Vertical mammaplasty with a clamp technique

The vertical mammaplasty with a clamp technique is a personal adaptation of the clamp technique that leaves a single vertical scar in addition to the periareolar scar. This technique uses a superior pedicle from the dermal vault technique. There is no need for preoperative markings. The glandular tissue is removed with constant reference to the breast base. The skin is excised around a new clamp, which leaves only a vertical scar. This retrospective study includes 100 patients operated between 1996 and 2000. A total of 96% of the patients have been happy with the final cosmetic result. The best results were obtained when breast ptosis and moderate hypertrophy were present. The complication rate was 4%. This technique is as reliable as other procedures using the superior flap technique. A vertical scar is obtained by using a new clamp that allows a perfect match of the gland to its cutaneous cover. It is also a fast technique to perform (75 minutes).     

A new periareolar mammaplasty: the "round block" technique

The "round block" acts as a keystone supporting the mammary cone. The keystone lies in the dermodermic, glandulo-glandular, and glandulo-musculoperiosteal unions fixed definitively with nonresorbable suture, by a crisscross mastopexy, and by a circular nonresorbable suture of woven nylon included in the periareolar circular dermo-dermic scar block. This technique can be used in numerous types of breast surgery: In cases of ptosis or hypertrophy, it allows the scar to go up to the periareolar circle which is in itself generally inconspicuous. In cases of hypotrophy, the use of the round block technique permits easy access for insertion of the prosthesis as it simultaneously corrects ptosis. In cases of tumoral excision, the round block produces a discreet scar and a more regular breast contour. In all types of mammoplasty, the main goal is to limit the scar. The scar in the submammary fold is visible, particularly when one is lying down. The ideal result is confining the scar to the periarolar area.     

Universal hip fixator "Zespol". Construction of the fixator, principles of function, instrumentation, surgical technique, indications and results of treatment]

The construction and principles of function of hip fixator based on Zespol method, with compression of the fragments provided by elastic deformation of a plate is presented. Original instrumentation, operative technique and indications for this type of osteosynthesis is described. Results analysis revealed that out of 64 patients 10 died within 6 month from surgery, all of them older than 80 years of age. In 46 from remaining 56 patients a union of fractured bone was found. There were 82.2% of good results in patients with femoral neck fracture and 87.5% in the group with trochanteric fractures. Few complications produces hope for Zespol hip fixator to become valuable device for treatment both trochanteric and femoral neck fractures.     

Vertical mammaplasty: Postoperative changes, complications and patient evaluation

The aim of the present study was to investigate postoperative changes after vertical mammaplasty. Between 2002 and 2005, 72 consecutive patients aged 15 to 69 years with an average weight of 72 kg underwent bilateral vertical mammaplasty. Forty-two patients attended the regular follow-up one week, four weeks, three months, six months and one year after the operation. Nipple diameter, notch-to-nipple distance, scar length and the number of skin folds along the vertical scar were evaluated. Complications were recorded during the entire follow-up period. A questionnaire was used to document patient satisfaction 12 months after the operation. The main changes took place during the first three months after surgery. Nipple diameter showed an average increase of 28% after surgery, and the notch-to-nipple distance increased by an average of 17% over the intraoperative value. The average increase of the scar length after one year was 22%. The rate of complications was low, and patient satisfaction was high.     

Ureterolysis: technique, indications

Ureteral obstruction due to idiopathic retroperitoneal fibrosis is a rare but severe clinical problem. The open approaches, as well as surgical techniques used to prevent stenosis recurrence, are described. Ureterolysis remains the procedure to relieve ureteral obstruction. The ureter is dissected and freed from the fibrotic process, and then separated to prevent the recurrence of the stenosis. Recently, the development of Laparoscopic urology has allowed for minimal invasive treatment of many urological problems. We present our technique of ureterolysis for extrinsic ureteral obstruction. Advantages and complications of each method are considered and indications are proposed.     

Vertical trapezius musculocutaneous flap: A retrospective study

From 1986 to 2001, 17 patients (aged 26–77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12–25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.     

Vertebroplasty--basic science, indications and technique

INTRODUCTION: Vertebroplasty is a relatively new procedure for the treatment of vertebral body fractures of different origin. Due to early promising results the rate of performed procedures increases constantly. Indeed an increasing number of partially severe complications are reported. A summary of the existing findings seems therefore necessary. METHODS: On the basis of a medline inquiry important aspects of vertebroplasty in the fields of basic science, diagnostics, indications, contraindications, technique, results and complications were compiled. RESULTS: Especially for the field of indications, possible longterm effects and for the "ideal" technique open questions exist, mainly due to missing prospective, randomized long-term clinical trials. CONCLUSIONS: A final assessment of the significance of vertebroplasty for osteoporotic fractures in comparison to conservative treatment is actually not possible. In contrast vertebroplasty is a therapeutical option for malignomas in selected cases.     

