Different Types Of Incisions Research Articles

Changes in the corneal surface in eyes undergoing small incision cataract surgery with frown incision

Abstract Context: Small incision cataract surgery (SICS) is a popular technique for the management of cataracts as it is fast, efficient, and less costly than other surgical methods. It can be done with different types of incisions like a frown, “V,” straight for making the sclerocorneal tunnel. Postoperative changes in the corneal surface are an important concern for both the patient and the surgeon. Aims: In this study, we aim to compare the corneal surface changes between two surgical hands in the eyes undergoing SICS with frown incision. Settings and Design: It is a hospital-based, prospective, cross-sectional study. Materials and Methods: It is a cross-sectional, prospective, hospital-based study. A total of 120 eyes undergoing SICS were taken, and divided into two groups according to the two expert surgeons. The frown incision was given in all eyes. Results: In a cross-sectional study of 120 patients, we found that there was no significant difference in the demographic profile of patients in the two groups. The changes in K1 and K2 after frown incision were insignificant in group 1 with a P value of 0.08 and 0.2, respectively. Similarly, keratometric changes in group 2 were insignificant with a P value of 0.05 and 0.06 for K1 and K2, respectively. Conclusion: The study shows that frown incision leads to insignificant keratometric changes even when the surgical hand is different. However, refraction could vary according to the surgeon and the patient’s optical medium.

Minimally invasive intervention for gynecomastia excision: two case reports

Gynecomastia is characterized by abnormal and excessive development of breast tissue in male patients. Depending on the volume of the breasts and the amount of excess skin, it may be unilateral or bilateral. Surgery is considered the standard of care, with several techniques documented, including different types of incisions made in the periareolar or intra-areolar skin. The most common surgical technique is conventional open surgery, which utilizes a semicircular inferior periareolar incision. To achieve superior aesthetic outcomes, various alternatives to open surgery have been proposed, including vacuum-assisted excision, endoscopic mastectomy, and liposuction Herein, we present two cases involving male patients, aged 29 and 24, who reported bilateral breast enlargement. We used the same incision for both liposuction and glandular excision. Our patients underwent combined liposuction on two planes: subcutaneous and subglandular, accompanied by sharp parenchymal excision. These small incisions, measuring 1–1.5 cm, are discreetly placed within the inframammary fold across the breast width. The patients experienced an uneventful recovery without any complications.

Vascular Anatomy and Variations of the Anterior Abdominal Wall - Significance in Abdominal Surgery.

Detailed knowledge of the human anatomy is an integral part of every surgical procedure. The majority of surgery related complications are due to a failure to possess appropriate knowledge of human anatomy. However, surgeons pay less attention of the anatomy of the anterior abdominal wall. It is composed of nine abdominal layers, which are composed of fascias, muscles, nerves, and vessels. Many superficial and deep vessels and their anastomoses supply the anterior abdominal wall. Moreover, anatomical variations of these vessels are often presented. Intraoperative and postoperative complications associated with entry and closure of the anterior abdominal wall could compromise the best surgical procedure. Therefore, sound knowledge of the vascular anatomy of the anterior abdominal wall is fundamental and a prerequisite to having a favourable quality of patient care. The purpose of the present article is to describe and delineate the vascular anatomy and variations of the anterior abdominal wall and its application in abdominal surgery. Consequently, the most types of abdominal incisions and laparoscopic accesses will be discussed. Furthermore, the possibility of vessels injury related to different types of incisions and accesses will be outlined in detail. Morphological characteristics and distribution pattern of the vascular system of the anterior abdominal wall is illustrated by using figures either from open surgery, different types of imaging modalities or embalmed cadaveric dissections. Oblique skin incisions in the upper or lower abdomen such as McBurney, Chevron and Kocher are not the topic of the present article.

Outcome Analysis Depending on the Different Types of Incision following Immediate Breast Reconstruction.

