Low Complication Rate Research Articles

Ultrasound-Guided Female Equilibrated Minimal Muscularization and Enhancement (U-Femme)

Abstract Background High-Definition Liposculpture has undergone significant evolution since its initial description, with the goal of achieving more natural outcomes and a muscular-defined appearance. The introduction of intramuscular fat grafting has enhanced contouring capabilities, with its applications extending to various muscle groups. Subperiosteal fat grafting efficacy and safety is well-established in facial surgery. Objectives Describe our technique of combining ultrasound-guided subperiosteal lipoinjection of the anterior superior iliac spine (Bikini Bridge) plus intramuscular fat grafting of the internal oblique muscles with High Definition Liposculpture. Methods A retrospective cohort study was conducted across different specialized plastic surgery centers. Adult patients who underwent Bikini Bridge and Dynamic Definition Liposculpture were included. All patients were informed of the innovative use of the technique and consented to participate. Descriptive statistical analysis was performed to summarize the variables. Results A total of 105 consecutive patients were included for analysis. Patients were mostly women (86,7%) plus 14 male patients (13,3%) who were in gender reassignment process. Mean age was 34,3 years (SD 8,7 years) and median body mass index was 22,9 kg/m2 (SD 2,74 kg/m2). All patients underwent fat grafting the Iliac spines + the oblique muscles as an additional procedure to High Definition Liposculpture. Median volume of fat injected was 15 cc (IQR 12 cc) for the iliac spines and 40 cc for the internal obliques. No major complications were reported. Conclusions Ultrasound-guided intramuscular and subperiosteal fat grafting of the abdomen is a safe and reproducible procedure, resulting in a harmonious and athletic appearance with natural-looking outcomes, high satisfaction, a very low rate of complications.

Can suction technology be a potential game changer that reshapes pediatric endourological interventions? Results from a scoping review.

To systematically review the use of suction/vacuum-assisted retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in children/adolescents with kidney stones. The PICOS model (Patient Intervention Comparison Outcome Study type) was used to frame and answer the clinical question; P: children and adolescent men with kidney stones; I: use of suction during PCNL or RIRS; C: no suction devices or none; O: complications and stone-free rate (SFR); S: prospective and retrospective studies; case reports. The literature search was performed on 14th May 2024 using Embase, PubMed, and Scopus. Only English papers were accepted. Ten articles were included. There were 9 papers on mini-PCNL and the remaining one compared mini-PCNL with RIRS. PCNL studies found excellent SFR (73-100%) with zero transfusion rate and a low rate of infectious complications (fever up to 9.6% and sepsis rate of 1%). Among these studies, there was a case report on the use of shock pulse lithotripter with complete stone clearance. Our review shows that there is little data on the use of suction/vacuum-assisted mini-PCNL/RIRS in kidney stone children/adolescents. However, these preliminary data demonstrated that vacuum-assisted mini-PCNL had excellent SFR with a low rate of complications.

Splenic Artery Embolization for Post-Liver Transplant Ascites

AbstractOrthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. However, OLT may be associated with certain postoperative management challenges. Though refractory ascites (RA) is not a common complication post-OLT, it can have a significant impact on patient outcomes and quality of life. RA post-OLT can be caused by portal hyperperfusion. In this article, a systematic review of the literature was pursued to analyze the effectiveness of splenic artery embolization (SAE) with RA after OLT. Data sources included MEDLINE, EMBASE, and CENTRAL from inception to March 2024. Studies reporting on patients treated with SAE for the management of RA following OLT, from inception to March 2024, were included. Morbidity, mortality, and clinical resolution were synthesized through a narrative review. A total of eight articles were identified, including 80 patients. In the majority of the patients, the SAE was performed using a vascular plug. After SAE, no cases associated with mortality were reported. Severe complications (Clavien III) occurred in 2.5% (n = 2) of patients. The success rate, with clinical resolution of symptomatology (ascites), ranged in these articles between 97 and 100%. The approach to the management of RA post-OLT should focus on identifying the underlying cause. If the RA is associated with portal hyperperfusion, it can be managed with SAE. Particularly proximal SAE seems to be highly effective for the resolution of ascites and the procedure is associated with a low complication rate.

