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Purpose: To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary. Materials and Methods: A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated. Results: A total of 35 studies were included in the metaanalysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%). Conclusions: ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Osteosarcoma at the first metacarpal is extremely rare. Reconstructing the metacarpal after tumor resection is essential, as the thumb accounts for approximately 40%–50% of hand function. Although autografts, arthroplasty, and transposition have been reported as reconstruction options, their use is limited by complications such as secondary injury, nonunion, and displacement. In this study, we present a case of a patient with first metacarpal osteosarcoma who underwent tumor resection followed by reconstruction with a 3D‐printed metacarpal prosthesis. We tend to introduce a novel strategy to reconstruct the first metacarpal and restore the hand function.A 30‐year‐old male with 5‐month history of first metacarpal swelling in the left hand was admitted to our center. Imaging examinations and incision biopsy confirmed a diagnosis of intramedullary well‐differentiated osteosarcoma. A 3D‐printed metacarpal prosthesis was then designed to achieve carpometacarpal (CMC) joint fusion and thumb metacarpophalangeal (MCP) joint reconstruction. Postoperative evaluations included X‐ray and tomosynthesis‐shimadzu metal artifact reduction technology (T‐SMART) imaging to assess bone‐prosthesis integration. Hand function was measured using the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.The tumor was completely resected, and a 3D‐printed metacarpal prosthesis was performed to reconstruct the tumor defect. Postoperative imaging showed that the interface between bone and prosthesis was integrated and that there was no loose, displacement, or fracture of the implant. At the last follow‐up, the patient had an MSTS score of 25/30 and a DASH score of 8/100. The range of motion on thumb MCP joint was 30° of flexion and 0° of extension. The Kapandji thumb opposition score was 4 points. The grip strength was 9 kg (compared to 30 kg on the contralateral side) and the key‐pinch strength was 3 kg (compared to 8 kg on the contralateral side).3D‐printed metacarpal prosthesis could be an effective reconstruction option for patients with low‐grade malignant tumors. Themulti‐planar fixation achieved through 3D surgical planning helps maintain thumb function and restore overall hand function. [ABSTRACT FROM AUTHOR]

Purpose: The Madrid Posterior Component Separation technique (Madrid PCS) is an approach for abdominal wall reconstruction that leverages anatomical landmarks to optimize outcomes. This manuscript describes ten essential steps for performing the Madrid PCS, focusing on technique, safety, and efficiency. Methods: A comprehensive step-by-step approach is outlined, beginning with the initial incision and adhesiolysis, progressing through retromuscular dissection, and concluding with lateral release and subxiphoid dissection. Emphasis is placed on key anatomical landmarks, tissue planes, and surgical maneuvers critical for each phase. Detailed tips and tricks, challenging scenarios, and potential risks are provided to enhance the reproducibility and safety of the procedure. Results: Applying these ten steps provides an organized and methodical approach to the Madrid PCS. The focus on anatomical landmarks minimizes the risk of complications such as nerve injury, peritoneal tears, and inadvertent organ damage, while ensuring for the optimal placement of prosthetic materials. Conclusion: Adherence to these ten steps, based on anatomical landmarks, significantly improves the safety and effectiveness of the Madrid PCS technique. By understanding the nuances of the procedure, surgeons can achieve consistent and reproducible results in complex abdominal wall reconstructions. [ABSTRACT FROM AUTHOR]

Background: Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks. Objective: Evaluation of efficacy and safety of continuous blanket sutures (CBS) for fixation of large autologous conjunctival grafts in patients with severe recurrent pterygium with symblepharon. Methods: Retrospective, observational case series. Thirty-nine patients (40 eyes) were included, all with severe recurrent pterygium with symblepharon. During surgery, CBS was employed to affix large autologous conjunctival grafts to the exposed sclera, aiming to restore the ocular surface to smoothness as much as possible. All patients were followed up for more than one year. Main outcome measures include the rate of recurrence, improvement of eye movement, and intraoperative and postoperative complications. Results: Nearly all patients exhibited a smooth ocular surface and largely restored physiological structures during the follow-up period. There were no graft loss or contraction cases until the last follow-up, with only three eyes experiencing a pterygium recurrence (recurrence rate 7.5%, 3/40). Preoperative eye movement limitations improved significantly from 2.10 ± 0.71 (range 1–3) to 0.33 ± 0.53 (range 0–2; p < 0.001) post-surgery. Other postoperative complications included varying degrees of corneal scarring and a single instance of conjunctival granulomatous hyperplasia (1 eye, 2.5%). Conclusion: When addressing severe recurrent pterygium with Symblepharon, using CBS to secure large autologous conjunctival grafts during surgery can achieve favorable postoperative outcomes. This surgical method is safe and feasible and effectively rebuilds a smooth ocular surface, improves the appearance of the ocular surface, and reduces the recurrence rate of pterygium after excision. [ABSTRACT FROM AUTHOR]

Lateral extra-articular tenodesis (LET) has shown an upswing in popularity since the role of antero-lateral rotatory instability (ALRI) in ACL tears has become better understood. Its primary aim is to restore antero-lateral rotatory stability and hence reduce stresses placed on the ACL graft in high-risk individuals which should reduce graft failure rates. Many techniques have been described for LET using a variety of fixation methods (screws, anchors, etc.). Most of these techniques rely on a large incision laterally. We describe a novel technique ('mini-LET') which uses a 3–4 cm incision, to improve cosmesis. [ABSTRACT FROM AUTHOR]

Background: It has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments. Methods: Six below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured. Results: In all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures. Conclusions: The proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored. Level of evidence: Level III, A cadaveric study. [ABSTRACT FROM AUTHOR]

