Excellent Cosmetic Results Research Articles

A CASE REPORT: THE STAGED RETRO AURICULAR FLAPS FOR AURICLE RECONSTRUCTION AFTER TRAUMATIC AMPUTATIONS

Highlights: Instances of severe ear injuries are uncommon. The paragraph explores the efficacy of the staged retro-auricular flap (SRF) as a proficient approach to ear reconstruction. SRF demonstrates the ability to successfully reinstate the ear's dimensions, contour, and functionality, yielding highly satisfactory functional and aesthetic outcomes. Abstract: Introduction: A complete amputation or other severe auricular injury is rare. The amputated ear also presents a significant problem for the plastic surgeon. Case Illustration: A 29-year-old man had his left ear amputated due to trauma presented. He cut off his ear to get rid of the whisper because he has a history of psychiatric illnesses and complaints about hearing them. The remaining portion of the cartilage that was still linked to the ear attachment area was sutured to the preserved cartilage. The defect is covered using a stage pedicle flap. A skin transplant was used to close the donor flap's retro-auricular defect, which was its secondary defect. Discussion: A random-pattern flap with an abundant vascular supply is the staged retro-auricular flap (SRF). This flap's main disadvantage is the two-stage process required to complete it. Excellent cosmetic outcomes can be achieved by matching skin color and texture well in the postauricular sulcus, mastoid area, and posterior ear. Conclusion: SRF is an efficient ear reconstruction technique that offers relatively little operational morbidity and can restore the ear's size and shape with good to exceptional functional and cosmetic results when used on appropriately chosen helical ear abnormalities.

Safety and Performance of a New Burr Hole Covering Device: Results of the Multicenter COVER Registry.

Burr hole covering in brain surgical procedures can avoid complications and unaesthetic results. The aim of this registry was to assess the safety and performance of a new polymeric burr hole covering device (Cranial COVER, NEOS Surgery). A multicenter, prospective, clinical registry design was used for the study. All the patients who fulfilled the inclusion criteria were included in the study and followed up for 6 months. Baseline clinical parameters, surgical variables (technical success of the implantation, surgeon satisfaction), postoperative variables (aesthetic and functional results, neuroimaging artifacts), and adverse events were evaluated. Forty-three Cranial COVER devices were implanted in 30 patients. Most of them were implanted in frontal locations (53.5%). After implantation, 97.7% of the devices completely covered the burr hole, and 100% perfectly adapted to the skull surface. All surgeons ranked their satisfaction with the implantation procedure as very high or high. No artifacts were detected in any of the neuroimaging studies performed and no adverse events related with the device or its implantation were reported during the follow-up. There were significantly more scalp depressions associated with uncovered than with Cranial COVER-covered burr holes (p = 0.040). Patient satisfaction with covered burr holes located in the frontal and parietal areas was 9.0 ± 1.4 over 10. Cranial COVER is a safe and reliable burr hole covering system that offers excellent cosmetic results and high satisfaction rates for both surgeons and patients. Cranial COVER is highly adaptable to the skull surface, and it was predominantly used in frontal locations due to their cosmetic importance.

Ventricular septal defect’s closure via right thoracotomy: Experiences with 100 consecutive cases from Vietnam National Children’s Hospital

We evaluated the feasibility and effectiveness of the right vertical sub-axillary incision used for the closure of ventricular septal defect. 100 patients (55 males and 45 females) who consecutively underwent surgical repair of their ventricular septal defect at our institution from January 2020 to November 2021 were retrospectively reviewed. Technique considerations were right thoracotomy with a vertical mid-axillary line mini-incision, and central cannulation for cardiopulmonary bypass. Median age was 13 months; median weight was 8.7 kg. The mean cardiopulmonary bypass time and aortic cross-clamp time were 67 ± 16 minutes, 51 ± 15 minutes respectively. The ICU stay was 2.2 ± 1.2 days, mechanical ventilation time was 12.9 ± 28.2 hours, postoperative hospital stays was 9.9 ± 4.9 days. Morbidities were pneumonia (20%); surgical site infection (3%); subcutaneous emphysema (44%); transient arrythmias (10%). There was no conversion to another approach. There was no early or mid-terms mortality with a mean follow up of 15.8 ± 5.2 months. All patients are in a good health status. No significant residual defects were found on their last follow-up echocardiography. In conclusion, the ventricular septal defect’s closure via right thoracotomy at Vietnam National Children’s Hospital is a safe and feasible procedure with excellent cosmetic results.

