Incision Line Research Articles

Combination of W-plasty and Botulinum Neurotoxin Type A Injection for Preventing Rhytidectomy Scar in Asians.

This study was conducted to see if better scar results could be obtained by administering botulinum neurotoxin type A (BoNTA) injection and W-plasty incision for preventing rhytidectomy scar. All patients underwent extended deep-plane rhytidectomy in two groups. Group 1 had a straight incision line, and BoNTA was not given. Group 2 was injected with W-plasty and BoNTA. Photos were taken before surgery and twelve months after surgery. Two aesthetic surgeons analyzed the results using MSS, MSRS, and SBSES. Interrater reliability was measured using the intraclass correlation coefficient (ICC). Forty-nine patients were included in the study. Group 1 (Straight incision, No BoNTA) had 26, and Group 2 (W-plasty, BoNTA) had 23 patients. The interrater reliability in Group 1 was excellent for MSS (ICC, 0.957 [0.904-0.981]), and good in two of the interrater reliability measures (ICCs, 0.897 [0.769-0.954] for MSRS, and 0.821 [0.605-0.919] for SBSES). Interrater reliability in Group 2 was good in two out of three measures (ICCs, 0.760 [0.423-0.899] for MSS, 0.746 [0.392-0.893] for MSRS, and 0.851 [0.654-0.937] for SBSES). There was a significant statistical difference between Group 1 and Group 2, showing that Group 2 has superior outcomes (MSS, 6.596 ± 1.569 vs. 5.435 ± 0.590, P = 0.001; MSRS, 4.346 ± 0.967 vs. 3.652 ± 0.510, P = 0.003; SBSES, 3.788 ± 0.695 vs. 4.261 ± 0.541, P = 0.012). Analyzed by three dedicated scar assessments, better results were obtained through combining W-plasty and BoNTA injections, so it is expected to be a useful method for improving scars. 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 .

Single-Stage Suction-Assisted Lipectomy with Dermal Mastopexy: An Alternative Procedure in Repeated Reduction Mammaplasty with Questionable Nipple-Areola Complex Vascularity.

A majority of malpractice claims in plastic surgery involve complications following breast surgery.1 Nipple-areola complex necrosis is a devastating complication in reduction mammaplasty secondary to compromised vascular supply. The risk of nipple-areola complex necrosis increases in repeated reduction mammaplasty, particularly when the previously used technique is unknown and operative reports are unobtainable. The appropriate technique for repeated reduction mammaplasty remains controversial, as several approaches have been advocated in the literature.2 Many of these techniques involve full-thickness incisions and wide tissue excision for volume reduction, and thus carry the intrinsic risk of nipple-areola complex necrosis due to violation of the underlying vasculature. Suction-assisted lipectomy with dermal mastopexy is a novel technique for repeated reduction mammaplasties to preserve nipple-areola complex vasculature and sensation. An inverted-T de-epithelialization is marked preoperatively (Fig. 1). Each breast is instilled with 1 liter of tumescent solution consisting of 1 liter of Ringer’s lactate with 1:1,000,000 epinephrine and 50 cc of 1% lidocaine. De-epithelialization is undertaken while the breast is tumesced, and the raw surface provides access points for suction-assisted lipectomy. Liposuction is accomplished using a MedGyn Rigid Currette size 7 (MedGyn Products, Addison, Ill.). After suction-assisted lipectomy, dermal mastopexy is completed with interrupted sutures, imbricating the dermal surface.Fig. 1.: Intraoperative views of suction-assisted lipectomy with dermal mastopexy. The midline axis, inframammary fold, nipple-areola complex, distance from sternal notch to nipple, and incision lines were marked along the breast (left). There was much less excess skin in repeated reduction mammaplasties than in primary reductions, and the nipple-areola complex rarely had to be moved more than a couple of centimeters. De-epithelialization of the breast then provides access for suction-assisted lipectomy (right).Eleven suction-assisted lipectomy with dermal mastopexy procedures were performed from 2008 to 2019. The median patient age was 43 years (±9.9 years) and the median time between reductions was 14.5 years (±5.9 years). Average total volume reduction per breast was 800 cc (±200 cc). There were no intraoperative complications in the cohort. Two patients had postoperative complications of wound dehiscence requiring eventual return to the operating room for hypertrophic scar revision. After a follow-up period of 6 months, all patients reported intact nipple-areola complex sensation, and nipple-areola complex vasculature was preserved in all cases. All patients reported decreased symptoms associated with macromastia, such as rashes and back pain. All patients reported satisfaction with their final breast size and symmetry. Aside from aesthetic considerations, any breast reduction must also take oncologic considerations into account. Preoperative imaging was performed in most of our patients to identify malignancies and serve as a comparative baseline for future mammograms. Reduction mammaplasty with liposuction has been shown to trigger deep intraparenchymal calcification development.3 Most of these changes are macrocalcifications, however, and are rarely confused with malignant-appearing microcalcifications when reviewed by experienced radiologists.3 The evidence suggests that liposuction with dermal mastopexy does not interfere with detection of malignancies any more than traditional techniques.4 In this small review, we show that repeated reduction mammaplasty can be as complication-free as the initial reduction with nipple-areola complex preservation. Furthermore, this approach can be critically useful in the setting of unknown prior surgical techniques. Limitations to our study include our small sample size and lack of a standardized comparison group. Furthermore, while suction-assisted lipectomy is a favorable approach for breasts composed largely of fatty tissue, this technique is not appropriate for breasts composed of mostly glandular tissue.5 Therefore, suction-assisted lipectomy with dermal mastopexy may offer a significant advantage for older patients due to the progressive fatty involution of breast tissue with age. DISCLOSURE The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for this work.