DIEP flap with implant placement has a favorable complication profile compared to implant-only or flap-only reconstruction.

Hybrid deep inferior epigastric perforator (DIEP) flap and simultaneous silicone implant breast reconstruction procedures ("DIEP+I") have many conceptual advantages compared to either reconstruction method alone, but the outcomes of DIEP+I reconstruction have not yet been well studied. Therefore, the purpose of this study was to compare the outcomes of DIEP+I with implant-only and DIEP-only reconstruction. A retrospective review was conducted of patients undergoing DIEP+I, implant-only, and DIEP-only breast reconstruction from 2019-2023 at a single institution. Demographics and complication rates were compared between groups. A total of 145 patients were included in the DIEP+I (N = 26), implant-only (N = 59), and DIEP-only (N = 60) groups. The DIEP+I group had a lower overall complication rate than implant-only reconstruction (18.4% vs 41.1%, P = 0.014), which was primarily due to the lower incidence of infections in the DIEP+I group (2.6% vs 22.2%, P = 0.006). Accordingly, DIEP+I reconstruction decreased the odds of infection by 90% (OR = 0.095, P = 0.024) compared to implant-only reconstruction. The DIEP+I group had similar rates of wound healing and implant-related complications compared to the implant-only and DIEP-only groups, and no patients in the DIEP+I group experienced flap loss. DIEP+I breast reconstruction had a lower rate of infectious complications than implant-only reconstruction, and no higher rate of flap compromise or wound healing complications. This technique could be considered as a means of minimizing infection risk in patients with other risk factors who are seeking implant-based reconstruction, and of enhancing breast projection in patients who are seeking DIEP flap reconstruction.

Evaluating the Accuracy and Efficiency of Imaging Modalities in Guiding Ablation for Metastatic Spinal Column Tumors: A Systematic Review

Background/Objectives: Spinal metastases are a frequent and serious complication in cancer patients, often causing severe pain, instability, and neurological deficits. Thermal ablation techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) have emerged as minimally invasive treatments. These techniques rely on precise imaging guidance to effectively target lesions while minimizing complications. This systematic review aims to compare the efficacy of different imaging modalities—computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, and mixed techniques—in guiding thermal ablation for spinal metastases, focusing on success rates and complications. Methods: A systematic literature search was conducted across PubMed, OVID, Google Scholar, and Web of Science databases, yielding 3733 studies. After screening, 51 studies met the eligibility criteria. Data on success rates, tumor recurrence, complications, and patient outcomes were extracted. Success was defined as no procedure-related mortality, tumor recurrence or expansion, or nerve injury. This systematic review followed PRISMA guidelines and was registered with PROSPERO (ID: CRD42024567174). Results: CT-guided thermal ablation demonstrated high success rates, especially with RFA (75% complete success). Although less frequently employed, MRI guidance showed lower complication rates and improved soft-tissue contrast. Fluoroscopy-guided procedures were effective but had a higher incidence of nerve injury and incomplete tumor control. Mixed imaging techniques, such as CBCT-MRI fusion, showed potential for reducing complications and improving targeting accuracy. Conclusions: CT remains the most reliable imaging modality for guiding thermal ablation in spinal metastases, while MRI provides enhanced safety in complex cases. Fluoroscopy, although effective for real-time guidance, presents limitations in soft-tissue contrast. Mixed imaging techniques like CBCT-MRI fusion offer promising solutions by combining the advantages of both CT and MRI, warranting further exploration in future studies.

Comparison of NeedleTrainer™ and ultrasound tissue simulator in a simulated environment among novice regional anaesthesia practitioners

BackgroundUtilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand–eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users’ feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™.MethodsForty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale.ResultsBlue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p < 0.001), higher first- pass success rate (100% vs 80.9%), and lower complication rate (0% vs 19.1%). Higher overall learning satisfaction scores (28 ± 4 vs 25 ± 4, p = 0.003) and confidence scores after training (13 ± 2 vs 12 ± 2, p < 0.001) were recorded for the Blue Phantom model.ConclusionsWe postulated that the artificial intelligence structure recognition software enables NeedleTrainer users to attain shorter time-to-target. That being said, Blue Phantom provides better operator learning satisfaction, improved confidence, higher success and lower complication rates among novice RA practitioners, possibly due to greater tactile feedback during the simulated training.

