Faster Functional Recovery Research Articles

BONE-CEREBRAL CHANNEL REAMING IN THE TREATMENT OF LIMBS BONE FRACTURES

The object of the study: clinical effect of intramedullary blocking osteosynthesis of fractures of the bones of the extremities without reaming of the bone marrow canal. The problem to be solved: determination of the influence of surgical technology of intramedullary blocking osteosynthesis of bone fractures without reaming of the bone marrow canal on the qualitative and anatomical and functional results of treatment. Main scientific results. The term of fusion of bone fragments in complete groups (including all localizations) in the group of patients who underwent surgery with reaming of the bone marrow canal was 4.21±0.46 months, while in the group without reaming of the canal it was much shorter – 3.47±0.51 months Faster functional recovery of the limbs was also observed in cases that precluded bone marrow reaming – 96 % of good and 4 % satisfactory scores were obtained (80 % good and 20 % satisfactory in bone marrow reaming). The technology of closed intramedullary blocking osteosynthesis without reaming of the bone marrow can optimize the time of fusion of bone fragments and get 91 % good and 9 % satisfactory results. Its effectiveness is to reduce the number of satisfactory treatment results by 19 %, the absence of unsatisfactory and increase the share of good results by 23 %. The area of practical use of research results: clinics of traumatological profile of different levels, in which surgical treatment of fractures of the bones of the extremities are done. An innovative technological product: technology of closed intramedullary blocking osteosynthesis without reaming of the bone marrow canal. The area of application of an innovative technological product: clinical practice of using the technology of closed intramedullary blocking osteosynthesis without reaming of the bone marrow canal.

Comparison of the safety and outcomes between keyhole surgery and total laminectomy for resection of intradural extramedullary spinal cord tumors

Objective: To compare the safety and outcomes between keyhole surgery and total laminectomy for resection of intradural extramedullary spinal cord tumors. Methods: Retrospectively collected the clinical data of 102 patients with intradural extramedullary spinal cord tumors(≤3 cm) treated by surgery in Department of Orthopedics in Fujian Provincial Hospital from January 2014 to January 2017. Fifty cases underwent the keyhole surgery and the other 52 received total laminectomy. The operation time, volume of intraoperative bleeding, the leaving bed time, the length of postoperative hospital stay, drainage, postoperative complications, intraoperative neuroelectrophysiological monitoring (IONM), preoperative and postoperative visual analogue score (VAS), neck disability index (NDI), Oswestry disability index (ODI), McCormick spinal cord function grading were analyzed and compared between the two groups to evaluate the safety and clinical outcomes. The data of two groups were compared by t, χ(2) or rank sum test. Results: The keyhole group was followed up for (30±15) months and the total laminectomy group was followed up for (45±15) months. All the tumors were completely resected. All the incision healed well and no cerebrospinal fluid leakage occurred. There was no statistically significant differences in baseline data, operation time, the results of IONM, preoperative and 3 months, 6 months, 12 months postoperative VAS, NDI (cervical tumors), ODI (thoracic and lumbar tumors), McCormick spinal cord function grading, tumor recurrence between the two groups (all P>0.05). The keyhole group had less intraoperative bleeding than that in the total laminectomy group ((73±24) ml vs (136±26) ml, t=-12.610, P<0.05), earlier postoperative leaving bed time ((1.4±0.6) d vs (6.5±1.0) d, t=-31.822, P<0.05), and the postoperative hospital stay was shorter ((4.3±0.8) d vs (11.2±2.0) d, t=-22.319, P<0.05), and it was more advantageous in terms of drainage. The VAS, NDI and ODI in the keyhole group improved significantly compared with those in the total laminectomy group 2 weeks post operation (all P<0.05). Conclusion: Compared with the total laminectomy, keyhole surgery is suitable for the treatment of intradural extramedullary spinal cord tumors with small size and limited location, and it is equivalently safe with faster functional recovery.

