Long-term Results Of Reconstructive Surgery Research Articles

Long-term results of reconstructive surgery in posttraumatic deformities of the proximal epymetaphysis of the tibia

BACKGROUND: Tibial plateau fractures (TPF) are common and account for up to 1% of all fractures. The most unfavorable results of their treatment occur with nonunion, malunion, and malunion of TPF fractures. Unfavorable functional results of treatment are due to the occurrence of stiffness in the joint, the development of post-traumatic osteoarthritis, instability in the joint and the presence of infectious complications. In this case, there are indications for surgical treatment of intraarticular fractures of TPF.
 AIM: to evaluate long-term results and factors leading to knee arthroplasty after reconstructive surgery for post-traumatic deformities of the proximal tibial epimetaphysis.
 MATERIALS AND METHODS: The long-term (in terms of 5 to 10 years) treatment results were assessed in 46 patients with malunion of intra-articular fractures of the tibial plateau, operated in the period from 2010 to 2015.The average age of patients was 47.611 years. We considered both cases of neglected conservative treatment (87%) and cases with unsuccessful surgical fixation (13%).
 RESULTS: The KOOS pain score was 75.0 [66.6; 94.0] points, which corresponds to a good result. Satisfactory results were observed during the examination on the basis of daily physical activity (66.1 [51.5; 85.3] points) and on the basis of symptoms and stiffness (65.4 [53.6; 86.0] points). Average scores for the attribute physical activity while playing sports, games and entertainment and for the attribute quality of life 53.75 [25.0; 81.0] and 53.8 [25.0; 81.0] points, respectively, were assessed as unsatisfactory. In terms of up to 10 years, 5 out of 46 patients (10.9%) underwent knee arthroplasty. A statistically significant relationship was determined between the varus deformity more than 3 persisting after reconstructive surgery (r=0.664, p 0.0001), the time period between injury and reconstructive surgery (r=0.262, p=0.007) and the appearance of indications for TKA.
 CONCLUSION: The study revealed a statistically significant direct correlation relationships between persisting varus deformity more than 3, as well as a long time interval between injury and the performed reconstructive surgery with the emergence of indications for arthroplasty.

ANALYSIS OF SHORT AND LONG-TERM RESULTS OF RECONSTRUCTIVE- RESTORATIVE PHASE AFTER THE OPERATIONS LIKE HARTMANN

AIM. To improve short and long-term results of reconstructive surgery in patients with complicated colorectal cancer. PATIENTS AND METHODS. Results of 63 patients who had Hartmann procedure for complicated colorectal cancer and thereafter undergone reconstructive surgery were analized. RESULTS. Restorative surgerys was performed at different time interval after the primary surgery. Sphincterometry was done in all patients with the aim to assess the functional integrity of the anal sphincter. CONCLUSION. Suggested optimal period for reconstructive surgery is 1-3 months after the primary surgery.

Long‐Term Results of Reconstructive Surgery for Peyronie's Disease

Peyronie's disease (PD) is an acquired benign connective tissue disorder that involves the tunica albuginea of the penis and can cause penile deformity and shortening. Because this condition is frequently associated with cardiovascular risk factors, a degree of erectile dysfunction is frequently present. The surgical management of PD should be offered once the acute phase of the disease has settled and the deformity is stable. To critically review the most recent literature published on the surgical management of PD. A nonstructured PubMed-based review of the literature published in the last 10 years, searching for the words "Peyronie's disease," "erectile dysfunction," "plication," "grafting," "plaque," and "penile prosthesis," has been carried out. The outcome of the various surgical procedures is reported. Surgery represents at present the gold standard treatment for PD. The type of procedure should be decided according to the degree of deformity, the quality of the erection, and penile length. Surgery still represents the gold standard treatment in patients with PD and aims at obtaining a penis straight, rigid, and long enough for penetrative sexual intercourse. Adequate preoperative patient's selection, counselling and the choice of the right type of procedure according to the degree of penile shortening, the type of deformity and the quality of the erection are paramount to achieving satisfactory results. Garaffa G, Kuehhas FE, De Luca F, and Ralph DJ. Long-term results of reconstructive surgery for Peyronie's disease. Sex Med Rev 2015;3:113-121.

Ultrasound duplex scanning in evaluation of long-term results of reconstructive surgery in patients with peripheral occlusive arterial disease

The most frequently used operations in patients with peripheral occlusive arterial disease are aorto-femoral bypass (AFB) and femoro-popliteal bypass (FPB). In cases non suitable for direct reconstruction femoro-femoral cross-over grafting (FFCG) is used. One of the most frequent causes of unsatisfactory long-term results of reconstructive surgery in patients with peripheral occlusive arterial disease is restenosis in reconstruction area. One of the most frequently used methods of evaluation of reconstruction area alteration is ultrasound duple x scanning (UDS) of arteries of lower extremity. The abstract represents the analysis of efficacy of ultrasound duplex scanning in evaluation of long-term results of reconstructive surgery in patients with peripheral occlusive arterial disease. The study included 52 patients. The patients were divided into three groups according to the method of operative treatment used: AFB was performed in 13 patients, FFCG was performed in 9 patients, FPB was performed in 25 patients.

