scholarly journals Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

2021 ◽  
Vol 48 (3) ◽  
pp. 261-268
Author(s):  
Nandita Melati Putri ◽  
Narottama Tunjung ◽  
Patricia Marcellina Sadikin
Keyword(s):  
Retrospective Study ◽  
Operative Time ◽  
Defect Size ◽  
Island Flap ◽  
Defect Closure ◽  
Type Iii ◽  
Type Iv ◽  
Major Complications ◽  
Average Operative Time ◽  
Average Defect

Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap.Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps.Results The median age of the patients at surgery was 10.5 days (range, 1–369 days) and the average defect size was 22.5 cm2 (range, 7.1–55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45–120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects.Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.

scholarly journals Laparoscopic management of appendicular lump

2020 ◽  
Vol 7 (9) ◽  
pp. 3065
Author(s):  
Manoj Kumar Chaudhary ◽  
Mrinal Shankar ◽  
Tridip Dutta Baruah ◽  
Rubik Ray ◽  
Shubham Samal
Keyword(s):  
Retrospective Study ◽  
Learning Curve ◽  
Treatment Cost ◽  
Operative Time ◽  
Site Infection ◽  
Early Recovery ◽  
Operative Complications ◽  
Average Operative Time ◽  
Laparoscopic Intervention ◽  
Time Of Admission

The surgical management of an appendicular lump remains controversial. With the revolution and advancement of laparoscopic instrumentation and technical learning curve, it is possible to remove an inflamed appendix in presence of lump. This retrospective study was performed between August 2018 and August 2019 in AIIMS Raipur, 86 patients were treated for appendicitis laparoscopically, in these 14 patients had appendicular lump at the time of admission. 12 patients (total 14; 2 patients were excluded) underwent laparoscopic intervention for appendicular lump. Average operative time were 90 minutes. Average post-operative hospital stay were 5 days. Post-operative complications were seen in 2 patients (surgical site infection). In histopathology report, appendicular inflammation suggestive of appendicitis were present in all operated cases. We conclude, early laparoscopic appendectomy confirms the diagnosis. It is safe and feasible in patients with appendicular lump. It reduces the treatment cost, early recovery and satisfactory overall outcome.

scholarly journals Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

2021 ◽  
Vol 8 (1) ◽  
pp. 30-37
Author(s):  
Narottama Tunjung ◽  
Nandita Melati Putri
Keyword(s):  
Retrospective Study ◽  
Operative Time ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complete Healing ◽  
Type Iv ◽  
Pressure Injury ◽  
The Mean ◽  
The Right ◽  
Thorough Debridement

Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

scholarly journals Trans-urethral bladder suture in female patients: Not a tour de force but a quick and realistic answer to complex situations

2021 ◽  
pp. 039156032110011
Author(s):  
Fanourios Georgiades ◽  
Chryssanthos Kouriefs ◽  
Jonathan Makanjuola ◽  
Philippe Grange
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Laser Lithotripsy ◽  
Defect Closure ◽  
Management Options ◽  
Mattress Suture ◽  
Needle Holder ◽  
Effective Option ◽  
Average Operative Time

Introduction: Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible. Methods: Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle. Results: The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases. Conclusions: We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.

scholarly journals Plastic Surgery Techniques for the Improvement of Outcomes of Complex Obstetric Fistula Repairs

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Rachel Pope ◽  
Mary Stokes ◽  
Chisomo Chalamanda ◽  
Jeffrey Wilkinson
Keyword(s):  
Operative Time ◽  
Obstetric Fistula ◽  
Muscle Flap ◽  
Gracilis Muscle ◽  
Tissue Loss ◽  
Type Iii ◽  
Improved Outcomes ◽  
Estimated Blood Loss ◽  
Average Operative Time ◽  
Type 3

