Incision Line Research Articles

The optimal angle of the mediolateral episiotomy at crowning of the head during labor

The aim of the mediolateral episiotomy incision is to increase the diameter of the soft tissue of the vaginal outlet to facilitate birth and to prevent vaginal tears. Episiotomy angles that are too narrow and close to the midline increase the risk of obstetric anal sphincter injuries. In order to determine the optimal angle of the episiotomy, we assessed the changes in the angles of episiotomy lines marked during the first stage of labor and measured at the time of crowning of the head. Incision lines for mediolateral episiotomy were marked on the perineal skin at angles of 30°, 45°, and 60° from the midline during the first stage of labor in women with a singleton pregnancy. The angles of the marked lines were measured at crowning of the head. Mediolateral episiotomy was performed only for obstetric indications. The study included 102 women with a singleton pregnancy. Of these women, 50 were primiparous and 52 were multiparous. All angles marked during the first stage of labor increased significantly (by more than 30°) at crowning of the head. Similar changes were observed in primiparous and multiparous women. The angle of the mediolateral episiotomy line was significantly greater at crowning of the head than when marked during the first stage of labor. To achieve the desired episiotomy angle, it is important to take into consideration the changes in mediolateral episiotomy angles that occur during labor.

Postsurgical Pyoderma Gangrenosum Versus Necrotizing Fasciitis: Can We Spot the Difference?

Pyoderma gangrenosum is a rare noninfectious cutaneous disease characterized by expanding areas of skin ulceration around necrotic centers with purulent debris. Exceptionally, it can be precipitated by surgery alone, and this entity has been described as postsurgical pyoderma gangrenosum (PSPG). Cases of PSPG in the literature are rare. We performed a retrospective review of the current literature on PSPG and highlight some observed differences between these conditions. We also present our experience of PSPG imitating an infectious process post reduction mammoplasty. Although PSPG can demonstrate fever, malaise, systemic signs, and serology that mimic the sepsis of necrotizing fasciitis, we identify some features that can aid diagnosis of pyoderma gangrenosum in the absence of pathergy (which is pathognomonic). These include premorbid inflammatory bowel disease, hematological malignancy, or inflammatory polyarthritis; the exquisite and disproportionate pain associated (in particular within surrounding normal skin); symmetrical changes on both breasts; specific histopathological changes with absence of microorganisms; cutaneous wounds demonstrating an ulcerated, violaceous, and undermined edge; and, in this case, bilaterally spared nipple-areola complexes suggesting progression within continuous skin up to but not across incision lines. We hope that, in encouraging a higher index of suspicion, prompt diagnosis, and accurate treatment, a better outcome for both patient and surgeon can be achieved in future cases.

Clinical application of combining double suture fixation and resection partial fat retro-orbicularis oculus in some specially difficult blepharoplasty

Objective To summarize the experience of clinical application of combining double suture fixation and resection of partial fat retro-orbicularis oculus in some specially difficult blepharoplasty. Methods During upper blepharoplasty, patients with heaviness and bulkiness in the both upper eyelid and lateral upper orbital region, we combined double suture fixation and resection partial fat retro-orbicularis oculus. First, partial pretarsal bulky fat was resected, and to form skin-orbicularis-oculi composite below incision line. And then, some thickened fat retro-orbicularis oculus was resected, which was also named preseptal and retro-orbicularis oculus fat (ROOF). Double suture fixation techniques were applied to form dynamic and physiological double eyelid. Results 146 cases had satisfactory effectiveness, except for 2 cases with secondary operation because of some superficial double eyelid creases, and 1 case had hematoma, and 3 had transient numbness in the lateral supraorbital nerve region. They were satisfied with healthy eyelid skins, concealed incision and non-serious complications followed at 3-24 months postoperatively. Conclusions Combining double suture fixation and resection of partial fat retro-orbicularis oculus would appear to be a useful adjunct to standard blepharoplasty techniques in selected patients. Key words: Blepharoplasty; Double suture fixation; Fat retro-orbicularis oculus

How to Improve Cannulation Rates During Endoscopic Retrograde Cholangiopancreatography

How to Improve Cannulation Rates During Endoscopic Retrograde Cholangiopancreatography

