Multiplicative Reconstruction Technique Research Articles

Feasibility and surgical outcomes of simultaneous urethral reconstruction for synchronous urethral strictures.

To evaluate the feasibility and surgical outcomes of simultaneous urethral reconstruction for synchronous urethral strictures (SUS) and analyze the surgical techniques employed for different stricture combinations. Twenty-two male patients with SUS who underwent urethral reconstruction between February 2018 and July 2023 were retrospectively reviewed. Stricture locations and lengths were evaluated using cystoscopy and urethrography after urethral rest for at least 3 months. Multiple reconstruction techniques were employed based on stricture characteristics, including anastomotic urethroplasty, substitution urethroplasty, staged urethroplasty, perineal urethrostomy, and deep lateral incision of the bladder neck. Anatomical success was defined as the ability to pass a cystoscope without resistance and void without additional interventions. The median age was 72, with iatrogenic causes accounting for 77.2%. The most common stricture combination was strictures at the penoscrotal junction and proximal bulbar urethra (59.1%). Two (9.1%) had strictures in three locations, and one (4.5%) had strictures in four locations. A total of 15 different combinations of reconstruction techniques were utilized to address various stricture patterns. Overall, 86.4% were treated in one stage. The median operation time was 177 min, and the median blood loss was 72 mL. At a median follow-up of 31 months, anatomical success was achieved at 77.3%. No perioperative complications were observed. Simultaneous repair of SUS is feasible using various reconstructive techniques tailored to each stricture site. The high prevalence of iatrogenic etiology and previous transurethral treatments emphasize the importance of appropriate initial management of urethral strictures.

SUCCESSFUL MACROVASCULAR PENILE REIMPLANTATION AFTER TRAUMATIC AMPUTATION IN A YOUNG MALE

Penile amputation is an uncommon occurrence that arises from acts of self-mutilation, unintentional trauma, or deliberate assault. In recent advances, multiple reconstructive techniques provide excellent outcomes for penile re-plantation. Here, we present a case of successful penile re-plantation and urethroplasty following 24 hours of ischemia in a 22-year-old male with complete urethral injury and a partially amputated penis. As far we know , this is one among the longest documented ischemia time for successful macrosurgical penile re-plantation. After 6 weeks of penile re-plantation, the patient recovered well and showed normal urination, erectile function, return of sensations, and satisfactory cosmetic outcome. Penile amputation injuries should be managed in a specialist center with expert urological and plastic surgeons of micro/macrosurgical reconstruction. The main aim of this study is to evaluate the treatment regimen and prognosis of macrosurgical re-plantation of penile stump.

Influence of biliary and vascular resection types on morbidity in hepatectomies with vascular involvement.

Hepatectomies associated with vascular resections pose a technical challenge for surgeons, involving multiple reconstruction techniques. Moreover, adding clinical and surgical risks in the postoperative setting of these complex procedures are mainly due to prolonged surgical periods and potential complications inherent to vascular manipulation. Leveraging the expertise of a Cancer Center, we propose an institutional assessment utilizing the case series from A. C. Camargo Cancer Center in hepatectomies associated with vascular resection, evaluating postoperative complications and outcomes while highlighting clinical, laboratory, pathological, and surgical factors that may influence results. To assess mortality and morbidity associated with hepatectomies involving vascular resection. From a prospective database, a study was performed evaluating postoperative survival and morbidity using scoring systems such as Clavien-Dindo through a cohort analysis. From a total of 1021 liver resections for a period of 10 years, 31 cases were evaluated from a unique cancer center in Brazil! Factors such as the performance of major hepatectomies, the need for blood transfusion, and the administration of neoadjuvant or adjuvant systemic therapy did not appear to influence the outcome of morbidity or mortality. However, the resection of the associated bile duct and the type of vascular resection seemed to influence morbidity outcomes with statistical significance (p = 0.006+ …). Hepatectomies associated with vascular resections are safe in selected cases and when performed in referral centers. Factors such as associated bile duct resection and type of vascular resection should be considered for procedure indication.