Background: As part of a larger study on the outcomes of obstetric fistula surgery, a review on patient outcomes when using gracilis muscle and/or Singapore flaps was conducted. Methods: The database queried includes over 1700 patients. Fifty-five cases were identified having had either a gracilis muscle and or a Singapore flap as part of the repair. Results: Twenty-one patients had a Singapore flap only. Median age was 26 years (19-55), four had one prior repair and two had two prior repair attempts. Nine cases were Goh type 3 and nine were Goh type 4 indicating urethral involvement. 71% (n=15) were >3 centimeters in diameter. Median estimated blood loss (ebl) was 200 ml and average OR time was 2.5 hours. Median catheter duration 17 days (13-25). 81% (n=17) were dye test negative, with an average pad weight of 19.2 grams. 19 patients had a gracilis muscle flap alone with median age of 43 (23-70). Four had one previous repair, one had four previous repairs. Nine were Goh type 3 and eight were Goh type 4. 70% (n=12) had a fistula >3 cm in diameter and 88% (n=15) had type iii considerations (previous repair attempt, circumferential, or severe scarring). Median ebl was 250 ml and average operative time was two hours and 30 minutes. Median catheter duration was 17 days (14-31). 82% (n=14) had negative dye tests, with average pad weight of 19 grams. 16 patients had both a Singapore and a gracilis. Median age was 31 (15-70), nine were Goh type 3, seven were Goh type 4. 87.5% (n=14) had a fistula that was more than 3 cm in diameter and 87.5% (n=14) were type iii. Median ebl was 300 ml (250-1000 ml), and average operative time was 3 hours and 45 minutes. 81% (n=13) had a negative dye test, with two patients going home positive and returning negative over the course of four months. Average pad weight was 18.9 grams. Conclusion: For large fistulas with a significant amount of vaginal tissue loss, the Singapore flap is a potential option for improved outcomes. For recurrent cases and those with poor quality tissue, the gracilis muscle may lead to overall improved outcomes. Overall, these techniques are useful for complex obstetric fistula cases where outcomes are generally less favorable. Further prospective studies are needed.

scholarly journals Plastic Surgery Techniques for the Improvement of Outcomes of Complex Obstetric Fistula Repairs

2018 ◽  
Vol 13 (2) ◽  
pp. 41-43
Author(s):  
Rachel Pope ◽  
Mary Stokes ◽  
Roger H. Brown ◽  
Chisomo Chalamanda ◽  
Larry H. Hollier ◽  
...  
Keyword(s):  
Operative Time ◽  
Obstetric Fistula ◽  
Muscle Flap ◽  
Gracilis Muscle ◽  
Tissue Loss ◽  
Type Iii ◽  
Improved Outcomes ◽  
Estimated Blood Loss ◽  
Average Operative Time ◽  
Type 3

Aims: As part of a larger study on the outcomes of obstetric fistula surgery, a review on patient outcomes when using gracilis muscle and/or Singapore flaps was conducted. Methods: The database queried includes over 1700 patients. Fifty-six cases were identified having had either a gracilis muscle and or a Singapore flap as part of the repair. Results: Twenty-one patients had a Singapore flap only. Median age was 26 years (19-55), four had one prior repair and two had two prior repair attempts. Nine cases were Goh type 3 and nine were Goh type 4 indicating urethral involvement. 71% (n=15) were >3 centimeters in diameter. Median estimated blood loss (ebl) was 200 ml and average OR time was 2.5 hours. Median catheter duration 17 days (13-25). 81% (n=17) were dye test negative, with an average pad weight of 19.2 grams. 19 patients had a gracilis muscle flap alone with median age of 43 (23-70). Four had one previous repair, one had four previous repairs. Nine were Goh type 3 and eight were Goh type 4. 70% (n=12) had a fistula >3 cm in diameter and 88% (n=15) had type iii considerations (previous repair attempt, circumferential, or severe scarring). Median ebl was 250 ml and average operative time was two hours and 30 minutes. Median catheter duration was 17 days (14-31). 82% (n=14) had negative dye tests, with average pad weight of 19 grams. 16 patients had both a Singapore and a gracilis. Median age was 31 (15-70), nine were Goh type 3, seven were Goh type 4. 87.5% (n=14) had a fistula that was more than 3 cm in diameter and 87.5% (n=14) were type iii. Median ebl was 300 ml (250-1000 ml), and average operative time was 3 hours and 45 minutes. 81% (n=13) had a negative dye test, with two patients going home positive and returning negative over the course of four months. Average pad weight was 18.9 grams.  Conclusions: For large fistulas with a significant amount of vaginal tissue loss, the Singapore flap is a potential option for improved outcomes. For recurrent cases and those with poor quality tissue, the gracilis muscle may lead to overall improved outcomes. Overall, these techniques are useful for complex obstetric fistula cases where outcomes are generally less favorable. Further prospective studies are needed.