Transuncal Selective Amygdalohippocampectomy by an Inferolateral Preseptal Endoscopic Approach Through Inferior Eyelid Conjunctival Incision: An Anatomic Study.

Transorbital endoscopic approaches have been described for pathologies of anterior and middle fossae. Standard lateral orbitotomy gives access to mesial temporal lobe, but the axis of work is partially obscured by the temporal pole and working corridor is limited. To evaluate the usefulness of an inferolateral orbitotomy to provide a more direct corridor to perform a transuncal selective amygdalohippocampectomy. Three adult cadaveric specimens were used for a total of 6 dissections. A step-by-step description and illustration of the transuncal corridor for a selective amygdalohippocampectomy were performed using the inferolateral orbitotomy through an inferior eyelid conjunctival incision. The anatomic landmarks were demonstrated in detail. Orbitotomies and angles of work were measured from computed tomography scans, and the area of resection was illustrated by postdissection MRI. Inferior eyelid conjunctival incision was made for exposure of the inferior orbital rim. Inferolateral transorbital approach was performed to access the transuncal corridor. Endoscopic selective amygdalohippocampectomy was performed through the entorhinal cortex without damage to the temporal neocortex or Meyer's loop. The mean horizontal diameter of the osteotomy was 14.4 mm, and the vertical one was 13.6 mm. The mean angles of work were 65° and 35.5° in the axial and sagittal planes, respectively. Complete amygdalohippocampectomy was achieved in all 6 dissections. Transuncal selective amygdalohippocampectomy was feasible in cadaveric specimens using the inferolateral transorbital endoscopic approach avoiding damage to the temporal neocortex and Meyer's loop. The inferior eyelid conjunctival incision may result in an excellent cosmetic outcome.

Efficacy and Safety of Photodynamic Therapy for the Treatment of Actinic Keratoses: A Meta-Analysis Update of Randomized Controlled Trials.

Actinic keratoses (AKs) are common and some may evolve into squamous cell carcinoma. Photodynamic therapy (PDT), imiquimod, cryotherapy, and other methods have been reported to have good effects. However, which treatment is the most effective with the best cosmetic results and fewest complications is uncertain. To evaluate which method has the best efficacy and cosmetic results with less adverse events and recurrence rate. All relevant articles up to July 31, 2022 were searched from Cochrane, Embase, and PubMed databases. Extract and analyze the data of efficacy, cosmetic results, local reactions, and adverse effects. Twenty-nine articles with 3,,850 participants and 24,747 lesions were included. Quality of evidence was generally high. The efficacy of PDT was better in complete response (CR) (lesions CR; risk ratio (RR) 1.87; 95% confidence interval (CI) 1.55-1.87/patient CR; RR 3.07; 95% CI 2.07-4.56), overall preference, and cosmetic results. The time cumulative meta-analysis showed that the curative effect was gradually increasing before 2004, and then gradually stabilizing. Two groups showed no statistically significant differences in recurrence. Compared with other methods, PDT is significantly more effective for AK with excellent cosmetic results and reversible adverse effects.

How I do it: combined bypass for adult moyamoya disease with maximal consideration of cosmetic aspects.

Combined bypass, including direct and indirect procedures, has been recognized as the maximal revascularization to prevent further hemorrhagic or ischemic stroke in adult moyamoya disease (MMD). It is also important to consider cosmetic aspects when planning combined bypass for MMD. However, there are few reports that have described the cosmetic considerations in bypass surgery for MMD. We demonstrate our surgical techniques aimed at achieving extended revascularization as well as excellent cosmetic outcomes with figures and video. Our combined bypass procedures which focus on achieving maximal cosmetic results are effective methods that require no special instruments or techniques.

