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Question mark ear (QME) is a congenital abnormality characterized by a prominent curve within the helix that resembles a question mark. Several surgical reconstruction techniques have been proposed to treat this deformity. In this study, we aimed to evaluate the cosmetic outcomes of a new cartilage and postauricular flap surgical reconstruction technique for patients diagnosed with severe QME. From 2017 to 2023, 33 patients with severe QMEs were treated with a new reconstruction surgical technique at the Plastic Surgery Hospital of Peking Union Medical College. The perimeter, width, length, and auriculocephalic angles of both ears were measured and compared to assess the symmetry. The patient's satisfaction with the surgical outcomes and incidence of post-operative complications were also evaluated. The average follow-up duration was 15.48 months. The auricular perimeter, width, and length changed significantly after surgery. The dimensions of the left and right ear did not vary significantly in patients with unilateral or bilateral severe QME after surgery and at the end of the 1-year follow-up. Most patients (87.88%) or carers were satisfied with the cosmetic outcomes after surgery. All patients underwent suture removal 14 days after surgery and exhibited excellent wound healing without any complications such as hematoma, infection, and flap necrosis. Our new surgical reconstruction technique for severe QME resulted in good cosmetic outcomes, high patient satisfaction, fast recovery, and no post-operative complications. [Display omitted] [ABSTRACT FROM AUTHOR]

Background/Objectives: Vesicoureteral reflux (VUR) is considered one of the major causes of post-renal transplant febrile urinary tract infections (UTI), leading to impaired renal function and the premature loss of the renal graft. We aimed to evaluate whether surgical VUR correction, such as open redo ureteric reimplantation, could be an option for treatment and provide better outcomes in post-transplant care for patients with UTI compared to their pre-VUR correction clinical state. Methods: Our study presents a retrospective analysis of 10 kidney transplant recipients with febrile UTI at the Renal Transplant Service of a Brazilian public hospital from 2010 to 2020. We selected patients who primarily underwent a surgical correction of post-transplant VUR, which was corrected by extravesical reimplantation without a stent in all patients by the same professional surgeon. Results: From 710 patients who received kidney transplants, 10 patients (1.4%) suffered from febrile UTI post-transplant and underwent surgical correction for VUR. Despite the study's limitations, such as its retrospective nature and limited sample size, the efficacy of open extravesical ureteral reimplantation in reducing post-operative febrile UTI in renal transplant patients was observed. Conclusions: As febrile UTI can contribute significantly to patient mortality after kidney transplantation and VUR emerges as a major cause of post-transplant febrile UTI, it is essential to treat it and consider the surgical outcome. This study emphasizes the timely detection and effective treatment of VUR via extravesical techniques to reduce febrile UTI occurrences post-transplant and it contributes insights into the role of surgical interventions in addressing VUR-related complications post-kidney transplantation. [ABSTRACT FROM AUTHOR]

Background: As a rare auricular deformity, despite numerous surgical procedures for correcting moderate-to-severe question mark ears described in past studies, there remains a need to explore a more cost-effective approach. The optimal utilization of ear cartilage and surrounding skin while achieving superior outcomes continues to pose a significant challenge. Methods: From 2018 to 2023, twenty-four patients with unilateral question mark ear were enrolled in this study. Seven of them were severe type deformities (absence of lower part of auricle), and seventeen were moderate (only cleft between helix and lobule). All patients were treated with new method using local cartilage and flap without damage in unaffected area. Results: All patients were satisfied with significant improvement of question mark ear and the overall symmetrical appearance. The surgical scar was not obvious. No complications were observed. The follow-up period revealed that the corrective procedure kept producing the symmetrical and cosmetic results. Conclusion: Our new method enables optimal utilization of deformed tissue and surrounding skin, rendering this method effective and reliable for correcting moderate-to-severe question mark ears. 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]

AIMS: The aim of the study was to assess preoperative radiographic parameters predictive of cervical deformity (CD) autocorrection in patients undergoing thoracolumbar deformity (ASD) surgery. This was a retrospective cohort study. Methods: Inclusion criteria were operative ASD patients with complete baseline (BL) and 2-year radiographic data. Patients with cervical fusion during index surgery, revision involving cervical fusion, and those who developed proximal junctional kyphosis by 2-year postoperative were excluded from the study. If patients met CD criteria at BL but not at 6 weeks or 2 years postoperatively, they were considered autocorrected (AC). Descriptive and univariate analysis, binominal logistic regression, and multivariable backward stepwise regression. Results: Two hundred and twenty ASD patients were included. 51.4% of patients had preoperative CD. By 6-week postoperative, 32.7% achieved AC. At 2 years, 24.8% of preoperative CD patients obtained AC. 2-year AC patients had lower BL sacral slope, lumbar lordosis (LL), T1 slope, cervical lordosis (CL), and C2-T3, and T2-T12 kyphosis (all P < 0.05). Patients with BL-unmatched Roussouly types are corrected postoperatively and are more likely to experience autocorrection at 1 year (45.2% vs. 19.0%; P = 0.042) and at 2 years (31% vs. 4.8%; P = 0.018). Multivariable analysis revealed that patients with BL-mismatched Roussouly types were corrected postoperatively and showed a significant increase in likelihood of AC at 1 year (odds ratio [OR]: 18.72; P = 0.029) and 2 years (OR: 8.5; P = 0.047). Similarly, BL LL (OR: 0.772; P = 0.003) and CL (OR: 0.829; P = 0.005) exhibited significant predictive value for autocorrection at 1 year and 2 years (OR: 0.927; P = 0.004 | OR: 0.942; P = 0.039; respectively). Conclusions: Autocorrection is more likely in patients with postoperatively corrected Roussouly types, those with lower BL cervical, and LL. Given these findings, it may not be necessary to routinely extend reconstruction into the cervical spine for ASD patients with similar characteristics to those in this study.

Background or purpose: Intermittent exotropia is the most common cause of divergent deviation. Pattern strabismus may coexist with horizontal deviations in up 35% of cases. Managing pattern strabismus concomitantly with the correction of horizontal strabismus poses a challenge due to imbalances in force vectors. This study aims to evaluate the effects of planning an intermittent exotropia surgery considering the presence of pattern strabismus and its surgical resolution. Methods: Observational retrospective study of patients with intermittent exotropia who underwent surgical correction at center between 2017 and 2022. Patients were categorized by the presence of pattern strabismus and furthermore by surgical technique for the correction of said incomitance (weakening of inferior oblique muscles or vertical transposition of lateral rectus muscles). Outcomes of post-surgical horizontal deviation and presence of postoperative pattern strabismus were statistical analyzed between groups using SPSS software v28.0. A p-value <0,05 was considered significant. Results: A total of 169 patients had surgical correction for intermittent exotropia. Pattern strabismus was observed in 35,5% of patients, primarily V-pattern (88,3%). Most were male (58, 35%) with mean age of 15,13±16,38 years. 41,7% patients with pattern strabismus underwent correction of the incomitance. All techniques showed significant reduction of horizontal near (p<0,001) and distance (p<0,001) deviation. However, incomitance correction favored strongly not only the collapsing of pattern strabismus (p=0,027) but also achieved better results in postoperative distance (p=0,002) and near (p=0,031) horizontal deviation. The two techniques for resolution of pattern strabismus showed comparable results in postoperative horizontal near deviation values and resolution of pattern strabismus, favoring vertical transposition in horizontal distance deviation values (p=0,015). Conclusions: The presence of pattern deviations should be actively persecuted in pre-operatively appointments to plan the surgery appropriately, as benefits in correcting the vertical incomitance are supported by this study findings. Both vertical transposition of lateral rectus muscles and weakening of inferior oblique muscles are effective techniques to correct vertical incomitances. [ABSTRACT FROM AUTHOR]

Purpose: Management of fibular hemimelia includes either prosthetic care with or without a suitable amputation or tibial lengthening. Many studies have documented the success of both procedures. Most parents of these children refuse an amputation or have no access to good prosthetic care. The author presents a limb-salvage procedure with tibial lengthening and ankle stabilization. Methods: Twelve children of fibular hemimelia with 14 extremities had been subjected to limb lengthening after lateral leg release. To correct the valgus procurvatum, double oblique diaphyseal osteotomy (DODO) of the tibia was performed in 11 extremities. The age of the patients ranged from two to 15 years with the median of five years. All were male. The proposed procedure included three stages of loosening, lengthening, and stabilization with ankle arthrodesis at a later stage. Results: All patients returned for follow-up for the first four years and had been walking on their sensate feet. With DODO followed by fixator/traction could straighten and lengthen the tibia simultaneously and correct the valgus procurvatum. Ankle stabilization provided stability and a plantigrade foot. A follow-up of six to 30 years with a median of ten years has been reported. Conclusion: A new procedure of loosening, lengthening, and stabilization of the leg with ankle arthrodesis has been proposed. A follow-up of 30 years with a median of ten years of the said procedure has been reported. The procedure provides a long-lasting plantigrade and painless foot that has sensation and proprioception. An amputation at any level has not been recommended. [ABSTRACT FROM AUTHOR]