Flexor Hallucis Longus Tendon Impingement Syndrome: All-inside Arthroscopic Treatment and Long-term Follow-up

This study aimed to evaluate the surgical technique and long-term clinical outcomes of all-inside arthroscopic treatment for flexor hallucis longus (FHL) tendon impingement syndrome. We retrospectively evaluated 34 FHL tendon impingement syndrome patients with complete follow-up data who were admitted from June 2015 to August 2018 and underwent the all-inside arthroscopy technique. The subjects consisted of 20 (58.82%) males and 14 (41.18%) females, with a mean age of 32.7 ± 10.2 (range 21-52) years. The cases consisted of 19 (55.88%) right and 15 (44.12%) left feet. The mean disease duration was 18.5 ± 9.1 (range 10-43) months. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS), Karlsson Ankle Functional Score (KAFS), and 36-item Short Form Health Survey questionnaire (SF-36) scores for pain were 3.6 ± 1.2, 84.1 ± 9.6, 86.3 ± 10.7, and 94.7 ± 9.3, respectively. All patients were treated with all-inside posterior arthroscopy for the debridement of the FHL tendon sheath combined with partial muscle belly resection. Post-operative follow-up and observation of the patients' pain and ankle movement were evaluated using VAS, AOFAS, KAFS, and SF-36. All incisions were healed in the first stage, and no complications such as nerve, blood vessel, or tendon injuries occurred. The hospital stays were 3 to 5 days, with a mean of 3.7 ± 1.3 days. All patients were followed up for 12 to 36 months, with a mean follow-up time of 25.4 ± 8.5 months. By the last follow-up, the ankle joint and hallux movement were normal and returned to the pre-pain state for these patients. The VAS score decreased to 0.2 ± 0.1, while the AOFAS, KAFS, and SF-36 scores increased to 97.7 ± 8.5, 97.9 ± 8.2, and 118.2 ± 8.4, respectively. Advantages of all-inside posterior arthroscopic partial muscle belly resection for the treatment of FHL tendon impingement syndrome include small surgical trauma, fast functional recovery, and reliable outcomes. This procedure is therefore worthy of clinical attention and promotion.

The impact of enhanced recovery on open and laparoscopic liver resections.

Enhanced recovery after surgery programs (ERP) have been implemented in many surgical specialties. Their impact in liver surgery is poorly understood and approach-specific ERPs have not yet been assessed. This retrospective study aims to analyse the effect of such programs on liver resection. All patients undergoing liver resection at a tertiary referral centre between January 2009 and April 2019 were identified. Primary outcome was the length of stay (LOS), secondary outcomes were functional recovery, complications and readmission rates. Patients in the ERP with different protocols for open, laparoscopic, major and minor resections were compared to a historical cohort. Of 1056 patients, 644 were treated within the ERP. A comparable duration of hospital stay [7days (IQR (interquartile range) 6-12) vs 7days (IQR 5-9) p = 0.047] and faster functional recovery with fewercomplications was found in the ERP group [94 (50.5%) vs 103 (35.9%) p < 0.002]. Those advantages were smaller after open minor compared to open major resection. In patients undergoing laparoscopic resection no differences were observed except for a lower readmission rate [21 (9.3%) vs 13 (3.6%) p = 0.005]. Multivariable analysis showed that laparoscopy was associated with a shorter LOS. ERPs offer significant advantages in open liver surgery. Those advantages are less evident after laparoscopic resection.

Cocktail Treatment with a Gelatin Sponge Impregnated with Ropivacaine, Dexamethasone, and Vitamin B12 Promotes Early Postoperative Recovery after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective, Case-Controlled Study

Percutaneous endoscopic lumbar discectomy (PELD) can only relieve mechanical compression but cannot directly reduce the inflammatory reaction of the adjacent nerve root, which contributes to persistent pain and physical disabilities postoperatively. Numerous studies have explored the application of epidural steroids after an open lumbar discectomy in relieving pain by reducing local inflammatory reactions and further peridural scar formation. To explore that whether "cocktail treatment" in which a gelatin sponge was impregnated with ropivacaine, dexamethasone, and vitamin B12 promoted early postoperative recovery after PELD. Retrospective, case-controlled study. All data were from Hong-Hui Hospital in Xi'an. Between January 2016 and January 2017, 100 patients of single-level lumbar disc herniation were treated with PELD in our hospitals. The cocktail treatment was applied in the first 50 patients (group cocktail), and an equal size gelatin sponge without drugs was used in the other 50 patients as control (group noncocktail). The clinical outcome evaluation included the Visual Analog Scale (VAS) score for back and leg pain and Oswestry Disability Index (ODI) score. There was a significant difference in the mean periods of return to work (4.25 ± 1.88 weeks in the cocktail group and 5.18 ± 2.19 weeks in the noncocktail group) (P < 0.01). Compared with the preoperative data, a significant improvement in VAS scores of back pain and sciatica and ODI were observed in each follow-up interval (P < 0.05, respectively). In the noncocktail group, there were visible fluctuations in the 3 indicators within the first week after surgery. This phenomenon was not observed in the cocktail group, a difference that was statistically significant (P < 0.05, respectively). In further follow-up, no significant differences were observed between the 2 groups (P > 0.05, respectively). The nonrandomized, single-center, retrospective design is a major limitation of this study. The "cocktail treatment" with a gelatin sponge impregnated with ropivacaine, dexamethasone, and vitamin B12 promotes early and satisfactory back and leg pain relief and fast functional recovery after PELD. Endoscopic lumbar discectomy, lumbar disc herniation, steroids, nerve root block, gelatin sponge.

