Double-incision Technique Research Articles

A modified double-incision technique to place tunneled central lines in children.

In children, there are two main techniques for placing a tunneled central venous catheter: single-incision (single puncture) and conventional (two punctures). Both have unique advantages and disadvantages. The modified single-stick technique combines the two aforementioned techniques to access the central venous system in an optimized way. This technique is feasible to perform particularly in young children and has a short learning curve for adult interventional radiologists.

Comparative Study between Single Incision versus Two Separate Incisions in Conservative Breast Surgery and Excising the Sentinel Lymph Node in Upper Outer Quadrant Early Breast Cancer (Retrospective Study)

Abstract Background Single incision technique is an oncoplastic surgery aimed to remove both the breast tumour and sentinel lymph node through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. However, this procedure is more difficult, since visualization and the resection space are limited, demanding greater experience from the surgeon. Objective To compare between single incision in excising upper outer breast tumour and sentinel lymph node versus two separate incisions in conservative breast surgery as regard locoregional recurrence, cosmetic outcome and post operative complications. (seroma formation and wound infection). Patients and Methods This is a retrospective cohort study to compare between single incision in excising upper outer breast tumour and sentinel lymph node versus two separate incisions in conservative breast surgery as regard locoregional recurrence, cosmetic outcome and post operative complication. Results Lymphedema occurred in 3 patients 1 from Group A and 2 from group B but this shows no statistical significance. None of the previously stated complications resulted in delay of post- operative adjuvant therapy and all patients were sent to receive their appropriate therapy according to schedule. None of them have had any other problem such as delayed wound healing or compromised final cosmetic outcome. In our study only one patient from group B had malignant recurrence during follow up visits through 3 year after the surgical removal of the tumor but this has no significance proving that single incision technique is safe from oncological point of view like double incision technique. Conclusion The single incision technique was shown to be providing comparable post operative parameters with better cosmetic results suggesting that the single incision technique is superior to double incision in selected cases.

Body Contouring as Gender-Affirming Surgery in Transgender Patients: A Systematic Review of the Current Literature.

Background: There is an increasing demand for body contouring and gender-affirming surgeries, and so is the need to compare outcomes between techniques. Gender dysphoria is a discrepancy between gender identity and the sex assigned at birth. One way to address this is to perform procedures to enable patients to look according to their desired gender identity. Gaps in knowledge regarding the best approaches and which surgical techniques yield the most patient satisfaction remain. This article summarizes up-to-date studies, including upper and lower body contouring procedures. Methods: A systematic review was performed using terms related to body contouring in gender-affirming surgery for transgender patients. All articles included surgical and patient-reported outcomes following either chest or lower body contouring procedures. Results: 15 studies, including trans male chest wall contouring, trans female breast augmentation, and lower body contouring, with 1811 patients, fulfilled the inclusion criteria. The double incision (DI) techniques consistently resected more tissue and had better BODY Q scores than non-overweight patients. Bleeding was increased in periareolar, semicircular, and obese patients with DI techniques. Nipple depigmentation and sensation loss were more common with double-incision-free nipple graft techniques (DIFNG). Lower body contouring patients had average implant sizes bigger than 200 mL and reported 2 gluteal implant displacements, 1 exposure, and one rupture. Eight percent of patients who underwent large-volume fat grafting reported dissatisfaction due to fat reabsorption. Conclusions: The debate between the double incision and periareolar techniques continues. Variations of the DIFNG technique continue to be the most common approach; however, nipple depigmentation and loss of sensation are also more common with it. Regarding increased bleeding with periareolar techniques, there is still no evidence that hormonal therapy may be playing a role in it. For lower-body trans female contouring, implants could help with the longevity of contouring results in patients needing large-volume fat grafting. There is an increasing evaluation of gender-affirming body contouring patient-reported outcomes; however, there is still a need for a validated way to report satisfaction scores in lower body contouring. Validated surveys could help identify surgical candidates based on satisfaction patterns, specifically for transgender and non-binary patients.

Implant-Based Gluteal Augmentation:Comparing Complications Between Single- and Double-Incision Techniques.

