Incision Line Research Articles

Decorated Bone Tube Manufacture in Early Bronze Age Israel: Experimental Analysis of Bone Preparation and Incising

ABSTRACT Experimental replication of decorated bone tubes was carried out to determine possible methods of defleshing and to define the nature of linear cut-marks on the bones made by different cutting implements. These studies were carried out to interpret more precisely the production techniques for incised bone tubes recovered from Early Bronze Age (EB) contexts at the site of Tell el-Hesi dating to 2800–2700 bce (EBIIIA). Previous studies had assumed that the bones were incised using metal chisels found on-site, but the new experiments demonstrate that the incised lines were most likely made using denticulated metal (copper/bronze) saws. Modern cow metapodials were defleshed and then cut and sawn with different types of tools. Impressions were made of the experimental and archaeological incised lines and the impressions were studied using Scanning Electron Microscopy. The incised lines made using denticulated metal saws most closely match the incised lines of the ancient incised bone tubes.

Modification of the lesser curvature incision line enhanced gastric conduit perfusion as determined by indocyanine green fluorescence imaging and decreased the incidence of anastomotic leakage following esophagectomy

Abstract Aim This study aimed to investigate the effectiveness of a modified incision line on the lesser curvature for gastric conduit formation during esophagectomy in enhancing the perfusion of gastric conduit as determined by indocyanine green fluorescence imaging and reducing the incidence of anastomotic leakage. Methods A total of 272 patients who underwent esophagectomy at our institute between 2014 and 2022 were enrolled in this study. These patients were divided based on two different types of cutlines on the lesser curvature: conventional group (n = 141) following the traditional cutline and modified group (n = 131) adopting a modified cutline. Gastric conduit perfusion was assessed by ICG fluorescence imaging, and clinical outcomes after esophagectomy were evaluated. Results The distance from the pylorus to the cutline was significantly longer in the modified group compared with the conventional group (median: 9.0 cm vs. 5.0 cm, p < 0.001). The blood flow speed in the gastric conduit wall was significantly higher in the modified group than that in the conventional group (median: 2.81 cm/s vs. 2.54 cm/s, p = 0.001). Furthermore, anastomotic leakage was significantly lower (p = 0.024) and hospital stay was significantly shorter (p < 0.001) in the modified group compared with the conventional group. Multivariate analysis identified blood flow speed in the gastric conduit wall as the only variable significantly associated with anastomotic leakage. Conclusions ICG fluorescence imaging is a feasible, reliable method for the assessment of gastric conduit perfusion. Modified lesser curvature cutline could enhance gastric conduit perfusion, promote blood circulation around the anastomotic site, and reduce the risk of anastomotic leakage after esophagectomy.

400. MODIFICATION OF THE LESSER CURVATURE INCISION ENHANCES GASTRIC CONDUIT BLOOD FLOW AND DECREASE ANASTOMOTIC LEAKAGE RISK AFTER ESOPHAGECTOMY

Abstract Background We conducted this study to investigate the effectiveness of a modified incision line on the lesser curvature for gastric conduit formation during esophagectomy in enhancing the perfusion of the gastric conduit, as determined by indocyanine green (ICG) fluorescence imaging, and reducing the incidence of anastomotic leakage. Methods A total of 272 patients who underwent esophagectomy at our institution between June 2014 and August 2022 were enrolled in the study. The patients were divided into two groups in accordance with the type of cutline on the lesser curvature: the Conventional group, consisting of patients operated on until 2018 (Conventional group; n = 141), in which the traditional cutline (5.0 cm from the pylorus in routine) was adopted, and the Current group, consisting of patients operated on from 2019 until date (Current group; n = 131), in which a modified cutline on the lesser curvature was adopted, that allowed preservation of the entire right gastric artery was adopted (hereinafter, modified cutline) was adopted. Gastric conduit perfusion during the surgery was assessed by intraoperative ICG fluorescence imaging, and the clinical outcomes after esophagectomy were also evaluated. Results All patients underwent esophagectomy with regional lymph node dissection and gastric conduit reconstruction via the retrosternal route. The distance from the pylorus to the cutline was significantly longer in the Current group as compared with the Conv group (median: 9.0 cm vs. 5.0 cm, p < 0.001). The blood flow speed in the gastric conduit wall assessed by ICG fluorescence imaging was significantly higher in the Current group than that in the Conventional group (median: 2.81 cm/sec vs. 2.54 cm/sec, p = 0.001). Furthermore, the incidence of anastomotic leakage was significantly lower (p = 0.024) and the hospital stay significantly shorter (p < 0.001) in the Current group as compared with the Conventional group. Logistic regression analysis using the data of the entire cohort identified the blood flow velocity in the gastric conduit wall as the only variable that was significantly (negatively) associated with anastomotic leakage. Conclusions ICG fluorescence imaging is a feasible, reliable method for intraoperative assessment of gastric conduit perfusion. Use of the modified lesser curvature cutline could enhance gastric conduit perfusion, promote blood circulation around the anastomosis and ultimately reduce the risk of anastomotic leakage after esophagectomy.

