the field continues to grow. Refinement of the presented methods will continue as additional evidence and outcomes become available in AW-VCA.

Reoperative Transaxillary Approach Algorithm: Extending the Surgical Alternatives for Secondary Breast Augmentation in the Era of Scarless Surgery

2020 ◽  
Vol 40 (11) ◽  
pp. 1179-1192 ◽  
Author(s):  
Alexandre Mendonça Munhoz
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Transaxillary Approach ◽  
Scarless Surgery ◽  
Aesthetic Result ◽  
Axillary Incision ◽  
Grade Ii

Abstract Background Although the transaxillary approach (TAA) is useful in primary breast augmentation (BA) surgery, drawbacks of this technique include the need to correct complications arising from reuse of the axillary incision. Objectives The purpose of this study was to assess the outcomes of secondary BA procedures performed via the TAA in a cohort of patients operated on by a single surgeon and to provide an algorithm for reoperative TAA technique selection. Methods Sixty-two patients (122 breasts) underwent secondary TAA BA, which was indicated for capsular contracture (CC) in 35 patients (56.4%). Periods for analysis included less than 10 days, 1, 3, 6, and 12 months, and then at 2-year intervals postprocedure. Results Forty-three patients (69.3%) had a previous premuscular (PM) pocket; in 35 (81.3%) of these patients the new pocket was kept in the same position. Nineteen patients (30.7%) had a previous submuscular pocket, and 15 patients (78.9%) had the new pocket transferred to the PM plane. Ten cases of complications were observed in 8 patients (16.1%), Baker grade II/III CC in 3 (4.8%), and axillary banding in 2 (3.2%), during a mean follow-up of 72 months (range, 6-170 months). Fifty-nine patients (95.1%) were either very satisfied or satisfied with their aesthetic result. Conclusions Recent progress in surgical techniques has led to significant improvements in aesthetic outcomes following BA. The TAA can play a useful role in secondary BA cases and our results show this procedure to be useful, with acceptable complication rates, and the added bonus of avoiding additional scarring on the breast. Level of Evidence: 4

Niche Reconstructive Techniques for Complex Abdominal Wall Reconstruction: A Review

2014 ◽  
Vol 80 (4) ◽  
pp. 327-334 ◽  
Author(s):  
Gloria R. Sue ◽  
Deepak Narayan
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Surgical Techniques ◽  
Abdominal Wall Defects ◽  
Recurrence Rates ◽  
Surgical Morbidity ◽  
Abdominal Wall Repair ◽  
Surgical Methods ◽  
Latissimus Dorsi Myocutaneous Flap ◽  
Reconstructive Techniques

Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair. The specific techniques reviewed include use of delayed and tunneled pedicled tensor fascia lata myofascial flap, de-epithelialized flap closure, free latissimus dorsi myocutaneous flap with or without innervation, and abdominal wall transplant. These niche surgical techniques have great potential to reduce recurrence rates when used in the proper setting for complex abdominal wall reconstruction. More studies are needed to evaluate the relative use of these techniques with the more widely established surgical methods of reconstruction.

scholarly journals Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
V. Lambropoulos ◽  
E. Mylona ◽  
V. Mouravas ◽  
C. Tsakalidis ◽  
I. Spyridakis ◽  
...  
Keyword(s):  
Case Report ◽  
Postoperative Complications ◽  
Abdominal Wall ◽  
Surgical Techniques ◽  
Abdominal Hernia ◽  
Abdominal Wall Defects ◽  
Common Complication ◽  
Dermal Matrix ◽  
Real Challenge ◽  
Ventral Hernias

Introduction.Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose.Case Report.We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh.Conclusion.Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence.

scholarly journals A comprehensive scoping review of tibial cysts after anterior cruciate ligament reconstruction

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Nuno Camelo Barbosa ◽  
João Pedro Campos ◽  
Vânia Capelão ◽  
Vikram Kandhari ◽  
Thais Dutra Vieira ◽  
...  
Keyword(s):  
Scoping Review ◽  
Cruciate Ligament ◽  
Cyst Formation ◽  
Graft Fixation ◽  
Future Research ◽  
Level Of Evidence ◽  
Absorbable Implants ◽  
Pubmed Database ◽  
Scoping Reviews ◽  
Cyst Development

Abstract Purpose The purpose of this study was to perform a scoping review of published literature reporting on surgical management of tibial cysts which developed after ACLR. Methods A scoping review was conducted following the Arksey and O’Malley framework for scoping studies and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines. A search strategy using the terms [“Tibial Cyst” AND “ACL”], [“Pretibial Cyst” AND “ACL”] was applied to the PUBMED database. Results Thirty-seven studies published between 1990 and 2019 were a part of this scoping review. Non-absorbable implants for tibial graft fixation were used in 10 studies (comprising a total 21 patients), while bio-absorbable implants were used in 27 studies (comprising a total 115 patients). Incidence of tibial cyst was reported in 3 studies (434 primary ACLRs) from whom 3.9% (n = 17) developed tibial cyst. Tibial cyst development in relation to use of bio-absorbable screws for tibial ACL graft fixation was reported in 16 studies (42.1%). Use of bio-absorbable screws with another factor was found to be related to tibial cyst development in another 1 study (2.6%). Most common symptoms were presence of mass or swelling, pain, tenderness, drainage, instability and effusion. Conclusion This scoping review demonstrated that tibial cysts is more frequently related to bioabsorbable screws, however it can also occur due to other causes. Current literature on tibial cyst after ACLR is of low-quality evidence. Future research is required to better understand aetiology, risk factors for cyst formation and the best possible mode of management. Level of evidence IV

scholarly journals Procalcitonin to Predict Severity of Acute Cholangitis and Need for Urgent Biliary Decompression: Systematic Scoping Review

2021 ◽  
Author(s):  
Krixie Silangcruz ◽  
Yoshito Nishimura ◽  
Torrey Czech ◽  
Nobuhiko Kimura ◽  
James Yess
Keyword(s):  
Scoping Review ◽  
Acute Cholangitis ◽  
Control Design ◽  
Case Control ◽  
Biliary Decompression ◽  
Level Of Evidence ◽  
Future Studies ◽  
Potential Biomarker ◽  
Scoping Reviews ◽  
Definition Of

Background: Serum Procalcitonin (PCT) has been reported as a potential biomarker to predict the severity of acute cholangitis (AC) or the need for urgent biliary decompression. This study aimed to identify and summarize the existing research about the serum PCT and the severity of AC, and to find gaps where future studies can be targeted towards. Methods: Following the PRISMA Extension for Scoping Reviews, MEDLINE, EMBASE, and Google Scholar were searched for all peer-reviewed articles with relevant keywords including "cholangitis" and "procalcitonin" from their inception to July 13, 2021. Results: We identified six studies. All the studies employed case-control design and aimed to evaluate the usefulness of serum PCT to predict the severity of AC with key identified outcomes. While potential cut-off values of serum PCT for severe AC ranged from 1.8–3.1 ng/mL, studies used different severity criteria and the definition of urgent biliary decompression. No studies proposed cut-off PCT values for the need for urgent biliary decompression. Conclusion: This scoping review identified that the current level of evidence regarding the usefulness of serum PCT in assessing the severity of AC. Further clinical research is warranted with a focus on standardized outcome measures employing prospective or experimental designs.

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