Combined Infrahyoid and Inferior Constrictor Muscle Release for Tension-Free Anastomosis during Primary Tracheal Repair

1992 ◽  
Vol 107 (3) ◽  
pp. 430-433 ◽  
Author(s):  
Hugh F. Biller ◽  
Michael A. Munier
Keyword(s):  
Success Rate ◽  
Operative Technique ◽  
Perioperative Management ◽  
Primary Repair ◽  
Primary Anastomosis ◽  
Management Problem ◽  
Tension Free ◽  
Constrictor Muscle ◽  
Free Closure ◽  
Combined Technique

Although tracheal stenosis is not a common clinical entity, it still presents a significant management problem, despite recent endoscopic advances. Surgical correction by resection and primary anastomosis is the preferred treatment, provided the repair can be performed without excessive tension. Various release techniques have been described in order to achieve mobility and, thereby, a tension-free anastomosis. This article presents a combined infrahyoid muscle and inferior constrictor muscle release to assure maximum mobility of the laryngotracheal complex, thus allowing tension-free closure. A series of ten patients who underwent primary repair using the combined technique is presented, and the operative technique is described. The indications, age, length of stenosis, and minimum 1 year followup of these patients are presented, as well as perioperative management and complications. The success rate with this technique is 90%.

scholarly journals Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

2021 ◽  
pp. 014556132110079
Author(s):  
Tongyu Cao ◽  
Qingguo Zhang
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Ear Reconstruction ◽  
Lower Pole ◽  
Tension Free ◽  
Subsequent Exposure ◽  
Free Closure ◽  
Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

scholarly journals Does Hamulotomy during Palatoplasty Have Any Effect on Hearing Ability in Nonsyndromic Cleft Palate Patients? A Prospective, Single Blind, Comparative Study

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Anuj Jain ◽  
Pranali Nimonkar ◽  
Nitin Bhola ◽  
Rajiv Borle ◽  
Anendd Jadhav ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Middle Ear ◽  
Function Evaluation ◽  
Tension Free ◽  
Hearing Ability ◽  
Significant Difference ◽  
Tube Dysfunction ◽  
The Difference ◽  
Free Closure ◽  
Age Range

The primary goal of palatoplasty is to achieve a tension-free palatal closure ensuring no postoperative complications. Many surgeons fracture the pterygoid hamulus to minimize tension during palatoplasty. However, this maneuver gained criticism by some authors on the grounds that it may lead to Eustachian Tube dysfunction. Our study intended to figure out the relationship of hamulus fracture with the postoperative state of middle ear in cleft palate children. Fifty consecutive cleft palate patients with an age range of 10 months to 5 years were recruited. All the patients were assigned to either hamulotomy or nonhamulotomy group preoperatively. The patients were subjected to otoscopic examination and auditory function evaluation by brainstem evoked response audiometry (BERA) preoperatively and 1 month and 6 months postoperatively. Otoscopy revealed that the difference in the improvement of middle ear status in both groups was statistically insignificant. Moreover, there was no significant difference in the BERA outcomes of the fracture and nonfracture populations. Complication rate in both groups was also statistically not significant. It can be concluded that hamulotomy does not have any effect on the hearing ability in cleft palate population, so hamulotomy can be performed for tension-free closure during palatoplasty.

Outcomes of Primary Repair and Primary Anastomosis in War-Related Colon Injuries

2009 ◽  
Vol 66 (5) ◽  
pp. 1286-1293 ◽  
Author(s):  
Amy Vertrees ◽  
Matthew Wakefield ◽  
Chris Pickett ◽  
Lauren Greer ◽  
Abralena Wilson ◽  
...  
Keyword(s):  
Primary Repair ◽  
Primary Anastomosis ◽  
Colon Injuries

scholarly journals Are Combined Techniques Using Video Laryngoscopes and Dynamic Stylets Superior to Fiberoptic Techniques for Anticipated Difficult Intubations? A Retrospective Case Control Study

2021 ◽  
Author(s):  
Ashka Shah ◽  
Lauren Knecht ◽  
Cameron Jacobson ◽  
Sean Runnels ◽  
Angela Presson ◽  
...  
Keyword(s):  
Success Rate ◽  
Case Control Study ◽  
Salt Lake ◽  
Salt Lake City ◽  
Ease Of Use ◽  
Retrospective Case ◽  
First Pass ◽  
Lake City ◽  
Combined Technique ◽  
Control Study