Efficacy of a novel traction method: outside-lesion clip-thread method for gastric endoscopic submucosal dissection of lesions of the greater curvature of the upper/middle stomach (with video).

Gastric endoscopic submucosal dissection (ESD) for lesions located on the greater curvature of the upper and middle (U/M) third of the stomach remains challenging, even for experienced endoscopists. Accordingly, we have developed a novel traction technique, termed the outside-lesion clip-thread method (O-CTM). In this method, a clip thread is attached to the healthy mucosa outside the circumferential incision line, and traction is applied to bring the scope and lesion into proximity for ESD. Here, we assessed the efficacy of ESD using the O-CTM compared to ESD without the O-CTM. We retrospectively reviewed data from 63 consecutive patients who underwent gastric ESD for 63 lesions located on the greater curvature of the U/M third of the stomach between September 2015 and April 2024. The primary outcome was the operation time, and secondary outcomes were resection speed, en bloc resection, R0 resection and complications in the O-CTM and without O-CTM ESD groups. Of the 63 included lesions, 37 were resected without the O-CTM between September 2015 and June 2022 (without O-CTM group), and 26 lesions were resected using the O-CTM between July 2022 and April 2024 (O-CTM group). The O-CTM group had significantly shorter operation times (40min vs. 77min, p = 0.01) than the without O-CTM group. The resection speed was also significantly faster (20.1 mm2/min vs. 11.3 mm2/min, p = 0.02). No significant differences in en bloc resection rate, R0 resection rate, and complications were observed. Gastric ESD using O-CTM is beneficial when compared with the ESD without O-CTM in reducing operation time and improving resection speeds for treating lesions located on the greater curvature of the U/M region.

Comparison of the Incidence of Surgical Site Infection in Abdominal Wound Closure: Antibiotic-Coated Polyglactin 910 Suture Versus Polyglactin Suture With Local Infiltration of Antibiotic Along the Incision Line.

Aim and objectives The purpose of this study is to compare the incidence of surgical site infection (SSI) rates in abdominal wound closure utilizing antibacterial-coated(triclosan-coated) suture material versus conventional suture material with subcutaneous antibacterial infiltration along the incision line. Materials and method This prospective and comparative (randomized, non-blinded clinical trial) was conducted at the Postgraduate Department of Surgery, Swaroop Rani Nehru Hospital, associated with Motilal Nehru Medical College, Prayagraj, India. The sample size was calculated to be one hundred. The patients in Group A underwent laparotomy using polyglactin 910 coated with triclosan. The patients in Group B underwent normal suture closure and local infiltration of broad-spectrum antibiotics (1 gram of ceftriaxone in 10 ml distilled water, along with the incision). Results There was no discernible difference between the various groups onpostoperativeday (POD) 14, 21, and 30. In Group A, 100.0% of individuals had healed wound status (POD 30). Group B had healed wound status among the 96.0% of members (POD 30). Twenty percent of the people in Group A had SSI whereas 38.0% of the participants in Group B had SSI. There was no discernible difference between the two groups regarding the distribution of culture (χ² = 7.741, p = 0.127). Conclusion Triclosan-coated sutures are more effective than subcutaneous antibiotic infiltration along the incision line in lowering the frequency of SSI during primary laparotomy wound closure.