A New Guiding Suturing Technique for Reshaping of the Antihelix in Patients with Prominent Ears.

Prominent ears are the most common congenital anomaly of the head and neck. A complete understanding of the definition of prominent ears is necessary. The present retrospective study described guiding sutures to hold the antihelix in a temporary corrected position before placing the permanent Mustardé sutures. This study was performed between January 2021 and February 2023. All patients with prominent ear deformities subjected to guiding sutures and Mustardé-based otoplasty were included. The surgical-related outcomes and surgeons' satisfaction were evaluated. The patients' satisfaction and health-related quality of life were reported. The current study included 60 patients with prominent ear deformities. There were 34 (56.66%) males and 26 (43.33%) females with a mean age of 12.2±7.8 years. The mean total operative time was 49±22 minutes. Five (8.33%) patients had suture extrusion, and no case of asymmetry, recurrence, or skin necrosis was documented.There were 55 (91.66%) patients satisfied with the final appearance of their ears, and five (8.33%) patients were not satisfied. The mean general health subscale was 57.1±6.9, and the mean physical health subscale was 8.7±1.5. The guiding sutures allowed easy accessibility for reshaping the antihelix in patients with prominent ears. These sutures allowed a relatively shorter operative time, and stable reshaping of the antihelix allowed for a shorter recovery time. This was associated with a low complication rate with no asymmetry, recurrence, or revision surgery.Patients operated on under local anesthesia achieved shorter operative time and better pain control. 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 .

Side effects and complications of high dose-rate brachytherapy: literature review and our own observations

Background. Among malignant tumors in men in Russia, prostate cancer is the most common comprising 17 %. Despite the high effectiveness of radiotherapy for prostate cancer in about 20 % of patients, radiation damage of the pelvic organs develops affecting bladder, rectum, and intrapelvic cellular tissue.Aim. To evaluate early and late complications of high dose-rate brachytherapy.Materials and methods. Literature review was performed, and our own results of treatment of 276 patients using high dose-rate brachytherapy as monotherapy with different fractionation regimens: 19 Gy per 1 fraction and 15 Gy per 2 fractions were analyzed.Results. High dose-rate brachytherapy as monotherapy is associated with low complication rate. There were no statistically significant differences between singleand two-fraction regimens. Evaluation of complication severity per the RTOG (Radiation Therapy Oncology Group) classification did not show complication severity above grade III. Early complications were diagnosed in 1.1 %, late in 3.3 % of cases. Between the treatment and comparison groups, no statistically significant differences in the frequency of urinary system organ symptoms per the IPSS (International Prostate Symptom Score) questionnaire were registered. Mean score per the IPSS prior to treatment was 4.0 (3.0–6.0) in the treatment group and 4.0 (3.0–8.5) in the comparison group. Mean follow-up duration in the treatment group was 65.0 (60.0–70.0) months, in the comparison group – 55.0 (49.5–65.0) months. After the treatment, mean IPSS score was 5.0 (4.0–5.0) in the treatment group and 5.0 (3.0–7.0) in the comparison group.Conclusion. High dose-rate brachytherapy as monotherapy and in combination with external beam therapy is a safe and effective treatment method in prostate cancer. Serious and late complications are rare, however toxic effects of severity grades I or II can develop. Careful patient selection for brachytherapy, therapy planning methods, as well as active management of early and late toxicity by a multidisciplinary team with knowledge and experience in treatment of side effects of radiotherapy can help optimize treatment with high dose-rate brachytherapy.

Robot-assisted partial nephrectomy vs. percutaneous cryoablation for T1a renal tumors: a single-center retrospective analysis of outcomes and costs.