Background Immediate breast reconstruction following nipple-sparing mastectomy (NSM) is widely used for its cosmetic benefits. Due to the lack of guidelines, the types of incisions in NSM vary and which method is superior remains a debate. In this study, we hypothesized that the periareolar incision has a higher risk of complications, such as nipple-areolar complex (NAC) necrosis, than other incisions. Methods A retrospective chart review was conducted and divided into three groups: the periareolar, radial, and lateral incision groups. The reconstruction method and complications of NAC necrosis, wound dehiscence, seroma, hematoma, infection, and reconstruction failure were investigated. Results A total of 103 patients (periareolar incision (33%, n = 34), radial incision (39.8%, n = 41), and lateral incision (27.2%, n = 28)) who underwent NSM and immediate breast reconstruction from 2018 to 2020 were included. The reconstruction methods were direct-to-implant, DIEP flap, LD flap, and PAP flap, and there was all of which had no statistically significant difference between the groups regarding the reconstruction method (p=0.257). In terms of complications, there was no significant difference in NAC necrosis (29.4%, 19.5%, and 21.4%, in the periareolar, radial, and lateral groups, respectively; p=0.578), wound dehiscence, seroma or hematoma, infection, and reconstruction failure. Conclusion Breast reconstruction following NSM through periareolar incision does not increase the incidence of complications, including NAC necrosis. However, since only Asian patients with low BMI were included, if an appropriate patient group is selected for immediate reconstruction after NSM, reconstruction can be safely performed through the periareolar incision, and good cosmetic results can be obtained.

Surgical Anatomy of Anterior Abdominal Wall: Know before you Incise

Incision and closure of the abdominal wall is among the most frequently performed surgical procedures. Anteriorabdominal wall is the first structure which a surgeon encounters in any abdominal surgery. Both in open surgeryand laparoscopic surgery, correct knowledge of layered structure of the anterior abdominal wall is a must to enterthe abdominal wall with maximum efficacy and safety. Hence knowledge of all structures which one encounterson entering abdominal wall layer by layer is essential for surgeon. Here we discuss in detail about anatomy ofabdominal wall and different types of incisions.

Minimally invasive approach in radio distal end fractures, three different types of incisions.

Two techniques are described to treat distal radius fractures: conventional (Henry approach) and minimally invasive plate osteosynthesis. The latter technique has been described by different authors such as Imatani et al. and Zenke et al.This was a descriptive retrospective study, analyzing 26 adult patients with unstable distal radius fracture, extra-articular type A or partially intra-articular type B according to AO. The approaches used were: (i) single longitudinal palmar incision; (ii) double T-incision (horizontal and vertical) and (iii) double position II.Ages were between 21 and 78 years. Most affected hand was the right. Most common fracture was 23B2 (AO classification). In total, 84.6% of the patients did not present complications. According to the functional evaluation of the wrist by the Mayo Clinic, 31% showed excellent results, 42% showed good results, 27% showed fair results.The techniques had satisfactory results for the osteosynthesis with more aesthetic and less invasive approach.

A Historical Review of Indian Perspectives on Techniques of Tympanoplasty.

Reconstructive surgery of the conductive hearing mechanism is collectively called as tympanoplasty, which has gradually evolved over time with the contributions from all over the word. The aim of the present historical review is to summarize the Indian contributions in the development of the technique of tympanoplasty. The literature review was conducted using only the “Medline” search using keywords “tympanoplasty” and “ossiculoplasty” in “India” on 15th June 2016. A total of 195 articles and abstracts were found dated from the year 1998 onwards. Articles describing work on technique were included, and those describing only experimentation with graft material were excluded. All articles were fully read and analysed. It was found that there had been experiments regarding the choice of anaesthesia and the use of combinations of different chemical agents for this purpose. There were suggestions in favour of monitored anaesthesia care for the surgery in select patients. Surgeons expressed their perspectives on the time and conditions for the surgery, laterality of surgery, different types of incisions, use of endoscopes, graft placement techniques, ossicular replacements with autologous or allogenic grafts, and the timing of prophylactic antibiotic therapy given after or during the surgery. The range of work is wide and covers most of the aspects of surgery; however, the incorporation of a uniform methodology and standards reporting results were lacking in the articles reviewed.