Background Spinal cord hemangioblastomas are rare benign and highly vascular tumors that develop either sporadically or as part of von Hippel–Lindau (VHL) disease. Generally, complete resection without significant neurologic deficit remains considerably challenging due to the risk of massive bleeding. The current study therefore aimed to describe en bloc resection of spinal cord hemangioblastomas according to the typical anatomical structures of peripheral lesions and evaluate the neurofunctional prognosis of this technique. Methods A total of 39 spinal cord hemangioblastomas from a series of 19 patients who underwent en bloc resection were retrospectively analyzed. In all cases, clinical and radiologic characteristics, as well as surgical tenets, were retrospectively determined and analyzed. Short- and long-term outcomes were analyzed using the McCormick grade and Odom's criteria. Factors significantly associated with poor neurologic function after en bloc resection were also determined. Results All 39 spinal cord hemangioblastomas, including 28 intramedullary, 2 intramedullary–extramedullary, and 9 extramedullary lesions, were located dorsally or dorsolaterally (100.0%). The most common lesion location was the thoracic segment (53.8%), with most of the lesions being accompanied by syringomyelia (94.7%). Long-term follow-up (mean: 103 ± 50.4 months) for prognosis determination revealed that 88.2% (15/17) of all cases had stable or improved neurofunctional outcomes according to the McCormick grade and Odom's criteria. Only one case with VHL disease developed recurrence 4 years after surgery. Additionally, statistical analysis showed that VHL disease was an independent prognostic factor associated with deteriorating neurologic function (p = 0.015). Conclusions En bloc resection facilitated satisfactory long-term functional outcomes in patients with spinal cord hemangioblastomas. Given that VHL disease was identified as a predictor of poor long-term outcomes, regular long-term follow-up of patients with VHL-associated spinal cord hemangioblastoma seems necessary. [ABSTRACT FROM AUTHOR]

In the last years, one-anastomosis gastric bypass (OAGB) has been proposed more frequently as obesity surgery technique. Several trials have demonstrated that the easier technical feasibility does not affect the long-term surgical result. However, concern about increased risk of gastric and esophageal cancers has been expressed by several bariatric surgeons. The present study reports the 2nd case of cancer of the gastrointestinal-jejunal anastomosis in a OAGB patient focusing the attention on some technical issues correlated and offering a systematic review of the literature. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate biomechanical properties of tendon turnover repair in comparison to direct repair and Pulvertaft weave. A total of 48 sheep flexor tendons were assigned to eight groups comprising single or double tendon turnover repair, tendon turnover segment (without tenorrhaphy), direct repair or Pulvertaft weave. Tensile strength, stiffness and failure mechanisms were evaluated with a 500 N load cell. Turnover repair showed no significant difference in tensile strength to direct repair. Failure in turnover repair occurred largely at the site of tenorrhaphy due to suture pull-through or suture rupture. the increase in cross-sectional area after turnover repair was similar to that after direct repair, but less than after Pulvertaft weave. Tendon turnover offers tensile strength similar to direct repair with no associated increase in bulk. It provides a biomechanically secure and quicker alternative to tendon grafting for reconstructing tendon defects, without secondary donor site morbidity. Level of evidence: V [ABSTRACT FROM AUTHOR]

Objective: To determine associations of demographic, morphologic, and treatment protocol parameters with quality of life (QoL), appearance/speech satisfaction, and psychological adjustment. Design: Observational study utilizing retrospective report of protocol variables and current outcome variables. Setting: Six North American cleft treatment clinics. Participants: Children, ages 8.0–10.99 years, with Cleft Lip ± Alveolus, Cleft Palate, Cleft Lip and Palate, and parents (N = 284). Outcome Measures: Pediatric QoL Inventory (PedsQL): Parent, Child, Family Impact Module (FIM); Patient Reported Outcome Measurement Information System (PROMIS); Child Behavior Checklist (CBCL); CLEFT-Q. Results: Outcome scores were average with few differences by cleft type. Multiple regression analyses yielded significant associations (Ps <.05) between socioeconomic status, race, and age at assessment and parent- and self-reported measures. Females had higher PROMIS Depression (β=.20) but lower CBCL Affective (β = −.16) and PROMIS Stigma scores (β= −.24). Incomplete cleft lip was associated with lower PROMIS Depression, and more positive ratings of CLEFT-Q: Nose, Nostril, Lip Scar; CBCL Competence scores, (βs = −.17 to.17). Younger Age at Lip Closure was associated with higher CBCL School Competence (β= −.18). Younger Age at Palate Closure was associated with higher Child PedsQL Total, Physical, Psychosocial QoL, and better CLEFT-Q Speech Function (βs = −.18 to −.15). Furlow Palatoplasty was associated with more CBCL Externalizing Problems (β =.17) higher CBCL Activities (β =.16). For all diagnoses, fewer Total Cleft-Related Surgeries was associated with lower PROMIS Stigma and higher CBCL Total Competence and Activities (βs = −.16 to.15). Conclusions: Demographic characteristics, lip morphology, and treatment variables are related to later psychological functioning. [ABSTRACT FROM AUTHOR]

Background: Ear keloids, often resulting from ear piercing or other traumas, significantly alter appearance, adversely impacting patients' quality of life and psychological well-being. Thus, developing an effective and esthetically pleasing surgical repair technique is crucial for enhancing patient quality of life. Methods: This study introduces a novel tripartite surgical approach, which includes arcuate incision design, blind dissection for scar flap, and centrifugal keloid core serial shave excision (ABC for short). This technique is particularly suited for keloids induced by ear piercing that are inoperable for direct suturing or where direct suturing significantly alters the ear contour. Results: In this study, 17 patients underwent the surgical treatment without observing special complications such as infection or necrosis. Long-term postoperative follow-up demonstrated good restoration of the ear contour, with only one case of recurrence. Patients expressed satisfaction with both the surgical process and outcomes. Conclusions: The triple surgical technique (ABC surgery method) for treating auricular keloids has demonstrated excellent repair results, significantly improving auricle shape. Despite relying on the surgeon's experience, keloid characteristics, and patient comorbidities, it provides an effective treatment option. When combined with local radiotherapy, the recurrence rate is also significantly controlled. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions Current surgical strategies for thoracic ossification of the ligamentum flavum (TOLF) are denounced by thoracic kyphosis, loss of spinal motion range, etc. A new surgical technique, laminoplasty and in‐site regrafting (LPIR), was modified to address the problems. This study aimed to report the safety and feasibility of LPIR for TOLF treatment.This retrospective study reported the outcome of eight consecutive patients (3 males and 5 females, mean age 52.87 years) with TOLF who underwent LPIR surgery from January 2019 to March 2024. Pre‐ and post‐operative data including x‐ray, computerized tomography (CT), magnetic resonance imaging (MRI), the modified Japanese Orthopedic Association score (mJOA), the visual analog scale (VAS), and complications were collected to evaluate the outcome.All surgeries were performed successfully, significantly alleviating symptoms postoperatively. During an average follow‐up period of 28.63 months, the VAS score reduced from 4.50 ± 1.00 pre‐operatively to 1.63 ± 0.48 on the third post‐operative day and further reduced to 0.50 ± 0.70 during the last follow‐up. The mJOA score increased from 3.63 ± 0.70 pre‐operatively to 6.13 ± 0.78 on the third postoperative day and further increased to 8.88 ± 1.27 during the last follow‐up. No severe complications were observed.LPIR exhibited significant safety and feasibility for treating TOLF, offering a novel strategy for managing this problem. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters.Retrospective case–control study conducted at a high‐volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post‐CD relaparotomy, compared with a control group that did not undergo a relaparotomy.Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78–5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54–14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10–10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79–12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06–12.48, P < 0.01).Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions. [ABSTRACT FROM AUTHOR]

