Retrospective Review of Patients Operated on with Bilateral Cleft Lip through Surgical Outreaches in Kenya

This was a study to evaluate the characteristics and outcome of patients operated on with bilateral cleft lip through surgical outreach programs in Kenya between January 2006 and December 2011. Files for fifty-nine patients operated on during the study period were evaluated. The mean age for surgery was ten months with about forty-five percent of the patients more than one year of age. No presurgical orthopaedic devices were utilized on any of the patients. Mulliken surgical technique and the Manchester technique were the commonest surgical techniques in equal proportions. An overall complication rate of about 7.5 percent was noted. In conclusion we noted a delay in the surgical management of the majority of our patients. This resulted in a backlog of cases. There is thus a need to intensify more surgical outreach camps as well as training more surgeons to assist in the management of clefts. Cleft surgery is a relatively safe surgery that could be carried out in relatively remote centers through surgical outreach programs. This was evidenced by the low complication rates in our series.

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Cleft Lip Repair

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0049 ◽

2019 ◽

pp. 503-518

Author(s):

Samuel Lance ◽

Catherine Tsai ◽

Amanda Gosman

Keyword(s):

Surgical Technique ◽

Plastic Surgery ◽

Clinical Evaluation ◽

Postoperative Care ◽

Cleft Lip ◽

Surgical Techniques ◽

Bilateral Cleft Lip ◽

Cleft Lip Repair ◽

Rotation Advancement

Understanding the anatomy and surgical technique for repair of the unilateral and bilateral cleft lip remain essential to the practice of plastic surgery. This chapter summarizes the relevant anatomy, clinical evaluation, surgical technique, and postoperative care of the cleft lip patient. Step-by-step surgical descriptions and illustrations are provided along with commentary regarding common pitfalls encountered with these techniques. The surgical techniques described are a modified Millard rotation advancement technique for repair of the unilateral cleft lip and a modified Byrd repair for correction of the bilateral cleft lip.

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Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

Urologia Internationalis ◽

10.1159/000517787 ◽

2021 ◽

pp. 1-8

Author(s):

Przemysław Adamczyk ◽

Paweł Pobłocki ◽

Mateusz Kadlubowski ◽

Adam Ostrowski ◽

Witold Mikołajczak ◽

...

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Complication Rate ◽

Tnm Stage ◽

Complication Rates ◽

Open Approach ◽

Invasive Approach ◽

Asa Score

Purpose: This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. Methods: A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). Results: The surgical technique was significantly related to the number of complications (p < 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (p < 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (p < 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. Conclusions: The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

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Other Scar Types: Optimal Functional and Aesthetic Outcome of Scarring in Cleft Patients

Textbook on Scar Management ◽

10.1007/978-3-030-44766-3_7 ◽

2020 ◽

pp. 51-57

Author(s):

Wouter B. van der Sluis ◽

Nirvana S. S. Kornmann ◽

Robin A. Tan ◽

Johan P. W. Don Griot

Keyword(s):

Surgical Technique ◽

Psychosocial Functioning ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Surgical Techniques ◽

Anatomical Structures ◽

Patient Dissatisfaction ◽

Optimal Function ◽

Scar Management

AbstractCleft lip and palate are facial and oral malformation due to failures in the embryologic craniofacial development during early pregnancy. A unilateral cleft lip and palate is the most common type, whereby the upper lip, the orbicularis muscle, the alveolar bone, the floor of the nose, and the hard and soft palate are interrupted, creating an open communication between nasopharynx and oropharynx. Patients with a cleft lip and palate are treated in specialized cleft centers by a multidisciplinary team. Having cleft lip and/or palate has a noteworthy impact on quality of life and psychosocial functioning. Postoperative scarring is a common cause of patient dissatisfaction. The goal of cleft lip surgery is to close the lip, provide optimal function in terms of speech, mastication, dental protection, breathing and feeding, and provide an aesthetically pleasing facial scar. Precise surgical technique and adequate aligning of anatomical structures is important for the postoperative aesthetic result and scar formation. Different surgical techniques are available for this purpose. Optimal scar management can be divided in surgical (precise surgical technique, planning, and adequate aligning of anatomical structures) and nonsurgical methods (botulinum toxin, silicone application, carbon dioxide fractional laser).