Minimally Invasive Plate Osteosynthesis for Distal Radius Fractures: Are There Any Advantages Against Conventional Technique?

Purpose of the study — to illustrate the potential and to evaluate the late term results of minimally invasive plate fixation for distal radius fractures (DRF) and compare it to the treatment outcomes for patients with similar injuries where internal fixation was performed through conventional volar surgical approach. Material and Methods. 96 patients with DRF fractures were included into the study who underwent volar plate fixation by with angular stability. The main group included 42 patients (29 women and 13 men) with DMR where minimally invasive volar approach was used. Mean age of patients was 38 years (from 21 to 57 years). Control group consisted of 54 patients (33 women and 21 men) with mean age of 43 years (from 26 to 64 years) who underwent fracture stabilization via conventional volar approach. Minimal follow up after surgery and discharge was 3 months. In the late period roentgenological, functional and cosmetic outcomes were evaluated as well as patients’ satisfaction by QuickDASH-9 survey. Results. 95 patients (98.9%) demonstrated fracture consolidation in terms up to 6 weeks irrespective of surgical technique which was confirmed by X-rays during control examination. In one female patient (1.1%) consolidation following minimally invasive plating was not achieved even in one year after surgery which was considered as distal radius pseudarthrosis but featuring excellent functional outcome. Surgery time for minimally invasive fixation was 47 (41;53) minutes and for conventional surgical approach – 43 (37;46) minutes (р = 0.731). Mean time of image intensifier use during internal fixation averaged 54 (47;63) seconds during minimally invasive technique and 33 (29;37) seconds for conventional open technique (р = 0.046). Statistically significant larger flexion and extension ranges, pronation and supination angles as well as higher grip force were observed in the group of minimally invasive internal fixation in 1, 2 and 3 months after the surgery (р0.001). Statistically lower scores for QuickDASH-9 survey were reported for the main group in 2 and 3 months postoperatively (р0.001). Cosmetic results were better in patients after minimally invasive approach. Conclusion. Minimally invasive plating fixation of DRF is the efficient and relatively safe surgical option for such injuries. The key arguments for such approach: preservation of bone vascularization which minimally slows down fracture healing, reduced risk of infectious complications, fast functional wrist recovery already in early postoperative period as well as satisfaction of patients with cosmetic effects.

Efficacy and safety of minimally invasive axial presacral L5-S1 interbody fusion in the treatment of lumbosacral spine pathology: a retrospective clinical and radiographic analysis.

Background:The surgical treatment of degenerative disc disease L5-S1 is considerably controversial. The purpose of this study was to evaluate the radiographic and clinical results of patients treated with AxiaLif® Technique (AxiaLif®, AMSGroup, Italy) using a minimally invasive pre-sacral approach.Methods:From 2013 to 2018 a total of 52 patients have been treated (12 M, 40 F; mean age 46.3 years). Diagnosis included L5 isthmic spondylolisthesis low-grade dysplasia, primary and secondary degenerative disc disease. 43 patients have been followed for at least 2 years. Fusion assessment was based on plain radiographs and Brantigan fusion criteria at 1, 6, 12 and 24 months after surgery. All patients completed the VAS and ODI at baseline through last follow-up.Results:Clinical results showed good pain resolution. VAS back demonstrated an average reduction over baseline of 50%, 57%, 71%, 77% at 3, 6, 12 and 24 months, respectively (p<0.001). ODI demonstrated an average reduction over baseline of 38%, 51%, 67%, and 72% at the same time points (p<0.001). Complete fusion was demonstrated in 65% of cases, 30% partial fusion and 5% in the absence of bony bridges visible radiographically. We had two major complications, as 1 retroperitoneal hematoma and 1 spondylodiscitis, and one minor complication, as a superficial infection of the surgical wound.Conclusions:The surgical treatment of degenerative disc disease at L5-S1 with minimally invasive technique Axialif showed good radiographic and clinical outcomes with an acceptable rate of complications. Moreover, shorter hospitalization and faster functional recovery are adding factors to choice this technique. (www.actabiomedica.it)

The role of superior capsular approach (SuperPATH) in the treatment of femoral neck fractures with hemiarthroplasty implantation: our experience and review of literature.

