Surgical Treatment of Chronic Hand Ischemia: A Systematic Review and Case Series

2019 ◽  
Vol 24 (03) ◽  
pp. 359-370
Author(s):  
David L. Colen ◽  
Oded Ben-Amotz ◽  
Thibaudeau Stephanie ◽  
Arman Serebrakian ◽  
Martin J. Carney ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Ulnar Artery ◽  
Pharmacologic Therapy ◽  
Cold Intolerance ◽  
Algorithmic Approach ◽  
Surgical Interventions ◽  
Hand Ischemia

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.

scholarly journals A systematic review of the non-surgical treatment of Perthes’ disease

2020 ◽  
Vol 1 (12) ◽  
pp. 720-730
Author(s):  
Adam M. Galloway ◽  
Thomas van-Hille ◽  
Daniel C. Perry ◽  
Colin Holton ◽  
Laura Mason ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Cohort Studies ◽  
Patient Outcomes ◽  
Surgical Intervention ◽  
Perthes Disease ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Surgical Interventions ◽  
Non Surgical Treatment

Aims Perthes’ disease is a condition leading to necrosis of the femoral head. It is most common in children aged four to nine years, affecting around one per 1,200 children in the UK. Management typically includes non-surgical treatment options, such as physiotherapy with/without surgical intervention. However, there is significant variation in care with no consensus on the most effective treatment option. Methods This systematic review aims to evaluate the effectiveness of non-surgical interventions for the treatment of Perthes’ disease. Comparative studies (experimental or observational) of any non-surgical intervention compared directly with any alternative intervention (surgical, non-surgical or no intervention) were identified from: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMcare, Allied and Complementary Medicine Database (AMED), and the Physiotherapy Evidence Database (PEDro). Data were extracted on interventions compared and methodological quality. For post-intervention primary outcome of radiological scores (Stulberg and/or Mose), event rates for poor scores were calculated with significance values. Secondary outcomes included functional measures, such as range of movement, and patient-reported outcomes such as health-related quality of life. Results In all, 15 studies (1,745 participants) were eligible for inclusion: eight prospective cohort studies, seven retrospective cohort studies, and no randomized controlled trials were identified. Non-surgical interventions largely focused on orthotic management (14/15 studies) and physical interventions such as muscle strengthening or stretching (5/15 studies). Most studies were of high/unknown risk of bias, and the range of patient outcomes was very limited, as was reporting of treatment protocols. Similar proportions of children achieving poor radiological outcomes were found for orthotic management and physical interventions, such as physiotherapy or weightbearing alteration, compared with surgical interventions or no intervention. Conclusion Evidence from non-randomized studies found no robust evidence regarding the most effective non-surgical interventions for the treatment of children with Perthes’ disease. Future research, employing randomized trial designs, and reporting a wider range of patient outcomes is urgently needed to inform clinical practice. Cite this article: Bone Jt Open 2020;1-12:720–730.

scholarly journals Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ayobobola A. Apampa ◽  
Ayesha Ali ◽  
Bryar Kadir ◽  
Zubair Ahmed
Keyword(s):  
Systematic Review ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Adult Population ◽  
Flail Chest ◽  
Surgical Interventions ◽  
Surgical Methods ◽  
Surgical Fixation ◽  
Randomised Controlled ◽  
Pulmonary Status

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

2019 ◽  
Vol 133 (03) ◽  
pp. 168-176 ◽  
Author(s):  
S Sharma ◽  
J C R Wormald ◽  
J M Fishman ◽  
P Andrews ◽  
B T Kotecha
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Current Evidence ◽  
Nasal Surgery ◽  
Surgical Interventions ◽  
Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

scholarly journals Correction of High Corneal Astigmatism during Cataract Surgery

2019 ◽  
Vol 15 (4) ◽  
pp. 405-410 ◽  
Author(s):  
K. B. Pershin ◽  
N. F. Pashinova ◽  
M. E. Konovalov ◽  
E. P. Gurmizov ◽  
O. Yu. Zubenko ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Clinical Experience ◽  
Intraocular Lens ◽  
Surgical Intervention ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Toric Intraocular Lens ◽  
Surgical Interventions ◽  
Uncorrected Visual Acuity

