A different perspective for morbidity related to Fournier’s gangrene: which scoring system is more reliable to predict requirement of skin graft and flaps in survivors of Fournier’s gangrene?

International Urology and Nephrology - To identify the prognostic factors that might predict morbidity related to Fournier’s gangrene (FG) and particularly requirement of skin grafting and...     

Autologus groin lymph node transfer for “sentinel lymph network” reconstruction after head-and-neck cancer resection and neck lymph node dissection: a case report

Local or distant metastatic recurrence after therapy is observed in 20–30% of cases of head-and-neck cancer. An unfavorable course may occur after cervical lymph node dissection due to loss of immunoprotective lymph nodes in the head-and-neck region. To overcome this problem, we performed autologous lymph node transplantation from the groin after head-and-neck cancer resection and cervical lymph node dissection. The patient was a 63-year-old man with squamous cell carcinoma in the mesopharyngeal lateral wall. After tumor resection and right cervical lymph node dissection, a lymph node-containing superficial circumflex iliac artery perforator flap was transplanted from the left groin. Pathological examination showed that cancer had invaded the primary tumor tissue stump. Thus, radiotherapy (66 Gy) was performed for the residual tumor from days 28 to 84 after surgery. At 12 months after surgery, no recurrent lesion or has developed. The biopsy of flap and lymphatic vessel endothelial hyaluronan receptor-1 (LYVE1) immunostaining shows creditable lymph network in the flap, compared with normal free flap. This case suggests that autologous lymph node transplantation may keep watch on cancer recurrence by reconstruction of the lymph node system in the resected region, and we suggest that this approach may be very useful in cancer therapy.     

Quality of life,patient satisfaction and cosmetic outcome after delayed breast reconstruction using DIEP flap: a 10 years’ follow-up survey

Autologous breast reconstruction (BR) aims to restore body image and improve health-related quality of life in women undergoing mastectomy due to breast cancer. We wanted to explore patient-reported cosmetic results and satisfaction 10 or more years post BR surgery, using deep inferior epigastric perforator flap (DIEP). This is a follow-up study based on the same patient population of 34 patients undergoing delayed DIEP-flap procedure during 2001–2004 at Oslo University Hospital investigated by our group and published in 2008; Four patients died during the 10 years’ follow-up time and four patients with total or partial flap failure were excluded. The average age for reconstruction was 51.4?years (SD 5.8). The participants answered study-specific questions based on the first study, evaluated cosmetic results using the visual analog scale (VAS) and BREAST-Q post-mastectomy reconstruction module. The response rate was 85% (22/26). A significantly reduced number of patients reported satisfaction with the appearance of breasts (p?=?.035). The consistency of the reconstructed breast was significantly better evaluated with VAS score (p?=?.039). The patients reported overall satisfactory results based on Q-scores using the BREAST-Q post-mastectomy reconstruction module. Patients reported a generally high level of satisfaction with BR and cosmetic results 10 or more years after delayed DIEP-flap procedure. Although a significantly decreased number of patients reported satisfaction with the appearance of the breast, almost all patients would have chosen BR again, and the consistency of the reconstructed breast was evaluated as improved.     

A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren��s contracture

Background  

Needle aponeurotomy and collagenase injection are alternative treatments of Dupuytren’s contracture to open partial fasciectomy; however, reported data are difficult to interpret without a formal systematic review.     

Hiatal hernia, Barrett’s esophagus, and long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux

Background

The aim of this study was to determine the long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux disease (GERD), and possible prognostic factors.

Methods

A cohort of 271 patients, operated on at a university hospital from 1996 through 2002, was eligible for evaluation after a median interval of 102?months (range?=?12–158). The time between surgery and recurrence of reflux symptoms (i.e., time to treatment failure) served as the end point for statistical analysis. Putative risk factors for symptom recurrence were analyzed by univariate analysis and by using Cox’s multiple-hazards regression.

