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1.
Sandra Sexton Ryan Tulowitzki Craig A. Jones Silvi Shah George Hajduczok Kenneth W. Gross Mandip Panesar 《Clinical and experimental nephrology》2016,20(2):162-168
Background
Renin–angiotensin system (RAS) activation increases angiotensin II production stimulating profibrotic factors, especially in the setting of chronic kidney disease. Nephrogenic systemic fibrosis (NSF) has been associated with gadolinium (Gd) exposure and renal failure. RAS involvement in NSF is unclear compared to transforming growth factor beta and Smad. RenTag mice were chosen to investigate the role of RAS in NSF-like dermal fibrosis because they demonstrated dermal fibrosis at birth, perturbations of RAS in subcutaneous tissue, and renal failure within 4 weeks of age.Methods
Wild-type and RenTag mice were injected weekly with a supratherapeutic dose of intravenous gadodiamide (3.0 mmol/kg body weight) and killed at 12 weeks of age for skin and kidney histology.Results
RenTag mice had elevated BUN levels, pitted kidneys, and glomerular damage. RenTag mice skin revealed an increased density of fibroblasts, no mucopolysaccharide deposits, and increased collagen fibril density regardless of Gd exposure. Skin and kidney histopathology of wild-type mice were normal regardless of Gd exposure. CD34 positivity was higher in RenTag compared to wild-type.Conclusions
Since RenTag dermal lesions remained unchanged after gadolinium exposure in the setting of renal failure, this animal model suggests perturbations of subcutaneous RAS may be involved in Gd-naïve dermal fibrosis.2.
Marian S. Wettstein Cédric Poyet Nico C. Grossmann Christian D. Fankhauser Etienne X. Keller Marko Kozomara Salome Meyer Tullio Sulser Alexander Müller Thomas Hermanns 《World journal of urology》2016,34(9):1261-1267
Purpose
To assess whether and to what extent irrigation fluid absorption occurs during laser vaporization (LV) of the prostate using the 180 W XPS? GreenLight laser.Methods
This prospective investigation was performed in a tertiary care center with a consecutive series of patients undergoing 180 W LV of the prostate. Intraoperative irrigation was performed with isotonic saline containing 1 % ethanol. The volume of irrigation fluid absorption was calculated from periodically performed breath ethanol measurements during LV. Additionally, intraoperative changes in biochemical and hematological blood parameters were assessed.Results
Positive breath ethanol tests were detectable in 22 of 54 patients. The median absorption volume in these patients was 950 ml (range 208–4579 ml). Ten patients absorbed more than 2000 ml. Absorbers had smaller prostates, more capsular perforations and injuries to venous sinuses, and more total energy was applied with higher output power. Five patients had transient symptoms potentially related to fluid absorption. A significant drop in hemoglobin, hematocrit, venous pH and bicarbonate and an increase in chloride were detectable in the absorber group. These changes were significantly different in the non-absorber group.Conclusions
Absorption of irrigation fluid did occur in a relevant proportion of patients undergoing XPS? GreenLight LV. High-volume absorption (≥2000 ml), which might be clinically relevant, was detectable in almost 20 % of all procedures. Absorption of saline irrigation fluid does not result in a classical TUR syndrome, but fluid and chloride overload can lead to serious complications, particularly in cardiovascular high-risk patients. Thus, patients with symptoms potentially related to fluid absorption should be monitored carefully.3.