Salvage resection of recurrent polyp after polypectomy on the colorectal anastomosis using endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) enables secure R0 resection irrespective of size or location of the lesion. However, severe fibrosis is still a condition in which ESD is technically challenging. Here we report a case for which we performed salvage ESD for a recurrent polyp after polypectomy on the colorectal anastomosis. A 77-year-old woman who had undergone polypectomy for a polyp on the anastomosis of a previous laparoscopic sigmoidectomy was referred to our endoscopy unit for removal of its recurrence. Colonoscopy revealed a sessile polyp 15 mm in diameter on the anastomosis (Fig. 1A). We decided to perform ESD as a salvage treatment (Video 1, available online at www.VideoGIE.org). We started with a circumferential mucosal incision using dry cut mode effect 2, 30 W, from the anal side, using a Dual Knife (KD-655Q; Olympus, Tokyo, Japan), followed by submucosal dissection using swift coagulation mode effect 3, 30 W. A surgical staple remained on the incision line (Fig. 1B) and it was retrieved by biopsy forceps (Radial Jaw 4; Boston Scientific, Natick, Mass) (Figs. 1C and D). As expected, there was severe fibrosis in the submucosal layer (Fig. 1E), so we carefully dissected it using an ST hood (DH15-GR; Fujifilm, Tokyo, Japan) and Hook knife (KD-620QR; Olympus). During submucosal dissection, we encountered many staples, which we retrieved. Finally, we resected a lesion, although a tiny residue remained on the margin of the lesion, which was resected by a snare (Figs. 1F and G). The pathologic diagnosis was low-grade tubular adenoma (Fig. 1H). Follow-up colonoscopy 6 months later revealed that the post-ESD ulcer had become completely scarred without residual lesion (Fig. 1I). ESD is still technically difficult for lesions with severe fibrosis. In this case, use of ESD managed to avoid the need for repetitive surgery by highly skillful hands and multiple devices. When perforation occurs during ESD, we attempt to close the perforation site using endoscopic clipping; if that fails, conversion to surgery is necessary. When endoscopic clipping succeeds, localized peritonitis is managed with conservative care, including fasting and intravenous antibiotic administration, but if generalized peritonitis occurs, again, conversion to surgery may be needed. In any case, consultation with a surgeon is necessary, so it is important to maintain good relationships with surgeons. All authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJmNGUyMzA3MTk4Y2I3MDI5Y2MzZWYwM2VkOGZmZWY5OSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5MzM5ODc3fQ.LOBgqiPZKxi6M5tf8LJ7CemdeNGwLKSF5WbpgAriEm5B8jR7raH2F6ZagtnXwPU1rzU_pGWJCr5pBA4e0kwhFA5If84TTVSwOqNQp7j9oelcmY4pvFSUEsy04jx3r7nozoNPgr3UNQN9OkldLFyhBcB5bJscHnGaUVkWrG8ujMPUDVgx25ws4WYP6goKMz_Tono-f28fj3w5YRVsffynuQuHfuIlMcxks48GOwyWFPD_byBpnOgM-PNXf3hi0ftiHDhaFso8wMFrvTT1QuCaMXUyautrRknGbTQLiLBKIqvvsplinv5fRcztjY2RZzyXD6FMqdODuN_q8_xzuil0LQ Download .mp4 (47.66 MB) Help with .mp4 files Video 1Salvage endoscopic submucosal dissection for recurrent polyp after polypectomy on the colorectal anastomosis. Download .docx (.01 MB) Help with docx files Video Script

Effect of intrafragmentary bupivacaine (haematoma block) on analgesic requirements in dogs undergoing fracture repair

