Incision Line Research Articles

Male Surgical Neck Rejuvenation.

Patients who are aging, with weight gain, and increased skin laxity, request dermatologists to improve their neck area. Surgical and nonsurgical options are reviewed as well as benefits and side effects. This article will focus on how surgical techniques can be applied for male patients in particular. To review surgical neck rejuvenation therapies available currently to find the best option for male patients. Surgical treatment of the male neck to improve mandibular contour and loose neck skin requires tightening of the platysmal muscle and usually skin removal in the postauricular sulcus and into the hairline. Most patients choose to have this performed underline tumescent anesthesia when given the choice of sedation versus local anesthesia. The other surgical variations of improving the neck contour on a male include using a direct excision by a midline incision starting in the submental crease and extending down the anterior neck. This approach allows for maximum tightening of the platysmal bands. The incision line can be minimized using intraoperative laser resurfacing immediately after suturing. Chin implants are necessary in some patients to give good neck improvement. The isolated neck lift is one the most common procedures requested by men asking for neck improvement.

Thighplasty: improving aesthetics through revival of the medial, horizontal procedure: A safe and scar-saving option

Thighplasty is a common bodycontouring procedure, but also associated with a high complication rate. The purpose of this study was to access the outcome of the medial horizontal thigh lift as it is a common surgical technique regarding thigh deformity correction performed at the authors' department. Surgical keysteps, clinical applications, advantages and disadvantages of the procedure are shown. Postoperative evaluation took place with special focus on individual patient satisfaction. Retrospective analysis of 25 bilateral thigh lifts with single medial horizontal incision line was performed. Evaluated data include patient age, sex, body mass index, combined procedures, additional liposuction, weight loss, former bariatric surgery, comorbidities, smoking status and surgical complications. Follow-up was performed with a standardized protocol and the scar was accessed according to the Vancouver-Scare-Scale. Additionally the patients were asked to complete a questionnaire divided into the sections 'scars', 'postoperative result' and 'sexuality'. Average patient-age was 43 years. Average follow-up was 2 years and 8 months. Average weight loss before surgery was 57 kg. 36% of all patients additionally received a liposuction of the medial thigh. In six cases (24%), we observed complications, which were designated as 'minor complications' in five times (conservative management without problems) and 'major complication' in one time (surgical revision). Postoperative patient-satisfaction was high. Compared to the horizontal and vertical combined thigh lift with the classic T-shaped incision lines we observed fewer complications and a reduction of postoperative morbidity. Additionally patient satisfaction was very high. We estimate that the main reason therefore is the avoidance of the vertical scar and its associated short- and longterm problems. The evaluated data confirm the medial horizontal thighplasty as a good and valuablesurgical option for the management of thigh deformities with moderate skin and tissue excess, localized in the upper part of the thigh.

Parallel vertical compression sutures to control bleeding in cases of placenta previa and accreta

Objective: To evaluate the effectiveness of full-thickness vertical compression suture and intrauterine catheter in cases with placenta previa/accreta. Study design: This study was conducted on Obstetrics and Gynecology emergency unit of Sohag University Hospital. Two longitudinal parallel full-thickness suture was taken using delayed absorbable suture (No. 2 Vicryl…) the entry of needle through anterior wall of lower uterine segment just above the internal os 2–3 cm medial to lateral aspect of lower uterine segment then completely piercing the posterior wall and then return from posterior wall to anterior wall 1–2 cm below incision line of the uterus. Another suture was taken in other side in the same manner. The Foley’s catheter was inserted through the incision line into the cervix and balloon was inflated by 20–30 cc saline. Results: Two hundred and seventy-eight cases were included in the research. There were 107 cases without significant bleeding from lower uterine segment and no maneuver was needed. The remaining 171 cases were managed by vertical compression suture and intrauterine Foley’s catheter which was successful in 168 cases (98.2%) to stop the bleeding. Only three cases cesarean total hysterectomy was needed. Conclusions: Vertical lateral compression sutures with inserting inflated balloon of Foley’s catheter is an effective method for controlling bleeding in cases of placenta previa/accreta.

