scholarly journals Factors Associated with Development of in Coronary Stent Restenosis — the Results of a Multislice Computed Tomography 1-year Follow-up Study

2016 ◽  
Vol 1 (1) ◽  
pp. 37-41
Author(s):  
Laura Jani ◽  
András Mester ◽  
Alexandra Stănescu ◽  
Sebastian Condrea ◽  
Monica Chiţu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Primary Pci ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Introduction: Percutaneous coronary intervention is the first therapeutic choice in the treatment of symptomatic coronary artery disease and Multi-Slice Computed Tomography Coronary Angiography (MSCT-CA) is a new non-invasive diagnostic tool in the follow-up of these patients. The aim of our study was to evaluate the rate of in-stent restenosis (ISR), to identify the predictive factors for ISR at 1 year after PCI and to assess the progression of non-culprit lesions, using a MSCT-CA follow-up. Material and methods: The study included 30 patients with acute coronary syndrome treated with one BMS implantation. The patients were divided into Group A (9 patients) presenting ISR and Group B (21 patients) without ISR at 1 year MSCT-CA follow-up. Results: ISR lesions were mostly localized on the LAD (45%). No significant difference between the study groups was identified for risk factors, as male gender (77.7% vs. 85.71%, p = 0.62), hypertension (88.8% vs. 95.23%, p = 0.51), smoking status (33.3% vs. 72.22%, p = 0.23), history of CVD (55.5% vs. 47.61%, p >0.99), diabetes (11.11% vs. 19.04%, p >0.99), hyperlipidemia (22.22% vs. 52.38%, p = 0.22), CKD (44.44% vs. 14.28%, p = 0.15), age, triglycerides and SYNTAX Score. A significant difference was recorded in baseline cholesterol level (141.7 ± 8.788 vs. 182.8 ± 12; p = 0.029). Ca Score at 1 year was significantly higher in patients with ISR (603.1 ± 529.3 vs. 259.4 ± 354.6; p = 0.005). 66.67% of patients from Group A presented significant non-culprit lesions at baseline vs. 23.81% in Group B (p = 0.041). Conclusions: MSCT-CA is a useful non-invasive diagnostic tool for ISR in the follow-up of patients who underwent primary PCI for an acute coronary syndrome. The presence of significant non-culprit lesions at the time of the primary PCI could be a predictive factor for ISR. A Ca Score >400 determined at 1-year follow-up is associated with a higher rate of ISR, and could be considered a significant cardiovascular risk factor for this group of patients. Further studies are required in order to elucidate the role of various imaging biomarkers in predicting the development of ISR.

scholarly journals P1269 Relationship between left ventricle mass index and abdominal obesity in patients with metabolic syndrome hospitalized due to acute coronary syndrome

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Furman-Niedziejko ◽  
P Rostoff ◽  
I Palka ◽  
M Golonka ◽  
K Golinska-Grzybala ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Acute Coronary Syndrome ◽  
Waist Circumference ◽  
Abdominal Obesity ◽  
Left Ventricle Mass ◽  
Coronary Syndrome ◽  
Diagnosis Group ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background There is evidence that metabolic syndrome (MS), as a cluster of acute coronary syndrome (ACS) risk factors, is associated with increased left ventricle mass index (LVMI). According to the 2009 IDF criteria of MS diagnosis, elevated waist circumference (≥94 cm in M, ≥80 cm in F), as a determinant of abdominal obesity (AO), is not an obligatory component of MS. Little is known about the relation of abdominal obesity to LVMI in pts with ACS. Purpose The aim of this study was to evaluate the relationship between abdominal obesity and LVMI, determined as LVM/H2,7, in patients with MS hospitalized due to ACS. Methods 444 consecutive pts were enrolled based on ACS diagnosis. The pts were divided into two groups depending on MS diagnosis: group A – 310 pts with MS and AO (205 M, mean age 63.3 ± 10.5 yrs), group B - 134 pts without MS (101 M, mean age 61,4 ± 12.7 yrs). The group A was divided to two subgroups depending on AO diagnosis: group A1 - 288 pts with MS and AO (185 M, mean age 63.4 ± 10.2 yrs and group A2 - 22 pts with MS without AO (19 M, mean age 62,6 ± 12.7 yrs). In all enrolled pts hypertension was diagnosed. Results A significant difference was found between group A and B with the respect to LVMI (68.4 ± 25.9 vs. 58.3 ± 16.5, p < 0.05). In the group B, a significant association was found between LVMI and waist circumference (r = 0.39, p < 0.05), weight (r = 0.22, p = 0.012), as well as BMI (r = 0.35, p < 0.05). In group A, LVMI was significantly correlated only with weight (r = 0.24, p < 0.05). No significant differences were found between pts with AO and without AO with respect to LVMI (68.9 ± 26.2 vs. 61.4 ± 20.9, p = 0.187). Conclusion 1. In individuals without MS hospitalized due to acute coronary syndrome significant positive correlation was found between LVMI and waist circumference, weight as well as BMI. 2. There is significant difference between pts with MS and without MS with the respect to LVMI. 3. No significant differences were found in LVMI between pts with AO and without AO.

