Good Long-term Functional Results Research Articles

Luxación congénita de rodilla. Protocolo terapéutico y resultados funcionales a largo plazo

Background and objectiveCongenital knee dislocation is a very rare entity, characterised by deformity in knee recurvatum present at birth, and there is currently no consensus on the optimal treatment. The aim of the present study is to analyse the functional results and long-term complications after the application of a protocol of therapeutic action for the management of congenital knee dislocation (CKD) created in a reference centre for child orthopaedics. Materials and methodsRetrospective descriptive study of patients with congenital dislocation of the knee who followed CRPL between January 1997 and December 2010. Demographic variables, type of treatment, functional outcomes at the end of the follow-up, complications and relapses were studied. The conservative treatment consisted of serial casts, leaving the surgical treatment for cases in which passive flexion was not achieved above 30° or the conservative treatment failed. Results9 patients (11 knees) met the inclusion criteria. The 66.7% were girls and the average follow-up was 15 years (9-22). In all cases, conservative treatment was initiated. Of the 11 knees treated, less than half (36%) required surgery. The average Lysholm questionnaire was 90.3 points, the WOMAC pain 0.4 (0-1), WOMAC stiffness 1.8 (0-6) and WOMAC function 3.8 (1-12). ConclusionsThe existence and application of the PLCR protocol in a pathology as rare as congenital knee dislocation suggests good long-term functional results with few complications and no recurrences.

Colonic interposition, a contemporary experience: technical aspects and outcomes.

Colonic interposition is rarely used as an oesophageal replacement after resection, as the preferred use of stomach involves less anastomoses and lower risks of major complications. The functional outcome from the colonic conduit is also unpredictable. This report documents the spectrum of experience of a high-volume oesophageal centre, highlighting indications, techniques and functional outcomes. A retrospective review was undertaken of a prospective database from 2012 to 2016. Four of 252 (1.5%) cases in this time period utilised colon interposition. Two cases were for gastric conduit necrosis following oesophageal cancer resections, one for caustic ingestion with both an oesophago-bronchial fistula and gastric injury, and one for a primary oesophageal malignancy in a patient whom previously had a total gastrectomy. All patients had either a retrosternal or posterior mediastinal isoperistaltic right colon conduit placed. Two of three cancer patients are alive and disease free at 3 and 5years, respectively. Surviving patients are weight stable and tolerating a normal diet. Both report excellent quality of life using validated assessment tools. Colonic interposition is rarely required in modern oesophageal practice, but with this technique good long-term nutritional and functional outcomes can be obtained. It is required in the armamentarium of a specialist centre, and training given its rarity may require novel approaches such as simulation and cadaveric-based training.

Five-years outcome of medial patellofemoral ligament reconstruction in isolated post-traumatic tear: A retrospective study

IntroductionMedial patellofemoral ligament (MPFL) reconstruction is the procedure of choice for lateral patellar dislocation. However, studies depicting the long terms results of this procedure is lacking. The present study was conducted to evaluate the functional outcomes after MPFL reconstruction at a minimum of five years follow-up. MethodsThis study was retrospective evaluations of patients who underwent MPFL reconstruction by basket weave method. A total of 35 patients (37 knees) with isolated MPFL tear who met the inclusion criteria were included in this study. These patients were assessed for functional outcome scores including Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity score at a minimum follow-up of 5 years. ResultsThe mean follow-up was 81.57 ± 16.07 months and mean age of patients was 19.56 ± 8.02 years. There was no re-dislocation in any of the patients but 4 patients had apprehension test positive (10.81%). The mean Kujala score, IKDC score and Lysholm score preoperatively and postoperatively after MPFL reconstruction were 62.20 ± 16.86 and 90.32 ± 16.42 respectively (p < 0.0001); 58.62 ± 14.34 and 85.15 ± 7.65 respectively (p < 0.0001); 68.21 ± 10.72 and 95.30 ± 8.02 respectively (p < 0.0001) at the five-year follow-up. Mean Tegner score pre-injury and post-surgery was 6.23 ± 2.10 and 5.82 ± 1.90 respectively (p = 0.38) at a mean follow-up of five years. ConclusionsMPFL reconstruction surgery for isolated MPFL tears without any associated bony deformity, or soft tissue alterations has a good long-term functional outcome.

