scholarly journals Secondary nipple reconstruction using two surgical techniques

2021 ◽  
Vol 48 (6) ◽  
pp. 590-598
Author(s):  
Jae-Ho Chung ◽  
Da-Som Kim ◽  
Hyun-Dong Yeo ◽  
Seung-Pil Jung ◽  
Seung-Ha Park ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Surgical Techniques ◽  
Nipple Reconstruction ◽  
Purse String Suture ◽  
Purse String ◽  
Multiple Causes

Background Although the initial projection after primary nipple reconstruction is excellent, nipple projection gradually flattens in most cases due to multiple causes. Although various methods have been reported to rebuild the nipple after nipple flattening, the most effective method of secondary nipple reconstruction remains unknown. The aim of this study was to review our institution’s experiences with secondary nipple reconstruction.Methods We conducted a retrospective review from March 2012 to January 2019. We performed secondary nipple reconstruction if the primary reconstructed nipple height differed by more than 6 mm from the normal nipple height. We chose the method of nipple revision according to the degree of tissue scarring and the remaining nipple projection.Results We performed secondary nipple reconstruction on a total of 27 nipples, using pursestring sutures for 19 nipples and star flaps in eight nipples. The median follow-up period was 8 months (range, 6–19 months) after the final nipple reconstruction. Among the 19 nipples reconstructed using purse-string sutures, 10 (53%) demonstrated acceptable projection of more than 5 mm. Among the eight nipples reconstructed using star flaps, six (75%) showed acceptable projection of more than 5 mm. Most of the patients (73%) were satisfied (scores of 4 or 5) with the nipple reconstruction overall.Conclusions Few studies have presented favorable outcomes of secondary nipple reconstruction. When the star flap and purse-string suture methods were used depending on the remaining nipple height and scarring, appropriate projection could be achieved.

scholarly journals SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Carol P. S. Lam ◽  
Jason C. S. Yam ◽  
Flora H. S. Lau ◽  
Dorothy S. P. Fan ◽  
C. Y. Wong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Retrospective Review ◽  
Surgical Outcome ◽  
Surgical Techniques ◽  
Effective Procedure ◽  
Successful Outcome ◽  
Range Of Movement ◽  
Scleral Fixation ◽  
Fixation Group

Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus.Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR) and lateral rectus (LR) with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed.Results. There is significant overall improvement both in postoperative angle of esodeviation (P<0.01) and postoperative range of movement (P=0.042). Comparing between the sclera fixation group (11 eyes) versus nonscleral fixation group (21 eyes), the postoperative horizontal deviation, the postoperative vertical deviation, successful outcome, and the change in horizontal deviation were not significantly different (P>0.05).Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.

scholarly journals The S-Plus lift: a short-scar, long-flap rhytidectomy

2010 ◽  
Vol 92 (7) ◽  
pp. 577-582 ◽  
Author(s):  
Steven B Hopping ◽  
Sasa Janjanin ◽  
Neil Tanna ◽  
Arjun S Joshi
Keyword(s):  
Soft Tissues ◽  
Hybrid Technique ◽  
Purse String Suture ◽  
Purse String ◽  
Lower Face ◽  
Elective Surgical Procedures ◽  
Strong Trend ◽  
Novel Approach ◽  
Nasolabial Folds

