Successful treatment of subarachnoid-pleural fistula using pericardial fat pad and fibrin glue after chest wall resection for lung cancer

A 46-year-old male underwent a right adrenalectomy and a left upper lobectomy with an en-block resection of the involved chest wall. The proximal rib resections (third and fourth ribs) were performed at the costvertebral joints. Hemorrhage occurred from near the 3rd intervertebral foramen. The bleeding site was packed with oxycellulose to control the bleeding. Two hours after the operation, the patient complained of paraplegia due to spinal cord compression caused by swollen oxycellulose. An emergency operation was performed. The oxycellulose was carefully removed from the intervertebral foramen. Cerebrospinal fluid was exudated from the spinal canal, however, suggesting an iatrogenic subarachnoid-pleural fistula (ISPF). Autologous fat fragments individually combined with fibrin glue, was packed gently into the intervertebral foramen. The orifice of the foramen was then covered with a pericardial fat pad. The postoperative course was uneventful. This new technique is a direct and effective treatment for an ISPF.     

A new technique for muscle flap closure of the empyema space in complicated chronic bronchopleural fistula

OBJECTIVES: It is difficult to close the empyema space once it is opened, especially in cases complicated with a chronic bronchopleural fistula. A muscle flap closure is generally employed to prevent this situation. However, this operation occasionally fails because the space newly recurs around the fistula due to atrophic change occurring in these translocated muscles. The aim of the present new technique was to prevent inspiratory pressure from the inside of the bronchus by bronchial emboli, and help the adhesion between the fistula stump and the muscle flap, even if they have become atrophic and no longer have sufficient volume to fill the entire empyema space. METHODS: We carried out fiberscopic embolism of causative bronchioles followed by muscle flap closure in 4 patients in whom open drainage had already been performed against parapneumonic empyema within the bronchial fistula. The bronchial fistula was plugged from the inside of the bronchus by silicon material, and stainless steel wire was used to connect this plug tightly to the muscle flaps, so that the fistula was sandwiched between them. In all cases, we succeeded in complete closure of the bronchial fistula and empyema space without using the omentum, and there has been no recurrence. CONCLUSION: The presented new technique was beneficial for achieving muscle flap closure of the empyema space with a chronic bronchopleural fistula.     

Pedicled buccal fat pad flap for intraoral malignant defects: A series of 29 cases

A buccal fat pad (BFP) as a flap for reconstruction of defects in the oral cavity has been described for a variety of benign conditions. We describe the indications, advantages, and complications of the BFP flap and report our clinical experience with the flap for intraoral reconstruction after tumor removal. From 2005 to 2008, we analyzed 29 patients in the age range of 32 to 82 years old who underwent a pedicled BFP flap reconstruction for oral defects after intraoral tumor removal. Postoperative wound healing and complications including any recurrence was followed-up prospectively. Most of the patients had an uneventful immediate postoperative period with signs of buccal fat pad epithelialization by the end of the first week and complete epithelialization at the end of the first month. On continued follow-up, a linear band of fibrous tissue under the epithelialized mucosa replaced the once reconstructed buccal fat pad. Three patients had varying degrees of hemorrhage: one of them had hematoma that healed with severe fibrosis and of the remaining two, one had a partial flap loss and one had a complete flap loss. Judicious use of buccal fat pad reconstruction offers a simple, convenient, and reliable way to reconstruct small to medium defects of the oral cavity with low morbidity, even in older patients who would not be able to tolerate time-consuming flap reconstruction procedures.     

Delayed buccal fat pad herniation: An unusual complication of buccal flap in cleft surgery

Buccal musculomucosal flap is commonly used in cleft palate surgery for providing additional lining when nasal mucosa is inadequate. We report an unusual complication of progressively increasing fat herniation from the sutured donor site which started appearing on the third postoperative day. This necessitated excision of the protruding fat pad on the seventh postoperative day. The possible mechanism and precautions for prevention of this complication are discussed.     

