A safer, simpler, classic intrafascial supracervical hysterectomy technique.

OBJECTIVES: Our aim is to introduce the technical aspects and advantages of a new classic intrafascial supracervical hysterectomy (CISH) technique over the conventional technique. METHODS: We performed a retrospective evaluation (Canadian Task Force classification II-2) of 200 women who underwent conventional CISH technique (100 cases), between March 2000 and September 2000, or the new CISH technique (100 cases) between May 2002 and November 2002. The charts of these 200 women were reviewed regarding patient characteristics, indications, uterine weight, estimated blood loss, operating time, and hemoglobin change. RESULTS: The women who underwent the new CISH had significantly shorter operating time as compared with operating time for the conventional method. Although no significant difference existed in the estimated blood loss, the hemoglobin change, which is an objective sign of blood loss, was significantly smaller using the new CISH technique than using the conventional CISH technique. CONCLUSIONS: The new CISH technique is safer, more convenient, faster, and results in less blood loss than the conventional technique, especially when the uterus is markedly enlarged by a large myoma, the ovarian ligament is too short, or the ovary and uterus are very closely adherent.     

Three-portal technique for laparoscopic cholecystectomy

We devised special maneuvers and techniques, which we refer to as “the three-portal technique,” for the performance of laparoscopic cholecystectomy. With this technique, the primary surgeon operates from the right side of the patient, beginning dissection at the posterior surface of the gallbladder and advancing until the neck of the gallbladder is sufficiently separated from the hepatic bed. The particular advantages of our technique are that the quadrate lobe of the liver does not obstruct the operative field, because of the direction of the dissecting forceps controlled by the operator’s right hand, and there is less contact between the various instruments. Sixteen patients with gallstones were successfully treated with this new technique, and no morbidity was attributable to the procedure.     

翻瓣与不翻瓣技术在口腔种植中的应用效果比较

目的 比较在口腔种植中应用翻瓣与不翻瓣技术的效果。方法 选取2021年1月-2023年10月于苏州口 腔医院行口腔种植的80例患者为研究对象,根据口腔种植方法不同分为A组、B组,各40例。A组采用翻瓣 技术,B组采用不翻瓣技术,比较两组围手术期指标、疼痛程度、牙齿美观度、并发症发生率、种植成功 率。结果 B组手术时间、术后疼痛持续时间、术后肿胀持续时间均短于A组（P ＜0.05）;B组VAS评分低 于A组（P ＜0.05）;B组种植成功率为97.50%,高于A组的90.00%,但差异无统计学意义（P ＞0.05）;B组 并发症发生率为2.50%,低于A组的22.50%（P ＜0.05）;B组PES评分、WES评分均高于A组（P ＜0.05）。 结论 翻瓣技术、不翻瓣技术在口腔种植中均可取得较为理想的效果,尤其是不翻瓣技术,更有利于 缩短手术时间及术后疼痛、肿胀持续时间,促进术后康复进程,且术后并发症发生几率较小,牙齿美 观度较高。     

Gold standard for inguinal hernia repair: Shouldice or Lichtenstein?

Summary In the knowledge that Lichtenstein inguinal hernia repair is becoming increasingly popular we evaluated this technique in a prospective randomized study. Would the Lichtenstein repair show significant advantages in order to justify it replacing the Shouldice technique, the standard for hernia repair of the last ten years? Between January 1996 and December 1997 the study was undertaken on 385 male patients suffering from 410 primary inguinal hernias. On 164 patients the Shouldice technique (SD) was used and on 221 patients the Lichtenstein repair (LS). 50 % of the operations were performed under local anesthesia, 50 % under spinal anesthesia. The 410 operations were done by 51 different surgeons, most of them in trainee programs. The postoperative local complication rate and duration of hospitalization were similar in both groups. Significant differences were noted concerning operation-time (LS: 80 min, SD: 88 min, p < 0,005) and return to work (LS: 25 days, SD: 41 days, p < 0,00005). The tension-free repair under local anesthesia described by Lichtenstein is an easy operation, with a low complication rate and short recovery period. The Lichtenstein technique is an ideal hernia repair with low costs, high patient comfort and suitability for day-surgery.     