Combining Rhinoplasty With Upper Lip-Lift Using a Single Incision Line.

Combining Rhinoplasty With Upper Lip-Lift Using a Single Incision Line.

The Nasal Tip Rotation Flap for Reconstruction of the Lateral Nasal Tip, Anterior Ala, and Soft Triangle: The Authors' Experience With 55 Patients.

Defects of the lateral nasal tip, anterior ala, and soft triangle subunits lack reconstructive options that are consistently satisfactory. For such defects, the novel anterior-based nasal tip rotation flap provides functional and aesthetic results in a single operative session. To describe the authors' experience with the nasal tip rotation flap, including patient selection and design modifications to enhance aesthetic success. An IRB-approved retrospective database review of nasal tip rotation flap repairs was performed at the Medical University of South Carolina and Stanford University Medical Center. The design and surgical technique of this flap are described and illustrated, emphasizing factors such as nasal shape and defect location in modifying flap design. The nasal tip rotation is a single-stage, local flap that provides optimal tissue match with recapitulation of the native topography of the nasal tip and incision lines that are well hidden at the junction of cosmetic subunits. The mechanics of the flap distribute closure tension widely across the alar rim without focal notching or airway compromise. The nasal tip rotation flap is a reliable, cosmetically elegant repair that fills a gap in the reconstructive options for anterior ala and soft triangle defects on the nose.

Endoscopic Full Thickness Resection (EFTR) of a Gastric Submucosal Tumor

Incidental submucosal tumors can be found in about one in three hundred upper endoscopies. Currently, EUS can aid in establishing diagnosis of highly malignant features of a nodule, but it cannot provide appropriate malignant potential due to absence of histological mitotic count. FNA is useful for making a definitive diagnosis, but many times it can be inconclusive which submits the patient to continued endoscopic surveillance. We present a case of a full thickness resection of a gastric submucosal nodule followed by endoscopic suturing to close the defect. We present an 81-year-old male complaining of GERD. An EGD showed an incidental gastric body nodule. An EUS revealed a 1.5 cm by 1.4 cm submucosal tumor extending into the muscularis propria. Cytology from FNA showed spindle cells, suggestive of a GIST. Using an IT nano knife, we made a 360-degree circumferential incision extending into the sub-mucosa. Hemostasis was achieved by using coagulation forceps for small vessels, and hemostatic clip for larger vessels. The incision was then extended deeper into the muscularis layers along the line of the initial incision. With the IT nano knife, we completed the 300-degree full thickness incision. We intentionally avoided the last 60 degrees of the serosal layer to prevent migration of the resected specimen into the peritoneum. A four centimeter full thickness defect was seen visualizing the mesenteric fat endoscopically. The remaining pedicle was resected using a hot snare and retrieved using a roth net. The defect was closed with interrupted sutures using an overstich device. A helix device was used to facilitate suturing. Pathology confirmed full thickness resection. CT abdomen with enteric contrast confirmed adequate closure of the resection site. Patient was discharged after 23-hour observation. A two month follow up endoscopy showed hyperplastic tissue at the suture site without any residual nodule. This technique of endoscopic full thickness resection using an overstich device for closure is technically feasible, safe and provides definitive diagnosis with malignant risk stratification eliminating the need for continued endoscopic surveillance. Watch the video: https://goo.gl/QAEuLg

073_16955-Q1 Low Anterior Axillary Implantation of an Implantable Cardioverter-Defibrillator in a Patient with Recurrent Bilateral Pectoral Infection

A 38-year-old male with ischemic cardiomyopathy had recurrent implantable cardioverter-defibrillator (ICD) device infections with two infections on the left pectoral region and one infection on the right pectoral region in a few months. We performed a low anterior axillary line incision with

Cervicofacial Flap: Can We Save Patient's Sideburns?

