The Sternocleidomastoid Myocutaneous Flap: A Laryngeal Preservation Option for Total Hypopharyngoesophageal Stenosis

Complete hypopharyngoesophageal (HPE) stenosis is rare and a challenging condition to treat. When endoscopic therapy fails, total laryngectomy with or without pharyngeal reconstruction is usually performed. We present a retrospective case series involving 3 patients with complete HPE stenosis who failed endoscopic repair and were gastrostomy dependent. All were managed successfully with the sternocleidomastoid myocutaneous (SCM) flap. A temporary fistula occurred in 1 patient. Hospitalization ranged from 5 to 15 days, patients resumed oral intake from 21 to 82 days postoperatively, and their gastrostomy tubes were removed from 28 to 165 days postoperatively. We suggest that the SCM flap is a laryngeal preservation option for reconstruction of complete HPE stenosis when endoscopic techniques fail. This flap allows HPE repair and reconstruction within the same surgical field, imposes no significant donor site morbidity, and affords good functional and cosmetic outcomes.

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Outcome After Modified Grice-Green Procedure (SAMBB) for Arthritic Acquired Adult Flatfoot

Foot & Ankle International ◽

10.1177/1071100720938665 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1404-1410

Author(s):

Massimiliano Mosca ◽

Silvio Caravelli ◽

Emanuele Vocale ◽

Simone Massimi ◽

Mario Fuiano ◽

...

Keyword(s):

Donor Site ◽

Case Series ◽

Donor Site Morbidity ◽

Mean Value ◽

Average Score ◽

Bone Block ◽

Retrospective Case ◽

Level Of Evidence ◽

Subtalar Arthritis

Background: Adult acquired flatfoot deformity is a well-known and recognized cause of pain and disability. The purpose of this retrospective study was to describe radiographic and clinical outcomes of the modified mini bone block distraction subtalar arthrodesis (SAMBB) in adult patients affected by adult flatfoot with subtalar joint osteoarthritis at a midterm mean follow-up. Methods: A retrospective review of our database identified patients. Radiological imaging was used to evaluate angular corrections (Meary’s angle [MA], talar coverage angle [TC], and calcaneal pitch angle [CP]) to assess the rate of union and highlight the possible progression of arthritis in nearby joints. Clinical evaluation was performed at the time of surgery and at the final follow-up using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Sixty-two feet were evaluated at a mean follow-up of 6.2 ± 4.2 years. Results: The AOFAS score improved from a mean value of 48.1 ± 6.1 to a postoperative average score of 87.7 ± 5. CP, TC, and MA showed a postoperative improvement to 17.7 ± 2.1, 2.9 ± 0.7, and 0.6 ± 0.6 degrees, respectively, at the final follow-up, and all deformities were corrected. Five complications (8%) were reported: 1 major and 4 minor. No graft reabsorption, sural nerve neuralgia, or donor site morbidity was recorded. Conclusion: To our knowledge, this study is the first report of a modified Grice-Green technique (SAMBB) that is a safe and effective treatment of flatfoot in the adult with subtalar arthritis. Level of evidence: Level IV, retrospective case series.

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

Otolaryngology ◽

10.1177/0194599814549731 ◽

2014 ◽

Vol 151 (5) ◽

pp. 791-796 ◽

Cited By ~ 3

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.

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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

Journal of Clinical Medicine ◽

10.3390/jcm10204749 ◽

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.

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Case Series: Use of Coralline Hydroxyapatite Graft In Faciomaxillary Surgery

Journal of Regenerative Biology and Medicine ◽

10.37191/mapsci-2582-385x-3(5)-088 ◽

2021 ◽

Author(s):

Gordon Slater

Keyword(s):

Bone Graft ◽

Disease Transmission ◽

Bone Ingrowth ◽

Donor Site ◽

Case Series ◽

Bone Graft Substitute ◽

Donor Site Morbidity ◽

Coralline Hydroxyapatite ◽

Important Solution ◽

The Ideal

Bone grafting represents an important solution for defects in maxillofacial and orthopaedic surgeries. Ideal properties of a bone graft allow proper integration, enabling cosmetic appeal and mechanical functionality. Whilst current autograft, allograft and xenograft applications do exist and are regularly used clinically, they are associated with numerous solutions, such as availability, disease transmission and donor site morbidity. Synthetic and naturally sourced solutions can avoid these issues, whilst maintaining the ideal bone integrative properties of their autograft counterparts. This case series aims to identify the effectiveness of a natural bone graft substitute, coralline hydroxyapatite, in maxillofacial applications, and demonstrate that coralline hydroxyapatite encourages bone ingrowth for dental defects.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118808242 ◽

2018 ◽

Vol 6 (11) ◽

pp. 232596711880824 ◽

Cited By ~ 18

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.

