Excision Of Scar Tissue Research Articles

The experience of metroplasty at the stage of delivery in pregnant women with two cesarean section operations in the anamnesis

The purpose of our study is to evaluate the effectiveness of metroplasty at the stage of abdominal delivery in women with a history of two cesarean section operationsMaterials and methods. From 2020 to 2022, 150 pregnant women were examined. The patients were divided into 3 groups: the first group - pregnant women with a history of cesarean section, the second group – pregnant women with two cesarean sections. In these groups, metroplasty was performed at the stage of delivery. The third control group consisted of pregnant women with a history of two cesarean sections who underwent surgical delivery without excision of scar tissue in the lower segment.Metroplasty was performed before fetal extraction with a whole fetal bladder in accordance with the patent "Method of metroplasty during operative delivery in women with two or more cesarean sections".In order to study the dynamics of changes in scar thickness, all women underwent ultrasound examination 2 hours later, on the third day after delivery, and 6 months after delivery.The results of the study. Resection of the scar area on the uterus during repeated cesarean section improves the residual thickness of the myometrium, which is determined by ultrasound 6 months after surgery. This technique allows you to form a functionally consistent scar on the uterus after two cesarean section operations.

The use of the dura mater at the final stage of reconstructive plastic surgical treatment of cicatricial stenosis of the larynx and trachea

The article presents an analysis of the plastic reconstructive surgery effectiveness for patients with an extended tracheal defect using an allograft based on the dura mater (DM) at the final stage of surgical treatment of laryngeal and tracheal cicatricial stenosis. The study included 20 patients with cicatricial stenosis of the larynx and trachea, who were previously performed plastic reconstructive treatment with scar tissue excision in the lumen of the respiratory tract and restoration of the supporting frame of the larynx and trachea using allografts based on costal allocartilage. The age of the patients ranged from 21 to 54 years, the duration of the disease was from 1 to 5 years. After a standard clinical and laboratory examination, with a mandatory video endoscopic examination of the larynx and trachea, multislice computed tomography of the larynx and trachea, patients underwent plastic closure of the tracheal defect using DM. Dynamic outpatient monitoring was carried out once a week for 1 month, once a month for 3 months, control examination was done 6 months after surgical treatment. The results of the study demonstrated a full-fledged social and labor rehabilitation of all 20 patients after the final stage of surgical treatment using DM, the absence of rejection reaction and migration of allo-implantation material, the preserved lumen of the larynx and trachea with a rigid supporting skeleton and the absence of anterior tracheal wall floatation. The use of DM as an additional strengthening of the anterior tracheal wall for patients with deficiency of muscular aponeurotic tissues and more than 2 cm size tracheal defect is highly effective at the final stage of surgical treatment for plastic closure of the tracheal defect.

Pollybeak deformity: how to avoid, how to cure.

We reviewed the Pollybeak deformity from prevention to treatment in all aspects. Research methods included searching online databases such as Google, Google Scholar, PubMed, and Proquest Central at King Saud University. We used terms like "Pollybeak deformity", "rhinoplasty", "etiology", and "treatment" to find related articles. Pollybeak deformity, an undesirable side effect of rhinoplasty, manifests as a dorsal nasal convexity resembling a parrot's beak. A dorsal hump that develops in the supratip region of the nose "pushes" the tip down, leading to under-rotation. Several factors may be at play here. When a surgeon fails to recognize the aberrant tip-supratip relationship that distinguishes this abnormality during the intraoperative evaluation of the nose, the result is a pollybeak. There is also the risk of pollybeak deformity, which the surgeon might be unable to predict. Supratip scar tissue is more common in people with thick skin and soft tissue envelopes. Medical intervention is only effective for soft-tissue pollybeaks when caught early. Injecting corticosteroids into the supratip dead space can alleviate edema and slow scar tissue formation. Surgical excision of scar tissue from the dorsum of the nose can repair the pollybeak deformity. Surgical correction of a supratip fullness that causes a disparity between the tip and supratip is known as a "pollybeak deformity". The appearance of the nose in some individuals with pollybeak deformity can resemble that of a bird, which can cause them to feel self-conscious and embarrassed. Therefore, treatment with medicine or surgery is required for these ailments.

