Removal Of Implants Research Articles

Dual Intraoperative Management of a Patient Withrare form of Epilepsy- Hot Water Epilepsy and Corrected Ventricular Septal Defect Undergoing Implant Exit Removal of Tibia

Hot water Epilepsy (HWE) is a type of epilepsy which occurs when hot water is poured over the body. Patient undergoing implant exit removal of tibia was intra operatively managed who has the history of corrected VSD and hot water epilepsy.

Nationally Representative Trends in Incidence of Procedures Done Concomitantly With Primary and Revision Total Ankle From 2012 to 2020

Background As new literature emerges and practice patterns fluctuate, there is a significant potential for variation with regard to adjunctive procedures performed with primary total ankle arthroplasty (pTAA) and revision total ankle arthroplasty (rTAA). Our study aims to evaluate yearly trends in the incidence of concomitant procedures and compare the incidence of adjunctive procedures between pTAA and rTAA. Methods The 2012-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all pTAA and rTAA. The number of concurrent procedures was compared between pTAA and rTAA and compared across years available in the most current version of the NSQIP database (2012-2020). Results Patients undergoing pTAA had a higher mean age than patients undergoing rTAA (64 vs 61 years; P < .001), and patients undergoing rTAA had higher wound class (P < .001), indicating higher levels of contamination. Concurrent procedures were performed significantly less frequently with pTAA than rTAA (mean procedures 0.82 vs 1.30; P < .001). Removal of deep implants was more commonly coded with rTAA than pTAA (9.0% vs 17.7%; P < .001). Gastrocnemius recession was more frequently performed with pTAA than rTAA (10.4% vs 3.0%; P = .001). Conclusion As pTAA and rTAA increase in incidence throughout the United States, there is increased importance on furthering our understanding of these procedures. This study provides a nationally representative analysis of adjunctive procedures with pTAA and rTAA from 2012 to 2020. Generally, more adjunctive procedures are performed with rTAA versus pTAA, confirming the high complexity of rTAA. Levels of Evidence: Level III

Proximal radioulnar synostosis following Monteggia fracture-dislocation: a case report

Introduction and importance: Radioulnar synostosis is a rare complication of a forearm fracture that restricts pronation-supination. This study presents a case of proximal radioulnar synostosis in an adult male after Monteggia fracture-dislocation who had a loss of pronation and supination movements. Case presentation: Herein, we report a case of proximal radioulnar synostosis in a 43-year-old man who presented with loss of pronation and supination of the right forearm that restricted his daily activities. He had a history of Monteggia fracture-dislocation 9 months back, which was managed with open reduction and internal fixation with a dynamic compression plate. Plain radiography and computed tomography of the right forearm after 9 months of operation showed an implant in situ with proximal radioulnar synostosis. Implant removal was performed and the excess fibro-osseous connection in the proximal radius and ulna was removed. Clinical discussion: Forearm injuries that affect the interosseous membrane may result in radioulnar synostosis. Trauma and treatment-related factors increase the risk of radioulnar synostosis. The fibro-osseous fusion between the forearm bones restricts the pronation and supination movements. Conclusion: Loss of pronation-supination following forearm fracture should raise suspicion of radioulnar synostosis.

Research progress of phage therapy in orthopedic implant-related infection

The widespread application of implantable materials has brought about a corresponding increase in implant-related complications, with implant-associated infections being the most critical. Biofilms, which often form on these implants, can significantly impede the effectiveness of traditional antibiotic therapies. Therefore, strategies such as surgical removal of infected implants and prolonged antibiotic treatment have been acknowledged as effective measures to eradicate these infections. However,the challenges of antibiotic resistance and biofilm persistence often result in recurrent or hard-to-control infections, posing severe health threats to patients. Recent studies suggest that phages, a type of virus, can directly eliminate pathogenic bacteria and degrade biofilms. Furthermore, clinical trials have demonstrated promising therapeutic results with the combined use of phages and antibiotics. Consequently, this innovative therapy holds significant potential as an effective solution for managing implant-associated infections. This paper rigorously investigates and evaluates the potential value of phage therapy in addressing orthopedic implant-associated infections, based on a comprehensive review of relevant scientific literature.

