The Significance of Intraoperative Electromyographic “Lateral Spread” in Predicting Outcome of Microvascular Decompression for Hemifacial Spasm

Objectives During microvascular decompression (MVD) of the facial nerve for hemifacial spasm (HFS), an abnormal muscle response can be recorded upon stimulation of the facial nerve, also known as the lateral spread response. This response may vanish after MVD and has been associated with a successful outcome. The purpose of this study was to determine if resolution of lateral spread correlated with the elimination of HFS in a single surgeon''s experience. Design and Setting (1) Retrospective analysis of 38 patients undergoing MVD with intraoperative electromyography for HFS. (2) Meta-analysis of studies from the literature. Main Outcome Measure Presence or absence of HFS and any complications. Results Lateral spread response was seen in 36 patients; 20 patients had full resolution. Of these, 15 patients became HFS free, and 5 five patients still had some degree of HFS. Sixteen patients had a persistent lateral spread response despite a technically successful MVD; 11 of these became spasm free, and 5 still suffered from some degree of facial twitching. Analyzing 16 studies reporting a total of 1301 patients, a significant correlation (p < 0.0001) between response cessation and resolution of HFS was found. Conclusion The role of monitoring lateral spread response as a predictor for clinical outcome is limited.     

Reconstruction of Compound Loss of Lateral Malleolus and Lateral Ankle Ligaments with Double-Bundle Achilles Tendon–Bone Allograft

Open ankle fracture, including compound loss of the lateral malleolus, lateral ankle ligaments, and overlying skin, is a severe injury and can result in ankle instability and permanent disability. Treatment of this injury is challenging and requires bone grafting and soft tissue reconstruction. In the present report, we describe a unique reconstruction technique for compound loss of the lateral malleolus, lateral ankle ligaments, and the overlying skin using a double-bundle Achilles tendon–bone allograft combined with a reverse sural fasciocutaneous flap. The patient obtained a stable ankle with nearly full range of motion and displayed satisfactory function during the follow-up period.     

Omental Free-tissue Transfer for Coverage of Complex Upper Extremity and Hand Defects—The Forgotten Flap

Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in seven patients with complex upper-extremity defects between 1999 and 2008 was performed. Indications, operative technique, and outcome were evaluated. Patient age ranged from 12 to 59 years with five male and two female patients. Indications included tissue defects due to crush-degloving injuries, pitbull mauling, or necrotizing soft tissue infection. All patients had prior operations including: revascularization, debridement, tendon repair, skin grafts, and/or fixation of associated fractures. One patient sustained severe bilateral crush-degloving injuries requiring free omental hemiflap coverage of both hands. The mean defect size was 291 cm² with all patients achieving complete wound coverage. No flap loss or major complications were noted. Laparoscopic-assisted omental free flap harvest was performed in conjunction with the general surgery team in three cases. Mean follow-up was 2 years. The omental free flap is a valuable, often overlooked reconstructive option. The long vascular pedicle and large amount of pliable, well-vascularized tissue allow the flap to be aggressively contoured to meet the needs of complex three-dimensional defects. In addition, laparoscopic-assisted harvest may aid with flap dissection and may result in reduced donor-site morbidity.     

RETRACTED ARTICLE: Additional and Different Application of the Bilobed Flap: Bilobed in Bilobed Flap for Reconstruction of the Lower–Upper Lid and Lateral Canthal Defects

BACKGROUND: The rich blood supply to the skin of the face provides the reconstructive surgeon much variability with local flap planning. However, in the design of local flaps, incisions should be placed where the tension of the suture lines will not distort landmarks such as the lip, the ala, and especially the eyelid. METHODS: A case is presented with a different and further application of the bilobed flap in reconstruction of upper-lower and lateral canthal region defects. RESULTS: With the described approach, the early postoperative and 18-month follow-up periods were seen as uneventful. CONCLUSION: With regard to these local flap options, although the bilobed flap is an extremely useful flap whose usefulness in coverage of facial defects has been well described, no report has described its usage for eyelids and the lateral canthal region of this bilobed (bilobed in bilobed) flap variation.     