The use of incisional negative pressure wound therapy on high-risk breast cancer mastectomy patients

BackgroundThe main complications seen in patients who have undergone modified radical mastectomy (MRM) are seroma, surgical site infection, hematoma, wound dehiscence, flap necrosis, and nerve damage. While these complications lead to some problems the most feared effect in the early period is that they cause a delay in adjuvant treatment. Incisional Negative Pressure Wound Therapy (iNPWT) decreases wound dehiscence by reducing oedema and tension, especially in the incision line. This study aim to compare recovery times and wound site complications between patients treated with conventional wound dressings and patients treated with iNPWT after MRM. MethodsA retrospective screening was made of the data of 50 patients who underwent MRM because of breast cancer in the General Surgery Clinic of XXX Hospital between 2018 and 2022, and were at high-risk of wound site complications. Two groups were formed as 30 patients applied with iNPWT and 20 patients applied with conventional dressings. ResultsThe mean age of the 50 female patients was 53.58 years (range, 30–80 years). The most frequently seen complications were seroma (20 patients) and partial flap ischaemia (14 patients). The mean number of iNPWT applications was 1.30 (range, 1–2), and the mean number of days of application was 4.47 (range, 2–9). Postoperative seroma was observed in 8 patients in the iNPWT group and in 12 patients in the conventional dressings group (p = 0.018). Flap ischaemia and the probability of dehiscence was determined at a statistically significantly higher rate in the patients in the conventional dressings groups (p = 0.005, p = 0.021). ConclusionThe results of this study demonstrated that the use of iNPWT significantly reduced the amount of postoperative drainage, thereby contributing to early drain removal. Furthermore, iNPWT significantly reduced postoperative seroma, flap ischaemia, and flap dehiscence compared to conventional dressings.

Precise maxillofacial soft tissue reconstruction: A combination of cone beam computed tomography and 3dMD photogrammetry system

IntroductionThe reconstruction of both extra- and intra-oral soft tissue defects, particularly in restoring the morphology of the lip and the corners of the mouth, has posed a significant challenge for surgeons. Inappropriate methods often lead to maxillofacial deformity which then causes psychological and functional problems. This study aimed to address the challenge of reconstructing extensive and complex maxillofacial soft tissue defects, mainly focusing on the lip, the corners of the mouth, and the surrounding areas. Materials and methodsWe developed a reconstruction approach by combining the 3dMDface System (3dMD) with the cone beam computed tomography (CBCT). Firstly, with the extra-oral incision line, we evaluated the shape and the size of the extra-oral defect with 3dMD digitally. Then we used the corresponding maxillary and mandible tooth positions to record the intra-oral defect, which was then converted to digital images by combining 3dMD and CBCT. The islands of the anterolateral thigh perforator flap were then designed after the locations of the perforators were detected with Doppler ultrasonography. ResultsA clinical case diagnosed as dermatofibrosarcoma protuberans was presented to illustrate the approach. The patient's tumor resection and the size of multiple defects were measured and simulated via the virtual surgery system. A three-island perforator flap from the descending branch of the lateral femoral circumflex artery was designed accurately. Two weeks postoperatively, the flap was healed as anticipated and the patient was satisfied with the profile. ConclusionThe combination of the 3dMD and CBCT technologies improves the accuracy and fitness of extra- and intra-oral soft tissue reconstruction.

Anatomical considerations for the subcutaneous implantable cardioverter-defibrillator (SICD) implantation: a cadaver-based analysis