BackgroundThe conventional cervicofacial flap may cause the aesthetic problem of sideburns with a mismatched shape and arrangement. We developed a modified method with the goals of minimizing the destruction of the shape and arrangement of the sideburns and minimizing complications in comparison with the conventional method.MethodsThe incision line was designed to descend just in front of the sideburns, without passing through them, and then to ascend with the sideburns posteriorly when a cervicofacial flap is performed, unlike the conventional method. Patients in whom this method was applied (group B) and patients who underwent surgery using the conventional method (group A) were investigated in a retrospective study. The method was evaluated by assessing changes in the arrangement of the sideburns and patients' satisfaction, and differences in the complication rate.ResultsIn group A, 23 of the 31 patients experienced changes in the arrangement of their sideburns. Most patients who experienced a change in the arrangement of their sideburns were dissatisfied with the change. The patients in group B did not experience such changes, and the defects were well reconstructed. Most of them were satisfied with the final sideburn arrangement.ConclusionA novel method was used to preserve the sideburns while performing a cervicofacial flap. As a result, the appearance of the sideburns was well preserved and the satisfaction of patients was also high. Moreover, this technique could also prove useful for reconstruction without any increase in complications compared to the conventional method.

Persistent postherniorrhaphy pain following inguinal hernia repair: A cross-sectional study of prevalence, pain characteristics, and effects on quality of life

IntroductionChronic inguinal pain due to the inguinal hernia repair is still a serious consideration, and its incidence is evident in approximately 3%–6% of the patients. The purpose of this study was performed to assess the prevalence of chronic pain after inguinal hernia repair and the effects on the quality of life in our patient. MethodsThe records of the patients who were 18 years of age or older and had had an inguinal hernia repair under spinal anesthesia after receiving a diagnosis of inguinal hernia at this hospital from 2009 to 2015 were accessed through the hospital's data system. Patients who had signed the informed consent agreement were given an Inguinal Pain Questionnaire (IPQ) and a Douleur Neuropathique 4 (DN-4) questionnaire after recording their demographic data on the appointment day. Surgical incision line was evaluated with a dolorimeter and mild touch hypoesthesia, needle-touch hypoesthesia, brushing allodynia were evaluated with cotton, and 0.711 mm diameter Von-Frey filament (Touch-Test Sensory Evaluator Kit; North Coast Medical, Inc., Gilroy, CA, USA). ResultsThe total number of patients who had ASA I-II scores and who had undergone a one-sided inguinal hernia repair under spinal anesthesia in elective conditions with at least three or more months of recovery time months was 619. Of these 264 patients, 203 with absence of pain (score of the severest pain over the past week and now was 0) were classified as the Non-Pain group and 61 patients with inguinal pain (score of the severest pain over the past week or now was 1 or more) were classified as the Pain group.The incidence of chronic pain after inguinal hernia surgery was 23.48% (n = 61) in our study. The pain was localized at and near the surgical incision and radiated into the scrotum in 17.73% (n = 36) of the male patients having chronic pain. While chronic pain developed in 60 out of 239 patients who had pain prior to the surgery. The presence of pain prior to the surgery was evaluated as an effective factor for the chronic groin pain. Neuropathic pain was detected with the DN-4 questionnaire in 6 (2.95%) out of 203 patients who stated that they had no pain during the physical examination and the week prior to the exam. The frequency of chronic pain after inguinal hernia repair was found 23.48% in our study. This is the same rate as previously reported. Quality of life of these patients was affected. We believe that there is an urgent need for prospective randomized studies with the aim of determining a standardized methodology towards preventive measures after determining the risk factors of chronic pain developed in the post inguinal hernia repair period.

Retroperitoneal Laparoscopic Nephrotomy Along the Brodel Line and Tumor Enucleation for Complete Intraparenchymal Renal Tumors: A Single Institution Experience.

