The Clinical Guiding Role of the Distribution of Corneal Nerves in the Selection of Incision for Penetrating Corneal Surgery in Canines

The cornea is one of the regions with the highest density of nerve terminals in the animal body and it bears such functions as nourishing the cornea and maintaining corneal sensation. In veterinary clinical practice, the corneoscleral limbus incision is frequently applied in cataract surgery, peripheral iridectomy, and other procedures for glaucoma. Inevitably, it would cause damage to the nerve roots that enter the cornea from the corneal limbus, thus inducing a series of complications. In this paper, the in vitro cornea (39 corneas from 23 canines, with ages ranging from 8 months old to 3 years old, including 12 male canines and 11 female canines) was divided into 6 zones, and the whole cornea was stained with gold chloride. After staining, corneal nerves formed neural networks at different levels of cornea. There was no significant difference in the number of nerve roots at the corneoscleral limbus between different zones (F = 1.983, p = 0.082), and the nerve roots at the corneoscleral limbus (mean value, 24.43; 95% CI, 23.43–25.42) were evenly distributed. Additionally, there was no significant difference in the number of corneal nerve roots between male and female canines (p = 0.143). There was also no significant difference in the number of corneal nerve roots between adult canines and puppies (p = 0.324). The results of the above analysis will provide a reasonable anatomical basis for selecting the incision location and orientation of penetrating surgery for the canine cornea in veterinary practice.

Surgery-related predictors of kneeling ability following total knee arthroplasty: a systematic review and meta-analysis

Purpose Kneeling ability is among the poorest outcomes following total knee arthroplasty (TKA). The purpose of this meta-analysis was to: (1) quantify kneeling ability after TKA; (2) identify surgical approaches and prosthesis designs that improve kneeling ability following TKA; and (3) quantify the effectiveness of these approaches. Methods We performed a systematic review in accordance with the PRISMA guidelines of multiple medical databases. Data relating to demographics, TKA technique, prosthesis design, and kneeling-specific outcomes were extracted. Comparative outcomes data were pooled using a random effects model. Results Thirty-six studies met the eligibility criteria. The proportion of patients able to kneel increased with longer follow-up (36.8% at a minimum of 1 year follow-up versus 47.6% after a minimum of 3 years follow-up, p < 0.001). The odds of kneeling were greater for patients undergoing an anterolateral incision compared with an anteromedial incision (OR 3.0, 95% CI 1.3–6.9, p = 0.02); a transverse incision compared with a longitudinal incision (OR 3.5, 95% CI 1.4–8.7, p = 0.008); and a shorter incision compared with a longer incision (OR 8.5, 95% CI 2.3–30.9, p = 0.001). The odds of kneeling were worse for a mobile prosthesis compared with a fixed platform design (OR 0.3, 95% CI 0.1–0.7, p = 0.005). Conclusion A large majority of patients are unable to kneel following TKA, although the ability to kneel improves over time. This evidence may facilitate preoperative patient counseling. Variations in choice of incision location and length may affect ability to kneel; however, high-quality randomized trials are needed to corroborate our findings.

Three dimensional printed models of the airway for preoperative planning of open Laryngotracheal surgery in children: Surgeon’s perception of utility

Background Preoperative planning of open laryngotracheal surgery is important for achieving good results. This study examines the surgeon’s perception of the importance of using life size 3D printed models of the pediatric airway on surgical decision making. Methods Life-size three-dimensional models of the upper airway were created based on CT images of children scheduled for laryngotracheal-reconstruction and cricotracheal resection with anastomosis. Five pediatric airway surgeons evaluated the three-dimensional models for determining the surgical approach, incision location and length, graft length, and need for single or double-stage surgery of seven children (median age 4.4 years, M:F ratio 4:3). They rated the importance of the three-dimensional model findings compared to the direct laryngoscopy videos and CT findings for each domain on a validated Likert scale of 1–5. Results The mean rating for all domains was 3.6 ± 0.63 (“moderately important” to “very important”), and the median rating was 4 (“very important”). There was full agreement between raters for length of incision and length of graft. The between-rater agreement was 0.608 (“good”) for surgical approach, 0.585 (“moderate”) for incision location, and 0.429 (“moderate”) for need for single- or two-stage surgery. Conclusion Patient-specific three-dimensional printed models of children’s upper airways were scored by pediatric airway surgeons as being moderately to very important for preoperative planning of open laryngotracheal surgery. Large–scale, objective outcome studies are warranted to establish the reliability and efficiency of these models. Graphical abstract

Effect of Endoscopic Versus Open Saphenous Vein Harvesting Technique on Leg Wound Complications