Intramedullary Fixation with Cannulated Screw After Resection of Enchondroma in the Hand: Technique Description and Case Series

Enchondromas are primary, benign bone neoplasms that arise from intramedullary proliferation of hyaline cartilage cells. Slow and progressive in growth, enchondromas can lead to bone destruction, deformities, and fractures. The treatment of enchondromas remains controversial. We hereby describe the technique for bone fixation using headless intramedullary screws (HISs) after enchondroma resection in the long bones of the hand. From January 2018 to June 2021, all patients treated with HISs after the resection of enchondroma of the hand were retrospectively assessed and included in the study. The series comprised four patients with a minimum postoperative follow-up period of 12 months. Postoperative functional results were measured according to Takigawa criteria and postoperative radiographic results were graded according to the Tordai system. After tumor resection and screw fixation, one patient had autologous bone grafting from the iliac crest, and another had the defect filled with calcium phosphate cement. All patients were followed up for at least 12 months, and the mean healing time of the pathologic fracture was 5 weeks. There were neither complications related to the procedure nor the need for a second surgery. We describe the technique of intramedullary headless screws for bone fixation after enchondroma resection in the long bones of the hand, as well as the excellent functional, cosmetic, and radiographic results of four patients treated with the technique presented herewith. Therapeutic IV.

V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION

You have accessJournal of UrologyCME1 Apr 2023V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION Rogerio Huang, Akhil Saji, Mubashir Billah, Daniel Bassily, Benjamin Rudnick, Michael Stifelman, and Mutahar Ahmed Rogerio HuangRogerio Huang More articles by this author , Akhil SajiAkhil Saji More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Benjamin RudnickBenjamin Rudnick More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the United States, 80,000 new cases of bladder cancer are diagnosed every year. 30% are muscle invasive at the time of diagnosis, requiring radical cystectomy and ileal conduit being the most common type of urinary diversion. A rare complication is a ureteroileal anastomotic stricture (UIS), which occurs in 2-3% of cases. The gold standard treatment is an open repair. The advent of laparoscopy and robotics has allowed these revisions to be done with improved morbidity. In 2018, the single port robotic system has further enabled advances in minimally invasive surgery. There remains a paucity of educational videos on how to perform single port surgery. We aim to demonstrate a single port ureteroileal conduit revision. METHODS: An IRB approval was obtained at our institution and prospective data was collected on all patients undergoing a single port robotic UIS revision from January 2019 - April 2022. This case demonstration involves a 74 year old male who had a radical cystectomy with ileal conduit in June 2021. He subsequently developed bilateral UIS and elected for a single port UIS revision. RESULTS: The total operative time was 155 minutes and estimated blood loss was 25 mL. The patient’s pain was well controlled and his length of stay was 24 hours. There were no postoperative complications. The patient’s pfannenstiel incision healed with excellent cosmetic results. A renal ultrasound done at 3 months showed resolution of hydronephrosis. In a preliminary review, a single surgeon at our institution performed 6 single port UIS revisions. The mean OR time was 152.4 minutes and the mean estimated blood loss was 30.8 mL. The mean length of stay was 2.2 days. The 30-day postoperative complication rate was 0%. CONCLUSIONS: The single port Da Vinci robotic UIS revision is a novel and effective technique. The single port robot offers a superior platform to access tight spaces and excellent precision for dissection and ureteral anastomotic suturing. A single Pfannenstiel incision site allows easy access to the conduit as well as improved cosmesis. Single site surgery can significantly reduce pain and length of stay. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e510 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rogerio Huang More articles by this author Akhil Saji More articles by this author Mubashir Billah More articles by this author Daniel Bassily More articles by this author Benjamin Rudnick More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

SKIN SURFACE BRACHYTHERAPY FOR CUTANEOUS T LYMPHOMA: CASE REPORT AND REVIEW OF LITERATURE

Cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of extranodal non-Hodgkins lymphomas that are characterized by a cutaneous infiltration of malignant monoclonal T lymphocytes.At the early stages, CTCLs are often misdiagnosed as benign skin conditions and the treatment is still not well codified. We report the diagnostic and therapeutic path of a case of cutaneous anaplastic large celllymphoma located in the left forearm treated by skin surface brachytherapy(SS-BT) in theRadiotherapy-Brachytherapy department of the HASSANII university hospital center in FES. In our patient SS-BT provided us an excellent local control andgood cosmetic results.