Laparoscopic hysterectomy: technique, indications

Today, hysterectomy is, after caesarean section, the most frequent surgical intervention performed in fertile women. Introduced in 1989, laparoscopic hysterectomy remains poorly diffused: today, less than 5% of all hysterectomies remain done by laparoscopy. Nevertheless after a correct learning curve, laparoscopic hysterectomy finds perfect indications in benign and even some malignant indications. In these conditions, the complication rate is similar to those of the other surgical routes. Currently the limitations of this technique are the very bulky uterus, contraindicated uterine morcellation, the lengthening of the operative time potentially generated by this technique, and the lack of experienced instructors.     

Nine year longitudinal retrospective study of Taekwondo injuries

This retrospective longitudinal study aims to describe reported Taekwondo injuries and to examine associations between competitor experience level, age and gender, and the type, location, and mechanism of injury sustained. Additionally, we examined whether recent rule changes concerning increased point value of head shots in adult Taekwondo competition had affected injury incidence.This study was a summation of 9 years of data of competition injury reports, which included 904 injury reports spanning 58 individual competitions. The data was collected on standardized injury reports at time of injury during competition. Care was provided to the athletes, but the type of care provided was not included in the study. Participants included athletes injured during competition who sought care by the health care team, and for whom an injury report was filled out. The data analysis was performed at the Canadian Memorial Chiropractic College.The three most common locations of presenting injury were the head (19%), foot (16%), and thigh (9%). The most common mechanism of presenting injury was found to be a defensive kick (44%), followed by an offensive kick (35%). The most commonly diagnosed injuries were contusions (36%), sprains (19%), and strains (15%). Coloured belts had a higher incidence of contusions, while black belts sustained more joint irritation injuries. Black belts were more likely to suffer multiple injuries. Colored belts suffered more injuries while receiving a kick, while black belts had a larger influence of past history of injury. We found no significant difference in location or type of injury when comparing pre versus post rule change. The most common locations of injury are head, foot, and thigh respectively, and are areas for concern when considering preventative measures. Colour belt competitors are more likely to sustain contusions, which the authors believe is due to more aggressive tactics and lack of control. Those more likely to be injured tend to be younger than 18 years. Recent rule changes have no significant effect on head injuries.     

Vertical trapezius musculocutaneous flap: a retrospective study.

From 1986 to 2001, 17 patients (aged 26-77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12-25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.     

Post operative infections of the spine: technique,indications and results of the surgical treatment - A retrospective study of 90 cases