PO-647-07 ULTRASOUND-GUIDED INTERMUSCULAR IMPLANTATION TECHNIQUE FOR A SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

Intermuscular implantation has been recommended for subcutaneous implantable cardioverter-defibrillator (SICD). In general, however, the skin incision line is determined empirically without considering the individual position of the latissimus dorsi muscles (LDM) and serratus anterior muscles (SAM).

Incised Lines: Planning and Design in the Late Formative E Group at Yaxuná, Yucatán, Mexico

Although direct evidence of civic planning is rare among Mesoamerican sites, such features offer great insight into past practices, intentions, and urban transformation. Using data from the transition to the Late Formative period (ca. 400–300 BC), I argue that direct evidence of urban planning is present in the monumental constructions of Yaxuná in Yucatán, Mexico. There, investigators detected a series of carefully rendered incised lines directly on Floor 6 of the E Group plaza. Along with the buildings' exposed surfaces, incised lines served as visual markers for placing rubble and dry-core fill into two categories: large dry-core stones and small compact fill. These visual distinctions informed the location of features built on top of this fill, including Floor 5 and a causeway spanning the plaza's central axis, distinguished from the white floor surfacesascab(a durable product of pulverized limestone) by a red-orange color. The incised lines at Yaxuná grant insight into how ancient builders envisioned public works and then implemented and completed features in a step-by-step design process, which required precision and foresight.

Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach.

The greatest challenge of a free-muscle transfer in facial reanimation surgery is anchoring muscle to perioral soft tissue. An additional incision provides a better way to anchor the transferred muscle but leaves a visible scar. Herein, we compared the functional and aesthetic outcomes in a conventional facelift incision approach with and without the addition of a red line incision. This study included patients experiencing unilateral facial paralysis who underwent free gracilis transfer between December 2016 and December 2018. Anchoring through facelift incision with extended neck incision was performed in the control group, while a red line incision was added in the red line group by avoiding extended neck incision. Oral commissure excursion, upper lip and commissure height differences, and symmetry were measured. A total of 24 patients met the criteria and were included in this study. Of these, 10 patients were assigned to the red line group and 14 to the control group. The red line and control groups demonstrated a similar symmetry index in both resting (0.96 ± 0.18 and 0.92 ± 0.10, respectively; p = 0.435) and smiling (0.94 ± 0.12 and 0.91 ± 0.10, respectively; p = 0.314). However, the upper lip height difference demonstrated greater postoperative improvement (resting: 2.12 ± 1.13 vs. 3.92 ± 1.41 mm, p = 0.002, and smiling: 1.68 ± 0.88 vs. 3.41 ± 1.69 mm, p = 0.004, respectively). A scar could be easily concealed on the mucocutaneous line of the lip. This novel method for muscle anchoring in facial reanimation surgery allows surgeons to approach perioral muscle more directly. This leads to improved surgical results by securely anchoring the transferred muscles using a fixation point that is more medially located than in other approaches. Our method is effective and offers an improved surgical outcome for the free functional gracilis muscle transfer.