Treatment of intractable septic ankle arthritis with a continuous closed irrigation system.

The study aimed to evaluate the efficacy of a continuous closed irrigation system (CCIS) after open debridement for patients with intractable septic ankle arthritis. The retrospective study analyzed the intractable septic arthritis of 12 (6 males, 6 females; mean age: 64.1±14.7 years; range, 33 to 80 years) patients managed by CCIS between July 2015 and July 2020. All patients had previously undergone operations to treat septic ankle arthritis without resolution of the infection. After open debridement, the CCIS was usually equipped with two outflow tubes and one inflow tube. Saline inflow was about 1 L per day. The mean follow-up period was 30.8±14.9 (range, 15 to 70) months. The CCIS was maintained for a mean of 5.1±2.1 (range, 3 to 7) days. The mean number of operations the patients had previously undergone was 2.83±1.5 (range, 1 to 6). For 11 (91.6%) out of 12 patients, infection did not recur after one-time CCIS, and laboratory test results remained normal. Six patients had previously undergone total ankle replacement arthroplasty. These patients underwent antibiotics-mixed cement arthroplasty after CCIS. For five of six with infected total ankle replacement arthroplasty, infection did not recur after CCIS. However, one patient without the removal of both implants experienced recurrence at the same site after four postoperative months. In the reoperation, after the removal of both implants and the application of antibiotics-mixed cement arthroplasty, the infection was cleared. Use of CCIS after open debridement for intractable septic ankle arthritis is a good treatment option since it is relatively simple and safe, with good results.

Elective implant removal in the upper extremity: only symptomatic patients benefit

PurposeElective implant removal (IR) in the upper extremity remains controversial. Implants in the olecranon and clavicle are commonly removed for prominence, unlike in the distal radius. Patient-reported symptomatic cannot be verified, and nonspecific discomfort remains unquantified. In this study, indications and outcomes of IR at the clavicle, olecranon and distal radius were evaluated, with a focus on postoperative patient satisfaction.Materials and methodsIn this retrospective, single-center cohort study, patients, who received elective IR of the clavicle, olecranon and distal radius were included. Patients were followed up at least six weeks after IR. Outcomes included patient satisfaction, symptom resolution, and complications.ResultsOne hundred and eighty-nine patients were included. Unspecific symptoms of discomfort were the most prevalent indication for IR (48.7%), followed by pain (29.6%) and objective limited range of motion (ROM) (7%). Pain and limited ROM combined was observed in 13.8%. Subjective benefit following IR was described in 54%. Patients with limited ROM (OR 4.7, p < 0.001) or pain (OR 4.1, p < 0.001) were more likely to experience alleviation of complaints. Patients with unspecific symptoms of discomfort, often did not report improvement. Major complications occurred in 2%. Refractures were detected at the clavicle (3.7%) and at the olecranon (2.5%). Minor complication rate was 5%.ConclusionIR is a safe procedure in the upper extremity. Indications based on unspecific symptoms of discomfort have a significant lower rate of patient satisfaction postoperatively. Elective IR should be considered cautiously, if it is driven primarily by unspecific symptoms of discomfort. Patient education is relevant to prevent dissatisfying outcome.

Additively manufactured Ti–Ta–Cu alloys for the next-generation load-bearing implants

Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the most efficient defense against colonization, especially in the case of secondary infection, leading to surgical removal of implants and in some cases even limbs. In this study, laser powder bed fusion was implemented to fabricate Ti3Al2V alloy by a 1:1 weight mixture of CpTi and Ti6Al4V powders. Ti-Tantalum (Ta)–Copper (Cu) alloys were further analyzed by the addition of Ta and Cu into the Ti3Al2V custom alloy. The biological, mechanical, and tribo-biocorrosion properties of Ti3Al2V alloy were evaluated. A 10 wt.% Ta (10Ta) and 3 wt.% Cu (3Cu) were added to the Ti3Al2V alloy to enhance biocompatibility and impart inherent bacterial resistance. Additively manufactured implants were investigated for resistance against Pseudomonas aeruginosa and Staphylococcus aureus strains of bacteria for up to 48 h. A 3 wt.% Cu addition to Ti3Al2V displayed improved antibacterial efficacy, i.e. 78%–86% with respect to CpTi. Mechanical properties for Ti3Al2V–10Ta–3Cu alloy were evaluated, demonstrating excellent fatigue resistance, exceptional shear strength, and improved tribological and tribo-biocorrosion characteristics when compared to Ti6Al4V. In vivo studies using a rat distal femur model revealed improved early-stage osseointegration for alloys with 10 wt.% Ta addition compared to CpTi and Ti6Al4V. The 3 wt.% Cu-added compositions displayed biocompatibility and no adverse inflammatory response in vivo. Our results establish the Ti3Al2V–10Ta–3Cu alloy’s synergistic effect on improving both in vivo biocompatibility and microbial resistance for the next generation of load-bearing metallic implants.