Background: There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review was to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction. Methods: A systematic review following PRISMA guidelines was undertaken. All clinical studies published in MEDLINE, Embase, PubMed, and the Cochrane Library Database from inception until December 2023 reporting on the use of percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool. Results: A total of 942 potential studies were identified, of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies (n = 14/18) used an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (American Orthopaedic Foot & Ankle Society ankle-hindfoot score and visual analog scale for pain) and radiologic outcomes (fourth-fifth intermetatarsal angle and fifth metatarsophalangeal angle). Complication rates ranged from 0% to 21.4%. The nonunion rate was 0% to 5.6%. Overall risk of bias was low to moderate. The most common complication was development of a hypertrophic callus that tended to resorb over time without needing further surgical intervention. Conclusion: The results of this systematic review must be considered in light of the methodologic limitations of the studies analyzed—including additional procedures performed at the same time as the bunionette correction, lack of comparative studies, and heterogeneity of the case series included. Despite these limitations, our review suggests that percutaneous techniques for bunionette deformity correction are generally clinically safe and associated with improvement in radiographic alignment and patient-reported outcome measures. [ABSTRACT FROM AUTHOR]

Simple Summary: In a groundbreaking procedure, our team successfully performed surgery on a young Ragdoll cat with a rare type of heart defect known as an infundibular muscular ventricular septal defect, which is a hole between the two lower heart chambers. This condition, if left untreated, can lead to severe heart problems. Therefore, the surgery was performed using a method called cardiopulmonary bypass, which is quite unusual in cats. This approach involved stopping the heart temporarily to repair the defect safely. Despite being a challenging situation, in which an adjacent structure was unintentionally damaged intraoperatively, resulting in a temporary complication that was treated non-surgically, the cat recovered well. By 490 days postoperatively, the cat was healthy with only a minor residual defect, showing that the heart had nearly returned to its normal size. This case highlights a promising surgical option for treating similar heart defects in cats, which can potentially improve their quality of life significantly. Therefore, with proper surgical treatment, even in cases of severe congenital heart disease in cats, owners will be able to live with their cats without the need for numerous medications. Ventricular septal defects (VSDs) can lead to congestive heart failure and pulmonary hypertension, particularly in patients with large shunts. However, no surgical treatment for feline VSD has been reported. Here, we elucidated the first surgical correction of an infundibular muscular VSD in a one-year-old Ragdoll cat, atypically located and classified under the Soto classification rather than the standard Kirklin classification, through cardiac arrest using cardiopulmonary bypass—a method rarely used in feline cardiac surgery. Detailed echocardiography revealed that the defect required intervention owing to left heart and main pulmonary artery enlargement. Despite the VSD being located on the contralateral side, as anticipated in the preoperative examinations, the choice of median sternotomy allowed for the successful closure of the defect. Conversely, the insertion of two cannulas into the ascending aorta resulted in damage to the adjacent thoracic duct, causing transient chylothorax, which was resolved with conservative treatment. Cardiac arrest induced by a cardioplegic solution facilitated the surgical procedure, although it leads to anemia in cats. However, on postoperative day 490, the patient exhibited only minor residual shunting, with normalized heart size, and remained healthy. This technique appears to be a viable treatment option for congenital heart disease in cats. [ABSTRACT FROM AUTHOR]

Introduction: Developmental Dysplasia of the Hip (DDH) is an anatomical deformation resulting from abnormal formation of the structures that make up the hip joint. Due to abnormal biomechanics patients with hip dysplasia usually develop radiographic osteoarthritis. Aim of the study: Despite the introduction of screening tests in children, DDH remains an issue among adults. For this group of patients, it is essential to begin treatment as early as possible to prevent early-onset osteoarthritis of the hip joint. In adults it is often too late to implement non-invasive methods such as braces or orthoses. Therefore, in this study, we aim to describe other treatment options for adults with DDH, considering both surgical and non-surgical methods. In the following work, we present both the advantages and complications associated with these surgical methods. Additionally, we describe the non-surgical alternative method of progressive resistance training (PRT) and consider the possibilities of combining it with surgical techniques. We also discuss the potential for pharmacological treatment. Material and Methods: Review of studies available through open-access sources on PubMed, Google Scholar, and the National Library of Medicine. Conclusions: The decision to quickly implement an appropriate treatment plan is crucial for improving the patient's quality of life. The choice of treatment method should consider the patient's age and the severity of the disease. Adults with DDH are most often qualified for surgical procedures, which include periacetabular osteotomy (PAO) and total hip replacement (THR). However, for some patients, surgical procedures may be contraindicated or impossible, and in such cases, other non-invasive methods, such as resistance training or appropriate pharmacotherapy, should be considered. Keywords: hip joint, osteoarthritis, surgery, conservative therapy, hip, Surgical Correction

In newborns with congenital heart defects and duct-dependent pulmonary circulation, the first stage of palliative intervention may involve the systemic-to-pulmonary artery shunt (SPAS) placement or the patent ductus arteriosus (PDA) stenting. SPAS placement is a traditional method, but the trend towards reducing the invasiveness of surgical interventions has led to PDA stenting use as a preferred method to ensure a reliable source of pulmonary blood flow. The aim. To compare pre- and postoperative indicators, complications, and long-term outcomes in two groups of patients after SPAS placement and PDA stenting. Materials and methods. This single-center retrospective study included 82 newborns who underwent SPAS placement (Group I) and 47 patients who underwent PDA stenting (Group II) from 2015 to 2023. Baseline clinical data were similar in both groups. The arterial blood oxygen saturation (SaO2) was significantly lower in the PDA stenting group compared to the SPAS group (65.7 ± 11.1% vs. 79.2 ± 10.6%, respectively) (p < 0.00001). There was higher percentage of genetic/concomitant pathology in Group II, 13 (27.6%) versus 10 (12.2%), p = 0.02. Results. There was no statistically significant difference between the analyzed patient groups in clinical status indicators in the postoperative period, including: the duration of artificial lung ventilation (165.5 ± 94 and 150 ± 113 in groups I and II, respectively) (p = 0.87) and length of stay in the intensive care unit (14 ± 7 and 13.6 ± 9.4 days) (p = 0.76). However, SaO2 was higher in Group I than in Group II (81 ± 5.5% vs. 85 ± 4.6%, respectively) (p = 0.02). Before the next stage of surgical correction, the Nakata index in Group II was significantly higher than that in Group I (225 ± 87.4 mm2/m2 vs. 168 ± 35.9 mm2/m2, respectively) (p = 0.048). The percentage of reoperations was higher in Group II (17 [36.1%] versus 14 [17.1%]), however, the overall (14.9% and 26.8%) and late (9.1% and 19.5%) mortality rates were lower in Group II. Conclusion. Considering the similar results in both patient groups, stenting may be an effective option to increase the pulmonary blood flow in newborns. Due to its minimally invasive procedure, this method may be a choice for premature newborns and children with complex comorbidities. However, SPAS placement remains an important palliative intervention, particularly in cases where ductus arteriosus is tortuous and in congenital heart defects with complex intracardiac anatomy postponing radical correction until older age.

