Incision Procedure Research Articles

Botulinum toxin chemodenervation for childhood strabismus in England: National and local patterns of practice.

BackgroundBotulinum toxin injection chemodenervation is a well-established intervention for adult strabismus, and has also been recognised as an effective alternative to routine incisional surgery for paediatric disease. We aimed to investigate the temporal patterns of practice, indications and outcomes of chemodenervation for paediatric strabismus at national and tertiary centre level.MethodsRetrospective study using routinely collected patient data: Hospital Episode Statistics (HES) data were used to identify children undergoing non-incisional strabismus procedures in England from 2007 to 2016. Single–centre retrospective data on children undergoing botulinum toxin injections (Dysport® 2.5 units/ 0.1ml) as an isolated intervention (not involving incisional procedures) was undertaken to identify indications and outcomes. Successful outcome was defined as deviation <11 prism dioptres (PD).ResultsBetween 2007 and 2016, there was no increase in the proportion of childhood strabismus involving non-incisional procedures. Amongst 150 children undergoing chemodenervation for strabismus within the tertiary centre, the most common diagnoses were acute onset esotropia (n = 34), infantile esotropia (n = 16) and consecutive exotropia (n = 15). Median age at injection was 8.5 years (range 0.9–15 years), and median follow up 12 months (6 months—11 years). Success rates differed by diagnosis, from 66% (non or partially accommodative esotropia) to 0% (congenital cranial disorders). Adverse events were seen in 62/150, 41%, most commonly transient ptosis (39%, n = 58). Overcorrection was seen in 14/119, 13%. Mild subconjunctival haemorrhage (n = 2) was the only other adverse event.ConclusionsBotulinum toxin for childhood strabismus has an acceptable safety profile, and considerable potential therapeutic benefit. However, nationally there has been no increased uptake of chemodenervation non-incisional procedures. Further prospective studies are necessary to understand the predictors of outcome within the separate clinical subgroups, to guide clinical decision making.

Efficiency of assisted hatching of the cryopreserved–melted embryos

Purpose . To measure outcomes of clinical research of efficiency of assisted hatching of cryopreserved embryos. Materials and methods. Patients who had un successful cycles IVF/ICSI with transfer of fresh embryos have been selected for participation in the research between 2014 and 2016 years. Patients were distributed in a random way for participation in the experiment and control groups. Results of embryos transfer of one or two cryopreserved and melted embryos were considered only. Embryos were cryopreserved at a stage of blastocyst, 5 days after extraction of oocytes by method of vitrification. Melting procedure was conducted in the morning of a day of embryos transfer following the instructions of the vitrification medium producer Cryotech (Japan). Assisted hatching was conducted with use of micropipettes of Holding Pipette Cook Medical (Australia) and Assisted Hatching/Zona Drilling Pipette Cook Medical (Australia). The treated embryos were cultivated up to a repeated estimation of morphology of embryos before transfer. Transfer of embryos has been conducted by a standard method with the use of catheter for non-invasive transfer of embryo Sydney IVF Cook Medical (Australia). The quantity of the transferred embryos varied from one to two. Results . 100 cryopreserved embryos were transferred which have been distributed in a random way either to the group with the assisted hatching or to the control group (without assisted hatching). A number of parameters of patients from both groups was analyzed, i.e. age of the patient at the time of melting of embryos, duration of infertility, causes of infertility, quantity of previous unsuccessful cycles IVF/ICSI. Any essential differences between patients within two groups based on the aforementioned parameters were not revealed. Also, there were no essential differences in number of the melted embryos, survival rate of embryos, quantity of the embryos transferred to patients. However, at the same time, parameters of positive results of tests on HCG (human chorionic gonadotropin) (42 % against 27 %) and quantity of clinical pregnancy (35 % against 24 %) were statistically higher in the group with assisted hatching comparatively to the control group (P < 0.004; P < 0.001 accordingly). Conclusions . Implantation of the transfered embryos and number of clinical pregnancies were statistically improved due to selection of the optimum freezing conditions and subsequent cultivation and conducting of procedure of mechanical incision of ZP.