Efficacy of transdermal microneedling redermalization with high-molecular-weight hyaluronic acid and sodium succinate in the correction of postacne scars

BACKGROUND: Acne is a chronic inflammatory skin disease of multifactorial nature that affects more than 80% of adolescents and is one of the top 10 most common diseases in the world. Currently, dermatologists have various techniques for the correction of postacne scars: from minimally invasive hydroxy acid peels to surgical excision of scar tissue. One of the most effective, affordable, and at the same time minimally invasive and safe treatment methods is microneedling ― micro-damage of the skin with thin needles in the lesion area, stimulating the production of collagen and elastin.
 AIM: to study the efficacy and safety of transdermal redermalization with microneedling using high-molecular-weight hyaluronic acid and sodium succinate in patients with atrophic postacne scars of varying severity.
 MATERIALS AND METHODS: A prospective study was carried out at the Clinic of Skin and Venereal Diseases of the Sechenov University. A. Rakhmanov, Sechenov University, with the participation of 80 patients with postacne scars of varying severity. The Hyalual Perfoskin Complex device was used for microneedling in combination with a sodium succinate preparation based on hyaluronic acid. The apparatus was used in a linear technique along the Langer tension lines and in mutually perpendicular direction, 1015 passes in each area (lower jaw, cheek-curve area, forehead area). Each subject underwent 4 treatments at 21-day intervals. Clinical assessment of the treatment dynamics before and after treatment was performed using the Miravex 3D multispectral imaging device. Before and after treatment, patients were evaluated for the severity of postacne scars according to the International Qualitative Scale for the classification of postacne scars, as well as a dermatological index of quality of life. Subjective evaluation of the effectiveness of therapy by the physician and the patient was performed using the International Global Aesthetic Improvement Scale one month after each treatment and 3 months after the last treatment.
 RESULTS: Among the 80 patients, 47 women and 33 men aged 18 to 46 years had atrophic postacne scars of varying severity: I in 9, II in 26, III in 40, and IV in 5 patients; the rashes were most often localized to the cheek-cusp (55; 69%) and forehead (15; 19%) and were represented by U-shaped (35; 44%), V-shaped (17; 21%), M-shaped (19; 24%) and macular (9; 11%) patterns. The duration of the disease averaged 5.33.2 years. Improvement of the clinical picture was observed in 92.5% of cases after treatment. For example, 8 patients with I degree of scarring managed to achieve complete clearing of the skin; out of 26 patients with II degree of scarring, 15 patients achieved I degree of severity and 10 patients experienced clinical remission at the end of treatment; in the group of patients with III degree of scarring (n=40), 18 patients had I degree of severity, 20 patients had II degree of severity; in the group of patients with IV degree of severity after 4 treatments, 2 patients had III degree of severity and 1 patient had II degree of severity. The dermatological quality of life index decreased by 77% on the average: from 18.632.28 to 4.253.16. The final result was considered "optimal aesthetic result" by doctors and patients in 86% and 82% of cases, respectively, "significant improvement" in 4% and 12% of cases, respectively, "improvement" in 2.5% and 4% of cases, respectively, and "no change" in 7.5% and 2%, respectively. All patients noted good tolerability of treatment. Thus, side effects in the form of skin redness and painful sensations were insignificant and passed on their own within 23 days after the procedure.
 CONCLUSION: Microneedling with high-molecular-weight hyaluronic acid and sodium succinate has demonstrated high efficacy and safety in the treatment of postacne scars of varying severity. The minimal invasiveness and affordability of the procedure result in high patient adherence to therapy.

Median nerve entrapment in surgical scar: a rare complication in volar plating of fractures of distal end radius

A 25-year-old male presented to our OPD with pain and swelling of right wrist following trauma by RTA. X ray showed comminuted intraarticular fracture distal end radius (R) and confirmed with 3D CT. Patient was operated 15 days later with plate osteosynthesis using a 3-hole Elli’s T plate. The patient presented with complaints of numbness and tingling sensations over lateral 3 and half fingers about 2 months after surgery. Previous scar tissue excision was done which exposed the median nerve adhesions in its distal course with the scar tissue followed by median nerve neurolysis with carpal tunnel release was done.