Macular edema secondary to retinal vein occlusion in a real-life setting: a multicenter, nationwide, 3-year follow-up study.

To evaluate the presence of macular edema secondary to retinal vein occlusion (RVO)-both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-3 years after diagnosis in patients who underwent intravitreal therapy and to identify potential prognostic factors and biomarkers of persistent macular edema. National multicenter, observational, exploratory, retrospective cohort study of 104 consecutive patients with macular edema secondary to RVO diagnosed from January 2014 to December 2015 with minimum 3-year follow-up time. Data analyzed included best-corrected visual acuity (BCVA), clinical and demographic data, and spectral domain optical coherence tomography parameters. At final observation, median baseline central retinal thickness significantly improved from baseline 538 to 290 μm (p < 0.001) and complete macular edema resolution was achieved in 51.0% of patients (56.3% and 42.5% in BRVO and CRVO patients, respectively). BCVA also improved (p < 0.01). Logistic regression analysis revealed a relationship between recurrence of macular edema and disorganization of retinal inner layers (DRIL) at baseline (odds ratio = 2.88; p = 0.013). Good long-term anatomical and functional outcomes are achieved with intravitreal treatments in RVO patients. Anatomical success and visual gains seen in the first year were maintained throughout the entire follow-up, though DRIL is a major risk factor for recurrence.

Long-term outcome of patients with primary or secondary tumors of the proximal femur treated by bipolar modular tumor prosthesis.

The proximal femur is a common area for primary and also metastatic bone tumors. The objective of this study was to assess the long-term functional and oncological outcomes of patients with malignant primary or secondary tumors of the proximal femur, who underwent proximal femoral resection then reconstruction using bipolar modular tumor prosthesis. Sixty patients with proximal femoral malignant tumors underwent resection and bipolar modular prosthesis between 2000 and 2016, were retrospectively reviewed. Based on diagnosis and presence or absence of pathological fracture, patients were divided into groups. The functional outcome of the patients was evaluated using the Musculoskeletal Tumor Society (MSTS) functional scoring system for the lower extremities. The mean age was 38 (9-80) years at the time of primary surgery. Pathological fracture was the presentation in 28 patients. The study included 44 patients with primary bone tumor and 16 patients with a secondary bone tumor. The mean MSTS functional score of the patients was 24.3 (range, 18-30) points with no significant difference in patients with primary or secondary tumors. The rate of complications in the present series was 45%. The most frequent complication was an infection in 10 patients (16.7%), followed by aseptic loosening in 7 patients (11.7%). Local recurrence of primary bone tumors occurred in three out of 44 patients (6.8%). Modular bipolar tumor prosthesis has a good long-term functional result in both primary and secondary tumors of the proximal femur, with no significant effect of age, presence or absence of pathological fracture or femoral resection length on the functional outcome. It was found that the only statistically significant variable regarding the risk of infection is previous surgeries. Level IV, retrospective case series.

Vesicovaginal Fistula Repair by Modified Martius Flap: A Step-by-Step Surgical Technique Video.

Fistula repair in the perineal region represents a major challenge for surgeons. It is important for the medical community to facilitate and disclose these techniques. The aim of this article was to show a stepwise approach for a direct repair and use of a Martius flap for a vesicovaginal fistula. We show a single case performed in a patient who presented with a vesicovaginal fistula diagnosed after surgery, which did not respond to conservative management. The procedure consists of the following steps: intraoperative cystoscopy, anatomical direct repair of the fistulous tract between the bladder and vagina, and modified Martius flap. Martius flap is a repair technique used for complex fistula in the perineal region. It is a simple, safe, and reproducible procedure with good long-term functional and esthetic results.

Seed skin grafts for reconstruction ofdistal limb defects in 15 dogs.