Abstract Background Subcutaneous implantable cardioverter-defibrillators (SICDs) offer primary and secondary prevention of sudden death without transvenous leads in individuals not requiring pacing therapy. Intermuscular placement of the SICD generator between the latissimus dorsi (LDM) and serratus anterior (SAM) muscles is often recommended. This specific technique results in reduced defibrillation impedance and subsequently optimal defibrillation thresholds, reduced risk of pocket complications and infections, reduced device migration, and enhanced patient comfort and cosmetic outcomes. Despite the recommendation for an intermuscular implant technique utilizing a mid-axillary incision line, there is limited research describing this anatomical space to avoid complications. In this anatomic study, we examined this anatomical space. Our aim was to provide a better understanding of the interplay between the involved muscles and a proper location of an incision line. We also defined the location of the long thoracic nerve (LTN) relative to this space, which if transected, would lead to a winged scapula. Methods We examined 18 cadavers; 12 (66.7%) were female donors and 6 (33.3%) were males. We measured the distance from the anterior border of the LDM in relation to the cadaver back (A) and in relation to the anterior-posterior diameter of the chest (B). We performed these measurements at the 5th and 7th rib levels, and then averaged these measurements. We also measured the distance from the back to where the LTN enters SAM at the 4th, 5th, and 6th ribs. Results Analysis of the obtained data showed that the mean distance from the back to the anterior border of LDM at the 5th rib was 7.55 cm (5.65 – 10.85 cm) and at the 7th rib was 7.60 cm (5.35– 10.35 cm). Mean distance from the back to the anterior LDM border in both 5th and 7th ribs combined was 7.58 cm (5.50 – 1.06 cm). The mean anterior-posterior diameter of the chest wall at the fifth rib was 21.45 cm (18.55 – 24.75 cm). The mean A/B ratio (that is the ratio between the distance from the back to the anterior LDM border in comparison to the anterior-posterior chest diameter) was 0.4 with a standard deviation of +/- 0.1 (range 0.27-0.45). The LTN was running anterior to the LDM border at the 4th rib level, and posterior to the LDM border at the 5th and 6th ribs level. The LTN entered the SAM at the 4th rib level in 6.6%, at the 5th rib in 46.6% and at the 6th rib in 46.6% of cadavers. Discussion Intermuscular technique for S-ICD implantation is recommended as the preferred procedural approach. In our postmortem study, the anterior LDM border was variable but posterior to the mid-axillary line with a variable A/B ratio of 0.27 – 0.45. Our study also demonstrates the proximity of the long thoracic nerve (LTN) in comparison to the anterior LDM border. Caution should be taken when implanting S-ICD devices to avoid LTN injury.

Experience in the Use of Surgical Access to the Distal Part of the Radius in Comminuted Intra-articular Fractures

Introduction. Fractures of the distal radius occupy a leading place in the general structure of limb injuries. In most cases, they are comminuted in nature and require open reduction and fixation. With traditional surgical approaches to the distal radius, there is a risk of injury to the tendons of the muscles of the anterior group of the forearm and the median nerve; in addition, the skin incision lines pass through the projection of the gap of the wrist joint, which leads to the formation of painful scars and difficulty moving in the early postoperative period.The purpose of the work is to evaluate the results of using a new surgical approach to the distal radius for the treatment of comminuted intra-articular fractures.Materials and methods. A retrospective analysis of the results of surgical treatment of 124 patients aged 19 to 78 years with a fracture of the distal radius for the period from 2015 to 2019 was carried out. A patient with a fracture of the distal epimetaphysis of the radius, Fernandez type III, underwent surgery through the proposed approach.Results. Aſter transosseous osteosynthesis with a distraction external fixation device, on the sixth day, open reduction, bone graſting and plate osteosynthesis were performed through the proposed approach. Restoration of congruence of the articular surfaces of the wrist joint has been achieved. In the early postoperative period, movement in the joint is free, discomfort during the rehabilitation program is minimal. Aſter 12 months, movements in the joint are fully realized.Discussion. The new access makes it possible to improve the conditions for operations on the distal part of the radius with its fractures, creates a sufficiently spacious and safe access to the radius, which allows you to preserve the muscular part of the square pronator and does not violate the anatomy of the synovial sheaths of the tendons of the muscles of the anterior forearm group, which is prevention of the development of deficiency of rotational movements of the forearm and contractures of the hand and fingers in early and late postoperative periods.Conclusion. The developed new surgical approach to the distal radius provides optimalvisualization of the fracture andis low-traumatic, which has a positive effect on restoring full range of motionin the wrist jointin the early stages aſter surgery.

Implementation of delayed intervention in open approach rhinoplasty for patients with supratip scarring

The columellar incision and dissection which were integral steps in open rhinoplasty play a crucial role in achieving optimal results. However, scarring in the supratip region may pose challenges to skin circulation, potentially leading to complications such as flap loss. This study aims to establish the safety and efficacy of the open rhinoplasty technique as a viable alternative for patients with substantial scars in the supratip region typically addressed using the closed rhinoplasty technique. Patients with scars on the tip or supratip region were operated clinic between February 2010 and March 2023. To mitigate the risk of tip necrosis, a meticulous two-step delay approach was employed. In the initial outpatient procedure, performed under local anesthesia, we opted for a columellar incision. Subsequently, the columellar arteries were identified and cauterized to facilitate the delay procedure. Following a ten-day interval, all patients underwent standard open rhinoplasty. The columellar artery delay procedure proved instrumental in executing successful open rhinoplasty without compromising skin circulation between the scarred supratip and columellar incision line. Our findings suggest that the columellar delay procedure effectively prevents flap loss in open rhinoplasty patients with scars in the supratip and columellar regions. This brief outpatient intervention, lasting approximately ten minutes, provides a reliable method for adopting the open approach in primary rhinoplasty cases, irrespective of prior scarring. Level IV, therapeutic study.