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes.

We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding "satisfaction with breasts after surgery" (p = 0.026), "sexual well-being after intervention" (p = 0.010) and "satisfaction with the information received" (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.

Implant Removal After Medial Opening Wedge High Tibial Osteotomy Provides Implant-Related Pain Relief and Functional Improvement

PurposeTo (1) investigate the incidence of implant-related pain after medial opening wedge high tibial osteotomy (MOWHTO) using locking plate, (2) determine whether implant removal provides pain relief and functional improvement, and (3) evaluate bone healing and loss of correction after implant removal. Materials and MethodsBetween March 2014 and September 2017, MOWHTO was performed without bone graft. The inclusion criteria were patients who underwent implant removal after MOWHTO and were followed up for a minimum of 2 years. Patients were evaluated for implant removal one and two years after surgery. Clinical and functional evaluations were conducted to investigate implant-related pain using the visual analog scale, Lysholm score, and Tegner score. The radiographic indices measured were the gap-filling rate, weight-bearing line (WBL) ratio, hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), and posterior tibial slope angle (PTSA). ResultsA total of 55 patients were enrolled. Fifty-one (92.7%) patients experienced implant-related pain prior to implant removal, with 43 and eight patients reporting mild pain and moderate pain, respectively. At one and two years after implant removal, mild pain was six (10.9%) and five (9.1%) patients, respectively. The remaining patients reported no implant-related pain. Prior to implant removal and one year after implant removal, the Lysholm score improved from 77.0±5.6 to 86.8±5.7 (P<0.001), and the Tegner score improved from 3.3±1.2 to 3.9±1.3 (P<0.001). The mean gap-filling rate was 84.4%±9.6% at implant removal, and it significantly increased to 93.7%±5.4% and 97.4%±2.6% at one and two years after implant removal, respectively (P<0.001) For the WBL ratio, HKAA, MPTA, and PTSA, no statistical differences were found after implant removal. ConclusionThe incidence of implant-related pain after MOWHTO using medial proximal tibial locking plate was high. Implant removal provides pain relief and functional improvement (met minimal clinically important differences). Even after implant removal, bone healing progressed gradually without a loss of correction in all patients.

ε-Poly-l-lysine-hydroxyphenyl propionic acid/IL-4 composite hydrogels with inflammation regulation and antibacterial activity for improving integration stability of soft tissues and orthopedic implants

The failure of orthopedic implants is usually caused by inflammation, poor tissue integration, and infection, which can lead to pain, limited mobility, dysfunction of patients. This may require additional surgical interventions, such as removal, replacement, or repair of implants, as well as related treatment measures such as antibiotic therapy, physical therapy. Here, an injectable hydrogel carrier was developed for the steady release of inflammatory regulators to reduce the surface tissue inflammatory response of orthopedic implants and induce soft tissue regeneration, ultimately achieving the promotion of implants stability. The hydrogels carrier was prepared by hydroxyphenyl propionic acid-modified ε-Poly-l-lysine (EPA), hydrogen peroxide and horseradish peroxidase, which showed antibacterial bioactive and stable factor release ability. Due to the introduction of IL-4, EPA@IL-4 hydrogels showed good inflammatory regulation. EPA@IL-4 hydrogels regulated the differentiation of macrophages into M2 in inflammatory environment in vitro, and promoted endothelial cells to show a more obvious trend of tube formation. The composite hydrogels reduced the inflammation on the surface of the implants in vivo, induced local endothelial cell angiogenesis, and had more collagen deposition and new granulation tissue. Therefore, EPA hydrogels based on IL-4 release are promising candidates for promoting of implants surface anti-inflammatory, soft tissue regeneration, and anti-infection.