Penuma® Concealed Surgery Technique Featuring A New Scrotal Incision

ABSTRACT Introduction Innovation in surgical techniques can lead to enhanced patient outcomes and increased efficiency. Penuma®, a silicone penile sleeve implant used for cosmetic enhancement of the penis, has traditionally been inserted through an infrapubic incision. Recently, a new scrotal incision method for silicone penile sleeve implantation has been developed named the “concealed” technique. Compared to the traditional infrapubic entry point, a longitudinal 1-2 cm incision is made to the left or right lateral base of the penis on the scrotum. Aside from the incision location, the remainder of the procedure mirrors that of the traditional suprapubic technique. Objective The purpose of this video is to demonstrate the “concealed” technique with the insertion of the Penuma® implant through a scrotal incision. Methods Multiple prosthetic urologists have conducted the Penuma® insertion procedure, employing the “concealed” technique. The technique is demonstrated and narrated in the video. Patients were followed post-operatively for at least three months following the procedure to help identify the benefits of the “concealed” technique versus the traditional infrapubic approach. Results Various benefits have been observed using this technique. The first benefit is the lack of a visible incision. After three months of healing, the resultant scar appears hidden by the scrotal rugae giving the appearance that no procedure had taken place. Secondly, the procedure time has been reduced by an average of 10 minutes. Third, there appears to be less retraction of the penis immediately after the procedure. With the traditional suprapubic entry point, the placement of closing sutures may cause scar contraction and tightness leading to temporary retraction in flaccid size immediately after the procedure. Comparatively, the “concealed” method utilizes a scrotal incision line, which allows the suprapubic and abdominal skin to remain not incised, leading to immediate penile skin expansion without the initial, temporary retraction. Finally, post-operatively, the concealed technique has led to a lowered likelihood of seroma formation due to no abdominal wall dissection. This has led to decreased swelling and fluid accumulation. Consequently, this has also led to less reliance on the surgical drain (1-2 days vs. 3-4 days with the tradition technique). Conclusions The new scrotal approach named the “concealed” technique appears to be a simpler, quicker, and more aesthetically favorable alternative to the traditional suprapubic approach. The “concealed” technique is especially ideal in cosmetic surgery where peno-centric patients are focused on penile appearance. Physicians employing the use of the scrotal incision seem to agree that there is a lessened chance of seroma formation, simpler post-operative care, and favorable immediate results. Further evaluation must be conducted to identify additional benefits, but the initial benefits appear to be very promising. Disclosure No

Laparoendoscopic single‐site surgery for urachal remnant with extraperitoneal approach through a suprapubic port