Advancements in Deep Learning for Minimally Invasive Surgery: A Journey through Surgical System Evolution

The surge in artificial intelligence (AI) applications across diverse fields owes much to advancements in deep learning and computational processing speed. In medicine, AI's reach extends to medical image analysis and genomic data interpretation. More recently, AI's role in analyzing minimally invasive surgery (MIS) videos has gained traction, with a growing body of research focusing on organ and anatomy identification, instrument recognition, procedure recognition, surgical phase delineation, surgery duration prediction, optimal incision line identification, and surgical education. Concurrently, the development of autonomous surgical robots, exemplified by the Smart Tissue Autonomous Robot (STAR) and RAVEN systems, has shown promising strides. Notably, STAR is currently employed in laparoscopic imaging to discern the surgical site from laparoscopic images and is undergoing trials for an automated suturing system, albeit in animal models. This review contemplates the prospect of fully autonomous surgical robots in the future.

Advancements in Deep Learning for Minimally Invasive Surgery: A Journey through Surgical System Evolution

The surge in artificial intelligence (AI) applications across diverse fields owes much to advancements in deep learning and computational processing speed. In medicine, AI's reach extends to medical image analysis and genomic data interpretation. More recently, AI's role in analyzing minimally invasive surgery (MIS) videos has gained traction, with a growing body of research focusing on organ and anatomy identification, instrument recognition, procedure recognition, surgical phase delineation, surgery duration prediction, optimal incision line identification, and surgical education. Concurrently, the development of autonomous surgical robots, exemplified by the Smart Tissue Autonomous Robot (STAR) and RAVEN systems, has shown promising strides. Notably, STAR is currently employed in laparoscopic imaging to discern the surgical site from laparoscopic images and is undergoing trials for an automated suturing system, albeit in animal models. This review contemplates the prospect of fully autonomous surgical robots in the future.

The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery.

To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold. We conducted a retrospective analysis on clinical data from patients who underwent medial canthal skin redundancy reconstruction surgery from September 2019 to January 2023. The surgical procedure involved a preoperative design for the incision line, suborbicularis oculi dissection to create a muscle flap, and the use of a reverse Z-flap for the reconstruction of the lateral canthal fold. Postoperative follow-up assessments focused on the intercanthal distance, positional changes of the medial canthus point, alterations in the medial canthus angle, and patient satisfaction levels. The statistical evaluation was carried out utilizing paired t -tests, with a P -value of less than 0.05 denoting statistical significance. Postsurgery, the lacrimal prominences were less exposed, and inner canthal angles naturally reshaped. Inconspicuous scarring with diminished reverse Z-plasty marks was noted within 3 months. The average ICD has increased by 3 to 6mm, corresponding to elongation ratios of 9.09% to 28.30%. Preoperatively, the ICD averaged 31.25±2.32mm, expanding postoperatively to 35.19±2.26mm. The canthal angle enlarged significantly from 49.031±6.627 to 62.188±6.662. Inner canthal points shifted notably postsurgery, with a decrease in x-value and an increase in y-value, signalling a movement upwards and away from the nose. Patient satisfaction is high. The reverse Z-plasty technique has proven to be an effective approach for reconstructing the epicanthal fold. The clarity and precision of the incision design, coupled with the stability of postoperative results, demonstrate that this method can reliably achieve successful epicanthal fold reconstruction.