Abstract 13663: 90-day Safety and Performance Outcomes With a Novel Extravascular ICD Lead

Introduction: Long-term transvenous implantable cardioverter defibrillator (ICD) leads have many pitfalls. There is in development a novel extravascular (EV) ICD lead for sensing and defibrillation of ventricular tachyarrhythmias (VT/VF) utilizing commercially available DF-4 ICD pulse generators. We evaluate here 90-day safety and performance outcomes for delivery, stability, sensing, and defibrillation using this prototype EV lead. Methods: 18 patients scheduled to undergo de novo or replacement ICD were enrolled in a prospective, nonrandomized study (SECURE-EV STUDY). Each subject was simultaneously implanted with EV ICD lead (AtaCor, SanClemente, CA) attached to a commercially available ICD pulse generator. Study lead was delivered with a designed tool into left parasternal anterior mediastinum via a selected 4th, 5th or 6th intercostal space. Over 90 days pts were evaluated intermittently for defibrillation energy requirements, matched sensing events between both devices, stability of lead position and adverse events. Results: 16/18 of enrolled subjects received study device. Lead failed implant in 2 due to (1) intercostal ossification and (1) mediastinal adhesions. Prior to 30-days, 4 subjects were withdrawn from study due to pneumothorax, wound dehiscence, death unrelated to IV-ICD implantation and early elective lead removal. Over 90-days of simultaneous sensing, 4 events of VT/VF in 3 pts were detected by both devices. There was 1 AF discrimination error &amp; 1 atrial oversensing event detected by both devices. There were 4 events of non-cardiac noise in 4 pts detected by EV-ICD only. 1 event of Twave oversensing was detected by TV-ICD. 23 conversion tests in 13 subjects were performed at energy (26 to 30 J delivered, 1 tested with 35J) at 30- and 90-day visits, with successful conversion in all 23. Mean time between fibrillation detection and shock delivery was 10.7 seconds. Conclusion: This study showed feasibility of sensing and defibrillating induced VT/VF with intercostal placed prototype extravascular ICD lead. Findings with ICD lead was consistent across 4 commercially available ICDs. Simultaneous sensing of VT/VF in ambulatory pts was matched. Non-cardiac inappropriate sensing with EV-ICD lead is being addressed in new prototype.

Recent Patents on Intervention Auxiliary Device of Tracheal Stent

Background: The trachea is an essential part of the respiratory system. Lesions such as inflammatory granulomas cause Bronchial stenosis, which may be life-threatening. Tracheal stent placement is vital for treating airway stenosis, relieving dyspnea, and improving symptoms. Objective: This paper reviews the patents of tracheal stent placement and removal and auxiliary devices for diagnosis in recent years (from 2007 to the present) and introduces the characteristics and development of tracheal stent implantation, treatment, and assistive removal devices. In order to meet the need for more rapid operation and cause less harm to the human trachea, the structure of the tracheal stent surgical device needs to be improved continuously. Methods: This paper summarizes the research status of tracheal stent placement and removal and auxiliary devices for diagnosis and treatment in recent years and discusses the structural types and applications of tracheal stent auxiliary devices. Results: This paper summarizes the patent application of tracheal stent placement and removal and auxiliary devices for diagnosis and treatment at the present stage. This paper analyzes the main problems in its development and discusses the solutions to the problems and the future research direction. Conclusion: Tracheal stent surgical devices need further improvement in mechanical design, control strategy, etc. Tracheal stent surgical devices should be developed into universal, semi-automatic, and multi-functional machines. The relevant patents of the auxiliary device of the tracheal stent need to be developed.