ObjectiveTo test the efficacy of intraoperative intrafragmentary administration of bupivacaine (haematoma block) in controlling postoperative pain in dogs undergoing osteosynthesis of long-bone isolated diaphyseal fractures. Study designRandomized, ‘blinded’, placebo-controlled, prospective study. AnimalsA total of 23 client-owned dogs with isolated long-bone fractures. MethodsDogs were allocated randomly to two groups: bupivacaine group (B) or placebo group (P). Group B dogs (n = 11) were administered an intraoperative intrafragmentary injection of 0.5% bupivacaine (1.1 mg kg–1) just before fracture fixation, whereas group P dogs (n = 12) were administered normal saline. Postoperative pain evaluations using the University of Melbourne Pain Scale (UMPS) and algometer were performed upon arrival to the recovery room and 1, 2, 4, 6, 8, 20 and 32 hours later. Algometer measurements were performed on: the incision site, a healthy region near the fracture line and the contralateral healthy limb. When the pain score exceeded 14 points in the UMPS, rescue analgesia was administered. The time-standardised area under the curve (AUCst) was used to compare UMPS scores and mechanical pain thresholds between the two groups. ResultsNone of the group B dogs required rescue analgesia, whereas eight of the 12 group P dogs did (p = 0.001). The pain threshold AUCst at the incision line was higher in group B [16.3 (2.9–41.6) N] than in group P [5.6 (2.5–17.4) N] (p = 0.029). The mean UMPS score AUCst was lower in group B (3.7 ± 1.8) than in group P (9.4 ± 4.6) (p = 0.016). In a small number of animals of both groups that were evaluated radiologically, adequate bone healing was noted. Conclusions and clinical relevanceAn intraoperative bupivacaine haematoma block is a simple, quick and effective method that can be used to aid in postoperative pain control in dogs submitted to long-bone osteosynthesis.

Modified S-Flap for Nipple Reconstruction.

Nipple reconstruction is an important last step in the process of autologous or implant-based breast reconstruction. A multitude of techniques have been described, among others the S-flap. To prevent nipple retraction after surgery, we modified the originally described method by Cronin. By adding an S-shaped incision line, the flap can be transposed with less tension and sutured on top of the new nipple along a curved line. Furthermore, two small triangular flaps were inserted at the base for reinforcement and reduced linear contraction. Assessment was completed by measuring nipple diameter and projection with a caliper. A total of 16 patients underwent the technique, of whom 11 could be followed after 3 and 6months. Overall patient satisfaction with the aesthetic result was high, and we observed no infection or necrosis. Nipples were stable in size and shape at 6months. Although reduction of 68% in projection and 31% in diameter was observed, the nipples remained pleasantly similar to the contralateral non-operated side. The modified S-flap is a simple and reliable technique for moderate-sized nipple reconstruction. By providing more tissue at the base, size and projection remain stable and durable. Moreover, by a modified linear incision line at the base, tension and subsequent scar contraction is minimal. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Laparoscopic endoscopic cooperative surgery for early gastric cancer

The laparoscopic and endoscopic cooperative surgery (LECS) has been developed as a surgical procedure for submucosal tumor (SMT). The original LECS is not applicable for lesions with tumor exposed on the mucosal surface due to oncological safety. We describe surgical procedures of closed LECS for early gastric cancer cases, which don’t require opening of the stomach wall. We routinely combine partial resection (closed LECS) of early gastric cancer with sentinel lymphatic basin (LB) dissection. The stomach are laparoscopically conducted and a local injection of 0.5 mL indocyanine green (ICG) 0.5% (5 mg/mL) is endoscopically performed. Under the laparoscopic view of ICG fluorescence, the LB is dissected. Following removal of the whole sentinel node (SN), the LB is sent for the intraoperative pathology diagnosis. The closed LECS is started when all examinations confirm negative SN. The procedure corresponds to the regular LECS; a mucosal incision is made to connect the dot marking. Marking is made endoscopically during laparoscopy using pyocyanine along the dissection line of the circumferential incision on the submucosal layer. A sponge material spacer that is adjusted to the size of the marking line is prepared, which is applied to the serosal surface of the tumor, and serosal muscular layer suture is evenly added until the sponge is completely buried. The oral endoscopic operation is resumed, and incision of the muscular layer/serosa of the bulging tumor is made. The resected specimen is collected orally with an endoscopic retrieval device. After carefully confirming the operation field both endoscopically and laparoscopically, the operation is ended. The combination of the LECS and the SNNS techniques, while applicable cases are limited, is expected to be established as the effective surgical procedure of partial gastrectomy for early gastric cancer. In the future, we will develop the procedure carefully and proactively.