Gluteal implants are gaining popularity as an alternative to fat grafting for gluteal augmentation. This study aims to compare complication rates between single- and double-incision techniques for implant placement in gluteal augmentation from a single surgeon's experience. Retrospective analysis of a single surgeon's implant-based gluteal augmentations was conducted between October 2018 and August 2022. Consecutive patient cases were reviewed at the beginning and end of the designated period to compare both incision techniques after switching from the single- to double-incision technique in September 2020. Demographics and postoperative complications were compared. Statistical comparisons were made using the independent sample t-test for quantitative variables and the Fisher's exact test for categorical variables. The study included 134 single-incision patients (247 implants) and 47 double-incision patients (91 implants). Baseline demographic and clinical characteristics between the two groups were similar. Overall complication rate per implant was higher in the single-incision group (16.6% vs. 6.6%, p = 0.02). The most common complication per implant was delayed wound healing (single incision: 9.7%, double incision: 5.5%). The odds ratio of developing at least one complication in the double compared to the single-incision group was 0.44 (95% CI: 0.19, 0.92). The double incision techniquedemonstrates a lower complication rate than the single-incision technique for implant-based gluteal augmentation. The most common complication in both groups was delayed wound healing which responded in most patients to conservative wound care. These results support using the double-incision technique for implant-based gluteal augmentation. 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 .

Clinical Efficacy Analysis of Circumferential Upper Arm Liposuction with Double Incision: A Study of 496 Cases.

In cases where the upper arm exhibits an irregular cylindrical appearance with subcutaneous fat concentrated primarily in the posterior lateral aspect, traditional localized fat suction techniques may lead to uneven or disharmonious results when addressing this concern. Many practitioners have turned to circumferential fat suction methods using multi-incision approaches to ensure effective results and fat removal. However, these methods often involve numerous incisions and complex procedures, necessitating the development of new, more efficient surgical techniques. We collected and screened patients who underwent upper arm circumferential liposuction with a double incision technique at our hospital from October 2020 to February 2023. A total of 496 cases were included in our retrospective analysis, in which we examined factors such as the length of surgery, arm circumference before and after surgery, subcutaneous tissue thickness before and after surgery, fat suction volume, postoperative satisfaction, and postoperative complications of the patients. The average length of surgery was 71.7min. 458 cases (92.3%) showed significant improvement, 23 cases (4.6%) reported satisfaction, and 10 cases (2.0%) were essentially satisfied. Additionally, 339 cases (68.3%) experienced an improvement in skin laxity. Four cases (0.8%) developed localized hard nodules with slight tenderness in the early postoperative period, which resolved without special treatment after observation and follow-up for 1-3months. Three cases (0.6%) reported localized pain or numbness, and they were given oral medication. Their symptoms disappeared after 1-3months of observation and follow-up. Three cases (0.6%) had localized pain or numbness, and their symptoms disappeared. All of these cases improved and resolved after onemonth of taking mecobalamin tablets. There were also three cases (0.6%) with mild pigmentation of the incision and two cases (0.4%) with mild limitation of unilateral upper arm abduction movement. However, upper arm activities were not affected after threemonths to oneyear of follow-up. No serious complications were reported, resulting in an overall satisfaction rate of 99.0%. The double incision upper arm liposuction is safe, effective, time-saving, with high satisfaction and fewer complications, and is worthy of clinical popularization and application. 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 .

Gender-affirming mastectomy in transmasculine individuals in The Netherlands: a large cohort study on outcomes and trends