This update of the guidelines on vesicoureteral reflux (VUR) in children emphasises the importance of treating bladder and bowel dysfunction (BBD) if/when present. Although the current literature does not provide any reliable information regarding the duration of continuous antibiotic prophylaxis (CAP) in VUR patients, a practical approach might be to consider CAP until BBD resolution. The prescriptive literature on vesicoureteral reflux (VUR) is still limited and thus the level of evidence is generally low. The aim of these guidelines is to provide a practical approach to the treatment of VUR that is based on risk analysis and selective indications for both diagnostic tests and interventions. We provide a 2023 update on the chapter on VUR in children from the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) guidelines. A structured literature review was performed for all relevant publications published from the last update up to March 2022. The most important updates are as follows. Bladder and bowel dysfunction (BBD) is common in toilet-trained children presenting with urinary tract infection (UTI) with or without primary VUR and increases the risk of febrile UTI and focal uptake defects on a radionuclide scan. Continuous antibiotic prophylaxis (CAP) may not be required in every VUR patient. Although the literature does not provide any reliable information on CAP duration in VUR patients, a practical approach would be to consider CAP until there is no further BBD. Recommendations for children with febrile UTI and high-grade VUR include initial medical treatment, with surgical care reserved for CAP noncompliance, breakthrough febrile UTIs despite CAP, and symptomatic VUR that persists during long-term follow-up. Comparison of laparoscopic extravesical versus transvesicoscopic ureteral reimplantation demonstrated that both are good option in terms of resolution and complication rates. Extravesical surgery is the most common approach used for robotic reimplantation, with a wide range of variations and success rates. This summary of the updated 2023 EAU/ESPU guidelines provides practical considerations for the management and diagnostic evaluation of VUR in children. For children with VUR, it is important to treat BBD if present. A practical approach regarding the duration of CAP is to consider administration until BBD resolution. We provide a summary and update of guidelines on the diagnosis and management of urinary reflux (where urine flows back up through the urinary tract) in children. Treatment of bladder and bowel dysfunction is critical, as this is common in toilet-trained children presenting with urinary tract infection. [ABSTRACT FROM AUTHOR]

Background: Sunken upper eyelids, characterized by hollowing in the upper orbital region, can contribute to an aged or fatigued appearance. We aim to report on the surgical technique and its effects, involving the release of the arcus marginalis of the upper eyelid and the precise distribution of orbital fat. Methods: From December 2021 to March 2023, a total of 84 eyelids from 42 patients who underwent surgical correction for sunken upper eyelids, utilizing the upper arcus marginalis release and precision fat distribution technique, were included in this study. Preoperative and postoperative sunken depths were measured and statistically analyzed. Aesthetic satisfaction was assessed through patient questionnaires. Results: Preoperative and postoperative sunken depths measured 9.2 ± 2.2 mm and 5.9 ± 2.3 mm, respectively. The mean improvement was 3.3 mm, a change of statistical significance. Aesthetic outcomes and patient satisfaction yielded favorable results. No major complications were observed during the follow‐up period. Conclusion: The upper arcus marginalis release and orbital fat distribution technique demonstrated favorable outcomes in correcting sunken upper eyelids. This procedure ensures stable placement of orbital fat at the deepest sunken point, resulting in aesthetically pleasing and enduring results. This technique serves as a valuable alternative for patients with moderate to severe sunken eyelids. [ABSTRACT FROM AUTHOR]

Objective. To analyze the results of surgical treatment of patients with rigid posttraumatic deformities of the thoracolumbar spine operated on using Schwab 5 osteotomy through combined and posterior approaches. Material and Methods. A retrospective cohort study was conducted. Study group included 60 patients (m/f = 25/35). Median age was 48 (26–58) years, median time since injury was 11 (9–14) months, and minimum follow-up period was 2 years. A two-stage intervention with resection of the vertebral body, correction of the deformity, and placement of an interbody implant through the anterior approach followed by final fixation through the posterior approach (VCR a+p group) was performed in 29 cases. Vertebral body resection through the posterior approach with correction of the deformity, installation of an interbody implant, and rigid transpedicular fixation (VCRp group) was performed in 31 cases. In all patients, the magnitude of correction was assessed, as well as the following parameters: frontal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. The results of treatment were evaluated in dynamics by the level of pain syndrome (VAS) and quality of life (ODI), as well as based on the analysis of postoperative complications. Results. The groups were comparable in terms of gender, age, magnitude of the kyphotic component of the deformity, level of pain syndrome and degree of initial neurological deficit (p > 0.05). Correction of the deformity kyphotic component was significantly better in patients in the VCR p group compared to those in the VCRa+p group (p = 0.036). Both groups showed a significant decrease in the level of pain syndrome 3 months after surgery. However, further follow-up showed a tendency for back pain to increase on average one year after surgery in the VCRa+p group. A total of 67 complications were revealed in 40 (66.7 %) patients. Herewith, in the early postoperative period there were 55 complications in 31 patients, and in the late period there were 12 complications in 9 patients. Analysis of early complications showed a higher incidence of anemia (p = 0.002) and liquorrhea (p = 0.017) in the VCRp group compared to those in the VCRa+p group. The incidence of long-term complications did not differ significantly between groups (p = 0.866). An increase in back pain in the long-term period was observed in 12 (41.4 %) patients of the VCR a+p group and in 4 (12.9 %) patients of the VCR p group. Analysis of risk factors for this condition showed a tendency for back pain to increase in the long-term period in patients with residual local deformity against the background of low pelvic index values. Conclusion. Correction of the kyphotic component of deformity was significantly better in patients of the VCR p group, which was accompanied by greater surgical trauma and incidence of early postoperative complications. The tendency of patients’ quality of life to deteriorate in the long-term follow-up period seems to be related to the occurrence of pain syndrome in the lumbar spine in patients with residual kyphotic deformity against the background of initially low compensatory capabilities.

Cervical spinal deformity (CSD) is a complex condition characterized by abnormal curvature and cervical spine alignment. It can lead to a multitude of symptoms, including chronic pain, neurological deficits, and functional impairments, severely impacting an individual’s health-related quality of life (HRQoL). Surgical intervention is often necessary to address the deformity and alleviate symptoms, but optimal surgical strategies remain a topic of ongoing research and debate. This narrative review aims to provide an in-depth overview of the surgical management of CSD, focusing on optimizing patient outcomes and enhancing readers’ understanding of the complexities involved. We begin by discussing the importance of preoperative assessment, including comprehensive radiographic evaluation and careful consideration of the global spinal alignment. The relationship between the cervical spine and the reciprocal changes that occur are explored to guide surgeons in their decision-making process. Furthermore, we delve into the selection of fusion levels, emphasizing the significance of identifying the primary driver of deformity. We review the current literature on optimal alignment targets and strategies to optimize surgical planning. By providing a comprehensive analysis of the surgical management of CSD, this review aims to enhance the readers’ knowledge and assist surgeons in making informed decisions when planning and executing surgical interventions. Understanding the intricacies of CSD correction and the latest advancements in the field can ultimately improve patient outcomes and enhance HRQoL for individuals suffering from this challenging condition.

Introduction. Van Praagh A3 variant of truncus arteriosus (TA A3) is a condition when the one pulmonary artery branch origins from the TA, the other is filled through the patent ductus arteriosus (PDA). PDA constriction in the early neonatal period can cause absence of blood supply to the one pulmonary artery branch. To prevent this, prolonged infusion of prostaglandin E1, PDA stenting or systemic-to-pulmonary shunt are used. These methods allow to postpone total repair (TR) and reduce mortality risks associated with neonatal period. The aim. To analyze research papers dedicated to endovascular approach of TA A3 staged treatment and to present our own experience. Materials and methods. We conducted a systematic literature search and analyzed various options for the TA A3 staged treatment. After the review, we used endovascular approach as the first stage of treatment in our clinical case. We studied a newborn weighing 4 kg with TA A3 (left pulmonary artery branch origins from the non-coronary sinus of the truncal valve, right pulmonary artery branch filling through the PDA). Nakata index was 83 mm2/m2. McGoon ratio was 1. We decided to perform PDA stenting with the aim of postponing surgical correction until the patient’s optimal age and weight. Discussion. In total, the number of publications about TA A3 staged treatment is limited. Most institutions prefer TA A3 staged treatment in newborns, because it is associated with a lower risk of complications than early TR. In our clinical case, the first step was PDA stenting. The staged approach allowed us to perform TR with a good result at the age of 3 months. Before TR, Nakata index and McGoon ratio were increased to 248 mm2/m2 and 1.9, respectively. Conclusions. The current trend of TA A3 repair has few different options of staged treatment. Staged approach helps to get out of the newborn period and achieves the optimal condition for TR. Our patient successfully received PDA stenting as the first stage of treatment, which created conditions for the pulmonary artery branches growth. The second stage was TR with good long-term results. After analyzing the publications, we noted that the use of endovascular PDA stenting is a good and safe alternative to surgical palliative treatment.