Acute Acetabular Protrusion: the Hardinge Approach for Implant Removal and One-stage Hip Reconstruction

Acute penetration of a total hip arthroplasty into the pelvic cavity is a grave and potentially catastrophic scenario. Fortunately, this complication is uncommon and rarely encountered during a surgical career. Currently, a two-stage procedure is favoured by most surgeons, but the evidence for this is unconvincing and may expose the patient to unnecessary risks. Furthermore, a two-stage approach may be more suitable for the more common chronic migration of a loose acetabular shell, which fundamentally differs from acute pelvic penetration. We present the case of a 76-year-old man referred to our institution for reconstructive surgery following acute pelvic penetration of the acetabular shell during total hip arthroplasty. We used a single-stage Hardinge approach to retrieve the shell and successfully reconstruct the acetabulum. Specific indications for using this method are proposed. In carefully selected cases of intrapelvic implants, a single-stage method can improve patient outcomes while minimising unnecessary risks associated with the conventional two-stage approach.

Pediatric forearm fractures: evaluating implant removal timing and complications with exposed titanium-elastic nail tips

Aims: The current study investigates complication rates, timing of implant removal, and correlations between removal timing and complications/refractures in pediatric forearm fracture patients who had exposed titanium-elastic nail (TEN) tips.&#x0D; Methods: This retrospective single-center study analyzed pediatric forearm fractures in patients who underwent TEN with exposed tips. Inclusion criteria covered cases between August 2018 and January 2022, focusing on children with both-bone forearm fractures and unsuccessful conservative treatment. Data included demographics, fracture details, reduction type, implant removal timing, complications, and refracture rates.&#x0D; Results: Between August 2018 and August 2022, the study involved 65 children (54 boys, 11 girls), aged 4 to 15 years. Implant removal occurred at 4 to 11 weeks, on average at 7.17±1.52 weeks. Fracture location was distal 1/3 (9.2%), middle 1/3 (78.5%), proximal 1/3 (12.3%). The predominant causes of fractures were falls (89.2%). Fracture types consisted of open fractures (6.2%) and closed fractures (93.8%). Reduction methods included mini-open reduction (9.2%) and closed reduction (90.8%). Implant removal occurred at or before 6 weeks for 43.1% of cases, while it exceeded 6 weeks for 56.9% of cases. Complications were noted in 21.5% of cases, encompassing delayed union (14.3%), hypertrophic granuloma (7.1%), infection (21.4%), skin irritation (42.9%), and refracture (14.3%). Clinical outcomes were classified as excellent in 83.1% of cases and good in 16.9% of cases. No statistically significant differences were observed in complications (p=0.351) or clinical outcomes (p=0.441) based on implant removal timing.&#x0D; Conclusion: Contrary to belief, exposing nail tips, not burying them, is safe, cost-effective, and leads to minimal complications with positive clinical outcomes. Implant removal timing did not significantly impact clinical outcomes or complications. TENs used in forearm fractures can be removed before 6 weeks when adequate union is observed.

Preoperative antibiotics reduce early surgical site infections after orthopaedic implant removal: a propensity-matched cohort study

Implant removal in orthopaedics after fracture consolidation is a very common procedure but is still associated with a high rate of surgical site infection (SSI). Antibiotic prophylaxis is not recommended but advocated by some. To assess the efficacy of antibiotic prophylaxis in the prevention of early SSI following orthopaedic implant removal. A monocentric retrospective cohort study was conducted. Patients who underwent orthopaedic implant removal procedures performed from 2016 to 2021 were included. A 1:1 propensity score matching function was used to create a cohort with matched baseline characteristics and associated risk factors for SSI. Inter-cohort comparison of the occurrence of SSI (superficial or deep) and revision surgery for SSI, after propensity score matching, was performed using the odds ratio to determine the effect of preoperative antibiotic prophylaxis. In total, 965 distinct surgical procedures were included. Of these, 69 (7.15%) had an SSI, 24 (35.7%) of which required surgical revision; 214 procedures (22.18%) were performed under preoperative antibiotic prophylaxis. The propensity-matched cohort consisted of 396 procedures (198 with and without antibiotic prophylaxis). The SSI rates were 11.11% and 3.03%, respectively, in the control and antibiotic prophylaxis groups (odds ratio: 0.25; 95% confidence interval: 0.099; 0.63; P = 0.011). No difference was found for revision surgery. Preoperative administration of antibiotic prophylaxis considerably reduces the risk of SSI during the removal of an orthopaedic implant without increasing the risk of side-effects.

