Incidence Of Patient Satisfaction Research Articles

Radiofrequency Ablation for the Treatment of Painful Neuroma

Mechanical compression of interdigital nerves beneath the deep transverse intermetatarsal ligament and between the metatarsal heads leads to painful irritation and possible fibrosis. Conservative measures of padding and injections often fail to provide long-term relief. Surgical excision provides definitive relief, but the procedure is not without risk. Incomplete excision and stump neuroma formation are a few of the possible complications associate with open excision. This retrospective cohort study was performed to provide a review of the available literature on the identification and treatment of interdigital neuromas and to examine the overall incidence of patient satisfaction after radiofrequency ablation as definitive treatment for interdigital neuroma formation. This study population consisted of 32 patients (25 females and 7 males with 1 patient having bilateral procedures) with a mean age of 46.3 ± 17 (range 31 to 65) years. For all procedures, the median patient satisfaction score was 92.5 (interquartile range 50 to 100) of 100, with a mean follow-up period of > 2.5 years. Only 1 patient in the study population reported no relief after 3 total procedures. Radiofrequency ablation offers a minimally invasive alternative with a short postoperative recovery course and considerably fewer complications compared with surgical excision of the intermetatarsal neuroma as described in prior reports.

Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus

Retrograde intramedullary nailing for tibiotalocalcaneal arthrodesis is a salvage procedure reserved for severe cases of deformity. The aim of the present study was to compare the outcomes of this technique in patients with and without diabetes mellitus (DM). A total of 61 patients with and 56 without DM underwent retrograde intramedullary nailing and had a minimum follow-up period of 12 months. The overall incidence of complication was 45.2%; however, the overall incidence of complications between those with and without DM was not significantly different (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.38 to 1.65, p = .54). Patients with DM had a significantly greater rate of superficial infections (OR 8.3, 95% CI 1.01 to 68.67, p = .03). However, no difference was seen in the rate of deep infection (OR 0.90, 95% CI 0.34 to 2.46, p = .83) or noninfectious complications (OR 0.50, 95% CI 0.23 to 1.13, p = .09). Successful limb salvage was achieved for 96.8% of the patients with DM and 94.7% of those without DM (p = .66). A femoral head allograft was used in 32 (27.4%) of 117 patients to substitute for an osseous void. Of the 32 patients who required a femoral head allograft, 21 (67.7%) experienced a complication compared with 32 (37.6%) of 85 patients who did not require a femoral head allograft (OR 3.16, 95% CI 1.35 to 7.41, p = .008). The incidence of patient satisfaction was 80% for patients with DM and 72% for those without DM (p = .36). Despite a high incidence of complications, limb salvage was accomplished in approximately 95% of patients with complicated deformities. Four patients (6.56%) with DM experienced a tibia fracture; therefore, we now routinely use a 300-mm-long nail for this reconstruction.

Augmentation mammaplasty. Retropectoral versus retromammary implantation

Abstract Although the weight of evidence generally indicates that improved contracture rates with retropectoral placement of the prosthesis and excellent aesthetic results can be obtained with this approach, there remains a significant cadre of surgeons who believe their own retromammary results are equal to or better than the alternative. Our experience with retromammary augmentation since 1963 indicates that fibrous capsular contracture around the implant is a persistent sequela. By placing the prosthesis behind the pectoral muscle, we believe we have achieved a significant decrease in this occurrence. Whereas there are a variety of hypothetical explanations for this observation, it may be that interposition of additional soft tissue between the implant and the observer may disguise the otherwise apparent problem, thus making its correction more apparent than real. Whatever the explanation, however, we have had fewer patients requiring fibrous capsule release and a higher incidence of patient satisfaction by placing the prosthesis behind the pectoral muscle.

Selective gastric vagotomy.

<h3>Introduction</h3> Vagotomy is now recognized as an effective procedure for the control of duodenal ulcer disease. The neurectomy contributes little to the risk of the operation, and whether combined with gastric drainage or antrectomy, the incidence of patient satisfaction is excellent.^1,2 Unfortunately vagus nerve interruption is associated with significant side-effects. Approximately one-third of these patients experience a postvagotomy syndrome characterized by intermittent diarrhea and abdominal distention. Usually the symptoms are mild and not volunteered, requiring direct queries to elicit their presence. On occasion however, their severity leaves the patient dissatisfied with the over-all result of the operation. In 1948 Jackson described to this association a modification of the vagotomy operation specifically conceived to avoid these undesirable sequelae. The increasing popularity of vagectomy as the operation of choice for intractable duodenal ulcer, coupled with the recognition of the frequency with which the postoperative syndrome is encountered, merits a reevaluation of