The aim of this study is to compare perioperative, functional, and oncological outcomes between robot-assisted partial nephrectomy (RAPN) and cryoablation (CRYO), based on a 3-year experience at our Institution. Additionally, a secondary aim is to conduct a comparative cost analysis between the two procedures. A retrospective analysis was conducted, including patients who underwent RAPN or CRYO between January 2020 and December 2023. Group 1 consisted of 59 patients who underwent RAPN, while Group 2 included 38 patients who had CRYO. The evaluation parameters included baseline characteristics, perioperative, functional, and oncological outcomes, as well as total hospitalization costs. Operative time (OT), average length of hospital stay (LOS), and emetic blood loss (EBL) were significantly lower in the CRYO group. Furthermore, CRYO showed a significantly lower rate of postoperative complications of any grade (7.8% vs 16.9%); however, this was associated with a considerably higher recurrence rate (5.7% vs 1.7%). No substantial differences were found in long-term functional outcomes (ΔeGFR). In terms of costs, CRYO was more cost-effective than RAPN (€5473 vs €10,672), although the gap was partially offset by a higher reimbursement "DRG" rate for robotic partial nephrectomy (€7386 vs €4384). Robot-assisted partial nephrectomy (RAPN) remains the preferred option for treating small renal masses (sRM), providing excellent oncological results and acceptable morbidity. However, percutaneous cryoablation is a valid alternative, particularly for patients unfit for surgery, as long as meticulous postoperative follow-up is carried out.

Outpatient periurethral injections of polyacrylamide hydrogel (Bulkamid®) under local anesthesia in the office: a prospective single-center series

ObjectiveTo report our experience of outpatient peri-urethral injections of Bulkamid® under local anesthesia in the office in female patients for stress urinary incontinence (SUI). Polyacrylamide hydrogel (Bulkamid®) is a relatively recent bulking agent which may have a better safety profile than previous generations. MethodsThe data of all women who underwent outpatient peri-urethral Bulkamid® injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and August 2023. This therapeutic option was offered to patients who had SUI if > 80-year-old and/or had multiple comorbidities or if they declined all other therapeutic options. ResultsNinety-two patients were included. The mean age was 78 years (30-97). Twenty-two patients experienced postoperative complications (21%), seventeen were Clavien 1 complication, only one complication was Clavien =4. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes.Peri-urethral Bulkamid® injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with a great tolerance and with similar functional outcomes than previously reported. The injections have a low rate of complications and every complication has been well tolerated. ConclusionThese options may be of great value in frail patients and those looking for a minimally invasive treatment. The local anesthesia protocol with the office setting may be of particular interest.

Complications and risk factors associated with zygomatic implants: retrospective analysis with 73 consecutive patients followed for 3.5 years.

This retrospective study analyzed zygomatic implant (ZI) survival and implant success (based on ORIS criteria) in patients treated for maxilla atrophy or after reconstruction failure. Implants were placed as quads (4 ZIs) or hybrids (ZIs and conventional implants in premaxilla) in edentulous patients using various surgical approaches, evolving from the sinus slot to Chow's extended sinus lift technique with or without Bichat fat pad. The procedure was followed by immediate loading, while clinical and radiographic evaluations spanned at least 1 year after implantation. The primary outcome was the implant survival at follow-up, and the secondary was the implant success, assessed as complications according to ORIS criteria: prosthetic offset, sinus status, peri-implant soft tissue health, and implant stability. A total of 73 consecutive patients, treated with 217 ZIs and 76 conventional implants, were included, with mean follow-up of 3.5 years (range, 1-9.8 years). Four ZIs failed in 3 patients, including 1 patient with a zygomatic bone fracture. The cumulative survival rate was 98.16%. Although in 2 additional cases, implants lost stability, they achieved delayed osseointegration. Other complications included 21 sinus reactions (excluding the 4 failures) and 28 peri-implant inflammatory reactions. ZIs offered a predictable treatment option for extreme upper jawbone atrophy with a relatively low complication rate and no severe injuries. The Chow technique with the Bichat fat pad positively impacted ZI success and survival, whereas smoking, implantation in fresh sockets, and the limited experience of the surgeon negatively affected the outcomes.

Restoring mobility: roles of percutaneous consolidation for pelvic ring bone lesions-a multicenter study.