Reconstruction of a deformed umbilicus with a keloid using a single triangular incision line: a case report

A common goal in reconstructing the umbilicus is to achieve an aesthetically pleasing result. This single-subject study demonstrates the outcome of managing an umbilical keloid scar using a single excisional line. A patient presented with a large, oval keloid scar at the center of his abdomen. The scar, measuring 4×3 cm in diameter, was deformed to the extent that it completely obscured the umbilicus. The patient frequently experienced intermittent inflammation at the site of the scar. We planned a triangular incision around the keloid. The umbilical keloid was excised and reconstructed using a flap anchored along the lower edge of the triangle. The triangular flap was elevated and the deep dermis of its cephalic portion was attached to the linea alba. The remainder of the flap was sutured at the center to create a conical shape. Eleven months post-procedure, the umbilicus maintained an aesthetically pleasing appearance with proper depth, superior hooding, and a concave shape without protrusion. An advantage of this straightforward surgical method is that it allows for simultaneous resection and reconstruction without the need for additional flap design. This method is expected to be a useful option for reconstructing umbilical keloids the size of a fully developed umbilicus.

The “Angel-Wing” Combined Labia Minoraplasty/Majoraplasty

Background: Reduction of prominent/hypertrophic/ptotic vulvar labia minora and/or labia majora is an increasingly common surgical procedure in the hands of plastic and cosmetic surgeons and female genital cosmetic and reconstructive surgeons. While several techniques for these reductions are described in the literature and are individually modified by experienced practitioners, 2 procedures for the minora (linear and wedge-type reductions), and the vertically-aligned reduction of redundant majora are the most utilized techniques. It is not unusual for a woman to present to her potential surgeon requesting “work” on both minora and majora. Historically, this has necessitated two separate incision lines (minora and majora) bilaterally, often resulting in a long case, difficult recovery, and a significant potential for visible incision lines and gaping of the vaginal introitus. Objective: To introduce a novel single-incision-line technique for combining labia minoraplasty and labia majoraplasty. Methods: A modification of a classic central V-Wedge technique is affected by “shifting” the wedge incision line across the interlabial fold to encompass a portion of the medial labum majorum, both reducing redundancy and “lifting” the lowermost portion of the majora to correct ptosis. This is accomplished in one incision line with “en-bloc” closure of both minora and majora, placing the incision line mostly within the interlabial fold. Results: The author has completed eight wedge-type combined labia minora-majoraplasties without complication and with 2.5-36 months of follow-up. Discussion: This modification in Wedge design converts two separate procedures into one, making the surgery both less time-consuming, easier to recover from, and more visually esthetic for those patients who are capable of the more rigorous recovery protocol that wedge procedures mandate. Conclusion: The “Angel-Wing combined labia minoraplasty + labia majoraplasty appears to be a relevant option for combined labia minor hypertrophy and labia majora deflation and redundancy.

Review On Biological Properties of Suture Materials

Suture is a general term for all materials used to stitch torn tissues. Surgical sutures are imperative in management of surgical and traumatic wounds. Sutures are primarily used to oppose tissues together to assist and accelerate the recovery process after an incident or surgical operation. In addition, sutures also aid in obliteration of dead space, even distribution of stress on the incision line, and maintenance of adequate tensile strength throughout the critical wound healing process until appropriate tissue strength is achieved. Considering availability of a wide variety of suture materials, it’s important to know the differences between various sutures before making an informed decision. Suture material's overall performance is influenced by its physical qualities, handling features, and biological factors. The aim of this seminar paper is to give highlights on the biological properties of suture materials. Suturing is not simply about closing a wound; it is a skill that requires finesse and can significantly impact the healing process, reduce complications, and even affect long-term results. Suture selection involves the choice of both the appropriate type and size of suture material. Sutures may cause different host reactions in living tissues. While the suture remains in the tissue, it can trigger the inflammation cascade through different pathways such as degradation, a foreign body reaction, an allergic reaction, or abrasion. Natural suture materials such as catgut and silk are more immunogenic than synthetic materials because they are degraded by proteolysis in contrast to synthetic suture materials, which are degraded by hydrolysis. Therefore, surgery professionals should choose a suture material with good tissue acceptance.

A Technical Note on a Modified Subcrestal Buccal Flap Approach to All-on-Four: A Case Report.

