Endoscopic access to fascia lata for use in static facial reanimation—a cadaveric and clinical study

Background

Current methods of autogenous fascia lata harvest for the static surgical treatment of longstanding facial paralysis often result in a high level of donor site morbidity and unsightly visual scarring on the patient’s lateral thigh due to the open technique traditionally used. With endoscopic access already being widely used in other areas of plastic and reconstructive surgery, it was hypothesised that it would be feasible to retrieve sufficient amounts of fascia lata endoscopically to achieve satisfactory static facial reanimation.

Methods

In the first instance, we used an 85-year-old female cadaver selected from the regular stock at the University of Glasgow to establish if retrieval of fascia lata endoscopically was feasible. Through two small incisions on the lateral aspect of the thigh (proximally and distally), we successfully retrieved a strip of fascia lata measuring 9?×?2.5 cm. Due to the ease of access, one of the authors then performed endoscopic retrieval of the fascia lata for five patients requiring static facial reanimation.

Results

It was shown that in all cases it was feasible to retrieve sufficient amounts of fascia lata to perform static facial reanimation with a similar operating time compared to the open technique which is currently used. In addition, there were no complications related to donor site morbidity.

Conclusions

We have shown that endoscopic access to the fascia lata for use in static facial reanimation is perfectly feasible, with no complications, minimal scarring and no significant increase in operating time compared to the traditional open technique currently used. Level of Evidence: Level V, therapeutic study.     

Anomalous boron isotope effects on electronic structure and lattice dynamics of CuB2O4

Copper metaborate had a unique crystal structure and exhibited noteworthy magnetic phase transitions at 21 and 10 K. The electronic structure and lattice dynamics of copper metaborate Cu¹¹B₂O₄ single crystals were investigated and compared with the optical properties of CuB₂O₄, to assess the boron isotope effect. The optical absorption spectrum at room temperature revealed two charge-transfer bands at approximately 4.30 and 5.21 eV with an extrapolated direct optical band gap of 3.16 ± 0.07 eV. Compared with the data on CuB₂O₄, the electronic transitions were shifted to lower energies upon the replacement of a heavier boron isotope. The band gap was also determined to be lower in Cu¹¹B₂O₄. Anomalies in the temperature dependence of the optical band gap were observed below 21 K. Furthermore, 38 Raman-active phonon modes were identified in the room-temperature Raman scattering spectrum of Cu¹¹B₂O₄, which were also observed in CuB₂O₄ with a shift to lower frequencies. No broadening caused by isotopic changes was observed. As the temperature decreased, phonon frequencies shifted to higher wavenumbers and the linewidth decreased. Anomalous softening in the Raman peaks below 21 K was also revealed.

Copper metaborate had a unique crystal structure and exhibited noteworthy magnetic phase transitions at 21 and 10 K.     

Postpneumonectomy bronchopleural fistula: analysis of risk factors and the role of bronchial stump coverage

Surgery Today - Bronchopleural fistula (BPF) is a potentially fatal complication of pneumonectomy. We analyze its occurrence rate, risk factors, and the methods used for its prevention. We reviewed...     

Adverse Tumor Biology Associated with Mesenterico-Portal Vein Resection Influences Survival in Patients with Pancreatic Ductal Adenocarcinoma

Background

Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial.

Patients and Methods

Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD?VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed.

Results

Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD?VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD?VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD?VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival.

Conclusions

PD with VR has similar morbidity but worse OS compared with a PD?VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.