C. Ziegler I. Neshkova K. Schmidt R. Meffert M. Jakubietz R. Jakubietz 《Operative Orthopadie und Traumatologie》2016,28(2):111-127
Objective
Reconstruction of the ruptured ulnar collateral ligament of the metacarpophalangeal (MP) joint of the thumb.Indications
Ruptured ulnar collateral ligament of the thumb MP joint with instability: joint opening of more than 30° in flexion and more than 20° in extension, Stener lesion, displaced avulsion fractures.Contraindications
Abrasions, wound-healing disturbance, skin disease, osteoarthritis.Surgical technique
Curved skin incision dorsoulnar above the thumb MP joint. Protection of the branches of the superficial radial nerve. Incision of the adductor aponeurosis. Exposing the ulnar collateral ligament; opening and examination of the joint. Depending on the injury, primary suture repair, transosseous suture, repair with a bone anchor, osteosynthesis with K-wires or small screws in avulsion fracture, ligament reconstruction in chronic instability or older injury.Postoperative treatment
Cast splint of the MP joint until swelling subsides; cast immobilization for 6 weeks; range-of-motion exercises, avoiding forced radial deviation of the MP joint for 3 months.Results
Complete joint stability 3 months postoperatively in all 34 patients with rupture of the ulnar collateral ligament.4.
Objective
To evaluate iliopsoas atrophy and loss of function after displaced lesser trochanter fracture of the hip.Design
Cohort study.Setting
District hospital.Patients
Twenty consecutive patients with pertrochanteric fracture and displacement of the lesser trochanter of?>?20 mm.Intervention
Fracture fixation with either an intramedullary nail or a plate.Outcome measurements
Clinical scores (Harris hip, WOMAC), hip flexion strength measurements, and magnetic resonance imaging findings.Results
Compared with the contralateral non-operated side, the affected side showed no difference in hip flexion force in the supine upright neutral position and at 30° of flexion (205.4 N vs 221.7 N and 178.9 N vs. 192.1 N at 0° and 30° flexion, respectively). However, the affected side showed a significantly greater degree of fatty infiltration compared with the contralateral side (global fatty degeneration index 1.085 vs 0.784), predominantly within the psoas and iliacus muscles.Conclusion
Severe displacement of the lesser trochanter (>?20 mm) in pertrochanteric fractures did not reduce hip flexion strength compared with the contralateral side. Displacement of the lesser trochanter in such cases can lead to fatty infiltration of the iliopsoas muscle unit. The amount of displacement of the lesser trochanter did not affect the degree of fatty infiltration.Level of evidence
II.5.
Objective
To clarify the contribution of the subcutaneous area during breast approach endoscopic thyroidectomy (BAET), with regard to invasiveness-related outcomes.Methods
Seventy-two patients were randomly assigned to two groups: standard dissection and limited dissection. Postoperative pain and inflammatory response were compared between groups.Results
The groups were well matched except for subcutaneous dissection area (137.11 ± 21.10 vs. 83.69 ± 12.10 cm2, p < 0.0001). No significant difference was found with regard to VAS score and postoperative inflammatory response.Conclusion
Our RCT indicated that the subcutaneous area plays a less important role with regard to BAET-related postoperative pain.6.
Purpose
To present a new and alternative method for surgical treatment of recurrent inguinal hernia after total extraperitoneal patch plastic (TEP).Methods
From January 2005 to September 2015, 35 patients (34 male, 1 female; mean age 65 ± 12.6 years) with recurrent inguinal hernia following TEP were operated at the Kliniken Essen-Mitte using a simplified method consisting of re-fixation of the primary mesh to the inguinal ligament by an anterior approach.Results
The mean operating time was 47 ± 22 min. All complications were minor with an overall incidence of 6%. After a mean follow-up of 54 months one re-recurrence was observed.Conclusions
This Simplified Hernia Repair is safe and avoids additional foreign body implantation. Therefore, it is our method of choice for recurrent inguinal hernias after TEP.7.
8.
G. D. Musters O. Lapid J. Stoker B. F. Musters W. A. Bemelman P. J. Tanis 《Hernia》2016,20(5):747-754
Purpose
This study aimed to determine the outcome of perineal hernia repair with a biological mesh after abdominoperineal resection (APR).Method
All consecutive patients who underwent perineal hernia repair with a porcine acellular dermal mesh between 2010 and 2014 were included. Follow-up was performed by clinical examination and MRI.Results
Fifteen patients underwent perineal hernia repair after a median of 25 months from APR. Four patients had a concomitant contaminated perineal defect, for which a gluteal fasciocutaneous flap was added in three patients. Wound infection occurred in three patients. After a median follow-up of 17 months (IQR 12–24), a clinically recurrent perineal hernia developed in 7 patients (47 %): 6 of 11 patients after a non-cross-linked mesh and 1 of 4 patients after a cross-linked mesh (p = 0.57). Routine MRI at a median of 17 months revealed a recurrent perineal hernia in 7 of 10 evaluable patients, with clinical confirmation of recurrence in 5 of these 7 patients. No recurrent hernia was observed in the three patients with combined flap reconstruction for contaminated perineal defects.Conclusion
A high recurrence rate was observed after biological mesh repair of a perineal hernia following APR.9.