Functional and Aesthetic Outcomes in Facial Reconstructions with Multiple Composite Axial Flaps – Case Report

The article presents a case of facial reconstruction with several facial axial flaps for a posttraumatic defect of the left upper lip, medial cheek region and left nasal wing. The case refers to a 58-year-old patient who is hospitalized for a facial trauma which involves only the soft tissues, resulting from a car accident.The immediate reconstruction of all the affected aesthetic units using multiple reconstructive techniques allowed the favorable resolution of the case in the shortest possible time. We used advancement and rotation orbicularis oris innervated musculocutaneous flaps for reconstruction of the left upper lip, cervicofacial cutaneous flap for the medial cheek defect and composite forehead flap for the reconstruction of the left nasal wing. The simultaneous use of different types of flaps made possible the total healing after 4 weeks after the accident and the social and professional integration of the patient.Complex facial trauma often involves both skeletal and soft tissue damage, presenting significant challenges in both initial management and long-term reconstruction. These injuries can result from various etiologies including motor vehicle accidents, assaults, sports injuries, and falls. Effective treatment requires a multidisciplinary approach to address the intricate anatomy and functional importance of facial structures.

Reconstructive techniques following low anterior resection for carcinoma of the rectum.

Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied. PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31st, 2023. Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown. In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.

NOVEL SINGLE-STRAND ‘SHORT ISOMETRIC CONSTRUCT’ (SIC) MEDIAL COLLATERAL LIGAMENT RECONSTRUCTION RESTORES VALGUS AND ROTATIONAL STABILITY THROUGHOUT KNEE RANGE OF MOTION

AbstractIntroductionPersistent medial laxity increases the risk of failure for ACL reconstruction. To address this, multiple reconstruction techniques have been created. To date, no single strand reconstruction constructs have been able to restore both valgus and rotational stability. In response to this, a novel single strand Short Isometric Construct (SIC) MCL reconstruction was developed.MethodsEight fresh-frozen cadaveric specimens were tested in three states: 1) intact 2) after sMCL and dMCL transection, and 3) after SIC MCL reconstruction. In each state, four loading conditions were applied at varying flexion angles: 90N anterior drawer, 5Nm tibial external rotation torque, 8Nm valgus torque, and combined 90N anterior drawer plus 5Nm tibial external rotation torque.ResultsTransection of the sMCL and dMCL resulted in increased laxity with external rotation torque, valgus torque, and combined anterior drawer plus external rotation. SIC MCL reconstruction restored external rotation and valgus stability to intact levels throughout all degrees of flexion. In the combined test SIC MCL reconstruction also restored stability to intact levels for both anterior distraction and external rotation throughout the range of motion. No significant differences were noted between intact and SIC reconstruction.ConclusionThe single-limb short isometric construct (SIC) MCL reconstruction restored native valgus and rotatory stability to a sMCL- and dMCL-deficient knee in biomechanical testing.

Cultured Skin Autograft in Subtotal Pediatric Scalp Avulsion.

Pediatric scalp avulsions represent a reconstructive challenge because of the unique features of scalp tissue. When microsurgical reimplantation is not feasible, alternative approaches such as skin grafting, free flap transfer with latissimus flap, or tissue expansion are considered. Generally, there is no consensus regarding management of this trauma, and, oftentimes, multiple reconstructive techniques may be needed for definitive coverage. This case study describes the reconstruction of a pediatric subtotal scalp avulsion using a dermal regeneration template and novel autologous homologous skin construct. This case was complicated by the absence of original tissue for reimplantation, excessive size of the defect relative to body habitus, and family concerns for future hair-bearing function. The reconstruction successfully provided definitive coverage and significantly reduced the size of the donor site and associated compilations. However, the hair-bearing potential of the tissue has yet to be determined.