To evaluate the feasibility and outcomes of retroperitoneal laparoscopic nephrotomy along the Brodel line and tumor enucleation (TE) for complete intraparenchymal renal tumors. We retrospectively analyzed the medical charts of patients with complete endophytic tumors and who underwent retroperitoneal laparoscopic nephrotomy along the Brodel line and TE between 2012 and 2015. Perioperative data, surgical technique, pathologic variables, complications, functional, and oncologic outcomes were reviewed. Twenty-one patients (mean age of 50 years; mean body mass index of 25.8 kg/m2) were treated with retroperitoneal laparoscopic TE along the Brodel line incision. The mean tumor size was 2.0 cm, and the mean RENAL score was 9.4. The main surgical outcomes were mean operative time of 94 minutes, mean estimated blood loss of 63 mL, and mean warm ischemia time of 28.4 minutes. Pathology showed clear renal cell carcinoma (n = 16), papillary renal cell carcinoma (n = 4), and reninoma (n = 1). No positive margin was found, and no perioperative complication occurred. The mean glomerular filtration rate of the affected kidney was 31.5 mL/minute/1.73 m2 three months after the surgery. In a median follow-up of 20 months (range of 4-36 months), no evidence of tumor recurrence or metastasis was found. For patients with complete intraparenchymal renal tumors, retroperitoneal laparoscopic parenchyma incision along the Brodel line and TE can be safely and effectively performed in centers with significant laparoscopic expertise.

The minipterional approach for ruptured and unruptured anterior circulation aneurysms: Our initial experience.

Objective:To report our experience with the minipterional (MPT) craniotomy approach for anterior circulation aneurysms and to discuss the clinical outcomes as well as to evaluate the advantages of this unique approach.Materials and Methods:Single-center retrospective review of 57 cases involving anterior circulation aneurysms both ruptured and unruptured aneurysms treated with the MPT. We analyzed the clinical and patient demographic data, aneurysm characteristics, surgical outcomes, and complications in these individuals.Results:Between July 2008 and March 2014, of the 57 patients reviewed: 45 had middle cerebral artery (MCA), 6 had internal carotid artery terminus, and 7 had posterior communicating artery aneurysms. 20 of the 57 patients presented with a ruptured aneurysm. The average aneurysm size was 5.8 mm. The length of hospitalization for unruptured aneurysm cases ranged between 3 and 5 days. The average follow-up for all cases was 21.5 months. Successful clipping of the aneurysms was obtained in all patients. None of the cases required additional skin incisions or craniotomy extensions. The overall surgical outcomes were favorable. There was no postoperative facial nerve damage, temporalis muscle wasting, or symptoms of paresthesias around the incision line. Two patients developed a postoperative stroke manifested as symptoms of unilateral arm and facial weakness, receptive aphasia, and dysarthria.Conclusion:The MPT provides a reliable and less invasive alternative to the standard pterional craniotomy. Furthermore, ruptured and unruptured anterior circulation aneurysms can safely and effectively be treated with limited bone removal which provides better cosmetic outcomes and excellent postoperative temporalis muscle function.

Avoidance of the vaginal incision site for mesh placement in vaginal wall prolapse surgery: A prospective study

ObjectiveTo evaluate efficacy of a minimal surface area, vaginally-installed polypropylene tape (VPT), avoiding insertion on the incision line to treat an anterior, posterior or anteroposterior vaginal wall prolapse. Study designPatients with an anterior, posterior or anteroposterior vaginal wall prolapse waiting for surgical treatment were included in the study. Primary outcome was the incidence of prolapse recurrence reported with combined outcome measures and was reported with Kaplan-Meier cumulative incidence. Secondary outcomes were operative complications, adverse events, urinary, colorectal and sexual functions as well as quality of life. Participation in the study involved up to 8 visits over 5 years. At each visit, patients used a self-reported questionnaire to report symptoms related to pain, urinary, colorectal, sexual functions, and quality of life. A physical examination was also performed. Paired t-tests were used to investigate change in POP-Q and quality of life measurements since baseline. Results71 patients underwent the procedure and were followed-up for an average (standard deviation) of 32.5 (18.7) months. Only 2 (2.8%) women experienced a recurrence of their pelvic organ prolapse. Only one case of erosion and no case of persistent pain have been recorded up to 5 years post-surgery. Quality of life was improved and then sustained throughout the follow-up period (p<0.01). ConclusionThis VPT surgical procedure is safe and has a high level of efficacy to treat anterior, posterior or anteroposterior vaginal wall prolapse. It is also associated with improvements in quality of life of patients which are sustained for many years.