Patients, who need cataract surgical treatment, often fail to achieve a high uncorrected visual acuity after surgery due to the concomitant astigmatism involved. Currently, surgeons are increasingly performing combined surgical interventions, including relaxing limbal keratotomic incisions (manual keratotomy) or femtoarcuatous keratotomy, as well as implanting toric intraocular lenses. In recent years, additional toric intraocular lenses have been available. Purpose: to analyze our own clinical experience of implanting an additional toric intraocular lens to correct corneal astigmatism in three clinical cases. The article presents our clinical experience of successful correction of residual corneal astigmatism after previous cataract phacoemulsification with the implantation of a monofocal toric intraocular lens in three patients patients aged 70, 61 and 54 years. In all cases, an additional toric intraocular lens Add-on Torica-sPB pre-filled in the cartridge with a good refractive effect was implanted. The uncorrected visual acuity was 1.0 in all the investigated cases at the follow-upo period of 6 months after the surgical intervention. Calculation of the toric intraocular lens optical power was performed using an online calculator. A feature of surgical intervention was the repositioning of the additional toric intraocular lens into the ciliary sulcus. Changes in the data of keratotopography before and after surgery were absent. In none of the investigated cases, intra- and postoperative complications and dislocation of the implanted additional toric intraocular lens were determined. Based on these cases, high predictability, efficacy and safety of implantation of an additional toric intraocular lens are shown, in the case of residual middle-grade corneal astigmatism after the initial cataract phacoemulsification with the toric intraocular lens implantation. This approach can be successfully used in patients during one-stage surgical treatment of cataract and associated high-grade corneal astigmatism, expanding existing protocols for the treatment of this group of patients.

scholarly journals Surgical Treatment of Juvenile Femoral Head Epiphysiolysis in Children

2016 ◽  
Vol 23 (1) ◽  
pp. 40-47
Author(s):  
D. B Barsukov ◽  
A. I Krasnov ◽  
M. M Kamosko ◽  
V. E Baskov ◽  
I. Yu Pozdnikin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Femoral Head ◽  
Femoral Neck ◽  
Surgical Intervention ◽  
Treatment Results ◽  
Surgical Interventions ◽  
X Ray ◽  
Endochondral Growth

To optimize the anatomical and functional surgical treatment results in patients with early (I-II) stages of juvenile femoral head epiphysiolysis both pre- and postoperative data of clinical, x-ray and magnetic-resonance examinations were analyzed for 120 patients aged 11 - 15 years. Maximum follow up period after surgical interventions, i.e. femoral head epiphysiodesis (n=60) and femoral head epiphysis fixation (n=60) made up 23 and 3 years, respectively. It was shown that surgical intervention for the fixation of femoral head epiphysis ensured reliable stability of the epiphysis preventing the latter from displacement development and progression, and did not exert significant influence upon either femoral neck and head endochondral growth or the length of the upper extremity.

scholarly journals Surgical Intervention for Paediatric Infusion-Related Extravasation Injury: A Systematic Review

2019 ◽  
Author(s):  
MR Little ◽  
S Dupré ◽  
JCR Wormald ◽  
MD Gardiner ◽  
C Gale ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Surgical Intervention ◽  
Case Series ◽  
National Institutes Of Health ◽  
Assessment Tools ◽  
Cochrane Central Register ◽  
List Type ◽  
Study Quality ◽  
Study Quality Assessment

AbstractObjectivesThis systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine and summarize their outcomes.MethodsWe performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. All studies other than case reports were eligible for inclusion if the population was younger than 18 years old, there was a surgical intervention aimed at treating extravasation injury and they reported on outcomes. Risk of bias was graded according to the National Institutes of Health (NIH) study quality assessment tools.Results26 studies involving 728 children were included – one before-and-after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking.ConclusionThere is a lack of high quality evidence to support treatment of extravasation injury in children. A definitive trial of extravasation injuries, or a centralized extravasation register using a universal grading scheme and core outcome set with adequate follow-up, are required to provide evidence to guide clinician decision-making.Strengths and LimitationsA systematic review was performed according to PRISMA guidelines and registered on PROSPEROTwo authors used a bespoke inclusion/exclusion form to independently assess study eligibilityStudies were eligible for inclusion if the population was younger than 18 years old, if there was a surgical intervention aimed at treating extravasation injury in any setting and if they reported on short- or long-term outcomesTwo researchers also independently assessed the included studies’ risk of methodological bias using the National Institutes of Health (NIH) study quality assessment tools18 years old may represent a relatively arbitrary cut-off age to differentiate between ‘paediatric’ and ‘adult’ in terms of extravasation injury