Two-Stage Penile Reconstruction after Paraffin Injection: A Case Report and a Systematic Review of the Literature

Penile injection of foreign materials is an obsolete practice often performed by non-medical personnel in order to enlarge penile size. A systematic review of the literature from 1956 to 2022 was conducted in accordance with the general guidelines recommended by the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included full papers published from 1956 to 2022. We also described a case report of a 23 year old Bulgarian male affected by penile paraffinoma who underwent a 2-stages surgical technique. A total of 152 cases have been reported, with a median age of 37.9 ranging from 18 to 64 years. Six different techniques have been described in the whole literature: bilateral scrotal flap, simple excision of the paraffinoma with primary closure, two-stage scrotum skin flap, medial prepuce-soprapubic advancement flap technique and penile reconstruction using split thickness skin graft (STSG) or full thickness skin graft (FTSG). An analysis of the distribution among early and late complications was then carried out. In our experience, among the variety of surgical techniques described, a two-stage penile reconstruction using scrotal skin results in excellent cosmetic and functional outcomes, with a low rate of complications.

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae.

The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off the posterior vaginal wall and out of the vestibule, the perineal body muscles, where the fistula had been, were reinforced and an anoplasty was then performed. Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.

A novel technique C-conchoplasty in canal wall down tympnomastoidectomy

Background Numerous methods for meatoplasty and conchoplasty have been introduced, but no clear V/S(the meatal cavity volume to the cross-sectional) was given and many patients have complained about poor cosmesis on follow-up. Aims To explore the proper size, and cosmetic shape of the external auditory meatus and auditory canal for canal wall-down tympnomastoidectomy (CWD). Material and Methods In this observational case series study 36 patients undergone CWD with C-conchoplasty that uses a C-shape skin incision on the concha were reviewed. S and V/S of the preoperative, postoperative and contralateral normal ears were observed. We analyzed the relationship between the epithelialization time and postoperative V/S. Long-term efficacy observation and the shape of the meatus after the operation were observed. Results C-conchoplasty could effectively enlarge S and reduce V/S. The postoperative V/S were closer to the normal ear than that if we didn’t do C-conchoplasty. The greater difference of V/S between the post-operative ears and the contralateral normal ears, the longer the epithelialization time will be. C-conchoplasty produced an excellent cosmetic result. No other complications were noted. Conclusions and Significance The C-conchoplasty, which is a novel and easy technique in CWD, offers good functional and excellent cosmetic results with minimal risk of complications.

Single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy in ulcerative colitis; surgical technique and results of a 7-year experience

Total abdominal colectomy with end ileostomy is the first stage of the three-stage surgical treatment of medically refractory ulcerative colitis. Laparoscopic surgery is a safe approach offering several benefits. Single-incision laparoscopic surgery is an alternative minimally invasive approach providing excellent cosmetic results. Literature on single-incision laparoscopic clockwise continuous total abdominal colectomy in the treatment of ulcerative colitis is limited. Aim of the study is to describe our surgical technique and report the outcomes. Medically refractory ulcerative colitis patients who underwent single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy by a single surgeon between January 2013 and December 2020 at our tertiary care center are included. Patient charts were reviewed retrospectively. 52 patients were included in the final analysis. 51.9% patients were male with the median age of 31.5years and body mass index of 22.2kg/m2. Median duration of operation was 100min with estimated blood loss of 50ml. There were no intraoperative complications, conversions to conventional laparoscopy or open surgery. Postoperative complications were reported in 13 (25%) patients with most common being ileus (17.3%). 3 patients had surgical site infections. 2 patients had postoperative bleeding requiring blood transfusion. 2 patients had reoperation within postoperative 30days. Median length of hospital stay was 2days. No mortalities were reported. Single-incision laparoscopic clockwise continuous approach is safe and effective in ulcerative colitis patients undergoing total abdominal colectomy with end ileostomy. Further prospective randomized studies are warranted.