Background: Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction. Methods: Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Results: Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees (P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees (P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees (P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees (P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference (P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence. Conclusion: Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. [ABSTRACT FROM AUTHOR]

Background: One of the most complicated and challenging problems in the field of craniofacial surgery is orbital hypertelorism (ORH). It was described as a wider-than-normal interorbital distance. It may only affect one side sometimes, or it may be bilateral. This study aims to evaluate the accuracy of virtual simulation for preoperative planning in hypertelorism surgery. Methods: Ten patients who were hospitalized at Tanta University Hospitals' Plastic and Reconstructive Surgery Department were included in this prospective study for ORH surgery. All patients underwent full history taking, clinical examinations, and routine laboratory investigations. Preoperative planning: 3D visualization and simulation composed of the following stages: visualization of the craniofacial skeleton, osteotomy simulation, and D facial skeleton prediction. Results: The planned interorbital distance (IOD) in the virtual simulation model ranged between 20 and 25 with a mean value of 21.95 ± 1.36 mm. The postoperative IOD ranged between 19 and 24 with a mean value of 20.9 ± 1.52 mm. IOD was insignificantly different between post and planned IOD (P = 0.112). Relapse ranged between 0 and 4 mm after a 1-year follow-up with a mean value of 2.10 ± 1.50, indicating the value of virtual simulation in preoperative planning to achieve accurate sites for osteotomies and the amount of interorbital bone to be removed. Conclusions: Virtual 3D planning allows for improved surgical planning and a sharper concentration on crucial technical maneuvers during surgery. The main advantage of this technology is that repositioning is significantly more accurate and efficient than the conventional technique. Level of evidence: Level IV, Therapeutic study. [ABSTRACT FROM AUTHOR]

One of the most common surgical treatment options for breast cancer is radical mastectomy, which affects the quality of life of patients in remission and their psychological state. One of the solutions to this problem is the use of skin and muscle flaps from other anatomical areas, in particular the back, for plastic reconstruction of the breast after radical mastectomy. The study aimed to present the practical implementation of reconstruction of both breasts in the remote period of radical mastectomy in a patient in remission of breast cancer using a skin and muscle flap of the broadest back muscle in combination with an implant. The patient, who met the criteria for participation in the study, had previously undergone a radical mastectomy of the right breast for direct indications along with radiotherapy. Delayed breast reconstruction within the study was performed 6 years after the planned right-sided mastectomy. The first surgical intervention included marking the back and breast area, excision and harvesting of the flap, preparation of the implantation site and its placement with the implant. Three months after the operation, she underwent a prophylactic mastectomy of the left breast based on molecular genetic testing with immediate reconstruction using the second flap of the broadest back muscle. The surgery was performed using a perimammary approach. Due to the available dissection, various anatomical configurations of the flap, and low-variability vascular anatomy, the latissimus dorsi flap is an adequate choice of material for the reconstruction of radical postmastectomy interventions. The final result of bilateral use of the flap for breast reconstruction after mastectomy is in favour of restoration of the anatomical tissue defect and a satisfactory aesthetic option, without complications in the form of seromas, haematomas, or pain. The result has a positive impact on the quality of life of a patient in remission of breast cancer

Ventricular septal defects (VSDs) can lead to congestive heart failure and pulmonary hypertension, particularly in patients with large shunts. However, no surgical treatment for feline VSD has been reported. Here, we elucidated the first surgical correction of an infundibular muscular VSD in a one-year-old Ragdoll cat, atypically located and classified under the Soto classification rather than the standard Kirklin classification, through cardiac arrest using cardiopulmonary bypass—a method rarely used in feline cardiac surgery. Detailed echocardiography revealed that the defect required intervention owing to left heart and main pulmonary artery enlargement. Despite the VSD being located on the contralateral side, as anticipated in the preoperative examinations, the choice of median sternotomy allowed for the successful closure of the defect. Conversely, the insertion of two cannulas into the ascending aorta resulted in damage to the adjacent thoracic duct, causing transient chylothorax, which was resolved with conservative treatment. Cardiac arrest induced by a cardioplegic solution facilitated the surgical procedure, although it leads to anemia in cats. However, on postoperative day 490, the patient exhibited only minor residual shunting, with normalized heart size, and remained healthy. This technique appears to be a viable treatment option for congenital heart disease in cats.

Aim. To evaluate the effectiveness of hyaluronic acid anti-adhesion gel in surgical correction of distal tubal occlusion in restoring natural fertility in patients with infertility. Materials and methods. A prospective cohort study was conducted. The main group (group 1) included 54 women; the comparison group (group 2) included 58 women with tuboperitoneal infertility due to distal occlusion of the fallopian tubes. In group 1 patients, at the final stage of endoscopic reconstructive plastic surgery on the surface of the fallopian tubes, anti-adhesion barrier Anti-adhesion was applied (5 mL per each operated fallopian tube). Primary outcomes (patency of the fallopian tubes after 3 months) and secondary outcomes (onset of uterine pregnancy during the first year) were assessed. Statistical results were processed using the IBM SPSS Statistics version 25.0 software package. Results. Within 3 months after surgical treatment, the patency of the fallopian tubes was reported in 32 (59.3%) group 1 patients and 24 (41.4%) group 2 patients (2=3.445; p=0.064). The rate of uterine pregnancy in group 1 during the first year after surgical treatment was significantly higher than in group 2: 21 (38.9%) and 12 (20.7%) women, respectively (2=4.447; p=0.035). Conclusion. Endoscopic reconstructive plastic surgeries using hyaluronic acid-based anti-adhesion gel in patients with distal tubal occlusion slightly reduces the frequency of postoperative reocclusions of the fallopian tubes within 3 months after surgical treatment and significantly increase the rate of uterine pregnancy during the year after surgery mainly due to patients with grade IIIIV of adhesive process in the pelvis.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional growth disorder. Corrective surgical procedures are the recommended treatment option for a thoracic angle exceeding 50° and a lumbar major curve of 40°. Over the past few years, dynamic growth modulation implants have been developed as alternatives to permanent fusion. The ApiFix system was designed as a 2D "posterior dynamic device" for curve correction. After implantation in a minimally invasive procedure, it uses polyaxial joints and a self-adjusting rod to preserve the degree of motion and to accommodate the patient's growth. It provides an effective method of controlling deformity and fills the gap between the conservative treatment of major curves that are >35° and the fusion procedure. The objective of the two-center cohort study was the analysis of the correction results of patients, who underwent surgical intervention with the ApiFix system. The inclusion criteria were AIS, Lenke type 1 or type 5, a major curve on bending films of ≤30°, and an angle of the major curve of between 35° and 60°. Postoperative radiograph data were obtained longitudinally for up to 24 months of follow-up and compared to preoperative (preop) values. For comparisons of the different time points, non-parametric tests (Wilcoxon) or paired t-tests for normally distributed values were used to analyze repeated measures. Overall, 36 patients (25 female and 11 male) were treated with the ApiFix system from April 2018 to October 2020. Lenke type 1 was identified in 21 (58%) cases and Lenke type 5 was identified in 15 (42%) cases. The average angle of the thoracic major curve for Lenke 1 was 43°. The preoperative lumbar major curve (Lenke 5) was determined to be 43°. Over a follow-up of 24 months, a correction of the major curve to an average of 20° was observed for Lenke 1 and that to an average of 15° was observed for Lenke 5. Lenke type 1 and type 5 showed significant changes in the major curve over the individual test intervals in the paired comparisons compared to the starting angle (Lenke 1: preop—24 months, 0.002; Lenke 5: preop—24 months, 0.043). Overall, 11 events were recorded in the follow-up period, that required revision surgery. We distinguished between repeated interventions required after reaching the maximum distraction length of the implant due to the continued growth of the patient (n = 4) and complications, such as infections or problems associated with the anchorage of the implant (n = 7). The results from the present cohort revealed a statistically significant improvement in the postoperatively measured angles of the major and minor curves in the follow-up after 24 months. Consequently, the results were comparable to those of the already established vertebral body tethering method. Alignment in AIS via dynamic correction systems in combination with a possible growth modulation has been a treatment alternative to surgical fusing procedures for more than a decade. However, the long-term corrective effect has to be validated in further studies. [ABSTRACT FROM AUTHOR]

Introduction: Hypospadias is a condition when the urethra distal opens on the bottom of the penis and has a ventral penile curvature. Hypospadias is the second most frequent genital birth abnormality in boys after cryptorchidism. Surgery is the standard treatment of choice and has a significant risk problem. There are many surgical procedure complications, especially in appearance and function. This article discusses the appropriate operative management and the best long-term outcome. Methods: The data was culled and selected from the ten years of full-text English publication (2012-2022) utilizing the PubMed and Google Scholar databases. Meta-analyses (PRISMA) paradigm and PICO investigation of management techniques and long-term outcomes in clinical and randomized clinical trials. Result: From 149 search articles, 7 met the inclusion criteria. The gland penis size and the meatal location did not affect the outcome of the surgical technique. However, 58/432 patients required reoperation, and 61(13%) had urethroplasty complications (UC), although not statistically significant (OR 0.8, 95% CI: 0.7-0.9). Testosterone is advised for small penises, narrow glands, thin urethral plates, and proximal hypospadias (67 vs. 87%). Preoperative antibiotics reduce the incidence of infection (17/150 repairs), tubularized incised plate (TIP), and the stent is recommended. Conclusion: The recommended strategies are good perioperative treatment, including antibiotics, testosterone treatment, surgery ages (6-18 months), tubularized incised plate (TIP) technique, and stent postoperative. [ABSTRACT FROM AUTHOR]