Post operative infection in spine surgery is a well known complication. The authors studied a series of 90 patients in accordance with an homogenous strategy based on the excision of necrotic and infected tissues, associated with appropriate antibiotics.The results are analyzed according to the degree of infection (which is based on the type of germs and their associations), and type of patients, the delay in diagnosis and the anatomical extension of the infected lesions.Making a difference between superficial and deep infection is of no therapeutic value and may lead to wrong and inadequate treatment.One must separate the common infections (which are due to germs as staphylococcus aureus or others from the urinary or digestive tract), and severe infections (which are either due to a per operative massive and deep contamination, or associated with patient's poor general condition).This series is mainly about posterior approaches to the spine, with or without osteosynthesis. Technical problems for treatment depend on the site of infection, particularly at the thoracic kyphosis level, or at the lumbar level where the muscle necrosis can be extensive. At the cervical level, the infection of an anterior approach mandates a check on the respiratory and digestive tracts.Removing the osteosynthesis is not mandatory in post operative spinal infections, as it may induce severe mechanical destabilization. An anterior approach is not necessarily required in the case of a posterior infection, except with massive contamination of an anterior graft. In some cases, posterior lumbar interbody fusion can lead to the indication for anterior cage removal.Pseudarthrosis of an infected spine, initially treated to obtain fusion, is still the worst complication. In case of previous posterior infection, even a severe one, fusion can still be obtained through a secondary anterior or posterior approach for grafting, with or without osteosynthesis.In this series, there was no neurological complication due to infection.However, eight diceases occured in weak patients with neurological involvement. This points out the importance of the general treatment associated with the surgery, and the necessity of a thorough assessment. a thorough assessment.Résumé Les infections post-opératoires représentent une complication largement documentée dans le domaine de la chirurgie du rachis. Les auteurs étudient une série de 90 patients traités selon une stratégie homogène basée sur l'excision des tissus nécrosés et infectés associée à l'utilisation d'un traitement antibiotique adapté. Les résultats sont analysés en fonction du degré d'infection (basé sur le type de germe et leurs associations) de l'état des patients, du délai pour le diagnostic et de l'étendue anatomique des lésions infectieuses. L'opposition entre infection superficielle et profonde semble sans intérêt sur le plan thérapeutique et peut conduire à un traitement insuffisant ou mal adapté.Il est important de séparer les infections classiques (qui sont dûes à des germes comme le staphylocoque doré ou d'autres germes provenant de la sphère urinaire ou digestive) et les infections sévères (qui sont soit dûes à une contamination per-opératoire massive et profonde ou associées à des patients dont létat général est déficient).Cette série est principalement basée sur les abord postérieurs du rachis avec ou sans ostéosynthèse. Les problèmes techniques pour le traitement dépendent du site de l'infection: aux niveaux thoracique et lombaire, la nécrose musculaire peut être très extensive. Au niveau cervical, l'infection d'un abord antérieur impose de vérifier l'intégrité du tractus aéro-digestif.L'ablation initiale du matériel n'est pas nécessaire dans beaucoup de cas d'infections post-opératoires car elle peut induire des destabilisations sévères et des complications mécaniques supplémentaires. Un abord antérieur n'est pas forcément nécessaire en cas d'infection postérieure mises à part les contaminations massives d'une greffe antérieure ou une infection d'une cage intervertébrale réalisée pour une fusion intersomatique par voie postérieure.La pseudarthrose des greffes sur un rachis infecté qui a été traité initialement pour obtenir une fusion reste encore la plus sévère des complications. Dans les cas d'infections postérieures même sévères, la fusion peut être encore obtenue secondairement grâce à un abord antérieur ultérieur ou même un abord postérieur pour des greffes complémentaires avec ou sans ostéosynthèse.Dans cette série, les auteurs ne signalent aucune complication neurologique dûe à l'infection. Néanmoins, 8 décès sont à déplorer chez des patients fragiles avec signes neurologiques initiaux. Ceci souligne l'importance du traitement général associé à la chirurgie et la nécessité d'un bilan complet de ces malades.EBJIS Congress, Leuven     

Roux-en-Y gastrojejunostomy: indications,technique, results

61 gastrojejunostomies were constructed between 1981-1999 in 58 cases (43 cases were operated between 1991-1999). 30 cases have previously suffered various gastric operations; in 28 cases the Roux-en-Y was the first gastric operation (27 operated on between 1991-1999). Radiologic and endobioptic studies were routine for diagnostic and follow-up evaluation, but various scintigraphic studies were performed in selected cases. The surgical technique was tailored for each case, according to the preoperative strategy. The indications for surgery were the following: 19-reflux disease; 14-severe peptic disease (9-reccurence, 3-postbulbar lesion, 2-juxtacardial ulcer); 8-peptic disease associated to reflux disease; 8-gastric cancer; 8-various early or late complications after gastrectomy; 1-lymphocytic gastritis. There were 4 early reoperations and 3 deceased. In 3 cases late reintervention was mandatory (for Zollinger-Ellison syndrome, peptic ulcer secondary to gastrectomy for cancer, Roux-stasis syndrome) and the Roux pattern was preserved; in 2 cases the antireflux effect of the operation was lost after the reoperation.     

Trapeziometacarpal osteoarthritis: surgical technique and results of "stabilized resection-arthroplasty".

Since 1973, 212 hands of 179 patients with disabling trapeziometacarpal osteoarthritis were treated with resection-arthroplasty stabilized by capsuloplasty and intermetacarpal ligament construction; 159 patients (180 hands) could be followed up (average, 7.8 years; range, 1 to 17.3 years). Pain relief was excellent in 89%, good in 10%, and fair in 1%. Patients were "delighted" (78%), "satisfied" (18%), "indifferent" (2%), or "disappointed" (2%) with their functional results. Palmar abduction improved 25%. The tip of the thumb reached the fifth metacarpophalangeal joint in 97% of the hands. Grip strength improved 29%; key pinch, 19%; pulp pinch, 24%. First metacarpal was stable in 94% of the cases. Scaphometacarpal space averaged 5.5 mm. There were three complete failures (2%); complications were mild and infrequent. Because of its good, predictable results, "stabilized resection-arthroplasty" is our preferred surgical treatment for osteoarthritic trapeziometacarpal joints.