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Le front est la partie crânienne de la face et représente une composante importante de l'esthétique faciale. Les déformations liées aux craniosténoses sont typiques par les modifications en hauteur, en largeur et en angulation du front. Les traitements chirurgicaux crâniofaciaux sont codifiés et basés sur une découpe osseuse frontale suivie de son repositionnement avec ostéosynthèse résorbable chez l'enfant. Les techniques ont peu changé depuis les descriptions princeps. Aujourd'hui, la distraction ou les ressorts permettent des remodelages précoces avec des morbidités faibles. Les séquelles sont essentiellement liées à des défauts de croissance à la jonction frontotemporale et sont corrigées le plus souvent par greffe de graisse autologue. L'existence de mutations génétiques associées à la craniosténose augmente le risque de reprise chirurgicale dans les six premières années de vie. The forehead is the cranial part of the forehead, and represents an important component of facial esthetics. The deformations linked to craniosynostoses are characterized by modifications in height, width, and angulation. Their surgical correction during childhood is based on well-established techniques of remodeling using resorbable osteosynthesis. Today, distraction and springs allow less invasive procedures with good outcomes. Sequellae mainly correspond to hypotrophies of the temporal region, corrected with fat grafting. The presence of a mutation increases the risk of reoperation in the first six years of life. [ABSTRACT FROM AUTHOR]

Background: Pulmonary resection is an important part of comprehensive treatment of lung cancer. Despite the progress in recent thoracic surgery, reoperation is occasionally inevitable for managing severe perioperative complications. This study aimed to investigate the incidence and causes of perioperative reoperation in lung cancer patients. Methods: We retrospectively collected patients who underwent reoperation following pulmonary resection from January 2010 to February 2021 in China‐Japan Friendship Hospital. Results: Among the 5032 lung cancer patients who received primary pulmonary resection in our institute, 37 patients underwent perioperative reoperation with the rate being 0.74%. Lobectomy was the most frequently executed procedure (56.8%). The mean duration of the primary surgery was 143.6 ± 65.1 min. About half of the cases received secondary surgery within 24 h of the primary surgery, whereas only one case underwent secondary surgery 30 days after the primary surgery (due to chylous leakage). The major causes of the reoperation were bleeding (73.0%), chylous leakage (13.5%), lobar torsion (5.4%), air leakage (2.7%), atelectasis (2.9%), and cardiac herniation (2.7%). Conclusion: The most prevalent reasons for unplanned reoperation following pulmonary resection in lung cancer patients include bleeding, chylous leakage, and lobar torsion. The strict control of the surgical indications and standardization of surgical procedures are fundamental to reduce unplanned secondary operations after pulmonary resections. Timely identification of the need to secondary surgery is also important to ensure patients' safety. [ABSTRACT FROM AUTHOR]

Traditional imaging modalities used to assess velopharyngeal insufficiency (VPI) do not allow for direct visualization of underlying velopharyngeal (VP) structures and musculature which could impact surgical planning. This limitation can be overcome via structural magnetic resonance imaging (MRI), the only current imaging tool that provides direct visualization of salient VP structures. MRI has been used extensively in research; however, it has had limited clinical use. Factors that restrict clinical use of VP MRI include limited access to optimized VP MRI protocols and uncertainty regarding how to interpret VP MRI findings. The purpose of this paper is to outline a framework for establishing a novel VP MRI scan protocol and to detail the process of interpreting scans of the velopharynx at rest and during speech tasks. Additionally, this paper includes common scan parameters needed to allow for visualization of velopharynx and techniques for the elicitation of speech during scans. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Pulmonary resection is an important part of comprehensive treatment of lung cancer. Despite the progress in recent thoracic surgery, reoperation is occasionally inevitable for managing severe perioperative complications. This study aimed to investigate the incidence and causes of perioperative reoperation in lung cancer patients. Methods We retrospectively collected patients who underwent reoperation following pulmonary resection from January 2010 to February 2021 in China‐Japan Friendship Hospital. Results Among the 5032 lung cancer patients who received primary pulmonary resection in our institute, 37 patients underwent perioperative reoperation with the rate being 0.74%. Lobectomy was the most frequently executed procedure (56.8%). The mean duration of the primary surgery was 143.6 ± 65.1 min. About half of the cases received secondary surgery within 24 h of the primary surgery, whereas only one case underwent secondary surgery 30 days after the primary surgery (due to chylous leakage). The major causes of the reoperation were bleeding (73.0%), chylous leakage (13.5%), lobar torsion (5.4%), air leakage (2.7%), atelectasis (2.9%), and cardiac herniation (2.7%). Conclusion The most prevalent reasons for unplanned reoperation following pulmonary resection in lung cancer patients include bleeding, chylous leakage, and lobar torsion. The strict control of the surgical indications and standardization of surgical procedures are fundamental to reduce unplanned secondary operations after pulmonary resections. Timely identification of the need to secondary surgery is also important to ensure patients' safety.

PurposeWe aimed to determine which variables were associated with persistent symptoms or need for further surgery in patients treated with in situ fixation for stable slipped capital femoral epiphysis. We hypothesized that patients with greater proximal femoral deformity would require revision surgical intervention.MethodsWe prospectively collected data on stable slipped capital femoral epiphysis patients who underwent in situ screw fixation at a single institution. Demographic and radiographic information, as well as patient-reported outcomes, were collected.ResultsForty-six patients (54 hips) with an average follow-up of 3.5 years (range: 2.0-8.5) and mean pre-op Southwick slip angle of 40.5° ± 19.4° were studied. We observed one complication following the index procedure (2%). Twelve hips (22%) went on to have a secondary procedure 2.7 ± 2.2 years after the index surgery. Severe slips were 14.8× more likely to undergo a secondary procedure than mild and moderate slips (p  0.6). Hips requiring a secondary procedure had significantly lower Hip disability and Osteoarthritis Outcome scores (76.8 ± 18.4) at final follow-up compared to hips that did not require additional surgery (86.8 ± 15.7) (p = 0.042).ConclusionWith minimum 2-year follow-up, 22% of patients required a secondary surgery. Patient-reported outcomes did not correlate with slip severity, but were found to be significantly higher in slipped capital femoral epiphysis patients that did not require a secondary procedure. Prophylactic treatment of all slip-related cam deformity was not found to be necessary in this prospective cohort. Patients with moderate-to-severe slips may require secondary surgery.Level of evidenceLevel II.