Imperforate Hymen about a Case

Imperforate hymen is a congenital obstructive abnormality of the female genital tract and its incidence is estimated at 1/2000 female births. The diagnosis may go unnoticed during the examination of the new born in the birth room. Most often, this malformation is discovered at puberty. Treatment of Imperforate hymen is hymenotomy or hymenectomy. Different types of incisions are mentioned in the literature. We have reported the case of a 14-year-old girl with hematocolpos and hematometra on hymenal impforforate. In cultures and religions where the loss of the hymen is a social problem among unmarried girls, a medical certificate must be given to the patient.

Case Report of a 12-Year-Old Girl with Imperforate Hymen—Review of the Literature on Incision Techniques and Further Treatment of Patients

Background: Imperforate hymen (IH) is formed if no canal is created between the vaginal plate and the urogenital sinus. Treatment of IH is surgical. Different types of incisions and postoperative treatment are proposed. Case: A 12-year-old girl presented with a 3-day history of pain in the lower abdomen. Examination of the external genitalia disclosed a bulging hymen. Ultrasound examination of her lower abdomen revealed hematocolpos. A diagnosis of hematocolpos caused by IH was established and surgical treatment was decided. Conclusion: Treatment of choice for IH is undeniably surgical. Although different types of procedures have been proposed, the surgeon should choose the one that best suits the patient’s needs without harming anatomical structures closely related to the hymen.

Outcome of small minimal incision technique & posteriorly based periosteal flap with subcutaneous closure in cochlear implant surgery

Background: Although cortical mastoidectomy and posterior tympanotomy has not changed for more than 40 years, the major changes are in the skin flap incision and implant technique in CI surgery. Regarding the incision technique the smaller the incision with less soft tissue manipulation the best. Post-operative healing and scar result also small incision have adequate blood supply and venous drainage, graft has good exposure and coverage of the PP field. There are different types of incisions and flaps which are used by different surgeons around the world for cochlear implant surgery. In this study 3 types of incisions and flaps were used, Small incision for cochlear implant surgery reduce the morbidity and increase parent satisfaction as compared with wider access operation incisions also will prevent the scalp flap complication, this is achieved by good flab design that should have adequate blood supply and venous drainage, enough field exposure and coverage. Methods: This is retrospective study for 145 child age ranges between (1-5)years old, underwent cochlear implant surgery with deferent companies (AB, cochlear, med el) in Al-Yarmouk Teaching Hospital/ENT department from 2014- July.2018. 3 types of incisions and flaps were used, Slight curve line post auricle incision (Small hair line post-auricle incision), Lazy S incision, Small post-auricle with superior extension, was made with posterior flap elevation was used as an axis to the mastoid cavity and the wheel for the implant device, with subcutaneous closure and without skin closure. Result: It’s found that there is early healing, no major flap complication by using Slight curve line post auricle incision (Small hair line post-auricle incision), no skin stitches are required, end with minimum or no scar, minimum time consuming and easy follow-up for the children post-operatively.

Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Women With Previous Abdominal Incisions: A Comparison of Complication Rates.

The deep inferior epigastric artery perforator (DIEP) flap is currently the most widely used method for autologous microsurgical breast reconstruction. There are mixed data in the literature regarding the impact of previous abdominal surgery on DIEP flap success in breast reconstruction. With this study, we take a closer look at the effect of prior abdominal surgery on DIEP flap and donor-site complications, with a particular focus on the different types of incisions and their influence on surgical outcomes. A retrospective cohort study was conducted over a 6-year period. Five hundred forty-four consecutive DIEP flaps were divided into a control group (321 flaps) without previous abdominal surgery and an incision group (223 flaps) with previous abdominal surgery. A comparison between both groups was made in terms of flap and donor-site complications followed by a subgroup analysis based on single types of abdominal incisions. There were no significant differences between both groups in terms of age, body mass index, flap weight, smoking history, prior radiotherapy, diabetes, and coagulopathy (P > 0.05). The most common incision was low transverse incision (n = 116) followed by laparoscopy port (n = 103) and midline (n = 46) incisions. We found no significant differences between the control group and incision group in terms of flap complications. Subgroup analysis revealed that none of the 3 types of incision increase the flap or donor-site complications. Smoking and flap weight were the only 2 independent predictors for donor-site complications. The results from this large series of consecutive DIEP flaps from our institution confirm that autologous breast reconstruction with DIEP flap can be safely performed in patients who have had previous abdominal surgeries; however, counseling patients about smoking is critical to avoid potential donor-site complications.