Background and aim of the work:since 2003, a series of so called ‘micro-posterior’ approaches have been developed in the orthopaedic surgery to perform total hip replacement. These techniques present several theoretical advantages compared to the classic postero-lateral approach: reduction in blood loss, post-operative pain, and length of stay but also improving functional outcomes. In our hypothesis these goals could also be obtained in patients with femoral neck fractures, especially in the elderly with several comorbidities.Methods:In our series we performed 50 consecutive cemented hemiarthroplasties through SuperPATH approach. At the latest follow-up (FU) 41 patients were included in the study. Clinical and radiological evaluation was performed before the surgery and at the latest FU using VAS score, Harris Hip Score (HHS) and conventional AP and LL X-rays.Results:We didn’t report any intra-operative complication (i.e. periprosthetic fractures, vasculo-nervous injuries or dislocations) or any case with a dysmetria greater than 1 cm. Mean blood transfusion units were 0.8 during surgery (0 – 4) and 1,6 after surgery (0-4). We reported a mean length of stay of 9.7 days (range 7-15) mainly due to our patients’ high comorbidity rate. At the last one-year FU no cases of dislocation, infection and clinical or radiographical signs of prosthetic loosening were recorded. All our patients returned to the same activity level before femoral fracture occurred, according to HHS.Conclusion:The SuperPATH is a real minimally invasive approach with a low rate of intra- and post-operative complications. It is related to a reduced dislocation rate and potentially to a reduced infection rate compared to the conventional surgical approaches, allowing, furthermore, a faster functional recovery. According to our experience the advantages of this type of approach can be obtained in the trauma field too. (www.actabiomedica.it)

Laparoscopic surgery versus open surgery for gastric cancer: big data analysis based on nationwide administrative claims data

PurposeAccumulated evidence indicates laparoscopic surgery (LS) has the advantages of less wound pain, less blood loss, shorter hospitalization, and faster functional recovery than open surgery (OS). Previous studies have analyzed the advantages of LS based on hospital data. This study is the first to compare surgical outcomes and health economic data using nationwide administrative claims datasets for gastric cancer.MethodsThe claims datasets of the Health Insurance Review and Assessment Service for patients that underwent gastrectomy from May 2012 to April 2017 were analyzed. A total of 76,445 cases (LS, 42,395 and OS, 34,050) were included. Postoperative complications and medical costs were included in the analysis.ResultsWe analyzed 76,445 cases of gastrectomy. Analysis showed LS was associated with fewer surgical wound infections (2,114 [6.21%] vs. 1,057 [2.49%], P < 0.001), minor abdominal infections and abscesses (826 [2.43%] vs. 390 [0.92%], P < 0.001), cases of surgery-related peritonitis (50 [0.15%] vs. 31 [0.07%], P = 0.0019), repair surgeries (28 [0.08%] vs. 3 [0.01%], P < 0.001), reoperations (504 [1.48%] vs. 343 [0.81%], P < 0.001), less antibiotic use (1,717 [5.04%] vs. 1,268 [2.99%], P < 0.001), and shorter hospital stays (13.61 days vs. 9.97 days, P < 0.001). However, average medical cost was 510,734 Korean Won (444 US dollar) higher for LS than OS.ConclusionThe study confirms the clinical benefits of LS over OS for gastrectomy in terms of fewer postoperative complications and shorter hospital stays. However, the average medical cost of LS was higher than that of OS.