Digital replantation is a challenging and at-time tedious operation, but if approached thoughtfully and with reasonable expectations can be a reliable and rewarding undertaking. This article summarizes technical considerations for digital replantations involving flexor tendon zone II. The article has been ordered according to the recommended sequence of a structure-by-structure repair in a non-thumb digit. Special considerations are described for thumb, multiple digits, and heterotopic replantation. [ABSTRACT FROM AUTHOR]

Background: Primary and secondary tumors of the abdominal lower third of the bony thorax are relatively rare. Therefore, indications and techniques for chest wall reconstructions in this area are not well defined. Methods: The techniques for reconstructing basal chest wall defects using the diaphragm are described. Indications for phrenoplasty are limited to reconstruction after full-thickness resection of at least two of the last four ribs in the midaxillary line. The diaphragm can be used for reconstructive purposes both if it is intact and if it is partially involved in the resection of the chest wall. Results: At our institution, the abovementioned reconstructive technique was successfully performed in five patients with an uneventful post-operative course. Conclusions: The main advantages of these methods are the use of promptly available, high-quality autologous tissue and the exclusion of the pleural space from the defect area, thus transforming a thoracic defect into an abdominal one. The disadvantage is a variable reduction in the volume of the hemithorax. These techniques could be compared with other reconstruction techniques using pre-/post-operative respiratory functional tests. [ABSTRACT FROM AUTHOR]

Purpose: Oblique lumbar interbody fusion (OLIF) has become a popular technique for treating adult degenerative scoliosis (ADS), but traditional OLIF technology often requires repositioning for one‐stage or staged posterior fixation. The objective of this pilot study was to describe the surgical technique of simultaneous single‐position OLIF and percutaneous pedicle screw fixation (OLIF 360) under O‐Arm navigation for modified MISDEF type II ADS. Methods: Between June 2022 and December 2023, six patients classified as having modified MISDEF type II ADS underwent OLIF 360 assisted by O‐Arm navigation at our institution. Intraoperative blood loss, duration of operation, and complications related to the OLIF 360 procedure were recorded. The preoperative and postoperative spinal pelvic parameters were measured using X‐rays. The accuracy of pedicel screws was recorded in accordance with the modified Gertzbein–Robbins classification on CT. Postoperative MRI was performed to evaluate the indirect decompressive effect. The Japanese Orthopedic Association score for low back pain was used to evaluate surgical outcomes. Results: Navigated OLIF 360 were performed in six ADS patients with 44 percutaneous pedicel screws and 16 cages placement, including four women and two men. The mean operation time was 160.83 ± 33.23 min, and the mean blood loss was 111.67 ± 39.71 mL. Postoperative spinal pelvic parameters and spinal stenosis degree improved significantly on X‐ray and MRI. All screws were clinically acceptable according to the Gertzbein–Robbins classification, with 92.7% grade A and 7.3% grade B. No serious intraoperative and postoperative adverse events were recorded in all patients. The JOA scores for low back pain of all patients were significantly improved at postoperative 1 month and the final follow‐up. Conclusion: We report on a case series and describe navigated OLIF 360 in treating modified MISDEF type II ADS patients. Navigation‐assisted OLIF 360 has shown encouraging surgical outcomes with good spinal imbalance correction and indirect decompression. [ABSTRACT FROM AUTHOR]

Background: Dual mobility total joint arthroplasty is gaining popularity for trapeziometacarpal joint (TMCJ) arthritis, with evolving indications, surgical technique and rehabilitation. The aim of this study was to obtain detailed insight into the variations in indications, surgical technique and rehabilitation for TMCJ arthroplasty with dual mobility implants, across a large international cohort of surgeons. The secondary aim was to analyse if there were differences in TMCJ arthroplasty between highly and less experienced surgeons. Methods: An anonymised online survey was developed and distributed to the international hand surgery community of surgeons performing TMCJ arthroplasty. Responses were summarised, and a sub-analysis comparing indications, contra-indications, surgical technique, implant placement, rehabilitation and complications between highly and less experienced surgeons was performed. Results: Of the 203 included respondents, 59 were considered highly experienced. Most respondents perform TMCJ arthroplasty under regional anaesthesia (84%), via a dorsolateral approach (78%) and with image-guidance for cup placement (84%). However, there is considerable variation in handling of scaphotrapeziotrapezoidal (STT) arthritis, cup positioning landmarks, postoperative immobilisation, first extensor compartment release and revision techniques. Highly experienced surgeons performed TMCJ arthroplasty for a larger proportion of their patients undergoing surgery for TMCJ arthritis, and a trapezium smaller than 8 mm or STT-OA was less frequently considered a contra-indication. Highly experienced surgeons preferred freehand osteotomy of the metacarpal and allowed office workers to return to work earlier. Conclusions: This survey shows that there is considerable variation in (contra)indications, surgical technique and rehabilitation amongst surgeons performing TMCJ arthroplasty, but only a few differences between highly and less experienced surgeons were identified. This data provides a reference for surgeons who want to familiarise themselves with increasingly popular procedure and may help surgeons already performing TMCJ arthroplasty to identify potential topics for future research to optimise its outcome. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. Methods: The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. Results: The duration of tracheal reconstruction was 30–60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. Conclusion: The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea. [ABSTRACT FROM AUTHOR]

