Excision Of Muscle Research Articles

A Novel Endoscopic Approach to Fibroadipose Vascular Anomaly

BackgroundOpen surgery is the standard treatment for fibroadipose vascular anomalies (FAVA). This study evaluated an endoscopic approach for FAVA, assessing its safety and feasibility. MethodsData from October 1, 2019, and May 1, 2024, were analyzed from the Vascular Anomalies Center database at our institution. Patients with FAVA Stage I (pain stage) or II (contracture stage) were included and divided into the endoscopic surgery group (ESG) and open surgery group (OSG). ResultsIn total, 101 patients underwent 110 procedures. In ESG, 42 patients (16 males and 26 females; 31 with Stage I and 11 with Stage II) underwent radical excision (with tendon lengthening in 2 patients). Ten patients underwent an open surgery. In OSG, 63 patients (18 males and 45 females; 30 with Stage I and 33 with Stage II) underwent radical excision (with tendon lengthening in 12 patients). The OSG had significantly shorter operative time than the ESG (p = 0.009). Furthermore, The OSG had longer hospitalization time (p = 0.022) than the ESG. The blood loss in the OSG was greater than that in the ESG, but without statistical difference (p = 0.069). During follow-up, the incidence of wound complications (p = 0.121) and residual symptoms (p = 0.179) were slightly higher in the OSG. ConclusionsEndoscopic surgery is a safe and effective treatment for FAVA, promoting faster habilitation and improved patient satisfaction. This method may also serve as a reference for the excision of other benign muscle and soft tissue masses.

Anomalous papillary muscle insertion into the mitral valve leaflet in hypertrophic obstructive cardiomyopathy: a lip nevus sign in echocardiography.

Anomalous papillary muscle (APM) insertion into the mitral valve leaflet is rare but clinically important in hypertrophic obstructive cardiomyopathy (HOCM). In this study, we report the detection rate of APM insertion into the mitral valve using preoperative imaging modalities and the surgical outcomes of the patients. By retrospectively reviewing the clinical records of patients with HOCM who underwent surgical treatment by a single operation group at our center from January 2020 to June 2023, patients with APM insertion into the mitral valve leaflet were identified. Baseline data, image characteristics, and surgical outcomes were analyzed. The incidence of APM insertion into the mitral valve leaflet was 5.1% (8/157). The insertion site was located at A3 in six cases, which was more common than at A2 (n = 2). Preoperative echocardiography was used to identify two patients (25%) with APM insertion. We observed a particular echocardiographic feature for APM in HOCM patients, which was noted as a "lip nevus sign", with a higher detection rate (62.5%). All patients successfully underwent septal myectomy with concomitant APM excision or mitral valve replacement via the transaortic (n = 5) or transmitral (n = 3) approach. The mean age was 49.0 ± 17.4 years and seven patients (87.5%) were female. Interventricular septum thickness (17.0 mm vs. 13.3 mm, P = 0.012) and left ventricular outflow gradient (117.5 mmHg vs. 7.5 mmHg, P = 0.012) were significantly decreased after surgery. Residual outflow obstruction, systolic anterior motion, and ≥3+ mitral regurgitation were negative. During the follow-up of 26.2 ± 12.2 months, there were no reported operations, adverse events, mitral regurgitation aggravations, recurrences of outflow obstruction, or instances of SAM. Papillary muscles inserted into the mitral valve leaflet are a subtype of subvalvular malformation in HOCM that requires surgical correction. The lip nevus sign on echocardiography is a characteristic of APM insertion in HOCM and may improve the preoperative detection rate. Adequate myectomy with anomalous papillary muscle excision has achieved good results in reducing the outflow gradient and eliminating mitral regurgitation, with good outcomes at short-to-intermediate follow-up.

Long-Term Improvement of Crow's Feet Wrinkles in Combination With Cervicofacial and Temporal Lifting: Review of the Literature.