Systematic Review and Meta-Analysis of the Use of Hyaluronic Acid Injections to Restore Interproximal Papillae

The absence of interdental papillae leads to the appearance of black triangles. For most patients, the appearance of these triangles is an important reason for concern and affects their social relationships. Multiple reconstruction techniques have been developed with different degrees of success and predictability. The main aim of this study was to evaluate the efficiency of hyaluronic acid (HA) injected into interproximal papillae 6 months after injection and to perform a systematic review and meta-analysis. After a systematic review, seven articles were selected: two clinical randomised controlled trials and five clinical trials. In total, 127 patients with a deficiency in upper papillae in the front of the maxilla and jaw were included in the study. The height variable was evaluated (mm) 6 months after HA injection. In total, 166 interproximal papillae were studied. Four articles showed an important difference in favour of intervention. The total result regarding in the injection of HA was favourable with an approximate average filling of 0.47 mm in the height of the interdental papilla. The injection of HA for the reconstruction of deficient papillae in the region of the upper and lower maxilla was a possible option treatment strategy in mild black triangles.

Intra- and Extrathoracic Malignant Tracheoesophageal Fistula-A Differentiated Reconstructive Algorithm.

Simple SummaryTracheoesophageal fistulae (TEF) after oncologic resections represent a therapeutic challenge. Reconstructive options vary from the upper to the lower airways and include the complete therapeutic armamentarium from pedicled flaps to chimeric free flaps. Derived from the experience of 18 oncologic patients with TEF, we present a therapeutic algorithm that may guide future treatment strategies and shows that an interdisciplinary approach leads to satisfying success rates. However, disease-specific morbidity has to be anticipated.Background: Tracheoesophageal fistulae (TEF) after oncologic resections and multimodal treatment are life-threatening and surgically challenging. Radiation and prior procedures hamper wound healing and lead to high complication rates. We present an interdisciplinary algorithm for the treatment of TEF derived from the therapy of consecutive patients. Patients and methods: 18 patients (3 females, 15 males) treated for TEF from January 2015 to July 2017 were included. Two patients were treated palliatively, whereas reconstructions were attempted in 16 cases undergoing 24 procedures. Discontinuity resection and secondary gastric pull-up were performed in two patients. Pedicled reconstructions were pectoralis major (n = 2), sternocleidomastoid muscle (n = 2), latissimus dorsi (n = 1) or intercostal muscle (ICM, n = 7) flaps. Free flaps were anterolateral thigh (ALT, n = 4), combined anterolateral thigh/anteromedial thigh (ALT/AMT, n = 1), jejunum (n = 3) or combined ALT–jejunum flaps (n = 2). Results: Regarding all 18 patients, 11 of 16 reconstructive attempts were primarily successful (61%), whereas long-term success after multiple procedures was possible in 83% (n = 15). The 30-day survival was 89%. Derived from the experience, patients were divided into three subgroups (extrathoracic, cervicothoracic, intrathroracic TEF) and a treatment algorithm was developed. Primary reconstructions for extra- and cervicothoracic TEF were pedicled flaps, whereas free flaps were used in recurrent or persistent cases. Pedicled ICM flaps were mostly used for intrathoracic TEF. Conclusion: TEF after multimodal tumor treatment require concerted interdisciplinary efforts for successful reconstruction. We describe a differentiated reconstructive approach including multiple reconstructive techniques from pedicled to chimeric ALT/jejunum flaps. Hereby, successful reconstructions are mostly possible. However, disease and patient-specific morbidity has to be anticipated and requires further interdisciplinary management.