INTRODUCTION As rhytidectomy is one of the most elective surgical procedures, there is a strong trend toward less aggressive operative techniques. The authors introduce the S-Plus lift, a ‘long flap’ superficial musculo-aponeurotic system (SMAS) imbrication technique that diminishes risks, decreases recovery time, and yields long-lasting results. PATIENTS AND METHODS This paper describes a novel approach to mid-facial rejuvenation that combines the limited incision of an S-lift with two SMASectomies, purse-string suture imbrication of the extended supraplatysmal plane (ESP) and SMAS, and malar soft tissue suspension. SMAS excisions are performed pre-auricularly, and in the region overlying the anterior edge of the parotid gland. Purse-string imbrication sutures are designed to close the SMAS defects, pull the soft tissues of the neck upward, pull the jowl and lower face posteriorly and superiorly, and tighten the platysma. Ancillary purse-string suture lifts the malar fat pad and cheek soft tissues vertically, which achieves mid-face fullness and lifting. Compared to S-lift, the technique extends its efficacy in those patients who have moderate-to-severe mid-facial laxity, prominent nasolabial folds, and platysma redundancy. RESULTS A review of 144 consecutive S-Plus lifts performed by a single surgeon (SBH), with at least 6 months of follow-up, was performed. Over a 3-year period, 130 (90.3%) females and 14 (9.7%) males underwent S-Plus lift. S-Plus lift as primary rhytidectomy was performed in 132 (91.7%) and as secondary in 12 (8.3%) cases. Complication rate was low and comparable with other techniques of rhytidectomy. CONCLUSIONS The S-Plus lift is a novel, hybrid technique with pleasing results, short down-time, and high patient satisfaction rate. The technique combines two SMASectomies with purse-string suture imbrication of the ESP and SMAS, and malar fat suture suspension.

scholarly journals A Comparative Study Between Different Surgical Techniques For Left Atrial Exclusion in Patients Undergoing Concomitant Cardiac Surgery

2021 ◽  
Vol 24 (5) ◽  
pp. E901-E905
Author(s):  
Ahmed Abdeljawad ◽  
Yasser Shaban Mubarak
Keyword(s):  
Cardiac Surgery ◽  
Surgical Technique ◽  
Left Atrial ◽  
Oral Anticoagulants ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Thromboembolic Events ◽  
Purse String Suture ◽  
Purse String ◽  
Suture Ligation

Objectives: To find out the most successful surgical technique to obliterate left atrial appendage (LAA) in atrial fibrillation (AF) patients who had undergone concomitant cardiac surgery. Background: About 10%-65% of patients develop AF following cardiac surgery [Rho 2009; Mathew 2004; Maesen 2012]. Cerebral cardio-embolic stroke remains the most serious complication in AF patients. LAA is the main anatomical source for thromboembolic events. The use of oral anticoagulants (OAG) is considered to be an effective method for reduction of thromboembolic complications [Johnson 2000]. The use of oral anticoagulants is faced by two important facts which are the therapy duration is still unknown [Kirchhof 2017] and importantly that between 30-50% of patients are not candidates for oral anticoagulants due to the high bleeding risk or other contraindications [Johnson 2000; Kirchhof 2017; Kirchhof 2014]. In such patients, LAA obliteration would be an optimal alternative technique as it will reduce the stroke risk by 50% [Go 2014]. Several surgical techniques with variable degrees of success rates have been used.  It still is unclear which surgical technique is optimum to achieve a successful obliteration of the LAA and a considerable reduction of the postoperative stroke events in AF patients. Patients and methods: A total of 100 patients have been subjected to surgical LAA exclusion from April 2017 to April 2019 in two different centers. All patients had postoperative transesophageal echo (TEE) examination to confirm the success of LAA occlusion. All patients included in our study suffered from AF at the time of surgery or in past history, which was confirmed by ECG examination in their previous medical files. A variety of surgical techniques to close the LAA have been utilized, including surgical excision by means of scissors, patch exclusion by means of an endocardial patch, suture exclusion and finally stapler exclusion. TEE examination 16 months postoperatively divided our patients into four groups as follows: successful LAA occlusion, Patent LAA, excluded LAA with persistent flow into LAA, and remnant LAA with a stump connection with LAA more than 1 cm. Results: Out of 100 patients, 30 patients (30%) underwent surgical LAA excision, 24 patients (24%) underwent surgical epicardial suture ligation, eight patients (8%) underwent patch exclusion using autologous pericardial patch, 33 patients (33%) underwent LAA internal orifice purse string suture obliteration, and five patients (5%) underwent stapler exclusion. Forty-two patients out of 100 (42%) showed successful LAA closure. The successful LAA occlusion occurred mostly in LAA excision patients 87%, 24% in LAA internal orifice purse string suture obliteration patients, 21% in epicardial suture ligation patients, and 37.5% in patch exclusion patients. The stapler exclusion was very disappointing as we did not record a single case out of the five patients who showed a successful LAA occlusion. Stroke events were recorded in all surgical techniques except the LAA excision technique. The stroke rate after two years follow up was zero in the surgical excision group, 49% in the suture exclusion group, 20% in the patch exclusion group, and 40% in stapler exclusion group. Conclusion: Surgical LAA excision is the most successful technique for LAA occlusion and represents a promising technique for the reduction of thromboembolic events in AF patients who undergo a concomitant cardiac surgery.