A treatment protocol for chronic post-pneumonectomy empyema associated with bronchopleural fistula: A single-centre retrospective study

Chronic post-pneumonectomy empyema (CPPE) associated with bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. This study aims to propose a treatment protocol for managing this severe disease. From July 2009 to June 2021, 47 CPPE with BPF patients were treated in our department. CT scan with 3D reconstruction was used to detect BPF and to evaluate the location and volume of empyema cavity. Different surgical techniques were used to close BPFs according to they sizes. Multiple pedicled muscle flaps were chosen to fill the empyema cavity, and among them, latissimus dorsi (LD) was the mostly used flap. For cases that regional flaps were not suitable, free flaps were used. Patients were followed-up from 7.9 to 102.8 months. Forty-four patients (93.6%) healed after the operation. Closure of BPFs failed in three patients (6.4%), leading to regional infection. These patients were treated by bronchoscopic application of sealants, continuous drainage and antibiotics, and they eventually healed. Total or partial flap loss was not seen in any of the cases. Treatment protocol was proposed based on these results. CT scan with 3D reconstruction is an effective examination to evaluate pleural cavity defect and BPF. Proper technique to close the BPF and right choice of flap to fulfil the empyema cavity are the two most important key points to treat CPPE associated with BPF patients.     

The composite meniscal-capsular-fat pad flap in a lateral approach to the fixed valgus knee: an anatomical study

We present an anatomical study on the vascular supply to the patellar fat pad. Forty knees from fresh cadavers were dissected after injecting the femoral artery with colored latex. In all cases, the vascular supply to the fat pad depended essentially on the lateral inferior genicular artery, which enters this structure at its posterolateral extent. In the cases in which the fat pad flap was raised before the injection of latex, we observed good vascularization of the flap by the lateral genicular artery. This is a safe vascularized flap that offers an optimal covering of knee prostheses in fixed valgus knee deformities. An optimal procedure for raising the flap is proposed.     

带蒂筋膜脂肪瓣联合肌腱移植重建手背伸肌腱功能的临床研究

目的：探讨应用带蒂筋膜脂肪瓣联合肌腱移植修复手背部创伤后肌腱缺损的临床应用。方法：2003年4月～2009年12月,行腹部轴型带筋膜及脂肪组织皮瓣修复手背部缺损,二期在脂肪层内行肌腱移植,修复肌腱缺损7例16指。结果：随访6～24个月,根据TAM评定标准,优13指,良1指,中1指,治疗效果满意。结论：应用带蒂筋膜脂肪瓣修复手背部软组织缺损,脂肪层内行肌腱移植,可以很好地防止肌腱粘连的发生。     

A treatment protocol for chronic post‐pneumonectomy empyema associated with bronchopleural fistula: A single‐centre retrospective study

Chronic post‐pneumonectomy empyema (CPPE) associated with bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. This study aims to propose a treatment protocol for managing this severe disease. From July 2009 to June 2021, 47 CPPE with BPF patients were treated in our department. CT scan with 3D reconstruction was used to detect BPF and to evaluate the location and volume of empyema cavity. Different surgical techniques were used to close BPFs according to they sizes. Multiple pedicled muscle flaps were chosen to fill the empyema cavity, and among them, latissimus dorsi (LD) was the mostly used flap. For cases that regional flaps were not suitable, free flaps were used. Patients were followed‐up from 7.9 to 102.8 months. Forty‐four patients (93.6%) healed after the operation. Closure of BPFs failed in three patients (6.4%), leading to regional infection. These patients were treated by bronchoscopic application of sealants, continuous drainage and antibiotics, and they eventually healed. Total or partial flap loss was not seen in any of the cases. Treatment protocol was proposed based on these results. CT scan with 3D reconstruction is an effective examination to evaluate pleural cavity defect and BPF. Proper technique to close the BPF and right choice of flap to fulfil the empyema cavity are the two most important key points to treat CPPE associated with BPF patients.     