Background: EVH has become prevalent in recent years due to its reduced morbidity and increased patient satisfaction. We designed and carried out a prospective study of patients undergoing CABG to compare outcomes of open versus endoscopic harvesting technique for great saphenous vein. Two groups of patients who underwent elective Coronary artery bypass grafting at our hospitals between January 2018 and October 2020 were included. Endoscopic vein harvesting group (50 patients) was performed endoscopic technique compared with Open Vein Harvesting group (50 patients) was performed open surgical incision for harvesting. Both groups were demographically similar and received identical management. Leg wound was evaluated at discharge, 2 weeks, and 4 weeks for evidence of complications. Early outcomes were compared included, infection, gaped wound and re-suture, pain, satisfied cosmetically and mobilization. Results: Endoscopic vein harvesting group had increased harvest time and decreased incision closure time when compared with Open Vein Harvesting. The average hospitalization time was 6.5 ± 2.2 days for Endoscopic vein harvesting group and 9.2 ± 2.9 days for Open Vein Harvesting group. In Endoscopic vein harvesting group, no significant hematomas were observed. In Open Vein Harvesting group, hematomas were detected in 2 patients and were surgically evacuated. In Endoscopic vein harvesting group, edema occurred less frequently. Infection of the incision location did not occur in Endoscopic vein harvesting group. Leg wound complications were significantly reduced in Endoscopic vein harvesting group in comparison with Open Vein Harvesting group. Conclusions: Endoscopic vein harvesting decreases leg wound complications and increases patient’s satisfaction cosmetically.

Breast Augmentation

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. This review contains 12 figures, 6 tables, 1 video, and 74 references. Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging

A Comparison of Wound Complications With Surgical Treatment of Achilles Tendon Conditions Using 2 Surgical Approaches

Background: Wound complications are a concern with the open treatment of Achilles tendon conditions. The location of the incision may impact the risk of wound complications because of its relationship to the blood supply to the skin. There is no consensus as to the safest incision location. The purpose of this study was to evaluate and compare the rates of sural nerve injury and wound complications including superficial or deep infections and wound dehiscence between posterior midline and posteromedial surgical incision locations. Methods: 125 patients with Achilles tendon rupture or Achilles tendinopathy were treated with open surgery through a longitudinal posterior midline or posteromedial incision. An L-shaped incision was used in the posteromedial group for cases of insertional repair. Postoperative complications including sural nerve injuries, superficial wound complications, superficial infections, deep wound infections, return to the operating room, and need for soft tissue coverage were recorded and rates were compared between the groups. Results: No significant differences were detected between the posteromedial and posterior incision groups in rates of sural nerve injuries, superficial infection, or deep wound infection. The posterior incision group had significantly fewer wound complications. The wound complications in the posteromedial group primarily occurred when an L-shaped incision was used for insertional repair. No patients in either group required debridement or soft tissue/flap coverage. Conclusion: The posterior incision location had significantly fewer wound complications. The use of an L-shaped incision was likely responsible for the wound complications in this group rather than the location of the incision. The use of a medial incision was not found to decrease the rate of sural nerve injury. Level of Evidence: Level III.

Effects of incision location on specimen quality and complications for temporal artery biopsy

Objectives Giant cell arteritis is a vision and potentially life-threatening condition requiring prompt and accurate diagnosis. The current gold standard of diagnosis is temporal artery biopsy. The purpose of this study is to review the technique of temporal biopsy in regard to incision placement, and to determine specimen quality and the incidence of complications, specifically seventh nerve injury. Methods Retrospective cohort study of 125 consecutive patients (137 biopsies) who underwent temporal artery biopsy. Variables concerning the procedure collected included laterality, incision placement, Doppler ultrasound utilization, length of intraoperative and pathologic specimens, result of the biopsy, motor nerve deficit, brow ptosis, and any intra or postoperative complications. Results The patient population was 73% female and 86% Caucasian. The average age at the time of the biopsy was 73.8 (range = 56–89, SD = 8.7). Doppler localization was used on 45% of patients. The mean intraoperative specimen length was 2.6 cm (range = 1.5–4.1, SD = 0.6) and fixed specimen length was 2.0 cm (range = 0.8–4.0, SD = 0.7). Biopsy results were positive in 18% of cases. There were no patients who displayed seventh nerve injury at one-week follow-up. One patient (0.7%) reported persistent anesthesia and one (0.7%) reported persistent paresthesia at the incision site. There were no other intraoperative or postoperative complications reported. Conclusions Placement of the incision at or posterior to the temporal hairline reduces the risk of seventh nerve injury. The posterior incision placement did not affect the quality of specimens or decrease the yield of biopsy results as compared to other studies. The overall complication rate (3%) was minimal and did not involve any motor nerve injury.