To report the surgical technique of seed skin grafting and clinical application for reconstruction of wounds on the distal limb of client-owned dogs. Medical records from The Animal Hospital at Murdoch University were retrospectively reviewed for dogs requiring reconstruction using seed grafting for distal limb skin defects between January 2009 and May 2020. Fifteen dogs were included. Grafting was performed on distal limb wounds at or below the carpus or tarsus, following trauma (n=12) or neoplasia excision (n=3). Complete epithelialisation with minimal contracture was recorded at a median of 4 weeks (range 3 to 8 weeks) after implantation. Median follow-up was 37 months (range 3 to 55 months) after grafting. Postoperative complications included epidermal inclusion cyst in two dogs. Good functional outcome with acceptable cosmesis despite sparse hair growth was achieved in all cases. Seed grafting is a simple technique that can be used reliably to reconstruct wounds on the distal limb in dogs where other reconstructive techniques are not suitable. Complete epithelialisation with sparse hair growth, good long-term functional outcome and minimal complications can be expected.

High patient satisfaction and good long-term functional outcome after endoscopic calcaneoplasty in patients with retrocalcaneal bursitis

PurposeThe primary objective of this study was to determine the degree of patient satisfaction at a minimum of 5 years of follow-up after endoscopic calcaneoplasty. The secondary objectives were to assess functional outcome measures, pain scores, analysis of bone removal, reformation of exostosis at follow-up and correlation of the size of the exostosis and recurrent or persisting complaints.MethodsThis study evaluated patients who underwent endoscopic calcaneoplasty, between January 1st 2000 and December 31st 2010, for the diagnosis of retrocalcaneal bursitis. The evaluation consisted of PROMs (patient-reported outcome measures), a questionnaire and a visit to the outpatient clinic for physical examination and a standard lateral weight-bearing radiograph of the ankle. Patient satisfaction, functional outcomes and pain scores were measured by use of a numeric rating scale (NRS). Size of the posterosuperior calcaneal exostosis was measured on a standard lateral weight-bearing radiograph using parallel pitch lines (PPL) and the Fowler–Philip angle (PFA).ResultsThe response rate was 28 out of 55 (51%) and the median time to follow-up was 101(IQR 88.5–131.8) months. The median satisfaction score for treatment results was 8.5 out of 10 (IQR 6–10). FAOS symptoms 84.5 (IQR 58.0–96.4), FAOS pain 90.3 (IQR 45.1–100.0), FAOS ADL 94.9 (IQR 58.1–100.0), FAOS sport 90.0 (IQR 36.3–100.0) and FAOS QOL 71.9 (IQR 37.5–93.8) and median AOFAS was 100 (IQR 89–100). The median PLL difference between before operation and 2 weeks after the operation was − 4 mm (IQR-6 and -1) and the median PLL difference between 2 weeks after the operation and at follow-up was 1 mm (0–2). The median PFA was 65 (63–69) at baseline, 66.5 (60.8–70.3) 2 weeks after the operation and 64 (60.8–65.3) at follow-up.ConclusionDespite the limited response rate, this study shows high patient satisfaction and good long-term functional outcome in patients affected by retrocalcaneal bursitis who underwent endoscopic calcaneoplasty.Level of evidenceLevel IV.

The Radial Floating Cup radial head prosthesis to treat radial head fractures: functional and radiographic results after more than 12years of mean follow-up.