纵劈尿道板卷管法和尿道口基底血管皮瓣法对前型尿道下裂治疗效果的比较

目的 :对比评价纵劈尿道板卷管法 (Snodgrass法 )和尿道口基底血管皮瓣法 (Mathieu法 )对前型尿道下裂的治疗效果。　方法 :分别采用Mathieu法和Snodgrass法治疗没有或仅有轻度阴茎下曲的前型尿道下裂 4 3例和 36例 ,对比手术成功率、术后并发症和术后外观。　结果 :Snodgrass法平均手术时间 (80min)明显少于Mathieu法 (1 1 5min ,P <0 .0 5 )。随访 3～ 1 0个月 ,术后并发症分别为 8例 (2 2 .2 %)和 1 6例 (37.2 %,P >0 .0 5 ) ,其中尿瘘发生率分别为 8.3%和 2 5 .6 %(P <0 .0 5 ) ,尿道狭窄发生率分别为 5 .6 %和 2 .3%(P >0 .0 5 ) ,切口裂开发生率分别为 8.3%和2 .3%(P >0 .0 5 ) ,Mathieu法皮瓣坏死 3例。　结论 :Snodgrass法手术操作简便 ,术后尿瘘发生率低 ,术后外观满意。对于没有或仅有轻度阴茎下曲的前型尿道下裂 ,Snodgrass法是替代Mathieu法的首选术式。     

Tumescent and syringe liposculpture: A logical partnership

Aesthetic Plastic Surgery - Liposuction has been traditionally performed under general anesthesia. Standard instrumentation for the procedure has included blunt-tipped suction cannulae connected to...     

Clubfoot: Etiology and treatment

Congenital talipes equinovarus is the commonest congenital anomaly with an incidence of one to two per 1000 live births. Over the centuries it has been treated by various modalities, but the dilemma facing the surgeon has been a strong tendency to relapse. With the use of the Ponseti technique, the number of patients who undergo soft tissue release has decreased. This technique probably represents a panacea for the treatment of this unsolved mystery.     

消化管吻合技术有关问题的探讨

随着对消化管愈合过程认识的进步及新技术的采用,消化管吻合术出现了一些新的发展趋势,如单层吻合法、对合缝合技术及机械吻合.本文就上述问题作一综述.     

肿胀技术在皮肤软组织扩张术中的应用探讨

目的:探讨肿胀技术在皮肤软组织扩张术中的临床意义。方法:在行皮肤软组织扩张术的I期手术时,在扩张器置入的区域,根据置入的部位和置入的层次注射0.06%肿胀液,然后切开皮肤皮下,按术前标记的剥离范围剥离,缝合切口,拆线后注水;在行皮肤软组织扩张术的II期手术时,取出扩张器后,将皮瓣旋转或推进,切除病变,在扩张包膜基底注射0.06%肿胀液,将扩张包膜切除,缝合切口。结果:自2000年1月～2005年1月,共治疗了50个病例100个扩张器,均获得了满意效果。结论:肿胀技术在皮肤软组织扩张术的I、II期手术中,具有便于腔隙的剥离和减少副损伤,以及减少术中和术后出血,减轻患者术后术区疼痛等优点。     

Preparation of cement spacer in treatment of segmental bone defects in children by the induced membrane technique: A technical note

The Masquelet Induced Membrane Technique (IMT) is one of the tools in the surgeon’s armamentarium for the management of segmental bone defects. The first stage of the IMT includes the insertion of a cement spacer, which is typically fashioned by the free-hand technique. We propose a novel technique for preparation of the cement spacer using a split syringe barrel as a mould. This technique produces a uniformly cylindrical spacer with minimum cement spillage, while also minimizing thermal damage to the surrounding soft tissues. It is a simple and cost-effective method that can be adapted for use in any long bone in children.     

改良Heron法建立异种异位心脏移植模型

目的对Heron法颈部袖套血管吻合建立心脏移植模型的手术方法进行部分改进,建立简化的豚鼠→SD大鼠异种异位心脏移植模型。方法异种心脏移植供体为雄性豚鼠64只,普通级,体重250～350g;受体为雄性SD大鼠64只,清洁级,体重300～350g。采用改进的套管技术通过自制Cuff管将豚鼠供心的升主动脉、肺动脉与SD大鼠受体的右侧颈总动脉、颈外静脉分别进行吻合。结果单人操作连续进行正式试验64次,总手术时间45～60min,吻合时间2～5min,供心冷缺血平均14±3min。手术成功率100%,无吻合口漏血或血管回流受阻,移植物复跳率100%。结论改良Heron法建立大鼠颈部异种心脏移植无需显微外科操作,是一种简便、经济实用、稳定可靠和易于复制的器官移植研究动物模型。     

Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment

INTRODUCTION

The objective of this study was to analyse, prospectively, the outcome of a new technique – excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at the lower end of the incision.

PATIENTS AND METHODS

Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence.