IntroductionNo standard procedure has been established for laparoendoscopic single‐site surgery for urachal remnants (LESS‐U). This study aimed to report the novel surgical techniques and initial outcomes of laparoendoscopic single‐site surgery with an extraperitoneal approach through a suprapubic port for urachal remnants (spLESS).MethodsFifty‐five patients (median age, 27 years; range, 15–69 years) who underwent LESS‐U were analyzed. To overcome the limitations inherent in the conventional procedure (LESS‐U through an umbilical port: uLESS), we modified the port placement and approached via the extraperitoneal space. spLESS is a novel procedure which reduces intestinal damage caused by the extraperitoneal approach and overcomes incomplete resection of the urachal remnant, especially in the bladder dome. Three trocars are inserted into the extraperitoneal space through a suprapubic port in spLESS, and complete resection of the urachal remnant from the umbilicus to the bladder is performed with an appropriate incision line. Patient characteristics and perioperative results were retrospectively collected. Cosmetic outcomes were prospectively evaluated using self‐administered questionnaires (body image and photo‐series questionnaire).ResultsspLESS and uLESS were performed in 43 and 12 patients, respectively. No differences were observed between the perioperative results. The cosmetic outcomes were compared between the groups using body image and photo‐series questionnaires. No patient developed major complications; there was no recurrence in either group.ConclusionsspLESS is a novel procedure which can completely resect the urachal remnant and reduce the risk of intestinal damage. spLESS is a safe, effective, and feasible procedure with high postoperative cosmesis.

Successful separation of male pygopagus with anal canal and urethral reconstruction: a case report

BackgroundPygopagus is a type of conjoined twin binding at the buttocks. Some cases of pygopagus involve the fusion of the gastrointestinal tract, urinary tract, and spinal cord. Few cases of male pygopagus have been reported; however, the prognosis after separation is unclear. Herein, we report a case of male pygopagus in which successful separation was performed with the reconstruction of the anal canal.Case presentationTwins with male pygopagus were born at 35 weeks by cesarean section. They shared a common anus, penis, and scrotum with four testes. The infants had normal defecation and urination after birth. The separation surgery was scheduled when they were 5 months. Two distinct anesthesia teams and four surgical teams (neurosurgery, pediatric urology, plastic surgery, and pediatric surgery) were involved in the multidisciplinary approach. After separating the spinal cord, we found that the anal canal and sphincter muscle complex were fused near the anal aperture, and we separated them. The fused penis and testis were separated and reconstructed using the same incisional line as the other separation, and the reconstructions of the anal canals with the sphincter muscle complex were completed. Both patients had an uneventful postoperative course. At 2 years of age, they could walk and defecate independently. In addition, they voided spontaneously without urinary incontinence at the time of 3 years and 11 months.ConclusionsSeparation of the spinal cord with anal canal and urethral reconstruction is important for male pygopagus patients as it allows them to preserve their independent function.

3D multimodal teaching of human anatomy and autopsy with real human data

With advances in digitalization, the industrial, education, and research sectors have made use of novel methods to train their staff and students. Simulations and visualizations of real-life situations allow effective and tailored learning strategies. In medicine, the advancement of three-dimensional (3D) surface documentation technologies, particularly close-range photogrammetry, are used to document pathologies or procedural steps in 3D. Subsequently created 3D models enhanced by adding annotations, incision lines, explanations, and animations can be used for educational purposes. In this paper, we describe possible ways to improve or extend actual learning methods in medical teaching and show a concept for possible application. As various teaching tools already exist, we aim to add a teaching approach using 3D visualization. Therefore, a forensic dissection of the neck was documented in 3D, annotated and prepared for teaching using animated videos, 3D PDFs and virtual reality. In the future, the dissection of each body part and organ will be documented using the procedure presented in this paper. The aim of this method is to provide a technique to teach human anatomy and autopsy steps to both medical students and forensic pathologists.

Can minimally invasive surgical techniques reduce the incidence of postoperative adhesions?

<br><b>Introduction:</b> Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.</br> <br><b>Aim:</b> This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.</br> <br><b>Material and methods:</b> Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).</br> <br><b>Results:</b> One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39-82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p < 0.05).</br> <br><b>Conclusions:</b> Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.</br&gt.