Complex reimplantation of an inflatable penile prosthesis with scar tissue excision and distal corporal defect repair with Tutoplast® pericardium allograft

AbstractBackgroundPatients with inflatable penile prostheses (IPP) may experience erosions after years of use or after indwelling Foley catheter placement. IPP erosions should be managed as an infection with the entire IPP removed. Replacing IPPs in erosion patients can be challenging due to extensive scarring development. Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long‐term success of IPP reimplantation.Case PresentationHerein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie's disease, presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery. The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy. A complete explantation of IPP was then performed. Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast® pericardium allograft. The procedure was successful with proper IPP position and good function without any penile deformity.ConclusionThe use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision. The Tutoplast® pericardium allograft reinforcement can provide long‐term durability, flexibility, and a lower risk of infection.

Tissue Recycling with Split-Thickness Skin Graft Harvested from a Failed Free Flap

Failure of free flaps is frustrating for both patients and surgeons. Since a large amount of tissue was already used in the first operation, much consideration should be given to donor site and tissue preservation in revision procedures. Recycling tissue by salvaging skin from the failed flap is one option. A 59-year-old man with a scar contracture deformity on his right medial thigh underwent scar tissue excision and thoracodorsal artery perforator free flap coverage. Unfortunately, flap compromise was found on the second postoperative day and flap salvage failed due to extensive thrombus. A second thoracodorsal artery perforator free flap from the contralateral side was used for revision surgery. A split-thickness skin graft was performed with skin harvested from the failed flap to cover the second donor site. Multiple hand-held retractors provided appropriate tension for harvesting the skin. The grafted skin was successfully taken after 3 weeks. This study explores the viability of a split-thickness skin harvested from a failed flap with more than 48 hours of ischemic time. The reusability of skin from a failed free flap in revision surgery can both minimize the need for additional donor sites and reduce unnecessary pain.

Resection of Scar Tissue in Rats With Spinal Cord Injury Can Promote the Expression of βⅢ-tubulin in the Injured Area

Previous research shows that scar tissue formed in the injured area after spinal cord injury blocks nerve regeneration and functional recovery. However, those researchers tried to prevent the formation of scar after spinal cord injury to promote nerve regeneration, but it ran counter to their desire, indicating that the formation of scar might play a role in functional recovery after spinal cord injury. To investigate roles of scar formation on functional repair after spinal cord injury, we selected several different key time points to resect the scar tissue formed after spinal cord injury based on the rat models of the T8-T9 transection injury of spinal cord. First, the recovery of motor function was evaluated by Basso Beattie Bresnahan score and electrophysiologic examination; second, the pathologic features of functional recovery were analyzed mainly by immunofluorescence βⅢ-tubulin staining; finally, the genes related to the recovery of motor function were predicted by high-throughput sequencing analysis. Immunofluorescence results showed that the resection of scar tissue promoted significantly the recovery of motor function and the expression of βⅢ-tubulin in the injured area in the second week after spinal cord injury. Furthermore, RNA-seq studies showed that Tubb3 and Tubb6 gene expression and other neural regeneration pathways were significantly different in the tissue before and after early resection. Excision of scar tissue in the second week promoted nerve regeneration after spinal cord injury. Tubb3 and Tubb6 genes might be the potential targets for spinal cord injury therapy in our study.

Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy

To demonstrate laparoscopic management of a molar scar ectopic pregnancy. Stepwise demonstration of the technique with narrated video footage. Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively. Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].