Purpose
To evaluate the efficacy and safety of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RALP).Methods
From July 2014 to December 2016, TAPP inguinal hernia repair was conducted in 40 consecutive patients who had previously undergone RALP. Their data were retrospectively analyzed as an uncontrolled case series.Results
The mean operation time in patients who had previously undergone RALP was 99.5 ± 38.0 min. The intraoperative blood loss volume was small, and the duration of hospitalization was 2.0 ± 0.5 days. No intraoperative complications or major postoperative complications occurred. During the average 11.2-month follow-up period, no patients who had previously undergone prostatectomy developed recurrence.Conclusions
Laparoscopic TAPP inguinal hernia repair after RALP was safe and effective. TAPP inguinal hernia repair may be a valuable alternative to open hernioplasty.10.
Background
Steri-Strips (3M, Two Harbors, MN, USA) have recently been employed for skin closures after orthopedic surgeries. Here we compare the performance of Steri-Strips and skin staples for wound closure after primary total knee arthroplasties (TKAs).Methods
A total of 76 consecutive osteoarthritic knees (71 patients) that underwent a primary TKA at our facility were included in this study. Thirty-eight knees received Steri-Strips for wound closure and were evaluated prospectively. The other 38 knees were closed with skin staples (Staple group) and evaluated retrospectively.Results
No deep or superficial infections developed in this series. Although Steri-Strips detached from three knees during the 10-day postoperative period, no dehiscence was observed. Thirteen knees developed blisters around the surgical incision in the Steri-Strip group compared with five knees in the Staple group. The average operative time for the Steri-Strip group was 60.6 min (SD 7.3) compared with 54.1 min (SD 6.9) in the Staple group. There were significant differences in operative time (p < 0.001) and tourniquet time (p < 0.001) between the two groups. The average time until patients were permitted to start showering was significantly shorter in the Steri-Strip group (p = 0.0496). The material cost for Steri-Strips was approximately $3.00 USD for one operation compared with $26 USD for skin staplers.Conclusions
Wound closure with Steri-Strips after a TKA does not require postoperative material removal and may have improved safety, comfort, cosmesis and cost-effectiveness compared with traditional skin closures.Level of evidence
Level II, Prognostic study.11.
Background
There is a renewed interest in autologous fillers for facial rejuvenation. We used PRP combined with cultured fibroblasts as an attractive alternative to synthetic fillers.Methods
Twenty adults (17 women and 3 men: mean age 45 years: range 36–65 years) participated in a clinical trial to improve the fold in the skin of the nasolabial folds by having 1 ml of platelet-rich plasma (PRP) combined with cultured fibroblasts injected into each side.Results
Sixteen patients had an 80 % increase in thickness of the skin adjacent to the nasolabial fold at the 9-month follow-up. Fifteen patients also showed an increase in dermal density, and in 7, there was an increase in the hydration of the facial skin. In 16 patients, the sebum quality of the skin either improved on one side or both sides of the cheek (adjacent to the nasolabial fold). Wrinkle depth on either one or both sides of the nasolabial fold was reduced in 15 patients. Seventeen patients (85 %) were satisfied with the result and would undergo the procedure again. In standardised photography, the contour of the nasolabial fold was improved in 15 patients.Conclusions
This technique softens the nasolabial folds as well as improves the condition of the adjacent skin. This improvement was present after 9 months and did not appear to diminish with time. PRP when combined with cultured fibroblasts can act as an effective autologous filler.Level of Evidence: Level IV, therapeutic study12.