scholarly journals Comparison of Stump Burying using Laparoscopic and Open Methods in Complicated Acute Appendicitis

2020 ◽  
Author(s):  
Sina Ferahman ◽  
Turgut Dönmez ◽  
Serhan Yılmaz ◽  
Sezer Akbulut ◽  
Ahmet Sürek ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Surgical Complications ◽  
Open Appendectomy ◽  
Surgical Techniques ◽  
Laparoscopic Technique ◽  
Purse String Suture ◽  
Purse String ◽  
Appendiceal Stump ◽  
Complicated Acute Appendicitis

Objective: The choice of laparoscopic technique in the treatment of complicated acute appendicitis (CAA) harbours debatable evidence because of higher rates of surgical complications such as postoperative intraabdominal abscess (POIIA). The aim of this study is to compare postoperative results of appendiceal stump (AS) ligation and its burial into the cecum using laparoscopic or open surgical techniques in patients with CAA. Method: This is a single-center and retrospective analysis of patients with CAA operated between May 2018 and April 2020. AS was intracorporeally knotted with silk and buried in the cecum with a purse-string suture (PSS). The patients were divided into open appendectomy (OA) and laparoscopic appendectomy (LA) groups. Data concerning demographic characteristics, intraoperative variables, hospital stay, surgical complications, morbidities, and postoperative findings were compared. Results: A total of 66 patients including 36 patients (54.54%) underwent LA and 30 patients had OA were enrolled in the study. Partial resection of cecum was performed in one patient in the OA group and two patients in the LA group with the help of a stapler due to cecal floor necrosis. The operative time and duration of hospital stay were significantly shorter in the LA group compared to the OA group. Surgical site infection and POIAA were significantlymore frequent in the OA group (p<0.001). Conclusion: In acute complicated appendicitis, laparoscopic method can be applied as an effective method by closing the appendiceal stump and burying into the cecum with a purse-string suture.

scholarly journals The “Purse-string” Technique for Shoulder Stabilization, Description of the Technique, Long term Results and Literature Review

2017 ◽  
Vol 11 (1) ◽  
pp. 183-188
Author(s):  
Georgios Arealis ◽  
Joana Bento Rodrigues ◽  
Natalie Hope ◽  
Ofer Levy
Keyword(s):  
Leisure Activities ◽  
Surgical Techniques ◽  
Spot Weld ◽  
Long Term Results ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Purse String ◽  
Almost All

Background: Over the last 2 decades arthroscopic stabilization and Bankart repair has gained popularity due to the advances in materials and surgical techniques. Results of arthroscopic stabilization have been similar to open without the risks of it. The number of anchors used has been suggested to be very important in “spot-weld” arthroscopic stabilization however the “purse-string” technique (PST) can achieve similar results using only one anchor. We describe technique and long term results from using the PST and search the literature for other papers regarding PST. Methods: Between 2003 and 2013 a total of 193 patients were operated. Patients included those with anterior instability. Using PubMed relevant studies reporting results of PST were identified. Results: Mean follow up was 2 (range 0.5 to 3) years. 9 (4.7%) patients experienced recurrent instability. Almost all patients (97%) returned to their sporting and leisure activities and all professional athletes went back to the same sport. One more UK centre reported 6.1% recurrence in 114 patients at 4 years follow up. These results are similar to the published 11% recurrence of instability after “spot-weld” arthroscopic techniques at 11 years clinical follow-up. Conclusion: This study indicates that PST is safe and effective alternative method for the treatment of anterior shoulder instability. In this technique with one anchor simultaneous repair of labrum, creation of an anterior bumper and capsular shift can be achieved. It has the advantage of being cheaper, faster yet efficient with good long term results and leaves space for revision anchors in case of recurrence.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

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