Obstructive hypertrophic cardiomyopathy (obstructive HCM) is a hereditary disease characterized by septal hypertrophy and dynamic left ventricular outflow tract (LVOT) obstruction. Other than septal hypertrophy, mitral valve abnormalities are also quite common in patients with obstructive HCM, which may contribute to systolic anterior motion (SAM) of the mitral valve and LVOT obstruction. Surgical myectomy is the standard treatment to achieve anatomic correction of obstructive HCM, but controversies remain on whether and how the mitral valve procedures should be performed at the same time. In this review, we first described the mitral valve abnormalities in patients with obstructive HCM and their surgical corrections, we then explained the controversies based on current clinical studies, and we finally made a brief introduction on our surgical strategy and results. [ABSTRACT FROM AUTHOR]

Background: Plano-valgus deformity of the feet is a common reason for contacting an orthopedist. Pediatric orthopedics uses technologies, in particular, subtalar arthroeresis, that do not violate the physiological growth of the patient. Aim: to choose the optimal methods for the correction of foot deformity in children and adolescents. Analysis of the results of the surgical treatment. Methods: In the period from 2013 to 2022, 482 patients were operated on for flat-foot deformity. Subtalar arthroeresis surgery was performed in 405 cases in various combinations. Results: The 9-year-long observation of the patients after the surgical treatment showed that in most cases there was a persistent positive effect, namely: no complaints of pain syndrome, no clinical and radiological pictures of a plano-valgus foot, patients led an active lifestyle, including sports. On average, after 17.7 months, 66 cases (16.1%) required replacement of the subtalar implant due to the physiological growth of patients. In 125 cases (31.2%) the implant was removed on average 31.2 months after placement. Unsatisfactory results were noted in 14 patients (3.4%). Conclusions: The technique of subtalar arthroeresis, as a low-traumatic one, does not interfere with the physiological growth of the foot skeleton, does not limit physiological loads after the surgical treatment, and is actively used in the childhood and adolescence. The peculiarity of the subtalar arthroeresis in a patient with the physiological growth of the foot skeleton is a high probability of the subtalar implant replacement.

BackgroundFor cervical deformity (CD) surgery, goals include realignment, improved patient quality of life, and improved clinical outcomes. There is limited research identifying patients most likely to achieve all three.ObjectiveThe objective is to create a model predicting good 1-year postoperative realignment, quality of life, and clinical outcomes following CD surgery using baseline demographic, clinical, and radiographic factors.MethodsRetrospective review of a multicenter CD database. CD patients were defined as having one of the following radiographic criteria: Cervical sagittal vertical axis (cSVA) >4 cm, cervical kyphosis/scoliosis >10°° or chin-brow vertical angle >25°. The outcome assessed was whether a patient achieved both a good radiographic and clinical outcome. The primary analysis was stepwise regression models which generated a dataset-specific prediction model for achieving a good radiographic and clinical outcome. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the final model with 95% confidence intervals.ResultsSeventy-three CD patients were included (61.8 years, 58.9% F). The final model predicting the achievement of a good overall outcome (radiographic and clinical) yielded an AUC of 73.5% and included the following baseline demographic, clinical, and radiographic factors: mild-moderate myelopathy (Modified Japanese Orthopedic Association >12), no pedicle subtraction osteotomy, no prior cervical spine surgery, posterior lowest instrumented vertebra (LIV) at T1 or above, thoracic kyphosis >33°°, T1 slope

Objective. To analyze long-term results of surgical correction of kyphosis due to Scheuermann’s disease. Material and Methods. Design: retrospective cohort study. The study group included 43 patients (m/f ratio, 34/9). The mean age was 19.1 (14–32) years; the mean postoperative follow-up was 6 ± 10 (5–20) years. Two-stage surgery including discectomy and interbody fusion followed by posterior correction and fusion was conducted in 35 cases (Group A). Eight patients (Group B) underwent only posterior correction and spinal fusion. The following parameters were determined for each patient: thoracic kyphosis (TK), lumbar lordosis (LL) (scoliotic deformity of the thoracic/thoracolumbar spine, if the curve magnitude was > 5°), sagittal vertical axis (SVA), sagittal stable vertebra (SSV), first lordotic vertebra (FLV), proximal junctional angle (PJA) and distal junctional angle (DJA). All measurements were performed immediately before surgery, one week after surgery, and at the end of the follow-up period. All patients answered the SRS-24 questionnaire after surgery and at end of the follow-up period. Results. Groups were comparable in terms of age and gender of patients, body mass index and initial Cobb angle (p < 0.05). The curve decreased from 77.8° to 40.7° in Group A and from 81.7° to 41.6° in Group B. The loss of correction was 9.1° and 6.0° in groups A and B, respectively. The parameters of lumbar lordosis remained normal during the follow-up period. At implant density less than 1.2, deformity correction and correction loss were 44.5° (54.7 %) and 3.9°, respectively (p < 0.05). Proximal junctional kyphosis (PJK) was detected in 21 out of 43 patients (48.8 %). The frequency of PJK was 45.4 % among patients whose upper end vertebra was included in the fusion and 60 % among those whose upper end vertebra was not included. PJK developed in eight (47.8 %) out of 17 patients with kyphosis correction ≥ 50 % and in 13 (50.0 %) of those with correction < 50 %. The rate of DJK development was 39.5 %. The lower instrumented vertebra (LIV) was located proximal to the sagittal stable vertebra in 16 cases, with 12 (75 %) of them being diagnosed with DJK. In 27 patients, LIV was located either at the SSV level or distal to it, the number of DJK cases was 5 (18.5 %); p < 0.05. Only two patients with complications required unplanned interventions. According to the patient questionnaires, the surgical outcome score increases between the immediate and long-term postoperative periods for all domains and from 88.4 to 91.4 in total. The same applies to answer to the question about consent to surgical treatment on the same conditions: positive answers increased from 82 to 86 %. Conclusions. Two-stage surgery, as a more difficult and prolonged one, has no advantages over one-stage operation in terms of correction magnitude and stability of the achieved effect. Surgical treatment improves the quality of life of patients with Scheuermann’s disease, and the improvement continues in the long-term postoperative period.

Relevance . The relevance of the problem of pelvic prolapse is due to the prevalence of the disease, the tendency to rejuvenation and progression. This, according to the survey, affects the quality of life of women, leads to disruption of sexual functioning, and reduces the ability to work. The methods of surgical treatment that exist in the arsenal of modern operative gynecology can contribute to the development of cicatricial adhesions, infectious complications and recurrence of prolapse, which creates the need for repeated interventions. The development and introduction into practice of new methods of treatment is a natural necessity. The most effective technique for the surgical treatment of genital prolapse is laparoscopic sacrocolpopexy using titanium silk implants. Materials and Methods. A prospective cohort study of 30 patients aged 37 to 74 years with clinical manifestations of grade II-IV prolapse, statistical data analysis and analysis of the results of a survey of patients in the postoperative period in dynamics over 3-6-12 months from 2019 to 2021 was carried out. The study used a three-stage method of surgical assistance (patent dated September 15, 2020 No. 2020130382/14 (054923) in the volume - laparoscopic promontofixation, MacCoul sacro-uterine ligament plasty, colporrhaphy, colpoperineorrhaphy, levatoroplasty. Results and Discussion. It has been established that pregnancy and childbirth are among the main factors provoking the development of pelvic floor muscle failure. The duration of postoperative follow-up in our study was 3-14 months. No complications were diagnosed during this period. In 12 patients (40.0 %) during the first month there were periodic pulling pains in the lower abdomen and perineum, in 2 (6.6 %) - urinary incontinence. Titanium silk has a lower affinity for surrounding tissues compared to polypropylene scaffold systems, which makes it possible to consider it as an alternative material to synthetic analogues and reduce the risk of mesh-associated complications. The resistance of the titanium endoprosthesis to antiseptics and microbial agents predisposes to its long-term use and the absence of the need for replacement. Conclusion. The data obtained make it possible to judge the high efficiency of the developed technique for the surgical treatment of pelvic prolapse of pelvic floor defects in patients with rectocele and cystocele, minimizing the recurrence of the disease and the risk of developing mesh-associated complications, which allows choosing a personalized management strategy for this cohort of patients.