Importance
In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care.Objective
To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients.Design
We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention.Setting
The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi.Participants
All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014).Intervention
Lay people were trained to take and record vital signs.Main outcomes and measures
The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis.Results
Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded.Conclusions and relevance
The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.13.
Purpose
The purpose of this study is to evaluate the surgical technique and review the therapeutic effect of vacuum sealing drainage combined with ileostomy treating patients of traumatically buttock skin necrosis.Methods
26 patients with buttock wounds were dressed and 6–12 days later, buttock skin necrosis boundaries were clear and debridement was performed. General surgeons were invited to perform the ileostomy. Thorough debridement was conducted and vacuum sealing drainage (VSD) devices were used to cover buttock wounds. Debridement and VSD were operated every 5–7 days until the granulation tissue of buttock wound was fresh. Then epidermal skin graft from thigh was performed to cover the granulation wound. About 3 months later after skin graft survival completely, the ileum was reversed by general surgeons and the patients recovered defecation using anus.Results
The granulation tissues of all patients were fresh after debridement and VSD 2–3 times. In 20 cases, transplanted epidermal skin grew well. In six cases, necrosis was observed at the margins of the flap and further debridement and skin graft were conducted. During the follow-up period of approximate 6 months, the flaps grew well and the patients defecated normally from anus.Conclusions
Treating traumatically cutaneous necrosis of buttocks with vacuum sealing drainage and ileostomy can gain good therapeutic effect.14.
Charlotte Caspara Uth Jens Jørgen Elberg Claus Zachariae 《European journal of plastic surgery》2016,39(6):441-448
Background
The usage of dermal fillers has increased significantly in recent years. Soft tissue augmentation with fillers helps to diminish the facial lines and to restore volume and fullness in the face at a relatively low cost. With the increasing number of treatments, the number of complications is likely to increase as well.Methods
A total of 37 patients with complications were collected retrospectively during a period of 13 years using original data files. Information on the type, date, number and location of the injections, type and date of complications, treatment, bacteria, and pathology were registered.Results
The most commonly injected material in this series was Polyacrylamide (35.1 %) and Hyaluronic Acid (18.9 %). Most of the patients had filler injected in the lips (54.1 %), periorally (40.5 %), and in the cheek area (29.7 %). The median period between filler injection and complications was 2 years (range 1 day–8 years). The most common reported complications were edema (81 %), noduli (67.7 %), infections (54.1 %), discoloration (51.4 %), and granuloma formation (48.6 %). Surgical removal of the filler material was attempted in four patients.Conclusions
With the increased use of dermal fillers and the derived complications, there is a need to determine the optimal treatment for those patients, as a wrong treatment strategy can lead to scarring. This study suggests general recommendations for the referral and treatment of patients with more severe complications associated with dermal filler injection.Level of Evidence: Level IV, therapeutic study.15.
J. Richter P. Mayer M. Immendörfer M. Schulz M. Schlumberger P. Schuster 《Operative Orthopadie und Traumatologie》2016,28(1):65-77
Objective
Anatomic reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side to regain patellofemoral stability.Indications
Recurrent dislocations, primary dislocation with high risk of recurrence, and dislocations with (osteo-)chondral flake fractures. As combined approach together with other procedures (trochleoplasty, tibial tubercle osteotomy). Revisions.Contraindications
As an isolated procedure in patients with high degrees of trochlear dysplasia, chronic dislocation of the patella, and patellofemoral maltracking without instability.Surgical technique
Harvesting of the gracilis tendon. Drilling of a V-shaped tunnel with a special aiming device in anatomic position on the medial side of the patella. Drilling of a femoral tunnel in anatomic position under fluoroscopic control. Passage of the graft, arthroscopic-guided tensioning, and femoral fixation with a biodegradable interference screw.Postoperative management
Partial weight bearing (20 kg) for 1–2 weeks. No limitation in range of motion. No orthosis. Specific sports allowed after approximately 3 months.Results
Perioperative complications associated specifically with the technique were observed in 1.0?% (7 of 729 cases). In a series of 72 consecutive cases from May 2010 to October 2010, the following were recorded after 4.0 ± 0.1 years: recurrent dislocations in 3.2?%, a Tegner activity score of 5.1 ± 1.8, and subjective satisfaction in 92?% (follow-up rate 87.5?%). No fracture of the patella was seen in any of our patients.16.