Intratesticular and incisional line infiltration with ropivacaine for castration in medetomidine–butorphanol–midazolam sedated dogs

ObjectiveTo evaluate whether intratesticular and incisional ropivacaine infiltration produces sufficient intra- and postoperative analgesia for castrating dogs under sedation. Study designRandomized, blinded, controlled clinical study. AnimalsTwenty-three healthy dogs weighing 5.8–35.6 kg admitted for castration. MethodsDogs were sedated with medetomidine (0.01 mg kg−1), butorphanol (0.2 mg kg−1) and midazolam (0.2 mg kg−1) intramuscularly, and were randomly assigned to group R, 0.2–0.4 mL kg−1 of ropivacaine 0.5%, or group S, an equivalent volume of saline injected intratesticularly and along the incision line. If persistent motion was observed during surgery, sedation was considered to be insufficient and general anaesthesia was induced. Carprofen 2.2 mg kg−1 was administered postoperatively. Pain was evaluated in all dogs before sedation and postoperatively following atipamezole administration at 1, 2, 4, 8 and 24 hours using an interactive visual analogue scale (IVAS; 0–100), the Glasgow composite pain scale-short form (CMPS-SF; 0–24), and a mechanical algometer. Methadone 0.3 mg kg−1 was administered intravenously to dogs if IVAS >30 or CMPS-SF >4. ResultsThere was no significant difference between groups for the number of dogs administered general anaesthesia. The time from the beginning of surgery to induction of general anaesthesia was significantly shorter [median (range)] in group S [6 (3–25) minutes] than in group R [56 (36–76) minutes]. At 8 hours IVAS was significantly higher in group S (14 ± 10) than in group R (6 ± 4). Conclusions and clinical relevanceIntratesticular and incisional ropivacaine infiltration delayed the time to anaesthesia induction, and provided analgesia after castration performed under deep sedation in dogs. Intratesticular local anaesthesia can be an important part of the anaesthetic plan for castration.

Design of a Locator for Designing the Shortest Incision for a Polygonal Dural Window.

When a wide polygonal dural window is created, a short dural incision length is preferred by surgeons because suturing a wastefully long incision line during closure is troublesome. A locator to facilitate making the shortest dural incision when creating a polygonal dural window would be helpful. We geometrically analyzed the shortest incision design for a pentagonal dural window and produced a simple locator for intraoperatively implementing this design. The design for a pentagonal dural window with the shortest incision is the same as the design for a minimum Steiner tree (MST) problem with five vertices. The MST consists of three interconnected Steiner points (SPs) with three equal, radiating branches. We produced a template of the features of the MST for a polygon (MST template) as a locator. The MST template consists of several uniform Steiner units (SUs), each of which has an SP at the center and three wings that branch off of the SP, and each SU also has three slits through which the wings of another unit can pass. This mechanism allows us to freely adjust the distance between the SPs of separate SUs. In clinical practice, we can create the shortest incision design for a quadrilateral or pentagon by arranging MST templates combining two or three SUs. If we open a wide dural window, the total incision lengths created using our method are 1–5 cm shorter than conventional incisions. The MST template accurately and easily reveals the shortest incision design.

Tackling Post-Operative Cutaneous Scarring with Autologous Cell Therapy

Regenerative medicine has brought about refreshing new thinking about age old problems. However, some problems remain mostly untouched and are not being addressed. A point in question is the track of scar tissue left behind post-operatively, which reveals the surgeon’s line of invasive incision. This confers on the patient an adverse psychological reminder and burden for the rest of his/her life. Most patients cannot afford corrective plastic surgery to ameliorate this skin defect. This paper seeks to ask whether biomedical scientists could play a role in arriving at a more pleasing cosmetic result, using a simple cell culture procedure of isolating un-manipulated autologous primary epidermal and dermal cells from a small skin tissue segment in close proximity to the surgeon’s incision line.

The Use of Zigs and Zags to Reduce Scarring over “Keloid Triangles” during Excisional Surgery: Biomechanics, Review and Recommendations

Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.

Clonidine as an Adjuvant to Lignocaine Infiltration for Prolongation of Analgesia after Episiotomy.