Despite a number of surgical procedures for the reconstruction of moderate to severe constricted ears described in the literature, a most cost-effective method remains to be explored. It is still a challenge to maximize the full use of the ear cartilage and surrounding skin while achieving the best results. From 2011 to 2016, seven constricted ear patients were enrolled in this study. Five of them were moderate (type IIB Tanzer classification) deformities, and two were severe (type III Tanzer classification). All constricted ear patients were treated with bilateral cartilage flaps bridging and the V-Y advancement flap from preauricular skin, with the option of inserting a conchal cartilage graft if additional stability was required. Mean follow-up period was 4.0 ± 3.5years. All patients were satisfied with significant increase in the height of the constricted ears, also with the reconstruction of scapha and antihelix. The surgical scar was not obvious. No complications were observed. Long-term follow-up period revealed that the reconstructive procedure produced the long-lasting cosmetic results. Combination of bilateral cartilage flaps bridging with V-Y advancement of preauricular flap can make full use of its deformed tissue and surrounding skin. The method is effective and reliable in the reconstruction of moderate and some severe constricted ears. [ABSTRACT FROM AUTHOR]

Sternal cleft accompanied by pectus excavatum is a rare type of congenital anomaly of the chest wall. Surgical correction is a suitable approach to restore the heart, large vessels, and respiratory dynamics early. This is a report of the successful surgical correction of upper sternal cleft anomaly accompanied by pectus excavatum in a child. The pectus excavatum was corrected without the use of any prosthesis. The cleft was closed by primary approximation with enough dissected pectoralis major muscle and partial thymectomy, mobility, and flexibility ensured by pectus correction. The integrity of the sternum and the chest wall was normal at the end of the 12-month follow-up period. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort.Objective: The aim was to describe the two-year outcomes for patients undergoing surgical correction of cervical deformity (CD).Background: Adult CD has been shown to compromise health-related quality of life. While advances in spinal realignment have shown promising short-term clinical results in this parameter, the long-term outcomes of CD corrective surgery remain unclear.Materials and Methods: Operative CD patients >18 years with two-year (2Y) health-related quality of life/radiographic data were included. Improvement in radiographic, neurologic, and health-related quality of life outcomes were reported. Patients with a prior cervical fusion and patients with the greatest and smallest change based on Neck Disability Index (NDI), numeric rating scale (NRS) neck, modified Japanese Orthopaedic Association (mJOA) were compared using multivariable analysis controlling for age, and frailty, and invasiveness.Results: One hundred and fifty-eight patients were included in this study. By 2Y, 96.3% of patients improved in Ames cervical sagittal vertical axis modifier, 34.2% in T1 slope minus cervical lordosis (TS-CL), 42.0% in horizontal gaze modifier, and 40.9% in SVA modifier. In addition, 65.5% of patients improved in Passias CL modifier, 53.3% in TS-CL modifier, 100% in C2-T3 modifier, 88.9% in C2S modifier, and 81.0% in MGS modifier severity by 2Y. The cohort significantly improved from baseline to 2Y in NDI, NRS Neck, and mJOA, all P <0.05. 59.3% of patients met minimal clinically important difference for NDI, 62.3% for NRS Neck, and 37.3% for mJOA. Ninety-seven patients presented with at least one neurologic deficit at baseline and 63.9% no longer reported that deficit at follow-up. There were 45 (34.6%) cases of distal junctional kyphosis (DJK) (∆DJKA>10° between lower instrumented vertebra and lower instrumented vertebra-2), of which 17 were distal junctional failure (distal junctional failure-DJK requiring reoperation). Patients with the greatest beneficial change were less likely to have had a complication in the two-year follow-up period.Conclusion: Correction of CD results in notable clinical and radiographic improvement with most patients achieving favorable outcomes after two years. However, complications including DJK or failure remain prevalent. [ABSTRACT FROM AUTHOR]

The study aim was to identify risk factors associated with complications following open reduction and internal fixation of mandibular fractures. A retrospective cohort study was conducted in patients who were treated for mandibular fractures in a single center between January 2010 and December 2020. Authors classified postoperative complications as overall complications, infections, and reoperations. Factors that may be associated with these complications were grouped as patient, wound, and management variables. Statistical analysis was performed to determine whether these factors influenced complications. Among 175 patients, 125 underwent open reduction and internal fixation. Among patient variables, alcohol consumption was a risk factor for overall complications (p = 0.03) and reoperation (p = 0.02). Among wound variables, the more severe the external wound, the greater the incidence of overall complications (p = 0.001) and infections (p < 0.001). Presence of two or more fracture sites was a risk factor for reoperation (p = 0.038). Among management variables, intraoral and extraoral approaches increased the rates of overall complications, infections, and reoperation. In the multivariate analysis, only intraoral and extraoral approaches were associated with significant risks for overall complications (OR = 5.63, p = 0.017) and infections (OR = 11.53, p = 0.005). Alcohol consumption, external wound severity, multiple fracture site, and incision approach were related to postoperative complications. These findings can help guide surgical decisions and manage patient expectations after surgery. [ABSTRACT FROM AUTHOR]

Introduction Hermaphroditism is less frequently reported in dogs and is often associated with infertility. Case report An 8‐month‐old French bulldog weighing 5 kg with an enlarged structure protruding from the vulva was clinically diagnosed with hermaphroditism. Physical, hormonal assay, computed tomography, and gross and histological studies were done in addition to successfully detailed surgical correction. On physical examination, the dog showed the presence of an os‐clitoris protruded from the vulvar labia. Hormonal levels of estradiol, testosterone, and progesterone were 6.39 pg/ml, 0.4 ng/ml, and 8.67ng/ml, respectively. Surgical removal of internal gonadal tissues and os clirectomy operations were conducted after the exploratory laparotomy. The removed gonadal tissues were identical to that of a female with testicles instead of ovaries, according to a gross examination. Histological examination confirmed gonads as testis, with inactive seminiferous tubules and epididymis attached to uterine horns. Conclusion The congenital anomalies in the present case were diagnosed as male pseudohermaphroditism (MPH). Surgical correction was performed, and the owner's satisfaction was achieved.

A two-year-old, Mongrel, intact male dog was presented to Madras Veterinary College Teaching Hospital with a complaint of postprandial regurgitation that was repeated at each meal. On physical examination, the animal was below ideal weight and with mild respiratory distress. It was suspected of megaesophagus. Thoracic contrast radiography revealed the presence of an esophageal diverticulum along with foreign bodies at the level of the base of the heart. The diverticulum was surgically corrected and the animal made an uneventful recovery. Six months follow-up did not show any recurrence of symptoms. This paper describes an acquired esophageal diverticulum in a dog. Diverticulectomy is an effective surgical technique to remove a large esophageal diverticulum and can be performed with good outcomes.

In this review are discussed the most important questions of diagnostics, surgical treatment and complications in the context of anaesthesia choice and performance in children and adolescents with different variants of vertebral scoliotic deformity. Vertebral scoliotic deformity is a multi-etiological disease and significant clinical problem due to frequency and severity of complications when disease progresses. Surgery is performed in severe and super severe scoliotic deformity when conservative treatment is not effective. Surgical treatment of severe scoliotic deformity allows to improve physiological function of vertebral column and internal organs’ function, improve quality of life and increase life expectancy. Surgical treatment of severe scoliotic deformity is one of the most complex problem in traumatology and orthopedics which requires multidisciplinary coordination of surgeon, anesthesiologist, narrow specialists and the patient at every step of treatment. The most significant problems in surgical treatment of severe scoliotic deformity are forecasting and blood loss management during the operation and in post-operative care which could reach several circulating blood volumes. The problems of blood loss minimization are discussed: patient’s position on operating table, acute normovolemic haemodilution, managed hypotension, use of antifibrinolythic medications, blood collection and re-infusion, blood transfusion. Blood loss forecasting is an important instrument to get a proactive information to develop personalized approach to patient’s care with assessment of intraoperative blood loss, risk of hemorrhagic shock and disseminated intravascular coagulation syndrome.