Evaluation of Cosmetic Results of Surgical Wound Closure in Dogs

Objective: To evaluate the correlation between wound cosmesis and pet owner satisfaction, to determine the agreement among vet surgeons, and pet owners evaluating a surgical wound with a visual assessment score (VAS), and to determine the agreement between the VAS, a semi-quantitative score of wound inflammation, and wound width. Background: Perception of post-surgical cosmesis by human patients has been found to influence their satisfaction and perceived adequacy of vet surgeons. Due to the trend of owners anthropomorphising pets, this logic can be extended to veterinary patients. Also, there is a lack of consistent, reliable methods to evaluate cosmesis have been developed, creating the need for a scoring system that is accurate and reproducible. Evidentiary value: This was a prospective cohort study with one hundred and seven patients. This study may not change day-to-day practices, but it will bring to light for practitioners the discordance between pet owners and vet surgeons concerning attractiveness of an incision as well as overall satisfaction with a procedure. Methods: Photographs of surgical wounds were taken immediately, 2 weeks, and 8 weeks after surgery in dogs. Owners were asked to evaluate satisfaction with the procedure and attractiveness of the incision using the VAS. Photos were evaluated for cosmetic outcome by pet owner and vet surgeon evaluators with different scoring systems. The reliability of the scoring systems was evaluated using intraclass correlations and kappa statistics as appropriate. Results: Owners’ evaluation of cosmetic outcome correlated with their overall satisfaction. (r 2 =0.37, where r 2 is the coefficient of determination, and can be used to determine what proportion of variance in one variable is predictable from the other variableThere was generally poor reliability of the subjective scoring between both vet surgeons and pet owners, and the less subjective scoring systems. Conclusion: The cosmetic outcome as judged by the owner accounted for 37% of the variability in satisfaction, that is to say that 37% of the total variation in satisfaction could be explained by the cosmetic outcome as evaluated by the owner. This suggests that wound cosmesis significantly influences clients’ satisfaction. However, the other methods of rating cosmesis evaluated in this study were unreliable. Application: The results of this study are relevant to all veterinarians in clinical practice, from general practice to tertiary referral centers. This study should be kept in mind when speaking with owners to establish pre-surgical expectations as well as mediating conflict due to a difference in opinion with regards to a surgical outcome.

Evolving Therapies for Fuchs Endothelial Dystrophy

Fuchs endothelial corneal dystrophy (FED) is one of the leading indications for corneal transplantation. Over the last two decades we have seen a significant shift in transplantation procedures for endothelial disease away from penetrating keratoplasty to small incision procedures such as Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. More recently, even newer concepts have come to light to explore options of regenerative therapy for FED, e.g. Descemet stripping without endothelial keratoplasty, Descemet membrane transplantation and the use of adjuncts such as Rho kinase inhibitors. Furthermore, alternative strategies involving tissue engineering approaches with the use of cell therapy are also reaching early clinical trial stage. With more information on the underlying genetic abnormalities in FED, gene therapy may be a possible future treatment.

Measuring satisfaction with appearance: Validation of the FACE-Q scales for double-eyelid blepharoplasty with minor incision in young Asians- retrospective study of 200 cases

Double eye-lid surgery is one of the most popular performed aesthetic procedures in young Asians. Reliable measurement of patient reported outcomes is crucial for facial aesthetics. The FACE-Q is a new patient-reported outcome tool (PRO) composed of numerous independently functioning scales and checklists designed to measure outcomes. Here we described FACE-Q scales for double eye-lid surgery with minor incision in young Asians. 200 patients (400 eyes) aged from 21 to 30 years-old were recruited from 2012 to 2014. They underwent minor incision procedure for double-eyelid blepharoplasty, epicanthic fold correction, excessive orbit fat removal and blepharoptosis correction simultaneously. An incision of 1cm long in the middle of upper eyelid and modified Park's Z-plasty for epicanthus correction were designed. Three stitches were carried out in levator aponeurosis-inferior dermis procedure. By the middle incision in the upper eyelid, blepharoptosis correction and excessive orbit fat removal can be executed. Those patients were asked to complete anonymously the FACE-Q by e-mail. FACE-Q scores were assessed for each domain (range, 0 to 100), with higher scores indicating greater satisfaction with appearance or superior quality of life. After a mean of 2 years' follow-up, postoperative complications included partial or complete loss of the double-eyelid fold in 8 and 0 cases, respectively, no hypertrophic scar formation, and asymmetric fold in four cases. One patient received re-operation on blepharoptosis correction. Except hematoma occurring in one female case, no obvious edema was observed. Patients demonstrated high levels of satisfaction with eye appearance overall (mean±SD, 81.7±18.3). Quality of Life Patients exhibited high levels of quality of life, including in social confidence (95.4±12.6), psychological well-being (97.8±10.3), and early life impact of the procedure (90.2±13.4). Patients reported high satisfaction with the decision to undergo and the outcome of the procedure. Minimally invasive procedure is a reliable tool for correcting disfigurement in double-eyelid blepharoplasty. However, this method is not suitable for those cases whose upper eyelids are featured by relaxation. Excessive amount of skin must be removed. Patients who responded in this study were extremely satisfied with their decision to undergo double-eyelid surgery and the outcomes and quality of life following the procedure.