Anatomical Emphasis for the Latissimus Dorsi Myocutaneous Flap for Breast Reconstructive Surgery Patient Education

Introduction & Objective Reconstructive surgeries among breast cancer survivors continue to increase due to public recognition of the disease and ever-increasing diagnoses. Multiple reconstructive techniques are presented to patients, each with indications relating to disease severity and patient presentation. The latissimus dorsi myocutaneous (LD) flap is one of several viable options for breast reconstruction with minimal post-operative complications and provides a natural-looking breast and sensation recovery. However, patient education materials with detailed anatomical illustrations are lacking. The objective of this study is to provide original patient education materials with detailed anatomical illustrations for breast reconstructive surgery, specifically the latissimus dorsi myocutaneous flap. Materials and Methods An extensive review of literature was conducted using a critical interpretive synthesis to obtain a detailed anatomical description of the LD flap as well as its indications for patient populations and post-operative complications. Results Articles containing relevant surgical descriptions of the LD flap procedure and the appropriate anatomy were used for incorporation in this review. Qualitative data analysis of literature revealed indications and anatomical details for original creation of illustrations for patient education. The LD flap is a useful graft for women with low BMI who wish to have a scar easily covered by undergarments. The LD flap is a skin, muscle, and fat flap supplied by the thoracodorsal artery and the thoracodorsal nerve. Variability exists but does not pose an issue to relocation of the flap through the tunnel created subcutaneously. The skin island is reattached in the area of the defect and can be cutaneously reinnervated via neurorrhaphy between the prominent intercostal nerves of the breast region. Women can have satisfactory results of the LD flap reconstruction, immediately or delayed. Reconstruction with a LD flap is widely tolerated with significant satisfaction and minimal post-operative complications. The LD flap had decreased satisfaction in those who selected an immediate reconstruction, potentially due to the expectation for the breast to look identical to the original. The recovery of sensation varies, but may never return fully. Conclusion With increasing demands for surgeons to make a perfect breast, numerous techniques presented to the patient can be overwhelming. It is important to supply adequate information concerning the LD flap operation for the patient to be informed and to have realistic expectations of the reconstruction outcome. Education with images and patient appropriate descriptions may help patients to have a better understanding of the surgery they are undergoing and the results to be expected. Significance As breast cancer maintains its place as one of the most common cancers among women in the United States, second only to certain forms of skin cancer, focus on the quality of life of survivors potentially can benefit millions. Future work aims to measure the effectiveness of anatomical illustrations in patient education materials pre- and post-surgery.

Treatment Alternatives for Recurrent Esophagogastric Junction Adenocarcinoma: Case Report of an Ileocolonic Reconstruction and Literature Review

Esophagogastric junction tumors are a challenging pathology for surgeons and the best treatment depends on an adequate initial localization and stadification. Approximately half of patients relapse after curative surgery during the first two years. Surgical resection could increase the survival of these patients, but the esophageal reconstruction is a surgical challenge for which there are multiple reconstruction techniques described with different organs.In this report, we present the case of a patient with an esophagogastric junction tumor treated initially with total gastrectomy and esophageal margin. The patient presented an anastomotic recurrence that was taken to surgical resection, but a second recurrence required a residual esophagectomy with ileocolonic reconstruction, to achieve adequate oncologic treatment.

A REASSESSMENT OF LEATHERWORK FROM THE SUTTON HOO SHIP BURIAL

The seventh-century ship burial at Sutton Hoo Mound 1, excavated in 1939, contained an impressive display of gold, silver and bronze objects, weapons and other offerings. Organic materials such as wood, textiles and leather were also present. The leather items were studied, and the results published in 1983, when two pairs of shoes were identified from the extremely fragmented remains that survived. Recently, a reassessment of the leather fragments revised the identification to two bags and a single pair of shoes. Multiple reconstruction techniques, developed over the last twenty years, were used to examine the leather fragments and associated metal fittings to provide a new understanding of the leather items and how they had been placed in the burial.

Intercalary Allograft Reconstruction of the Proximal Tibia With and Without a Free Fibula Flap in Pediatric Patients.