Efficacy of Cyanoacrylate in Intraoral Surgical Wound Closure

Objective: To evaluate the efficacy of cyanoacrylate tissue adhesives in the management of intraoral surgical wounds in term of wound healing. Material & Methods: Descriptive case series study. Department of oral and maxillofacial surgery. Punjab Dental Hospital, Lahore. 6 months i.e. from: 10-08-2017 to 10-02-2018. After meeting the inclusion criteria 140 patients were enrolled. Strict aseptic measures were taken. Tissue glue applied on the incision line in form of drops at equidistant intervals and then allowed to flow and set for 1-2 minutes. The researcher evaluated the efficacy of wound healing clinically on 15‘, 2"d and 7th postoperative day. All the collected data was entered and analyzed on SPSS version 21. Results: The mean age of patients was 34.16±9.57 years. Male to female ratio was 0.79:1. The wound healing was found in 128(91.4%) patients and the efficacy achieved in 128(91.43%) patients. Conclusion: The cyanoacrylate tissue adhesives is efficacious for the management of intraoral surgical wounds in term of wound healing Keywords: Wound Healing, Efficacy, Cyanoacrylate, Surgery

Outcome of Patients with Comminuted Fractures of Patella Treated with Claw Shape Plate, a case Series at a Tertiary Care Hospital

Introduction: Comminuted fractures of patella are usually dealt with partial or complete patellectomy which compromise the extensor mechanism. Claw plate is newly introduced device to fix comminuted fractures, which provide easy and efficacious method of preserving patella and is used in selected cases. Methods: This prospective observational case series was conducted at orthopaedic department Chandka Medical College (SMBBMU) Larkana from March 2020 to May 2021. Twenty one cases were selected via consecutive sampling with comminuted fracture of patella who were treated with newly introduced claw shape patellar plate. Age of patients was ranging from 18 years to 70 years. All patients were admitted in tertiary care hospital and were operated by senior surgeon. During procedure patella was approached through anterior mid line incision over knee, fracture reduced and fixed with claw shape patella plate. Post operatively patients were assessed on subsequent follow up visits and outcome of procedure was observed on the basis of functional (Clinical) and radiological results. The functional (clinical) outcome was measured on basis of Lysholm knee score and radiologically x-rays of knee were done to see union pattern. Final outcome of procedure was concluded after 6 month of operation. Results of all patients were compiled and analysed by using statistical package for Social Sciences (SPSS) Version 21 Results: Twenty one patients were enrolled in our study, among them 15(71.4%) were male and six (28.6) were female; the mean age of patients was 42.52 years. The mean length of operation was 55 minutes (40 to 72 minutes). Bone union on radiograph was observed at 20th weeks after surgery in all patients, mean age of fracture healing was 11.5 weeks, (Ranges from 6th to 20th week). At final evaluation found excellent results in 12 (71%) patients, five (29%) patients obtain good results, while four patients lost follow up. Conclusions: Partial or complete patellectomy can be avoided in comminuted patella fractures and patella can be preserved in these fractures by using claw shape patella plate. Keywords: Comminuted fractures, Patella, Claw plate.

An advanced transparent hydropolymer wound dressing for undisturbed post-op management of surgical wounds following hip and knee replacement: A prospective observational series.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are standardised surgical procedures for patients with complex comorbidities. The enhanced recovery after surgery (ERAS) protocol has shown reduced lengths of hospital stay and reduced postoperative complications. Currently, there is a paucity of recommendations in regards to dressing selection for postoperative wound care within the ERAS protocol. The aim of this study was to investigate the usefulness of a transparent hydropolymer wound dressing in suit for 14 days in 20 orthopaedic patients following hip or knee arthroplasty under the ERAS protocol. The majority of participants (90%) had a wear time of 14 days without the need for dressing removal. Clinicians rated the dressing very easy to apply with very good visibility of the incision line (100%). All participants reported the dressing to be ‘very comfortable’ (95%, n = 19) or ‘comfortable’ (5%, n = 1). Overall, the transparent hydropolymer dressing provided sufficient incision site visibility, reducing the need for dressing changes. To the best of our knowledge, this is the first study to show that the use of a transparent hydropolymer dressing in situ for 14 days to allow undisturbed wound healing.