This case report describes a dual full-arch rehabilitation focusing on a modified buccal incision for installation of four implants for full-arch rehabilitation of an edentulous maxilla. A modified buccal incision was performed in the subcrestal buccal region to promote direct access to the periosteum without incising the muscles in the region. For the installation of anterior implants, an 8.5 mm implant was locked in the cortical bone of the alveolar ridge and in the cortical bone of the floor of the pyriform cavity. The drilling point of the posterior implants was defined using the anterior implants as a visual reference, and the entry point could be visually estimated from the topography of the palatal surface of the maxilla. After bone leveling, the drilling enlargement sequence was carried out using drills that allowed the installation of long implants (18 mm). Straight mini-abutments were installed in the anterior implants and angled at 30º in the posterior implants. The flap was then perforated in the exact region where the mini-abutments were located. The buccal incision line was sutured with continuous 5-0 nylon suture. On the following day, aesthetic tests were carried out with teeth mounting. The patient presented minimal edema, and the lip motricity and smile width were completely preserved. The prosthesis was delivered five days after surgery. The suture was removed, and the prosthesis was installed while maintaining compression on the gingival tissue. The patient reported no pain during the prosthesis installation. The modified buccal flap enables implant placement for full-arch rehabilitation of an edentulous maxilla.

Lymphatic Mapping for LVA with Noncontrast Lymphatic Ultrasound: How We Do It.

Recently, lymphatic ultrasonography has received increasing attention. Although there are several reports on contrast-enhanced lymphatic ultrasound as a preoperative examination for lymphaticovenous anastomosis (LVA), we have been reporting the usefulness of preoperative noncontrast lymphatic ultrasound. In this article, the detailed procedure for conducting lymphatic ultrasound during the preoperative examination of LVA is thoroughly described. The only items required for lymphatic ultrasound are an ultrasound device, an echo jelly, a straw for marking, and a marker. We use an ordinary ultrasound device with an 18-MHz linear probe. We apply the Doppler, Crossing, Uncollapsible, Parallel, and Superficial fascia index to identify the lymphatic vessels. While imagining the course of the lymph vessels, we position the probe perpendicular to the long axis of the lymphatic vessels. When a vessel is found under the superficial fascia, the probe is moved proximally to trace the vessel's path. If the vessel transverses a nearby vein without connecting to it, it is most likely a lymphatic vessel. To confirm, we ensure that the vessel does not exhibit coloration in the Doppler mode. As LVA is most effective when the dilated lymph vessels are anastomosed, we use lymphatic ultrasound to identify the most dilated lymphatic vessels in each lymphosome, and mark incision lines where suitable veins are in close proximity. No contrast agent is required; therefore, medical staff such as nurses and ultrasound technicians can autonomously conduct the test.

Successful management of an unusual hypopigmented scar after surgical repair of a unilateral Tessier 7 cleft

Abstract Tessier No. 7 cleft is the most common atypical craniofacial cleft with an incidence of 1:3000–5642 births. This clinical report describes the successful management of a delayed, unusually hypopigmented postoperative facial scar following the surgical closure of a Tessier 7 cleft using the Pfeiffer wave line incision. In the absence of any other associated systemic lesions, the scar was treated as a localized leucoderma. The scar coloration improved dramatically with the chosen line of conservative medical treatment, and a surgical revision was not required. This report highlights the need for continuous follow up despite seemingly good short-term results. The medical management of the hypopigmented scar will aid fellow practitioners who may face similar dilemmas.

Oblique lateral interbody fusion at L5-S1: feasibility, surgical approach window, incision line, and influencing factors.

The primary aim of this study was to describe the feasibility, surgical approach window (SAW), and incision line (IL) for oblique lateral interbody fusion at L5-S1 (OLIF51) using computed tomography (CT). A secondary aim was to identify associations among approach characteristics and demographic and anthropometric factors. We performed a radiographic study of 50 male and 50 female subjects who received abdominal CT imaging. SAW was measured as the distance from the midline to the medial border of the iliac vessel. IL was measured at the skin surface corresponding to the distance between the center of the disc space and SAW lateral margin. OLIF51 feasibility was defined as the existence of at least a 1-cm SAW without retraction of soft tissues. For the left side, the OLIF51 SAW and IL were 12.1 ± 4.6 and 175.1 ± 55.3mm. For the right side, these measures were 10.0 ± 4.3 and 185.0 ± 52.5mm. Correlations of r = 0.648 (p < 0.001) and r = 0.656 (p < 0.001) were observed between weight and IL on the left and right sides, respectively. OLIF51 was not feasible 23% of the time. To our knowledge, this is the largest CT study to determine the feasibility of performing an OLIF51. Without the use of retraction, OLIF51 is not feasible 23% of the time. Left-sided OLIF51 allows for a larger surgical approach window and smaller incision compared to the right side. Larger incisions are required for adequate surgical exposure in patients with higher weight.