Limb salvage of the proximal tibia can be difficult due to the growth potential of and functional demands of the pediatric patients. Multiple reconstruction techniques exist, however, the ideal form of reconstruction is yet to be elucidated. The purpose of the current study is to evaluate outcomes in patients with an intercalary resection of the proximal tibia reconstructed with an allograft with or without a free vascularized fibula flap (FVF). Seventeen pediatric patients (9 males, 8 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12±4 years. The most common diagnoses were osteosarcoma (n=6) and Ewing sarcoma (n=6). Patients were reconstructed with an allograft alone (n=6) or supplemented with an FVF (n=11). All surviving patients had at least 2 years of clinical follow-up, with the mean follow-up of 12±7 years. The mean time to union of the allograft was 11±4 months, with 6 patients requiring additional bone grafting. There was no difference in the need for an additional bone graft (odds ratio=1.14, P=1.0) between patients with an FVF and those without. Four patients underwent an amputation, all with an allograft alone, due to disease recurrence (n=2) and due to infection (n=2). As such, there was a higher 10-year overall limb-salvage rate when the allograft was combined with an FVF compared with an allograft alone (100% vs. 33%, P=0.001). At last follow-up, the mean Mankin and Musculoskeletal Tumor Society rating was 86%, with a higher mean score in patients reconstructed with an FVF (94% vs. 70%, P=0.002). Use of an intercalary allograft supplemented with an FVF to reconstruct the proximal tibia provides a durable means of reconstruction with an excellent functional outcome following oncologic proximal tibia resection in a pediatric population. Level III-therapeutic level.

Outcomes Following Mangling Upper Extremity Trauma

Mangling injuries involve multiple tissue types and present a challenge for reconstructive surgeons. While multiple reconstructive techniques have been described for bones, vessels, nerves, and soft tissues, there are few studies examining the long-term functional outcomes of patients with mangled upper extremities. As a result, there are few evidence-based management paradigms to improve functional outcomes. This paper is a review of the literature throughout the past decade on the management of upper extremity trauma, with seven studies focused on long-term functional outcome measures. While there is little consensus in the medical literature on the preferred functional outcome measure for upper extremity trauma, even patients with the most severe injuries can achieve a reasonable functional outcome, with the ability to maintain employment and perform basic functions of daily living with their injured limb.

The surgical treatment of cerebrospinal fistula: Qualitative and quantitative analysis of indications and results

Cerebrospinal fistula might occur in different ways. CSF closure techniques have undergone significant evolution that has led to the consolidation of the transnasal endoscopic approach. Despite the existence of multiple publications, meaningful information is still lacking in clinical practice and the literature about the ideal method, material, and timing for repair of CSF. The purpose of this review was to summarize the success rate of endoscopic CSF leak repair as well as whether specific techniques or materials influence the primary success rate through a review of the latest advancements in endoscopic CSF management published in the past 10 years. The principles of multilayer reconstructions and the routine use of vascularized flaps in expanded endonasal surgery have reduced postoperative CSF leaks' failure rates between 5% and 10% (4% in this meta-analysis). Effective endoscopic anterior skull base (ASB) closure may be achieved by multiple reconstructive techniques, which should be tailored case by case according to the patient and defect conditions.

Medial Patellofemoral Ligament Reconstruction Using Achilles Tendon Allograft With Bone Block

Recurrent patellar instability is a common problem and often leads to a tear of the medial patellofemoral ligament. Multiple reconstruction techniques for the medial patellofemoral ligament (MPFL) exist. This Technical Note presents a technique for performing MPFL reconstruction using Achilles tendon allograft with a bone block. The advantages of this technique include (1) bone-to-bone healing in femoral tunnel; (2) docking the bone block in the femoral tunnel obviates the knee for calculating graft and tunnel length; (3) fixing the femoral side before the patellar side allows graft tensioning under direct visualization and avoids over-constraint; (4) the fanned portion of the Achilles tendon allows broad-based MPFL footprint coverage on the medial patellar ridge; and (5) it avoids the need for bone tunnel drilling in the patella, reducing the risk to penetration of the drill holes into the articular cartilage surface as well as the risk for patellar fracture.