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Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1668149 ◽

2018 ◽

Vol 29 (01) ◽

pp. 033-038 ◽

Cited By ~ 4

Author(s):

M. Klora ◽

J. Zeidler ◽

S. Eberhard ◽

S. Bassler ◽

S. Mayer ◽

...

Keyword(s):

Surgical Technique ◽

Ureteropelvic Junction Obstruction ◽

Length Of Hospital Stay ◽

Ureteropelvic Junction ◽

Treatment Modalities ◽

Complication Rates ◽

Laparoscopic Pyeloplasty ◽

Small Children ◽

The Mean ◽

Open Pyeloplasty

Introduction Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany. Materials and Methods Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year. Results A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty. Conclusion In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

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Total elbow arthroplasty in the United States: evaluation of cost, patient demographics, and complication rates

Orthopedic Reviews ◽

10.4081/or.2016.6113 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 17

Author(s):

Hanbing Zhou ◽

Nathan D. Orvets ◽

Gabriel Merlin ◽

Joshua Shaw ◽

Joshua S. Dines ◽

...

Keyword(s):

United States ◽

Direct Cost ◽

Complication Rate ◽

Readmission Rate ◽

The United States ◽

Total Elbow Arthroplasty ◽

Complication Rates ◽

Patient Demographics ◽

Elbow Arthroplasty ◽

The Mean

Total elbow arthroplasty (TEA) is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated inpatient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS), hospital direct cost, inhospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female) with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers) in the United States. The racial demographics included 2334 (74%) Caucasian, 285 (9%) black, 236 (7.5%) Hispanic, 16 (0.5%) Asian, and 283 (9%) other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%), re-operation (0.5%), and infection (0.4%). The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries.

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Use of the Modified Unilateral Cleft Lip Repair Technique to Establish a Cupid’s Bow With a Natural Structure

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620962364 ◽

2020 ◽

pp. 105566562096236

Author(s):

Tatsuya Ishigaki ◽

Akikazu Udagawa

Keyword(s):

Surgical Technique ◽

Cleft Lip ◽

Surgical Techniques ◽

Lateral Side ◽

Natural Structure ◽

Repair Technique ◽

Triangular Flap ◽

Cleft Lip Repair ◽

Unilateral Cleft Lip Repair ◽

Projection Point

Introduction: There are several surgical techniques for unilateral cleft lip repair. In most of these techniques, the points where the postoperative scars cross the vermilion border are on the peak of the Cupid’s bow. These scars make the shape of Cupid’s bow indistinct. To maintain the natural shape of the Cupid’s bow, we modified the surgical technique. Methods: We modified the modified Millard’s surgical technique (Onizuka’s surgical technique). The main point of this modification was as follows: we combined a small triangular flap and a vermilion triangular flap (described by Noordhoff). We maintained the projection point on the lateral side of cleft lip which was coordinated to the peak of the Cupid’s bow. Results: We could preserve the shape and symmetry of the peak of the Cupid’s bow. Conclusion: To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.

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Arthroscopic iliopsoas tenotomies: a systematic review of surgical technique and outcomes

Hip International ◽

10.1177/1120700020970519 ◽

2020 ◽

pp. 112070002097051

Author(s):

Remy Coulomb ◽

Bastien Nougarede ◽

Etienne Maury ◽

Philippe Marchand ◽

Olivier Mares ◽

...

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Complication Rate ◽

Data Extraction ◽

Central Compartment ◽

Direct Access ◽

Cochrane Library ◽

Complication Rates ◽

Lesser Trochanter ◽

Loss Of Strength

Purpose: To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA). Methods: A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated. Results: Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication. Conclusions: Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.

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Incidence of Bilateral Cleft Lip And Palate In A University Hospital Setting-A Retrospective Study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl3.2945 ◽

2020 ◽

Vol 11 (SPL3) ◽

pp. 363-367

Author(s):