Introduction: Gender-affirming mastectomy is frequently performed in transmasculine individuals. The aim of this study is to describe surgical and demographic trends and outcomes in a large group of individuals undergoing this procedure. Materials and methods: All individuals who underwent gender-affirming mastectomy from 01-1990 to 01-2023 in our center were identified. A retrospective chart study was conducted, recording medical history, use of medication including hormones, puberty suppression, surgical history, preoperative chest characteristics, BMI at surgery, surgical technique, concurrent surgical procedures, resection weight, complications and re-operations. Procedural, demographic and surgical trends were analyzed. Results: A total of 2030 individuals were included of whom 1350 (67%) underwent double incision, 551 (27%) donut, 67 (3%) peri-areolar, 55 (3%) batwing and 7 (<1%) another mastectomy technique. A steep increase of performed mastectomies was observed in recent years. The mean age of people undergoing this procedure is increasingly lower. Surgical trend analysis showed: an increase in the use of the double incision technique, a smaller chest was deemed eligible for donut mastectomy and a less frequent use of a pedicled nipple-areolar complex. Postoperative bleeding that required a reoperation under general anesthesia occurred in 142 (7.0%) individuals (6.3% after double incision, 7.1% after donut, 14.9% after peri-areolar and 12.8% following batwing mastectomy). One or multiple surgical corrections were performed in 19.9% after double incision, 31.2% after donut, 14.9% after peri-areolar and 32.7% following batwing mastectomy. The median clinical follow-up time was 3.2 years (IQR 0.6-6.4). Discussion: The frequency of performed mastectomy procedures has increased drastically over recent years. Specific surgical and demographic trends were identified.

Distal biceps tendon rupture: a comprehensive overview

Distal biceps tendon (DBT) is a relatively rare injury mainly occurring in middle-aged men while in eccentric biceps muscle contraction. Clinical appearance with proximal avulsion of the muscle and specific clinical tests are most of the time sufficient for diagnosing DBT, but if needed ultrasonography and MRI, most often in FABS view, can be used to ensure diagnosis of DBT and partial DBT. Surgical anatomical reinsertion has shown to be a successful method of treatment, although conservative treatment can be initiated in older patients. Two different approaches are described in literature: single- and double-incision techniques with different fixation methods proving to have similarly good results. Major complications of surgical intervention are posterior interosseous nerve palsy and symptomatic heterotropic ossification. Overall outcome of surgical intervention has shown high subjective satisfaction with slight weakness in flexion and supination but mostly without loss in range of motion.

Comparative Analysis of Surgical Approaches for Distal Biceps Tendon Rupture: Single-Incision Technique versus Double-Incision Technique.

Background: This study aimed to compare the outcomes of the single-incision technique with a distal biceps repair system versus the modified double-incision technique, specifically the Morrey-modified approach, Krackow sutures, and drill holes, for the management of acute and chronic distal biceps tendon rupture. The study was conducted at the Orthopedic-Traumatology Clinic II of SCJUPBT Timisoara, Romania, between 2014 and 2022. Methods: A total of sixty-nine patients with acute distal biceps tendon rupture and five patients with chronic distal tendon rupture were included in the study. Forty-eight cases underwent the single-incision technique with the distal biceps repair system, while twenty-four patients were treated with the modified double-incision technique. Results: Both surgical techniques demonstrated favorable outcomes in terms of successful tendon repair and functional restoration. However, the single-incision technique exhibited slightly superior results in terms of patient satisfaction, range of motion, and postoperative rehabilitation. The modified double-incision technique showed comparable outcomes but had a higher incidence of complications, particularly related to wound healing. Conclusion: The single-incision technique with the distal biceps repair system and the modified double-incision technique, including the Morrey-modified approach, Krackow sutures, and drill holes, are effective surgical approaches for the management of distal biceps tendon rupture. The single-incision technique yielded better functional outcomes and patient satisfaction, while the modified double-incision technique had a higher risk of complications. Further research with larger sample sizes and longer follow-up periods is necessary to validate these findings and determine the most appropriate surgical approach for distal biceps tendon rupture.

