New method of surgical correction of lesser toes deformity

Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes.

Boom and Bust Archaeology

As a discourse analysis of historical resource assessment documents and interviews with professional archaeologists, this study aims to inspect and critique the production of value in the Alberta historical resource value (HRV) system. The system of evaluation for historical value creates what can be described as a presence-absence model of archaeological significance that limits the ability for archaeologists to interpret and subjectively determine the historical value of materials. In addition, current systems often rely on a contractual relationship between archaeologists and industry to produce these reports, and rarely incorporate indigenous perspectives of significance. With a focus on the assumptions and functional result of HRIA assessments, we can examine the repercussions of the contemporary archaeological evaluative model within Alberta. A goal of this nascent assessment is to provide the opportunity for evaluation of a system that largely exists below the surface of public interest but has vast implications for future access to shared historical resources.

Distally Based Sural Flap in Children: Reliability Technique

The distally based sural flap often poses the problem of venous suffering that can lead to necrosis. We present a reconstruction of a loss of substance of the ankle in a 6 years old child, using a distal pedicle sural flap, made reliable by a racket like flap method, which reduces the risk of vascular complications and led to good integration of the flap, with a good functional result. Nevertheless, the aesthetic sequelae remain significant.

Surgical treatment of primary and recurrent pterygium

Purpose: to study the results of surgical treatment and the course of healing of primary and recurrent pterygium.Material and methods. 97 patients (117 eyes) with varying degrees of pterygium, of which 58 were men and 39 women, were clinically observed for 1 to 3 years. The patients, aged 51.5 ± 4.2 on average, were divided into 3 groups depending on the degree of pterygium, the frequency of relapses and the type of surgical treatment.Results. It was shown that primary pterygium of the I degree should best be operated according to McReynolds method, pterygium of the II degree or higher should optimally be removed with conjunctival plastics by a free flap grafting, while for recurrent pterygium of the III degree or higher, combined treatment is recommended: removal of the pterygium using brachytherapy.Conclusion. For an adequate functional result of surgery, an individual approach is required for each case depending on pterygium proliferation stage.

746 EXPERIENCE IN RECONSTRUCTION OF LARYNGOPHARYNGOESOPHAGECTOMIES IN A THIRD LEVEL CENTER

Pharyngoesophageal reconstruction after laryngo-pharyngo-esophagectomy, due to malignant or benign causes, is challenging due to its high morbidity and mortality. There are different reconstructive flaps: visceral flaps (pedicle stomach and colon flaps and free jejunum or colon grafts) and myocutaneous flaps (pedicle local flaps, such as the pectoralis major flap, or free grafts, such as the anterolateral thigh-ALT). The objective is to evaluate the morbidity and mortality and functional results of the reconstruction after laryngo-pharyngo-esophagectomy. Methods This is a retrospective study of patients who underwent laryngo-pharyngo-esophagectomy in our center, due to a benign cause (ingestion of caustic) or malignant (cancer of the larynx, pharynx, parathyroid and cervical esophagus) with circumferential pharyngeal reconstruction with flap, from 2008 to November 2020. Demographic variables, neoadjuvant treatment, procedure performed and flap used for reconstruction, complications related to reconstruction (fistula, stenosis, necrosis), postoperative complications, days until adequate swallowing, functional result of the flap, hospital stay, recurrence and mortality were collected. Results Twelve patients, with a median age of 59 years (45–78), underwent surgery, 1 case due to benign cause and 11 cases with an oncological diagnosis. There were complications related to the reconstruction in 42% of the patients (see table 1). Postoperative morbidity was 67% (75% Clavien-Dindo ≥ III). The median hospital stay was 21 days (16–94). The median time to swallowing was 13 days (3–73). An optimal functional result (oral intake) was achieved in 75% (only 3 patients with poor results). The median follow-up was 18 months (4–56), with a survival rate of 50%. 30-days mortality was 8% (1 case). Conclusion Our study shows a high morbidity and mortality after circumferential pharyngeal reconstruction, similar to literature published. We have observed a higher rate of reconstruction related complications (fistulas and stenosis) and worse functional results in reconstructions performed with gastroplasty and coloplasty after total laryngo-pharyngo-esophagectomy, compared to less aggressive local resections (laryngopharyngeal) with ALT free flap reconstruction.

Interrelationship Between Orthodontics and Implantology in Anterior Aesthetic Rehabilitation: A Case Report

The rehabilitation of complex cases in the anterior region of the maxilla may require knowledge of several dental specialties. when dental involvement also causes bone and gingival involvement, management usually requires adjustment of gingival zenitis and bone graft to compensate for bone loss. Objective: to discuss a case of previous orthodontic treatment for implant-prosthetic rehabilitation in the anterior region. Case report: This case report describes a 40-year-old patient who came with the intention of extracting the tooth and installing a bridge. The implant-prosthetic treatment was performed after previous orthodontic treatment to adapt the gingiva and space. Conclusion: The interrelationship of specialists in oral rehabilitation improved the aesthetic and functional result of this complex case. Orthodontic mechanics and periodontics adapted the space and improved the periodontal condition before the implant was installed, resulting in a very satisfactory aesthetic, improving the patient’s selfesteem

Hypotensive effect of micropulse laser cyclophotocoagulation in hemophthalmos with high intraocular pressure