Medium-term Results After Femoral Head Resection and Subtrochanteric Valgus Osteotomy in Children and Adolescents With Neuromuscular Disorders.

Various salvage surgical procedures for painful hip dislocation in adolescent patients with cerebral palsy exist. To date, no significant differences among these surgical techniques have been described. In our institution the McHale procedure is the standard of care for painful chronically dislocated hips with or without deformity of the femoral head in patients with cerebral palsy. This study focuses on mid-term results after surgical treatment. Surgical reports and patient charts were analyzed retrospectively. All x-rays were evaluated and migration of the proximal femur and heterotopic ossification according to Brooker were recorded. In addition, we conducted a telephone interview with the caretakers with special reference to pain preoperatively and postoperatively and after implant removal, sitting tolerance, range of motion, mobility, quality of life, and personal hygiene. Fifty-two patients (65 hips) with a mean age of 13.5 ± 3.6 years (range: 4 to -20y) were included. Mean surgery time was 178.4 ± 63.4 minutes (range: 45 to 380min) and mean follow-up was 45.17 ± 30.6 months (range: 12 to 204mo). A significant difference between preoperative and postoperative pain levels was found, P<0.001. Personal hygiene (P=0.02) and quality of life (P=0.013) improved significantly. Eighty-five percent of the caregivers would have the surgery performed on their child again and 81% of the caregivers would recommend the surgery to others. The removal of implants leads to a significant improvement in pain (P=0.011). A total of 22 complications in 65 McHale procedures (33.9%) were related to the procedures. A significant reduction in pain and a significant improvement of hygiene as well as quality of life can be achieved with the McHale procedure in painful chronically dislocated hips in patients with cerebral palsy. Overall, the procedure is predominantly experienced as helpful by the caregivers and recommended to others. The removal of the implants improves pain significantly, but complications may occur in one third of the patients. IV.

A systematic review on removal of osseointegrated implants: un update

BackgroundToday dental implants represent an effective therapy in case of partial or total edentulism, with an excellent success rate. Despite the results obtained, there may be biological or mechanical complications during the therapy, which lead to the loss of the implant. This systematic review aims to evaluate the current state of the art in the literature on techniques used for the removal of dental implants. Various aspects will be analyzed, such as the success of the technique, any complications, and the advantages and disadvantages of their use.MethodsTwo reviewers conducted a literature analysis (PubMed, Embase, Web of Science) of the last 20 years (2003–2023). The main criterion analyzed was the success of the technique, while secondary outcomes such as complications and risks of the technique were also analyzed. 258 articles were identified in the various search databases. 42 eligible articles were subsequently identified after an article screening. Only 18 full texts were subsequently included in the review.ResultsA total of 18 articles were selected and 1142 implants and 595 patients were included. The main techniques used were the Counter-Torque Ratchet Technique (CTRT), Piezoelectric bone surgery (PBS), trephine drills, carbide burs, Erbium, Chromium, Yttrium, Scandium, Gallium, Garnett (Er:Cr:YSGG) laser and carbon dioxide (CO2) laser. Combined uses of techniques have been identified such as: PBS and trephine burs or carbide burs, trephine burs with the use of a 3d-printed guide, CTRT and trephine burs. The technique with the highest success rate, less morbidity for the patient, and less removal of bone appears to be the CTRT.ConclusionsThe use of conservative techniques, especially CTRT, in bone removal is useful to allow for immediate implant placement in the removal area. However, further studies with a high sample size are needed to be performed on all techniques, particularly new randomized controlled trials (RCTs) that allow for the analysis of the success of alternative techniques such as Laser and Piezosurgery, which appear to be very promising.

Localization and removal of nonpalpable contraceptive implants: Experience from a teaching hospital in Ethiopia: Acase series.

To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented. Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.