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Facial Defect Reconstruction with Scalp Skin Grafts

Facial Plastic Surgery ◽

10.1055/s-0037-1603783 ◽

2017 ◽

Vol 33 (04) ◽

pp. 419-422 ◽

Cited By ~ 1

Author(s):

Matthew Voorman ◽

John Frodel ◽

Chelsea Obourn

Keyword(s):

Donor Site ◽

Case Series ◽

Donor Site Morbidity ◽

Ear Reconstruction ◽

Skin Grafts ◽

Facial Skin ◽

Skin Defects ◽

Facial Defect ◽

Thickness Skin ◽

Scalp Skin

AbstractThe objective of this study is to demonstrate the benefits of scalp-based split-thickness skin grafts as a reconstructive modality for facial skin defects, noting advantages relative to traditional harvest sites. The study is presented as a case series with chart review set in a tertiary referral center. We reviewed the charts of patients with facial skin defects whose reconstruction required more skin than could be harvested with standard full-thickness skin grafting techniques and, accordingly, included a split-thickness skin graft from the adjacent scalp. Preoperative and postoperative photographs, along with operative and postoperative records, were used to evaluate final cosmetic results and complications. We reviewed 15 patients, with ages ranging from 6 to 90 years. Common indications were skin cancer resection, avulsive skin trauma, and ear reconstruction. While patients generally had good cosmetic outcomes, with excellent color matching relative to traditional distant donor sites, a major advantage of the scalp donor site was low donor-site morbidity. Scalp donor sites were commonly reepithelialized at 7 to 10 days postoperatively and had low reported pain scores. There were no major complications. Reconstruction of facial skin defects that require skin coverage with split-thickness skin grafts can optimally be harvested from adjacent scalp skin, providing adequate cosmesis but, perhaps most importantly, much lower donor-site morbidity than with traditional nonhair-bearing donor sites.

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Rhytidectomy After Parotidectomy

The American Journal of Cosmetic Surgery ◽

10.1177/0748806817742050 ◽

2017 ◽

Vol 35 (2) ◽

pp. 92-98

Author(s):

Boris Paskhover ◽

Benjamin C. Paul ◽

David B. Rosenberg

Keyword(s):

Patient Satisfaction ◽

Facial Nerve ◽

Intraoperative Complications ◽

Case Series ◽

Surgical Anatomy ◽

Retrospective Case ◽

Neck Lift ◽

Parotid Surgery ◽

History Of ◽

Surgical Field

A history of prior parotidectomy is typically thought to substantially increase the risk of facial nerve injury for patients undergoing subsequent facelift surgery. For this reason, surgeons are often hesitant and may even elect not to perform facelift surgery on such patients. However, we have developed a safe and predictable operation for performing the post-parotidectomy rhytidectomy. Here, we present our rationale, approach, and results for performing this operation. This review is a retrospective case series. In total, 1200 facelifts from 2012 to 2016 performed by a single surgeon (D.B.R.) were reviewed. From these, 9 patients were identified as having had parotid surgery prior to rhytidectomy. Rhytidectomy was performed in 8 of 9 cases with a deep-plane, bilaminar approach. There were no intraoperative complications. One patient had a direct neck lift. There were no cases of revision. There were no cases of facial nerve damage including paresis or paralysis; 100% patient satisfaction was noted. Rhytidectomy with a deep-plane approach may be performed safely in patients who have undergone prior parotidectomy. Although there were no complications, revisions, postoperative asymmetry, or dissatisfaction in the patients in this study, it must be stressed that there is no substitute for a thorough appreciation of the surgical anatomy in combination with consideration of the changes to the surgical field that occur with parotid surgery.

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Establishing the Need for an Evidence-Based Treatment Algorithm for Peritonsillar Abscess in Children

Clinical Pediatrics ◽

10.1177/0009922818778048 ◽

2018 ◽

Vol 57 (12) ◽

pp. 1385-1390 ◽

Cited By ~ 2

Author(s):

Maria Carratola Grant ◽

Blake Raggio ◽

Blair Barton ◽

J. Lindhe Guarisco

Keyword(s):

Treatment Algorithm ◽

Case Series ◽

Cervical Lymphadenopathy ◽

Oral Intake ◽

Peritonsillar Abscess ◽

Retrospective Case ◽

Evidence Based Treatment ◽

Presenting Symptoms ◽

Evidenced Based ◽

Symptoms And Signs

In this retrospective case series, we report clinical factors associated with pediatric peritonsillar abscess (PTA), with hopes of contributing to the design of an evidenced-based, economic treatment approach. Charts were examined for presenting symptoms and signs. Each of these were analyzed for association with the presence of PTA and for association with treatment. We found that, with the exception of leukocytosis, the signs/symptoms that prompted treatment correlate with those that indicate the presence of PTA. However, there are several signs/symptoms, namely, referred otalgia, cervical lymphadenopathy, and decreased oral intake, that were associated with PTA but unassociated with treatment. Treatment can be aided by establishing an algorithm that accounts for the symptoms/signs most correlated with true, drainable abscess.

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Acute Macular Neuroretinopathy following Oral Intake of Adrenergic Flu Treatments

Case Reports in Ophthalmology ◽

10.1159/000487075 ◽

2018 ◽

Vol 9 (2) ◽

pp. 322-326 ◽

Cited By ~ 4

Author(s):

Dinu Stanescu-Segall ◽

Chong Yap ◽

Ben J.L. Burton

Keyword(s):

Young Patient ◽

Case Series ◽

Oral Intake ◽

Case Review ◽

Adrenergic Stimulation ◽

Retrospective Case ◽

Loss Of Vision ◽

Acute Macular Neuroretinopathy

Purpose: The purpose of this study was to report a case series of patients with acute macular neureretinopathy in which patients concomitantly used ephedrine or pseudo-ephedrine. Methods: This is a retrospective case review. Results: Two patients with retinal findings consistent with acute macular neuroretinopathy are presented. Conclusion: Acute macular neuroretinopathy should be considered in any young patient with unexplained loss of vision and exposed to direct or indirect adrenergic stimulation.

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