„Dog Ears“ nach Exzision einer Aknezyste

ZusammenfassungEine Patientin stellte sich in einer Hautarztpraxis zur Entfernung einer „Aknezyste“ im Bereich der Wange rechts vor. Die Exzision erfolgte in Lokalanästhesie; die histologische Befundung bestätigte die klinische Diagnose. Bei der Nachkontrolle der Exzisionsstelle wurde von der Patientin eine „Zipfelbildung“ an der Narbe bemängelt. Im Folgenden suchte die Patientin einen weiteren Hautarzt auf, der „Dog Ears“ an der Narbe diagnostizierte und eine spätere operative Korrektur empfahl, die schließlich in einer Fachklinik für Plastische und Ästhetische Chirurgie vorgenommen wurde.Die von der Patientin angerufene Schlichtungsstelle stellte fest, dass die nicht korrekte Wahl der Exzisionsstelle exakt nach der Lage der Hautspannungslinien des Gesichtes sowie die Nichteinhaltung eines Winkels von 30° an den jeweiligen Wundenden bei der Schnittführung nicht dem Facharztstandard entsprach und zu den „Dog Ears“ führte. Nach den vorliegenden Fotodokumentationen waren diese aufwerfenden Hautauszipfelungen als kosmetisch beeinträchtigend zu bewerten und bedurften nachfolgend einer Narbenkorrektur.Der vom behandelnden Hautarzt angeführte Wunsch der Patientin nach einer „möglichst kleinen Exzision und Narbe“ veranlasste diesen zu einem zu kleinen Wundverschluss in Abweichung vom Facharztstandard, wonach eine längere, elliptoide Exzision erforderlich gewesen wäre. Besteht ein Patient auf einem Abweichen vom Facharztstandard, sollte dies zur Vermeidung späterer Schadensersatzforderungen nach Aufklärung über die potenziell negativen Folgen schriftlich vereinbart werden.

Surgical correction of recurrent epiblepharon in Chinese children using modified skin re-draping epicanthoplasty

AIM: To evaluate the clinical efficacy of the modified skin re-draping epicanthoplasty procedure for correction of recurrent lower lid epiblepharon in Chinese children. METHODS: From 2016 to 2018, 18 children (10 males and 8 females, average age 6.2±1.7y; 30 eyes) with recurrent epiblepharon who attended Beijing Children’s Hospital were included in the study. All the children had undergone lower eyelid surgery for epiblepharon. Surgical design included using an additional incision along the upper palpebral margin, to avoid vertical scarring on the upper lid. The re-draping method was used to correct recurrent epiblepharon. Follow-up ranged from 3 to 24mo. Postoperative surgical outcomes, complications, and subjective satisfaction were evaluated. RESULTS: Complete correction of cilia touching the cornea was observed in all patients during an average follow-up of 7.1mo. No “dog ears” or obvious scars were formed after surgery. All parents were satisfied with the cosmetic results and none complained. Mean astigmatism decreased from 2.39±0.79 diopter (D) preoperatively to 2.19±0.79 D at 6mo after surgery; however, the difference was not significant. Best-corrected visual acuity improved, although the change in mean visual acuity was not significant. No recurrence occurred during the follow-up period. CONCLUSION: This surgical modified skin re-draping technique is effective and highly satisfactory for correction of recurrent epiblepharon. The approach is characterized by a simple design, a straightforward procedure, inconspicuous scarring, and good postoperative appearance.

Frequency and risk factors for postoperative aneurysm residual after microsurgical clipping

Objective Aneurysm residuals after clipping are a well-known problem, but the course of aneurysm remnants in follow-up is not well studied. No standards or follow-up guidelines exist for treatment of aneurysm remnants. The aim of this study was to evaluate the risk factors for postoperative aneurysm remnants and their changes during follow-up. Methods We performed a retrospective analysis of 666 aneurysms treated via clipping in our hospital from 2006 to 2016. Postoperative and follow-up angiographic data were analyzed for aneurysm remnants and regrowth. Clinical parameters and aneurysm-specific characteristics were correlated with radiological results. Results The frequency of aneurysm residuals was 12% (78/666). Aneurysms located in the middle cerebral artery (p = 0.02) showed a significantly lower risk for incomplete aneurysm occlusion. Larger aneurysms with a diameter of 11–25 mm (p = 0.005) showed a significantly higher risk for incomplete aneurysm occlusion. Five patients underwent re-clipping during the same hospital stay. Remnants were stratified based on morphological characteristics into “dog ears” (n = 60) and “broad based” (n = 13). The majority of the “dog ears” stayed stable, decreased in size, or vanished during follow-up. Broad-based remnants showed a higher risk of regrowth. Conclusions A middle cerebral artery location seems to lower the risk for the incomplete clip occlusion of an aneurysm. Greater aneurysm size (11–25 mm) is associated with a postoperative aneurysm remnant. The majority of “dog-ear” remnants appear to remain stable during follow-up. In these cases, unnecessarily frequent angiographic checks could be avoided. By contrast, broad-based residuals show a higher risk of regrowth that requires close imaging controls if retreatment cannot be performed immediately.