Purpose. To study the effectiveness of micropulse laser cyclophotocoagulation (CPC) use in the treatment of hemophthalmos with ophthalmic hypertension. Materials and methods. Examination and treatment of 11 patients (11 eyes) with fresh hemophthalmos with secondary uncompensated ophthalmic hypertension were carried out. Antiglaucoma surgery was considered inappropriate due to the high threat of serious hemorrhagic complications. To normalize intraocular pressure (IOP), patients underwent micropulse laser CPС. Results. After microimpulse CPС, all patients on the first day showed a decrease in IOP to an average of 26.6 mm Hg, after 7 days - up to 20.1 mm Hg. After 1 month, 7 patients (7 eyes), against the background of conservative treatment of hemophthalmos with a normalized IOP level (15-20 mm Hg), showed positive dynamics: the hemophthalmos was practically resorbed, an increase in visual acuity was achieved (from 0.3 to 0.8). In 4 patients (4 eyes) there was a decrease in the IOP level to 18-25 mm Hg. All patients underwent a successful vitrectomy with a high functional result, visual acuity ranged from 0.4 to 0.8. Conclusion. The use of micropulse laser CPС is pathogenetically justified and safe in patients with hemophthalmos in combination with high IOP. The use of this approach made it possible to achieve stable normalization of ophthalmotonus, increase the effectiveness of conservative therapy for hemophthalmos, and achieve restoration of visual functions in the examined patients. Key words: hemophthalmos, micropulse laser cyclophotocoagulation, intraocular pressure, ophthalmic hypertension.

Result of Ankle Fracture Fixation, Our Hospital Experience

Aims and Objectives: The goal of this study was to see the outcome of open reduction and internal fixation for ankle fractures. Methods: A prospective analysis of 40 ankle fractures of adult patients handled surgically using diverse approaches in the period from January 2019 to January 2020 at the Orthopedic department of SMBBIT, Dow University of Medical and Health Sciences. Karachi Pakistan. The ankle grading system developed by Baird and Jackson was used to assess the functional result. Results: We achieved 87.5 percent outstanding to good outcomes, 6.3 percent fair outcomes, and 6.2 percent bad outcomes in our study. The findings were comparable to those of other researchers around the world. Interpretation and Conclusion: In 87.5 percent of patients, the operational results were satisfactory, with good to outstanding functional outcomes. With stable fracture fixation, excellent outcomes are attained. Cancellous screws are better for internal fixation of the medial malleolus, while Malleolar screws are superior for that task. For ankle fractures treated surgically, patients may expect to have satisfactory function thereafter.

The results of replacement arthroplasty in the treatment of bone chondrosarcoma

This article reports on the results of replacement arthroplasty in the treatment of bone chondrosarcoma. As a result of replacement arthroplasty in 28 patients, post-surgical complications were observed in two (7.1 %) patients, and tumor recurrence was observed in two (7.1 %) patients. Infectious post-surgical complications were observed in one patient after replacement arthroplasty of coxofemoral joint; the endoprosthesis in this patient was removed, and cement spacer was implanted; six months later the replacement arthroplasty was repeated. The aseptic loosening of the endoprosthetic stem of the joint was observed in one patient after knee arthroplasty; the replacement arthroplasty was repeated. The chondrosarcoma recurrence was identified in two patients between 18 to 53 months; lower extremity amputation was performed in one patient at the level of the mid-third of the femur; lower extremity amputation was performed in one patient at the level of the lower third of the femur, and polychemotherapy courses, including further metastasectomy, were performed in three patients having dedifferentiated and mesenchymal chondrosarcoma with metastases in the lungs. The functional result in the extremity, depending on the tumor site (based on MSTS scoring system) after the endoprosthetic procedure constituted 68.4 to 89.2 %. The quality of life of patients, according to the EORTC QLQ-30 questionnaire, was 40–50 scores before the arthroplasty, while after the arthroplasty the score went up and constituted 85–90 on average. The overall three-year survival rate of patients with chondrosarcoma constituted 95.3 ± 1.7 % and the five-year survival rate was 89.7 ± 2.1 %. The survival rate for patients with mesenchymal and dedifferentiated chondrosarcoma constituted 0 %.

Analysis of surgical treatment results of the traumatic cataract with the lens capsule-ligament apparatus destruction and suture fixation of IOL

Purpose. To evaluate the surgical treatment results of traumatic cataract with the lens capsule-ligament apparatus destruction and suture fixation of IOLs. Materials and methods. 33 patients with traumatic cataract with the lens capsule-ligament apparatus destruction and suture fixation of IOLs aged 22 to 68 years were examined. All patients underwent phacoemulsification of traumatic cataract with IOL implantation using standard technology with a 2.0 mm tunnel incision. The result was evaluated on the first day, first and third months of observation. Results. On the 1st day after the operation the BCVA increased from 0.11±0.12 to 0.43±0.26, the IOP decreased from 21.67±1.5 to 20.97±1.2 mm Hg. By the 3rd month of observation the mean BCVA value was 0.61±0.29, IOP – 19.33±1.0 mm Hg. Conclusion. Traumatic cataract phacoemulsification with implantation and suture fixation of IOL is an effective method of treatment, allowing to achieve not only anatomical, but also a good functional result. Key words: traumatic cataract, phacoemulsification, IOL suture fixation.