Gene Expression Analysis of Urine Sediment: Evaluation for Potential Noninvasive Markers of Interstitial Cystitis/Bladder Pain Syndrome

We determined whether gene expression profiles in urine sediment could provide noninvasive markers for interstitial cystitis/bladder pain syndrome with and/or without Hunner lesions. Fresh catheterized urine was collected and centrifuged from 5 controls, and 5 Hunner lesion-free and 5 Hunner lesion bearing patients. RNA was extracted from pelleted material and quantified by gene expression microarray using the GeneChip® Human Gene ST Array. Three biologically likely hypotheses were tested, including 1) all 3 groups are distinct from each other, 2) controls are distinct from the 2 types combined of patients with interstitial cystitis/bladder pain syndrome and 3) patients with Hunner lesion-interstitial cystitis/bladder pain syndrome are distinct from controls and patients with nonHunner-lesion interstitial cystitis/bladder pain syndrome combined. For statistical parity an unlikely fourth hypothesis was included, that is patients with nonHunner-lesion interstitial cystitis/bladder pain syndrome are distinct from controls and patients with Hunner lesion-interstitial cystitis/bladder pain syndrome combined. Analysis supported selective up-regulation of genes in the Hunner lesion interstitial cystitis/bladder pain syndrome group (hypothesis 3), which were primarily associated with inflammation. The inflammatory profile was statistically similar to that reported in a prior Hunner lesion interstitial cystitis/bladder pain syndrome bladder biopsy study. Gene expression analysis of urine sediment was feasible in this pilot study. Expression profiles failed to discriminate nonHunner-lesion interstitial cystitis/bladder pain syndrome from controls and they are unlikely to be a noninvasive marker for nonHunner-lesion interstitial cystitis/bladder pain syndrome. In contrast, patients with Hunner lesion had increased proinflammatory gene expression in urine sediment, similar to that in a prior microarray study of bladder biopsies. If these preliminary results are validated in future research, they may lead to a noninvasive biomarker for Hunner lesion-interstitial cystitis/bladder pain syndrome.

Long-term Results of Reconstructive Surgery for the Unilateral Aortoiliac Occlusive Disease and Future Risks of Contralateral Iliac Events.

Our experience with unilateral iliac reconstructive surgery was retrospectively reviewed, and the long-term patency and the morphological information was disclosed. In addition, the prognosis of contralateral iliac artery was examined, because future contralateral iliac events seem to be important for durability of unilateral iliac revascularizations. 148 patients (mean age, 66.9 years; 88% male) who had undergone unilateral aortoiliac reconstruction without contralateral iliac lesions were evaluated. The unilateral aortoiliac reconstructive procedures included 112 (76%) aorto or iliofemoral bypasses, 27 (18%) femorofemoral bypasses, and 9 (6%) axillofemoral bypasses. The indications for arterial reconstruction were disabling claudication and limb salvage in 125 (84%) and 23 (16%) patients, respectively. Preoperative arteriograms were reviewed to determine the Inter-Society Consensus (TASC II) classification categorizing iliac artery lesions. Contralateral iliac events were defined as any arterial reconstructive procedure, intervention, amputation for progression of contralateral iliac disease, or repair of abdominal aortic aneurysm (AAA). The Kaplan-Meier survival analysis was used to predict long-term results in patients grouped based on various factors which were compared using univariate and multivariate analyses. In the 148 patients, unilateral iliac reconstructive procedures were undertaken in 83 (56%) patients with TASC II type D lesions, 34 (23%) patients with TASC II type C lesions, and 31 (21%) patients with TASC II type B lesions. Overall primary and secondary patency rates were 93.8% and 96.5% at 3 years and 90.0% and 93.9% at 5 years. A multivariate analysis disclosed critical limb ischemia influencing primary patency rates, and type of aortoiliac reconstruction or gender influencing secondary patency rates. TASC II classification did not affect primary or secondary patency rates. During the follow-up period, 15 contralateral iliac events occurred, including 11 aortoiliac reconstructive or interventional procedures, 3 repairs of AAA, and one case of bilateral thigh amputation due to acute aortic occlusion. The overall probability of contralateral iliac events was 2.2% at 3 years and 5.9% at 5 years. The long-term patency following unilateral iliac reconstructive surgery was satisfactory, and not affected by morphology of the iliac artery. Also, the future risk of contralateral iliac events appeared to be low.