Type of Lateral Internal Sphincterotomy Incision: Parallel or Vertical?

Background  

The lateral internal sphincterotomy (LIS) technique is considered the optimal surgical treatment for chronic anal fissures (CAFs), although questions remain regarding the best technique. The present study investigated whether the type of anoderm incision (vertical or parallel to the anus) affects wound healing, wound-related complications, incontinence, and recurrence rates in CAF patients undergoing open LIS.     

Lateral shelf acetabuloplasty in the treatment of Legg-Calvé-Perthes disease

Although head containment is extremely important for the development of the acetabulum and femoral head, there are debates about conservative and surgical treatment. Shelf acetabuloplasty is an effective means of treatment as regards the coverage of the femoral head within the acetabulum, which is the most important issue for the normal development of the hip joint. Nineteen hips of 18 patients were evaluated radiographically using the acetabulum-head index of Heyman and Herndon and the center-edge angle for containment. It was shown that postoperatively both indices improve to increase the containment, thus demonstrating the effectiveness of shelf acetabuloplasty.     

The Prognostic Value of E-Cadherin, α-, β-, and γ-Catenin in Urothelial Cancer of the Upper Urinary Tract

Objectives

To determine the value of loss of the expression of E-cadherin and cadherin-associated molecules as useful markers for both prognosis and bladder recurrence in patients with upper urinary tract cancer.

Materials and methods

In 61 paraffin-embedded nephroureterectomy specimens, the expression of E-cadherin and α-, β-, and γ-catenin was examined by immunohistochemical staining. To evaluate the prognostic significance, Kaplan-Meier survival curves were calculated and compared by the log-rank test. A multivariate test was performed to detect prognostic markers.

Results

Normal expression was found in 32 cases (52.5%) for E-cadherin, 41 cases (67.2%) for α-catenin, 42 cases (68.9%) for β-catenin, and 31 cases (50.8%) for γ-catenin. The expression patterns of E-cadherin and α-, β- and γ-catenin were significantly correlated with each other. Survival analysis showed a significant difference between normal and aberrant expression in each staining. Multivariate analysis revealed that tumor stage and the expression of E-cadherin were independent prognostic factors for cause-specific survival. In contrast, there was no significant correlation between the expression of E-cadherin and α-, β-, and γ-catenin and bladder recurrence.

Conclusion

Our data suggest E-cadherin may be a good prognostic marker for patients with upper urinary tract cancer.     

Upper cervical spine chordoma of C2–C3

Chordoma is a rare low-grade malignant neoplasm derived from the remnants of the embryonic notochord. This locally invasive neoplasm is subject to recurrence after treatment. The median survival time is estimated to be 6.3 years. Various treatment approaches have been attempted, including radical excision, radiotherapy and chemotherapy. Treatment outcome is significantly influenced by the size and site of the chordoma. Recently, Imatinib, a molecular-targeted agent, has been shown to have antitumor activity in chordoma. Proton radiotherapy, stereotactic radiotherapy and intensity-modulated radiotherapy have also been used. Surgical treatment is still the primary choice for chordoma. It has become more aggressive in recent years, evolving from intralesional or partial excision to en bloc resection. However, upper cervical localizations make such en bloc resection in most cases not possible. We present and discuss the therapeutic challenges of a young female with large retropharyngeal chordoma who presented to our institution after conventional photon beam radiotherapy. This C2/3 tumor was classified IB according to the Enneking classification. It distributed to layers A–D and sectors 1–6 according to the Weinstein Boriani Biagini Classification. The left vertebral artery (VA) was encapsulated and displaced. One stage intralesional extracapsular tumor excision and reconstruction was achieved by combined bilateral high anterior cervical approaches and posterior approach. No recurrence or metastasis was observed 3 years after the operation. She returned to her previous occupation as office worker.     

Prognostic Value of Modified Lateral Pillar Classification in Legg-Calv��-Perthes Disease

Background

To evaluate the usefulness of the modified lateral pillar classification as a prognostic factor in Legg-Calvé-Perthes disease (LCPD).