The new method of adjusting the gap for UKA

In unicompartmental knee arthroplasty (UKA), extension gap commonly decreases after inserting the trial components. As most of UKA technique incorporates the fixture of implants using bone cement, it is likely that the gap decreases further when inserting the actual implants. We performed a new additional procedure that enables a precise adjustment of the extension gap. Thirty-two patients who had undergone UKA (ZIMMER Unicompartmental High-Flex Knee System, Zimmer®, Warsaw) using the spacer block technique at our hospital in 2013 were reviewed. Ten cases had difficulties in achieving full extension after the trial implants were inserted, and hence, a new procedure of longitudinal incision between the medial collateral ligament and the posterior capsule was performed. This additional method created a mean increase of 3mm of the extension gap, and facilitated the knee to extend completely. There were no cases that had an increase in the flexion gap. Previously, a tibial osteotomy was added in such cases, but this had a risk of increasing not just the extension gap but also the flexion gap. This method is a valid technique for precise adjustments, and could also be applied to patients with severe flexion contracture to treat by UKA.

Salivary duct stenosis: diagnosis and treatment.

SUMMARYThe management of stenoses of the major salivary glands had undergone a significant change during the last 15-20 years. Accurate diagnosis forms the basis of adapted minimal invasive therapy. Conventional sialography and MR-sialography are useful examination tools, and ultrasound seems to be a first-line investigational tool if salivary duct stenosis is suspected as cause of gland obstruction. Sialendoscopy is the best choice to establish final diagnosis and characterise the stenosis in order to plan accurate treatment. In all major salivary glands, inflammatory stenosis can be distinguished from fibrotic stenosis. In the parotid duct system, an additional stenosis associated with various abnormalities of the duct system has been reported. Conservative therapy is not sufficient in the majority of cases. The development of a minimally invasive treatment regime, in which sialendoscopy plays a major role, has made the preservation of the gland and its function possible in over 90% of cases. Ductal incision procedures are the most important measure in submandibular duct stenoses, but sialendoscopy becomes more important in the more centrally located stenoses. Sialendoscopic controlled opening and dilation is the dominating method in parotid duct stenoses. In 10-15% of cases, success can be achieved after a combined treatment regime had been applied. This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.

Safety and Efficacy Outcomes of ZSI 475 Penile Prosthesis.

The aim of this study was to demonstrate safety and efficacy of ZSI 475 hydraulic penile prosthesis three components. Preparation, procedure and functional results are similar to AMS 700 and Coloplast Titan. This study was conducted from September 2012 to December 2016. From September 2012 to December 2016, 29 ZSI 475 hydraulic penile prostheses three components were implanted by six surgeons in 28 patients in five European centres. Mean age of patients was 60 years old (44-75). Standard peno-scrotal incision procedure was performed for the 28 patients. Erectile function was assessed by IIEF-5 self-administered questionnaire. Median follow-up was 35.11 months (8-47). Postoperative complications were limited to scrotal pump torsion that required a revision, an armed tubing breakage and a scrotal haematoma. At the end of follow-up, 100% of patients had a functional prosthesis and 92.86% were satisfied. Implantation, risks of complications, functional outcome and patient satisfaction with penile implant ZSI 475 are similar to standard hydraulic penile implants three components as AMS 700 and Coloplast Titan.

