Fixation of Multiple-Segmented Costosternal Cartilage Fracture in Flail Chest Injury: A Case Report

Early internal fixation of rib fractures in the setting of flail chest has proven benefits over traditional conservative treatment. This can decrease pneumonia, time on mechanical ventilation, length of stay in intensive care units, need for tracheostomy and increase in the pulmonary function test. However, there are few reports regarding on how to restore the costochondral junction, or costal cartilage in cases of anterior or anterolateral flail chest involving cartilage matrix of the ribs or costochondral joint. This case report describes a surgical technique to restore the costochondral junction with plate osteosynthesis and the results.

FACTORS ASSOCIATED WITH URETHROCUTANEOUS FISTULA COMPLICATION IN HYPOSPADIAS PATIENT AFTER URETHROPLASTY IN FATMAWATI GENERAL HOSPITAL: A RETROSPECTIVE COHORT DESIGN

Objective: This study compared several factors that are thought to contribute to the incidence of complications of urethroplasty fistula after urethroplasty, including meatus location, degree of chordee, surgical technique, and postoperative stent type. Material & Methods: This study is an analytical study with retrospective cohort design. After adjusting to the inclusion and exclusion criteria, 89 subjects with proximal hypospadias were subjected to urethroplasty at Fatmawati General Hospital, Jakarta from 2016 to 2019. An analysis of the relationship between several variables and the incidence of uretrocutaneous fistula was analyzed. Results: There was no significant difference between the one-stage and two-stage urethroplasty technique on the incidence of urethrocutaneous fistula (p = 0.063). There was no significant difference between the degree of chordee and complications of urethrocutaneous fistula after urethroplasty (p = 0.677). The relationship between the use of silastic stent, catheter, or cystostomy type was also not significant in complications of urethrocutaneous fistula (p = 0.576). The location of the urethral meatus also did not have a significant role in predicting the incidence of post-urethroplasty urethrocutaneous fistula (p = 0.169). Conclusion: Surgical technique (one stage and two stages), type of stent, degree of chordee, and location of the urethral meatus, did not have a significant correlation with the incidence of urethrocutaneous fistula in hypospadias patients after urethroplasty.

Lateral tarsal strip through osteotomies for recurrent ectropion and eyelid laxity correction

Objective to present a surgical technique for treating patients with recurrent ectropion and severe lower eyelid laxity. Methods Lateral tarsal strip and canthal fixation by osteotomy was performed in 6 patients with recurrent ectropion and 1 patient with extreme lower eyelid laxity secondary to an anophthalmic socket. Preoperative and postoperative photographs were evaluated in order to assess the outcomes of the procedure. Patients were followed up 4 weeks, 6 months, 12 months and 24 months of the postoperative period. The initial symptoms of the patients were eye redness, epiphora, foreign body sensation, aesthetic complaints, and facial asymmetry. Symptoms and aesthetic results were assessed by questioning, photographs, and fluorescein and lissamine green stains taken in each visit. Results No postoperative complications were observed. No recurrence episodes were reported during the follow-up period and physical appearance improvement and symptom severity reduction were maintained during the observation. Conclusion Lateral tarsal strip through osteotomies is an effective surgical procedure for treating severe recurrent ectropion cases or lower eyelid laxity and could be considered as an alternative treatment option or even a primary surgical technique in selected difficult cases.