Strategic neuronavigation-guided emergent endoscopic evacuation of the hematoma caused by ruptured brain arteriovenous malformation: Technical note and retrospective case series

The treatment strategy for ruptured brain arteriovenous malformations (bAVMs) in the acute phase is still controversial. We describe five consecutive cases of successful emergent endoscopic evacuation (EEE) of intracerebral hematoma (ICH) caused by ruptured bAVMs with the electromagnetic (EM)-neuronavigation system to avoid damage to the bAVMs intended to save valuable time in the emergent phase. A single-institution retrospective analysis was performed in patients with ruptured bAVMs treated by the EM-navigated EEE as part of the strategic multimodality therapy. EM-navigated EEE was performed as follows: 1) obtaining three-dimensional computed tomography to identify the location of the nidus, large draining vein, feeding artery, and hematoma; 2) using a supine position without rigid head fixation for both supra- and infratentorial hematoma; 3) planning the entry point and trajectory of the endoscope as far as possible from the location of the nidus using the EM-navigation system; 4) designing a linear skin incision line suitable for the endoscopic surgery as well as possible decompressive craniectomy; and 5) performing EM-navigated endoscopic partial evacuation of ICH. EM-navigated EEE of ICH was successfully performed for all 5 patients, resulting in partial removal of the ICH without rebleeding from bAVMs. The mean surgical time was 37 min. Subsequent strategic endovascular embolization and curative resection of bAVMs could be performed for all patients, achieving Glasgow Coma Scale score of 15. EM-navigated EEE of partial ICH may be valuable in the emergent phase of ruptured bAVMs with massive life-threatening ICH to reduce the intracranial pressure and to obtain better prognosis.

The Relationship of the Sural Nerve and Anatomic Landmarks Relevant to the Extensile Lateral and Sinus Tarsi Approaches: A 3T MRI Study

Category:Hindfoot; TraumaIntroduction/Purpose:The extensile lateral and sinus tarsi approaches are commonly used during foot and ankle surgery, and pose a risk of iatrogenic injury to the sural nerve, a cutaneous nerve that innervates the ankle and lateral foot. Our understanding of the SN's location is based primarily on anatomic cadaver studies with small sample sizes. Our research analyzes a large cohort of high-field 3 Tesla (3T) magnetic resonance images (MRI) of the ankle to obtain a more generalizable, in-vivo sample of the distal course of the SN. A better understanding of the course and variability of the sural nerve will allow surgeons to minimize the risk of iatrogenic injury to the SN.Methods:High-field 3T MRI studies of the ankle performed at our institution between January 2015 and December 2020 were analyzed. The vertical distance of the SN to the distal tip of the lateral malleolus (DTLM), horizontal distance of the SN to the DTLM, and the lateral border of the Achilles tendon (LBA) at the level of the DTLM were measured by 3 blinded reviewers. Also measured was the horizontal distance of the SN to the LBA at the level of superior Achilles insertion (SAI) onto the calcaneus, as well as 5 cm above the SAI. We then analyzed upper and lower quartile ranges to compare the outer anatomic distribution frequencies of the SN to the locations of common approach incision lines. This outer limit analysis may serve to quantify the variability of the SN.Results:A total of 204 3T MRIs of the ankle were included. 1st and 4th quartile ranges for vertical distance from the SN to the DTLM were 0.9-1.9 cm and 2.5-3.6 cm respectively. 1st and 4th quartile ranges for horizontal distance of the SN to the DTLM at the level of DTLM were 0.8-1.5 cm and 2.0-3.0 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA at the level of DTLM were 1.0-1.6 cm and 2.1-2.9 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA at the level of the SAI were 1.4-2.3 cm and 2.8-3.7 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA, 5 cm above SAI were 0.4-0.8 cm and 1.0-1.8 cm, respectively.Conclusion:The vertical distance from SN to DTLM was greater than the previously reported maximum of 2.6cm in 25% of cases. This highlights the risk of injury to the sural nerve with the extensile lateral approach. Our first quartile range for vertical distance of SN to DTLM of 0.9-1.9cm indicates that even at the lowest range of values, the SN remains clear of the incision line used in the sinus tarsi approach, which extends from the DTLM to the base of the fourth metatarsal. The sural nerve is still at risk during posterior extension or retraction of the sinus tarsi incision.