Plate-Rod Osteosynthesis in Dogs and Cats

Background: Most fractures are caused by traumatic processes due to car accidents, but they can also occur due to bullets, fights and falls. Surgical stabilization is often necessary and shows high rates of bone healing when its basic concepts are followed. The objective of this study is to report cases of shaft fracture in long bones stabilized with intramedullary pin and plate (IMPP) in order to evaluate pre- and postoperative clinical and radiographic signs, correlating the ideal surgical technique described on recent studies with complications resulting from the surgical procedure.Cases: This study includes patients undergoing osteosynthesis with intramedullary pin and plate from January 2015 to December 2016 at the Veterinary Medical Teaching Hospital of UFRGS. During this period, 13 animals (five cats and eight dogs) with long bone fractures were treated with the abovementioned association. Information on breed, age, sex, etiology of the fracture, affected bone, clinical signs, osteosynthesis technique, clinical progress, fracture healing, and postoperative complications was collected for the study. Late postoperative recovery was evaluated by telephone contact with owners. The mean age was 5.4 years (3 months - 15 years) and body weight 17.66 kg (3 - 28.4 kg). The fractures were due to being hit by a vehicle (5), bites (1), accident with a toy (1), and unknown (6).Discussion: All cases included in this study were in the femur, humerus or tibia. Fractures in the radius are also frequent in small animal traumatology, but in this case the use of an intramedullary pin is not recommended. All animals had diaphyseal fractures, which is an important prerequisite for IMPP stabilization. The IMPP association is mainly indicated in cases of comminuted fractures, when it is anatomically impossible to reduce fracture fragments, as occurred with nine patients in this study. The plate did not break of fail in any of the cases, as the association of an intramedullary pin with the plate significantly reduces tension on the plate, increasing bending strength up to ten times. One of the animals presented severe postoperative pain and could not adequately lean on the operated limb. Orthopedic and neurological evaluation led to the conclusion that the long pin in the region of the subtrochanteric fossa could be injuring the sciatic nerve and the animal was reoperated to cut the pin shorter. Pain stopped and after seven months the animal could lean on the limb and move normally, being proprioceptive and showing no pain on palpation and manipulation. The pin used in the IMPP technique should fill 30 to 40% of the diameter of the intramedullary canal at its narrowest portion. Of the 13 patients included in this study, six received pins within the recommended diameter, one received a pin larger than recommended, and five received pins smaller than recommended. The mean diameter of the pin related to the diameter of the medullary canal was 32.3% (19% - 54.8%). The bone healing rate described for IMPP is high (98%), three patients returned for this study reevaluation and all of them presented visible radiographic bone healing. We concluded that osteosynthesis associated with the use of intramedullary pin and plate resulted in adequate stabilization of fractures in the femur, tibia and humerus, allowing fast functional recovery with low complication rates.

Establishing a Protocol for Closed Treatment of Mandibular Condyle Fractures with Dynamic Elastic Therapy

Treatment of mandibular condyle fractures is controversial. Open treatment achieves anatomic reduction with occlusal stability and faster functional recovery but risks facial nerve injury and jeopardizes joint capsule circulation which can lead to bone resorption. Traditional closed treatment avoids these issues but requires prolonged fixation and risks subsequent facial asymmetry, occlusal disturbance, and ankylosis. Rather than wires, closed treatment with elastics allows for customizable management of a healing fracture with ability to alter vector and degree of traction to restore vertical height and occlusion with less discomfort and decreased risk for ankylosis. In this protocol, unilateral condylar fractures were treated with class II elastics ipsilateral to injury and class I contralaterally. Class III elastics were used contralaterally if additional traction was required and Class II elastics were placed bilaterally for bilateral fractures. Patients were sequentially advanced from fixating to guiding to supportive elastics by titrating elastic vector to any dental midline incongruency or chin deviation. Six patients were treated with this protocol with six-month follow-up. Fracture patterns included displaced and dislocated fractures as well as intracapsular and extracapsular condylar fractures. All patients at completion of the protocol had objective centric occlusion with no subjective malocclusion, chin deviation, facial asymmetry, or temporomandibular joint pain. These early data demonstrate a safe and efficacious innovative protocol for closed treatment of mandibular condylar fractures with dynamic elastic therapy.

Comprehensive Comparison of Liposomal Bupivacaine with Femoral Nerve Block for Pain Control Following Total Knee Arthroplasty: An Updated Systematic Review and Meta-Analysis.