Minimal incision as a promising technique for resection of pilonidal sinus in children

PurposeTo evaluate functional and long-term outcome of a minimal incision technique for resection of pilonidal sinus in children. Patients and methodsAll children who underwent surgery for pilonidal sinus in our institution between October 2008 and March 2015 were included. We performed a retrospective chart review and a follow-up telephone survey. Demographic, clinical and outcome data were compared between patients who underwent either minimal incision or wide excision surgery. ResultsStudy groups included 21 cases of minimal incision procedure and 21 cases of wide excision procedure with similar demographic and clinical characteristics. Postoperative functional outcome was significantly better in the minimal incision group with fewer days on analgesics (0 versus 2.5, P=0.005), fewer sick days (4 versus 14, P<0.001), and fewer days to full activity (10 versus 45, P<0.001). Reoperation rate was 28% for minimal incision and 9% for wide excision (P=0.238). Overall long-term favorable outcome (no reoperation/recurrent abscess/continued symptoms) rate was 62% after minimal incision and 45% after wide excision (P=0.354). ConclusionThe minimal incision is a promising technique for resection of pilonidal sinus in children as it is associated with better postoperative functional outcome and comparable long-term outcome compared with wide excision. Level of evidenceTherapeutic study- level III.

Enhanced Trabeculectomy: The Moorfields Safer Surgery System.

Trabeculectomy with antifibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of antifibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter covers preoperative, intraoperative, and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks, and poor bleb morphology. Surgical techniques to reduce the risk of postoperative fibrosis by the use of antifibrotic agents (including mitomycin C) are discussed in detail. These techniques are based on a combination of considerable clinical experience, observation, and laboratory research. The need to address pre-, intra-, and postoperative issues in each individual patient is emphasised. These changes are embodied in the system we call the "Moorfields Safer Surgery System." The use of these strategies has considerably reduced the incidence of major complications, including hypotony, cystic blebs, and endophthalmitis in practices around the world. Most of these techniques are simple, require minimal equipment, and can be easily mastered. They are associated with an improvement in overall outcome and it is hoped that this chapter will help the reader benefit from these advances.

Office-based Relaxing Incision Procedure for Correction of Astigmatism after Deep Anterior Lamellar Keratoplasty.

Purpose:To report the outcomes of a simple and effective office-based procedure for the correction of astigmatism after deep anterior lamellar keratoplasty (DALK).Methods:This study enrolled 24 consecutive keratoconic eyes that developed an intolerable amount of graft astigmatism after DALK. The location and extension of steep semi-meridians were determined using corneal topography. Office-based relaxing incision procedures were performed at the slit-lamp biomicroscope using a 27-gauge needle. Relaxing incisions were made at the donor-recipient interface on one side of the steepest meridian with an arc length of 45° to 60° and an initial depth of approximately 70–80% of the corneal thickness. Topography was performed after 30–40 minutes and the initial incision was enhanced in depth and length. If an acceptable amount of astigmatism was not achieved, another incision was created at the opposite semi-meridian during the same session.Results:Mean follow-up period was 13.1 ± 7.4 months. Mean preoperative best spectacle corrected visual acuity was 0.26 ± 0.14 logMAR, increasing to 0.22 ± 0.09 logMAR after the procedure (P = 0.20). Mean spherical equivalent refractive error increased from − 4.64 ± 3.06 diopters (D) preoperatively to −6.06 ± 3.15 D postoperatively (P = 0.01). Mean keratometric astigmatism was reduced by 2.95 ± 3.43 D and 5.16 ± 2.97 D measured using subtraction and vector analysis methods, respectively (P < 0.001). Microperforation occurred in one eye, which spontaneously improved with no sequelae.Conclusion:Office-based relaxing incision is a safe and effective procedure for the treatment of corneal graft astigmatism after DALK. This approach effectively decreases the need for the more costly alternative in the operating room.

Buccal mucosa is a promising graft in Peyronie's disease surgery. Our experience and a brief literature review on autologous grafting materials.

Peyronie's Disease (PD) is an under reported acquired benign condition that, at the moment, is not curable with medical therapy. Surgery represent the gold standard of treatment. Surgical approaches are several and they consist in "plication techniques" or plaque incision/excision with grafting of resulting albuginea defect. Among grafting procedures, albuginea defect substitution with autologous materials demonstrated over the years not inferior results respect to heterologous grafts. Buccal mucosa graft (BMG) is not usually emphasized in many review articles and clinical series are yet limited. We present our experience with seventeen plaque incision procedures and BMG in surgical correction of complex penile curvatures due to PD performed in a period of 30 months. Our analyses was focused on buccal mucosa graft characteristics as major determinant of the surgical success. We also conducted a brief literature review on autologous grafting materials used in reconstructive penile surgery for PD. Our cosmetics and functional results consists in a 100% of functional penile straightening with no relapses and 5,8% of de novo erectile dysfunction. Mean age was 56.4 years, mean follow-up of 22.5 (6-36) months. No complications graft related were observed. Operative time was 115.3 minutes in mean. Over 94% of patients referred they were "really much better" and "much better" satisfied based on PGI-I questionnaire administrated at the last follow- up visit. BMG is revealing as an optimal choice for reconstructive surgery in PD. Anatomical characteristics consisting in the great elasticity, the quick integration time and the easy harvesting technique lead to high cosmetics and functional success rate, without omitting economical and invasiveness aspects.