The lateral orbital crow's feet area is one for which rejuvenation is most frequently requested by patients. Moreover, lateral canthal wrinkles are a common source of dissatisfaction after rhytidoplasty. Botulinum toxin injection has emerged as a most popular, easy, and effective solution; nevertheless, repeated injections are required periodically for long-term effect. Other nonsurgical options have also been described to have some demonstrable advantages. Orbicularis oculi surgical manipulations have been described as well. A systematic PubMed literature search was conducted to identify clinical cohort studies including more than 10 patients describing surgical approaches for improvement of crows' feet wrinkles in combination with face and/or temporal lifts. The search was complemented by Embase, Medline, and Cochrane searches in addition to screening of reference lists of selected studies and simple term searches about surgical treatment of crow's feet. Fourteen studies satisfied the inclusion criteria and were included in this review describing various muscle excision techniques including vertical strip excision, lateral partial resection, wedge resection, muscle resection in "C" pattern, and enlarged myectomy of about one-third of the whole orbital extension in addition to muscle manipulation modalities, including muscle splaying, muscle division, muscle division and splaying, muscle undermining with partial denervation, and muscle suspension. Interposition of fascia between orbicularis muscle and overlying skin was also reported. View the few studies retrieved and the wide spectrum of reported techniques, it is not possible to determine from this review the most effective modality. Nevertheless, it seems that subcutaneous undermining of the lateral canthal area combined with splaying and traction of the orbicularis oculi muscle and fixation to the temporalis fascia with or without muscle division would yield the best long-term results. This review indicates also that surgical correction of crow's feet during rhytidectomy or temporal lift could be a positive complement to improve aesthetic outcome. Unfortunately, if not underreported, it is definitely neglected. We believe that this review may be an eye-opener for surgeons.

Mathematical Model of Anal Canal for Anal Fistula Surgery

Abstract: Purpose: Surgery is necessary for the treatment of an anal fistula. However, excision of some sphincter muscle would compromise sphincter integrity or function, which is the cause of a reduced success rate in the long term. In order to develop an appropriate surgical plan, a mathematical model that describes the relationship between the internal pressure of the anal canal and the structure of anal sphincters is required.
 Methods: The anatomical structure of the anal canal and the corresponding sphincter pressure can be measured by endoanal ultrasound (EAUS) imaging and manometry, respectively. Length-tension relationships for skeletal and smooth muscles, two major components of the external and internal anal sphincter, respectively, were reviewed first. 
 Results: Based on the information about the internal and external sphincters, two mathematical models, the thick-wall cylinder model and the two-layer model, have been created, from which the influence of complete or partial excision of the sphincter muscle can be estimated.
 Conclusions: The proposed thick-wall cylinder and two-layer models could describe the relationship between the internal anal canal pressure and the structure of anal sphincters, from which the influence of complete or partial excision of the sphincter muscle may be estimated.

A Novel Approach to Reduce Lid Weight in the Upper Eyelid Blepharoplasty: Split-Thickness Excision of the Palpebral Part of Orbicularis Oculi Muscle.

With the effect of advancing age and environmental factors, excess skin and muscle start to weigh on the eyelids and cause a tired facial expression. The prevailing opinion is that by partially excising muscle in surgical treatment, this load on the eyelid will be reduced, and more successful results will be obtained. Using a classic strip orbicularis oculi excision, the integrity of the muscle is disrupted, and morbidities such as lagophthalmos and edema increase. In this paper, we share our clinical experiences regarding the split excision of the palpebral part of the orbicularis oculi muscle and the subsequent process. Twenty-seven patients who applied to our clinic to undergo blepharoplasty were operated on under local anesthesia. The orbicularis oculi muscle was split-excised together with the skin from the marked areas. The split excision of the orbicularis oculi muscle did not cause prolonged edema. The general appearance of the eyelid and face of the patients was observed to have significantly improved in the third month after surgery compared with the preoperative period. No complications such as wound healing, hypertrophic scar, asymmetry, or infection were observed during the follow-up period. The split excision of the orbicularis oculi muscle can be considered a new and effective method in cases in which a muscle excision is planned as part of blepharoplasty. Prolonged edema due to the strip muscle excision is not observed clinically. This technique can eliminate the negative effects of excess muscle tissue on the eyelid without disrupting the integrity of the muscle. Evidence Based Medicine Level V.