Wound healing effect of Anzer origin propolis specimens on rats’ intestinal incision

This study was investigated the wound healing effect of Anzer origin propolis specimens on rats’ experimental intestinal incisions. Thirty-four male Wistar albino rats have been divided into five groups, weighing 250-300 gr. Water solution of Anzer propolis (PW3 [n=6], PW7 [n=6]) or ethanolic solution of Anzer propolis (PE3 [n=6], PE7 [n=6]) were administered. Control groups (K3 [n=5], K7 [n=5]) received no treatment. The surgical procedure (day 0) consisted of a laparotomy under general anesthesia, during which the colon was incised and repaired with sutures. The Anzer propolis specimen diluted with physiologic saline was administered by gavage (100 mg/kg/day) for 3 and 7 days before and after surgery to PW3 and PW7 groups. Ethanol dissolved Anzer propolis was administered by gavage (100 mg/kg/day) for 3 and 7 days before and after surgery to PE3 and PE7. Experimental animals have been humanly euthanized on the 3rd and 7th days for biochemical and histopathological evaluations. Serum total oxidant status, total antioxidant status, interleukin-1, interleukin-6, tumor necrosis factor-alpha, myeloperoxidase, hydroxyproline and nitric oxide, levels were measured by ELISA. The incision line sampled to evaluate inflammatory cells, fibroblastic activity, neovascularization, and collagen level. The study indicates that the ethanolic Anzer propolis solution's oral administration has a beneficial effect on intestinal wound healing for seven days pre-and postoperatively (PE7).

Scar formation after lower eyelid incision for reconstruction of the inferior orbital wall related to the lower eyelid crease or ridge in Asians.

BackgroundTranscutaneous lower eyelid approaches are associated with a risk of postoperative scarring depending on the distance between the incision line and the lower eyelid margin. The lower eyelid crease of Caucasians corresponds to a ridge-shaped fold in young Asians. However, this relationship has not been sufficiently evaluated in the latter. The authors, therefore, investigated the location of the scar and the lower eyelid crease or ridge to find the optimal location for the incision line.MethodsThis study included 60 out of 139 patients who underwent inferior orbital wall reconstruction through a lower eyelid skin incision between July 2019 and June 2020. According to the location of the scar, the patients were classified into three groups: group A ( ≥ 2 mm above the lower eyelid crease or ridge), group B (within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge), and group C (within the lower eyelid crease or ridge to 2 mm below the lower eyelid crease or ridge). At 6 or 12 months after surgery, the Patient and Observer Scar Assessment Scale (POSAS) score was obtained, the distance between the lower eyelid margin and the scar (DMS) and the distance between the margins of the peripheral pupil and the lower eyelid (DMPE) were measured, and the occurrence of ectropion was evaluated.ResultsGroup B had the lowest POSAS score (A: 22.7 ± 8.0, B: 20.9 ± 2.4, C: 32.5 ± 4.1, p < 0.001). Linear regression analysis showed that the DMS was positively correlated with the POSAS score (p < 0.001) and that the risk of DMPE widening increased as the DMS decreased (p = 0.029). None of the patients had ectropion.ConclusionWhen using the transcutaneous approach for inferior orbital wall reconstruction, the optimal incision site is within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge.

Evaluation of the Effectiveness of Modified Pectoral Nerve Blocks Type II (PECS II) for Vascular Access Port Implantation Using Cephalic Vein Venesection.