Effect of Local Ropivacaine on Hemodynamic Responses in Craniotomy Patients

ABSTRACTBackground: Increased intracranial pressure (ICP) with hemodynamic is of major concern to anesthesiologists and surgeons in craniotomy surgery. Thus, the management of hemodynamic stability is essential in neuro-anesthesia. This study was performed to investigate the effect of local infiltration of 0.5% ropivacaine on hemodynamic responses in craniotomy patients. Material and methods: 64 ASA class I -II patients, scheduled for elective craniotomies, were enrolled in this prospective randomized double blind placebo controlled study. These patients were randomly divided into the ropivacaine group, who were administered with 0.5% ropivacaine (n = 32), and the placebo group administered with 0.9% normal saline (NaCl) (n = 32). Anesthesia was induced with 3 µg/kg fentanyl, 5 mg/kg thiopental and 0.5 mg/kg atracurium, and was maintained with isoflurane (0.8–1 = MAC) in 50% N2O, 1 mg/kg /30 minutes, 40% oxygen and 0.05 mg/kg /hour fentanyl. Five minutes prior to surgery, 10 mL of 0.5% ropivacaine was injected in the line of skin incision in the ropivacaine group, while 10 mL of normal saline was injected in placebo group. Thereafter, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressures (MABP), and heart rate (HR) were measured before infiltration into the incision area, 30 seconds, 3 minutes, 5, 10, and 30 minutes after infiltration into the scalp. For higher BP and HR, an adjunct 0.5 mcg/kg of fentanyl was prescribed and administered. Results: A significant difference was observed for SBP, DBP, MABP and HR, between the two groups at different times during craniotomy (p < 0.05). A significant decrease was observed for SBP, DBP, MABP and HR during craniotomy in 0.5% ropivacaine group as compared with placebo group (p < 0.05). Conclusion: Local anesthetic of 0.05% ropivacaine scalp infiltration is effective in clinical usage of regional anesthesia for producing good quality anesthesia, it seems to be a significant choice for management of optimal hemodynamic profile, providing a better hemodynamic stability during craniotomy.

A new modification of Doyle splint (Hemi-split Doyle) in rhinoplasty with alar base reduction.

Patients perceive the pulling of a nasal splints as the most feared and stressful part of nasal surgery. Even the incisions made for alar base surgery can partly or entirely dehisce. So, we have been using modified Doyle silicone splints. We compared the modified Doyle silicone splints with conventional Doyle silicone splint. Included in the study were 64 patients undergoing alar base surgery together with open septorhinoplasty. Group 1 (n=32) patients received a conventional Doyle intranasal silicone splint and group 2 (n=32) received modified splint that we call a hemi-split Doyle splint. The pain felt by the patients during the removal of the splints was recorded according to the visual analogue scale (VAS). On days two and four postoperatively, the nasal stuffiness score (NOSE) was recorded. On day four postoperatively an intranasal examination was conducted to establish if dehiscence had occurred on the alar base incision line. In group 2, the pain scores during splints removal were significantly lower than those in group 1. Whereas no dehiscence on the alar base incision line was observed after tampon removal in group 2, the incision dehisced in eight patients in group 1. The NOSE scores on postoperative days two and four showed no difference between the groups. The hemi-split Doyle splint causes less pain during removal and particularly does not lead to dehiscence of incisions made during alar base surgery in rhinoplasty patients.

Cortisol concentration, pain and sedation scale in free roaming dogs treated with carprofen after ovariohysterectomy.