New technologies are increasingly widespread in medical practice. Particularly, the 3D view is considered among the most useful innovations for surgery. It allows the operator to reconstruct the patient's anatomy in his own mind, going beyond his personal imagination. In the last few years, a new facility has been experienced, it's the Exoscopy. Exoscopy is a magnified vision system, similar to Microscopy, but which also allows a tridimensional vision of the surgical anatomy. Despite Exoscopy having been used for years in Neurosurgery, it has been just rarely described in parotid surgery. We intend to report our experience with Exoscope Aesculap AEOS used to remove benign tumors of the parotid gland. We treated 14 patients with benign tumors of the parotid gland, since September 2023 to November 2023. Each surgery was conducted by the same expert surgeon which also reported his experience about intra-operative complications (as bleeding) in comparison to the traditional procedure without Exoscope. We evaluated the learning curve of Exoscope-Assisted Parotid Surgery comparing, among them, the operative times of the same procedures performed in chronological order. Each patient underwent the same follow-up which included three checks at one month, three months and six months. The follow-up was especially about the evaluation of palsy of the VII C.N. which was assessed through House-Brackmann score (H-B score). The results of our experience reports that the Exoscope is a useful tool for parotid gland surgery. It allows an excellent visualization of the facial nerve main trunk and its branches. Although the first procedures presented longer times in comparison to traditional surgery, the progressive reduction of the operative times demonstrates that the learning curve of Exoscopy is very fast. Certainly, more experience is required for the full introduction of Exoscopy in surgery practice of parotid gland but, now, its potentialities are highly exciting. [ABSTRACT FROM AUTHOR]

Although frontal prominence is an infrequent benign defect that causes no sequelae, it gives the patient distress due to its unaesthetic visual aspect. Proper surgical recontouring of the forehead can radically change one's appearance. In consequence, different techniques have been proposed for its management and correction. The aim of this study is to describe a surgical algorithm to treat male patients with forehead reduction to soften the "forceful" look. An observational cross-sectional study was conducted at the head and neck surgery ward of a general hospital between 2019 and 2022. We performed 35 forehead reduction operations on male patients. The median age was 29 years (range, 26–32 years). The forehead reduction procedures performed was categorized as follows: 27 anterior table osteotomy and 8 anterior table osteotomy contouring. Median forehead reduction was 2.7 mm (range, 2–3.2 mm). The average medical follow-up for patients was 6 months, with an interval ranging from 4 to 8 months. Surgery of the forehead in properly selected male patients is sufficiently safe that it can be done for entirely aesthetic reasons. The choice of surgical technique depends on the presence or absence of the pneumatized frontal sinus. If the frontal sinus is not pneumatized, an anterior table contouring is performed and if the frontal sinus is pneumatized, an anterior table osteotomy is preferred. [ABSTRACT FROM AUTHOR]

Introduction: Among super-microsurgical techniques, the anastomosis of vessels smaller than 0.5 mm is very difficult to perform due to the small diameter and thinness of the blood and lymphatic vessel walls. In this article, we report on the main points of super microsurgery, particularly on the anastomosis of veins and lymphatic vessels with diameters smaller than 0.5 mm. Methods and Results: Details of anastomosis of vessels smaller than 0.5 mm. (1) The outer wall of the first blood vessel near the abrupt end hook with the tip of the needle in the needle holder. The entire abrupt end of the first blood vessel was supported by forceps in the surgeon's left-hand. (2) The surgeon decided the entry point and angle of the needle while moving the tip. After the needle was fixed, a force was applied so that the needle could pass through to the vascular wall. (3) After the needle passed through, the tip was confirmed to be located in the lumen of the first blood vessel. (4) The tip of the needle was inserted into the lumen of the second blood vessel, and the bite was adjusted while touching the second blood vessel through the endometrium. (5) Once the tip was properly positioned, counter-traction was applied by holding the entire outer wall with a left-hand forceps. (6) The needle was held near the tip and pulled out along its curvature. The anastomosis time was 11.35 minutes on average (9 to 14 minutes). The patency rate for all 20 anastomosis procedures was also 100%. Conclusion: The important points of LVA for lymphatic vessels and veins smaller than 0.5 mm were reported. Once the surgeons are familiarized with this anastomosis procedure, they can typically perform one anastomosis in about 10 minutes. [ABSTRACT FROM AUTHOR]

To assess the feasibility, effectiveness, and safety of the robotic surgical approach in the treatment of severe diaphragmatic endometriosis (DE). Retrospective single-center study using data prospectively recorded in the Franco-European Multidisciplinary Institute of Endometriosis database and the National Observatory for Endometriosis database. Tertiary referral center. Endometriosis care center. Sixty consecutive patients undergoing robotic excision of severe DE from January 2020 to July 2023. Robotic excision of severe DE. Categorical and continuous variables were evaluated and compared using descriptive statistics. A p value of <.05 was considered statistically significant. Full-thickness diaphragmatic resection was performed in 76.7% of patients (46 of 60) and partial diaphragmatic muscle resection in 10% of cases (6 of 60). Peritoneal stripping technique was performed in 60% of patients (36 of 60), divided as follows: as the only technique in the case of extensive superficial diaphragmatic involvement in 13.3% of cases (8 of 60), in addition to full-thickness or partial diaphragmatic resection in the case of concomitant multiple foci in 46.7% of patients (28 of 60). Median operative time was 79.6 minutes with no statistically significative difference related to the surgeon performing surgery (p >.05). Intraoperative and postoperative complications occurred in 1.7% (1 of 60) and 6.6% of cases (4 of 60), respectively. Diaphragmatic hernia (Clavien-Dindo 3b) was the most common postoperative complication and required surgical repair in all cases. Median hospital stay was 24 hours. The rate of patients with complete recovery from DE symptoms has gradually increased during follow-up, reaching 89% after 12 months from surgery. In this case series, robotic treatment of severe DE in expert hands was feasible, effective, and safe. [ABSTRACT FROM AUTHOR]

Clinical care pathways help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety Committee (QIPS) of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG) and pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB). This current RYGB care pathway was created to address intraoperative care, defined as care occurring on the day of surgery from the preoperative holding area, through the operating room, and into the postanesthesia care unit (PACU). PubMed queries were performed from January 2001 to December 2019 and reviewed according to Level of Evidence regarding specific key questions developed by the committee. Evidence-based recommendations are made for care of patients undergoing RYGB including the pre-operative holding area, intra-operative management and performance of RYGB, and concurrent procedures. This document may provide guidance based on recent evidence to bariatric surgeons and providers for the intra-operative care for minimally invasive RYGB. [ABSTRACT FROM AUTHOR]