Distal biceps tendon ruptures: clinical features, diagnostic strategy and treatment options

Relevance. This paper reviews the latest evidence concerning distal biceps tendon repair, particularly aspects such as tear type, patient demographics, diagnostic clues, surgical indications, the anatomy of distal tendon insertion, radial tuberosity, single- vs double-incision reconstruction, fixation techniques (bone tunnels, distal biceps button, interference screw, button plus screw) and postoperative outcomes.Material and methods. The MEDLINE, Cochrane, Web of Science, Scopus and Elibrary online databases were searched using the keywords ‘distal biceps tendon’, ‘elbow’, ‘intramedullary’, ‘partial’. ‘complete’, ‘review’ and ‘rupture’. Sixty publications on distal biceps tendon rupture treatment were identified that appeared over 60 years, between 1951 and October 2021.Results and discussion. The review has demonstrated that complete deltoid ligament (DBT) tears are predominantly diagnosed clinically, while medical imaging has proven to be a valuable adjunct for diagnosing partial tears. Advances in clinical and medical imaging of partial tears have the potential to expedite the diagnostic process and guide treatment strategies. Primary repair is commonly employed for complete tears, utilizing either a single-incision or double-incision approach, resulting in favorable clinical outcomes. However, the double-incision technique carries a higher risk of heterotopic ossification, whereas the single-incision approach presents a greater risk of nerve-related complications. To mitigate the risk of posterior interosseous nerve lesions in single-incision repairs, intramedullary fixation may serve as a viable solution. Additionally, DBT endoscopy holds promise for the treatment of low-grade partial tears and tendinosis.

Minimally Invasive Bone-Patellar Tendon-Bone Graft Harvest Is Associated With Less Frequent Anterior Knee Pain at Rest Than Hamstring Graft Harvest After Anterior Cruciate Ligament Reconstruction at the 1-Year Follow-Up

To compare the incidence of postoperative anterior knee pain at rest and during "knee walking" in patients who had anterior cruciate ligament reconstruction (ACLR) surgery with hamstring tendon (HT) grafts versus bone-patellar tendon-bone (BPTB) grafts harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects. Adult patients who had undergone an ACLR and had completed a questionnaire enquiring about anterior knee symptoms at a minimum of 1 year postoperatively were identified. Two groups were compared: 1) patients who had received a BPTB graft harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects, and 2) patients who had received a HT graft. A total of 142 adult patients were included: 88 had a BPTB graft and 54 had a HT graft. The prevalence of anterior knee pain at rest was 10% in the BPTB group and 28% in the HT group (P= .006). Overall, knee walking scores were worse in the BPTB group when compared to the HG group, but the difference in the proportions of patients who found it impossible to knee-walk was not statistically significant (17% vs 6%; P= .069). Our results showed that pain at rest was less in the BTPB group compared to the HT group contradicting historic literature. In addition, there was no statistically significant difference between the 2 grafts when comparing the proportion of patients who found it "impossible" to knee-walk. Level III, retrospective comparative study.

Surgical management of adult supraclavicular hemangioma: a case report

Introduction: Hemangioma is one of the most common vascular anomalies. It is classified into two types: superficial hemangioma, also known as capillary hemangioma, which appears as brilliant red macular masses, and deep hemangioma, which appears as a soft, non-fluctuating, poorly defined, and occasionally bosselated nodule. Surgical excision is recommended for cavernous-type tumors, which are less sure to regress. Despite its benign origin and behavior, it can develop in any body part. However, its size and origin site may vary and make surgical excision more challenging due to the importance of the structures surrounding the mass. Thus, this study aims to explain the surgical management of adult supraclavicular hemangioma. Case Description: We present a case of primary cavernous hemangioma in 36 years-old-woman with no history of health problems that extends to the supraclavicular area and was linked to essential structures. The surgical excision was performed through a double-incision technique to prevent iatrogenic damage to the system. Postoperative evaluations revealed no impairment of motoric and sensory hand functions, and the patient was discharged three days postoperatively. Histopathologic findings were consistent with the diagnosis of hemangioma. Conclusion: The supraclavicular approach in surgery is challenging due to its critical location and closeness to key neurovascular structures. To obtain the best surgical outcome, the essential operating concepts include thorough dissection and a modified method to limit the risk of functional status and mobility impairment.