L. Walle B. Hohendorff T. Pillukat J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):38-46
Objective
Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren’s contracture.Indications
A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren’s contracture.Contraindications
Scars at the lateral–dorsal portion of the proximal phalanx (e.g., after burns).Surgical technique
Modified incision after Bruner (“mini-Bruner”). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral–dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant.Postoperative management
Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy.Results
Between 2002 and 2007, a total of 32 lateral–dorsal transposition flaps in 30 patients with recurrent Dupuytren’s disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.17.
Background
There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis.Aim
To highlight the current scientific basis of ranula development that informed the preferred surgical approach.Design
Retrospective cohort study.Setting
Public Tertiary Academic Health Institution.Method
A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken—June 1, 2008–December 31, 2015—from case files retrieved utilising the ICD-10 version 10 standard codes.Results
Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%).Conclusion
With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.18.
Objective
Tension-free skin closure after partial aponeurectomy of fingers in Dupuytren’s disease with flexion contracture.Indications
Contractures of the proximal interphalangeal (PIP) joint >30° in Dupuytren’s disease cannot sufficiently treated by Z-plasty due to the contracted skin conditions.Contraindications
Preoperative scar tissue or impaired circulation in the operation region and infections.Surgical technique
The primary plan is to place a sliding flap into the incision line with the PIP joint in a flexed position, under regional anesthesia and temporary arrest of the blood supply of the upper arm by cuffing. Definitive incising round the sliding flap after achieving a PIP extension position and covering of the sliding flap either by another dorsal side flap or by full thickness skin graft.Postoperative management
Immobilization in a palmar splint, hand physiotherapy and massaging of the scar.Results
In the time period June 2008 to December 2010 a total of 40 patients were surgically treated. The preoperative angle of contracture in the PIP joint was 30–60° in 25 patients (group 1), 60–90° in 10 patients (group 2) and > 90° in 5 patients (group 3). The angle of contracture 12 months postoperatively was 10–15° in group 1, 20–30° in group 2 and 30–40° in group 3 and after 24 months 15–20° in group 1, 30–45° in group 2 and 40–60° in group 3 . The angle of contracture of the PIP joint was greatest for digit 5. Revision surgery resulted in a poorer outcome. Recovery of sensation lasted up to 2 years after surgery. Complications which occurred were problems in wound healing (4), loss of a flap (1), partial loss of the skin transplant without revision (3), arthrodesis (1) and amputation of digit 5 (1).19.
S. Ochman M. J. Raschke C. Stukenborg-Colsman K. Daniilidis 《Operative Orthopadie und Traumatologie》2016,28(5):352-364
Objective
Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover.Indications
In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy.Contraindications
In the case of insufficient blood supply an expansion of the resection margins should be taken into account. If there are possible alternatives to amputation. Surgery for patients with renal failure requiring dialysis associated with increased complication rate.Surgical technique
A dorsal cuneiform resection is performed to facilitate implantation of a plantar skin transplant and wound healing. Important is the resection of bone in a slide oblique technique. Amputation scars should be outside pressure zones. Partial amputations in the area of the first ray as exarticulation or via the individual amputated segments possible (as opposed to toes 2–5).Postoperative management
Direct postoperative weight-bearing with rigid insole and dispensing aid for 6–8 weeks. Following complete wound healing, foot support with orthopedic arch and transverse strain relief should be advocated, together with a joint roll in ready-made individual shoes.Results
Both trauma and nontrauma cases were included in our present cohort. A total of 7 cases were surgically revised in 2014 due to superficial skin necrosis that was likely the result of skin tension from the wound stitches.20.
M. H. Abo-Ryia 《Hernia》2017,21(5):795-798