Objective: Schwannomas are benign, slow-growing tumors originating from Schwann cells in peripheral nerves, commonly affecting the median and ulnar nerves in the forearm and wrist. Surgical excision is the gold standard treatment. This study presents our treatment strategies and outcomes for large-sized ulnar and median nerve schwannomas at the forearm and wrist level. Methods: From 2012 to 2023, we enrolled 15 patients with schwannomas over 2 cm in size in the median or ulnar nerve at the forearm and wrist. The study included 12 patients with median nerve schwannomas (mean age: 61 years) and 3 with ulnar nerve schwannomas (mean age: 68 years), with a mean follow-up of 26.9 months. Results: After surgery, all patients with median nerve schwannomas experienced mild, transient numbness affecting fewer than two digits, resolving within six months without motor deficits. Ulnar nerve schwannoma excision caused mild numbness in two patients, also resolving within six months, but all three developed ulnar claw hand deformity, which persisted but improved at the last follow-up. Despite this, patients were satisfied with the surgery due to relief from severe tingling pain. Conclusions: Schwannomas of the median, ulnar, and other peripheral nerves should be removed by carefully dissecting the connecting nerve fascicles to avoid injury to healthy ones. Sensory deficits may occur but are unlikely to significantly impact quality of life. However, in motor-dominant nerves like the ulnar nerve, there is a risk of significant motor deficits that could affect hand function, though not completely. Therefore, thorough preoperative discussion and consideration of interfascicular nerve grafting are essential. [ABSTRACT FROM AUTHOR]

Background: To assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection ("Viscolift technique") in patients with severely subluxated cataracts. Methods: In the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery. Results: Thirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The "Viscolift technique" resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p < 0.001) at the last follow-up. No major complications were noted. Conclusions: The "Viscolift technique" proved to be a safe and effective surgical approach for recentering and elevating subluxated cataracts, thus allowing the surgeon to perform an easier and better-centered capsulorhexis. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedics, but there is still debate over the optimal fixation method for long-term durability: cement versus cementless bone ingrowth. Recent improvements in implant materials and technology have offered the possibility of cementless TKA to change clinical practice with durable, stable biological fixation of the implants, improved operative efficiency, and optimal long-term results, particularly in younger and more active patients. This symposium evaluated the history of cementless TKA, the recent resurgence, and appropriate patient selection, as well as the historical and modern-generation outcomes of each implant (tibia, femur, and patella). Additionally, surgical technique pearls to assist in reliable, reproducible outcomes were detailed. Historically, cemented fixation has been the gold standard for TKA. However, cementless fixation is increasing in prevalence in the United States and globally, with equivalent or improved results demonstrated in appropriately selected patients. Cementless TKA provides durable biologic fixation and successful long-term results with improved operating room efficiency. Cementless TKA may be broadly utilized in appropriately selected patients, with intraoperative care taken to perform meticulous bone cuts to promote appropriate bony contact and biologic fixation. [ABSTRACT FROM AUTHOR]

Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity. Patients undergoing acetabular distraction performed by 5 surgeons from 2002 to 2021 were identified across 5 institutions. Demographic, surgical, and postoperative outcomes, including radiographic component stability, were recorded. There were 53 of 91 (58.2%) patients (5 deceased, 33 lost to follow-up) consisting of 4 Paprosky IIC (7.5%), 8 Paprosky IIIA (15.1%), and 41 Paprosky IIIB (77.4%) defects included, with a mean follow-up time of 4.8 years (range, 2 to 13.5). Modular porous augments were used in 33 (62.3%) cases. Failure was defined as a subsequent revision of the acetabular construct. Among the 13 (24.5%) patients who returned to the operating room, 6 (46.2%) had a prior history of revision total hip arthroplasty before undergoing acetabular distraction. Only 5 (9.4%) patients underwent acetabular revision following acetabular distraction, leading to an overall cup survivorship of 90.6%. Of the remaining 48 patients, 46 (95.8%) had evidence of radiographic bridging callus of the chronic pelvic discontinuity at their last clinical follow-up. To our knowledge, in the largest series to date, acetabular distraction has proven to be a viable treatment for acetabular bone loss with a chronic pelvic discontinuity, with excellent early survivorship and radiographic evidence of bridging callus. Future studies with longer follow-ups are needed to further monitor the efficacy of this technique. Level III, Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Severe acetabular bone loss encountered during revision total hip arthroplasty (THA) poses a clinical challenge. In cases involving pelvic discontinuity, where the ilium is separated superiorly from the inferior ischiopubic segment through the acetabulum, acetabular distraction may be used to restore the biomechanics of the hemipelvis. This technique allows for correct sizing of the acetabulum, and the subsequent peripheral distraction and medial compression at the discontinuity provide initial mechanical stability and biological fixation as bone in growth occurs. Accordingly, this study aimed to assess long-term 5-year outcomes following acetabular distraction across 2 institutions. We retrospectively identified all patients who underwent revision THA in which the acetabular distraction technique was performed for the treatment of chronic pelvic discontinuity between 2002 and 2018. Demographic, operative, and clinical postoperative data were collected. Clinical endpoints included postoperative radiographic outcomes, complications requiring additional surgery, and reoperation for all causes. Only patients who had a minimum 5-year follow-up were included in this study. A total of 15 patients (Paprosky IIC: one patient, 6.7%; Paprosky IIIA: 5 patients, 33.3%; Paprosky IIIB: 9 patients, 60%) who had a mean follow-up time of 9 years (range, 5.1 to 13.5) were analyzed. Porous tantalum augments were used in 11 (73.3%) cases to primarily address posteriorsuperior defects (100%). There were 4 (26.7%) patients that required reoperation, only 2 of which were for indications related to the acetabular construct, leading to an overall survivorship of 86.7%. Both patients had a prior revision THA before the implementation of the distraction technique. Evidence of bridging callus formation was reported radiographically for 14 (93.3%) patients at the time of the last clinical follow-up. For patients who have chronic pelvic discontinuity, acetabular distraction shows promising long-term outcomes. Even so, larger multi-center studies are needed to better support the efficacy of this technique. Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Biliary reconstruction technique during liver transplant (LT) for primary sclerosing cholangitis (PSC) remains controversial. This study aimed to evaluate the incidence of biliary complications in patients with PSC having a duct‐to‐duct (DD) anastomosis or Roux‐en‐Y hepaticojejunostomy (HJ). Methods: A retrospective medical record review of patients with PSC undergoing LT at a single center between June 1st, 2000 and December 31st, 2022 was performed. Primary and secondary endpoints were the incidence of biliary strictures (anastomotic [BAS] and non‐anastomotic strictures [NAS]) and non‐stricture complications, respectively. Univariable and multivariable regression analyses were performed to identify associations with BAS formation. Patient survival was assessed using a Kaplan–Meier curve. Results: From 105 transplants performed for 101 patients, 54 (51.4%) and 51 (48.5%) received DD and HJ anastomoses. Mean recipient age and follow‐up was 47 ± 13 years and 98 ± 69 months. BAS was more common (48.1% vs. 27.5%, OR 2.45, 95% CI 1.09–5.54, p = 0.03) and occurred earlier (4.8 months, IQR 2.3–13.1 vs. 41.8 months, IQR 7.2–88.7, p = 0.001) in the DD than the HJ group. NAS (seen in 36.2% of transplants) had a comparable incidence (p = 0.53) in HJ (38.9%) and DD (33.3%) groups. No difference was seen between cohorts regarding time to NAS, requirement for extended biliary dilatation programs (clinically significant biliary stricture), bile leak, and graft failure. On multivariable analysis, only the anastomotic technique was associated with BAS (DD adjusted OR 3.00, 95% CI 1.19–7.56, p = 0.02). Conclusion: In carefully selected patients with PSC, DD anastomosis yielded similar outcomes to HJ anastomosis after liver transplantation. [ABSTRACT FROM AUTHOR]