Метод лечения рецидивирующего герпетического кератита на основе послойной кератопластики с фемтосекундным сопровождением (серия клинических случаев)

Purpose. To evaluate the clinical efficacy of lamellar keratoplasty in the treatment of recurrent herpetic keratitis with femtosecond laser-assisted corneal surgery. Material and methods. In two clinical cases, lamellar keratoplasty with femtosecond laser-assisted corneal surgery was performed. Preoperative and postoperative visual acuity, refractometry, keratotopography, pachymetry were examined. Conducted courses of conservative treatment: antiviral, anti-inflammatory, desensitization therapy using vaccination «Vitogerpavak». Results. Evidence of the effectiveness of the proposed method was obtained - stabilization and relief of the inflammatory process, increased visual acuity and cosmetic effect. Conclusion. Cases of successful treatment of recurrent herpetic keratitis after intensive courses of conservative treatment followed by lamellar keratoplasty with femtosecond laser-assisted surgery are presented. The use of femtolaser technologies, which allow dosed excision of the affected tissue at a certain depth according to predetermined parameters, contributes to the achievement of high functional results. Lamellar keratoplasty with the maximum possible excision of scar tissue and its replacement with a donor cornea is a minimally invasive effective method to restore the transparency of the cornea after therapeutic treatment of recurrent herpetic keratitis. Key words: keratoplasty, herpetic keratitis, femtosecond laser

Pathomorphological characteristics of the wound bed prior to skin autografting

Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.

Release of gastrocnemius aponeurosis and suture of the Achilles tendon end scar tissue managing the chronic Achilles tendon rupture

To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture. The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively, including 15 males and 2 females, aged 26 to 53 years with an average of (35.2±11.6) years old, and the time from injury to operation was 37 to 92 days with an average of (49.3±13.3) days. Myerson's classification included 6 cases of typeⅡ and 11 cases of typeⅢ. The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed. All patients were treated with gastrocnemius aponeurosis, appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture. The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation. The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation. American Orthopaedic Foot and Ankle Society ankle hindfoot score (AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score (ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture. All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months. The surgical incision healed in stageⅠ. Color Doppler ultrasound showed good continuity of Achilles tendon, local Achilles tendon slightly thickened and irregular fiber direction. The ankle plantar flexor force (92.2±3.9) N at 1 year after operation was significantly higher than that before operation (29.5±4.2) N (P<0.05);One year after operation, the AOFAS(91.20±3.30) was significantly higher than that before operation (42.20±4.40)(P<0.05);the ATRS (90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05). The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture, avoid injury to hallux flexor longus or flexor digitorum longus, with the plantar flexor muscle strength of the ankle was recovered well, is an effective method to treat chronic Achilles tendon rupture.

Management of Disastrous Complications of Penile Implant Surgery

Penile Prosthesis Implantation (PPI) is the definitive treatment for Erectile Dysfunction not responsive to conservative management strategies. Furthermore, it is a staple of surgical treatment of severe Peyronie's Disease (PD) and phallic reconstruction. Expert implantologists occasionally face disastrous complications of penile implant surgery which can prove to be very challenging. In this article we present a selected number of case reports which exemplify this kind of situations and discuss management strategies while also commenting on plausible aetiologies. The first case describes a PPI performed in end-stage fibrotic corpora after multiple instances of implantation/explant. The second and third cases show two diametrically opposed approaches to the management of glans necrosis after PPI in post-radical cystectomy patients. The fourth case describes the history of a diabetic patient suffering from glandular, corporal and urethral necrosis after a complicated PPI procedure. The fifth case reports the surgical treatment of a case of recurring PD due to severe scarring and shrinking of a vascular Dacron patch applied in a previous operation. Complication diagnosis in all patient was mainly clinical, intra- and postoperative, with Penile Color Doppler Ultrasonography performed when needed in order to demonstrate penile blood flow. The patients underwent complex surgical procedures that addressed each specific complication. Complex penile implants with fibrosis-related complications, penile prosthesis explant with and without surgical debridement of necrotic areas, penile prosthesis explant with necrotic penile shaft and urethral amputation with perineostomy, and complex corporoplasty with scar tissue excision and patch application with PPI were performed in the five patients. Penile anatomy and erectile function with PPI was achieved in 4 out of 5 patients. 1 of 5 patient is scheduled to undergo a total phallic reconstruction procedure at the time of this writing. Management of disastrous complications of penile implant surgery can be very challenging even in expert hands. In-and-out knowledge of possible PPI and PD complications is required to achieve an acceptable outcome. Bettocchi C, Osmonov D, van Renterghem K, etal. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021;18:1145-1157.