Long-term Results of Reconstructive Surgery for the Unilateral Aortoiliac Occlusive Disease and Future Risks of Contralateral Iliac Events

Objective: Our experience with unilateral iliac reconstructive surgery was retrospectively reviewed, and the long-term patency and the morphological information was disclosed. In addition, the prognosis of contralateral iliac artery was examined, because future contralateral iliac events seem to be important for durability of unilateral iliac revascularizations. Materials and Methods: 148 patients (mean age, 66.9 years; 88% male) who had undergone unilateral aortoiliac reconstruction without contralateral iliac lesions were evaluated. The unilateral aortoiliac reconstructive procedures included 112 (76%) aorto or iliofemoral bypasses, 27 (18%) femorofemoral bypasses, and 9 (6%) axillofemoral bypasses. The indications for arterial reconstruction were disabling claudication and limb salvage in 125 (84%) and 23 (16%) patients, respectively. Preoperative arteriograms were reviewed to determine the Inter-Society Consensus (TASC II) classification categorizing iliac artery lesions. Contralateral iliac events were defined as any arterial reconstructive procedure, intervention, amputation for progression of contralateral iliac disease, or repair of abdominal aortic aneurysm (AAA). The Kaplan-Meier survival analysis was used to predict long-term results in patients grouped based on various factors which were compared using univariate and multivariate analyses. Results: In the 148 patients, unilateral iliac reconstructive procedures were undertaken in 83 (56%) patients with TASC II type D lesions, 34 (23%) patients with TASC II type C lesions, and 31 (21%) patients with TASC II type B lesions. Overall primary and secondary patency rates were 93.8% and 96.5% at 3 years and 90.0% and 93.9% at 5 years. A multivariate analysis disclosed critical limb ischemia influencing primary patency rates, and type of aortoiliac reconstruction or gender influencing secondary patency rates. TASC II classification did not affect primary or secondary patency rates. During the follow-up period, 15 contralateral iliac events occurred, including 11 aortoiliac reconstructive or interventional procedures, 3 repairs of AAA, and one case of bilateral thigh amputation due to acute aortic occlusion. The overall probability of contralateral iliac events was 2.2% at 3 years and 5.9% at 5 years. Conclusion: The long-term patency following unilateral iliac reconstructive surgery was satisfactory, and not affected by morphology of the iliac artery. Also, the future risk of contralateral iliac events appeared to be low.

Long-Term Results of Reconstructive Surgery in Patients with Bladder Pain Syndrome/Interstitial Cystitis: Subtyping Is Imperative

To evaluate the long-term outcome after reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis subdivided into subtypes. A total of 47 patients, fulfilling the National Institutes of Health/National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria, were evaluated retrospectively. They all had undergone reconstructive surgery during the 25-year period of 1978 to 2003. The surgical procedures included noncontinent ureteroenterocutaneostomy (12 patients), supratrigonal cystectomy and ileocystoplasty (23 patients), continent urinary diversion (Kock pouch; 10 patients), continent orthotopic diversion (1 patient), and cecocystoplasty (1 patient). The series comprised 34 patients with classic Hunner type disease and 13 patients with nonulcer bladder pain syndrome/interstitial cystitis. The patients were preoperatively assessed by interview, visual analog pain scale, micturition diaries, urinalysis, intravenous urography, urethrocystoscopy, and bladder distension during anesthesia, including biopsy and, in selected cases, urodynamic evaluation. The data were obtained by surveying the clinical records. For 28 of the 34 patients with classic Hunner-type disease, the initial surgical procedure resulted in complete symptom resolution. Of the remaining 6 patients, 4 were successfully treated with a supplementary diversion procedure, cystectomy, or transurethral ulcer resection in the trigonal remnant. In contrast, only 3 of the 13 patients with nonulcer disease experienced symptom resolution after reconstructive surgery, and 2 of these required a supravesical diversion procedure. Reconstructive surgery for refractory bladder pain syndrome/interstitial cystitis is an appropriate last resort only for patients with end-stage Hunner's disease. The decision to embark on major reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis should be preceded by a thorough preoperative evaluation, with emphasis on assessment to determine the relevant subtype (ie, classic or nonulcer disease).

Long-term Results of Reconstructive Surgery for Acquired Valve Disease: Evaluation of Mitral and Aortic Valvuloplasty

To evaluate the long-term results of reconstructive surgery for mitral and aortic valve diseases, 58 patients treated with mitral valvuloplasty (MVP) and 18 patients with aortic valvuloplasty (AVP) were considered. In the MVP group simple annuloplasty was performed in 16 cases, tape annuloplasty in 39 cases, and mitral valve extension with homopericardium in 3 cases. In the AVP group a combination of slicing, commissurotomy, and commissuroplasty was performed in 15 cases and aortic valve extension in three. There was one operative death in the AVP group, and one late death in the MVP group. The percentage of patients who had no complications related to reconstructive surgery after 17 years was 88% in the MVP group, and 81.7% in the AVP group. Only three patients in the MVP group, and one in the AVP group required reoperation after the reconstruction. Thus, reconstructive surgery should be utilized, whenever possible, in the treatment of valvular disease, even of the aortic valve.

末梢動脈閉塞症に対する血行再建術の成績と問題点

末梢動脈閉塞症に対する血行再建術の成績と問題点

遠隔成績からみた末梢動脈閉塞症の手術と問題点 下肢慢性閉塞性動脈硬化症を中心に

遠隔成績からみた末梢動脈閉塞症の手術と問題点 下肢慢性閉塞性動脈硬化症を中心に

下肢閉塞性動脈硬化症血行再建術の遠隔成績 手術適応と再建術式の選択

下肢閉塞性動脈硬化症血行再建術の遠隔成績 手術適応と再建術式の選択