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Redfern ◽  
K Hyun ◽  
D Brieger ◽  
D Chew ◽  
J French ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Data Linkage ◽  
Research Network ◽  
Funding Source ◽  
Cardiovascular Research ◽  
Coronary Syndrome ◽  
Follow Up Study ◽  
Significant Difference

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

2021 ◽  
pp. 1-11
Keyword(s):  
Scale Score ◽  
Neck Disability Index ◽  
Implant Removal ◽  
Odontoid Fractures ◽  
Significant Difference ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

scholarly journals Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hwa Jun Kang ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Sungwook Kim ◽  
Mao Yuan Sun
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Fixation Method ◽  
Kirschner Wires ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

scholarly journals COMPARISON STUDY OF IVABRADINE WITH METOPROLOL IN MANAGEMENT OF ACUTE CORONARY SYNDROME

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Rishman Tandi ◽  
Tanvi Kumar ◽  
Amritpal Singh Kahlon ◽  
Aaftab Sethi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Coronary Syndrome ◽  
Group A ◽  
Group B

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed.   Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

scholarly journals A study to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT 380A in Indian women at a premier hospital in New Delhi, India

2017 ◽  
Vol 6 (9) ◽  
pp. 3992 ◽  
Author(s):  
Mansi Kumar ◽  
Mahesh Kumar ◽  
Parul Aggarwal ◽  
Archna Gangania ◽  
Rupali Dewan
Keyword(s):  
Removal Rate ◽  
New Delhi ◽  
Contraceptive Device ◽  
Indian Women ◽  
Significant Difference ◽  
Group A ◽  
Post Placental ◽  
Group B ◽  
Continuation Rates

Background: The Study was planned to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT380A in Indian women at Safdarjung Hospital New Delhi, after approval was obtained from Institutional Ethical committee.Methods: Study group consisted of 300 women, divided into two groups: Group A and Group B. The data was analysed by using ‘student “t” test/ non-parametric ‘Wilcoxon Mann Whitney’ for quantitative variables to evaluate the safety, efficacy and acceptability.Results: Mean age was 24.99 years (range: 19-35years), All women were married (off which 64% literate) and Mean parity in group A was 1.97 and 2.06 in group B. Mean pain score during intrauterine contraceptive device (IUCD) insertion on visual analogue scale was 2.93 in group A and 3 in group B and was not statistically different. 84% women completed 12 months follow up in group A and 83.33% women in group B. Strings were visible in 74% women in group A and in 34% women in group B at 1 month of IUCD insertion. Visibility of strings increased in successive follow up visits and was visible in >80% of women at the end of one year in the both groups. String visibility after intra-Caesarean insertion was delayed. Fifty one percent (n=77) subjects in group A and 54% (n=81) in group B experienced amenorrhea up to six months. Menorrhagia was reported in 7.33% in group A and women 8.66% in group B at the end of 1 year of follow up. Pain was complained by 26 out of 150 (17.3%) women in group A as compared to 36 out of 150 (24%) women in group B after 1 month of insertion. There was no case of PID in group A whereas there were 3 cases of PID in group B. There was no perforation/trauma and pregnancy in either group.Conclusions: Overall expulsion rate was 13% and removal rate was 5% in our study. Continuation rate was 83.3% in Cu 375 and 80.6% in CuT380A at 12 months. There was no significant difference between the IUCDs regarding the safety, efficacy and complications such as expulsion, bleeding etc.

STUDY ON EVALUATION OF SERUM GAMMA-GLUTAMYL TRANSFERASE (GGT) LEVELS IN ACUTE CORONARY SYNDROME

2021 ◽  
pp. 39-40
Author(s):  
Avtar Singh Dhanju ◽  
Deepshikha Singla ◽  
Pashaura Singh ◽  
Ajay Chhabra ◽  
Sukhraj Kaur
Keyword(s):  
Acute Coronary Syndrome ◽  
Cross Sectional Study ◽  
Gamma Glutamyl Transferase ◽  
Cross Sectional ◽  
Gamma Glutamyl ◽  
Coronary Syndrome ◽  
Healthy Control ◽  
Group A ◽  
Group B ◽  
Glutamyl Transferase

Aim: The present study was undertaken with the aim to evaluate serum Gamma Glutamyl Transferase (GGT) levels in patients of acute coronary syndrome. Methodology: This cross-sectional study was conducted on 50 cases with acute coronary syndrome (Group A) and 50 healthy control subjects (Group B) meeting inclusion and exclusion criteria. Results: There is signicant rise in serum GGT levels in patients presenting with ACS in Group A as compared to Group B. Conclusion: Higher levels of GGT in ACS patients with risk factors such as hypertension, dyslipidemia and smoking may serve as biomarker to predict the occurrence of ACS.