Y-Shaped Tendon Graft—A Technique in the Reconstruction of Posttraumatic Chronic Boutonniere Deformity

Current reconstruction strategies for chronic posttraumatic boutonniere deformities have variable outcomes and are prone to complications. This study aimed to describe the clinical outcomes of a Y-shaped tendon graft technique. In this retrospective case study, we reviewed the files of 18 patients treated with the Y-shaped tendon graft between January 2010 and January 2017. The technique involves release of the central slip, lateral bands, and transverse retinacular ligaments at the proximal interphalangeal (PIP) joint, total excision of scar tissue in the central slip and at the insertion site, and construction of 3 1.5-mm unicortical holes at the base of the middle phalanx, through which a Y-shaped graft of the palmaris longus is inserted to reconstruct the central slip and stabilize the lateral bands in a dorsal position. Clinical evaluations included measuring the active range of motion in the PIP joint and distal interphalangeal (DIP) joint, grip strength, Souter score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. The mean age of patients was 36.1 years, and 12 of the 18 patients were men. The average follow-up period was 23 months (range, 13-38 months). The preoperative PIP joint extension deficit was 48.0° ± 5.0° compared with 10.9° ± 9.3° after surgery. The preoperative DIP joint active flexion was 34.4° ± 8.0° compared with 71.4° ± 8.6° after surgery The outcomes based on the Souter score were 11 excellent, 5 good, and 2 poor. The QuickDASH score was 17.7 ± 6.4 before surgery and 11.2 ± 7.2 after surgery. The Y-shaped tendon graft can be a useful procedure for the correction of chronic boutonniere deformity; in our patient series, this provided good or excellent results in 16 of 18 patients. Therapeutic IV.

Outcome of successful graft take of Integra and split thickness skin graft after the release of post-burn neck contracture.

Objective: To determine the frequency of the successful graft take of Integra™ and split thickness skin graft after the release of post-burn neck contracture. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Centre, Lahore. Period: 1st October, 2017 to 30th September, 2018. Material &amp; Methods: A total of 70 cases, those who full filled the inclusion criteria were included in the study through non-probability consecutive sampling. Informed consent was obtained from all the patient. Integra was applied in all the patients after the release of contracture and excision of scar tissue and was inspected every 3-5 days. After 3 weeks, the outer layer of silicone sheet was removed and replaced by thin split-thickness skin graft. The graft was secured with skin staples, absorbent gauze and the crepe bandage. All the patients were followed up regularly and the final outcome was assessed at 6 weeks. Results: The mean age of the patients was observed as 34.51 ± 14.19 years with age range of 11to 59 years. Among these 70 patients 61.4% were male and 38.6% were females. The mean body mass index was observed to be 22.59 + 3.68 kg/m2. Out of these 70 patients, the outcome in terms of successful graft take with Integra treatment was achieved in 60 (85.7%) patients. On stratification, statistically insignificant difference was observed for the effect modifiers like age, gender and BMI. Conclusion: In our study we found that Integra and STSG can be considered as one of emerging and promising modality in burn management and reconstructive surgery with the significantly high success rate in terms of complete re vascularization and skin graft take.

Варианты хирургического лечения при хроническом рубцовом постинтубационном стенозе гортани у детей