Results

According to Kaplan–Meier estimates, the rate of reflux symptom recurrence was 15?% after 108?months, 11?% in cases without intestinal metaplasia, but 43?% in patients with long-segment (≥3?cm) Barrett’s esophagus (BE; p?<?0.0001). Reflux symptoms recurred in 22?% of cases with a hiatal hernia (HH)?≥3?cm before operation, but only in 7?% with smaller or absent HH (p?=?0.005). Multivariate analysis revealed a relative risk of 6.6 (CI?=?3.0–13.0) for long-segment BE and 3.0 (CI?=?1.7–10.1) for HH?≥?3?cm. A strong statistical interaction was found between HH?≥?3?cm and long-segment BE: the small group (n?=?18) of cases exhibiting both risk factors had an exaggerated recurrence rate of 72?% at 108?months.

Conclusions

Laparoscopic fundoplication for symptomatic GERD provided a long-lasting abolition of reflux symptoms in 231 of 271 (85?%) patients. HH?≥?3?cm and long-segment BE were shown as independent prognostic factors favoring recurrence.     

Can we predict immediate outcome after laparoscopic splenectomy for splenomegaly? Multivariate analysis of clinical, anatomic, and pathologic features after 3D reconstruction of the spleen

The laparoscopic approach is the treatment of choice for splenectomy, but its definitive role in splenomegaly is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathological. The aim of this study was to evaluate the predictive factors on outcome after laparoscopic splenectomy in splenomegaly. We reviewed patients submitted to laparoscopic splenectomy with a final spleen weight superior to 700 g. Three-dimensional reconstruction of the spleen was performed, and spleen volume and diameters were measured. Multivariate analysis showed that factors that predicted for conversion were mediolateral diameter ( P = .039, RR: 1.43) and platelet count (P < .05, RR: 1). For intraoperative bleeding, the predictive factor was spleen volume (P < .03, RR: 1.003). Anteroposterior spleen diameter was related to operative time (P = .011), and the factor related to postoperative morbidity was age (P = .049, RR: 0.941). Local anatomy and clinical factors affect surgical outcome in laparoscopic splenectomy for splenomegaly. These factors should be taken into account when planning this kind of procedure.     

Revisiting Gavello’s procedure for single-stage reconstruction of the earlobe: The vascular basis,technique and clinical uses

BACKGROUND:

Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello’s procedure was one of the earliest.

OBJECTIVE:

To revisit Gavello’s procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice.

METHODS:

The authors discuss the vascular basis of Gavello’s flap, and describe the clinical application of the single-stage Gavello’s procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe.

RESULTS:

Excellent cosmetic results have been achieved in all different clinical situations in the authors’ experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area.

DISCUSSION:

Gavello’s procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite.

CONCLUSION:

The simple, century-old Gavello’s procedure is still of great value for reconstruction of earlobe defects of diverse etiology.     

Adenocarcinoma Appearing very late after antireflux surgery for barrett’s esophagus: long-term follow-up,review of the literature,and addition of six patients

Antireflux surgery is supposed to prevent the development of adenocarcinoma in patients with Barrett’s esophagus. The purpose of this study was to determine the prevalence of adenocarcinoma late after antireflux surgery. A total of 161 patients with long-segment Barrett’s esophagus had antireflux surgery and were followed for a mean of 148 months (range 54 to 268 months) Clinical, endoscopic, histologic, and functional studies were performed. Of the original 161 patients, 147(91.3%) completed long-term follow-up. Six patients (4.1%) developed adenocarcinoma 4,5,6,9,17, and 18 years, respectively, after surgery. Five were men. Two of them were asymptomatic for 12 and 17 years. Three of them had extralong-segment Barrett’s esophagus. Five underwent manometric evaluation with only one showing an incompetent lower esophageal sphincter. In two cases, 24-hour pH studies showed massive acid reflux. Two patients had early adenocarcinoma, whereas four had advanced carcinoma. Adenocarcinoma in long-segment Barrett’s esophagus seems to develop mainly in patients with recurrence of pathologic reflux, especially among men. A review of the English language literature during the last 2 3 years found 25 articles dealing with Barrett’s esophagus and antireflux surgery. Most of these reports had only a few patients with short-term follow-up (<60 months). To determine the true prevalence of this complication, a long-term objective follow-up is necessary.