This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5–10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery. [ABSTRACT FROM AUTHOR]

Objective: To present the experience in transit reconstitution using the retroileal transmesenteric colorectal anastomosis technique. Materials and Methods: Retrospective, descriptive and narrative review of cases in which transit reconstitution with retroileal transmesenteric colorectal anastomosis was performed. Results: After extended left colectomies, transit reconstitution was performed in 3 cases through retroileal transmesenteric colorectal anastomosis. Two cases as transit reconstitution with open technique and one as intraoperative decision in laparoscopic resective surgery. No case presented complications related to the anastomosis. Discussion: This type of reconstitution proved to be a useful and easy tool to perform after left colectomy to achieve a tension-free anastomosis or avoid the need to complete a total colectomy. [ABSTRACT FROM AUTHOR]

Navigation in total knee arthroplasties has been recommended in recent years to facilitate the technique and improve its results. An extensive literature has compared it with conventional surgery, but its superiority has not been able to be demonstrated. Given the abundant bibliography and disparity in their conclusions, a good number of meta-analyses have been published that have attempted to summarize and schematize the results. We have reviewed 41 published meta-analyses comparing both techniques. Most of them have focused on the placement of implants and the restoration of the axes of the extremity, demonstrating the superiority of navigation. On the contrary, no clinically valuable differences have been observed when analyzing the clinical and functional results. However, navigation allows a dynamic view of the knee, an objective evaluation of the soft tissues and ligaments, and is essential for functional alignment as an individualized technique. [ABSTRACT FROM AUTHOR]

To describe a novel technique, posterior thoracic antidisplacement and fusion (PTAF), for a special type of ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL), and to evaluate its safety and efficacy. From July to December 2020, 5 consecutive patients with beak-type T-OPLL located at the thoracic vertebral body level underwent PTAF surgery. Their demographic data, radiological parameters, perioperative complications, and surgery-related findings were recorded and analyzed. The surgical outcomes were assessed using a modified Japanese Orthopedic Association scale, and the recovery rate was calculated using the Hirabayashi's method. All patients were followed up for at least two years. The mean thickness of OPLL was 9.4 ± 1.0 mm, and the OPLL spinal canal occupying ratio was 67.7% ± 8.5%. Postoperatively, the mean antidisplacement distance of OPLL was 8.1 ± 1.8 mm, and the average shortened distance of the spinal column was 6.0 ± 1.13 mm. The mean operation time and blood loss were 158.2 ± 26.3 minutes and 460 ± 89.4 mL, respectively. Perioperative complications were cerebrospinal fluid leakage and instrument failure, 2 cases each. The mean modified Japanese Orthopedic Association score was increased from 3.6 ± 2.9 before surgery to 9.4 ± 3.0 at the last follow-up, and the average recovery rate was 84.2 ± 30.5%. The preliminary clinical outcomes indicate that PTAF is a safe and effective method for the treatment of beak-type T-OPLL, which has its apex located at the vertebral body level and has a high spinal canal occupation ratio. [ABSTRACT FROM AUTHOR]

Various nonvascularized or vascularized techniques have been adopted in endoscopic endonasal surgery (EES) for repairing intraoperative cerebrospinal fluid (CSF) leaks after tumor resection. Vascularized nasoseptal flaps, free nasoseptal grafts, free turbinate grafts, and fascia lata and mashed muscle are frequently used. Outcomes of those grafts applied in the defects of different regions need to be clarified. The data from a series of 162 patients with skull base tumor who underwent EES that had intraoperative CSF leak between Jan 2012 and Jan 2021 were retrospectively analyzed. The regions included anterior skull base, sellar region, clivus and infratemporal fossa. Repair failure rate (RFR), meningitis rate, and associated risk factors were assessed. In total, 172 reconstructions were performed in 162 patients for the 4 sites of the skull base. There were 7 cases (4.3%) that had postoperative CSF leaks, which required second repair. The RFR for anterior skull base, sellar region, clivus, and infratemporal fossawas 2.6%, 2.2%, 16.7%, and 0%, respectively. The clivus defect was an independent risk factor for repair failure (P < 0.01). The postoperative meningitis rate was 5.6%. Repair failure was an independent risk factor for meningitis (P < 0.01). Vascularized nasoseptal flap, free nasoseptal graft, free turbinate graft, and fascia lata and mashed muscle are reliable autologous materials for repairing the dural defects in different regions during EES. Clivus reconstruction remains a great challenge, which had a higher RFR and meningitis rate. Repair failure is significantly associated with postoperative meningitis. [ABSTRACT FROM AUTHOR]

