Experienced Surgeons Research Articles

Metallic Intraocular Foreign Bodies Following Torsional Phacoemulsification Surgery

ABSTRACT Purpose This study aimed to determine the rate of retained metallic intraocular foreign bodies (IOFBs) following torsional phacoemulsification cataract surgery by an experienced surgeon and elucidate related surgical factors, particle origin theories from existing literature, and postoperative visual impact. Methods An observational study was conducted on 300 consecutive cases of cataract who underwent torsional phacoemulsification by a single surgeon using two-handed stop-and-chop technique. The incidence of retained IOFBs was observed and correlated with the surgical parameters and the density of cataract. Results Retained IOFBs were observed in 6 of 300 (2%) cases operated. These were significantly associated with higher cumulative dissipated energy and the density of cataract, but without impacting final vision. Conclusion Phacoemulsification retains inherent risks of metallic particle liberation from ultrasonically stressed instrumentation interacting within confined spaces. However, small retained IOFBs appear visually inconsequential over limited follow-up. Advances in technique, engineering design, and surgical quality control hold promise for further enhancing safety of the procedure.

Radical prostatectomy outcomes of prostate cancer cases: Insights from a leading surgeon's experience in Azerbaijan.

Prostate cancer is a significant health concern worldwide and ranks as the 4th most frequent cancer among men in Azerbaijan. While robot-assisted laparoscopic radical prostatectomy is the preferred surgical technique in many countries, open retropubic radical prostatectomy (ORP) remains the primary treatment option in Azerbaijan due to limited access to robotic surgical systems. This study aims to analyze the outcomes of ORP in patients with local and locally advanced prostate cancer. We retrospectively evaluated 95 men who underwent extraperitoneal retropubic ORP for prostate cancer at our center between May 2020 and December 2023. Comprehensive data on patient demographics, preoperative parameters, surgical details, and postoperative outcomes were collected. Statistical analyses were conducted using IBM SPSS 27.0 software. The mean age of the patients was 65.9 years. The median preoperative PSA level was 14.8 ng/mL, and lymph node enlargement was identified in 29.5% of patients. A rectal injury occurred in one patient (1.1%) as the only intraoperative complication. The mean intraoperative blood loss was 330 mL, and the median hospital stay was 6 days. A positive surgical margin was observed in 38.9% of cases. Diabetes mellitus and higher intraoperative blood loss were associated with prolonged hospital stays (≥ 7 days). Erectile dysfunction was reported in 52.6% of patients 6 months postoperatively, while urinary incontinence was observed in 2.2%. ORP outcomes in Azerbaijan are comparable to those reported for laparoscopic and robot-assisted techniques in terms of perioperative and oncological results. Despite the absence of advanced surgical technology, ORP remains an effective treatment option for prostate cancer when performed by experienced surgeons.

Histopathological Findings of Epithelial Invasion after Arcuate and Radial Keratotomies.

Complications after arcuate (АKs) and radial keratotomies (RKs) may include infection, delayed wound healing, and epithelial invasion. To assess the histopathologic findings of epithelial invasion following АK/RK. The study included patients who underwent penetrating keratoplasty (PK) after previous АK or RK treatment. In corneas with histologically confirmed epithelial invasion, the following parameters were examined: invasion depth (µm), width (µm) in the superficial, middle, and deep stroma, and the ratio of invasion depth to corneal thickness. The time between АK/RK and PK was compared for corneas with and without detectable epithelial invasion. Out of 31 excised corneas, 7 (22%) showed epithelial invasion 2 to 19 years (median 6 years) after АK/RK. Histological examination revealed different invasion patterns, with a mean depth of 315 (231 to 395) µm or 57% (46 to 66%) of corneal thickness. The mean width in the superficial stroma was 291 (75 to 789) µm, in the middle stroma 210 (33 to 422) µm, and in the deep stroma 164 (19 to 324) µm. No significant association was found between the presence of the epithelial invasion and the time after PK (p = 0.83). In almost a quarter of the eyes after АK or RK, epithelial invasion could be detected. The potential biomechanical instability associated with this should be considered in cases of trauma as well as in the context of planning cataract surgery or PK, particularly in the hands of less experienced surgeons. Nonmechanical contact-free excimer laser trephination may be helpful in PK.