The Gonzalez hernia revisited: Use of the ischiorectal fat pad to aid in the repair of rectovaginal and rectourethral fistulae

Introduction

During the development of the posterior sagittal approach to anorectal malformations a vital technical challenge was a precise midline dissection, which if off, allowed for the ischiorectal fat pad to bulge into the wound. This occurrence became affectionately known as a “Gonzalez hernia”, after a trainee of Dr Pena’s (and a co-author of this paper). We describe here an innovative use of the ischiorectal fat pad to aid in the repair of acquired rectovaginal and rectourethral fistulae.

Methods

Patients with recurrent vaginal or urethral fistulae were selected for review. The ischiorectal fat pad was deliberately mobilized (via a posterior sagittal or transanal approach) and used to buttress the repair of the posterior vagina or urethra.

Results

The ischiorectal fat pad technique was used in 9 patients. All had an acquired fistula (6 rectovaginal fistula, 3 rectourethral fistulas). We used the posterior sagittal approach in 7 and in 2 the transanal approach. Six patients had had at least two prior attempts at fistula repair. Six patients had a stoma, and 3 did not. There were no recurrences in greater than six month follow-up.

Discussion

The ischiorectal fat pad is easily visualized and mobilized, either via a posterior sagittal or transanal approach, providing excellent coverage with native, well-vascularized tissue, in an area that is difficult to heal. It is an excellent option for recurrent rectovaginal and rectovaginal fistulae and may have other additional creative applications.     

Rectal flap advancement – a simple and effective approach for the treatment of rectourethral fistula

Objective Rectourethral fistula is a rare complication of prostatic surgery and other pelvic procedures. We report our experience of surgical repair of using a rectal advancement flap. Patients Three patients with rectourethral fistula following prostatic surgery were treated. Two patients had an anterior partial thickness of rectal flap advancement via a trans‐anal approach without urinary or faecal diversion. In one patient a rectal flap repair was performed through a posterior transsphincteric approach following urinary and faecal diversion. Results No significant postoperative complications occured. Healing was successful in each patient and faecal and urinary continence was normal. Conclusion Transanal rectal advancement flap is a simple and effective technique for the treatment of a rectourethral fistula with no need for urinary or faecal diversion.     

皮瓣延迟后对皮瓣预制时间影响的实验研究

为了探寻缩短皮瓣预制时间的新方法，作者设计了两组皮瓣预制方法进行比较。Ａ组为皮瓣延迟实验组，Ｂ组为正常皮瓣预制对照组。皮瓣预制后２周进行血管灌注检查和皮瓣移植。结果：Ａ组皮瓣成活范围大，植入血管与原皮瓣之间血管吻合支多；Ｂ组皮瓣成活面积小，血管网形成范围小，吻合支少。结论：皮瓣延迟后皮瓣预制时间可大大缩短，从而缩短了手术周期。     

Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report

INTRODUCTIONTracheocutaneous fistula is a complication of tracheostomy. Tracheocutaneous fistulectomy followed by primary closure carries a high possibility of complications.PRESENTATION OF CASEAn 11-year-old boy underwent surgery to repair a tracheocutaneous fistula, using skin and muscle flaps. A vertical incision was made around the fistula and 3 skin flaps were prepared: 2 hinge flaps, and 1 to cover the skin defect (advanced flap). The 2 hinged turnover flaps were invaginated by multiple layered sutures, and a strap muscle flap was placed over the resulting tracheal closure. An advanced skin flap was used to cover the area of the previous defect. The patient was extubated immediately after surgery. He was discharged on the sixth postoperative day without tracheal leakage or subcutaneous emphysema. The patient is currently doing well, with no respiratory symptoms and no recurrence at the postoperative 5 months.DISCUSSIONOur technique is minimally invasive and has a low risk of lumen stenosis, other complications, or recurrence.CONCLUSIONThis technique demonstrates the multiple-layered closure of a tracheocutaneous fistula, using skin flaps and a muscle flap.     