Hand-Assisted laparoscopic donor nephrectomy PERiumbilical versus Pfannenstiel incision and return to normal physical ACTivity (HAPERPACT): study protocol for a randomized controlled trial

BackgroundHand-assisted laparoscopic living donor nephrectomy (HALDN) using a periumbilical or Pfannenstiel incision was developed to improve donor outcome after a kidney transplant. The aim of this study was to investigate two methods of hand assistance and kidney removal during HALDN and their effect on the time it takes for the donor to return to normal physical activity.Methods/designThis study was initiated in November 2017 and is expected to last for 2 years. To be eligible for the study, donors must be more than 20 years of age and must not be receiving permanent pain therapy. Only donors with a single artery and vein in the graft are being enrolled in this trial. Donors with infections or scars in the periumbilical or hypogastric area, bleeding disorders, chronic use of immunosuppressive agents, or active infection will be excluded. Donors will be randomly allocated to either a control arm (periumbilical incision) or an intervention arm (Pfannenstiel incision). The sample size was calculated as 26 organ donors in each group. The primary endpoint is the number of days it takes the donor to return to normal physical activity (up to 4 weeks after the operation). Secondary endpoints are intraoperative outcomes, including estimated blood loss, warm ischemia time, and duration of the operation. Postoperative pain will be assessed using the visual analog scale, rescue analgesic use, and peak expiratory flow rate. Length of hospital stay, physical activity score, time to return to work, donor satisfaction, cosmetic score, postoperative complications, and all-cause mortality in living donors will also be reported. Delayed graft function, primary non-function, serum creatinine levels, and glomerular filtration rate will also be assessed in the recipients after transplantation.DiscussionThis is the first randomized controlled trial to compare the time it takes the living donor to return to normal physical activity after HALDN using two different types of incision. The comprehensive findings of this study will help decide which nephrectomy procedure is best for living donors with regard to patient comfort and satisfaction as well as graft function in the recipient after transplantation.Trial registrationClinicalTrials.gov, NCT03317184. Registered on 23 October 2017.

Abstract 54: DIEP flaps in Women with Abdominal Scars: A Comparison of Complication Rates between Different Abdominal Incisions

PURPOSE: There are still concerns that abdominal surgery can compromise an abdominally based perforator flap in microsurgical breast reconstruction. With this study, we take a closer look at the effect of prior abdominal incisions on Deep Inferior Epigastric Artery Perforator (DIEP) flap and donor site complications, with a particular focus on the different types of incisions and their influence on surgical outcomes. METHODS: A retrospective case-control study was conducted over a 6-year period. 544 consecutive DIEP flaps were divided into a control group without previous abdominal surgery, and an incision group with previous abdominal surgery. A comparison between both groups was made in terms of flap and donor site complications, followed a sub-group analysis based on the type of abdominal incision. RESULTS: 223 flaps were included in the incision group and 321 in the control group. There were no significant differences between groups in terms of age, flap weight, smoking history, prior radiation history and comorbidities. We found a higher BMI in the incision group (p=0.01). There were no significant differences between the control group and the incision group in terms of flap complications (complete flap loss, partial flap loss and fat necrosis). However, donor site complications, specifically wound separation was found to occur at a higher incidence in the incision group (p=0.0001). In the sub-group analysis, patients with a low transverse incision had higher rates of fat necrosis (8.0% vs 23% p=0.0001) and donor site wound separation (9.0% vs 23% p=0.002). No statistically significant differences were found between patients in the control group and those with laparoscopic incisions on the one hand, and those with a combination of laparoscopic and low transverse incision on the other. CONCLUSION: The results from this large series of consecutive DIEP flaps from our institution confirms that autologous breast reconstruction with a DIEP flap can be safety performed in patients who have had previous abdominal surgeries; however, patients must be made aware of the increased risk of donor site complications. A. Doval: None. L. Daly: None. B. Lee: None. A.S. Dowlatshahi: None.

Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications.

Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications.

A prospective study of risk factors for abdominal wound dehiscence

Background: Dehiscence of abdominal wound is easily the most notorious complication observed in abdominal surgery. This study was conducted on 50 patients of abdominal wound dehiscence admitted and treated in department of general surgery at Nair charitable hospital for 1 year and a follow up period of 6 months to elucidate factors contributing to disruption and incidence of abdominal wound dehiscence in different types of incision. Methods: Fifty patients who have developed abdominal wound dehiscence or having bowel protrusion after any abdominal incisions for either emergency or elective abdominal operations were included in the study. Results: Abdominal wound dehiscence was most commonly seen in age group of 41- 60 years (40%) followed by 21-40 years (34%). Males (56%) were found to be more affected than females (44%). It was more common in emergency surgeries (56%) compared to elective surgeries (44%). Cholelithiasis (18%) was the most common disease associated with wound dehiscence followed by appendicitis (16%) and ileal perforation (12%). Vertical midline (70%) was the most common type of incision associated with wound dehiscence followed by Kocher’s incision (18%) and Mcburney’s incision (10%). Conclusions: Factors like anaemia, malnutrition, obesity, diabetes mellitus and cough and surgery factors like type of surgery (elective/emergency), underlying disease and type of incision, type of closure, suturing material and suturing method play important role in development of wound infection and subsequently development of wound dehiscence.

Surgical treatment of subungual glomus tumors: Experience with lateral subperiosteal and transungual approaches

Background: Nail bed deformity and tumor recurrence are the major complications of subungual glomus tumor surgery. Therefore, alternative methods to approach glomus tumors in the hand have been proposed in order to avoid further nail bed injury after surgical treatment. Methods: In this study, we report a series of 32 patients with glomus tumors in the subungual region of the hand, treated surgically with two different types of incisions. The clinical efficacy and safety of the surgical treatment of glomus tumors performed by the lateral subperiosteal or the transungual approaches were analyzed. Results: In transungual approach since the nail plate is extracted and the nail bed is incised, there is a high risk of postoperative nail deformity and late recovery. However, in lateral subperiosteal approach since only the skin lateral to the nail is incised without extracting nail plate and incising nail bed, the nail bed injury does not occur. Conclusion: As a result, early recovery occurs and postoperative nail deformity is unaccepted. The main advantages of lateral subperiosteal approach are reducing postoperative nail deformity and early recovery. However, not every glomus tumor is suitable for lateral subperiosteal approach. In peripherally located tumors, the lateral subperiosteal approach provides quick recovery of the cosmetic appearance and less deformation of the nail.

Curved incision under the costal margin in retroperitoneal tumor surgery.

This study was conducted to investigate the value of using a curved incision under the costal margin in retroperitoneal tumor surgery. Data on 68 patients with retroperitoneal tumors were reviewed. Of the 68 patients, 32 underwent tumor removal via a curved incision under the costal margin (group A) and the remaining 36 patients underwent a mid-abdominal oblique incision at the waist (group B). The patient outcomes were compared between the two groups to analyze the effects of the different types of incision on the completeness of resection, duration of operation, intraoperative blood loss, postoperative recovery time and surgical complications. The tumors from the 32 patients in group A were all successfully removed and the outcomes of the patients in group A, regarding tumor removal, duration of operation, amount of blood lost and surgical complications, were superior to those of the patients in group B. A route of incision is required that adequately exposes the internal limit or lower boundary of the tumor and ensures adequate surgical field visualization. The 32 patients underwent retroperitoneal tumor removal via a curved incision under the costal margin, plus a longitudinal incision along the lower boundary of the tumor at the midline of the abdomen. All the patients underwent complete tumor resection and recovered well after surgery, without necrosis at the incision site. In terms of duration of the operation, blood transfusion volume, mean length of hospital stay, weight of tumor removed, perioperative mortality, postoperative intestinal fistulas and rate of complete surgical resection, the outcomes of the patients in group A were superior to those of group B.

Voies d’abord en rhinoplastie

In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach--the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty.