Introduction: Ovarian granulosa cell tumors (GCT) include 2-3% of ovarian cancers. This study reported a rare case of granulosa at the age of 35 with early recurrence in sigmoid colon. Case presentation: A 35-year-old female, Noli Gravid, with a history of primary infertility and a complaint of abdominal pain referred to Ghaem Hospital in Mashhad, Iran. With the diagnosis of ovarian mass, she underwent laparotomy. The intraoperative frozen examination was for an ovarian granulosa tumor. Right salpingo-opheretomy with surgical staging and endometrial curettage were done. The final pathology was adult-type granulosa tumor and other samples were normal. Three cycles of chemotherapy were performed. After 18 months of non-follow up, she returned with a complaint of abdominal pain. An 8 cm mass on the left side of the pelvis was reported. She was candidate for surgery. There was a mass attached to the mesenter of the sigmoid colon which was resected and sent for frozen. Frozen analysis reported the recurrence of the granulosa tumor. A total hysterectomy with a left salpingo-oophorectomy was performed. Then she underwent pelvic radiotherapy. Conclusion: Recurrence is the main cause of patients' death. Due to late recurrence, patients should be trained to pay attention to the symptoms of recurrence in order to cooperate in long-term follow-up for early diagnosis of recurrence band treatment. Considering the rare cases of extra-pelvic and extra-genital recurrences, there is a need for new treatment strategies to be carried out in the form of clinical trials to improve the quality of life of patients and prevent frequent recurrences leading to their mortality.

Background: Neonatal Brachial plexus palsy is an injury during delivery that can lead to loss of motor function and limited range of motion in patients due to damage of nerves in the brachial plexus. This scoping review aims to explore types of procedures performed and assess outcomes of forearm and elbow secondary surgery in pediatric patients. Methods: Searches of PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Web of Sciences, and Scopus were completed to obtain studies describing surgical treatment of elbow and forearm in pediatric patients with neonatal Brachial plexus palsy. 865 abstracts and titles were screened by two independent reviewers resulting in 295 full text papers; after applying of inclusion and exclusion criteria 18 articles were included. The level of evidence of this study is level IV. Results: Ten main procedures were performed to regain function of the forearm and elbow in neonatal brachial plexus birth palsy patients. Procedures had different aims, with supination contracture (6) and elbow flexion restoration (5) being the most prevalent. The variance between preoperative and postoperative soft tissue and bony procedures outcomes decreased and showed improvement with respect to the aim of each procedure category. For soft tissue procedures, a statistically significant increase was found between preoperative and postoperative values for active elbow flexion, passive supination, and active supination. For bony procedures, there was a statistically significant decrease between preoperative and postoperative values of passive and active supination. Conclusion: Overall, all procedures completed in the assessed articles of this study were successful in their aim. Bony procedures, specifically osteotomies, were found to have a wider range of results, whereas soft tissue procedures were found to be more consistent and reproducible with respect to their outcomes. Bony and soft tissue procedures were found vary in their aims and outcomes. This study indicates the need for further research to augment knowledge about indications and long-term benefits to each procedure.

Introduction: Ovarian granulosa cell tumors (GCT) include 2-3% of ovarian cancers. This study reported a rare case of granulosa at the age of 35 with early recurrence in sigmoid colon. Case presentation: A 35-year-old female, Noli Gravid, with a history of primary infertility and a complaint of abdominal pain referred to Ghaem Hospital in Mashhad, Iran. With the diagnosis of ovarian mass, she underwent laparotomy. The intraoperative frozen examination was for an ovarian granulosa tumor. Right salpingoopheretomy with surgical staging and endometrial curettage were done. The final pathology was adult-type granulosa tumor and other samples were normal. Three cycles of chemotherapy were performed. After 18 months of non-follow up, she returned with a complaint of abdominal pain. An 8 cm mass on the left side of the pelvis was reported. She was candidate for surgery. There was a mass attached to the mesenter of the sigmoid colon which was resected and sent for frozen. Frozen analysis reported the recurrence of the granulosa tumor. A total hysterectomy with a left salpingo-oophorectomy was performed. Then she underwent pelvic radiotherapy. Conclusion: Recurrence is the main cause of patients' death. Due to late recurrence, patients should be trained to pay attention to the symptoms of recurrence in order to cooperate in long-term follow-up for early diagnosis of recurrence band treatment. Considering the rare cases of extra-pelvic and extra-genital recurrences, there is a need for new treatment strategies to be carried out in the form of clinical trials to improve the quality of life of patients and prevent frequent recurrences leading to their mortality. [ABSTRACT FROM AUTHOR]

The aim of this paper was to describe a modification to an old method to enhance the vermillion in adult cleft patients. We present ten consecutive patients who requested enhancement of the upper lip vermillion. The technique involves a continuous V plasty within the non-visible mucosa to elevate the vermillion. Each V incision is of a different size to match the defect. Then the V flaps are sutured to one another but the donor defect is left open to epithelialise. Adjunctive procedures are possible at the same time. There were no major complications but one patient was over corrected and needed reduction of mucosa. The technique offers a permanent enhancement of the vermillion and is a safe alternative to other methods of lip augmentation including fillers. [ABSTRACT FROM AUTHOR]

Abstract Background The first‐line systemic therapy for metastatic colorectal cancer (mCRC) is a combination of one targeted therapy agent and a chemotherapy doublet. Whether bevacizumab or anti‐epidermal growth factor receptor (anti‐EGFR) monoclonal antibody (mAb) is the more effective addition to a chemotherapy doublet as the first‐line treatment for inoperable KRAS wild‐type mCRC remains controversial in prior clinical trials. Moreover, the association between the sidedness of primary tumors and the efficacy of anti‐EGFR mAb needs to be addressed. Methods We established a cohort of patients with KRAS wild‐type mCRC who were treated with first‐line targeted therapy plus doublet chemotherapy between 2013 and 2018 using Taiwan's National Health Insurance Research Database. Secondary surgery was defined as either resection of primary tumors, liver metastases, lung metastases, or radiofrequency ablation. Results A total of 6482 patients were included; bevacizumab and anti‐EGFR mAb were the first‐line targeted therapies in 3334 (51.4%) and 3148 (48.6%) patients, respectively. Compared with those who received bevacizumab, patients who received anti‐EGFR mAb exhibited significantly longer overall survival (OS; median, 23.1 vs. 20.2 months, p = 0.012) and time to treatment failure (TTF; median, 11.3 vs. 10 months, p