Clinical practice guidelines for the treatment of squamous cell carcinoma of the head and neck: an assessment based on the AGREE II, AGREE-REX tools and the RIGHT checklist

ObjectiveThe aim of this study was to obtain several published clinical practice guidelines (CPGs) for Head and neck squamous cell carcinoma (HNSCC) and critically assess and compare their quality by using three guideline quality evaluation tools, namely, AGREE II, AGREE-REX, and RIGHT, to support the development of future CPGs for HNSCC.MethodsClinical practice guidelines related to the diagnosis and treatment of HNSCC were screened through a comprehensive systematic literature search. Data were extracted from the guidelines which met the inclusion criteria, and two experienced head and neck oncology surgeons were trained to act as independent reviewers. The quality of the retrieved guidelines that met the inclusion and exclusion criteria was evaluated by using the AGREE II, AGREE-REX, and RIGHT tools. Then, the quality of the guidelines that met the criteria was assessed. Finally, conclusions and recommendations were drawn based on the scoring results.ResultsA total of eight guidelines met the inclusion criteria. Four guidelines(written by ASCO, NCCN, CCO and KCE) scored > 60% in five or more AGREE II quality domains, two guidelines(written by ASCO and KCE) scored > 60% in all AGREE-REX quality domains, and two guidelines(written by ASCO and KCE) scored > 60% in all quality domains on the RIGHT checklist and were considered “recommendable”.ConclusionsThe authors recommend consulting the American Society of Clinical Oncology guidelines for HNSCC and suggest that future guideline development groups refer to the guideline evaluation framework for guideline writing to enhance the applicability and effectiveness of clinical practice guidelines.

Straight and helical plating with locking plates for proximal humeral shaft fractures- a biomechanical comparison under physiological load conditions.

Helical plating is an established method for treating proximal humeral shaft fractures, mitigating the risk of iatrogenic radial nerve damage. However, biomechanical test data on helical plates under physiological load condition is limited. Hence, the aim of this study was to compare the biomechanical performance of helical and straight PHILOS® Long plates in AO12C2 fractures using static and cyclic implant system testing. Helical and straight PHILOS® Long plates on artificial bone substitutes were tested under physiological axial static (n=6) and cyclic loading (n=12). The axial construct stiffness was the main parameter for comparing the biomechanical performance of the two groups. Mimicking a clinical scenario, the helical deformation was performed consecutively by an experienced surgeon using iron bending tools. The torsional angle was determined computationally from 3D-scanning models afterwards. Helical plating resulted in a significantly reduced axial construct stiffness in all test scenarios compared to conventional straight plating (static testing: p=0.012; cyclic testing: p≤0.010). No failure occurred within the range of physiological loading in both groups. Helical plating favors multidimensional deformation of the test sample in lateral-ventral direction under axial loading, resulting in a reduced axial construct stiffness and in an increased interfragmentary movement. No biomechanical failure is to be expected within physiological load boundaries.

Comparison Of Surgical Techniques Used In Post-Traumatic And Non-Traumatic Rhinoseptoplasty

Introduction: The main goals of septorhinoplasty are to correct cosmetic and functional defects, which may occur in a patient with no history of previous trauma. As the most prominent facial feature, the nose has an increased risk of injury. Nasal fracture may eventually result in significant defects; posing challenges to the surgeon.Aim: The aim of the study is to compare the technique used in post-traumatic and non -traumatic cases of rhinoplasties.Materials and methods: The study group consisted of 227 patients, mean age 37.511.4 years, median 36 years, age range from 18 to 79 years. Statistical analysis was performed using the Statistica 13.3 package StatSoft, Dell Statistica. Categorical variables are presented as frequencies and percentages. The Chi2 or Fisher’s exact test - when the number in cells were less than 5, was respectively used to check whether there was a correlation between nasal injuries and surgical technique. The level of statistical significance was assumed to be equal to α=0.05.Results: Statistically significant differences were found in the use of five techniques. Septal filtration to the spine (44.1% vs 10.7%), septal extension graft (5.9% vs 1.3%), spreader graft (41.1% vs 21.1%) and osteotomy (85.3% vs 61.0%) were all performed more in patients with nasal trauma. On the other hand, LC steal was performed significantly more often in patients without nasal trauma (36.5% vs 22.1%).Conclusions: Nose injuries lead to cosmetic and functional complications pose a challenge to the rhinoplasty surgeon. Optimal management in the case of posttraumatic nose requires surgeon's experience and precise surgical planning.