This study aimed to assess the early functional rehabilitation outcomes following percutaneous consolidation for pelvic ring tumor lesions. In this multicenter retrospective study, patients with pelvic bone tumor lesions, whether primitive or metastatic, underwent percutaneous consolidation (cementoplasty, screw fixation, or both). The primary outcome was postoperative weight-bearing ambulation. Secondary outcomes included hospitalization duration, procedural complications, and long-term consolidation. Inclusion criteria were patients treated for prophylactic consolidation or pathological fractures. Kaplan-Meier analysis was used for the primary outcome and hospital stay, with p-values < 0.05 indicating significance. A total of 143 consecutive procedures were performed in 138 patients (mean age, 65 years ± 13; 68 men) who underwent percutaneous screw fixation, cementoplasty, or both. Postoperative weight-bearing ambulation was achieved in 142/143 cases (99%). In total, 117/143 (82%) of these were in the first 24 h. 81/143 (57%) were discharged within 24 h (median, one day; Q3, one day; Q4, 112 days). 133/138 (96.5%) patients achieved long-term consolidation. The most common pattern was isolated acetabular involvement (N = 40; 28%). Of the 19 adverse events, 10 were asymptomatic. Three patients had delayed infections and one required screw removal. Percutaneous consolidation effectively achieved postoperative weight-bearing ambulation and represents a safe and durable treatment option for patients with pelvic bone lesions. ClinicalTrials.gov: NCT06155890. Question How can radiology continue to help improve care for patients with metastatic pelvic ring lesions? Findings 99% of patients achieved postoperative weight-bearing, with 82% doing so within 24 h. Clinical relevance Percutaneous consolidation enabled rapid functional rehabilitation of oncology patients, allowing short hospital stays with low complication rates, and demonstrating the expanding role of radiologists in diagnosis, risk assessment, and treatment planning, thereby enhancing patient care.

Preoperative Radiation Therapy is Not Associated with Postoperative Complications in Patients with Retroperitoneal Sarcoma.

The role of preoperative radiation therapy (RT) in the management of retroperitoneal sarcomas (RPS) remains controversial. A legitimate concern is the potential for worse outcomes after surgery for RPS with preoperative RT. The purpose of this study was to evaluate the impact of preoperative (± intraoperative) RT on postoperative complications in patients undergoing surgery for RPS. A total of 99 patients who underwent curative-intent surgery for primary RPS of any histology after preoperative RT from 2003 to 2021 were analyzed. Univariate and multivariate logistic regression analyses were performed to identify factors associated with postoperative morbidity and mortality. The median preoperative RT dose was 57.4Gy, and 17 patients received intraoperative RT to a median dose of 10Gy. The median number of organs resected was two. Postoperative complications within 30 days of surgery occurred in 47% of patients, including severe complications (Clavien-Dindo grades ≥IIIa) in 20% of patients. The 90-day mortality rate was 2%. On multivariate analysis, concomitant vascular resection was the only significant predictor of severe postoperative complications (odds ratio 8.76; p=0.0069). Despite increasing median preoperative RT doses from 50.4Gy in 2003-2012 to 63Gy (on a clinical trial) in 2013-2021, severe postoperative morbidity rates actually decreased from 26.3% to 16.1% (p=0.303). The administration of preoperative (± intraoperative) RT to patients with RPS resulted in similar postoperative complications as reported after surgery alone. Continuous advances in surgical and radiotherapeutic expertise resulted in lower complication rates over time despite increasing radiation doses.

Resection of Early Colorectal Neoplasms Using Endoscopic Submucosal Dissection: A Retrospective Multicenter Cohort Study.

Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the intention of improving its effectiveness. Patients and Methods: We conducted a multicenter, retrospective cohort study on 214 patients who underwent ESD procedures for early colorectal cancer from January 2016 to October 2023. Results:En bloc resection was achieved in 197 (92.1%) of ESD procedures, R0 resection in 149 (69.6%), and curative resection in 54 (40.9%). The submucosal invasion was classified as level 1 (SM1) in 96 cases (45.3%), level 2 (SM2) in 61 cases (28.8%), and level 3 (SM3) in 36 cases (17%). R0 resection was achieved more often in the rectum-92 (81.4%), compared to the right-24 (64.9%) and left colon-33 (61.1%), p = 0.009. In rectal tumors, R0 resection was achieved in 51 (98.1%) SM1 invasion, 27 (73%) SM2 invasion, and 13 (65%) SM3 invasion (p < 0.001). Lateral and vertical resection margins were positive in 12 (7.7%) and 52 (25.2%) cases, respectively. Vertical resection margins were statistically more often positive in lesions located in the right colon-11 cases (28.9%) and left colon-21 cases (38.9%), than in rectum-20 cases (17.5%); p = 0.010. Complications were found in 32 (15%) cases of ESD procedure-perforation in 12 cases (5.6%) and delayed bleeding in four cases (1.9%). Procedures performed in the right colon were associated with a significantly higher risk of any complications (30%) and perforations (15%) than those performed in the rectum (10.3% and 2.6%) or the left colon (13.8% and 5.2%; p = 0.016; p = 0.015), respectively. Conclusions: ESD for early colon cancer is a viable strategy due to its effectiveness and low complication rate. The ESD technique performed in the rectum yields the best results; however, in the right colon, it still requires careful attention.