Regina Elena Institute (R.E.I.) Protocol for Breast Implant Salvage: Preliminary Results

Introductionimplants are the most popular means of restoring the breast mound after mastectomy; the most feared complication is implant infection accounting for 4.8% to 35.4% of cases. Various antibiotic regimens or other surgical revisions to treat implant infections have been reported, but their failure rates are unacceptable. Implant removal is subsequently the most common recourse for managing prosthesis infections. we report preliminary results of infected breast implant salvage using our Regina Elena Institute (REI) protocol. MethodsSince June 2021, a prospective single-centre study has been ongoing for patients burdened by implant infection or exposure. All qualifying participants underwent our REI protocol. They receive a temporary smooth implant and 1 week of implant's pocket irrigation with antibiotic solution along with systemic antibiotic and then a new permanent prosthesis positioning. ResultsTen of whom completed at least 6 months of follow-up and were eligible for this preliminary analysis. Overall, the REI protocol was applied to 13 breasts. No infections relapsed during the 6-month minimum follow-up intervals; and no early capsular contraction was evident, resulting in good cosmetic outcomes for every treated breast. DiscussionThe smooth-surfaced implant's sizer helps maintain tissue expansion, preventing skin retraction; and the slightly smaller diameters used (compared with originals) facilitate antibiotic wash distribution. Combining a targeted systemic antibiotic and a topical agent is the best way to optimise infection resolution. This preliminary analysis has clear limitations. A larger population is warranted to increase the level of evidence. Longer follow-up is also advisable to monitor for delayed infection recurrence.

Comparison between Pre-Pectoral and Post-Pectoral Implant Reconstruction and Different Radiation Modalities on Breast Reconstruction Complications

Single Stage direct to implant (DTI) is a rising reconstruction approach. It has been speculated that prepectoral implant placement reduces reconstruction complications as well as using newer postmastectomy radiation (PMRT) modalities as protons. Largest series in this topic included 350 DTI patients with less than 30 patients receiving PMRT. We reviewed the charts of 2,187 patients (pts) who underwent mastectomy and reconstruction at our institution between 2000 and 2020. Pts only receiving DTI with and without PMRT were included. PMRT was delivered either with 3D conformal photon +/- chest wall electron boost (CWB) or proton therapy mainly with pencil beam scanning. All pts received conventional fractionation (50-50.4 Gy in 25-28 fractions). Patients on active protons clinical trials were excluded. Primary endpoints were reconstruction complications defined as infection/necrosis (I/N) requiring debridement; capsular contracture (CC) requiring capsulotomy and overall reconstruction failure (ORF: removal of permanent implant for any complication with and without salvage reconstruction). Subgroup analysis for pts receiving PMRT was done to explore impact of proton and photons on complications. Logistic and cox regression were used. Eight hundred nine pts received DTI, with an overall median follow-up of 6.2 years. Among the entire cohort, 78/809 (9.7%) had prepectoral implants while the rest had subpectoral implants with and without alloderm support. Of the entire cohort 391/809 (48.5%) received PMRT, among those 43/391 (11%) received protons. The 5 years cumulative incidence of CC was 8.5% and 6.6% among prepectoral vs subpectoral implants (HR = 1.2, p = 0.7). The 5 years cumulative incidence of ORF was 32.2% and 28.2% among prepectoral vs subpectoral implants (HR 1.1, p = 0.6). For pts receiving PMRT, the 5 years cumulative incidence of CC were 26.0% and 8.6% among protons vs photons (HR 3.7, p < 0.0005). The 5 years cumulative incidence of ORF were 38.2% and 30.1% among protons vs photons (HR 1.4, p = 0.2). Multivariable logistic regression analysis accounting for BMI, smoking history, diabetes, and PMRT showed no significant difference between prepectoral implants versus subpectoral coverage for CC (OR = 0.7, p = 0.5), and for ORF (OR = 0.9, p = 0.8). Subgroup multivariable analysis for those receiving PMRT only showed protons compared to photons significantly increased the risk of CC (OR = 5.3, p < 0.0001) and ORF (OR = 2.1, p = 0.03). No significant difference in I/N was noted between photons and protons or between prepectoral and subpectoral pts. For breast cancer patients receiving single stage direct to implant reconstruction with and without PMRT, prepectoral implant placement did not reduce the risk of complications. Proton therapy compared to photons significantly increased the risk of capsular contracture requiring capsulotomies and significantly increased overall reconstruction failures with implants removal.