Effects of robotic surgery experience on open radical prostatectomy results: single centre & single surgeon experience

This study aimed to evaluate the effect of robotic surgery experience on open radical prostatectomy (ORP) outcomes. We retrospectively reviewed 100 patients who underwent an ORP for clinically localised prostate cancer (PCa) performed by the same experienced surgeon. The groups included the last 50 patients before (Group 1) and the first 50 patients after (Group 2) robotic surgery experience. A detailed history, peroperative, and oncological data were recorded. Continence status and erectile functions were evaluated before surgery and at 1, 3, 6, and 12 months postoperatively by daily pad count and an International Index of Erectile Function (IIEF) short form and were compared between groups. The demographics and preoperative data were similar. The preoperative and postoperative Gleason score was higher in Group 2 (p = 0.001, 0.033; respectively). The operation time (200 vs. 115 min), estimated blood loss (400 vs. 200 ml), peroperative transfusion rate (46% vs. 8%), drain removal time (4 vs. 3 days), hospital stay (5 vs. 4 days), and urethral catheter removal time (21 vs. 14 days) were significantly lower in Group 2 (p < 0.001). The continence rate was significantly higher in Group 2 in the first month (p = 0.027), but no significant difference was found at 3, 6, and 12 months. Erectile functions (mean IIEF: 9.47 vs. 11.18 at 12th month, p = 0.220) showed no significant difference between the groups in the first year after surgery. In addition to ergonomic benefits, robotic surgery provides a significant surgical procedure experience due to its great visualisation. The most important advantages that robotic surgery adds to our ORP experience were improved early continence; less bleeding and a decreased need for transfusions; and a shorter operation time, hospital stay, and urethral catheter removal time.

Secondary intraocular lens implantation

In recent years, techniques for the secondary implantation of intraocular lenses have undergone significant further development. Despite the wide range of surgical indications, IOL dislocation and aphakia following complicated cataract surgery or other complicated intraocular procedures and trauma remain the most common reasons for secondary IOL implantation. In cases where it is not feasible to place the artificial lens in the capsular bag due to zonular weakness or insufficient stability of the capsular bag, the intraocular lens can be implanted in the anterior chamber or fixed in the ciliary sulcus, on the iris or on the sclera. The techniques differ not only in the anatomical structure of the fixation, but also in the type of intraocular lens and materials used. While some methods are technically easier and quicker to perform, the learning curve for other techniques is flatter and takes more time. The experienced ophthalmic surgeon should be familiar with several of these methods and be aware of the advantages, disadvantages and contraindications of the individual techniques in order to be able to choose the most suitable method based on the findings of the individual patient.

The experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit.

The World Health Organization (WHO) emphasizes the need for radical approaches in its Global Patient Safety Action Plan, particularly in terms of interprofessional and multidisciplinary approaches. The plan highlights the importance of providing training on patient safety for all professionals, focusing on team and task-based strategies that include bedside and simulation education. TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) is an educational programme developed to teach health care professionals on specific tools and strategies to enhance basic teamwork skills. Mutual support, one of the teamwork skills described in TeamSTEPPS®, involves team members assisting one another, providing and receiving feedback on performance, and advocating assertively when patient safety is threatened. The aim of this study was to explore the experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit (ICU) at Hacettepe University. The study employed a basic qualitative research design. The data were gathered through in-depth interviews and analysed with inductive content analysis in accordance with Elo and Kyngäs. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to describe and report the components of study design. We interviewed 13 participants: 6 surgeons and 7 nurses. Six themes were identified: mutual support, positiveness of working in a supportive environment, feedback, effective communication, patient safety and conflict resolution. The results of our study revealed that intra/inter-professional collaboration and mutual trust based on the variety of individual and workplace-related factors improved patient safety through individual motivation while monitoring and supporting each other in a positive environment, providing feedback and encouraging effective communication, patient advocacy and conflict resolution. Exploring the experiences, challenges and successes of health care workers in interprofessional collaboration is crucial. Understanding team dynamics, communication barriers and collaboration strategies can help promote more effective teamwork and contribute to the development of plans to improve the quality of patient care.

Operator Experience With Robot-Assisted Laparoscopic Rectal Resection and the Impact of Using an Extra Arm on Surgical Outcomes.

Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery. A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st-40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes. More anastomoses were performed closer to the anus in the Late group (p = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, p = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (p = 0.001). As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced.

The Facial Rejuvenation Enhancing Cheek Lift (FRENCH LIFT), a Facelift Technique that Treats Sagging of the Anterior Column of the Face: A Single Surgeon's 10-year Experience with 1100 Operated Patients.