Comparison of the Effects of Two Different Hollow Nails in the Treatment of the Young Pauwels Type Ⅲ Femoral Neck Fractures

2021 ◽  
Author(s):  
WENJING CHENG ◽  
GUOZHENG - DING
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Avascular Osteonecrosis ◽  
Significant Difference ◽  
Group A ◽  
Random Number Table ◽  
Screw Withdrawal ◽  
Group B

Abstract Background: At present, there is a higher complication rate after treatment of femoral neck fractures with three parallel hollow nails (PHN) in the young Pauwels type Ⅲ femoral neck fractures.For better effect,F-shape hollow nails(FHN) is used to treat femoral neck fractures.The purpose of this study is to compare the clinical efficacy of FHN and PHN and provide reference for clinical application.Methods: Thirty-eight consecutive patients admitted from January 2017 to January 2020 were selected for the study. According to random number table method, the patients were divided into two groups:group A (FHN) and group B (PHN). The gender, age, BMI, comorbidities, time from injury to operation and other general preoperative demographics were not statistically different (P>0.05). The data of the two groups can be comparable.The occurrence of avascular osteonecrosis of the femoral head (AVN), femoral neck shortening, hollow screw withdrawal was recorded in follow-up.Then, Harris hip score (HHS), pain visual analog score (VAS) of two group were obtained at the last follow-up. Results: The mean follow-up period after surgery was 21.4±10.1 (range, 14–29) months. There were 18 cases(mean age, 47.5±9.6) in group A, 20 cases (mean age, 48.6±10.1) in group B. There was no significant difference between the two groups in AVN, femoral neck shortening (P>0.05), the two groups had statistically significant differences in screw withdrawal (F=4.416, P<0.05). There was no significant difference in HHS and VAS between the two groups at the last follow-up (P>0.05).Conclusion: Three parallel hollow nails (PHN) and F-shape hollow nails (FHN) have similar short-term effects in the young Pauwels type Ⅲ femoral neck fractures, but the nail withdrawal rate of FNH is lower.

A PROSPECTIVE CONSIDERATIONS AND COMPARATIVE EFFICACY BETWEEN IVABRADINE VS BETA BLOCKERS IN SOUTH INDIAN ACUTE CORONARY SYNDROME PATIENTS

2019 ◽  
pp. 193-195
Author(s):  
Hemanth Kumar Lekkala
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Beta Blockers ◽  
Statistical Significance ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Nyha Classification ◽  
South Indian ◽  
Group A ◽  
Group B

Objectives: the objective of this study was to assess the role of heart rate in acute coronary syndrome with reduced ejection fraction, to assess contraindications for beta blockers, to assess the tolerability between Ivabradine and Beta-Blockers, to assess efficacy between Ivabradine and Beta Blockers, to assess patient condition according to NYHA classification. Methods: A Prospective observational study was conducted for a duration of6 months Study population includes 100 patients in which Group A-50, Group B-50. We were selected the subjects according to inclusion and exclusion criteria. The patients were classified in one of four categories based on their symptoms in regards to normal breathing and varying degrees in shortness of breath by using (The New York Heart Association) NYHA Classification. Results: Majority of the patients were in age group between (55-64)(32%) years of age are highly affected with ACS. Prevalence of ACS is high in Rural (56%). Both drugs decreased the mean heart rate to 89.97±10.27 (Group-A) versus 86.76±13.14 (Group-B) beats per minute (P=0.24). The result obtained are clinically and statistically significant with statistical significance at P>0.05. Conclusion:  In the present study we considered and compared the efficacy between Ivabradine and Beta Blockers in south Indian acute coronary syndrome patients shows Ivabradine is as effective as betablockers in reduction of heart rate.    

Treatment of Major Laparoscopic Bile Duct Injury: A Long-Term Follow-up Result

2011 ◽  
Vol 77 (12) ◽  
pp. 1584-1588 ◽  
Author(s):  
Xiao Dong Xu ◽  
You Cheng Zhang ◽  
Pen Gao ◽  
Farah Bahrani-Mougeot ◽  
Ling Yi Zhang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Tertiary Care ◽  
Secondary Operation ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Group D

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.

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