Geometry of the fusiform excision for skin lesions

Objective The fusiform excision technique is commonly used by surgeons to remove round skin lesions to minimize "dog-ears" at the ends of the incision. We propose a geometric analysis to easily design the fusiform incision and consequently standardize the surgical procedure. Background The classic ellipse is formed by tracing 2 arcs of a circle on the skin. The arcs, which are symmetrical with respect to the midline axis separating them, intersect at their ends to form a convex shape and classically result in a 1:3 width-length ratio between the short and long axes of the ellipse. Methods Using basic geometry rules, namely Pythagorean theorem and the ratios of the angles of right triangles, we first calculated the ratio between the radius of the lesion and the radius of the arcs of the circle of the fusiform incision and then the distance between the center of the lesion and the intersection between the line perpendicular to the axis of the fusiform excision and the tangent to the arcs of the circle. Results The ratio between the radius of the lesion and the radius of the arcs of the circle of the fusiform incision is 5 and the distance between the center of the lesion and the intersection between the vertical axis and the tangent is 2.25 for a fusiform incision with a width-length ratio of 1:3. We then generalized the formulas. Conclusions Our approach provides an introduction to the geometry of dermatologic surgery to students in order to standardize the surgical procedure.

P146 AN IMPROVEMENT TO THE CIRCULAR STAPLING ANASTOMOSIS TECHNIQUE DURING MINIMALLY

Aim The circular stapled (CS) technique with transoral placement of the anvil is commonly used to perform the esophago-gastric anastomosis during minimally invasive esophagectomy (MIE). The procedure is safe, efficient and highly reproducible, however the intersection between the circular plane of the stapler and the linear staple line of the esophageal stump can expose the anastomosis to the formation of dog ears and therefore increase the risk of anastomotic leakage (AL). We describe a simple modification of the CS technique that avoid the formation of staple lines intersection. Background and Methods We prospectively collected data on a small group of patients who underwent MIE for cancer using our modified CS technique. Our technical modification consists in folding the linear esophageal transection line with a stitch around the anvil shaft, in order to include the staple line in the resection during the EEATM firing (figure 1). Feasibility has been evaluated as the percentage of cases in which the improved anastomosis technique has been carried out successfully with the formation of a complete anastomotic ring. Safety has been defined as the absence of procedure related complications. Results MIE was performed in ten patients using our modified CS technique, median age was 55 years. All the procedures were successfully completed with complete resection of the linear esophageal staple line and no intraoperative complication. Only one patient developed a postoperative AL, that was only detected by barium swallow and did not cause any symptom or clinical sign. Conclusions Our modified CS technique is simple, feasible and safe. Further studies are needed to evaluate its efficacy in preventing the occurrence of anastomosis leakage.

Singularity#1 and MFA II. Singularität Nr. 1 und MFA II.

The Dog-Ears formal system (Bheemaiah, n.d.) is extended with MFA II architecture for the definition of Taskoids, needing adaptable designs and additive printing. We present a formal system to apply the formulation to illustrate Singularity#1 as an MFA II, application. The concept of Singularity and Singularity#1 and the MFA II design philosophy is explained, with an abstract photographic art.Keywords: Dog-Ears, Taskoids, Singularity, Singularity#1, Robotics, Conversational UI, additive printing.What:Singularity#1 is defined as an algorithmic machine evolution like genetic algorithms, in MFA II architecture, with the development of machine learning algorithms for the automated design of hardware and software and additive manufacturing of the hardware.MFA II is a multi-functional architecture, where side effects are primary too in a defined multi-functionality, it is inspired by MFA I architecture of form following function and behaviors from BEAM robotics, while BEAM is analog or mixed, MFA II is digital.Was:Singularity # 1 ist definiert als eine algorithmische Maschinenentwicklung wie genetische Algorithmen in der MFA II-Architektur mit der Entwicklung von Algorithmen für maschinelles Lernen für das automatisierte Design von Hardware und Software sowie für die additive Fertigung der Hardware. Es ähnelt der Singularität, die sich durch die Entwicklung von Hardware und Software für maschinelles Lernen durch A.I-Algorithmen auszeichnet.MFA II ist eine multifunktionale Architektur, bei der Nebenwirkungen auch bei einer definierten Multifunktionalität im Vordergrund stehen. Sie ist von der MFA I-Architektur mit Funktionen und Verhaltensweisen der BEAM-Robotik inspiriert, während BEAM analog oder gemischt und MFA II digital ist.How:We illustrate Singularity#1, in non-anthropomorphism in the design of Alexa skills and hardware tools for the sentient bot platform with additive manufacturing. Hardware extensions with the RetroSwitch are defined with a mathematical formulation, and templates with customization for the RetroSwitches and hardware designs are illustrated.TensorFlow is used for a mathematical formulation of MFA II with generalized Tensors.Wie:Wir veranschaulichen Singularität Nr. 1 im Nicht-Anthropomorphismus bei der Entwicklung von Alexa-Fertigkeiten und Hardware-Tools für die Plattform für empfindungsfähige Bots mit additiver Fertigung. Hardware-Erweiterungen mit dem RetroSwitch werden mit einer mathematischen Formulierung definiert, und Vorlagen mit Anpassungen für die RetroSwitches und Hardware-Designs werden veranschaulicht.TensorFlow wird für eine mathematische Formulierung von MFA II mit verallgemeinerten Tensoren mit eingebetteten Unendlichkeiten von Kovarianz und Kontravarianz und einer Konturintegralformulierung verwendet.