This study was performed to evaluate the long-term clinical and radiographic results of patients presenting with a radial head fracture who were treated surgically with a Judet Radial Floating Cup 2 (RFC2) radial head prosthesis. This was a retrospective, monocentric, observational, multi-operator, and continuous study performed between July 1997 and June 2009 on the treatment of radial head fracture using an RFC2 radial head prosthesis. The primary efficacy endpoint was the functional status of the operated elbow, evaluated using the Disability of Arm-Shoulder-Hand (Quick-DASH) score and the Mayo Elbow Performance Index (MEPI). The secondary endpoints were mobility and stability of the operated elbow, residual pain and grip strength, nature and rate of complications, as well as possible radiographic abnormalities during follow-up. Twenty-two patients were treated with the RFC2 for radial head fractures over the study period. Three (13.6%) were lost to follow-up, including one death. Of the remaining 19 patients, three RFCs had to be removed (15.8%). The final analysis involved 16 patients. The mean follow-up was 144months (range 109-225months; standard deviation [SD] = 49.9months) or 12years. The average Quick-DASH score was 23.01/100 (range 0-50; SD = 7.8) and three cases were rated as having "excellent" results according to the MEPI (18.7%), nine cases were rated as having "good" results in (56.2%), and four cases were rated as having "average" results (25%). The average mobility values were: 132° of flexion (range 120°-150°; SD = 11), 14.5° of extension deficit (range 0°-40°; SD = 5), 84.4° of pronation (range 20°-90°; SD = 8°), and 67.7° of supination (range 25°-85°; SD = 10). All patients had a stable elbow. The average grip strength on the affected side thus corresponded to 79% (range 44-100%; SD = 8.3%) of the grip strength on the healthy side. Four patients (25%) developed complications: three cases of algodystrophic syndrome (18.7%) and one case of early dislocation (6.2%). Radiographic evaluation revealed that there was a periprosthetic radio-lucencies in eight patients (50%), periarticular ossifications in 12 patients (75%), and lysis of the capitulum in two patients. There was no significant difference in MEPI ratings between patients with and without a periprosthetic radio-lucencies (P = 0.8018). Our results indicated that using the RFC 2 prosthesis to surgically treat radial head fractures provides good long-term functional results, including satisfactory mobility and stability.

Four-year outcomes of aflibercept treatment for neovascular age-related macular degeneration: Results from real-life setting.

To assess long-term structural and functional outcomes of intravitreal aflibercept (Eylea®) treatment for neovascular macular degeneration (nAMD) in a real-word setting. This was a retrospective, single-centre, non-randomized interventional cohort analysis. Data from treatment-naive patients with nAMD funded for treatment with intravitreal aflibercept in the period between 1 September 2013 and 28 February 2014 and who finished 4-year follow-up entered the analysis. Epidemiological data, visual acuity (VA) measured on ETDRS charts and injection numbers were recorded. Spectral domain optical coherence tomography (SD-OCT) data including presence or absence of macular fluid and automated central subfield macular thickness (CSMT) at year 1, 2, 3 and 4 were also recorded. Ninety-four eyes of 89 patients finished 4-year follow-up. The mean number of aflibercept injections received over 4 years was 19.3. At baseline, the mean VA (SD) (Snellen) was 54.1 ± 15.5 (20/100) ETDRS letters whilst the mean CSM (SD) was 296 ± 81 µm. At 4 years, the mean VA (SD) (Snellen) was 60.4 ± 20.0 (20/63) ETDRS letters (p < 0.0001). Mean CSMT (SD) was 218 ± 79 μm (p < 0.0001). Thirty-three percent of eyes gained ⩾15 ETDRS letters at end of 4 years, and 66 (70%) eyes had no macular fluid at the end of the follow-up. The results suggest that good long-term morphological and functional treatment outcomes can be achieved using intravitreal aflibercept for nAMD in a real-life clinical setting.

Four-Year Outcome of Aflibercept Treatment-Naïve Patients for Neovascular Age-Related Macular Degeneration: Evidence from a Clinical Setting.