The vascular access port implantation procedure can be performed using the venesection method by inserting a catheter into the cephalic vein in the region of the deltopectoral groove. This method eliminates the need for catheter tunneling. An alternative method to infiltration anaesthesia for port implantation may be a modified pectoral nerve block type II (PECS II). This study aimed to evaluate the effectiveness of modified PECS II for vascular access port implantation using cephalic vein venesection. This retrospective observational study was conducted at the 4th Military Clinical Hospital in Wroclaw, Poland. A group of 114 patients underwent the modified PECS II block and additional cutaneous infiltration anesthesia at the incision line. Pain intensity was assessed on the NRS scale measured intraoperatively at four points. The QoR-15 questionnaire was used to assess patient satisfaction during the first 24 h after surgery. The operator’s condition assessment score was used to assess surgical conditions and operator comfort. The analysis showed that the median pain intensity during vascular port implantation was 0. A statistically significant difference in pain intensity was demonstrated between the specialist’s group and the resident’s group at the second and third measurement points (p < 0.008; p < 0.012). The mean value on the QoR-15 scale was 132. There was a significant difference between the pain scores of the groups. The mean score in the pain position in the specialist’s group was 18 points and in the resident’s group, it was 19 points (p < 0.029). In conclusion, the present study revealed that the modified PECS II block is an effective and safe method of anesthesia for Port-A-Cath implantation.

The Compressiometer: Toward a New Skin Tensiometer for Research and Surgical Planning.

After surgery, around 35% of patients experience problems of excessive scarring, causing disfiguring and impaired function. An incision placed in the wrong direction causes unnecessary skin tension on the wound, resulting in increased collagen disposition and potentially hypertrophic scars. Currently, skin tension lines are used for incision planning. However, these lines are not universal and are a static representation of the skin tension that is in fact under influence of muscle action. By designing a new skin force measurement device the authors intend to make research on dynamic skin characteristics possible and to objectify incision planning and excision closure planning. The device applies a known compressive force to the skin in standardized directions and measures the displacement of the skin. This allows users to measure the skin reaction force in response to compression and to determine the optimal incision line or best wound closure direction. The device has an accuracy of 96% and a sensitivity of < 0.01 mm. It is compact, works non-invasively and standardizes measurement directions and is therefore an improvement over previously designed skin tensiometers.

Laser papillosphincterotomy in choledocholithiasis and acute biliary pancreatitis

Objective. The radical elimination of extrahepatic biliary tract pathology in choledocholithiasis and acute biliary pancreatitis (ABP) reduces the risk of infection and eliminates the source of endogenous intoxication; so, the search of safe and effective techniques for endoscopic papillosphincterotomy (EPT) is important.Purpose: to assess outcomes of laser-assisted endoscopic papillosphincterotomy.Material and methods. 288 patients with “wedged” (n = 111) and “valve” (n = 177) choledocholithiasis and acute biliary pancreatitis were divided into two groups depending on EPT technique: in the control group, a papillotome with electrocoagulation cord was used (n = 195); in the main group, laser scalpel was used (n = 93).Results. 87 patients with “wedged” choledocholithiasis were treated with EPT and an end electrode on the wedged stone. 16 patients out of them had mild bleeding which was stopped by irrigation with epinephrine solution (1 : 10 000) followed by the targeted coagulation. The average surgical time was 38 ± 16 min. In 24 patients with rigid and edematous medial wall of the duodenum due to acute biliary pancreatitis, the proposed device plus laser technique for papillosphincterotomy were used (patent of the Russian Federation No. 2614891). There was no bleeding, the average surgical time was 24 ± 12 min. In “valve” choledocholithiasis, laparoscopic cholecystectomy (LCE) was performed; calculi from the common bile duct were removed. In 108 patients during LCE, EPT was made via an antegrade catheter. In 69 patients with anatomical and physiological obstacles caused by the major duodenal papilla, we performed LCE and EPT with laser light via an antegrade guide light made of fluoroplastics (patent of the Russian Federation No. 41594). Concrements from the common bile duct were removed with the Dormia basket.Conclusions. Laser light causes less damage, reliably provides hemostasis along the incision line on the anterior wall of the major duodenal papilla; in addition, a wedged calculus in “wedged” choledocholithiasis and a fluoroplastic light guide in “valve” choledocholithiasis reliably protect the posterior wall of the major duodenal papilla from laser light damage. Laser techniques used in EPT make the treatment of choledocholithiasis in patients with ABP having anatomical and physiological problems due to the major duodenal papilla safe and effective.