Intrascrotal Incision: An Alternative Technique for the Management of Inguinoscrotal Pathologies, Experience from 76 Cases

Abstract Introduction The aim of this clinical study was to present our experience gained by using the intrascrotal incision through the mid raphe for the management of a variety of inguinoscrotal pathologies. Materials and Methods A total of 76 male patients, between 2 and 16 years, underwent surgical treatment through a mid raphe intrascrotal incision, for a wide range of inguinoscrotal diseases, including torsion of the spermatic cord, torsion of the testicular appendages, non-communicating hydrocele, communicating hydrocele, ectopic testis, retractile testicles, palpable undescended testis, testicular trauma and testicular prosthesis placement. Results All the patients had an uneventful postoperative recovery, with none mentioned complication, and none of them required convention to the traditional inguinal method. The follow-up examination ranged from 6 months to 3 years, with no surgical complication highlighted. Conclusions We recommend that the intrascrotal incision through the mid raphe may be considered as an alternative technique to inguinoscrotal pathologies, instead of other approaches. The ability to treat a variety of pathologies regarding both two hemi-scrotums and the inguinal region at the same time, the provision of adequate surgical site, while succeeding much less dissection and disruption of tissue, the excellent cosmetic result, the greater comfort for the ‘day-case’ child, the ability to use the scrotal septum in order to fix the testis in the scrotum and the avoidance of an extra incision are the main advantages of the intrascrotal incision.

Single Stage Reconstructive Surgery to Treat Anorectal Malformations in Neonates; Ten Years Experience

Objective: To present single surgeon’s ten years’ experience of Single stage reconstructive surgery in 26 neonates born with anorectal malformations (ARMs) and review of literature. Methodology: This is a retrospective study of 26 neonates admitted in NICU with diagnosis of ARMs between period of June 2011 to Oct 2021 and managed by single stage reconstructive surgery with an average follow up of three years. All these patients were full term. The diagnosis was confirmed on clinical examination supported by cross table lateral film in prone position after 24 hours and ultrasound evaluation of level of rectal pouch. Single stage reconstructive surgery was done under general anesthesia within 24 to 48 hours after birth. The outcome of single stage reconstruction of neonates with anorectal malformations is evaluated post operatively during an average regular follow up of 3 years. Results: All the 26 neonates are treated by single stage reconstructive surgery between 24 to 48 hours after birth during the period from June 2011 to Oct 2021 who were admitted with anorectal malformations in NICU after excluding associated congenital anomalies.  All the patients had excellent cosmetic and functional outcome without significant problem of wound infection. Only 3 female patients with recto-vestibular fistula had mild superficial wound infection and were managed conservatively. Conclusion: Single stage reconstructive surgery to treat ARMs in neonates I effective, safe and feasible with good continence. It avoids morbidity and higher cost associated with three stage surgeries and colostomy. This fact may further be confirmed through multi-institutional experience in large number of patients.

Microwave ablation without subsequent lumpectomy versus breast-conserving surgery for early breast cancer: a propensity score matching study

Purpose To compare the efficacy of ultrasound-guided percutaneous microwave ablation (MWA) without subsequent lumpectomy and breast-conserving surgery (BCS) in patients with early breast cancer (BC). Materials and methods This retrospective cohort study enrolled 106 patients with early BC (T0/1/2 N0/1 M0) treated by MWA (n = 21) or BCS (n = 85) from October 2014 to December 2020. Propensity score matching (PSM) was performed to balance the baseline characteristics between MWA and BCS groups. The tumor progression, overall survival (OS), disease-specific survival (DSS), complications, and cosmetic results were compared. Results After PSM, there were 21 patients with balanced baseline characteristics in each group. After a median follow-up of 43 months (range, 15–89 months), there was no significant difference in tumor progression (10% vs 2%, p = 0.18), OS (96% vs 99%, p = 0.36), DSS (100% vs 99%, p > 0.99), and complications (0% vs 19%, p = 0.58). The operation time of MWA was shorter (60 min vs 101 min, p < 0.001) than that of BCS. For the management of metastatic lymph nodes, five (5/21, 24%) patients with six metastatic nodes underwent ablation in the MWA group and three patients (3/21, 14%) with six metastatic nodes underwent axillary lymph node dissection in the BCS group. All the patients in the MWA group reported excellent cosmetic results, but 29% of BCS patients expressed dissatisfaction with breast asymmetry (10%) and scar formation (19%) (p < 0.001). Conclusion This pilot study indicated that in selected early BC patients, microwave ablation without subsequent lumpectomy had comparable tumor control effect with breast-conserving surgery and better cosmetic results at an intermediate follow-up. Highlights MWA without subsequent lumpectomy has a comparable interim survival effect and better cosmetic results as BCS in the treatment of selected early breast cancer. MWA has the potential to be a viable and promising therapeutic option for breast cancer patients reluctant or intolerant to surgery with the advantage of minimal invasion.