Abstract Difficult intubations can require advanced intubation techniques. Studies point to potential advantages of combined techniques using video laryngoscopes (VL) and dynamic stylets for anticipated difficult intubations. This study is designed to compare combined techniques to awake and asleep fiberoptic (FOB) techniques.Methods: 138,387 consecutive anaesthesia cases were reviewed for use of: FOB awake, FOB asleep, or combined technique (VL for visualization and either a FOB or a novel TCITM articulating introducer ((TCITM; Through The Cords, LLC; Salt Lake City, UT)) as dynamic stylets as a primary approach for anticipated difficult intubations. Primary end points measured: first attempt success rate, failure to intubate with the primary technique, “in-room to intubation’ time, reported traumatic intubation rate, and reported ease of intubation.Results: Significant differences were found between techniques. First pass success rate was highest in combined techniques (either VL + FOB or VL + TCITM) (88.7%) followed by FOB awake (74.2%, P<0.001) and FOB asleep (80.7%, P=0.06). “Failure to intubate with the primary technique” was lowest in combined techniques (1.8%) followed by FOB asleep (4.6%, P=0.11) and FOB awake (9.2%, P=0.002). “In room to intubated” time was fastest in combined techniques (13.0 minutes) followed by FOB asleep (15.1 minutes, P=0.002) and FOB awake (21.2 minutes, P<0.001). Combined techniques were rated as ‘easy’ more often (72%) followed by FOB asleep (62.9%, P=0.12) and FOB awake (38.2%, P<0.001). Combined techniques were rated as “atraumatic” more often (91.1%) followed by FOB asleep (89.4%, P=0.91) and FOB awake (75.8%, P<0.001). In subgroup analysis of combined techniques, VL + TCITM had the highest first attempt success rate (90.2%), lowest failure rate (1%, P=0.56), and shortest “in room to intubated time” (12.1 minutes, P=0.12). It was also rated as "easy” (83.3%, P<0.001), and “atraumatic“ (96.1%, P=0.009) more often than VL + FOB, FOB awake or FOB asleep.Conclusions: Combined techniques outperformed FOB techniques in terms of effectiveness, speed, ease of use, and patient injury in patients with risk factors for difficult intubation. As a sub-group of combined technique, VL + TCITM outperformed all other techniques. Combined techniques should be considered when managing difficult intubations.

scholarly journals SIGMOID VOLVULUS

2018 ◽  
Vol 25 (10) ◽  
pp. 1562-1567
Author(s):  
Ali Akbar Ghumro ◽  
Altaf Hussain Ghumro ◽  
Abdul Hakeem Jamali
Keyword(s):  
Primary Repair ◽  
Primary Anastomosis ◽  
Single Layer ◽  
Developed Countries ◽  
Large Bowel Obstruction ◽  
Sigmoid Volvulus ◽  
High Morbidity ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Medical University

Introduction: Sigmoid volvulus is the surgical emergency and significant causeof large bowel obstruction in with high morbidity and mortality. Disease is more prevalent indeveloping countries than developed countries. It contributes 15% of total bowel obstruction.Resection and primary anastomosis is the procedure of choice. It obviates the need ofcolostomy and subsequent reversal. Objectives: To determine the frequency of postoperativecomplications of primary repair in patients with either viable or gangrenous sigmoid volvulus.Study Design: Retrospective study. Setting: Surgical Unit 1 of Peoples Medical CollegeHospital now Medical University. Period: 2007 to Dec. 2013. Methodology: Patients with largebowel obstruction suspected to have sigmoid volvulus on clinical and radiological grounds werestudied. Laparotomy and resection of sigmoid colon followed by restoration of the continuity ofthe colon by single layer primary anastomosis were performed without colostomy. Results: In atotal 50 patients, sigmoid volvulus male female ratio was 9:1. Mean age was 49 years majority ofthe patients were in 6th to 7th decade of age. In 96% cases abdominal pain was the 1st symptomfollowed by constipation and distention, vomiting was the rare symptom. Different postoperativecomplication results were surgical site infection was the commonest complication in 40 (80%)while in 1 (2%) leak was there with mortality of only 1(2%) case. Conclusion: Primary resectionand single stage anastomosis is the best choice for the management of sigmoid volvulusdisease in both possibilities of viable or non viable gut provided patients condition is stable. Itobviates the burden of colostomy