Postcoarctation aneurysm is one of the most dangerous complications in the long-term period after surgery for coarctation of the aorta (CoA). Postcoarctation aneurysm formation is associated with high risk of aneurysm rupture, and, therefore, of patient death. Considering high risk of this pathology, it is necessary to study thoroughly the results of surgical treatment and quality of life after the correction and to develop measures to prevent the aneurysms formation. The aim. To present and analyze immediate and long-term effects of treatment of postcoarctation aneurysms of aorta. Materials and methods. We analyzed the long-term results of surgical treatment of postcoarctation aneurysms for 25 years of follow-up (1995–2020). We performed comparative analysis of the results of postcoarctation aneurysms surgical correction. Ninety-one patients were included in the study. All the patients were divided into two groups. Group I included 69 (75.8%) patients who underwent open surgical intervention. Group II included 16 (17.6%) patients who, in turn, were divided into two subgroups: group ІІ-A (5 patients) who underwent endovascular intervention, and group ІІ-B (11 patients) who received hybrid treatment of the discussed pathology. We studied and summarized the results of assessment of the quality of life in the operated patients in a long-term period using SF-36 questionnaire. Results. The study showed that postcoarctation aneurysms most often developed in patients operated for CoA by indirect isthmoplasty procedure (53.5%, n=31). Aneurysms most frequently developed due to the tear of the lower edge of the patch. Better results of surgical treatment were reported in patients of group ІІ. Average period from correction of CoA till correction of postcoarctation aneurysm was 22 years. The postoperative 30-day mortality in all the operated patients (n=85) was 8.2%. The causes of death were as follows: infectious complications in 4 patients (57.1%), hemorrhage in 3 patients (42.9%). Long-term results were observed in 93.5% patients (n= 79). Treatment results were good in 54 patients (68.3%), satisfactory in 16 patients (20.2%), and unsatisfactory in 7 patients (8.9%). Two (2.5%) patients died in the long-term follow-up period. Conclusions. It was established that after indirect isthmoplasty, the cause of the formation of postcoarctation aneurysm was mostly a tear in the lower edge of the patch. It is interesting to note that the younger were the patients by the time of coarctation correction, the longer was the period till the correction of postcoarctation aneurysm. The performed surgical interventions in postcoarctation aneurysms proved to be highly effective in the long term, and the assessment of long-term results in non-operated patients showed their necessity. Long-term quality of life assessment showed significant improvement. There was improvement in the parameter for physical functioning by 26.2%, for general health by 40.7%, and for everyday activities by 36.0%.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional growth disorder. Corrective surgical procedures are the recommended treatment option for a thoracic angle exceeding 50° and a lumbar major curve of 40°. Over the past few years, dynamic growth modulation implants have been developed as alternatives to permanent fusion. The ApiFix system was designed as a 2D “posterior dynamic device” for curve correction. After implantation in a minimally invasive procedure, it uses polyaxial joints and a self-adjusting rod to preserve the degree of motion and to accommodate the patient’s growth. It provides an effective method of controlling deformity and fills the gap between the conservative treatment of major curves that are >35° and the fusion procedure. The objective of the two-center cohort study was the analysis of the correction results of patients, who underwent surgical intervention with the ApiFix system. The inclusion criteria were AIS, Lenke type 1 or type 5, a major curve on bending films of ≤30°, and an angle of the major curve of between 35° and 60°. Postoperative radiograph data were obtained longitudinally for up to 24 months of follow-up and compared to preoperative (preop) values. For comparisons of the different time points, non-parametric tests (Wilcoxon) or paired t-tests for normally distributed values were used to analyze repeated measures. Overall, 36 patients (25 female and 11 male) were treated with the ApiFix system from April 2018 to October 2020. Lenke type 1 was identified in 21 (58%) cases and Lenke type 5 was identified in 15 (42%) cases. The average angle of the thoracic major curve for Lenke 1 was 43°. The preoperative lumbar major curve (Lenke 5) was determined to be 43°. Over a follow-up of 24 months, a correction of the major curve to an average of 20° was observed for Lenke 1 and that to an average of 15° was observed for Lenke 5. Lenke type 1 and type 5 showed significant changes in the major curve over the individual test intervals in the paired comparisons compared to the starting angle (Lenke 1: preop—24 months, 0.002; Lenke 5: preop—24 months, 0.043). Overall, 11 events were recorded in the follow-up period, that required revision surgery. We distinguished between repeated interventions required after reaching the maximum distraction length of the implant due to the continued growth of the patient (n = 4) and complications, such as infections or problems associated with the anchorage of the implant (n = 7). The results from the present cohort revealed a statistically significant improvement in the postoperatively measured angles of the major and minor curves in the follow-up after 24 months. Consequently, the results were comparable to those of the already established vertebral body tethering method. Alignment in AIS via dynamic correction systems in combination with a possible growth modulation has been a treatment alternative to surgical fusing procedures for more than a decade. However, the long-term corrective effect has to be validated in further studies.

BackgroundCurrent health-related quality of life (HRQL) metrics used to assess patient outcomes following surgical correction of cervical deformity (CD) are not deformity-specific and thus cannot capture all aspects of a patient's deformity and outcomes. The purpose of this study is to evaluate the sensitivity of different HRQL outcome measures in assessing CD patients' outcomes 1-year post-operatively.MethodsRetrospective review of prospective multi-center database. Inclusion criteria: CD patients ≥18 yrs with pre- and 1-year post-operative radiographs and HRQLs [modified Japanese Orthopaedic Association (mJOA), EuroQol five-dimensions (EQ-5D), neck disability index (NDI)]. Associations between changes in EQ5D and NDI with improvement at 1-year in mJOA scores were assessed by whether or not the patient met the minimum clinically important difference (MCID) as well as whether or not they improved by one or more categories (i.e., change from moderate to mild). Odds ratios reported with 95% confidence intervals.ResultsSixty-three CD patients were included (mean 62 y, 55.6% F). Average baseline NDI scores were 46.75, mJOA was 13.68, and EQ-5D 0.74. Overall baseline myelopathy breakdown: none-9.5%, mild-30.2%, moderate-42.9%, high-17.5%. At 1-year, 46% of patients improved in mJOA, 71.4% NDI, and 65.1% EQ-5D. 19% of patients met mJOA MCID, 44.4% NDI MCID, 19% EQ-5D MCID. One-point improvement in NDI increased the odds of mJOA improvement and reaching mJOA MCID (improvement: OR, 1.06, CI: 1.01-1.10, P=0.01; MCID: OR, 1.06, CI: 1.02-1.11, P=0.006). Improvement in EQ-5D by 0.1 increased the odds of improving in mJOA and reaching mJOA MCID at 1-year (improvement: OR, 3.85, CI: 1.51-9.76, P=0.005; MCID: OR, 3.88, CI: 1.52-9.88, P=0.005). While correlations exist between outcome measures, when modeling these outcomes while controlling for confounders including cSVA change, surgical invasiveness, age and CCI, these HRQLs were not strongly correlated.ConclusionsImprovements in functional outcomes, as defined by mJOA score, were correlated with changes in neck based disability and general health state, defined by NDI and EQ-5D respectively. In an adjusted model, however, these direct relationships were not maintained. A CD-specific HRQL might be more useful for surgeons in assessing patient outcomes using a single metric.

Background: The constricted ear is an auricular deformity produced by a deficiency in the circumference of the helical rim. The classification and corrective methods for constricted ears continue to be controversial. In order to identify them, the authors have reviewed and analyzed cases operated in a Chinese specialty clinic. Methods: Correction of constricted ears from January of 2017 to June of 2021 was retrospect through medical records. Data of patients' variables (including sex, age, laterality, type of constricted ear, presence of other ear anomalies), surgical techniques, esthetic outcomes, and postoperative complications have been collected. Results: The deformed ears were classified into four graded types by three criteria including deficiency of auricle cartilage, vertical height in dorsal view, and surgical outcome. A total of 68 constricted ears of 57 patients (type I, n = 6; type IIA, n = 41; type IIB, n = 19, and type III, n = 2) were enrolled in the study. Of the 66 constricted ears undergoing surgical correction, most of them were performed with helical expansion through auricular/costal cartilage graft, Mustardé-type mattress sutures, and tumbling cartilage flap. External molding using Vaseline gauze rolls was implemented on every case to assist reshaping the scapha. A triangular superficial temporal fascial flap was elevated to prevent the reoccurrence of lidding in some cases. Corrective techniques and esthetic outcomes for deformed cases of each graded type were described. Based on a four-point Likert scale, the average esthetic outcome score was 3.7. Conclusions: The classification was practical and the constricted ears were effectively corrected by simple surgical procedures without removal of deformed auricular cartilage. All corrections were performed in one stage. 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]