Most facelift techniques have limited effect on the nasolabial fold and the more medial part of the face. The facial rejuvenation enhancing cheek (FRENCH) lift can treat both jowl sagging and midface deflation by a monobloc vertical and oblique displacement of the anterior column of the face through an extended subcutaneous dissection. To explain the surgical technique and to show its efficacy on the nasolabial fold, jawline and infraorbital rim. We retrospectively included all patients operated by a single surgeon between 2014 and 2024. Data were collected and analyzed for patient demographics, outcomes and complications. In total, 1100 consecutive patients were included (53 males, 1047 females). Mean age was 58 (29-83) years. Primary facelift was performed in 968 patients, secondary in 132 patients. Associated procedures were performed in 679 cases (25 lipofillings, 509 blepharoplasties, 145 browlifts, 22 bichectomies). The complication rate was 7% (39 hematomas, 5 neuropraxias of the buccal branch, 6 neuropraxias of the mandibular branch, 7 infections, 26 skin necrosis). The FRENCH Lift is a safe and long-term effective facelift technique that allows the treatment of jowl fat sagging, nasolabial fold deepening and infraorbital rim hollowing by a vertical and oblique lifting of the more medial facial fat compartments. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prophylactic central lymph node dissection for low-risk papillary thyroid cancer-Impact on subsequent therapy.

For small papillary thyroid cancers (PTCs) with no lateral nodal involvement, American Thyroid Association guidelines recommend performing prophylactic central lymph node dissection (pCLND) if it influences further management. Our cohort study explored to what extent performing pCLND for small PTCs can de-escalate subsequent therapy including completion thyroidectomy and adjuvant radioactive iodine (RAI) ablation. Adults with T1, T2, and cN0 PTCs were identified from 42 centers across the prospectively maintained Australian and New Zealand Thyroid Cancer Registry (ANZTCR) between 2017 and 2023. Patients were excluded if they had clinical nodal involvement or distant metastases. Subsequent therapy and complication rates were compared between patients with and without pCLND. Out of 1290 patients with T1, T2, and cN0 PTCs (78% female and median age 53years), 660 (51%) received a total thyroidectomy and 630 (49%) received a hemithyroidectomy. Prophylactic CLND was performed for 477 patients (37%) and 36% uncovered occult lymph node metastases. After adjusting for differences in age, sex, and tumor characteristics, absence of lymph node metastasis after pCLND was independently associated with fewer completion thyroidectomies (adjusted relative risk [aRR]=0.65 and p=0.008) and reduced RAI ablation (aRR 0.55 and p<0.001). Additionally, pCLND was not associated with higher risks of recurrent laryngeal nerve injury (p=0.33), temporary hypocalcemia (p=0.21), or permanent hypoparathyroidism (p=0.48). In specialized settings across Australia and New Zealand, identifying negative lymph nodes from pCLND is associated with reduced completion thyroidectomies and RAI ablation amongst low risk cN0 PTCs. There were no additional complications rates when performed by experienced thyroid surgeons.

A right colectomy case study: transitioning to the Hugo RAS system with a novel 3-ports technique in experienced robotic colorectal practice.

Advancements in robotic technology have revolutionized general surgery, with new platforms and continuous improvements enhancing surgical procedures. Our unit adopted the Da Vinci Si model in 2012 and later the X model for various abdominal surgeries. In early 2023, we integrated the Hugo RAS system by Medtronic into our practice following comprehensive training. This study examines the transition of experienced robotic surgeons from the Da Vinci platform to the Hugo RAS system, focusing on robotic right hemicolectomy. We conducted a retrospective analysis of consecutive adult patients who underwent robotic right hemicolectomy using the Da Vinci X and Hugo RAS systems. Outcomes from the latest seven cases with the Da Vinci X system were compared to the initial seven cases with the Hugo RAS system. The baseline characteristics of the two groups were comparable, with no significant differences in age, sex, comorbidities, ASA score, or BMI. Operative times showed a trend towards being shorter with the Da Vinci X (127 ± 30min) compared to the Hugo RAS (163 ± 43min), but this was not statistically significant (p = 0.2). Other measures, including blood loss, anastomotic configuration, and length of hospital stay, were similar. Two non-surgical postoperative complications occurred in the Hugo RAS group, with no complications in the Da Vinci X group. There were no 30-day readmissions or reoperations in either group. Experienced robotic surgeons can seamlessly transition to the Hugo RAS system for right hemicolectomy, achieving comparable outcomes to the Da Vinci system.

Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss.

The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, the aim of this study was to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement. A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability. The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°. The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99). This study reveals a correlation between the sTEA and the DCL. Overall, 10° of external rotation of the dorsal femoral cortical bone to the sTEA may serve as a reliable landmark for initial position of the femoral component. Surgeons should be aware that there are outliers in this study in up to 17% of the measurements, which potentially could result in deviations of femoral component rotation.

Principles of Stereotactic Surgery.

Stereotactic procedures are used to manage a diverse set of patients across a variety of clinical contexts. The stereotactic devices and software used in these procedures vary between surgeons, but the fundamental principles that constitute safe and accurate execution do not. The aim of this work is to describe these principles to equip readers with a generalizable knowledge base to execute and understand stereotactic procedures. A combination of a review of the literature and empirical experience from several experienced surgeons led to the creation of this work. Thus, this work is descriptive and qualitative by nature, and the literature is used to support instead of generate the ideas of this framework. The principles detailed in this work are categorized based on 5 clinical domains: imaging, registration, mechanical accuracy, target planning and adjustment, and trajectory planning and adjustment. Illustrations and tables are used throughout to convey the concepts in an efficient manner. Stereotactic procedures are complex, requiring a thorough understanding of each step of the workflow. The concepts described in this work enable functional neurosurgeons with the fundamental knowledge necessary to provide optimal patient care.

Surgical and oncological outcomes of salvage radical prostatectomy after focal therapies: a matched-pair analysis.

To determine the surgical and oncologic outcomes of salvage radical prostatectomy (sRP) after FT failure. Patients who consecutively underwent primary RP or sRP after FT failure between 2008 and 2022 were retrospectively selected. Primary or sRP were performed with either a robot-assisted or open approach. All surgeries were performed by surgeons with experience of ≥ 500 cases. Biochemical recurrence-free survival (BFS), intra- and postoperative surgical and functional outcomes were assessed. To evaluate the impact of surgical setting, propensity score (PS) matching was performed. 80 patients received sRP. Outcomes were analyzed using PS-matched cohorts (203 RPs vs. 68 sRPs). After a median follow-up of 25.4 months, sRP and RP had equal BFS (24mo-BFS: 72.4% vs. 76.0% (p = 0.8)). No statistically significant differences were found between sRP and RP in terms of median operative time (OT) (171min vs. 168min), estimated blood loss (EBL) (500ml vs. 500ml), length of hospital stay (LOS) (7 days vs. 7 days) and time to catheter removal (11 days vs. 11 days) and 1-year continence rates (all standardized mean differences ≤ 0.1). The main limitation is the retrospective study design. In the hands of experienced surgeons, sRP after FT offered comparable surgical and oncologic outcomes as RP in a primary setting.

Surgeon experience affects perioperative pain in cats undergoing elective ovariohysterectomy: a randomized clinical trial.

This study aimed to compare the outcomes between surgeries performed by either experienced or inexperienced surgeons by assessing intraoperative nociception and perioperative analgesia. 16 healthy, client-owned female cats were randomly allocated into 2 groups of 8: one undergoing surgery by an experienced surgeon (GES group) and the other by inexperienced surgeons (GIS group). Both groups received IM premedication with acepromazine (0.05 mg/kg) and methadone (0.3 mg/kg). After 20 minutes, venipuncture and induction with propofol (dose-response, IV) were performed. Maintenance was achieved with inhaled isoflurane. Intraoperative vital parameters were monitored, and fentanyl (2.5 µg/kg, IV) was administered as rescue analgesia when needed. Postoperatively, pain was assessed with a visual analog scale and the multidimensional pain scale of the Universidade Estadual Paulista in Botucatu; morphine (0.2 mg/kg, IM) was used for rescue analgesia, as necessary. In the GIS group, significant increases in heart rate and systolic blood pressure were noted during surgery, especially during pedicle clamping. Respiratory rate and end-tidal isoflurane levels were higher in the GIS group at specific surgical stages. Survival analysis indicated that the GIS group had a greater need for fentanyl. Postoperative pain scores were generally low, but a higher proportion of GIS cats required rescue analgesia. Surgeon experience influences intraoperative parameters and fentanyl consumption. Inexperienced surgeons contribute to increased postoperative pain and poorer wound healing outcomes in cats undergoing elective ovariohysterectomy. Ovariohysterectomy is a common procedure in veterinary practice, and surgical expertise significantly impacts pain management and recovery. Yet, its effects have been underexplored, potentially compromising animal welfare.