scholarly journals Oral health of patients suffering from end-stage solid organ insufficiency prior to solid organ re-transplantation: a retrospective case series study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tobias Moest ◽  
Rainer Lutz ◽  
Arne Eric Jahn ◽  
Katharina Heller ◽  
Mario Schiffer ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Retrospective Case ◽  
Treatment Need ◽  
Case Series Study ◽  
Series Study ◽  
Radiological Examinations

Abstract Background The oral health of organ transplanted patients before organ re-transplantation is largely unknown. This retrospective clinical study evaluates the necessity for intraoral surgical intervention and/or conservative treatment in candidates awaiting organ re-transplantation, both for graft failure and for reasons of another upcoming solid organ transplantation (renal or non-renal). Methods From January 2015 to March 2020 n = 19 transplant recipients in evaluation on the waiting list for solid organ re-transplantation could be included in the retrospective case series study. Using clinical and radiological examinations, necessity for oral surgical or conservative dental treatment was evaluated. On the basis of anamnesis data, current kidney function, renal replacement treatment (RRT), and medication, a risk profile for several patient subgroups was created. Results The clinical and radiological examinations showed a conservative and/or surgical treatment need in n = 13 cases (68.42%). In n = 7 cases (36.84%) surgical intervention was recommended due to residual root remnants (n = 5), unclear mucosal changes (n = 1), and periimplantitis (n = 1). In n = 16 recipients (84.2%) RRT (n = 15 hemodialysis; n = 1 peritoneal dialysis) had been performed. N = 14 recipients (73.68%) received immunosuppressants. In n = 1 patient (5.3%) displayed intraoral and n = 4 patients (21.1%) extraoral neoplasms due to drug-induced immunosuppression. Conclusions Solid organ transplant recipients with renal failure present a complex treatment profile due to a double burden of uremia plus immunosuppressants. In cases of surgical treatment need a hospitalized setting is recommended, where potentially necessary follow-up care and close cooperation with disciplines of internal medicine is possible in order to avoid surgical and/or internal complications.

scholarly journals Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis

2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Second Stage ◽  
Standard Operations

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.

scholarly journals Volar radial wrist–forearm primary and recurrent ganglia of the flexor carpi radialis tendon secondary to pathology isolated to the trapezial fibro-osseous synovial sheath tunnel: A case series report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2097738
Author(s):  
Jerone T Landstrӧm
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Tendon Sheath ◽  
Etiologic Factor ◽  
Recurrence Rates ◽  
Flexor Carpi Radialis ◽  
Surgical Recurrence ◽  
Case Series Report ◽  
Series Report

Surgical treatment of primary and recurrent volar radial wrist–forearm ganglia has yielded higher recurrence rates of ganglia when compared to surgical treatment of dorsal wrist ganglia. The published surgical literature hypothesizes that the variability in etiology of volar radial wrist–forearm ganglia may account for the higher surgical recurrence rates of these ganglia. Currently, the literature states that volar radial wrist–forearm ganglia may be secondary to arthritic intercarpal joints, carpal interosseous ganglia, or by mechanical stress within tendon sheaths, joint capsules, and ligaments. The literature has not reported pathology isolated to the flexor carpi radialis tendon and its tendon sheath at the volar trapezial fibro-osseous synovial sheath tunnel as a cause of volar radial wrist–forearm ganglia. This case series reports findings of pathology isolated to the flexor carpi radialis tendon at the trapezial fibro-osseous synovial sheath tunnel that caused primary and recurrent volar radial wrist–forearm ganglia. The pathology identified in this case series hypothesizes an additional etiologic factor in development of volar radial wrist–forearm ganglia. Surgeon awareness of potential pathology of the flexor carpi radialis tendon at the trapezial fibro-osseous synovial sheath tunnel may reduce recurrence rates of volar radial wrist–forearm ganglia treated by surgical intervention.

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