Objective. To evaluate the effectiveness of a surgical tactics used for the treatment of children with chronic post-intubation laryngeal stenosis depending on the condition of their laryngeal cartilages. Patients and methods. We treated 47 children with chronic post-intubation laryngeal stenosis. Preoperative examination included endoscopy and computed tomography (CT) of the larynx and trachea. We evaluated the condition of their laryngeal cartilages in order to choose an optimal surgical tactics. Children with intact laryngeal cartilages (n = 20) have undergone endolaryngeal microsurgery using a CO2 laser. This method caused minimal injury due to submucosal excision of scar tissue, which enabled wound coverage with mucous microflaps to prevent recurrent stenosis. Surgery for extensive stenosis in the middle portion of the larynx was associated with a risk of recurrent scarring. In our study, we prevented it by using endografts during 21 days. However, patients with lesions in the subglottic larynx still had a high risk of recurrent stenosis (5 out of 12 patients) even if there was no evidence of damage to the laryngeal cartilages. Results. Twenty-seven patients with laryngeal post-intubation stenosis with lesions to the laryngeal cartilages detected before surgery have undergone extralaryngeal laryngotracheoplasty. Eighteen children have undergone laryngofissure with subsequent stenting between 6 and 18 months with a T-shaped silicone stent. Nine patients have undergone single-stage laryngotracheoplasty with autologous grafts. Conclusion. The methods used in this study have demonstrated high effectiveness, while the use of grafts reduced the number of stages of surgery and its duration. Key words: laryngotracheoplasty in children, laryngeal microsurgery, complications of tracheal intubation in children, chronic laryngeal stenosis, cartilage autologous grafts, CO2 laser

Outcomes of chronic distal biceps reconstruction with tendon grafting: a matched comparison with primary repair.

BackgroundThe purpose of this analysis was to analyze outcomes of distal biceps reconstruction with soft tissue allograft in the setting of chronic, irreparable distal biceps ruptures. The outcomes of these cases were then compared with a matched cohort of distal biceps ruptures that were able to be repaired primarily.MethodsRetrospective review of an institutional elbow surgery database was conducted. All cases of distal biceps repairs were identified by Common Procedural Terminology, ICD-9, and ICD-10 codes from January 2009 to March 2018. A direct review of operative reports was then conducted to identify which cases required allograft reconstruction. After identification of this population, a 2:1 manually matched cohort of patients who underwent primary repair was generated using age, gender, body mass index, and age-adjusted Charlson Comorbidity Index. Finally, the allograft reconstruction and matched primary repair cohorts were compared for reoperation, range of motion, and patient-reported outcomes scores.ResultsThere were 46 male patients who underwent distal biceps reconstruction with allograft (14 Achilles tendon, 32 semitendinosus) and they were matched to 92 male patients that underwent primary distal biceps repair. Mean patient age (46.9 ± 10.3 vs. 47.0 ± 9.8 years, P = .95), BMI (31.3 ± 5.3 vs. 31.3 ± 4.8 kg/m2, P = .60), and Charlson Comorbidity Index (1.2 ± 1.1 vs. 1.3 ± 0.9, P = .64) were similar between allograft reconstruction and primary repair groups. Disability of the Arm, Shoulder and Hand score (7.4 ± 18.0 vs. 1.6 ± 4.1, P = .23), Mayo Elbow Performance Score (92.1 ± 19.7 vs. 97.3 ± 6.4, P = .36), and Oxford Elbow Score (43.4 ± 11.0 vs. 46.8 ± 3.2, P = .25) were not significantly different between groups at mean 5.1 years (range, 1.5-10.9 years) after surgery. There were 1 of 42 (2.2%) allograft patients who require revision compared with 3 of 92 (3.3%, P = .719) in the primary repair group. In addition, one primary repair required reoperation for scar tissue excision and lateral antebrachial cutaneous neurolysis. Final range of motion data (twelve-week follow-up) for the allograft reconstruction group was similar to primary repair group in flexion (136.1° ± 5.3° vs. 135.9° ± 2.7°, P = .81), extension (0.8° ± 2.9° vs. 0.4° ± 1.7°, P = .53), pronation (78.0° ± 9.0° vs. 76.4° ± 15.4°, P = .50), supination (77.4° ± 10.7° vs. 77.5° ± 11.9°, P = .96).ConclusionPatients who underwent distal biceps reconstruction with a graft had similar failure rates, reoperation rates, final range of motion, and patient-reported outcomes scores as those treated without a graft. Patients can be consulted that direct repair in the acute setting is preferred; however, even in the setting of a distal biceps reconstruction with graft augmentation, they can expect low complications and good functional results.