Comprehensive evaluation of management strategies and rupture status in partially thrombosed aneurysms: a systematic review and meta-analysis

BackgroundThis meta-analysis aims to evaluate and compare the clinical and angiographic outcomes of different management strategies for partially thrombosed intracranial aneurysms (PTIAs).MethodsA systematic review was conducted using MEDLINE, Scopus, and...

Efficacy and safety of Le Fort colpocleisis in the treatment of stage III-IV pelvic organ prolapse

BackgroundLe Fort colpocleisis is an obliterative surgery for the treatment of pelvic organ prolapse (POP). In this study, we aimed to investigate the efficacy and safety of Le Fort colpocleisis in the treatment of patients with stage III-IV POP.MethodsThe study was designed as a retrospective analysis of a single-center case series. Patients with stage III-IV POP treated with Le Fort colpocleisis were included. Perioperative indicators, subjective and objective outcomes and complications were assessed. The POP-Quantification (POP-Q) system was used for objective outcome evaluation. Pelvic Floor Distress Questionnaire (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) were used for subjective outcome evaluation.ResultsA total of 54 patients with complete pre- and postoperative data completed follow-up and were included in our study. The mean ± standard deviation of operative time, intraoperative blood loss, recovery activity time, postoperative hospitalization time and total hospitalization time were 146.85 ± 37.01 min, 92.04 ± 68.31 ml, 2.81 ± 0.85 days, 6.5 ± 2.11 days and 13.52 ± 4.78 days, respectively. Within the median follow-up period of 38.5 months, the objective cure rate of Le Fort colpocleisis reached 98.15% (53/54), and the subjective cure rate reached 92.59% (50/54). No serious complications were reported during the perioperative period and follow-up period.ConclusionLe Fort colpocleisis is an effective and safe procedure for the treatment of severe POP. Because of its lower operative risk, better subjective and objective outcomes, lower rates of prolapse recurrence and perioperative complications, Le Fort colpocleisis should be considered as the recommended procedure for elderly patients with severe POP (stage III-IV).

Use of active low suction pressure (subgaleal) drains in chronic subdural haematoma surgery

Subdural drains are used to reduce recurrence after surgical evacuation of chronic subdural hematoma. There is a small risk of parenchymal injury. We hypothesize that using subgaleal drains with low active suction (-50mmHg to -100mmHg) may be a safer alternative while still maintaining efficacy in preventing recurrence. A retrospective review of adult patients who underwent surgical drainage of chronic subdural hematoma at our institution was performed. They were classified into 2 groups - subdural group and subgaleal group. We collected data on patient demographics, preoperative use of antiplatelets or anticoagulants, the type of drains used, laterality of burrhole surgery performed and postoperative complications, and recurrence. Descriptive statistics and regression analyses were used to analyse the data. 322 patients were recruited, with 172 receiving subgaleal drains with low active suction and 150 receiving passive subdural drains. There was no significant difference in the rate of recurrence with 11.0 % recurrence in the subgaleal drain group and 9.3% recurrence in the subdural drain group (p = 0.660). Patients who underwent active subgaleal drain insertion had significantly fewer complications, at 2.3% compared to 8.0% in patients who had passive subdural drains (p = 0.037). The use of subgaleal drains with low active suction led to significantly lower complication rates compared to the use of subdural drains, while maintaining its efficacy in preventing recurrence.

Arthroscopic Bankart repair versus arthroscopic Latarjet for anterior shoulder instability in adolescents.