Case report. An unusual cause of a patient presenting with an acutely locked knee: multiple benign fat pad cysts

Benign ganglion (synovial) cysts within the knee are uncommon and especially so when located in the infrapatellar fad pad. They cause many non-specific symptoms but usually present as a swelling. We report the case of a young gentleman with multiple benign synovial cysts within the fat pad causing a locked knee, which was treated with arthroscopically assisted open excision. We can find no previous reports of isolated multiple fat pad cysts causing acute locking of the knee.     

Boari flap vesicocalycostomy: a salvage drainage procedure for complete ureteric stricture and pyelocalyceal fistula

Abstract:  To increase the working knowledge on how to drain a transplanted kidney via the use of a Boari flap as a salvage procedure. A female with a transplant kidney had complete obstruction at the ureteropelvic junction and multiple strictures of the ureter causing deterioration of the graft function. Surgery was the only way to successfully drain the obstructed kidney, but conventional methods were not possible due to dense fibrosis around the kidney. A Boari flap to the lower pole calyx of the transplant kidney was therefore employed. A Boari flap vesicocalycostomy is a potential method available to the transplant surgeon to successfully restore graft function in a case where the transplant or native ureter is unsalvageable.     

Use of omental pedicle flap for the prevention of bronchopleural fistula after surgery: an unsuccessful case in a management of bronchopleural fistula

We report a case of bronchopleural fistula after preoperative neo-adjuvant chemotherapy for advanced lung cancer. A 55-year-old man admitted to our institution and was diagnosed to have advanced lung cancer. Right pneumonectomy was carried out after chemotherapy. Parietal pleura and the right main bronchus were thick because of severe fibrosis due to chemotherapy. On the 16th postoperative day, bronchopleural fistula was found. After drainage, further resection of bronchial stump and wrapping with omentum was carried out. However, he died of pneumonia due to repeated bronchopleural fistula. Since this experience, we use omental wrapping procedure in patients undergoing surgery for the hilar type lung cancer after chemotherapy, and conclude that omental wrapping is useful for prevention of bronchopleural fistula.     

髌下脂肪垫对全膝关节置换术后患者膝关节功能恢复影响的meta分析

目的通过meta分析评价髌下脂肪垫对全膝关节置换患者术后功能恢复的影响。 方法检索Cochrane Library、Embase、PubMed英文数据库和万方数据库、维普数据库以及中国知网数据库有关于髌下脂肪垫对全膝关节置换术后影响的临床随机对照试验（RCTs）和回顾性队列研究实验（RCSs）,使用Revman5.3软件进行meta分析。 结果最终共纳入8篇文献,其中英文文献4篇,中文文献4篇,共纳入全膝关节置换术病例1 474例,其中髌下脂肪垫切除术696例,髌下脂肪垫保留组778例。与髌下脂肪垫切除相比,髌下脂肪垫保留组可降低术后髌韧挛缩（MD=-2.34,95% CI：-3.38~-1.31,P<0.05）,麦克马斯特骨关节炎指数（WOMAC）评分（MD=2.34,95% CI：2.04~2.65,P<0.05）;提高膝关节功能评分（MD=-0.77,95% CI：-1.02~-0.52,P<0.05）,降低术后膝关节前侧疼痛发生率（RR=12.58,95% CI：3.24~48.75,P<0.05）。两组患者在术后膝关节活动度（MD=-7.53,95% CI：-20.27~5.21,P>0.05）,髌腱长度与髌骨最大长轴比值（Insall-Savatict）评分法（MD=-0.04,95% CI：-0.09~0.01,P>0.05）;术后膝关节返修率：（RD=0.01,95% CI：-0.01~0.02,P>0.05）方面无明显差异。 结论与髌下脂肪垫去除组相比,全膝关节置换术后髌下脂肪垫保留可以降低髌韧带痉挛程度,提高膝关节功能评分,同时可降低膝关节前侧疼痛。