Background:Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pregnant females reach hospital without antenatal checkup, and at that time, “episiotomy infiltration” becomes an ideal method for vaginal delivery. One of the most important problems after episiotomy is the severe perineal pain on the 1st day of postpartum period.Objectives:We compared the efficacy of clonidine 1 μg/kg as an adjuvant to 20 mg/ml lignocaine infiltration along the line of episiotomy incision for prolonging the duration and quality of analgesia with respect to various activities by single injection.Methodology:Majority of the patients, 94.2% in our study, had no idea about labor analgesia, and only 2.5% of all the patients expressed their interest to deliver without suffering from labor pains. One hundred and twenty pregnant female patients scheduled for full-term vaginal delivery were assigned into lignocaine and lignocaine-clonidine group according to infiltration they received. Pain scoring using visual analog scale and maternal satisfaction scale was monitored. At the end of the research project, the data were compiled and analyzed using appropriate statistical tests.Results:Duration of analgesia after episiotomy during sitting, walking, and squatting was 22.7 ± 1.32, 21.73 ± 1.47, and 19.875 ± 1.48 h in clonidine + lignocaine group and 6.06 ± 1.26, 5.33 ± 1.18, and 4.01 ± 1.28 h in lignocaine only group, respectively, which was highly statistically significant P < 0001.Conclusions:Clonidine when added to 2% lignocaine infiltration in episiotomy improves the quality and significantly enhances the duration of analgesia.

Treatment of a Gummy Smile Case with Reverse Vestibuloplasty

Gingival display greater than 3 mm results in a situation termed as gummy smile and this situation is often esthetically unacceptable for the individual. Different techniques have been used in case of hiperactive upper lip: botulinum toxin injections, lip elongations with rhinoplasties, lip muscle detachments, myotomies and lip repositionings. We aimed to a present a case of a female patient with excesssive gingival display treated using reverse vestibuloplasty. 47 year old female patient came to our periodontology clinics complaining of an unesthetic excessive gingival display more than 10 mm. A treatment model combining of crown lenghtening procedures, reverse vestibuloplasty and esthetic prosthetic rehabilitation was planned. After local anesthesia, a horizontal incision from right upper molar to the left upper molar was made in the mucogingival juncion. A paralel horizontal incison was also made 10 mm coronally and two vertical incisions were made in the most distal parts of the flap design. Half-thickness flap was reflected and tissue was removed. Two horizontal incision lines were connected using simple suttures, so the upper lip was not excessively mobile any longer. Crown-lenghtening procedures were also performed. After one week, suttures were removed. Healing was uneventful. About a month later, esthetic prosthetic rehabilitation was performed. High-level patient satisfaction was achieved. Discussion: Different techniques could also be combined in the existence of gummy smile. Conclusion/clinical significance: Reverse vestibuloplasty is a minimal invasive surgical procedure with satisfying esthetic results as an alternative to orthognatic surgery.

Blue ring technique for clearer visualization of incision line during corneal transplantation

Blue ring technique for clearer visualization of incision line during corneal transplantation

Classic high lateral tension and triangular resection methods to prevent dog ear and elongation scar in patients undergoing abdominoplasty: A comparative open-label clinical trial.

Background:One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. In the present study, efficacy of a new method compared with classical high lateral tension on preventing dog ear and elongation scar was evaluated.Materials and Methods:in an open-label, randomized clinical trial, seventy patients who were candidates for abdominoplasty were selected and randomly divided into two groups. The first group was operated by classic high lateral method and the second group was operated by a new method concentrating on changing incision line and angle. Dog ear prevention, length of scar, improvement, and postoperative complications were compared between the two groups.Results:The mean ± standard deviation (SD) length of scar in treated patients with classical and new abdominoplasty surgical methods was 53.68 ± 6.34 and 41.71 ± 1.78 cm, respectively, and the length of scar in the group treated with the new method was significantly shorter (P < 0.001). The mean ± SD distance between two anterior superior iliac spine in group treated by new method was significantly decreased after surgery (31.3 ± 1.3 cm) compared to before intervention (36.7 ± 3.9 cm) (P < 0.01).Conclusion:The new method is more likely to be successful in patients with high lateral tension abdominoplasty. However, according to the lack of similar studies in this regard and the fact that this method was introduced for the first time, it is recommended that further studies in this area are needed and patients in term of complications after surgery need a longer period of follow-up.

Free anteromedial thigh perforator flap: Complementing and completing the anterolateral thigh flap.