RESULTS

Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78–1.85) to a mean of 3.8 cm (95% CI, 3.77–3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12–38 months).

CONCLUSIONS

Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.     

瘤周肿胀技术配合皮肤软组织扩张术治疗头皮巨大神经纤维瘤

目的:探索头皮巨大神经纤维瘤切除术中减少出血及创面修复的方法.方法:2003年4月～2008年4月,应用瘤周肿胀技术配合皮肤软组织扩张术治疗头皮巨大神经纤维瘤8例.结果:8例患者均一次性完整切除瘤体,扩张皮瓣修复缺损创面.术中出血明显减少,出血量约100～300ml.随访3个月～1年,均未见肿瘤复发,扩张皮瓣成活良好.结论:瘤周肿胀技术配合扩张器技术可以较好地完成头皮巨大神经纤维瘤的完整切除及修复.     

Induced Membrane Technique for the Management of Segmental Femoral Defects: A Systematic Review and Meta-Analysis of Individual Participant Data

Several modifications of the induced membrane technique (IMT) have been reported, but there is no consensus regarding their results and prognosis. Moreover, most studies have focused on tibial defects; no meta-analysis of the treatment of femoral defects using the IMT has been reported. This systematic review and meta-analysis aimed to identify the potential risk factors of post-procedural complications following the treatment of segmental femoral defects using the IMT. A comprehensive search was performed on the Cochrane Library, EBSCO, EMBASE, Ovid, PubMed, Scopus, and Web of Science databases, using the keywords “femur,” “Masquelet technique,” and “induced membrane technique.” Original articles composed in English, having accessible individual patient data, and reporting more than two cases of bony defect or nonunion of femur or more than five cases of any body part were included. Post-procedural bone graft infections, final union status, and union time after second-stage operation were analyzed. Fourteen reports, including 90 patients, were used in this study. External fixation in second-stage surgery had an odds ratio of 9.267 for post-procedural bone graft infection (p = 0.047). The odds ratio of post-procedural bone graft infection and age >65 years for final non-union status was 51.05 (p = 0.003) and 9.18 (p = 0.042). Shorter union time was related to impregnated antibiotics in the spacer (p = 0.005), transplanting all-autologous grafts (p = 0.042), and the application of intramedullary nails as the second-stage fixation method (p = 0.050). The IMT appears to be reasonable and reproducible for femoral segmental bone defects. Several preoperative and surgical factors may affect post-procedural complications and union time.     

Basic interrupted versus continuous suturing techniques in bronchial anastomosis following sleeve lobectomy in dogs

Objective: Sleeve resection with or without lung resection is a valid conservative operation for patients with benign or malignant tumors; it enables the preservation of lung parenchyma. The aim of this prospective randomized study was to compare complications, operating time, and bronchial healing between the techniques of interrupted and continuous suturing for bronchial anastomosis in dogs. Methods: Twenty adult mongrel dogs each weighing 18–22 kg (average: 20 kg) were divided into two groups according to the anastomosis technique performed: group A, interrupted suturing and group B, continuous suturing. Each group comprised of 10 dogs. Following right thoracotomy, sleeve resection of the right cranial lobe was performed in all dogs. Basic interrupted sutures using 4/0 Vicryl (Ethicon, USA) were used in group A, and continuous sutures were used in group B. Results: The median anastomosis time was 15.2 min (range: 13–21 min) in group A and 9.6 min (range: 8–13 min) in group B. In all dogs, the anastomosis line was resected via right pneumonectomy for histopathological investigation 1 month after sleeve resection. Histopathological examination revealed that the healing of the anastomosis was not affected by the suturing technique applied. One dog from each group died on the fourth postoperative day; Fisher's exact test, p = 0.763. Conclusions: Our research revealed that the healing of the anastomosis was not affected by the suturing technique performed.     

The Sliding Technique: A Method to Treat the Overprojected Nasal Tip

BACKGROUND: This report aims to demonstrate the advantages of the sliding technique for reducing an overprojected tip. METHODS: In this study 271 patients (201 females, 70 males) were treated using this technique. It was used for isolated tip hypertrophy (N = 93) and combined deformities (N = 147). RESULTS: A medial sliding was performed in 109 patients, a lateral in 125 patients, and a combined lateral and medial sliding was used in 9 patients. Twenty patients needed additional skin resection at the columella. Follow-up of our first 80 patients showed an average reduction of around 11%. Only one patient of 80 in this study had to be revised. CONCLUSION: The sliding technique is safe and reliable as well as a logical and effective technique to deproject the nasal tip.