Single approach versus double-incision technique for the repair of distal biceps tendon ruptures

Single approach versus double-incision technique for the repair of distal biceps tendon ruptures

Penile prosthesis in severe corporal fibrosis: a history of a difficult case using the double corporotomy incision technique

Penile prosthesis implantation in corporal fibrosis is a significant surgical challenge even for experienced surgeons. As it is a rare occurrence, a small number of series with limited follow-up have been reported. Multiple surgical approaches to eliminate fibrous tissue and to place an implant have been described. In this report, a 48-year-old man had a history of delayed treatment priapism with no response to any erectile dysfunction treatment. Penile prosthesis was recommended but the surgical approach was difficult and complex. It is widely accepted that implanters have to deal with both a high complication rate and patient expectation. This article introduces a new surgical approach in this challenging case.

Double-Incision Technique for the Treatment of Distal Biceps Tendon Rupture.

A longitudinal antecubital incision of 3 to 4 cm allows dissection to identify and isolate the lateral antebrachial cutaneous nerve (LABCN). Supination of the forearm protects the posterior interosseus nerve, which often cannot be visualized. The distal portion of the distal biceps should be carefully identified and exposed. A high-resistance nonresorbable suture is sewn with use of a Krackow technique to whipstitch the distal 4 cm of the tendon. Alternatively, 2 sutures (4 strands) can be utilized. A curved forceps is placed in the interosseous space to identify the location for the second 4-cm incision, on the dorsal proximal forearm over the tip of the forceps with the forearm pronated. The radial tuberosity is exposed by bluntly separating the common extensor tendons, followed by transection of the supinator fibers. Two drill holes are made 5 mm apart from one another for suture passage. The tendon is passed across a loop of wire, from the anterior to the posterior incision. With the elbow at 90° of flexion and full pronation, the tendon is docked into the trough and the sutures are tied. Alternatively, the surgical repair of the distal biceps tendon rupture can be performed through a single anterior approach4. The exposure starts with a curved longitudinal antecubital incision, exploiting the interval between the brachioradialis and pronator teres with radial (lateral) retraction of the brachioradialis and medial retraction of the pronator teres. A single anterior incision allows repair through the use of various types of fixation devices, such as suture anchors, cortical buttons, and interference screws, but seems to carry an increased risk of neurological complications, especially in terms of paresthesias in the distribution of the LABCN. Nonoperative treatment might be acceptable for elderly patients with poor functional demands. The double-incision technique with bone-tunnel fixation provides good fixation strength with an expected low rate of neurological complications1. This approach offers a useful treatment option for young and active patients with physically demanding lifestyles. The double-incision technique is an effective and safe procedure to restore elbow functionality in patients with distal biceps tendon rupture. A meta-analysis1,4-16 revealed no significant differences in postoperative functional scores following procedures performed via the single-incision compared with double-incision approach. Although the differences were smaller than the minimal clinically important difference17, the single-incision technique yielded significantly greater flexion (mean ± standard deviation, 136° ± 13°) and pronation range of motion (79° ± 10°) compared with the double-incision technique (133° ± 13° and 75° ± 14°, respectively) at 2 years postoperatively. No differences in extension and supination were observed. Rates of heterotopic ossification ranged from 0.5% to 11% for the single-incision approach and from 1% to 21.4% for the double-incision approach, with significant differences favoring the single-incision technique, although in the majority of cases the heterotopic ossification was an incidental finding. Neurological complications were found in 24.5% and 13.4% cases for the single- and double-incision techniques, respectively, with a significant difference favoring the double-incision technique. When damage to specific nerves was evaluated, the double-incision technique was associated with significantly less risk of LABCN damage. One or 2 high-resistance nonresorbable sutures are sewn with use of a Krackow technique to whipstitch the distal 4 cm of the biceps tendon.A curved forceps is placed in the interosseous space to identify the location for the second incision, on the dorsal proximal forearm over the tip of the forceps.Pronation of the forearm protects the posterior interosseus nerve, which often cannot be visualized during volar dissection and bone fixation.Positioning the tendon more posteriorly on the radial tuberosity allows for optimal biomechanical function. ROM = range of motionCR = conventional radiologyMRI = magnetic resonance imagingUS = ultrasoundLABC = lateral antebrachial cutaneousPIN = posterior interosseous nerveHO = heterotopic ossificationCI = confidence intervalSI = single incisionDI = double incision.