Beware of the persistent abscess: Chronic granulomatous disease presenting with suppurative lymphadenitis

Abstract An 18-month old boy presented with axillary suppurative lymphadenitis, which failed to respond to conservative management. His care was transferred to pediatric surgeons for further management. Resolution of the abscess was not achieved despite two incision and drainage procedures. Cultures obtained from the abscess grew Serratia Marcescens , and Staphylococcus aureus . A diagnosis of chronic granulomatous disease (CGD) was made, subsequently identified to be x-linked. Review of a chest X-ray previously reported as normal identified focal consolidation. This was investigated with CT and thought to represent previous granuloma with current Staphylococcus infection. The boy was started on prophylactic septrin and itraconizole, in addition to 2 months of treatment antibiotics. The abscess healed, and a repeat CT demonstrated resolution of the cavitating lung lesion. A gastrostomy was inserted in preparation for a T cell-depleted haploidentical bone marrow transplantation, which to date appears to have been curative. Chronic granulomatous disease is a rare genetic primary immunodeficiency associated with high mortality if diagnosis is delayed. The recent establishment of a UK CGD registry has identified a far higher prevalence than previously thought. Stem cell transplantation now offers a potentially curative treatment, with better outcomes in younger children. It is therefore essential that pediatric surgeons are aware of this diagnosis, and that appropriate investigations are instituted when an abscess fails to resolve, or has cultured unusual organisms.

A randomised controlled trial of mini incision or conventional incision for saphenous vein harvesting in patients undergoing myocardial revascularization.

ObjectiveCompare the evolution regarding the complications concerning two types of incision (conventional × mini-incision), for saphenectomy in patients that go under myocardial revascularization or otherwise known as coronary artery bypass surgery.MethodsIn January 2012 to August 2013, 66 patients were prospectively selected for coronary artery bypass with cardiopulmonary bypass surgery. These were divided into two groups: Conventional and Mini-Incision, with 33 patients in each group chosen in a random fashion and with knowledge of which technique to be used being presented only at the start of the surgery. In the conventional group, the patients received an incision to the lower member of 7–10 cm. The patients in the Mini-Incision group received an incision to the lower member of 3–4 cm, both performed without the use of any special material.ResultsThe groups were similar in terms of clinical data and in the preoperative period. Males made up a greater part of the group with 63.7% and 81.9% in groups C and M, respectively. Among the complications analysed, edema (p = 0.011), hematoma (p = 0.020), dehiscence (p = 0.012) and infection (p = 0.012), were significantly greater in group C when compared to group M. When the matter comes to the variable in relation to the risk of Surgical Site Infections (SSI), no difference was found between the groups.ConclusionCoronary artery bypass surgery with mini-incision for saphenectomy, demonstrated a lower rate for preoperative complications when compared to saphenectomy under conventional incision procedures.

Non-tuberculous mycobacterial head and neck infections in children: Analysis of results and complications for various treatment modalities