To compare the efficacy of liposomal bupivacaine (LB) and femoral nerve block following total knee arthroplasty, we conducted this systematic review and meta‐analysis. 11 trials with 2,908 patients were included in this study. The pooled data demonstrated that total morphine consumption equivalents during the hospital stay was significantly increased in FNB group. In addition, LB has significantly better outcome in view of the postoperative functional recovery, such as the odds of fall, the incidences of straight leg rise (SLR), the number of patients who can walk independently in the day of surgery,the ambulation distance at POD1, the number of patients discharged at POD1. Consistent with the faster functional recovery, liposomal bupivacaine shortens the length of hospital stay. However, there was no significant difference between LB and FNB in terms of Visual Analogue Score (VAS) during the hospital stay. All in all, liposomal bupivacaine has significantly better outcome in view of the postoperative functional recovery and the length of hospital stay compared with femoral nerve block following the total knee arthroplasty.

Spinal endoscopy via percutaneous transforaminal approach for lumbar posterior ring apophysis separation

Objective To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach. Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018. There were 20 males and 12 females, aged 20-47 years [(33.7 ± 6.6)years]. All patients had single-segment lesions. The injured segments were at L3/4 in seven patients, L4/5 in 14 patients, L5/S1 in 11 patients. All patients were treated with spinal endoscopic surgery via percutaneous transforaminal approach. The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded. At 24 hours, 3 months and 12 months after operation, the efficacy was evaluated by visual analogue score (VAS), Oswestry dysfunction index (ODI) and modified MacNab criteria. Results All patients were followed up for 12-30 months, with an average of 15.5 months. The incision length was 7-9.5 mm [(8.0±0.9)mm], the average operation time was 60-155 minutes [(80.5±13.2) minutes], the average intraoperative blood loss was 5-25 ml [(10.6±5.7)ml] and the average number of fluoroscopy was 5-25 times [(9.4±3.4) times]. The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation. Postoperative dysesthesia was noted in one patient, who recovered after neurotrophy and physiotherapy after one week. There were no complications such as open surgery conversion, intervertebral space infection, nerve root injury and dural sac laceration. The VAS and ODI at 24 hours, 3 months and 12 months after operation [low back pain VAS: (3.4±1.5)point, (1.8±1.1)points, (1.7±0.9)points; leg pain VAS: (1.8±1.0)points, (1.6±0.8)points, (1.4±0.6)points; ODI: (26.8±9.7)%, (13.9±4.3)%, (12.8±2.8)%] were significantly improved compared with those before operation [ back pain VAS: (7.3±2.1)points, leg pain VAS: (7.9±2.7)points; ODI: (56.2±15.6)%] (P<0.05). According to the modified MacNab criteria, the results were excellent in 25 patients, good in five patients, and fair in two patients, with the excellent and good rate of 94%. Conclusion Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision, less complications, effective pain relief and fast functional recovery. Key words: Lumbar vertebrae; Endoscopy; Surgical procedures, minimally invasive

Rare Laryngeal Kaposi’s Sarcoma: Case Report and Innovative Surgical Approach

Abstract Kaposi’s sarcoma is an angioproliferative neoplasm that usually appears on the skin, but can also involve all organs and anatomic locations. The atypical manifestations of Kaposi’s sarcoma can mislead the diagnosis, which can result in a poor case management. The authors present a HIV-negative patient with Kaposi’s sarcoma with both usual and unusual locations such as the larynx, eyelids and bones. In the pre-therapeutic balance, we used NBI, which showed an intensely vascularized tumor in the larynx. The chosen method for treatment consisted in subtotal epiglotectomy performed under TransOral UltraSonic Surgery (TOUSS) approach. The use of TOUSS endoscopic surgery helped reduce the time of hospitalization, the patient did not need a nasogastric tube and was orally fed from the first postoperative day, with a better and faster functional recovery.

Pediatric extremity bone sarcoma reconstruction with the vascularized fibula flap: Observational study assessing long-term functional outcomes, complications, and survival

BackgroundLimb salvage is important in pediatric patients with bone sarcomas. The vascularized fibula flap is a versatile option, combined or not with a bone allograft. The authors evaluated the functional long-term outcomes, complications, and survival of using this technique in pediatric patients. MethodsA retrospective review of 27 pediatric patients reconstructed between 2011 and 2018 with the fibula flap after bone sarcoma resection was conducted. Long-term functional outcomes, complications, and survival were assessed. Variables analyzed were age, sex, Capanna technique, follow-up, complications, additional surgeries, time to weight bearing, length discrepancy, and sport practice. ResultsTwenty-seven patients with a mean age of 9.3 years were included. The mean follow-up was 44.33 months. The Capanna technique was performed in 15 patients. All extremities but one were salvaged. The overall complication rate was 74.07%. Fibula fracture and nonunion rates were 34.04% and 11.11%, respectively. Partial weight bearing was resumed at a mean of 9.07 months. About 79.17% of patients with a 12-month follow-up achieved full weight bearing.An age below 8 years was significantly associated with a lower major complication rate and a shorter time to weight bearing and full weight bearing. Major complications and additional surgeries were significantly associated with longer periods until weight bearing and full weight bearing. ConclusionsThe fibula flap allows the majority of extremities to be reconstructed. However, a high rate of complications and additional surgeries should be anticipated. Full weight bearing is usually achieved within the first year, with modest functional increase afterward. Less complications and a faster functional recovery are expected in patients below the age of 8 years.