Abstract Background Acute low energy pubic rami fractures in the elderly receive primarily conservative treatment. There is debate to what extent posterior ring involvement, which is detected superiorly by CT compared to X-ray, has an impact on outcome and may require modified treatment. We want to demonstrate if posterior ring involvement has an influence on different types of outcome in primarily conservatively treated acute FFP, questioning the usefulness of early CT. Additionally we analysed the early fracture pattern in cases where conservative treatment failed with need for secondary surgery. Methods A retrospective cohort study of 155 consecutive patients, recruited between 2009 and 2016, aged over 65 years diagnosed with an acute LE-PFr on X-ray at the emergency department of a single, level-one trauma centre and receiving an early CT. A set of outcome parameters was compared between patients with an isolated pubic rami fracture (CTia) and patients who had a combined posterior pelvic ring fracture (CTcp). Results There were 155 patients of whom 85.2% were female with a mean age of 83 years. 76.8% of patients living at home returned home and 15.5% moved to a nursing home. Mortality rate during hospitalisation was 6.4% and 14.8% at one year post-trauma. Secondary fracture displacement occurred in 22.6%. Secondary surgery was performed in 6 cases (3.9%). Median hospitalisation length of stay was 21 days (range 0 to 112 days). There was no significant association between the subgroups and change in residential status (p = 0.65), complications during hospitalisation (p = 0.75), mortality rate during admission (p = 0.75) and at 1 year (p = 0.88), readmission within 30 days (p = 0.46) and need for secondary surgery (p = 0.2). There was a significant increased median length of stay (p = 0.011) and rate of secondary displacement (p = 0.015) in subgroup CTcp. Secondary displacement had no impact on in-hospital complications (p = 0.7) nor mortality rate during admission (p = 0.79) or at 1 year (0.77). Early CT in patients who underwent secondary surgery showed stable B2.1 lesions in 4 of 6 cases. Conclusions Our data suggest that early CT in patients with conservatively treated acute LE-PFr in order to detect posterior lesions, has limited value in predicting failure of conservative treatment.

Secondary surgical procedures can be used in brachial plexus birth injury to correct shoulder movement imbalances. This study compares outcomes of the two secondary surgical procedure types: humeral osteotomies and soft tissue procedures. Outcome measures assessed included active and passive internal and external rotation, active and passive abduction and adduction, active and passive flexion and extension, percentage of the humeral head anterior to the middle glenoid fossa, glenoid version, and Mallet Score. Nineteen full-text articles were included in the analysis. Humeral osteotomies resulted in a loss of internal rotation postoperatively (−15.94°). Active internal rotation was not evaluated for soft tissue procedures. All other assessed outcomes were improved postoperatively for bony and soft tissue procedures. Bony procedures exhibited a greater degree of active external rotation postoperatively when compared to soft tissue procedures (+67° vs. +40°). Both bony and soft tissue procedures Improve shoulder function in children with neonatal brachial plexus palsy, however, soft tissue procedures showed greater consistency in outcomes.Level of Evidence: IV

Background: The first‐line systemic therapy for metastatic colorectal cancer (mCRC) is a combination of one targeted therapy agent and a chemotherapy doublet. Whether bevacizumab or anti‐epidermal growth factor receptor (anti‐EGFR) monoclonal antibody (mAb) is the more effective addition to a chemotherapy doublet as the first‐line treatment for inoperable KRAS wild‐type mCRC remains controversial in prior clinical trials. Moreover, the association between the sidedness of primary tumors and the efficacy of anti‐EGFR mAb needs to be addressed. Methods: We established a cohort of patients with KRAS wild‐type mCRC who were treated with first‐line targeted therapy plus doublet chemotherapy between 2013 and 2018 using Taiwan's National Health Insurance Research Database. Secondary surgery was defined as either resection of primary tumors, liver metastases, lung metastases, or radiofrequency ablation. Results: A total of 6482 patients were included; bevacizumab and anti‐EGFR mAb were the first‐line targeted therapies in 3334 (51.4%) and 3148 (48.6%) patients, respectively. Compared with those who received bevacizumab, patients who received anti‐EGFR mAb exhibited significantly longer overall survival (OS; median, 23.1 vs. 20.2 months, p = 0.012) and time to treatment failure (TTF; median, 11.3 vs. 10 months, p < 0.001). Among left‐sided primary tumors, the OS and TTF benefits of anti‐EGFR mAb remained. Among right‐sided primary tumors, the OS and TTF were similar regardless of the type of targeted therapy. In multivariate analyses, first‐line anti‐EGFR mAb therapy remained an independent predictor of longer OS and TTF for left‐sided primary tumors. Patients who received anti‐EGFR mAb were more likely to receive secondary surgery (29.6% vs. 22.6%, p < 0.0001) than patients who received bevacizumab. Conclusion: For patients who received first‐line doublet chemotherapy for KRAS wild‐type mCRC, adding anti‐EGFR mAb was associated with significantly longer OS and TTF, especially for left‐sided primary tumors. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid nodules are evaluated by fine-needle aspiration biopsy (FNAB) according to their radiologic characteristics. International guidelines recommend lobectomy according to the size of the nodules and FNAB results. The aim of this study is to assess whether lobectomy is one of the treatment choices in endemic areas. Methods: Patients who underwent lobectomy between January 2013 and September 2017 were studied retrospectively. Patients' demographic features, thyroid hormone levels, medications, FNAB results before the surgery, lobectomy indications, ultrasonographic features, final pathologies, and secondary surgical interventions were recorded. Results: Data of 388 patients who underwent lobectomy were examined. As patients were classified according to their FNAB results, all categories had higher malignancy rates than expected in the final pathology results. One hundred and eighteen (30.4%) patients had undergone completion thyroidectomy. The final pathology of the completion thyroidectomy samples showed 24.07% (n=26) malignancy. Discussion and Conclusion: FNAB is the gold standard for the malignancy risks in thyroid nodules in all guidelines. In endemic areas, this classification system may be inadequate. Two-staged thyroid surgery is becoming more popular. In our series, 30.4% of patients had undergone completion thyroidectomy according to their final pathology results. We need to add newer sights to guidelines for endemic areas. [ABSTRACT FROM AUTHOR]