The application of electrophysiology in the correction of spastic torticollis by triple surgery—report of 96 cases

ObjectiveTo investigate the effect and value of electrophysiology in the ‘triple operation’ (selective excision of spastic muscles in the neck, selective resection of the posterior branch of the cervical nerve and accessory neurotomy) of spastic torticollis.MethodsPreoperative electromyography (EMG) examination was performed on 96 patients with spastic torticollis treated in our hospital from January 2015 to December 2019. The results were used to assess the responsible muscles’ primary or secondary position and the function of antagonistic muscles and to formulate a personalised surgical plan. A Cascade PRO 16-channel electrophysiological diagnostic system (produced by Cadwell, USA) was used to record the evoked EMG. Target muscles were denervated under intraoperative electrophysiological monitoring and re-examined by EMG six months later to evaluate the efficacy.ResultsThe satisfactory rate of target muscle denervation was 95%, and the overall good rate was 79.1%.ConclusionElectrophysiological examination and intraoperative application may have a positive value in the selection of the operative method, improving the rate of denervation and evaluating the prognosis of the ‘triple operation’.

Effects on Facial Growth Following Masseter Muscle Resection in Growing Rats-A Systematic Review.

An individual's facial appearance is heavily influenced by facial symmetry. In the asymmetric mandible, periosteal apposition and endochondral ossification in one of the condyles may stimulate asymmetric growth of the body. Our aim was to review the impact on the growth following masseter resection. Relevant studies up to October 2022 were retrieved from PubMed, Scopus, and Web of Science. The PICOS method was utilized to determine eligibility, and the SYRCLE risk of bias tool was utilized to provide an estimate of potential bias. A predetermined algorithm was used to search the databases. The results of our systematic review of seven studies indicate that the masseter muscle strongly impacts craniofacial growth and development. Resection of the masseter muscle significantly reduces the sagittal and vertical development of the jaw in rats. In addition, the masseter muscle excision influences the mandibular morphology, including the condylar area, angle, and development direction of the jaw.

D88. A Friend or Foe? Evaluating Mesh Usage, Implant Location, and the Timeline of Capsular Contracture Development

PURPOSE: Acellular dermal matrix (ADM) and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over surgical techniques in implant-based reconstruction. The aim of this study is to compare no mesh usage to the use of biological matrices (ADM) or synthetic mesh (P4HB) in conjunction with various placement locations (pre-pectoral, retro-pectoral, total sub-muscular), and further examine the respective incidences and timelines of capsular contracture development within each subgroup. METHODS: A dataset consisting of 209 patients (406 samples) who had undergone two-stage reconstruction between 2012-2021 was used in the study. Univariate logistic regression was used for statistical analysis. Kaplan-Meier estimator was used to plot the survival curve for the various conditions. RESULTS: On univariate logistic regression (OR 1.95, p-value 0.004) and survival analysis (p-value 0.0082), P4HB mesh usage was linked to an increased risk of capsular contracture development. Out of the various placement modalities, retro-pectoral with P4HB yielded the highest contracture rate. Pre-pectoral placement with no mesh and retro-pectoral placement with ADM showed similar timelines of capsular contracture development. The lowest incidence of capsular contracture occurred in the pre-pectoral placement and no mesh subgroup (49/161, 30.4%). CONCLUSION: The use of P4HB mesh in two-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Pre-pectoral tissue expander and no mesh led to the lowest rate. There did not appear to be a significant difference in the timeline of contracture formation between retro-pectoral with ADM and pre-pectoral with no mesh usage.

Timeline and Incidence of Postoperative Complications in Prepectoral, Dual-Plane, and Total Submuscular Alloplastic Reconstruction With and Without Biosynthetic Scaffold Usage.

Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development. A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ 2 , Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis. On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis ( P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups. The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.

Development of a new surgical technique to infuse kynurenic acid to optic nerves in chickens for studying loss of myelination

Prolonged infusion of a high dose of kynurenic acid (KYNA) reduces the myelin content in the rat spinal cord with preservation of the axonal integrity and without inducing an inflammatory response. We hypothesized that subdural infusion of a high concentration of KYNA can induce myelin loss in the optic nerves (ONs) of chickens. However, existing methods to deliver agents to the ON are inefficient, unlocalized and provide only acute exposure. Thus, we developed a surgical approach for sustained delivery of KYNA to the chicken ON. In brief, the novel surgical technique, which does not include excision of the extraocular muscles, involves incision of the skin and underlying fascial sheath to access the optic nerve within the muscle cone, implantation of a catheter in the dura of the optic nerve, the other end of which exits the orbit under the skin. The catheter runs under the skin near the lateral canthus, over the ears to the back of the neck, where a second incision is made to both implant the osmotic pump and to attach the catheter to the osmotic pump. India ink was used to confirm prolonged sustained administration to the optic nerves and across the chiasm. This surgical model was used to investigate KYNA's effect(s) on myelin loss in the ON. ONs of 7-day old chickens were infused with 50 mM KYNA or phosphate buffered saline (PBS) for seven days. Analysis of KYNA-infused contralateral ON g-ratios and protein levels indicated a reduction in myelin. These findings demonstrate the utility of our surgical approach for sustained delivery of KYNA into the ON and suggest a role for KYNA in modulating CNS myelination.

The Conflict in Ukraine: Medical and Psychological Aspects

This mini-review analyzes medical and psychological aspects of the conflict in Ukraine. If the global power shifts to Russia, it may come along with losses of certain values. The quality of many services, products and foodstuffs will decline. Autocratic or military management style will gain sway also in the healthcare and science. Attributes of this style include the lack of criticism and objective discussion, paternalistic approach to patients, bossy management and occasional disregard of the principle of informed consent. Suboptimal practices have been used as per instructions and leading experts’ publications. To name but a few: the overuse of Halsted and Patey mastectomy with excision of pectoral muscles, coagulation of endocervical ectopies without cyto- or histological check for precancerous changes, parabulbar injections of placebos, extensive gastric resections for peptic ulcers, thoracic and abdominal surgery for bronchial asthma and diabetes mellitus, overuse of surgery in tuberculosis. Psychological issues related to the Ukraine conflict are discussed here. Repressed shame may cause aggression. Some topics discussed in this article are associated with shame, summarily reflected by the comparatively low life expectancy and world highest abortion rate in Russia. Instead of machismo and militarism, the propaganda should popularize the image of scrupulous and hardworking people.

Correction of Involutional Entropion by Excising Redundant Skin and Pretarsal Orbicularis Muscle without Vertical and Horizontal Tarsal Fixation.

This study evaluated the effect of the excision of redundant skin and pretarsal orbicularis muscle, without vertical or horizontal tarsal fixation, on the correction of involutional entropion. This retrospective interventional case series recruited patients with involutional entropion who underwent excision of redundant skin and pretarsal orbicularis muscle, without vertical or horizontal tarsal fixation, from May 2018 to December 2021. Preoperative clinical characteristics and surgical outcomes, including recurrence at 1, 3, and 6 months, were determined by reviewing the medical charts. Surgical treatment included the excision of redundant skin and pretarsal orbicularis muscle, without any tarsal fixation, and simple skin suture. All 52 patients (58 eyelids) attended every follow-up visit and were thus included in the analysis. Among 58 eyelids, 55 (94.8%) had satisfactory results. The recurrence rate was 3.45% (two eyelids) and the overcorrection rate was 1.7% (one eyelid). Excision of only redundant skin and the pretarsal orbicularis muscle, without capsulopalpebral fascia reattachment or horizontal lid laxity correction, is a simple surgery for correcting involutional entropion.