Volumetric measurements of a self-similar adverse pressure gradient turbulent boundary layer using single-camera light-field particle image velocimetry

As a novel volumetric particle image velocimetry technique, single-camera light-field PIV (LF-PIV) is able to acquire three-dimensional flow fields through a single camera. Compared with other multi-camera 3D PIV techniques, LF-PIV has distinct advantages, including concise hardware setup and low optical access requirements. Its capability has proven effective in many experimental investigations. In this study, the use of LF-PIV in measuring a self-similar adverse pressure-gradient turbulent boundary layer (APG-TBL) is demonstrated. Experiments are performed in a large water tunnel at the Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Monash University. Sets of 250 light-field PIV image pairs are captured covering both the inner and outer regions of the boundary layer. Instantaneous 3D velocity fields are reconstructed using a GPU accelerated density ray tracing multiplicative reconstruction technique (DRT-MART) and three-dimensional cross-correlation methods. The LF-PIV results are compared with two-dimensional PIV (2D-PIV) measurements of the same flow. Comparable accuracy to 2D-PIV is achieved for first- and second-order velocity statistics above approximately $$ y/\delta_{1} = 1 $$ .

Reconstruction of Traumatic Central Slip Injuries: Technique Using a Slip of Flexor Digitorum Superficialis.

Multiple reconstruction techniques have been described for correction of boutonniere deformities including direct repair, central slip reconstruction, lateral band reconstruction, transverse retinacular ligament reconstruction, staged reconstruction, and extensor tenotomy. Each technique has been reported to have variable results with complications including capsular contracture, loss of proximal interphalangeal flexion, and residual deformity. We describe a surgical technique for central slip reconstruction using a slip of the flexor digitorum superficialis tendon through a bone tunnel.

Scapholunate ligament reconstruction using the palmaris longus tendon and suture anchor fixation in chronic scapholunate instability.

Background:Multiple reconstruction techniques have been described in the management of chronic scapholunate (SL) instability, either based on the capsulodesis or tenodesis principle. It is uncertain which surgical method produces the best patient outcomes. We describe results of a technique using palmaris longus (PL) tendon for surgical reconstruction of the SL ligament and provide functional outcomes scores.Materials and Methods:We surgically reconstructed the SL ligament using a PL tendon graft secured with Mitek® bone anchors. Surgical technique with photographs is provided in the main text. Functional outcomes were measured using the disabilities of the arm, shoulder, and hand and Mayo wrist scores. Patient satisfaction was assessed using a simple measure.Results:Eleven patients attended mid-term followup (mean 45.8 months post-surgery) and had functional outcomes and satisfaction of this procedure that compared favorably to case series that used tenodesis for chronic SL ligament injuries. Almost all patients (n = 10) were able to return to regular employment. The majority of patients (n = 10) were satisfied with their primary reconstruction procedure.Conclusion:This technique avoids the use of drill holes to weave tendon through bone, uses an easy to access graft, and exploits the superior pullout strength of anchors while offering satisfactory functional outcomes that are comparable to alternative tenodesis techniques.

Minimally Invasive Anterolateral Ligament Reconstruction of the Knee

Anterior cruciate ligament (ACL) tears are among the most common knee injuries, and multiple reconstructive techniques have been described. However, studies frequently report an inability to duplicate native, dynamic knee function, particularly rotationally. This residual joint laxity that occasionally follows an ACL reconstruction can cause further problems post surgical intervention, including meniscal tears and especially late osteoarthritic change. Additionally, ACL graft retears are a concern, particularly in young patients. Although these undesired sequelae of ACL reconstruction could be a by-product of insufficient ACL reconstruction methods related to either graft placement or problems with graft healing and biology, it is also possible that failure to additionally address lateral extra-articular structures after ACL injury could play a role in the residual knee laxity of the affected knee. The purpose of this article is to show a minimally invasive technique for extra-articular anterolateral ligament reconstruction.