Background and Aim:One of the topic issues in animal welfare activities is the free roaming dog welfare especially in developing countries such as Serbia. The way of controlling population of free roaming dogs is their reproduction with the method of “Catch-Neuter-Release.” This complex process consists of capturing free roaming dogs in public areas, sterilizing, and returning them to the public area from which they were temporarily removed. Ovariohysterectomy present the period with a high intensity of stress reaction since many veterinarians in Serbia do not use analgesia for this group of dogs. The aim of this study was to compare the serum cortisol concentration before and after ovariohysterectomy and the level of post-operative pain and sedation in a group of free roaming female dogs treated with carprofen after surgical intervention and in a group with no treatment.Materials and Methods:The study was performed on a total of 20 female dogs under the program for free roaming dog control. Free-roaming dogs were captured in public areas by the communal animal hygiene service and were transported between 30 and 45 min to the clinic of a veterinary practice. Treatment began at 10:00 h on the next day and the bitches were kept in cages until they were returned to public locations from which they were temporarily removed to be sterilized. The G2 group received before closing the incision line carprofen in one dosage of 4 mg/kg given by subcutaneous injection into the scruff. Rescue protocol with carprofen was provided for G1 after 24 h following ovariohysterectomy same dosage as G2. Blood (2 ml) was collected from the cephalic vein of each dog in disposable plastic syringes, containing heparin (1:1000) 4 times: Before ovariohysterectomy, 30, 120 min and 24 h following ovariohysterectomy. Cortisol concentration was determined by enzyme-linked immunosorbent assay. The multifactorial pain and sedation scale were used for the assessment of pain and sedation.Results:In both groups, the lowest values of serum cortisol concentration were obtained before ovariohysterectomy. Cortisol levels in both groups were significantly higher (p<0.01) 30 and 120 min after ovariohysterectomy and showed a decreasing trend toward the end of the observation period (24 h). The results obtained 15 and 30 min after the surgical intervention have revealed a statistically significant difference between the groups (p<0.05) showing that female dogs treated with carprofen had a lower value on the pain scale and a higher value on the sedation scale compared to the group with no treatment.Conclusion:Carprofen provides both a restful consequence of sedation and a rapid return to a more normal physiological and behavioral state in dogs after ovariohysterectomy.

Clinical analysis of inlay labial mucosa graft urethroplasty forI period in the complexity hypospadias

Objective To explore the clinical effect of inlay labial mucosa graft urethroplasty (LMGU) forⅠperiod in the complexity hypospadias. Methods According to the digital table, 30 patients with complexity hypospadias were randomly divided into control group and observation group, 15 cases in each group. The control group took Ⅰ period operation. The observation group received surgery by stages to complete.Routine urinary diversion during operation was performed after bladder puncture and ostomy, and in the control group, the urethra was placed with self-made 10-14F lateral hole silica gel stent, which was extracted out in the middle of the perineum, left or right.After 12-14d removal postoperative, the urination was observed.The catheter in the observation group was removed after 10 d, the urethroplasty is performed 6 months later. The clinical effects of the two groups were compared. Results In the control group, postoperative urinary fistula in 2 cases(13.3%), urethral orifice in 1 case(6.7%). In the observation group, postoperative urinary fistula in 2 cases(13.3%), 6 months postoperatively in patients with urinary fistula to repair fistula was successful, urethral mouth narrow pure line incision. The incidence rate of complication of the control group was 20.0%, which of the observation group was 13.3%, the difference was not significant between the two groups(P>0.05). All cases were followed up for 1 to 2 years, did not occur urinary tract stones, hair growth, oral ulcers, such as the limited mouth complications. The penis was straight, beautiful shape. Conclusion Inlay LMGU Ⅰperiod is suitable for multiple surgery led to the lack of local incidence, urethral plate dysplasia and with severe penis abnormalities such as complexity in patients with hypospadias. The postoperative complications, micturition, penile appearance have no obvious differences compared with the stage, it is worthy of clinical popularization and application. Key words: Hypospadias; Lip

Stem cell therapy for reconstruction of alveolar cleft and trauma defects in adults: A randomized controlled, clinical trial

Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone. To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma. Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading. The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft. The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.