Peroneal Tendon Dislocation Treated with Arthroscopic Approach: A Case Report

Peroneal tendon dislocation is usually manifested as ankle instability and pain. Peroneal tendon dislocation is caused by ruptured of superior peroneal retinaculum (SPR) due to anatomical abnormality. SPR can be damaged due to excessive contraction force of dorsiflexion of the foot. The epidemiology of this pathology is also uncertain, because peroneal tendon dislocation is often mistaken for lateral ankle ligament sprain. The treatment should include conservative treatment and surgical treatment if it fails. A 20-year-old Indonesian Male attended orthopedic consultation with pain and snapping of the lateral side of left foot from 2 years ago after twisting his ankle during a recreational sport. Snapping was felt when doing sport exercise and in certain position. The tendon dislocation can be seen after that. On examination, he felt pain on palpation and snapping on lateral side of the ankle. The left ankle was snapped in a dorsiflexion and plantarflexion positions and can return into normal position. After conservative therapy, the condition did not improve. Then surgical intervention was suggested. Patient was operated on June 21st 2022 on a operating room with lateral decubitus position under subarachnoid anesthesia. The surgery was done with arthroscopic approach. During operation we found a SPR disruption, peroneus longus tendon longitudinal tear, low lying peroneus brevis muscle belly and shallow retromaleolar groove. These finding may increase the risk of dislocation. We performed a peroneus longus debridement, peroneal brevis muscle excision, retromaleolar groove deepening, and SPR repair are our best choice of treatment. Short leg splint and physiotherapy exercise were applied after surgery. Presented case of peroneal dislocation is very low. Usually for this case is best treated with surgical intervention. By using arthroscopy, we can detect abnormality and treat them at once. SPR repair and groove deepening with arthroscopic approach can offers a satisfactory outcome.

Predicting Depressor Anguli Oris Excision Outcomes Using Local Muscle Block.

Introduction: Although depressor anguli oris (DAO) muscle block is a useful tool to help predict which patients will respond positively to myectomy, DAO excision outcomes have not been correlated with smile changes after muscle block. Objective: To compare changes in smile symmetry after DAO muscle block with changes after DAO myectomy. Methods: Nonflaccid facial paralysis patients undergoing DAO excision at a tertiary care facial nerve center were prospectively studied from August 2021 to June 2022. Dental show, oral commissure excursion, and smile angle at baseline, after DAO muscle block, and after myectomy, were quantified. Results: Twenty-three patients underwent DAO muscle block followed by myectomy. DAO excision produced improved dental show (p = 0.006) and oral commissure excursion (p = 0.024) symmetry compared with muscle block. A strong correlation exists between changes in oral commissure excursion symmetry after muscle block and after myectomy. Moderate correlations exist for changes in smile angle and dental show symmetry. Conclusion: Although DAO muscle block is a good predictor of smile symmetry after muscle excision, typically excision results in improved dental show and oral commissure symmetry compared with block.

Aortic dissection following “ecstasy” use complicated by compartment syndrome

BackgroundPatients who present to the emergency department (ED) with acute chest pain should receive a thorough history and exam to rule out rare, life-threatening conditions, such as drug-induced acute aortic dissections (AD).Case presentationA 34-year-old man with a history of uncontrolled hypertension, smoking, and “ecstasy” use presented to the ED with an acute type A aortic dissection (AD). Following surgery to repair the dissection, he developed compartment syndrome of the lower extremity requiring muscle excision and neurolysis with subsequent wound debridement procedures.ConclusionPhysicians treating adults with symptoms and signs of aortic dissection should take a focused history about substance use and include AD on their differential. In addition, the extremities should be monitored for signs and symptoms of ischemia throughout the acute peri-surgical period(s).