Purpose: To determine the effect of surgical instrumentation on pulmonary function after surgery. Methods: A literature review was performed to identify articles reporting on the effect of scoliosis surgery on the pulmonary function in patients with spinal muscular atrophy (SMA). Data for each patient were extracted from included studies, and a meta-analysis was performed using the values of forced vital capacity (FVC) before and after surgery. Results: A total of 127 articles were reviewed, and ten articles were selected for data extraction according to inclusion criteria. The results of the meta-analysis showed no difference in respiratory function pre-operatively and at last follow-up. Four out of ten studies demonstrated similar results and five studies reported a decrease in pulmonary function after surgery. Only one study showed improvement in lung function. Conclusion: At the moment, there is insufficient evidence in the literature to support that spinal surgery can improve respiratory function. According to our meta-analysis study, vital capacity remains either unchanged or the rate of deterioration is decreased after surgery. Nevertheless, these are both considered favorable outcomes taking into account the natural course of the disease with progressive deterioration of pulmonary function over time. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO), reported that the most frequent vision problem is refractive error. It is experienced when the shape of the eye keeps light from focusing correctly on the retina. Refractive error proves to be a significant health issue as it is the most common cause of visual deterioration and the second leading cause of vision-loss internationally. There are many treatment modalities with public different preferences. Aim: to assess the awareness and attitude of the population with refractive error toward refractive correction methods particularly surgical procedures in Aseer region, Southern of Saudi Arabia. Methodology: A descriptive cross-sectional study targeting general population who lives in Asser region with refractive error. Data were collected using pre-structured electronic questionnaire. The questionnaire was used as a digital survey and distributed to all participants in a private and anonymous manner. Question was designed to elicit information in concise and objective manner. In addition, logics were used in the question so the subsequent answer would base on prior response. Final questionnaire was uploaded online using social media platforms. Results: A total of 402 participants with refractive errors completed the study questionnaire. Participants’ ages ranged from 16 to 70 years with mean age of 30.1 ± 12.9 years old. The most reported refractive error type was myopia (61.9%) followed by astigmatism (23.6%), and hyperopia (14.4%). The most reported refractive error corrective method was spectacles (72.4%), followed by refractive surgery (16.2%), spectacles with lenses (9.2%), and only lenses (2.2%). Exact of 239 (59.5%) of the study participants were aware of the surgical procedure for refractive error correction while a total of 118 (29.4%) of the study participants expect refractive surgeries to be dangerous. Conclusions: In conclusion, the current study revealed that myopia was the most reported refractive error and spectacles was the most used corrective method followed by surgery. Cosmetic issue with complications (eye infections) were the main factors behind refusing non-surgical modalities. Also, participants showed considerable awareness regarding surgical procedure and the attitude towards surgical approaches was not bad where vast majority think it is not dangerous. [ABSTRACT FROM AUTHOR]

Abstract Background Shortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue. Methods Patients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes. Results All patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30 ± 10.49 min, p

Objective Adult cervical deformity (ACD) is a debilitating spinal condition that causes significant pain, neurologic dysfunction, and functional impairment. Surgery is often performed to correct cervical alignment, but the optimal amount of correction required to improve patient-reported outcomes (PROs) are not yet well-defined. Methods A review of the literature was performed and Fisher z-transformation (Zr) was used to pool the correlation coefficients between alignment parameters and PROs. The strength of correlation was defined according to the following: poor (0

Introduction: The 49XXXXY Klinefelter variant is rare and chromosomal analysis is required for diagnosis. We discuss the surgical management of incomplete penoscrotal transposition and consider this characteristic as an associated genital anomaly. Presentation of case: We report the case of a patient who initially presented with a poor urinary stream. Physical examination revealed an incomplete penoscrotal transposition and a subcoronal hypospadias. Investigations included blood tests, abdominal Ultrasound and a chromosomal analysis. A multidisciplinary team (MDT) approach facilitated diagnosis of the 49 XXXXY Klinefelter variant. Discussion: At MDT, medical and surgical management were discussed with the parent. We opted for delayed surgical correction of the incomplete penoscrotal transposition in the pre-pubertal period due to unavailability of topical hormone therapy. Operative technique aimed to relocate the scrotum in a dependent position. This was achieved via an inverted omega incision to create scrotal flaps that were rotated inferomedially for midline closure. Post-operatively, the patient can now urinate standing up with a good stream and has improved cosmesis. Conclusion: Incomplete penoscrotal transposition can be surgically corrected in the pre pubertal period with a good functional outcome. Chromosomal analysis is necessary in evaluating this associated genital anomaly and for diagnosis of 49XXXXY Klinefelter variant.

Background: Imperforate hymen (IH) is the most common obstructive anomaly of female genital tract. Hymen saving has a great importance for both cultural and religious reasons. Conventional surgical treatment for this condition is cruciate incision hymenotomy or hymen-saving central annular hymenotomy (HSCAH). This study aimed to review presentations and management of neonate and adolescents with IH at one tertiary hospital over 12 year's period. The aim also was to stress upon importance of hymen saving to our Muslim community and improve knowledge, enable targeted education, and reduce unnecessary tests and diagnostic delay for this condition. Methods: Twenty-five patients with IH were diagnosed and treated in this retrospective cohort study over 12 years, from January 2010 till December 2021. Demographic characteristics of the patients, their symptoms and signs, investigations, type of operations, recurrence, and infections were recorded and analyzed. Results: Saudi accounted for the majority of IH cases (88%). There were fifteen adolescents, and ten were neonates. Bulging imperforate hymen, pelvic/abdominopelvic mass, constipation, acute urine retention, abdominal discomfort, and lower abdominal distension were among the signs and symptoms. All 25 patients had HSCAH, 21 of whom had primary HSCAH and four of whom had secondary HSCAH due to recurrence. To avoid recurrence, HSCAH was performed with suturing of the inner vaginal mucosa to the exterior vestibular mucosa. Conclusion: Early diagnosis of imperforate hymen for neonate and adolescent girls and prompt definitive HSCAH could have positive impact on treatment outcome and decrease complications and fulfill integrity of hymen as virginity of high importance in our Muslim community and other similar culture, where hymen-sparing procedure is preferred by most of these patients and families. [ABSTRACT FROM AUTHOR]

Background: Posterior spinal correction and fusion remains the most common surgical treatment in AIS. Surgeons currently favour all pedicle screw (AS) correction techniques with alternative implants being less utilised. The purpose of this study was to assess whether a hybrid hook–screw (HS) construct could achieve similar outcomes. Methods: A single centre, prospective cohort study was conducted. Patients with moderate and severe thoracic AIS (Lenke 1) were included. Clinical and radiological results of a standardised hybrid HS technique were compared with those obtained with an AS construct. All patients had a minimum 2-year follow-up. Results: 160 patients were included in this series (80 patients/group). The HS group had significantly reduced surgical time, blood loss and implant density. Both techniques achieved ≥75% scoliosis correction. The HS group was superior in restoring thoracic kyphosis and global sagittal balance with an average 31% increase in kyphosis compared to 10% with the AS group (p < 0.001). There was significant improvement in SRS-22 scores at 2 years postoperative (p < 0.001) in both groups. There were no neurological or visceral complications related to instrumentation, no detected non-union and no reoperations. The HS implant cost was significantly lower than that of AS, with a mean instrumentation saving of almost £2000/patient. Conclusion: A standardised hybrid HS technique achieved excellent correction of thoracic scoliosis, high patient satisfaction and low complication rates in patients with thoracic AIS. These results were comparable to the AS group. The HS technique achieved better correction of thoracic kyphosis and sagittal balance than the AS technique, together with reduced surgical time, blood loss and implant cost. [ABSTRACT FROM AUTHOR]

The surgical correction of a hallux valgus (HV) deformity improves radiological parameters and clinical outcomes. However, it is not known how these improvements are related between themselves. In this retrospective study, 73 women were assessed preoperatively and 60 months after HV surgical correction. Several radiological parameters were measured: the hallux valgus angle (HVA), I–II intermetatarsal angle (IMA) and sesamoid position. The functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (HMI) scale, and patient-reported outcomes (PROMs) were recorded with the Manchester–Oxford Foot Questionnaire (MOXFQ). A pre–post-surgery comparison of radiological and clinical values was performed, the correlation among them was studied and the differences pre–post-surgery in the radiological measurements compared with those for the clinical outcomes were studied. The results show that all the radiological parameters, functional outcomes and PROMs improved significantly from their pre-operative values to the follow-up values. Multivariate regression analysis showed a significant relationship (p < 0.001) between the differential pre–post-surgery AOFAS scoring only with two sesamoid position differential pre–post-surgery measures: position of medial sesamoid (PMS) and translation of the first metatarsal head (TMH). However, no significant association was observed between the pre–post-surgery radiological differences and the pre–post-surgery MOXFQ scoring. [ABSTRACT FROM AUTHOR]

A nine-month-old castrated male domestic shorthair presented for evaluation with a three-month history of hematuria. Portosystemic shunts and calculi within the bladder were suspected, and computed tomography angiography was performed. Computed tomography angiography identified an extrahepatic portosystemic shunt and a partial anomalous pulmonary venous connection, with the lobar vein of the right caudal lobe draining into the caudal vena cava. After anesthesia was administered to the cat, tachypnea and wheezing respiratory sounds were observed, and thoracic radiography revealed the right middle lung lobe atelectasis and an unstructured interstitial pattern in the left cranial lobe. Echocardiography showed left and right atrial enlargement and slight interventricular septal flattening in diastole. Based on these findings, cardiogenic pulmonary edema was suspected, and the cat was treated with furosemide. The clinical symptoms were resolved the next day. Closure of the extrahepatic portosystemic shunt was performed on days 47 and 157. Left atrial enlargement and interventricular septal flattening were attenuated after the procedure. At the time of writing this report (seventeen months after diagnosis), the cat exhibited no clinical signs, but subjective right atrial enlargement remained at approximately the same level. This report represents the first case of a partial anomalous pulmonary venous connection and a portosystemic shunt in a cat. [ABSTRACT FROM AUTHOR]