Effect of elastic abdominal binder on pain and functional recovery after caesarean delivery: a randomised controlled trial

The Elastic abdominal binder has been widely employed by clinicians for pain relief, wound complications prevention, improved pulmonary function, and stabilisation. However, these proposed benefits have not been properly examined in women following caesarean delivery. We aimed to examine the effects of post-caesarean elastic abdominal binder use on recovery by comparing post-operative pain, mobility and quality of life. Pregnant women undergoing caesarean delivery were randomly assigned into two groups: abdominal binder (90 patients) and control (90 patients). The primary outcomes included the daily visual analogue scale pain scores and the distance from the six-minute walk test. Baseline characteristics were similar between the groups. There was no significant difference in pain scores and six-minute walking distance between the study groups. There was no significant between-group difference in quality-of-life dimensions, overall health status, and post-operative complication. The positive effects of elastic abdominal binder use following caesarean delivery could not be demonstrated in this study.Impact statementWhat is already known on this subject? Elastic abdominal binder is commonly used after laparotomy to support incision. There was evidence to support the benefit of abdominal binder in reducing psychological distress during the first five days following laparotomy for other indications. From limited number of studies addressing caesarean section, the evidence for the benefits of the binder on pain, symptom distress, and change in haemoglobin level is conflicting.What do the results of this study add? In contrast to the results of the previous study, the beneficial effects of abdominal binder on pain reduction, functional recovery, and quality of life following caesarean delivery could not be demonstrated in this study.What are the implications of these findings for clinical practice and/or further research? The use of elastic abdominal binder after caesarean delivery is not associated with reduction of postoperative pain, faster functional recovery, and improved quality of life in our population. Further studies in other population with different characteristics may be worthwhile.

Video-assisted thoracoscopic treatment of pneumothorax

In the last three decades, minimally invasive techniques have progressively gained acceptance, as shown by the numerous studies published in the literature. Before the 1990s, video-assisted thoracoscopic surgery (VATS) was considered feasible almost exclusively for the diagnosis of pleural diseases. The availability of better instruments and endoscopic stapling devices allowed thoracoscopy to evolve into a new “therapeutic era”. Nowadays, VATS is considered the approach of choice for the treatment of pneumothorax and other lung, mediastinal and esophageal diseases, replacing traditional approaches as thoracotomy and sternotomy. The use of ports through small incisions (one to three-four) for the camera and surgical instruments allows the surgeon to explore the pleural cavity and work easily on the lung parenchyma. This approach translates into less discomfort for the patient, reduced morbidity, shorten hospital stay and faster functional recovery. The optimal treatment of pneumothorax certainly refers thoracoscopy as the approach of choice maintaining the same indications as for open surgery.

More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty.