Introduction The objective of the study is to report 4-year treatment outcome with intravitreal Aflibercept injections for neovascular age-related macular degeneration (nAMD) as first life therapy in real-life. Patients and Methods. This is a prospective, monocenter, observational case series analysis. Data from treatment-naïve patients with nAMD with at least 4 years of follow-up were included in the analysis. Data including age, gender, and visual acuity measured on Early Treatment of Diabetic Retinopathy Study charts (ETDRS) and injection numbers were recorded. Spectral domain optical coherence tomography (SD-OCT) data at baseline, month 3, month 6, month 12, year 2, 3, and 4 were also recorded. Patients were treated with a modified treat and extend (T&E) regimen. Results Of the 48 eyes with nAMD treated, only 31 eyes were available at the 4-year follow-up. The mean age was 81 ± 8 years. The VA gain was 7.3 ± 12.7 letters at 1 year 6.5 ± 12.5 letters at 2 years, VA gain 5.2 ± 17 letters at 3 years, and 6.2 ± 18.6 letters at 4 years. The reduction of central retinal thickness was 118 ± 187 μm at 4 years. Complete resolution of fluid was obtained in 18/31 eyes. The total number of injections was 5.7 ± 2.0 during the first year, 2.9 ± 2.9 during the second year, 3.5 ± 3.3 during the third year, and 4.0 ± 3.4 during the fourth year. The total number of injections was 16 ± 10.6, ranging from 3 to 52 injections. Ten eyes developed macular atrophy over the 4-year period. Conclusion The results suggest that good long-term morphological and functional outcome can be achieved using Aflibercept in clinical setting.

Abstract 168: Outcomes of Intra-Arterial Tissue Plasminogen Activator Rescue Therapy During Stroke Thrombectomy-Insights From the STAR Collaboration

Introduction: Intra-arterial tissue plasminogen activator (IA-tPA) can be used as rescue therapy during mechanical thrombectomy for stroke patients, mostly in the setting of distal occlusion. The outcomes of IA-tPA has not been assessed in large-scale multi-center studies yet. Methods: We used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which included prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe, and Asia. We compared the baseline characteristics, procedural metrics, rate of symptomatic intracranial hemorrhage (sICH), and long-term functional outcomes between thrombectomy patients who received rescue IA-tPA and a control group of thrombectomy patients with matched age, National Institute of Health stroke scale (NIHSS) on presentation, location of occlusion and IV-tPA receipt. Results: A total of 2827 thrombectomy patients were included in the STAR registry. Out of those, 205 patients received IA-tPA. We matched 191 patients from the IA-tPA group with a control group of 191 patients (table 1). No difference was seen in age, sex, race, vascular risk factors, or Alberta Stroke Program Early CT (ASPECT) score between both groups. In addition, procedural metrics, including onset to groin time, the procedure duration, and rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score≥2b) were similar. Finally, similar outcomes were noted in both groups, including the rate of sICH and good 90-day functional outcome (modified Rankin scale≤2). Conclusion: The use of IA-tPA as an adjunctive treatment to mechanical thrombectomy was safe but did not result in a higher rate of successful recanalization or good long-term functional outcomes.

Abstract WP3: Predictors and Outcomes of Successful First Pass in Neurothrombectomy- Insights From the STAR Collaboration

Introduction: Shorter procedure time during neurothrombectomy is a strong predictor for good outcomes in stroke patients with large vessel occlusion. We sought to assess the predictors and outcomes of successful first pass (SFP) using multi-center investigator-initiated database. Methods: Prospectively collected neurothrombectomy data from 11 thrombectomy-capable stroke centers was combined in the Stroke Thrombectomy and Aneurysm Registry (STAR). SFP was defined by achieving modified Thrombolysis in Cerebral Infarction (mTICI) score≥2b with a single thrombectomy device pass. We compared the baseline characteristics, procedural metrics, rate of symptomatic intracranial hemorrhage (sICH), and long-term functional outcomes between SFP and non-SFP patients. A multivariate logistic regression analysis was used to assess the predictors of SFP and evaluate whether SFP was an independent predictor for good long-term functional outcomes (90-day mRS≤2). Results: A total of 733 SFP patients and 1134 non-SFP patients were included in this analysis. SFP patients were older (73 vs. 70, P=0.001), had higher Alberta Stroke Program Early CT (ASPECT) score on presentation (9 vs. 8, P=0.002). The use of Solumbra technique was an independent predictor of SFP (OR 1.2, 95% CI 1.1-1.4, P=0.004) after controlling for age, sex, location of occlusion, National Institute of Health stroke scale (NIHSS) on presentation, intravenous alteplase (IV-tPA), and onset to groin (OTG) time. SFP was an independent predictor for good long-term functional outcomes (OR1.6, 95% CI 1.1-2.3, P=0.008) after controlling for age, sex, location of occlusion, NIHSS on presentation, OTG time, IV-tPA, procedure technique, and procedure duration. Conclusion: SFP lead to higher rates of functional independence in stroke patients with large vessel occlusion. These records reiterate the importance of SFP as a benchmark measure for stroke thrombectomy devices.

Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction

BackgroundPatients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement.MethodsAll patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement.ResultsFifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery.ConclusionIn the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.

Computed tomographic findings, surgical management and postoperative outcomes of large intermuscular lipomas in the hindlimb of 11 dogs.

Lipomas are benign adipose tissue tumours of mesenchymal origin and can originate in various locations. Intermuscular lipomas in the thigh can cause substantial hindlimb expansion in the dog. We describe the computed tomography findings, surgical management and the outcomes of 11 dogs with large intermuscular lipomas of the hindlimb. Retrospective case series. Medical records between 2009 and 2019 of dogs presenting to The Animal Hospital at Murdoch University were reviewed. Inclusion criteria included dogs with a histologically confirmed, large hindlimb lipoma that was surgically excised following preoperative computed tomography (CT) imaging. CT with intravenous contrast revealed a well-defined, smoothly marginated, fat attenuating mass with minimal vascularity, separating the muscle bellies of the caudal hindlimb. The mass was often in close proximity to the femoral artery and vein. All lipomas were marginally excised. At surgery, some lipomas were intimately associated with the sciatic nerve and some showed infiltration of, or attachment to, neighbouring muscle that could be excised en bloc with the lipoma. Postoperative closed-suction wound drainage was used in 6 of 11 dogs. One dog required revision surgery due to partial wound dehiscence. Long-term follow-up with owners reported good postoperative function of the affected hindlimb in all dogs. One dog developed an infiltrative lipoma in the same location 22 months post-excision. Preoperative CT allowed a presumptive diagnosis of intermuscular lipoma and facilitated surgical planning for marginal excision. Large intermuscular lipomas of the hindlimb can be safely excised with minimal short-term complications, good long-term functional outcome and low likelihood of recurrence.

Outcomes of interfacility helicopter transportation in acute stroke care.

To evaluate the long-term functional outcome of interhospital transfer of patients with stroke with suspected large vessel occlusion (LVO) using Helicopter Emergency Medical Services (HEMS). Records of consecutive patients evaluated through 2 telestroke networks and transferred to thrombectomy-capable stroke centers between March 2017 and March 2018 were reviewed. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to address confounding factors. Multivariate logistic regression analysis with IPTW was used to determine whether HEMS were associated with good long-term functional outcome (modified Rankin scale score ≤ 2). A total of 199 patients were included; median age was 67 years (interquartile range [IQR] 55-79 years), 90 (45.2%) were female, 120 (60.3%) were white, and 100 (50.3%) were transferred by HEMS. No significant differences between the 2 groups were found in mean age, sex, race, IV tissue plasminogen activator (tPA) receipt, and thrombectomy receipt. The median baseline NIH Stroke Scale score was 14 (IQR 9-18) in the helicopter group vs 11 (IQR 6-18) for patients transferred by ground (p = 0.039). The median transportation time was 60 minutes (IQR 49-70 minutes) by HEMS and 84 minutes (IQR 25-102 minutes) by ground (p < 0.001). After weighting baseline characteristics, the use of HEMS was associated with higher odds of good long-term outcome (OR 4.738, 95% CI 2.15-10.444, p < 0.001) controlling for transportation time, door-in-door-out time, and thrombectomy and tPA receipt. The magnitude of the HEMS effect was larger in thrombectomy patients who had successful recanalization (OR 1.758, 95% CI 1.178-2.512, p = 0.027). HEMS use was associated with better long-term functional outcome in patients with suspected LVO, independently of transportation time.

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.