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae.

The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off the posterior vaginal wall and out of the vestibule, the perineal body muscles, where the fistula had been, were reinforced and an anoplasty was then performed. Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.

The Transcaruncular Corridor of the Medial Transorbital Approach to the Frontal Lobe: Technical Nuances and Applications.

Medial orbital access through a transcaruncular corridor has yet to be fully characterized as a potential approach to intradural lesions within the skull base. Transorbital approaches present unique potential in the management of complex neurological pathologies and require subspecialty collaboration across multiple disciplines. A 62-year-old man presented with progressive confusion and mild left-sided weakness. He was found to have a right frontal lobe mass with significant vasogenic edema. A comprehensive systemic workup was otherwise unremarkable. A multidisciplinary skull base tumor board conference recommended a medial transorbital approach through transcaruncular corridor, which was performed by neurosurgery and oculoplastics services. Postoperative imaging demonstrated gross total resection of the right frontal lobe mass. Histopathologic evaluation was consistent with amelanotic melanoma with BRAF (V600E) mutation. At his last follow-up visit, 3 months after surgery, the patient did not experience any visual symptoms and had an excellent cosmetic outcome after surgery. The transcaruncular corridor through a medial transorbital approach provides a safe and reliable access to the anterior cranial fossa.

"Extended Frontalis Muscle Advancement Technique for Severe Congenital Blepharoptosis".

The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and under-correction. This article describes the authors' extended frontalis muscle advancement technique that takes extensive subcutaneous separation through the eyelid crease incision for the treatment of severe congenital blepharoptosis. A retrospective review was performed that included patients with severe congenital ptosis who underwent extended frontalis muscle advancement technique from April of 2019 to April of 2021. Preoperative evaluation included age, sex, and margin reflex distance 1 (MRD1), levator function, and lagophthalmos. Postoperative evaluation including correction result, closure function of eyelid, cosmetic result was performed at the last follow-up. From April of 2019 to April of 2021, a total of 102 patients (137 eyes) who underwent extended frontalis muscle advancement technique were included in the study. The mean postoperative MRD1 in unilateral and bilateral ptosis patients was 3.84 ± 0.60 mm and 3.86 ± 0.56, respectively, and 126 eyes (92.0 percent) showed successful correction. Postoperatively, the mean residual lagophthalmos was 0.88 ± 1.40 mm, and 127 eyes (92.7 percent) showed excellent or good eyelid closure function. The average score of cosmetic results was 8.29 ± 1.34, and 94 patients (92.2 percent) had an excellent or good cosmetic result. Extensive subcutaneous separation relieves the mutual restriction between the forehead skin and frontalis muscle. The extended frontalis muscle advancement technique is effective in correcting severe congenital ptosis, while minimizing under-correction, residual lagophthalmos, eyelid contour abnormality and eyebrow ptosis. Therapeutic, IV.

Perimammary uniportal vats fissureless right anterior segmentectomy for lung metastasectomy: a case report

: Secondary lung cancer is frequently witnessed in practice. Surgical resection is considered an essential approach in managing pulmonary metastases, with open or video-assisted thoracoscopic surgery (VATS) lobectomy typically preferred for centrally located metastasis. On the other hand, uniportal VATS anatomical segmentectomy provides an excellent lung parenchyma sparing technique to prevent the lobectomy, but it is challenging and demands strong skills in VATS. Therefore, we present a novel approach for uniportal VATS segmentectomy based on a vertical and curved utility incision performed in the perimammary fold of a 58-year-old female with a known case of colorectal cancer presented with a solitary lung metastasis located in the right anterior segment. The patient underwent, for the first time, a successful right perimammary uniportal VATS fissureless anterior segmentectomy. She experienced low postoperative pain, being the average postoperative pain (EVA scale) ± SD (0.466±0.9), and was discharged on the second postoperative day. Free margin was achieved and no recurrence has been observed within the last 20 months of follow-up. The patient is highly satisfied with the long-term cosmetic result due to a less-visible scar. In conclusion, the perimammary uniportal approach provides, low pain, short length hospital stay and an excellent cosmetic outcome. Further studies are required to prove the benefits of the perimammary approach.