Successful umbilicus salvage following concurrent infraumbilical single-port myomectomy and free transverse rectus abdominis myocutaneous flap elevation: a case report

Performing a concurrent gynecologic operation and mastectomy with immediate breast reconstruction using a free transverse rectus abdominis myocutaneous flap may increase the risk of complications such as umbilical necrosis due to vascular compromise. Imaging studies such as preoperative computed tomography angiography and intraoperative indocyanine green testing can provide information regarding the umbilical blood supply, facilitating decision-making for pedicle selection. Therefore, in situations where a coordinated operation is unavoidable, a thorough preoperative and intraoperative evaluation of the umbilical blood supply is recommended to avoid complications.

Using Patch ECG Device During Lower Third Molar Surgery

This study aimed to evaluate cardiac activity changes during lower third molar surgery concerning gender and anxiety levels. Thirty healthy subjects who required lower third molar surgery filled out Norman Corah dental anxiety scale (DAS) before surgery. A patch ECG device (Savvy, Institute ''Jožef Stefan'', Ljubljana, Slovenia) was applied to the patient to evaluate heart rate (HR) and heart rhythm. These parameters were assessed in 8 different intervals. Periods of the highest mean HR values—incision and flap elevation compared to the period with minimal mean HR values—during suturing showed statistical significance difference (p<0.05). The most common outstanding ECG finding was sinus tachycardia, especially in anxious compared to non-anxious patients. Extraction difficulty score was correlated with the procedure duration time and with the abnormal ECG findings in the period of tooth extraction. Significant cardiac activity changes are detected during surgery. Physiological manifestations of anxiety may be evaluated successfully using a patch ECG device.

Vertical Rectus Abdominis Myocutaneous-Pedicled Island Flap for Covering Defect of the Suprapubic Area: A Case Report

Immediate reconstruction of defects in the lower abdomen is challenging. We present a successful reconstruction case using a vertical rectus abdominis myocutaneous (VRAM) flap for a radiation ulcer on the suprapubic area following radiation therapy for recurred malignant melanoma. Before flap elevation, we conducted sufficient debridement until pliable healthy tissue was revealed. Afterwards, a 15×9 cm VRAM flap was elevated. We then inserted the flap through a suprafascial tunnel. At 6 months postoperatively, a completely healed aesthetic flap was achieved. This case is meaningful in that it involves a successful reconstruction of a sizable abdominal wall defect of the suprapubic area with unhealthy and unviable adjacent tissue following repeated surgery and chemoradiotherapy.

VESTIBULOPLASTY IN AN EXTREMELY ATROPHIC EDENTULOUS MANDIBLE USING A COMBINATION OF STRIP PALATAL GRAFT AND XENOGENEIC COLLAGEN MATRIX: A CASE REPORT

Purpose: The aim of this research was to evaluate the cumulative effect of using both epithelial autograft and xenogeneic collagen matrix as an alternative to single keratinized epithelial palatal autografts, which can prove beneficial for its reduced morbidity. Materials and methods: This study includes one female patient with an extremely atrophic mandible who requires deepening of the vestibulum in the anterior region in order to improve the stability of the removable denture. The surgical procedure included local anesthesia, one horizontal incision and a partial-thickness flap elevation. The exposed periosteum was covered by a small keratinized epithelial autograft from the hard palate at its apical aspect and a xenogeneic collagen matrix at its coronal portion. Follow up of the healing process was performed on the 7th, 14th, 30th day, after three and six months. Results: The postoperative period underwent without any complications in all areas. The healing process resulted in the formation of an additional area of keratinized mucosa - a mean gain value of 2.92 mm after six months, which led to a significant improvement of denture stability. Conclusion: The final result suggested that this technique shows great promise in compensating the disadvantages of using single grafting materials: the increased morbidity caused by the additional surgical site on the palate in the case of autografts and the greater shrinkage of the area of keratinized mucosa in a six months period when collagen matrixes are applied as a single grafting material in large edentulous areas.