Mutual understanding in the field of gender affirmation surgery: A systematic review of techniques and preferences for top surgery in nonbinary patients

Gender-affirming surgery (GAS) has taken great strides, allowing patients to live in bodies affirming their gender identities. This study reviews the unique nonbinary surgical and aesthetic techniques and preferences for top surgery to aid surgeons and patients in discussions surrounding this procedure. A literature review was conducted to include “nonbinary,” “gender identity,” “top surgery” and related terms. Peer-reviewed manuscripts addressing any gender-affirming top surgery technique in patients identifying as nonbinary and other synonymous terms were included. Of 818 non-duplicate studies identified, 10 met inclusion criteria. Most reported chest masculinization techniques in nonbinary patients. They most commonly underwent the double incision technique (88.8%), similar to transgender patients. However, nonbinary patients preferred a nonflat, androgynous-appearing chest, versus a flatter, masculine-appearing chest in transgender patients. Breast reduction provided increased flexibility for nonbinary patients to present as feminine or chest bind to present as masculine. Nonbinary patients differed in preferences for the nipple areolar complex (NAC), either preferring larger, rounder NAC located closer to the chest meridian with preserved sensitivity, or forgoing NAC reconstruction altogether. No studies reporting chest feminization techniques in nonbinary patients assigned male at birth (AMAB) were found. Nonbinary patients seeking chest masculinization prefer fuller chests with larger, sensitive NAC located closer to the chest meridian compared to transgender patients. No published studies discuss chest feminization, despite an estimated one-third of nonbinary patients being AMAB. Further studies are needed to provide patient-reported preferences and determine external factors possibly influencing decisions to undergo top surgery.

Masculinizing chest surgery for gender affirmation: A retrospective study of outcomes and patient reported satisfaction

BackgroundMasculinizing chest surgery is the most common gender-affirming surgery. The objective of our study is to report the surgical and patient reported outcomes of surgery performed by a breast surgery practice. MethodsBetween June 1, 2017 and December 31, 2019, eighty-one patients underwent surgery at a university-affiliated hospital. This study included a retrospective chart review and an anonymous survey. ResultsSeventy-five (93%) patients underwent double incision technique. Complications occurred in 25% of patients and two patients required reoperation within 30 days of surgery. The anonymous survey response rate was 47% (34/72). Patients were asked to rate their satisfaction with the cosmetic appearance and the median score was 90. Quality of life and mental health improvement was reported by most patients. Median follow up was 9 months. ConclusionsMasculinizing chest surgery performed by surgeons trained in breast surgery had a low rate of surgical complications and positive patient reported outcomes.

Distal biceps tendon repair: cost analysis of single- versus double-incision techniques in an ambulatory surgery center

The purpose of this study was to compare the cost differences for single- versus double-incision distal biceps repair at an ambulatory surgery center (ASC) given that similar clinical outcomes have been reported between these methods. A retrospective review of financial and medical records was completed for patients who underwent distal biceps tendon repair over a three-year period at a single private orthopedic practice. Variables analyzed include the cost to the ASC of operative time and the cost of differential surgical supplies, specifically implants and disposable supplies. A total of 10 surgeons performed 104 repairs. Nine surgeons performed repairs through a single incision with use of cortical button or suture anchor fixation, and one surgeon performed transosseous suture fixation through a double-incision approach. The median tourniquet time and procedure length were 31 (interquartile range [IQR] 27-40) and 44 (IQR 39-54) minutes for single-incision repairs and 68 minutes (IQR 61-75) and 110 minutes (IQR 103-113) for double-incision repairs which were significantly different across groups (P < .001, P < .001). The total surgical cost (operative time, implants, and disposables) for single-incision repairs was a median of $758 (IQR 732-803) compared with $606 (IQR 567-629) for double-incision repairs (P < .001). However, the procedure cost with implants (not including disposables) was not significantly different for single- (median [Mdn]= $500 [IQR 475-552]) and double-incision repairs (Mdn $552 [IQR 514-564]) (P= .14) although the procedure cost with disposables (not including implant costs) favored single-incision repairs (Mdn= $478 [IQR 452-523]) over double-incision repairs (Mdn= $606 [IQR 567-629]) (P < .001). In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs. Differences in surgical time cost between the two approaches could be consequential for ASCs and other stakeholders.