Anestesia em Jacaré-americano (Alligator mississipiensis) para Amputação de Membro

Background: The knowledge of secure anesthetic protocols for reptiles is very important, especially because they are aggressive species and they have peculiar physiology, unpredictable reactions to the same drug in different environmental conditions and different physiological responses can be observed. The anesthetic protocol aims immobilization, analgesia and muscle relaxation for adequate, safe and easily reversible anesthesia. Few reports have been described on anesthesia in animals and, before that, the objective of this study is to report the anesthetic protocol that was used and vital parameters monitoring in an Alligator mississipiensis that was submitted to surgery for limb amputation.Case: A female American alligator was attended, with about 8-year-old, 2 m long and 268,964 pounds, with fight history with other animal six months ago, resulting in a wound in the right toracic limb. When the lesion occurred, it was the breeding season of the species, so we chose not to perform the treatment at that time. An X-ray of the member was performed, which showed, among other changes, osteomyelitis and septic arthritis. Thus, the limb amputation was indicated. Ketamine association (10 mg/kg) and medetomidine (0.1 mg/kg) were used as anestesic premedication, both administered intramuscularly. For anesthetic induction, propofol (4 mg/kg) intravenously was used. The animal was intubated using an endotracheal tube number 11 without inflating the cuffing, and for the maintenance it was employed isoflurane. The heart rate was measured using Doppler and the respiratory rate by visual and balloon observation in the oxygen circular system. The other parameters were measured using a multiparameter monitor sensor connected to the tongue. The local anesthetic block was made close to the incision line, the medium third humerus with 2 mg/kg of 2% lidocaine without vasoconstrictor, diluted in 0.9% NaCl until the volume of 10 mL is completed to assist in analgesia. The parameters recorded during the procedure, which lasted 80 min, remained within the normal pattern of species (three breaths per minute, 30 heart beats per min and 80.6°F temperature). After surgery meloxicam (0.2 mg/kg) and atipamezole reverser (0.5 mg/kg) were administered, both intramuscularly. The animal took about seven hours to fully return from anesthesia.Discussion: Different anesthetics protocols may be employed to crocodilians using both local anesthetic techniques and general, in order to promote analgesia, muscle relaxation and adequate anesthesia. Still, it is very important to monitor the patient during the procedure, in order to be a different physiology kind of species. Cardiac auscultation is quite difficult in these animals, so it is recommended to use non-invasive electronic equipment as the Doppler, the multiparameter monitor, the pulse oximeter and esophageal stethoscope for assistance in monitoring heart and respiratory rate, providing important trans-operative information. The realization of amputations in crocodilians is common, however there are few reports in the literature about their anesthesia, this way, this article has a significant contribution to a better anesthetic protocol clarification to be used in these animals. Therefore, it is concluded that the anesthetic protocol based on premedication with ketamine and medetomindina, propofol induction and maintenance with isoflurane, besides local anesthesia with lidocaine was effective and safe for thoracic limb amputation surgery in an American alligator.

Are Incisional and Excisional Skin Tension Lines Biomechanically Different? Understanding the Interplay between Elastin and Collagen during Surgical Procedures

Background: Since Langer's first foray into studying cutaneous lines, although people have studied skin lines across the body, there has not been a study that elucidates changes to skin structure of elastin and collagen at different load levels. This study set out to look at whether incisional lines and excisional lines have different biodynamics and have to be considered differently.

Epidermal cyst mimicking incision line metastasis.

Epidermal cysts are cystic tumors lined with keratinized squamous layer and filled with keratin debris. Epidermal cysts may develop by implantation of surface epidermal layer into the dermis or subcutaneous tissue after trauma or surgical procedures. Cervix cancer spreads either directly or via the vascular and lymphatic systems. Distant skin metastasis of endometrium or cervix cancer is very rare. In this case report, a patient who had a history of cervix cancer operation 11 years ago and presented with a mass that mimicked incision line metastasis and was histopathologically diagnosed with epidermal cyst is presented.