Acute rupture and hemorrhage of pediatric brain arteriovenous malformations (AVMs) may lead to cerebral herniation or intractable intracranial hypertension, necessitating emerging surgical interventions to alleviate intracranial pressure. However, there is still controversy regarding the timing of treatment for ruptured AVMs. This study aimed to assess the feasibility of utilizing three-pillar expansive craniotomy (3PEC) at different times during the treatment of pediatric ruptured supratentorial AVMs. A retrospective analysis was conducted on all consecutive cases of acute rupture in supratentorial AVM children who underwent 3PEC at a single institution from 2020 to 2022. General information, clinical characteristics, radiological data, and prognosis were reviewed and analyzed. Thirteen children were included in the analysis. The intracranial pressure of all patients decreased to below 15 mmHg within 10 days. The expansion volume of the cranial cavity of the patients increased by 18.3 cm3 (95% confidence interval, 10.2–26.3; P < 0.001) compared to the hematoma volume. None of the patients required decompressive craniectomy due to intractable intracranial hypertension caused by cerebral swelling. The median waiting period for patients with delayed AVMs treatment was 8 days, during which no rebleeding occurred. Emergency intervention with 3PEC in children experiencing acutely ruptured supratentorial AVMs appears to be feasible. For children requiring delayed management of the AVMs, 3PEC may diminish the risk of rebleeding during the waiting period and shorten the waiting period. [ABSTRACT FROM AUTHOR]

Durable mechanical circulatory support options for patients with biventricular failure are limited. One emerging strategy is the use of 2 fully magnetically levitated durable ventricular assist devices (HeartMate 3s) in a biventricular configuration. The use of a HeartMate 3 as a right ventricular assist device (RVAD) requires several complex technical modifications. Here, we provide step-wise detailed figures and a comprehensive description of bilateral HeartMate 3 insertion, with a particular focus on right atrial inflow cannulation for the RVAD. Potential pitfalls and solutions are also described. [ABSTRACT FROM AUTHOR]

Background: Unstable fractures of the distal radius fractures (DRFs) may result in malunion, usually consisting of subsequent shortening and angular deviations. Ulnar shortening osteotomy (USO) is assumed to be a simpler procedure than radial correction osteotomy, resulting in fewer complications and comparable outcomes. The aim of this study was to identify the best surgical technique to perform USO to restore distal radioulnar joint congruency after DRF malunion. Methods: A systematic review of the literature is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in February 2022 to identify studies reporting outcomes and surgical technique for isolated USO. The primary outcome was complication rates. Secondary outcomes included functional, radiologic, and patient-rated outcomes. The methodological index for nonrandomized studies criteria were used to assess the quality of evidence. Results: Included were 12 cohorts (185 participants). Due to substantial heterogeneity, a meta-analysis could not be performed. The overall complication rate was 33% (95% confidence interval, 16% to 51%). The most reported complication was implant irritation (22%), often requiring removal of the implant (13%). Only 3% nonunions were mentioned. Functional and patient-rated outcomes improved in most patients after USO. Quality of evidence of the papers was low to very low. Common methodological flaws were related to retrospective research. Conclusion: No evident differences in complication rates and functional outcomes between the surgical techniques were observed. Based on this literature, most complications are related to implant irritation. Nonunion and infection rates were rare. Therefore, a surgical technique with a buried implant might be preferred. This hypothesis requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Tubercle aesthetics are under-emphasized in unilateral cleft lip repair. Teenagers and adults with repaired cleft lip often display a central whistle deformity medial to the cleft lip scar. Lateral segment vermillion elements that are often discarded at the time of the initial repair can be used for tubercle reconstruction. Methods: We obtained anthropometric measurements of the dry vermilion around the central tubercle in neonates with unilateral cleft lip to determine the extent and morphology of deficiencies. A modification of the Noordhoff vermillion flap is proposed with a trapezoidal configuration to precisely match the measured, dry vermillion deficiency. Results: Photographic documentation illustrates the surgical technique and results. Conclusions: Tubercle reconstruction is described using a modification of the Noordhoff flap. Four-year results are encouraging. Observations through maturity are needed. [ABSTRACT FROM AUTHOR]

Background/Objectives: Liver retransplantation (reLT) is the only option for pediatric patients experiencing graft loss. Despite recent advancements in surgical techniques and perioperative management, it remains a high-risk procedure. Our aim is to describe our experience in pediatric reLT, focusing on the technical aspects and surgical challenges. Methods: We systematically analyzed surgical reports from pediatric reLT performed at our center between 2006 and 2023 to identify recurrent intraoperative findings and specific surgical techniques. We focused on challenges encountered during different phases of reLT, including hepatectomy, vascular, and biliary reconstruction. Additionally, we compared patient and graft survival rates among different groups. Results: During the study period, 23 children underwent 25 reLT procedures at our center. Major surgical challenges included complex hepatectomy and vascular reconstructions, necessitating tailored approaches. Our analysis shows that patient and graft survival were significantly lower for reLT compared to primary transplantation (p = 0.002). Early reLT had a significantly lower graft survival compared to late reLT (p = 0.002), although patient survival was comparable (p = 0.278). Patient and graft survival rates were comparable between the first and second reLT (p = 0.300, p = 0.597). Patient survival tended to be higher after living-donor liver transplantation (LDLT) compared to deceased-donor liver transplantation (DDLT), although the difference was not statistically significant (p = 0.511). Conclusions: Pediatric reLT involves significant technical challenges and lower survival rates. Advances in perioperative management are crucial for improving outcomes. Further research is needed to optimize surgical strategies and evaluate the long-term benefits of LDLT in pediatric reLT. [ABSTRACT FROM AUTHOR]

Objective: To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery. Design: Descriptive clinical study with one group, prospective. Setting: Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam. Patients: 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery. Interventions: Interventions include PNAM and cheiloplasty by modified Millard technique. Main Outcome Measures: Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance. Results: After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm). Conclusion: Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures. Methods A systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated. Results Screening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment. Conclusion This study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

Abstract Background It has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments. Methods Six below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured. Results In all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures. Conclusions The proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored. Level of evidence Level III, A cadaveric study.