Outcome after total ankle arthroplasty with a minimum of five years follow-up: A systematic review and meta-analysis

BackgroundTotal ankle arthroplasty (TAA) is increasingly gaining recognition as an alternative to ankle arthrodesis in the treatment of end-stage ankle arthritis. Despite high rates of adverse events during early inception, newer generations of uncemented prosthesis and design modifications have improved outcomes. Questions remain regarding the long-term outcomes and implant survivorship of TAA. AimThis analysis aims to establish an updated review of intermediate and long-term clinical outcome and complication profile of TAA. Patients and methodsA multi database search was performed on 14th October 2018 according to PRISMA guidelines. All articles that involved patients undergoing uncemented TAA with 5 years minimum follow-up, reported clinical outcome or complication profile of TAA were included. Seventeen observational studies were included in the review, with 1127 and 262 ankles in the 5 and 10 years minimum follow-up groups respectively. ResultsMean difference between pre- and post-operative AOFAS score was 43.60 (95%CI: 37.51–49.69, p<0.001) at 5 years minimum follow-up. At 5 years minimum follow-up, pooled proportion (PP) of prostheses revision for any reason other than polyethylene exchange was 0.122 (95%CI: 0.084–0.173), all cause revision was 0.185 (95%CI: 0.131–0.256), unplanned reoperation was 0.288 (95%CI: 0.204–0.390) and all infection was 0.033 (95%CI: 0.021–0.051). At 10 years minimum follow-up, PP of prostheses revision for any reason other than polyethylene exchange was 0.202 (95%CI: 0.118–0.325), all cause revision was 0.305 (95%CI: 0.191–0.448), unplanned reoperation was 0.422 (95%CI: 0.260–0.603) and all infection was 0.029 (95%CI: 0.013–0.066). ConclusionDespite good intermediate and long-term functional outcome measures, TAA has relatively higher revision surgery prevalence with longer follow-up periods. Further research should be directed towards identifying patient populations that would best benefit from TAA and those at greatest risk of requiring revision surgery.

Фаллопротезирование через завенечный доступ c безграфтинговой корпоропластикой при эректильной дисфункции, сочетанной с болезнью Пейрони

Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) and concomitant penile curvature due to Peyronie disease. Methods for correction of penile deformity during prosthesis implantation are still under discussion, considering variable efficiency and higher risk of complications. Our aim was to describe clinical case which represent our first experience of performing multiple corporal incisions through innovative subcoronoral approach without subsequent substitution of tunica albuginea. As a result of graft-free technique an effective penile straightening was achieved after three-piece prosthesis implantation with good long-term functional and cosmetic results. The first experience of graft-free technique of corporotomy during penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with a combination of ED and Peyronie disease.

Long-term outcomes of robotic ventral mesh rectopexy for external rectal prolapse

Nowadays in Europe, laparoscopic ventral mesh rectopexy is the gold standard treatment of external rectal prolapse (ERP). The benefits of robot ventral mesh rectopexy (RVMR) are not clearly defined. The primary objective of the study was to evaluate the long-term results of RVMR. The secondary objective was to determine predictive factors of recurrence. Monocentric, retrospective study. Data, both pre-operative and peri-operative, were collected, and follow-up data were assessed prospectively by a telephone questionnaire. The study was performed in a tertiary referral center. Between August 2007 and August 2017, we evaluate all consecutive patients who underwent RVMR for ERP by three different surgeons. The primary outcome was the recurrence rate perceived by patients. Secondary outcome were functional results based on Knowles-Eccersley-Scott-Symptom score for constipation and Wexner score for incontinence, compared before and after surgery. During the study period 96 patients (86 women) underwent RVMR. The mean age was 62.3years (range 16-90). Twelve patients had a history of ERP repair. Sixty-nine patients were analyzed for long-term outcomes with a mean follow-up of 37months (range 2.3-92months). Recurrence rate was 12.5%. After surgery, constipation was significantly reduced: 44 patients were constipated before surgery versus 23 after surgery. Six patients described de novo constipation (6.25%). Fecal incontinence was significantly reduced: 59 patients were incontinent before surgery versus 14 after surgery. No predictive factor for recurrence was identified after multivariate analysis. No mesh related complications were related. In conclusion, RVMR presents good long-term functional result and a recurrence rate similar to LVMR as published in the literature. The rate of mesh related complications seems lower.