Monisha K ◽

Senthil Murugan P ◽

Aravind Kumar

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Hospital Setting ◽

Neck Region ◽

University Hospital ◽

High Prevalence ◽

Bilateral Cleft Lip ◽

Male Patients ◽

One Year

Cleft lip and palate (CLP) is one of the most prevalent malformations occurring in the head and neck region. Cleft lip and palate is the second most birth defect in the US after club foot. The incidence of Cleft lip and cleft palate is also very common in Indian Population with the rate of 1 in 700 births approximately. In India, the main reason for the formation of Cleft Lip and cleft palate is consanguineous marriage due to less awareness among people. Cleft lip can be unilateral or bilateral and may involve or palate. Again it can be further classified as Complete or Incomplete cleft lip and /or Cleft palate. Most of the patients were deprived of treatment, mainly due to their unawareness and their lower status. Cleft patients need comprehensive, cleft care management. So the aim of this study is to find the incidence of bilateral cleft lip or palate in patients who reported toSaveetha Dental College and Hospital, Chennai. This study is done with 76 patients40 males, 36 females)who visited a Saveetha Dental College during one year between June 2019-April 2020. All available data were extracted from patients case sheets and results were obtained through SPSS analysis. In this study, we observed that 90.5 % of patients reported with unilateral cleft lip and palate, where only 9.1% of patients reported with bilateral cases. Males were having high prevalence with 52.6 % and females 47.4%. conclusion, male patients had higher cleft lip and palate compared to females. The incidence of bilateral cases seen among cleft lip and palate is fewer in males.

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Cranioplasty following decompressive craniectomy – Analysis of complication rates and neurological outcomes: A single center study

Surgical Neurology International ◽

10.25259/sni_29_2019 ◽

2019 ◽

Vol 10 ◽

pp. 142 ◽

Cited By ~ 2

Author(s):

Saraj Singh ◽

Rakesh Singh ◽

Kapil Jain ◽

Bipin Walia

Keyword(s):

Decompressive Craniectomy ◽

Complication Rate ◽

Neurological Outcome ◽

Simple Procedure ◽

Surgical Techniques ◽

Bone Flap ◽

Intracerebral Hematoma ◽

Complication Rates ◽

Good Neurological Outcome ◽

Second Surgery

Background:Cranioplasty is the surgical intervention to repair cranial defects in both cosmetic and functional ways. Despite the fact that cranioplasty is a simple procedure, it is still associated with a relatively high complication rate, ranging between series from 12% to 50%.Methods:The author did a prospective cohort study of patients from August 2015 to December 2017, who had undergone decompressive craniectomy followed by cranioplasty after 6 weeks at our institution. All patients were followed up to 6 months after cranioplasty and complications were recorded both by imaging and clinically. The complications were classified as minor (subgaleal collection, seizures) who did not require the second surgery and major (hydrocephalus, bone flap infection) who required the second surgery. To find out neurological outcome, Glasgow coma score (GCS) and Glasgow outcome scale extended (GOSE) were recorded at 1 month, 3 months, and 6 months.Results:Overall complication rate in this study was 22.4% (16/72). Subgaleal collection was the most common complication (5.6%), followed by hydrocephalus (4.2%), seizure (4.2%), bone flap infection (2.8%), intracerebral hematoma (2.8%), empyema (1.4%), and subdural hematoma (SDH) (1.4%). Of these, 8.4% (n= 6/72) were major complication (hydrocephalusn= 3, bone flap infectionn= 2, and SDHn= 1) which required the second surgery. GCS and GOSE were assessed preoperatively and in postoperative period at 1 month, 3 months, and 6 months. Both mean values of GCS and GOSE showed a significant improvement at 3 and 6 months after cranioplasty.Conclusion:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications.Key Message:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications. However, complications rate can be brought down by meticulous timing of cranioplasty in a patient of well-controlled comorbidities and precise surgical techniques. However, storing bone in bone bank is not an additional factor for any postcranioplasty complications which was considered previously.

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Outcomes with gold wire and hydroxyapatite partial ossicular replacement prostheses in type 2 tympanoplasty: a preliminary study

The Journal of Laryngology & Otology ◽

10.1017/s0022215114003387 ◽

2015 ◽

Vol 129 (2) ◽

pp. 142-147 ◽

Cited By ~ 1

Author(s):

H Katilmis ◽

M Songu ◽

H Aslan ◽

Y Ozkul ◽

S Basoglu ◽

...

Keyword(s):

Bone Conduction ◽

Chronic Otitis Media ◽

Gold Wire ◽

Complication Rates ◽

Graft Take ◽

Ossicular Replacement ◽

The Mean ◽

One Year ◽

Replacement Prosthesis

AbstractObjectives:To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media.Method:This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted.Results:The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group (p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group (p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively (p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively (p = 0.687).Conclusion:The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.

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