Massive rotator cuff tears constitute approximately 20% of all rotator cuff tears. Poor tissue quality or significant retraction can lead to failure of the repair. The anterior rotator cuff cable is essential in transmitting force to the proximal humerus and serves as the main load-bearing structure within the supraspinatus. Utilizing the long head of the biceps tendon (LHBT) for anterior cable reconstruction in the setting of rotator cuff tears, known as biceps augmentation, has the potential for improved biomechanical and healing properties. Importantly, the proximal LHBT remains attached to the superior glenoid labrum, serving as a viable collagen scaffold, a structural scaffold for the cable, and potentially as a conduit for living tenocytes to migrate into the hypovascular region of the rotator cuff, promoting repair healing. Similar methods utilize the transfer of the intact LHBT into the rotator cuff without a biceps tenodesis. While this accomplishes the aforementioned goals, it may create a source of biceps pain in these patients, and it changes the length–tension relationship of the LHBT distal to the transfer site. In this technical note, we detail an anterior cable reconstruction employing an autologous LHBT to reinforce a repaired massive rotator cuff tear with concurrent subpectoral tenodesis of the LHBT to achieve goals of 1) rotator cuff augmentation and grafting and, importantly and 2) securing the LHBT in a subpectoral position to mitigate pain and maintain supination strength while maintaining the anatomic length–tension relationship of the biceps. We feel this approach is superior in ensuring sufficient tendon is retained for an effective transfer and allows for a subpectoral tenodesis to prevent biceps symptoms.

Purpose Oblique lumbar interbody fusion (OLIF) has become a popular technique for treating adult degenerative scoliosis (ADS), but traditional OLIF technology often requires repositioning for one‐stage or staged posterior fixation. The objective of this pilot study was to describe the surgical technique of simultaneous single‐position OLIF and percutaneous pedicle screw fixation (OLIF 360) under O‐Arm navigation for modified MISDEF type II ADS. Methods Between June 2022 and December 2023, six patients classified as having modified MISDEF type II ADS underwent OLIF 360 assisted by O‐Arm navigation at our institution. Intraoperative blood loss, duration of operation, and complications related to the OLIF 360 procedure were recorded. The preoperative and postoperative spinal pelvic parameters were measured using X‐rays. The accuracy of pedicel screws was recorded in accordance with the modified Gertzbein–Robbins classification on CT. Postoperative MRI was performed to evaluate the indirect decompressive effect. The Japanese Orthopedic Association score for low back pain was used to evaluate surgical outcomes. Results Navigated OLIF 360 were performed in six ADS patients with 44 percutaneous pedicel screws and 16 cages placement, including four women and two men. The mean operation time was 160.83 ± 33.23 min, and the mean blood loss was 111.67 ± 39.71 mL. Postoperative spinal pelvic parameters and spinal stenosis degree improved significantly on X‐ray and MRI. All screws were clinically acceptable according to the Gertzbein–Robbins classification, with 92.7% grade A and 7.3% grade B. No serious intraoperative and postoperative adverse events were recorded in all patients. The JOA scores for low back pain of all patients were significantly improved at postoperative 1 month and the final follow‐up. Conclusion We report on a case series and describe navigated OLIF 360 in treating modified MISDEF type II ADS patients. Navigation‐assisted OLIF 360 has shown encouraging surgical outcomes with good spinal imbalance correction and indirect decompression.

Abstract Objective Schwannomas are benign, slow-growing tumors originating from Schwann cells in peripheral nerves, commonly affecting the median and ulnar nerves in the forearm and wrist. Surgical excision is the gold standard treatment. This study presents our treatment strategies and outcomes for large-sized ulnar and median nerve schwannomas at the forearm and wrist level. Methods From 2012 to 2023, we enrolled 15 patients with schwannomas over 2 cm in size in the median or ulnar nerve at the forearm and wrist. The study included 12 patients with median nerve schwannomas (mean age: 61 years) and 3 with ulnar nerve schwannomas (mean age: 68 years), with a mean follow-up of 26.9 months. Results After surgery, all patients with median nerve schwannomas experienced mild, transient numbness affecting fewer than two digits, resolving within six months without motor deficits. Ulnar nerve schwannoma excision caused mild numbness in two patients, also resolving within six months, but all three developed ulnar claw hand deformity, which persisted but improved at the last follow-up. Despite this, patients were satisfied with the surgery due to relief from severe tingling pain. Conclusions Schwannomas of the median, ulnar, and other peripheral nerves should be removed by carefully dissecting the connecting nerve fascicles to avoid injury to healthy ones. Sensory deficits may occur but are unlikely to significantly impact quality of life. However, in motor-dominant nerves like the ulnar nerve, there is a risk of significant motor deficits that could affect hand function, though not completely. Therefore, thorough preoperative discussion and consideration of interfascicular nerve grafting are essential.

Abstract Background To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. Methods The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. Results The duration of tracheal reconstruction was 30–60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. Conclusion The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.

Abstract Background To assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection (“Viscolift technique”) in patients with severely subluxated cataracts. Methods In the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery. Results Thirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The “Viscolift technique” resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p

This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5–10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery.

AIM: To present a technique of transcapsular scleral fixation of the standard capsular tension ring (CTR) through equatorial capsulotomy and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. METHODS: This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction, transcapsular scleral fixation of the standard CTR through equatorial capsulotomy, in-the-bag IOL implantation and with at least 6mo follow-up. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), complications, and postoperative IOL tilt and decentration were recorded. RESULTS: Nine eyes of 7 patients with a mean follow-up of 11.0±3.7mo were included in this study. The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively (P

Laparoscopic techniques are being widely applied for peritoneal dialysis (PD) catheter (PDC) placement. The suture passer is a novel fixation tool that aims to reduce catheter migration. We compared the clinical value of the suture passer combined with two-hole laparoscopic PDC placement to open surgical placement by evaluating preoperative and postoperative conditions, as well as the onset of complications in both groups. A retrospective study was conducted including 169 patients who underwent PDC placement surgery from January 2021 to May 2023. Based on the method employed, patients were divided into two groups: the suture passer combined with a two-hole laparoscopy group (SLG) and the open surgical group (SG). Comprehensive patient information, including general data, preoperative and postoperative indicators, peritoneal function after surgery, and the incidence rate of complications, were collected and analyzed. The SLG showed a statistically significant decrease in operative time, intraoperative blood loss, and 6-month postoperative drift rate compared to the SG (p < 0.05). No statistically significant differences were observed between the two groups in terms of sex, age, primary disease, hospitalization time, hospitalization costs, preoperative and postoperative examination indicators, peritonitis, and omental wrapping. Suture passer combined with two-hole laparoscopic PDC placement, characterized by simplicity and facilitating secure catheter fixation, was deemed safe and effective for patients undergoing PD. It reduces the catheter migration rate and improved surgical comfort. Overall, this technique demonstrates favorable outcomes in clinical practice. [ABSTRACT FROM AUTHOR]