Microsurgery of chronic post-intubation laryngeal stenosis using a CO&lt;sub&gt;2&lt;/sub&gt;-laser

Introduction.Despite significant progress achieved in the surgical treatment of cicatricial laryngeal stenosis and cervical trachea in recent decades, this issue appears relevant, especially among people of young and working age.Aim of the study:To develop tactics for surgical treatment of post-intubation laryngeal stenosis using a CO2-laser.Materials and methods:During the period from 2015 to 2019, surgical treatment was performed for 105 patients with post-intubation cicatricial stenosis of the larynx using microsurgical techniques and a CO2-laser, provided that the cartilage frame of the larynx was preserved, which was determined in a preoperative examination.Results and discussion:In the postoperative period, patients were monitored from 6 months to 3 years. Localization of cicatricial post-intubation laryngeal stenosis in the vestibular region is quite rare. According to the results of the study, achievement of a stable functional result was obtained in 20 (84%) of 24 patients with lesions of the vocal section of the larynx, in one case a cicatricial membrane of this section of the larynx was required to be excised after one year, and laryngoplasty with extra laryngeal access in four cases. Post-intubation stenosis of sub-folded localization is most widespread, and in our observations they amounted to 79%. The use of endolaryngeal access using a CO2-laser made it possible to achieve a good functional result in 66% of cases, reconstruction of the larynx by extra-laryngeal access was required in 33%, and laryngotracheal resection in 1%.Conclusion:It is shown that the use of a CO2-laser in the surgical treatment of chronic post-intubation laryngeal stenosis significantly expands operational capabilities due to the high accuracy and low level of damage to surrounding tissues. This method allows the formation of minimal wound surfaces by submucosal excision of scar tissue and makes it possible to cover the wound with microlosks of the mucous membrane, reducing the time of epithelization in the intervention area, which is an important prevention of repeated stenosis. In the surgical treatment of extended stenosis of the middle part of the larynx, there are prerequisites for repeated wound replacement with scar tissue, which in our observations was avoided by using endoprostheses. The defeat of the sub-follicular part of the larynx is prone to restenosis even in the absence of data for the defeat of the cartilaginous framework of the larynx.

Isthmocele Repair: Robotic-Assisted Laparoscopy with Simultaneous Hysteroscopy

Video Objective To illustrate the use of robotic-assisted laparoscopy with simultaneous hysteroscopy for the repair of an isthmocele. Setting An isthmocele is a pouch-like anterior uterine wall defect at the site of a previous cesarean scar. The incidence is not well known but is estimated in the literature is between 19 and 88%. Complications arising from an isthmocele may include abnormal uterine bleeding (especially postmenstrual bleeding), abdominal pain, diminished fertility, ectopic pregnancy, or obstetric complications such as uterine rupture. Repair of isthmocele may be indicated for symptomatic relief and preservation of fertility. Multiple surgical approaches have been described in the literature including laparoscopic, hysteroscopic, and vaginal approaches. Interventions In this video, we illustrate the key surgical steps of robotic-assisted laparoscopy with simultaneous hysteroscopic guidance for the repair of an isthmocele. Key surgical steps include: 1. Pre-surgical planning with MRI 2. Diagnostic hysteroscopy for confirmation of isthmocele 3. Simultaneous laparoscopy for identification of borders 4. Strategic hysterotomy 5. Excision of scar tissue 6. Tension-free closure Conclusion Robotic-assisted laparoscopy with simultaneous hysteroscopy is a feasible and safe approach for the repair of an isthmocele.

Фаллопротезирование через завенечный доступ при тотальном кавернозном фиброзе

Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) accompanied by cavernous fibrosis. Methods for creation of space for penile cylinders during prosthesis implantation in patents with total cavernous fibrosis are still under discussion, considering high risk of complications and decrease in penile size. In the presented clinical case, a new surgical technique for performing a three-piece penile prosthesis implantation through subcoronal approach in patient with ED, complicated by total cavernous fibrosis, is described. This clinical case represents our first experience of excavation excision of scar tissue in cavernous bodies through an innovative subcoronoral approach. As a result of performing of excavation excision of scar tissue in cavernous bodies, capacious spaces were created which allowed to use a three-piece prosthesis with a standard cylinder diameter. It ensured good long-term functional and cosmetic results. The first experience of excavation excision of fibrotic cavernous bodies during inflatable penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with ED and total cavernous fibrosis.