Abstract Background Video‐assisted thoracoscopic surgery (VATS) is the preferred treatment for resectable non‐small cell lung cancer. The increased survival of patients after a first operation has caused increases in the incidence of locoregional recurrence or second primary lung cancer and a concomitant increase in the number of patients who require secondary surgery. Ipsilateral secondary operation is also commonly practiced, albeit with enhanced difficulty. Therefore, it is necessary to evaluate the feasibility and safety of VATS for ipsilateral lung cancer after pulmonary resection. Methods Patients who underwent ipsilateral secondary VATS in the West China Hospital, Sichuan University from 2012 to 2021 were assessed retrospectively. All included patients had a pulmonary resection. Clinical characteristics, perioperative outcomes, and survival data were collected, with an emphasis on conversion to thoracotomy, postoperative complications, 30‐day mortality, and survival. Logistic regression analysis was used to identify predictors of postoperative complications. Results Seventy patients were enrolled, of which 10 (14.3%) had converted thoracotomy, 17 (24.3%) had postoperative complications, and two (2.9%) had grade III complications. No patient died within 30 days after surgery. High Charlson comorbidity index (CCI) and severe pleural adhesion were independent predictors for complications. The median follow‐up was 50 months (range: 3–120), and the 5‐year overall survival was 78.2%. Conclusion Secondary VATS for ipsilateral lung cancer for patients who had pulmonary resection was feasible and safe. Strict preoperative evaluation and careful management of pleural adhesion are crucial for the success of the surgery.

Background : Due to its unpredictable retention rate, using autologous fat alone for the enhancement of breast volume is often unsatisfactory. To overcome this limitation, fat transfer has been proposed as an immediate adjuvant procedure to aesthetic breast surgery, creating the concept of hybrid mammoplasty. Fat transfer has already been shown to correct minor defects with good clinical outcome, but the amount of fat that can be safely transferred has not yet been identified. Our hypothesis is that contour improvement with small-volume fat transfer as a primary adjuvant treatment can lead to a better patient outcome. Methods: A retrospective single-centre uncontrolled case series study was conducted on 70 patients who underwent hybrid mammoplasties for aesthetic purposes only. Primary and secondary cases were included and divided into corresponding groups. An ad-hoc outcome scale based on clinical parameters was created to standardise results; results were analysed after a follow-up period of at least 12 months. Results: The overall results were reported as good in 48.7% of cases, moderate in 32.8%, and sufficient in 18.5%. Primary cases with small deformities showed a better outcome on our scale compared to revisional ones (57.4% good compared to 29%; p = 0.038). A transferred volume of fat up to 100 ml was associated with a higher retention rate (OR = 2.3; p = 0.032). Conclusions: Small breast contour deformities or prosthesis coverage can be easily corrected with fat transfer. Based on our score system, this technique is indicated for volume enhancement up to 100 ml; beyond that the outcome quality decreases, and further corrections would be needed. Level of evidence: Level IV, Therapeutic. [ABSTRACT FROM AUTHOR]

Background: To compare the efficacy of secondary pyeloplasty and balloon dilation and to analyze the risk factors for secondary surgical failure in patients with recurrent uretero-pelvic junction obstruction (UPJO). Methods: We retrospectively analyzed 65 patients with recurrent UPJO who underwent secondary surgery between September 2011 and March 2019, of whom 33 had complete baseline data and follow-up data. General clinical information, perioperative data, and follow-up results were collected from patients. Risk factors for surgical failure in patients with recurrent UPJO were analyzed using logistic regression. Results: The failure rates of secondary pyeloplasty and balloon dilation in secondary surgery were 16.7% and 33.3%, respectively. Univariate analysis showed that ureteral stenosis length and operative time were associated with secondary pyeloplasty and balloon dilatation failure (p < 0.05), and ureteral stenosis length was an independent risk factor for secondary pyeloplasty failure (OR = 0.074, 95% CI: 0.006–0.864, p = 0.038). In the balloon dilation group, treatment failure rates were significantly lower in patients with stenotic segment lengths less than 1 ± 0.32 cm than in patients with stenotic segment lengths greater than 1 ± 0.32 cm (p = 0.019). Conclusions: The secondary pyeloplasty may provide better benefit. Ureteral stricture length is an independent risk factor for failure of secondary pyeloplasty and a potential risk factor for balloon dilatation. Operation time is a potential risk factor for pyeloplasty and balloon dilatation. [ABSTRACT FROM AUTHOR]

Background: Acute low energy pubic rami fractures in the elderly receive primarily conservative treatment. There is debate to what extent posterior ring involvement, which is detected superiorly by CT compared to X-ray, has an impact on outcome and may require modified treatment. We want to demonstrate if posterior ring involvement has an influence on different types of outcome in primarily conservatively treated acute FFP, questioning the usefulness of early CT. Additionally we analysed the early fracture pattern in cases where conservative treatment failed with need for secondary surgery. Methods: A retrospective cohort study of 155 consecutive patients, recruited between 2009 and 2016, aged over 65 years diagnosed with an acute LE-PFr on X-ray at the emergency department of a single, level-one trauma centre and receiving an early CT. A set of outcome parameters was compared between patients with an isolated pubic rami fracture (CTia) and patients who had a combined posterior pelvic ring fracture (CTcp). Results: There were 155 patients of whom 85.2% were female with a mean age of 83 years. 76.8% of patients living at home returned home and 15.5% moved to a nursing home. Mortality rate during hospitalisation was 6.4% and 14.8% at one year post-trauma. Secondary fracture displacement occurred in 22.6%. Secondary surgery was performed in 6 cases (3.9%). Median hospitalisation length of stay was 21 days (range 0 to 112 days). There was no significant association between the subgroups and change in residential status (p = 0.65), complications during hospitalisation (p = 0.75), mortality rate during admission (p = 0.75) and at 1 year (p = 0.88), readmission within 30 days (p = 0.46) and need for secondary surgery (p = 0.2). There was a significant increased median length of stay (p = 0.011) and rate of secondary displacement (p = 0.015) in subgroup CTcp. Secondary displacement had no impact on in-hospital complications (p = 0.7) nor mortality rate during admission (p = 0.79) or at 1 year (0.77). Early CT in patients who underwent secondary surgery showed stable B2.1 lesions in 4 of 6 cases. Conclusions: Our data suggest that early CT in patients with conservatively treated acute LE-PFr in order to detect posterior lesions, has limited value in predicting failure of conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Video‐assisted thoracoscopic surgery (VATS) is the preferred treatment for resectable non‐small cell lung cancer. The increased survival of patients after a first operation has caused increases in the incidence of locoregional recurrence or second primary lung cancer and a concomitant increase in the number of patients who require secondary surgery. Ipsilateral secondary operation is also commonly practiced, albeit with enhanced difficulty. Therefore, it is necessary to evaluate the feasibility and safety of VATS for ipsilateral lung cancer after pulmonary resection. Methods: Patients who underwent ipsilateral secondary VATS in the West China Hospital, Sichuan University from 2012 to 2021 were assessed retrospectively. All included patients had a pulmonary resection. Clinical characteristics, perioperative outcomes, and survival data were collected, with an emphasis on conversion to thoracotomy, postoperative complications, 30‐day mortality, and survival. Logistic regression analysis was used to identify predictors of postoperative complications. Results: Seventy patients were enrolled, of which 10 (14.3%) had converted thoracotomy, 17 (24.3%) had postoperative complications, and two (2.9%) had grade III complications. No patient died within 30 days after surgery. High Charlson comorbidity index (CCI) and severe pleural adhesion were independent predictors for complications. The median follow‐up was 50 months (range: 3–120), and the 5‐year overall survival was 78.2%. Conclusion: Secondary VATS for ipsilateral lung cancer for patients who had pulmonary resection was feasible and safe. Strict preoperative evaluation and careful management of pleural adhesion are crucial for the success of the surgery. [ABSTRACT FROM AUTHOR]