Objective:Theobjective of this study was to determine the indications, utility, advantages and surgical approach for the anteromedial thigh (AMT) flap.Materials and Methods:We reviewed the records of the patients in whom the AMT flap was used for head and neck reconstruction. We use an anterior approach to harvest the anterolateral thigh (ALT) flap with a non-committal straight line incision. This preserves both ALT and AMT flap territories intact, and further decision is based on the intraoperative anatomy of perforator and pedicle. The ALT flap was usually used as the first choice when available and suitable.Results:Free AMT skin flaps were harvested in 24 patients. All flaps were used for the head and neck reconstruction. Two flaps had marginal flap necrosis. One flap was lost due to venous thrombosis.Discussion:The thigh is an excellent donor site as it has large available skin territory, expendable lateral circumflex femoral artery system and low donorsite morbidity. The ALT flap is the most commonly used flap for reconstruction of soft-tissue defects. However, it is characterised by variable vascular pedicle and perforator anatomy. The AMT flap is an excellent alternative when the ALT flap is not available due to variable perforator anatomy, injury to perforator, when an intermediate thickness is needed between distal and proximal thigh or a chimeric flap is needed.Conclusion:The AMT flap offers all the advantages of the ALT flap without increasing donor-site morbidity. The anterior non-committal approach keeps both the ALT and the AMT flap options viable.

초등학생 학교체육복 디자인 프로토타입 개발에 관한 연구

This study was done for the proposal for improvement for junior sportswear which is substitutable as uniforms in the form of elementary school and physical education uniforms by analyzing detailed features through investigation. Accordingly, we developed a prototype design for physical education uniforms as a symbol of the school to enhance the aesthetic and functional satisfaction. The results are as follows. When we developed physical education uniforms, we put activity on our first priority while taking the improvement in both aesthetic and functional aspects into consideration. In addition, we tried to make sure the uniforms reflect the refined and trendy elements to meet students needs to satisfy their aesthetic sense in dress. Reflecting the improvement proposals and preferences of the students, six different prototype designs were developed and evaluated on the basis of two concepts of "new basic" and "trendy". The highest ranking, the physical education uniforms design 1 is based on new basic concept and characterized with slim fit considering activity which will be worn as fall/winter physical education uniforms. Design 1 uses ottoman functional knit as a fabric material which is not only students favorite but also good in both flexibility and warmth. Top with style of high-neckline collar and full open zip-up is simplified with the incision lines and detail. It is a set-in sleeve design in which blue and yellow collars signifying school color are properly placed along with the incision lines in harmony.

The clinical research of surgical treatment in off-pump coronary artery bypass

Objective To summarize clinical effect and experience for surgical treatment in off-pump coronary artery bypass in 128 patients. Methods 128 cases of age older than 60 years with Coronary heart disease (CHD) undergoing surgical repair in off-pump coronary artery bypass from October 2013 to June 2016 were analyzed retrospectively in our department. All the patients received surgical repair in off-pump coronary artery bypass under general anesthesia by the sternum midline incision line. Summary the complications following surgery. Results Surgical operations were performed in all patients and no death occurred during surgery.The perioperative complications after surgery: low cardiac syndrome (3 cases), arrhythmia(7 cases),including supraventricular tachicardia(2cases),complete atrioventricular block (1 cases), atrial fibrillation(4 cases); pulmonary infection with hypoxemia(5 cases).Secondary endotracheal intubation (2 cases),pleural effusion(3 case),atelectasis (2 cases), kidney injury(1 case),brain injury(1 case). The average drainage of chest was 350 ml, the time for making use of respirometer was (10.12±3.46) h, the length of hospital stay was (10±6) d. All patients were followed up from 3 months to 3 years.As a result,postoperative cardiac function improved significantly. Conclusions Surgical repair in off-pump coronary artery bypass for older patients with Coronary heart disease is safe and effective, surgical technical experience accumulation and the improvement of postoperative care can help to further reduce the incidence of complications. Key words: Off-pump coronary artery bypass; Coronary heart disease; Cardiac surgical treatment

A randomized, controlled, multicentre clinical trial of post-extraction alveolar ridge preservation.

AimTo compare the effectiveness of two‐ridge preservation treatments.Materials and MethodsForty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross‐linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post‐operatively, and biopsies were retrieved for histomorphometric analysis at 6 months.ResultsPrimary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty‐seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites.Conclusion DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.