Methods

Thirty nine patients diagnosed with lateral pillar C in LCPD from May, 1977, to October, 2001 were reviewed, and their skeletal maturity was followed. The mean follow up duration was 12 years and 7 months (4 years, 6 months to 24 years, 9 months). Lateral pillar C classification was divided into C1 (50-75% collapse of the lateral pillar) and C2 (> 75%). All radiological and clinical prognostic factors were evaluated. The final results were evaluated according to the Stulberg classification.

Results

Twenty one and 18 of the affected hips were in groups C1 and C2, respectively. According to the Stulberg classification, the final results of group C1 were better than those of C2 (p = 0.002). Patients with more head-at-risk signs had significantly poorer outcomes.

Conclusions

The modified lateral pillar classification has significant value for predicting the prognosis of LCPD.     

Our ``Idèes Fixes' in Rhinoplasty: The Naso-Frontal Angle and the Alar Lateral Crus

An examination of the naso-frontal angle shows that a cranial or caudal shift in position affects the dorsum length. The fundamental aspect characterizing the naso-frontal angle is its width: it may be normal, too wide, or too narrow. It's easier to modify a too-narrow angle than a too-wide one. We show surgical techniques, emphasizing their method applied to the over-wide angle. The second ``idèe fixe' is the morphology of the alar lateral crus. Every variety of this structure has a peculiar property of shape and relationship with other elements that predetermines the therapeutic action. Diagrams and photographs are shown to describe the surgical techniques and the clinical results. There is also a demonstration of the method for alar lateral crus resection, which we call ``the long keel shape,' since it resembles the shape of a sailboat keel.     

Implantation Accuracy of a Lateral Unicompartmental Knee Arthroplasty: A Hoffa´s Fat Pad–Preserving Medial Approach Versus the Transpatellar Lateral Approach

BackgroundA small proportion of patients suffer from isolated lateral osteoarthritis where the sole lateral unicompartmental knee arthroplasty (UKA) is a possible treatment option. There, both a medial and a lateral surgical approach can be considered. This study should answer the question whether the lateral approach is superior to a modified medial approach in terms of implantation accuracy and subjective outcome.MethodsIn this retrospective study, 175 patients with lateral UKA were included between 2015 and 2020. In 82 patients, the lateral approach was used, and in 93 patients, the medial approach was used. To assess implantation accuracy, different imaging criteria on postoperative radiographs were analyzed. Postoperative patient-related outcome measurements (PROMs) (OKS, LEFS, and EQ5D) were evaluated. Statistical significance was assumed for P < .05.ResultsThe tibial implant relation to the tibial plateau diameter in the lateral approach was significantly larger than in the medial approach (23.6% vs 22.2%; P < .001). Significantly more deviations >15° regarding flexion position of the femoral implant (P = .002) and a higher number of deviations of the slope was found (P = .06) in the lateral approach. The lateral approach showed a significantly higher rate of lateral positioning of the femoral component (P = .007). Post-PROMs showed significant improvement in both approaches.ConclusionThe lateral approach is not superior regarding different radiological accuracy criteria. The Hoffa´s fat pad–preserving medial approach showed good results in implantation accuracy and therefore is a good alternative to implant lateral UKA. In addition, significant improvement in PROMs could be demonstrated.     

What Is The Upper Limit Of Cement Penetration For Different Femoral Hip Resurfacing Components?

We used a validated femoral resurfacing model to obtain measurements of pressure and temperature and quantify cement distribution as a function of inner geometry and cementing technique of five different femoral hip resurfacing components. The purpose was to investigate if manufacture cementing recommendations are reliable. ASR showed only with the recommended manual cementing technique low cement pressures of 58.0±50.2kPa and low interface temperatures of 33.3±4.1°C. BHR had large cement defects of 10.4 ± 1.1 mm. Conserve Plus caused the smallest cement penetration depths of 2.9 ± 0.6 mm. Durom was tolerant against changes of the cementing technique but showed the widest spread of temperature data 42.8 ± 7.0 °C. ReCap showed the highest risk for incomplete seating with a cement mantle thickness of 4.3 ± 0.9 mm. Polymerization heat did not exceed the threshold of 45 °C with a cement penetration depth of less than 4.2 mm in any circumstances of this study.