UPPER EYELID BLEPHAROPLASTY RESULTS AND EVALUATION OF PATIENT SATISFACTION

<p>The aim of the present study is to investigate the effects of upper eyelid blepharoplasty on surgical results, recovery time, complications, scar development and patient satisfaction in cases that undergo upper eyelid blepharoplasty. 184 eyes of 92 patients who had undergone upper eyelid blepharoplasty were evaluated in the present study. The patients were evaluated in terms of surgical results, complications, recovery time and scar development. In the postoperative second month, the patients were given Surgical Satisfaction Questionnaire and Glasgow Benefit Inventory (GBI) to determine the changes in the life quality of patients and surgical benefit and to determine the characteristics of this change. The mean age was found as 59,2 ±6,8 years and 81.5% of the patients were female. Skin and fat excision were performed in all patients. None of the patients underwent muscle excision. 86.9% of the patients stated that they were very satisfied with the surgery, 6.5% stated that they were satisfied, 5.5% stated that they were moderately satisfied and 1.1% stated that they were not satisfied. According to GBI results, an increase was found in both total GBI score and in sub-scores other than physical score. Upper eyelid blepharoplasty is a common surgery for functional reasons and aesthetic concerns. Accurate evaluation and surgery increase patients’ quality of life and patient satisfaction.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0567/a.php" alt="Hit counter" /></p>

Ventricular arrhythmias and sudden cardiac death caused by mitral valve prolapse: should we operate and when?

Abstract Background Several autopsy and observational studies have investigated the link between mitral valve prolapse (MVP) and sudden cardiac death (SCD) due to the well accepted yet rare occurrence of complex ventricular arrhythmia (VA) in this cohort. Few studies however have investigated whether arrhythmia burden and more importantly SCD are reduced following surgical correction of MVP. Purpose To investigate the impact of mitral valve surgery (MVS) (replacement or repair) on VA and SCD in patients with MVP. Methods A systematic review of the current literature was conducted using an electronic search of the PubMed database in October 2021. Studies were included if subjects had undergone mitral valve (MV) repair or replacement with documented rates of arrythmias/SCD pre- and post-intervention. Small patient numbers in individual reports precluded formal meta-analysis and results were reported on a per study basis. Results 19 identified studies (10 cohort studies, nine case studies) comprised 1322 patients with a pooled mean age of 63.4 years and 38.9% were female. 748 of the 1322 patients underwent MVS: 263 MV repair, 18 MV replacement (one with leaflet and papillary muscle excision), two MV repair with Maze procedure, 177 percutaneous transcatheter MV repair, 45 annuloplasty with or without valve repair, and in 243 cases the surgical method was not specified. Of the 10 included cohort studies, seven of the eight which investigated rates of VA post MVS concluded there was a significant reduction, while one reported the predisposition to arrythmia persisted after relieving the abnormal mechanical effects of non-ischaemic MR (75% due to MVP). One study reported a reduction in SCD post MVS. Each of the nine included case studies showed a reduction in VA post MVS. One study showed mitral annular disjunction (MAD) was independently associated with a higher risk of arrhythmic events, this link persisting with time dependent MVS although reduced compared to medical management. Conclusions The underlying mechanisms for VA and SCD associated with MVP are not completely understood, and guidelines for the surgical correction of MVP based on arrhythmic and SCD risk are lacking. This systematic review illustrates a possible reduction in VA following MVS. Further identification of patients at risk of SCD, and potential use of risk stratification algorithms, would allow for consideration of earlier management and appropriate use of implantable cardioverter-defibrillators (ICD) placement / MVS with an expected survival benefit. Funding Acknowledgement Type of funding sources: None.