The forehead is the cranial part of the forehead, and represents an important component of facial esthetics. The deformations linked to craniosynostoses are characterized by modifications in height, width, and angulation. Their surgical correction during childhood is based on well-established techniques of remodeling using resorbable osteosynthesis. Today, distraction and springs allow less invasive procedures with good outcomes. Sequellae mainly correspond to hypotrophies of the temporal region, corrected with fat grafting. The presence of a mutation increases the risk of reoperation in the first six years of life., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

We describe three cases of pseudoexfoliation syndrome (PEX) in which good outcomes were achieved after secondary intrascleral intraocular lens (IOL) fixation with capsule preservation for aphakic eyes. Three Japanese patients with PEX underwent phacoemulsification and aspiration (PEA) owing to challenges in IOL intracapsular fixation caused by zonular weakness. Case 1 involved an 83-year-old man with PEX. Six weeks post-PEA, 30-gauge needles were inserted to exit between the capsule and the iris. The IOL was fixed intrasclerally using the double-needle technique. Case 2 involved a 90-year-old man with PEX. The same abovementioned double-needle intrascleral IOL fixation procedure was performed eight weeks post-PEA. Intraoperative vitreous prolapse into the anterior chamber was observed, and anterior vitrectomy was performed. Case 3 involved an 80-year-old man with PEX. Seven weeks post-PEA, the patient underwent the same double-needle intrascleral IOL fixation procedure. Good IOL fixation was achieved in all patients without postoperative iris capture. No serious complications, including retinal detachment and vitreous hemorrhage, were observed. Preserving the capsule during secondary IOL scleral fixation for aphakic eyes can effectively reduce intraoperative vitreous prolapse, minimize surgical invasiveness, suppress iris flutter, and prevent capture of the pupillary IOL, making it a meaningful and acceptable approach, although the long-term risks, such as potential lens capsule drop, should be studied further., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nakagawa et al.)

Background: Upper extremity (UE) transplantation is a complex undertaking that may require emergent or elective secondary surgery (SS) days to years following transplant. Various patient and transplantation may help determine what SS is needed. In this study, we characterize the SS needed by our UE transplant patients. Methods: We retrospectively reviewed 6 patients who underwent hand and UE transplantation by one of the authors. Transplantation and SS details were obtained from medical records. Hand and arm function was quantified both subjectively (patient-reports) and objectively (Disabilities of the Arm, Shoulder, and Hand Score; Carroll test; Action Research Arm Tests; Box and Block test). Results: Six patients underwent transplantation for a total of 10 transplanted limbs. Five transplants were performed below and 5 above the elbow. Mean time post-transplantation at last follow-up was 5 years (range: 1-9 years). In all, 66.7% of the patients required SS: total 7 surgeries comprising 13 procedures. The most common procedures were to improve hand function—nerve decompressions and tendon transfer, both in above-elbow transplant. Both patients showed a mean improvement of 15 points on Carroll scores. One above-elbow transplant had a brachioplasty for excess skin and another had a hematoma evacuation immediately after transplantation. Procedures in the below-elbow transplants included multiple incision and drainages for a septic wrist and an open reduction and internal fixation for a forearm fracture. Conclusion: Patients receiving UE transplantation often require one or more secondary procedures which may vary with level of transplantation. Secondary surgery should be an important aspect of pretransplant planning and cost-effectiveness determinations. Level of Evidence: Level IV [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age. [ABSTRACT FROM AUTHOR]

Objective The use of endoscopic surgery in secondary tympanoplasty was analyzed by performing secondary endoscopic mastoid cavity reduction and tympanoplasty in patients after microscopic wall-down tympanoplasty. Methods In this study, six patients who had undergone open mastoidectomy through retroauricular approach under microscope for middle ear cholesteatoma were classified into three types according to the postoperative bone defects and facial nerve crest preservation: mastoid and antrum tympanicum bone defect type, antrum tympanicum defect type and mastoid and antrum tympanicum defect with flattened cavity. For each type, endoscopic cartilage filling of the operative cavity, tympanoplasty and reconstruction of the artificial auditory chain were performed. Results In the six patients, the tympanic membranes all healed postoperatively with good morphology, and the mastoid cavity and the defective area of the tympanic sinus were reduced to different degrees. The mean air conduction thresholds of the postoperative pure tone hearing threshold test results in 5 patients were all decreased compared with those preoperatively (40 dB HL vs 48 dB HL, 51 dB HL vs 61 dB HL, 53 dB HL vs 66 dB HL, 49 dB HL vs 72 dB HL, and 72 dB HL vs 87 dB HL) respectively. Conclusions Secondary endoscopic surgery can narrow the operative cavity, reduce scab residue, reduce cholesteatoma recurrence and reconstruct hearing, and staging can help develop surgical incisions and distinguish important anatomical landmarks. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of the study was to investigate the association between obesity and the presence of secondary surgery following neurolysis, direct nerve repair, or nerve grafting in patients with traumatic brachial plexus injury. Methods In this retrospective chart review spanning two Level I medical centers in a single metropolitan area, 57 patients who underwent neurolysis, direct nerve repair, or nerve grafting for brachial plexus injuries between 2002 and 2015 were identified. Risk regression analysis was used to evaluate the association between obesity status and secondary surgery. Results After controlling for the confounding variables of age, high energy injury, associated shoulder dislocation and associated clavicle fracture using multivariate regression (risk regression), the risk ratio of secondary surgery in obese patients compared to non-obese patients was 6.99 (P = 0.028). The most common secondary surgery was tendon or local muscle transfer. Conclusions There is an increased risk of secondary surgery in obese patients compared to non-obese patients of the same age and with the same severity of injury. The increased risk may be due to challenges related to powering a heavier upper extremity. A weight reduction program might be considered as part of the preoperative strategy.