Labelling of non-A, non-B hepatitis infected chimpanzee hepatocytes with nuclease-gold conjugates

1984 ◽  
Vol 42 ◽  
pp. 250-251
Author(s):  
G. D. Gagne ◽  
M. F. Miller ◽  
D. A. Peterson
Keyword(s):  
Endoplasmic Reticulum ◽  
Experimental Infection ◽  
Uranyl Acetate ◽  
Type I ◽  
Cellular Injury ◽  
Type Ii ◽  
Tubular Structures ◽  
Type Iii ◽  
Type Iv ◽  
Infected Chimpanzee

Experimental infection of chimpanzees with non-A, non-B hepatitis (NANB) or with delta agent hepatitis results in the appearance of characteristic cytoplasmic alterations in the hepatocytes. These alterations include spongelike inclusions (Type I), attached convoluted membranes (Type II), tubular structures (Type III), and microtubular aggregates (Type IV) (Fig. 1). Type I, II and III structures are, by association, believed to be derived from endoplasmic reticulum and may be morphogenetically related. Type IV structures are generally observed free in the cytoplasm but sometimes in the vicinity of type III structures. It is not known whether these structures are somehow involved in the replication and/or assembly of the putative NANB virus or whether they are simply nonspecific responses to cellular injury. When treated with uranyl acetate, type I, II and III structures stain intensely as if they might contain nucleic acids. If these structures do correspond to intermediates in the replication of a virus, one might expect them to contain DNA or RNA and the present study was undertaken to explore this possibility.

LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

2018 ◽  
Vol 8 (4) ◽  
pp. 76-80
Author(s):  
Thao Nguyen Minh ◽  
Vu Pham Anh ◽  
Tri Nguyen Huu ◽  
Phu Nguyen Doan Van ◽  
Phuc Nguyen Thanh ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Bilateral Hernia ◽  
Repair Method ◽  
Tapp Repair ◽  
Post Operation ◽  
Average Operative Time ◽  
The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

2020 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Operative Time ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Asa Score

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

scholarly journals A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze-hang Zheng ◽  
Fei Xu ◽  
Zheng-qiang Luo ◽  
Ye Ren ◽  
Tao Fu ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pelvic Fracture ◽  
Operative Time ◽  
Screw Placement ◽  
Screw Insertion ◽  
Average Operative Time ◽  
Free Hand Technique ◽  
Point To Point ◽  
Postoperative Fracture

Abstract Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

scholarly journals Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Tarun Goyal ◽  
Souvik Paul ◽  
Sushovan Banerjee ◽  
Lakshmana Das
Keyword(s):  
Cruciate Ligament ◽  
Lysholm Score ◽  
Activity Level ◽  
Type Ii ◽  
Hamstring Tendons ◽  
Peroneus Longus ◽  
Type Iii ◽  
Type Iv ◽  
Ikdc Score

Abstract Purpose This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts. Methods All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. Results A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Conclusion Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes. Level of evidence Level IV, case series.

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