Type of incision for below knee amputation

Below knee amputation (BKA) may be necessary in patients with advanced critical limb ischaemia or diabetic foot sepsis in whom no other treatment option is available. There is no consensus as to which surgical technique achieves the maximum rehabilitation potential. This is the third update of the review first published in 2004. To assess the effects of different types of incision on the outcome of BKA in people with lower limb ischaemia or diabetic foot sepsis, or both. The main focus of the review was to assess the relative merits of skew flap amputation versus the long posterior flap technique. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched 28 March 2013) and CENTRAL (2013, Issue 2). Randomised controlled trials comparing two or more types of skin incision for BKA were identified. People with lower limb ischaemia (acute or chronic) or diabetic foot sepsis, or both, were considered for inclusion. People undergoing below knee amputation for other conditions were excluded. One review author identified potential trials. Two review authors independently assessed trial quality and extracted the data. Additional information, if required, was sought from study authors. Three studies with a combined total of 309 participants were included in the review. One study compared two-stage versus one-stage BKA; one study compared skew flaps BKA versus long posterior flap BKA; and one study compared sagittal flaps BKA versus long posterior flap BKA. Overall the quality of the evidence from these studies was moderate. BKA using skew flaps or sagittal flaps conferred no advantage over the well established long posterior flap technique (primary stump healing was 60% for both skew flaps and long posterior flap (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.71 to 1.42) and primary stump healing was 58% for sagittal flaps and 55% for long posterior flap (Peto odds ratio (OR) 1.04, 95% CI 0.45 to 2.43). For participants with wet gangrene, a two-stage procedure with a guillotine amputation at the ankle followed by a definitive long posterior flap amputation led to better primary stump healing than a one-stage procedure (Peto OR 0.08, 95% CI 0.01 to 0.89). Post-operative infection rate or wound necrosis, reamputation, and mobility with a prosthetic limb were similar in the different comparisons. There is no evidence to show a benefit of one type of incision over another. However, in the presence of wet gangrene a two-stage procedure leads to better primary stump healing compared to a one-stage procedure. The choice of amputation technique can, therefore, be a matter of surgeon preference taking into account factors such as previous experience of a particular technique, the extent of non-viable tissue, and the location of pre-existing surgical scars.

Clinical outcomes following nipple–areola-sparing mastectomy with immediate implant-based breast reconstruction: a 12-year experience with an analysis of patient and breast-related factors for complications

Nipple-sparing mastectomy (NSM) is increasingly offered to women for therapeutic and prophylactic indications. Although, clinical series have been described, there are few studies describing risk factors for complications. The objective of this study is to evaluate the incidence of complications in a series of consecutive patients submitted to NSM and differences between clinical risk factors, breast volume, and different incision types. In a cohort-designed study, 158 reconstructed patients (invasive/in situ cancer and high risk for cancer) were stratified into groups based on different types of incision used (hemi-periareolar, double-circle periareolar, and Wise-pattern). They were matched for age, body mass index, associated clinical diseases, smoking, and weight of specimen. Also included were patients treated with adjuvant chemotherapy and postoperative radiotherapy. Mean follow-up was 65.6months. In 106 (67%) patients, NSM was performed for breast cancer treatment and in 52 (32.9%) for cancer prophylaxis. Thirty-nine (24.6%) patients were submitted to hemi-periareolar technique, 67 (42.4%) to double-circle periareolar incision, and 52 (33%) to Wise-pattern incision. The reconstruction was performed with tissue expander and implant-expander. Local recurrence rate was 3.7% and the incidence of distant metastases was 1.8%. Obese patients and higher weight of specimen had a higher risk for complications. After adjusting risk factors (BMI, weight of specimen), the complications were higher for patients submitted to hemi-periareolar and Wise-pattern incisions. This follow-up survey demonstrates that NSM facilitates optimal breast reconstruction by preserving the majority of the breast skin. Selected patients can have safe outcomes and therefore this may be a feasible option for breast cancer management. Success depends on coordinated planning with the oncologic surgeon and careful preoperative and intraoperative management. Surgical risk factors include incision type, obesity, and weight of breast specimen.