The Bankart and Latarjet procedures are two of the most common surgical techniques to treat anterior shoulder instability with satisfactory clinical and functional outcomes. However, the outcomes in the adolescent population remain unclear, and there is no information regarding the arthroscopic Latarjet in this population. The purpose of this study was to evaluate the outcomes of the arthroscopic Bankart and arthroscopic Latarjet procedures in the management of anterior shoulder instability in adolescents. We present a retrospective, matched-pair study of teenagers with anterior glenohumeral instability treated with an arthroscopic Bankart repair (ABR) or an arthroscopic Latarjet (AL) procedure with a minimum two-year follow-up. Preoperative demographic and clinical features, factors associated with dislocation, and complications were collected. Recurrence, defined as dislocation or subluxation, was established as the primary outcome. Clinical and functional outcomes were analyzed using objective (Rowe), and subjective (Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE)) scores. Additionally, the rate of return to sport was assessed. A total of 51 adolescents were included, of whom 46 (92%) were male, with 17 (33%) in the Latarjet group and 34 (66%) in the Bankart group. The mean age at time of surgery was 18 years (15 to 19). There were no intraoperative complications. At a median follow-up of nine years (IQR 2 to 18), recurrence was observed in 12 patients in the Bankart group (35.3%) and one patient in the Latarjet group (5.9%) (p = 0.023). Satisfactory postoperative outcomes were obtained, with mean Rowe, WOSI, and SANE scores noted at 95 (10 to 100), 325 (25 to 1,975), and 87.5 (10 to 100), respectively. Most patients (29 in the Bankart group (85.3%) and 16 in the Latarjet group (94.1%)) were able to return to sport (p = 0.452). The ABR and AL procedures both obtain satisfactory clinical and functional outcomes in the treatment of anterior glenohumeral instability in adolescents with a low complication rate. However, the ABR is associated with a significantly higher recurrence rate.

Pre- and Postoperative Ultrasound Assessment of Biceps Brachial Tendon Tears.

Rupture of the distal biceps brachii tendon is a rare but debilitating injury, resulting in significant loss of strength. Diagnosis of complete rupture is based on clinical history and physical tests, with surgical repair often recommended due to functional discomfort. Ultrasound (US) is a powerful tool for diagnosing and classifying ruptures, particularly partial ruptures, which is crucial for therapeutic decisions. A good understanding of the tendon's anatomical arrangement in two twisted bundles enables optimal analysis. If several surgical techniques are available, the minimally invasive approach to reinsert the tendon on the radial tuberosity is often preferred. Postoperative assessment includes radiographs, US, and sometimes magnetic resonance imaging, revealing postoperative changes with constant thickening of the repaired tendon. With accurate diagnosis and appropriate surgical technique, surgical repair has a low complication rate. Single-incision repairs show higher rates of re-tears and nerve injuries, and double-incision repairs are prone to heterotopic ossification.

The long-term results of treating radial neck fractures in children with the Metaizeau technique

Purpose: Radial neck fractures in children are rare, representing less than 1% of all pediatric fractures. While conservative treatments are often sufficient, displaced fractures may require closed or open reduction. The Metaizeau technique is widely accepted for closed reduction and internal fixation. This study aims to assess the long-term functional and radiological outcomes of this technique and identify any complications that may arise. Methods: This retrospective study analyzed 22 pediatric patients treated with the Metaizeau technique for proximal radius fractures between 2005 and 2018. Data on demographics, preoperative radiographs, and postoperative complications were reviewed. Outcomes were evaluated using radiographic and functional measures, including grip strength, the Mayo elbow performance score (MEPS), and the Tibone and Stolz classification. Results: The mean age at the time of injury was 9.9 years, with a mean follow-up period of 139 months (range: 72–213 months). Patients were classified as Judet type 3 ( n = 9), type 4a ( n = 9), or type 4b ( n = 4). The functional outcomes showed a mean MEPS score of 99 (range: 90–100), with 86% of patients achieving excellent results according to the Tibone and Stolz classification. Excellent outcomes were recorded in 100% of type 3, 77.7% of type 4a, and 75% of type 4b cases. Documented complications included one case of radioulnar synostosis and two cases of heterotopic ossification. Conclusions: The Metaizeau technique represents an efficacious treatment option for pediatric radial neck fractures, offering favorable long-term functional and radiological outcomes with a low complication rate. Long-term follow-up data further support the reliability of this technique. Types of Studies: Level IV.