ObjectivesAnalyze the results and complications of various surgical interventions in a large cohort of children with non-tuberculous mycobacterial (NTM) head and neck infections and suggest a heuristic treatment protocol for managing this condition while aiming to maximize cure and minimize complications. MethodsRetrospective chart review of 104 consecutive patients diagnosed with head and neck NTM at a tertiary paediatric hospital between January 1994 and December 2013 inclusive. Results104 patients ranged in age between 8 months to 15 years (mean age 27 months) were reviewed and 97 patients were included in the final analysis. 6 patients excluded due to lack of follow-up and one excluded due to systemic immunocompromised condition. Sub-sites of NTM infections were submandibular (n=48, 46%), cervical (n=40, 38%), parotid (n=18, 17%) and submental (n=4, 4%). Some patients had more than one lesion so counted twice. Higher cure rates were demonstrated for primary excision (81%, p<0.01) versus incisional interventions (44%, p<0.01). Marginal mandibular nerve palsy following surgery was seen in 7 patients (7.2%). This was permanent in 4 patients (4%) and temporary in 3 patients (3%). All children who were complicated with marginal mandibular palsies had lesions in the submandibular region. The rate of palsy for submandibular disease alone was 15%, while 8% presented permanent palsy and 6% temporary. Marginal mandibular nerve palsy was more likely following excisional compared to incisional procedures (6 versus 1 patient, p<0.01). Hypertrophic scarring occurred in 7 patients: 3 patients following excision and 4 patients after an incisional procedure. One patient suffered long term spinal accessory nerve damage presented as winged scapula. ConclusionsExcision of NTM provides better cure rates compared to incision although at the expense of long term post-surgical morbidity. Excision should probably be the first line of treatment when the risk for neural damage is low. Incision and drainage with or without antimycobacterial treatment may be the preferred option for at-risk sub-sites (submandibular or parotid) in order to reduce long term morbidity.

Experience with Open Prostatectomy in Lom&amp;#233;, Togo

Background: Open prostatectomy is the most commonly available surgical procedure for benign prostatic hyperplasia and this is the case in most countries in West African even with all the limitations of the procedure. Objective: The objective is to determine the pattern and outcomes of open prostatectomy in Lome. Patients & Methods: From December 2011 to November 2012, we conducted a descriptive cross-sectional study on a series of patients treated for prostate adenoma. Dysuria was assessed using the International Prostate Symptom Score (IPSS). The history of each patient was recorded, as well as paraclinical data. All patients were surgically treated via abdominal incision procedure. The data obtained included the patients’ demographics, clinical features, the IPSS scores, investigations, type of open prostatectomy, outcome and follow-up. The data were analyzed for means and frequencies using Epi Info version 3.5.3. Results: Fifty-four consecutive patients underwent surgery consecutively, their ages ranging from 40 to 92 years, with an average of 67.27 ± 12.50 years. In all, 46 (85.2%) patients presented with obstructive symptoms and 26 (48.1%) presented with urinary retention. The average prostate volume was 114.31 ± 20.11 cm3 with a range of 31 - 485 cm3. The average blood loss at surgery was 425.92 ± 38.2 ml with an average operating time of 66.05 ± 15.75 mins and the main complications were hemorrhaging and clot retention in 7 (13%), epididymo-orchitis in 9 (16.7%), and urinary incontinence in 6 (11.1%) patients. IPSS scores were under 7 in 92% of patients three months after surgery and the mortality rate was 3.7%. Conclusion: This study has shown that open prostatectomy in our environment is still the commonest surgical option for benign prostatic hyperplasia with good outcomes though with manageable complications.

Choice of surgical procedure and management of postoperative incision for anal fistula

Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

Management of ureteral obstruction with daVinci laparoscopic surgery

Management of ureteral obstruction with daVinci laparoscopic surgery

Orbicularis–levator–tarsus composite suture technique in double-eyelid operation

Fold loss and suture extrusion are fairly common in double-eyelid surgeries. We hereby explore a new composite suture technique that aims to reduce such complications and to improve the long-term aesthetic outcome. Based on the conventional external incision procedure, the suture procedure in our technique involves three stitches that fixate the orbicularis oculi, the levator aponeurosis, and the tarsal plate. This modified upper-eyelid blepharoplasty was performed in 98 patients (91 female and seven male, 196 eyes) with either congenital absence of the upper-eyelid folds (n = 84) or loss of fold from previous procedures (n = 14). The patients were followed up for 6-30 months. The complications were documented, and the overall outcomes of upper-eyelid folds were evaluated by both surgeons and patients as excellent, good, fair, or poor. Among 98 patients, 89 (91%) had excellent results and nine (9%) had good results; no patient had fair or poor results. Four patients had scar formation at postoperative week 2, all resolved without particular treatments at 6 months. The buried sutures could not be seen or felt through the skin. In addition, no suture extrusion was noted. There was no case of faded or disappeared folds during the follow-up. All patients were satisfied with the outcome. The composite suture technique ensures a firmer fixation and improves the aesthetic outcomes. It is a highly applicable and reliable approach for upper-eyelid blepharoplasty.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.