Although a tourniquet can effectively control intraoperative blood loss and offer clear surgical field in total knee arthroplasty (TKA), its optimal usage has been controversial. The aim of this research was to perform a systematic review and meta-analysis to compare and explore the best application of a tourniquet in TKA. MEDLINE, PubMed, EMBASE, the Cochrane Library, Wanfang database, and Web of Science were searched for randomized controlled trials (RCTs) comparing the four different strategies of tourniquet application in TKA. In Group I, a tourniquet was not used and was called the non-tourniquet (NT) group. In Group II, a tourniquet was only used during the cementation of implants and was called the specific duration tourniquet (SDT) group. In Group III, the tourniquet was only released before wound closure to control the bleeding sources and was called the majority duration tourniquet (MDT) group. In Group IV, a tourniquet was used throughout the procedure, from skin incision to wound closure and was called the whole duration tourniquet (WDT) group. Forty-six RCTs were included in this systematic review and meta-analysis. In a comparison between the NT and WDT groups (25 RCTs), intraoperative blood loss (IBL) (P = 0.0001) and range of motion (ROM) (P = 0.0001) were significantly increased in the NT group, while the visual analog score (VAS) (P = 0.0001), rate of deep vein thrombosis (DVT) (P = 0.01), and all complications (AC) (P = 0.0001) were significantly decreased in the NT group. In a comparison between the SDT and WDT groups (10 RCTs), IBL (P = 0.0001), TBL (P = 0.009), and ROM (P = 0.0001) were significantly increased in the SDT group, while thigh pain (P = 0.04) and the rate of DVT (P = 0.03) were significantly decreased in the SDT group. There were no significant differences between the MDT and WDT groups (12 RCTs) except for the rate of all complications (P = 0.01). Despite the decrease in IBL with a tourniquet, no difference was found in TBL. In conclusion, not using a tourniquet or only using it during the cementation of implants was preferable based on the faster functional recovery, lower rate of DVTs and complications compared with using a tourniquet throughout the TKA procedure. I.

Multimodal Prehabilitation to Enhance Functional Capacity Following Radical Cystectomy: A Randomized Controlled Trial

BackgroundIn patients with bladder cancer, poor functional status has remarkable deleterious effects on postoperative outcome and prognosis. Conditioning intervention initiated before surgery has the potential to reduce functional decline attributable to surgery. Nonetheless, evidence is lacking in patients undergoing radical cystectomy. ObjectiveTo determine whether a preoperative multimodal intervention (prehabilitation) is feasible and effective in radical cystectomy. Design, setting, and participantsThis study, conducted at an academic tertiary health care institution, enrolled adult patients scheduled for radical cystectomy. From August 2013 to October 2017, 70 patients were randomized: 35 to multimodal prehabilitation (prehab group) and 35 to standard care (control group). InterventionMultimodal prehabilitation was a preoperative conditioning intervention including aerobic and resistance exercise, diet therapy, and relaxation techniques. Outcome measurements and statistical analysisPrimary outcome was perioperative change in functional capacity, measured with the distance covered during a 6-min walk test (6MWD), assessed at baseline, before surgery, and at 4 and 8 wk after surgery. Data were compared using robust mixed linear models for repeated measures. Results and limitationsPreoperative change in 6MWD compared with baseline was not significantly different between groups (prehab group 40.8 [114.0] m vs control group 9.7 (108.4) m, p=0.250). However, at 4 wk after surgery, a significant difference in functional capacity was detected (6MWD, prehab group –15.4 [142.5] m vs control group –97.9 [123.8] m, p=0.014). No intervention-related adverse effects were reported. ConclusionsData suggested that multimodal prehabilitation resulted in faster functional recovery after radical cystectomy. Patient summaryAfter major cancer surgery, people usually feel week and tired, and have less energy to perform activities of daily living. In this study, we showed that using the time before surgery to promote exercise and good nutrition could fasten recovery after the surgical removal of the bladder.

Role of CD137L in lumbar spinal cord microglial cytokine responses following sciatic nerve crush

Abstract Previously, we showed that CD137 ligand (CD137L; AKA 4-1BBL) contributes to the development of behavioral hypersensitivity and functional recovery in mice following peripheral nerve injury-induced neuropathic pain. Mice that lack CD137L showed reduced sensory sensitivity and faster functional recovery. Here, we sought to further investigate the potential involvement of lumbar spinal cord microglial responses in CD137L-mediated behavioral changes following sciatic nerve crush. Lumbar spinal cord microglia were isolated from both wild type B6 and CD137L knockout (KO)_B6 mice via positive selection based on CD11b expression using magnetic beads at days 0 (naïve), 3, 7, 14, 28 and 56 following sciatic nerve crush or sham surgery. Following RNA extraction, qRT-PCR were performed to examine cytokine/chemokine expression in isolated microglia. Our preliminary results suggest that male mice had more measurable cytokine/chemokine responses than female mice. Despite that many cytokines are below the detection levels, we were able to observe increased expression of several chemokines, CCL2, CCL3, CCL4 and CCL5 in microglia from CD137L KO mice, which appeared to peak early following injury (Days 3–14) than that in microglia isolated from WT mice. Future study will determine the involvement of microglial chemokine responses in CD137L mediated sensory hypersensitivity and delayed functional recovery following peripheral nerve injury.