Accessory Soleus: Posterior Ankle Pain in Two Adolescent Athletes

Category: Sports Introduction/Purpose: Accessory soleus muscles are a rare cause of posterior ankle pain and swelling in adolescent athletes. The increased accessibility of MRI imaging has been a helpful aid its proper diagnosis and treatment. Different surgical treatment also exists including partial fasciotomy as well as surgical excision. This case report offers 2 cases of adolescent athletes with this finding causing pain and swelling in the posterior ankle limiting rigorous athletic activities that were treated with surgical excision of the accessory soleus. Methods: Two patients were evaluated in clinic for posterior ankle pain during participation in rigorous athletic activities. The first patient was a 13-year-old girl with posterior ankle pain and swelling while playing softball that limited her ability to pitch more than one inning. The second patient was a 17-year-old boy with posterior ankle pain and swelling that limited his ability to perform at peak performance during basketball games. Both patients had MRI evaluation of the ankles after months of no improvement with nonoperative treatment. MRI demonstrated accessory soleus muscles that was attributed to be the cause of their symptoms. After unsatisfactory symptom relief with nonoperative treatment measures, the two patients underwent surgical excision of the accessory soleus muscle. Results: Both patients underwent surgical excision of the accessory soleus muscle through a posteromedial approach. The accessory soleus muscle was found just anterior and medial to the Achilles tendon. The muscle was detached from its insertion into the calcaneus distally and traced back proximally. The muscle was then truncated proximally approximately 5-6 cm proximal to its insertion on the calcaneus. Both patients began weight bearing to tolerance in a walking boot immediately postoperatively. Both patients experienced resolution of their symptoms after surgical excision. Conclusion: Accessory soleus muscles are rare anomalous muscles of the posterior ankle that can cause pain and swelling with activity. Increased accessibility of MRI imaging has led to its diagnosis and treatment. Surgical excision is a reasonable surgical treatment option when nonoperative treatment fails to alleviate symptoms.

804 Accessory Extensor Digitorum Brevis Manus Muscle Presenting as a Painful Dorsal Hand Swelling - a Case Report

Abstract Hand and wrist pain are common presenting complaints in General Practice, Emergency Departments, and plastic surgery clinics across the UK. We present the case of a 43-year-old male who initially presented to his General Practitioner with an 18-month history of progressive pain and intermittent swelling to the dorsum of his right hand and wrist. Magnetic resonance imaging (MRI) and ultrasound (US) performed privately, when his symptoms first presented, were inconclusive, demonstrating generalised tenosynovitis. The patient had previously tried local steroid injections and shockwave therapy prior to being referred, neither of which relieved his symptoms. On examination in clinic, there was subtle fusiform prominence over the radio-dorsal aspect of his right hand, with tenderness on palpation and on extension of the wrist. An up-to-date MRI scan was performed which revealed an accessory extensor digitorum brevis manus (EDBM) muscle at the dorsal aspect of the right hand and wrist. The patient opted for excision of the accessory EDBM muscle, which was performed without complication under general anaesthetic and regional block. He made an unremarkable recovery. Whilst accessory extensor muscles in the hand are not unheard-of, variant EDBM muscles only account for around 1% of these, and only a handful have been documented in literature. When patients present with a painful swelling in the dorsum of the hand or wrist, which is exacerbated with repetitive use, a diagnosis of an accessory EDBM muscle should be considered a differential.

Outcomes of Lateral Tarsal Strip in Conjunction with a Minimal Skin Muscle Excision Underlying Cauterization in Korean Patients with Involutional Entropion.

We reviewed the medical records of 53 involutional entropion patients, who underwent lateral tarsal strip (LTS) with a minimal skin muscle excision by cauterization from March 2014 to December 2017, to evaluate the effectiveness and efficiency of LTS in conjunction with a minimal skin muscle excision using cautery in patients with involutional entropion. We evaluated the success rate, complications, recurrence rate, and degree of satisfaction of our technique. Of 53 patients, there were 5 bilateral cases for a total of 58 eyelids. The average of age was 71.2 years old (57–90 years). The average follow-up period was 18 months (12–39 months). The success rate for involutional entropion correction was 98.1% with our technique. There was one mild recurrence case at 7 months. In our study, the average operation time was 20.8 min (15–29 min) for 48 unilateral cases and 27.2 min (20–32 min) for 5 bilateral cases without intraoperative complications. Of 42 responders of patients’ satisfaction questionnaire, 38 patients showed good satisfaction and were willing to recommend the surgery to their acquaintances. The technique of LTS with minimal skin excision with cauterization was effective and provided satisfying outcomes to patients with involutional entropion.