Training in endoscopic ear surgery using the papaya petiole

Background Endoscopic ear surgery is a game changer in the field of otology. Training in endoscopic skills is essential for ENT residents, and is especially important during the coronavirus disease 2019 lockdown period. In such difficult times, ENT residents and surgeons can undergo hands-on training using a papaya petiole, even within their homes. Objective Endoscopic ear surgery training can be carried out using a papaya petiole, enabling the practice of grommet insertion, tympanomeatal flap elevation and foreign body removal from the external auditory canal. This model does not need any laboratory setup. Results and conclusion The hollow structure of the papaya petiole model is very similar to that of the external auditory canal, making training in endoscopic ear surgery easy. Use of the model helps a beginner to train in endoscopic handling and microsurgical instrumentation, and improves depth perception. In addition, it does not require high-end facilities to store equipment or undertake the training at any given point in time.

Dissection Methods in Abdominoplasty: A Systematic Review and Meta-Analysis

Abdominoplasty is one of the most common cosmetic procedures performed worldwide. Despite recent advances in surgical technique, the risk of complications remains high. The advantages of using various dissection devices as a method of flap elevation in abdominoplasty remains unclear. A systematic search was undertaken to identify studies comparing electrocautery dissection with scalpel dissection and plasma-kinetic energy-based dissection methods in abdominoplasty. A meta-analysis was performed using the selected studies. Seven studies were analyzed. These studies included a total of 1143 patients who underwent abdominoplasty using electrocautery (n = 617), steel scalpel (n = 457), or plasma dissection (n = 69). A meta-analysis was conducted, which showed an overall reduction in incidences of seroma, operative time, and length of hospital stay in the scalpel dissection group compared with the electrocautery group. The plasma dissection group showed a reduction in rate of postoperative wound infection and hematoma, as well as a reduction in drain output and length of hospital stay, compared with the electrocautery group. There are few studies comparing outcomes using different dissection techniques in abdominoplasty. These studies are small and heterogeneous in design. However, using plasma-kinetic energy-based devices or scalpel dissection appears to be associated with reduced complication rates, shorter operative time, lower drain volumes, and a reduction in the length of hospital stay.

Minimally invasive (flapless) crown lengthening by erbium:YAG laser in aesthetic zone

Crown lengthening is a surgical procedure aimed at exposure of a larger tooth surface by gingivectomy alone or with cortical bone remodelling for aesthetic purposes in the anterior zone of the maxilla or for reconstruction of teeth affected by subgingival caries. We report two cases of crown lengthening in the anterior maxilla for aesthetic purposes by gingival and bone re-contouring performed by erbium-doped yttrium aluminium garnet (erbium:YAG) laser. As highlighted in this report, the erbium:YAG laser-assisted crown lengthening is less invasive and also leads to faster clinical outcomes in contrast to the conventional surgical technique by scalpel incision, flap elevation and osteoplastic.

Minimal Incision Venectomy for Peripheral Septic Thrombophlebitis

Peripheral septic thrombophlebitis is an uncommon but potentially lethal condition fraught with systemic complications. Optimal treatment calls for surgical excision of the inflamed venous segment, followed by antimicrobial therapy. However, the extended skin incision and meticulous flap elevation of conventional venectomy leaves substantial residual scarring. Herein, we detail a minimal incision venectomy performed for peripheral septic thrombophlebitis in a 55-year-old man. The patient was initially admitted for conservative management of intracranial hemorrhage but subsequently developed high fever and hypotension. An abscessed intravenous catheter site of the left forearm was the apparent source. Following emergency drainage and serial irrigation, surgical venectomy was undertaken to radically remove the septic focus, excising a 10-cm segment of infected vein through a separate proximal incision. After the procedure, the patient’s recovery was complete and free of complications at postoperative 6-month visit. Under appropriate indications, minimal incision venectomy can be an effective therapeutic alternative with minimal scarring.