La reconstruction mammaire par implant présente des inconvénients à long terme et conduit un nombre croissant de patientes à demander une chirurgie secondaire de correction. Deux stratégies chirurgicales sont possibles : le changement d'implant (associé à des gestes de capsulectomie/capsulotomie et/ou lipofilling) et le retrait d'implant associé à l'apport d'un tissu autologue (lambeau et/ou lipofilling). Entre 2010 et 2018, 54 patientes ont bénéficié d'une chirurgie secondaire de correction d'une première reconstruction mammaire par implant. Les motifs d'insatisfaction de la reconstruction initiale, les interventions réalisées et les complications postopératoires ont été analysés. Le bien-être et la satisfaction des patientes ont été évalués au moyen du questionnaire BREAST-Q. Trente-quatre patientes ont bénéficié d'un changement de prothèse et 20 patientes d'un retrait définitif de leur prothèse associé à l'apport d'un tissu autologue. La présence d'une coque périprothétique, la douleur, l'aspect figé du sein et l'asymétrie mammaire étaient les motifs d'insatisfaction les plus fréquents. Avec un recul moyen de 2,6 ans, les patientes ayant bénéficié d'une conversion autologue étaient globalement plus satisfaites de l'aspect de leurs seins que les patientes ayant conservé un implant mammaire (p < 0,0001). En cas de mauvais résultat esthétique ou fonctionnel d'une reconstruction mammaire par implant, le retrait de la prothèse associé à une reconstruction autologue donne de meilleurs résultats en termes de bien-être et de satisfaction que le changement d'implant. Breast reconstruction with implants has long-term disadvantages and is leading an increasing number of patients to request secondary corrective surgery. Two surgical strategies are possible: implant replacement (associated with capsulectomy/capsulotomy and/or lipofilling procedures) and implant removal associated with the provision of autologous tissue (flap and/or lipofilling). Between 2010 and 2018, 54 patients underwent secondary surgery for correction of a first implant breast reconstruction. The reasons for dissatisfaction with the initial reconstruction, the procedures performed, and postoperative complications were analysed. Patient well-being and satisfaction were evaluated using the BREAST-Q questionnaire. Thirty-four patients benefited from a prosthesis change and 20 patients benefited from a permanent removal of their prosthesis combined with the addition of autologous tissue. The presence of a periprosthetic shell, pain, fixed appearance of the breast and breast asymmetry were the most frequent reasons for dissatisfaction. With a mean follow-up of 2.6 years, autologous conversion patients were generally more satisfied with the appearance of their breasts than patients who retained a breast implant (P < 0.0001). In cases of poor esthetic or functional outcomes of implant-based breast reconstruction, removal of the prosthesis in combination with autologous reconstruction provides better results in terms of well-being and satisfaction than implant replacement. [ABSTRACT FROM AUTHOR]

Traditional imaging modalities used to assess velopharyngeal insufficiency (VPI) do not allow for direct visualization of underlying velopharyngeal (VP) structures and musculature which could impact surgical planning. This limitation can be overcome via structural magnetic resonance imaging (MRI), the only current imaging tool that provides direct visualization of salient VP structures. MRI has been used extensively in research; however, it has had limited clinical use. Factors that restrict clinical use of VP MRI include limited access to optimized VP MRI protocols and uncertainty regarding how to interpret VP MRI findings. The purpose of this paper is to outline a framework for establishing a novel VP MRI scan protocol and to detail the process of interpreting scans of the velopharynx at rest and during speech tasks. Additionally, this paper includes common scan parameters needed to allow for visualization of velopharynx and techniques for the elicitation of speech during scans., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Slipped capital femoral epiphysis (SCFE) is a disease that occurs as a result of the posterior and inferior displacement of the femur head. SCFE is the most common hip pathology in adolescence. It is classified as stable and unstable SCFE according to the loadability of the affected leg. The widely accepted method for stable SCFE treatment is in situ pinning. In situ pinning is an effective method for relieving pain in the early period and preventing the progression of slippage. On the other hand, because of the non-anatomic reduction of physis, it is expected in middle and long-term osteoarthritis. Our aim in this study is to report the long-term functional outcomes of patients with SCFE who were treated with in situ fixation at a trauma center.Methods: This study was designed as a retrospective collection of data at a tertiary trauma center, and descriptive research based on prospective assessment and observation. Patients who were treated with closed-loop in situ pinning were evaluated retrospectively for acute, subacute, and chronic slip intensity according to the Southwick classification as mild, moderate, severe, and load-failing. Patient satisfaction surveys (SF-12, WOMAC, HHS, and HOS) were used to evaluate postoperative clinical and functional outcomes.Results: Overall, 33 patients were included in the study, and 38 hips (28 unilateral, 5 bilateral) were treated surgically. In total, 11 patients (33.3%) had no complaint. In 11 patients (33.3%), the main complaint was limping. The main complaint of 7 patients (21.2%) was restricted movement, and 4 patients (12.1%) were found to have underlying pain. The mean functional results of the patients after the first surgical treatment were HHS, 82.6; HOS, 87.2; WOMAC, 82.8; SF-12 PCS, 43.8. The SF-12 MCS was found to be 48.2.Conclusion: In this study, satisfactory results were obtained early in the in situ pinning method, and it was not enough to prevent osteoarthritis but other morbid complications in the long term.