Acute distal biceps tendon rupture: retrospective analysis of two different approaches and fixation techniques

PurposeThe aim of our study is to compare the modified double incision (DI) with bone tunnel reinsertion with the single-incision (SI) double tension slide technique in terms of clinical and functional outcomes and complication rates.MethodsA retrospective comparative analysis was performed on 65 patients treated for total distal biceps tendon rupture. The surgical technique adopted for each patient was based on the preference of two experienced elbow surgeons. The DASH and MAYO questionnaires, functional outcome and ROM were recorded in all subjects.ResultsOf 65 patients, we collected data of a cohort of 54 distal biceps tendon ruptures that satisfied inclusion criteria. Twenty-five were treated by modified DI and 29 SI techniques. The recovery of the complete ROM in terms of flexion/extension and prono-supination occurred in the 79.6% of the patients, without statistical significant difference between the adopted technique. We reported a complication rate of 12% and 20.7% for DI and SI techniques, respectively, without statistical correlation (P = 0.84). The average DASH score was similar for DI and SI techniques without significant differences (P = 0,848). The Mayo score results were excellent in the majority of the patients. No significant difference in MAYO results was reported comparing the surgical techniques (P = 1).ConclusionBoth techniques provide a reliable and strong repair with an optimal recovery of ROM returning to preinjury activity with substantially overlapping timelines.

Acute complete and partial distal biceps tendon ruptures: what have we learned? A review.

Acute distal biceps tendon (DBT) pathology includes bicipitoradial bursitis, tendinosis, partial and complete tears.Diagnosis of complete DBT tears is mainly clinical, whereas in partial tears medical imaging is a valuable addition to the clinical diagnosis.New insights in clinical and medical imaging of partial tears may reduce time to diagnosis and may guide the treatment plan.Most complete tears are best treated with primary repair using either a single-incision or double-incision approach with good clinical outcome.The double-incision technique has a higher risk of heterotopic ossification, whereas a single-incision technique carries a higher risk of nerve-related complications.Intramedullary fixation may be a viable solution to negate the risk of posterior interosseus nerve lesions in single-incision repairs.DBT endoscopy can be used to treat low-grade partial tears and tendinosis. Cite this article: EFORT Open Rev 2021;6:956-965. DOI: 10.1302/2058-5241.6.200145

Improved Surgical Outcome with Double Incision and Free Nipple Graft in Gender Confirmation Mastectomy.

Background:Mastectomy and chest-wall contouring is the most common gender confirmation surgery. With increasing prevalence of transgender individuals, there is a demand for better surgical outcomes and aesthetic results. Our aim was to evaluate surgical techniques used and assess modifications in gender confirmation mastectomies at Karolinska University hospital in Stockholm, Sweden.Methods:A retrospective cohort study was performed on 464 patients undergoing gender confirmation mastectomies in our department between 2009 and 2018. Patient demographics, psychiatric comorbidity, surgical method, and outcome were analyzed. Follow-up was at least one year.Results:The most frequently used surgical technique for gender confirmation mastectomies was double incision with free nipple graft (243 patients, 52.4%), followed by periareolar incision (113 patients, 24.4%) and semicircular incision (67 patients, 14.4%). The double incision technique and periareolar technique were associated with 18.9% and 28.3% complications, 3.3% and 12.4% acute reoperations, 28.4% and 65.5% secondary revisions, respectively. The double incision technique increased from being used in 17.8% of all mastectomies during 2009–2013 to 62.9% during 2014–2018, while periareolar incision decreased from 43.0% to 18.5%.Conclusions:The current study describes a successful transition of surgical technique from periareolar incision to double incision with free nipple graft in gender confirmation mastectomy, leading to significant improvements in the overall outcome with fewer complications, less acute reoperations and less secondary corrections. Hence, we consider the double incision with free nipple graft technique to be the favored technique in the vast majority of cases in female-to-male chest wall contouring.