Quantifying tension in tension-free hiatal hernia repair: a new intra-operative technique

2019 ◽  
Vol 33 (9) ◽  
pp. 3040-3049 ◽  
Author(s):  
Lalin Navaratne ◽  
Hutan Ashrafian ◽  
Alberto Martínez-Isla
Keyword(s):  
Hernia Repair ◽  
Hiatal Hernia ◽  
Operative Technique ◽  
Hiatal Hernia Repair ◽  
Tension Free

Defining Outcomes after Colon Resection in Blunt Trauma: Is Diversion or Primary Anastomosis More Favorable?

2018 ◽  
Vol 84 (8) ◽  
pp. 1288-1293 ◽  
Author(s):  
Alaina M. Lasinski ◽  
Lindsay Gil ◽  
Anai N. Kothari ◽  
Michael J. Anstadt ◽  
Richard P. Gonzalez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Primary Repair ◽  
Perioperative Complications ◽  
Primary Anastomosis ◽  
Data Bank ◽  
Colon Resection ◽  
Colon Injury

Previous literature demonstrates the safety of primary repair in penetrating colon injury requiring resection, without the creation of a diverting ostomy. It is unknown whether a similar approach can be applied to patients with blunt colon injury. The aim of this study was to measure outcomes in patients who underwent colon resection with and without ostomy creation after blunt trauma injury to help direct future management. Using the National Trauma Data Bank for years 2008 to 2012, we identified patients with blunt trauma mechanisms who underwent colectomy. Patients were stratified into two groups: primary anastomosis and diversion with ostomy. Primary outcome was inpatient mortality. Secondary outcomes included length of stay and perioperative complications. All risk-adjusted analyses were performed using logistic regression with consideration of interactions. Five hundred eighty-one observations met our inclusion criteria. Baseline characteristics between the two groups were similar with the exception of age (37.3 vs 42.2 years, P < 0.001) and admission Glasgow coma score (13.2 vs 12.1, P = 0.002). Risk-adjusted mortality for the two groups was not statistically significant (2.3% vs 3.0%, P = 0.63); however, patients with primary anastomosis had a shorter length of stay (18.2 vs 28.1, P < 0.001), fewer days in the intensive care unit (10.9 vs 16.2, P < 0.001), and fewer ventilator days (10.5 vs 14.6, P = 0.01). In patients requiring colon resection after blunt trauma, mortality is not different for those who receive a primary anastomosis versus ostomy. Patients without diversion had shorter hospital stays, intensive care unit days, and ventilator days. These data support that primary anastomosis is safe in this patient population.

scholarly journals Design and Performance Evaluation of a Distributed OFDMA-Based MAC Protocol for MANETs

2014 ◽  
Vol 2014 ◽  
pp. 1-15
Author(s):  
Jaesung Park ◽  
Jiyoung Chung ◽  
Hyungyu Lee ◽  
Jung-Ryun Lee
Keyword(s):  
Resource Management ◽  
Success Rate ◽  
Data Transmission ◽  
Ad Hoc ◽  
Mac Protocol ◽  
Resource Reservation ◽  
Frame Structure ◽  
Management Problem ◽  
Distributed Mac ◽  
Logical Errors

In this paper, we propose a distributed MAC protocol for OFDMA-based wireless mobile ad hoc multihop networks, in which the resource reservation and data transmission procedures are operated in a distributed manner. A frame format is designed considering the characteristics of OFDMA that each node can transmit or receive data to or from multiple nodes simultaneously. Under this frame structure, we propose a distributed resource management method including network state estimation and resource reservation processes. We categorize five types of logical errors according to their root causes and show that two of the logical errors are inevitable while three of them are avoided under the proposed distributed MAC protocol. In addition, we provide a systematic method to determine the advertisement period of each node by presenting a clear relation between the accuracy of estimated network states and the signaling overhead. We evaluate the performance of the proposed protocol in respect of the reservation success rate and the success rate of data transmission. Since our method focuses on avoiding logical errors, it could be easily placed on top of the other resource allocation methods focusing on the physical layer issues of the resource management problem and interworked with them.

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