Background: The burden of cleft care throughout a patients' life includes plastic surgery, otolaryngology (ENT), speech therapy and dental and orthodontic care, all of which are required to achieve an optimal outcome. We aimed to determine the burden of care across multiple specialties in babies born with cleft lip and/or palate up to the age of 21 years. We compare the outcomes to two larger multi-centre studies: the Americleft and Eurocleft studies. Methods: The regional database was used and all babies born between 1988 and 1995 were included. Medical records and the cleft database were used to determine cleft subtype, operations and outpatient appointments (plastics, ENT, dental, orthodontic, speech and language), hospital stay and length of follow-up. Results: A total of 321 patients with cleft lip and/or palate were born between 1988 and 1995. Complete data was available for 106 (33%). Primary and secondary plastic surgery operations increased with increasing cleft severity. Secondary surgery was highest in unilateral cleft lip and palate (UCLP)—64%. Total inpatient stay for plastic surgery operations was highest for bilateral cleft lip and palate (BCLP) (16.4 days) compared with 7.7 for incomplete cleft palate (iCPO). The outpatient burden for all specialities was highest in complex cleft patients: 48.5 appointments compared with 25.5 for children with an incomplete cleft palate. Follow-up time increased from 14.2 to 20.5 years. Conclusions: Unsurprisingly, both the inpatient and outpatient burdens of care are influenced by the complexity of the cleft and increase with worsening severity. Our results will help inform parents of the likely trajectory their child will face when diagnosed with each subtype of cleft. The 2014 data shows that modern cleft care is changing; a combination of reduced hospital stay and the addition of streamlined outpatient appointments will both be of great benefit. The influence of modern day life will hopefully reduce the associated burden that has been highlighted in this paper and it is vital the benefits of modernisation are communicated to parents as well. Level of evidence: Level III, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Background: Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. Materials and Methods: The study group consisted of 65 hips treated between 6 and 12 months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6–12) months and the mean follow-up was 4.2 ± 1.5 years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. Results: Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was − 14.8° ± 3.5° versus − 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). Conclusions: No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to investigate the association between obesity and the presence of secondary surgery following neurolysis, direct nerve repair, or nerve grafting in patients with traumatic brachial plexus injury.Methods: In this retrospective chart review spanning two Level I medical centers in a single metropolitan area, 57 patients who underwent neurolysis, direct nerve repair, or nerve grafting for brachial plexus injuries between 2002 and 2015 were identified. Risk regression analysis was used to evaluate the association between obesity status and secondary surgery.Results: After controlling for the confounding variables of age, high energy injury, associated shoulder dislocation and associated clavicle fracture using multivariate regression (risk regression), the risk ratio of secondary surgery in obese patients compared to non-obese patients was 6.99 (P = 0.028). The most common secondary surgery was tendon or local muscle transfer.Conclusions: There is an increased risk of secondary surgery in obese patients compared to non-obese patients of the same age and with the same severity of injury. The increased risk may be due to challenges related to powering a heavier upper extremity. A weight reduction program might be considered as part of the preoperative strategy. [ABSTRACT FROM AUTHOR]

Background: We would like to describe our experience with Peroneus Brevis flap in complicated Achilles tendon re-ruptures with fringed stumps.Methods: Eight patients with monolateral re-rupture of Achilles tendon were selected as eligible for surgical repair with Peroneus Brevis flap. Patients' outcome was evaluated clinically (ATRS and ROM), functionally (Gait analysis) and MRI was performed before and after surgery.Results: Effective coverage of tissue defect was reached in all patients. Functional assessment evaluation results were registered in a follow-up time that ranged from 12 to 18 months. ATRS and ROM tests' results showed good functional recovery without functional limitations or subjective reports pain. Post-operative MRI showed no signs of inflammation or tissue gaps. Gait analysis showed a partial reduction of performance in the affected side that did not affect patients' quality of life.Conclusions: In the presence of fringed stumps in Achilles tendon re-rupture, tendon flaps have the benefits of autologous tissues transfers and present less risks of failure than free flaps. Among them, Peroneus Brevis flap is easy to perform and leads to donor site's low morbidity. Our preliminary experience provides support for this technique to be potentially validated in larger more controlled trial. [ABSTRACT FROM AUTHOR]

Objective: To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. Design: Retrospective cohort study. Setting: Forty-nine pediatric hospitals. Participants: Children who underwent cleft lip repair between 1999 and 2015. Main outcome measure: Time from primary cleft lip repair to secondary lip surgery. Results: By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P <.01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. Conclusions: There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers. [ABSTRACT FROM AUTHOR]

La prise en charge secondaire des craniosténoses simples consiste surtout en des retouches esthétiques, et beaucoup plus rarement en des reprises fonctionnelles (cranioplasties ou insuffisances de correction). La prise en charge chirurgicale des faciocraniosténoses nécessite dans la plupart des cas de nombreuses interventions dont la séquence est variable selon la mutation. Habituellement, il est souhaitable de débuter la prise en charge par une expansion crânienne postérieure avant l'âge de 6 mois, le traitement d'une descente des amygdales cérébelleuses avant un an, et un monobloc fronto-facial à partir de l'âge de 18–24 mois. La prise en charge peut varier, mais il est préférable de retarder ou d'éviter la dérivation ventriculaire. Si le protocole initial ne suit pas ces règles, la prise en charge secondaire devient beaucoup plus complexe. La prise en charge primaire par avancement fronto-orbitaire compromet généralement le rattrapage par avancement fronto-facial monobloc, de même si un avancement facial précoce a été réalisé. Néanmoins, en chirurgie secondaire, on peut être amené à réaliser un monobloc de rattrapage, malgré les ostéotomies précédentes antérieures, mais avec un risque de morbidité accrue. Secondary surgeries for single craniosynostosis surgeries are mainly esthetic refinements rather than functional indications. However, cranioplasties for bone defects correction or insufficient corrections may be undertaken. Management of syndromic craniosynostoses usually requires multiple surgical interventions, the sequence of which might vary per the genetic mutation. It is commonplace to start with posterior vault expansion before age 6 months, then treat cerebellar tonsillar herniation by the age of twelve months, and delay fronto-facial monobloc advancement until at least 18–24 months of age. Ventricular shunting is preferably avoided or delayed. Failure to respect these guidelines can significantly complicate the subsequent management. Primary fronto-orbital advancement or early facial osteotomy type Le Fort3, may compromise the subsequent fronto-facial monobloc advancement. However, this salvage secondary monobloc may be undertaken in some instances despite previous anterior osteotomies with a higher morbidity. [ABSTRACT FROM AUTHOR]