On the consequences of intra-operative release versus over-tensioning of the posterior cruciate ligament in total knee arthroplasty.

Intra-operative tensioning of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) is commonly based on the surgeon's experience, resulting in a possibly loose or overly tight PCL. To date, the consequences of different PCL tensioning scenarios for the post-operative biomechanics of the knee remain unclear. Using a comprehensive musculoskeletal modelling approach that allows predictive joint kinematic and kinetic balance, we assessed variations in the movement and loading patterns of the knee as well as changes in ligament and muscle forces during walking in response to systematic variations in the PCL reference strain. The results indicate only small differences in the tibiofemoral and patellofemoral kinematics and kinetics for scenarios involving up to 10% release of the PCL (relative to the baseline reference scenario with 2% residual strain). These observations remain valid for simulations performed with high- as well as with low-conformity implant designs. However, over-tensioning of the ligament was found to considerably overload the tibiofemoral joint, including altered contact mechanics, and may therefore shorten the implant longevity. Finally, no meaningful impact of the PCL reference strain on the muscle force patterns was observed. This study therefore favours balancing the knee with a slightly loose rather than tense PCL, if appropriate intra-operative PCL tension cannot be objectively achieved.

The Use of Reinforced Ovine Mesh in Implant Breast Reconstruction: Equivalent Outcomes to Human Acellular Dermal Matrices and More Cost-effective.

The use of "mesh" in implant-based reconstruction is widespread, with both acellular dermal matrices (ADMs) and extracellular matrices (ECMs) being used, especially in prepectoral device placement. This study compared Ovitex (ovine ECM) versus human cadaveric ADMs to determine safety profiles and cost-effectiveness. A single surgeon's longitudinal experience with 2-stage, immediate tissue expander breast reconstruction from 2018 to 2023 was analyzed. Patients with AlloDerm and Cortiva (human ADM) were compared with those receiving Ovitex, and 90-day complications were analyzed by chi-squared and analysis of variance. Costs of each mesh were tabulated based on available market data. Patient demographics were comparable. Of 127 patients, 85 received ovine ECM (163 breasts) and 42 received cadaveric ADM (81 breasts). No significant difference between the groups for complications requiring return to the operating room (12.7% ovine vs 14.8% human (P = 0.31) or minor complications (9.8% ovine vs 7.4% human, P = 0.34). There was no difference between reconstructive success and failure between the 2 groups (P = 0.066). The cost of Ovitex was 24%-38% cheaper than Cortiva and AlloDerm, respectively. In this longitudinal, single-surgeon study of 2 different types of meshes in 2-stage expander implant breast reconstruction, we found ovine multilaminated reinforced extracellular matrix (Ovitex) was comparable in outcomes with human acellular dermal matrices (AlloDerm and Cortiva). Ovine mesh was considerably cheaper. Multiple factors determine which mesh should be chosen for implant breast reconstruction. This study supports the use of Ovitex as a cost-effective substitute for human acellular dermal matrices in implant breast reconstruction.

Closed Reduction Followed by Percutaneous Fixation of Acute Femoral Neck Fractures in Young Adults: A Retrospective Cohort Study

OBJECTIVES: To evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique because it pertains to reduction quality, rates of union, and risk factors for complication. METHODS: Design: Retrospective cohort study with radiograph and electronic medical record review. Setting: Level 1 Swiss Trauma Center. Patient Selection Criteria: Between 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous internal fixation were selected. Exclusion criteria were open reduction technique, age older than 65 years or younger than 16 years, pathologic fractures, and associated femoral head or shaft fractures. Outcome Measures and Comparisons: Primary outcome was quality of reduction, as assessed by 3 experienced trauma surgeons' evaluation of intraoperative and/or first postoperative radiographs using the overall impression, the Garden alignment index, and Lowell criteria. In addition, clinical outcomes, conversion to arthroplasty, and complications after closed reduction and fixation of femoral neck fractures were reviewed. RESULTS: A total of 54 patients with a median interquartile range age of 57.5 (48–60) years were included. Among them, 22 (41%) were women and 32 (59%) were men. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (P = 0.03). CONCLUSIONS: The study supported the use of the closed reduction technique for acute FNF in patients younger than 65 years, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index, and Lowell criteria, in evaluating the quality of the reduction. In addition, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.