La plastie abdominale (PA) est une intervention courante de chirurgie plastique qui permet de retirer l'excès cutanéo-graisseux inesthétique et gênant de la paroi abdominale antérieure. Dans 30 % des cas, les résultats s'avèrent insuffisants et motivent une demande de réintervention qui peut aller de la simple révision cicatricielle sous anesthésie locale à la reprise complète de l'intervention. Les principaux défauts à l'origine des plasties abdominales secondaires sont les excès cutanés persistants, les bourrelets graisseux résiduels, des malpositions cicatricielles ou les anomalies de l'ombilic. Le respect de certaines règles techniques lors de la PA primaire est susceptible de limiter ces défauts postopératoires à l'origine des reprises. Devant une imperfection de résultat postopératoire, une analyse clinique méthodique permet de déterminer les causes et de choisir la solution corrective la plus adaptée afin d'obtenir in fine la satisfaction du patient. The abdominoplasty (AP) is a common type of plastic surgery procedure that removes unsightly and uncomfortable cutaneous and fatty excess from the anterior abdominal wall. In 30% of the cases, the results prove to be insufficient and motivate a request for reintervention which goes from the simple cicatricial revision under local anesthesia to the complete recovery of the procedure. The defects at the origin of the secondary abominoplasty are persistent skin excess, residual fat deposits, scarring malpositions or abnormalities of the umbilicus. The respect of certain technical rules during the primary AP are likely to limit the postoperative defects at the origin of these surgical revisions. When an imperfection of result is found postoperatively, the methodical clinical analysis of the defect will allow in determining the cause and to choose the most adapted corrective solution in order to obtain finally the satisfaction of the patient. [ABSTRACT FROM AUTHOR]

Le pectus excavatum affecte environ une personne sur 500 : c'est la malformation du thorax la plus fréquente. Plusieurs techniques chirurgicales ou médicales ont été proposées. Certaines peuvent entraîner des complications ou des résultats insuffisants. La chirurgie secondaire du pectus excavatum par implants profonds sur mesure 3D est une solution élégante et efficace. Elle permet d'obtenir le bon résultat esthétique attendu par les patients en l'absence de contexte fonctionnel respiratoire ou cardiovasculaire. The pectus excavatum affects about one in 500 people. It is the most common malformation of the thorax. Several surgical or medical techniques have been proposed. Some are followed by complications or insufficient results. Secondary surgery with a deep customized 3D implant, may be an elegant and effective solution; it allows to obtain a good aesthetic result expected by patients in the absence of any respiratory or cardiovascular functional context. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the rates and types of complications and secondary surgeries after mini-open carpal tunnel release. Methods: A retrospective cohort study was performed for 1,328 patients who underwent mini-open carpal tunnel release from August 2008 to July 2013. Patients were excluded for acute trauma, the index procedure being revision surgery, neoplasm, age less than 18 years, incomplete records, and postoperative follow-up less than 1 month, which yielded 904 patients who underwent 1,144 surgeries. Results: Of 1,144 carpal tunnel releases performed, 14 (1.2%) were noted to have a complication at final follow-up, with no cases of major nerve or vessel injury. Fourteen patients (1.2%) underwent secondary surgery, including 11 cases for persistent or recurrent carpal tunnel syndrome and 3 cases for infection or hematoma. Chronic kidney disease was associated with an increased risk of complication. Diabetes mellitus, chronic kidney disease, and cervical radiculopathy were associated with an increased risk of secondary surgery. Conclusions: The short-term complication and secondary surgery rates of mini-open carpal tunnel release are low. Patients with diabetes mellitus, chronic kidney disease, and cervical radiculopathy should be counseled regarding risks of complication and secondary surgery. [ABSTRACT FROM AUTHOR]

Objective: To identify child-, surgeon- and hospital-specific factors at the time of primary cleft palate repair that are associated with the use of secondary palate surgery. Design: Retrospective cohort study. Setting: Forty-nine pediatric hospitals. Participants: Children who underwent cleft palate repair between 1998 and 2015. Main Outcome Measure: Time from primary cleft palate repair to secondary palate surgery. Results: By 5 years after the primary palate repair, 27.5% of children had undergone secondary palate surgery. In multivariable analysis, cleft type and age at primary palate repair were both associated with secondary surgery (P <.01). Children with unilateral cleft lip and palate had a 1.69-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.54-1.85) compared to children with cleft palate alone. Primary palate repair before 9 months had a 3.99-fold increased hazard of secondary surgery (95% CI: 3.39-4.07) compared to repair at 16 to 24 months of age. After adjusting for cleft type, age at repair, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P <.01). For children with isolated cleft palate, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 8.5% to 46.0% across surgeons and 9.1% to 49.4% across hospitals. Conclusions: There are substantial differences among surgeons and hospitals in the rates of secondary palate surgery. Further work is needed to identify causes for this variation among providers and develop interventions to reduce the need for secondary surgery. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the wound complication (WC) rate and to determine the risk factors for WC in patients with soft tissue sarcoma treated with preoperative radiotherapy followed by surgical resection. Using the database of Oxford University Hospital (OUH) we retrospectively studied 126 cases of soft tissue sarcomas treated with preoperative radiotherapy and surgery between 2007 and 2021. WC were defined as minor wound complication (MiWC) not requiring surgical intervention or major wound complication (MaWC) if they received a secondary surgical intervention. Univariate and multiple regression analyses were performed using frequency of WC and MaWC as a dependent variable. The incidence of WC and MaWC was 43.7% (55/126) and 19% (24/126). Age (OR:1.03, 95%CI: 1.00–1.06, p = 0.016), tumor size (OR:1.11, 95%CI:1.01–1.21, p = 0.027) and tumor site namely proximal lower limb vs upper limb (OR:10.87, 95%CI 1.15–103.03, p = 0.038) were risk factors on multivariate analysis. In nested case control analysis, the incidence of MaWC was 43.6% (24/55), the mean recovery time is 143 days in patients with MaWC. Smoking increases the risk for MaWC (OR:8.32, 95%CI:1.36–49.99, p = 0.022). The time interval between surgery and wound complication reduces the risk for MaWC (OR:0.91, 95%CI:0.84–0.99, p = 0.028) in multivariate analysis. Age, tumor site and size are risk factors for WC requiring preoperative radiotherapy. Smoking and the time interval between surgery and wound complication are risk factors for MaWC as compared with MiWC. MaWC rate (19%) are comparable to those in postoperative radiotherapy and surgery alone. • Preoperative radiotherapy has a similar major wound complications with post-operative radiotherapy and surgery without radiotherapy. • The classification and management of Mi/Ma WC should be included in analysis of predictive factors as 56% of the wound complications after preoperative radiotherapy can be managed conservatively and 75% of the MaWC can be managed in conservative surgery. • Patient age, tumor size and site notably the proximal lower limb are risk factors for incidence of WC. • Smoking and the time interval between surgery and WC are risk factors for MaWC when compared with MiWC. • With 0% (preoperative radiotherapy) vs 7–26% (postoperative radiotherapy) of delaying rate and 19% (preoperative radiotherapy) vs 17% (postoperative radiotherapy) of MaWC rate in pre- and postoperative radiotherapy, preoperative radiotherapy is functionally preferable in treating extremity and trunk STS. [ABSTRACT FROM AUTHOR]