Need For Revision Operation Research Articles

Developing incisional hernia after open liver resection and liver transplantation: A single-center risk factor analysis

Abstract INTRODUCTION: Open liver surgery is one of the most common abdominal surgeries, which is associated with a higher risk of developing an incisional hernia (IH). This is mainly because of the extent and type of the surgical incisions in this type of surgery. Of course, many other risk factors may interfere with wound healing and can increase the risk of developing IH after this type of surgery. In this study, we analyzed several perioperative risk factors, particularly the type of surgical incision and the technical suture aspects. MATERIALS AND METHODS: Retrospectively, we analyzed the development of incisional hernia within the first 36 postoperative months clinically and image-morphologically among 155 patients who had undergone an open liver resection or liver transplantation and met the inclusion criteria between 2015 and 2020 in our institution. RESULTS: Most of the incisional hernias occurred during the first 16 postoperative months, with a peak incidence in the eighth postoperative month. The most important preoperative risk factors were the positive past medical history of other hernias (P = 0.05) and overweight/ obesity (P = 0.018). From the operative course, many risk factors were detected, like an intraoperative blood loss of > 1,000 ml (P = 0.043) and an intraoperative blood transfusion of > 10 PRBCs (P = 0.001), a Mercedes-star incision (P = 0.007), the use of Vicryl (polyglactin 910) sutures and interrupted suture techniques for the fascial reconstruction (P = 0.045) and (P = 0.006), and a long operative time of > 240 min (P = 0.033). Postoperative ascites formation as well as the need for revision operation due to a postoperative complication were associated with higher incidence rates of developing IH (P = 0.02) and (P = 0.014). CONCLUSIONS: The development of IH cannot be avoided. But the leading risk factors can be modified or optimized. From our experience and according to this analysis, we recommend the careful selection of the surgical approach for each patient and promotion of the use of the minimally invasive approaches, avoiding the angulated incisions as much as possible, applying the running suture technique with (polydioxanone) PDS-loops for the fascial reconstruction, minimizing the intraoperative blood loss and need for blood transfusion, shortening the operative time as much as possible, early detection of postoperative formation of ascites, and managing it properly. In the event of need for a revision operation due to a postoperative complication, a reinforced reconstruction of the fascia can be considered.

Management of Traumatic Radial and Ulnar Artery Injuries and Risk Factors for Amputation

IntroductionTraumatic injuries to the radial and/or ulnar arteries represent a subset of arterial injuries. In the absence of injury to both forearm arteries, treatment was historically ligation if perfusion was maintained to the hand via the uninjured vessels or adequate collateral vessels. We sought to determine management of traumatic forearm arterial injuries in 2019 and to identify risk factors for major upper extremity amputation. MethodsThe American College of Surgeons Trauma Quality Improvement Program database was queried by International Classification of Diseases 10 code for patients with traumatic radial and/or ulnar artery injuries within the year 2019. Patient demographics, Injury Severity Score, time to operating room, type of repair, outcomes, and mortality were collected. Multivariable logistic regression was used to identify risk factors for major upper extremity amputation. ResultsA total of 4048 patients with traumatic radial and/or ulnar artery injuries were identified. A total of 1907 radial artery operations were performed including repair (59%), ligation (29%), and interposition bypass (12%). A total of 1637 ulnar artery operations were completed including repair (67%), ligation (21%), and interposition bypass (12%). Major upper extremity amputation occurred in 0.6%. Older age (adjusted odds ratio [AOR]: 1.014, 95% confidence interval [CI]: 1.004-1.024, P = 0.0048), blunt mechanism (AOR: 2.457, 95% CI: 1.730-3.497, P < 0.0.0001), and ipsilateral radial and ulnar artery injury (AOR: 2.148, 95% CI: 1.298-3.553, P = 0.0029) were associated with major amputation. Surgical revascularization, time to operating room, fasciotomy, and compartment syndrome were not associated with major amputation, but this may be secondary to Type II error. ConclusionsIn the operating room, radial and ulnar artery injuries were managed more often with restoration of flow versus ligation. Older age, blunt mechanism, and ipsilateral radial and ulnar artery injury were associated with major amputation. Amputation rate was low at 3% overall and 0.6% for amputation of the hand or a more proximal level. Upper extremity fracture, upper extremity nerve injury, and ipsilateral radial and ulnar artery injury were associated with need for revision operation.

Controlling Supratip Break and Tip Rotation and Projection with Preservation of the Pitanguy Ligament.

In this article, the author describes a new closed rhinoplasty technique in which the Pitanguy ligament was protected, ultimately resulting in better supratip break, tip projection, and tip rotation. Based on the inclusion and exclusion criteria, the records of 156 patients who underwent surgery with this "Pitanguy ligament protection and suturing" technique were evaluated retrospectively. In this novel technique, the Pitanguy ligament was dissected from the proximal and distal points with scissors in the lower third, and it was left intact. There was no need for revision operations in any patient. Twelve months after surgery, the Rhinoplasty Outcome Evaluation scores ranged between 80 and 100 points. The median score was 86.5 points. Patient satisfaction was excellent in 90% of the included cases. Protection of the Pitanguy ligament and attachment of this ligament to the nasal tip create better tip definition and generate several aesthetic and functional advantages. Therapeutic, IV.

Apert Syndrome Type III Hand: Prevalence and Outcomes.

The Upton type III hand, which represents the most severe hand type among Apert syndrome patients, has been considered the least prevalent hand type. The objective of this study is to address type III Apert hand prevalence and describe treatment strategies that will result in a 5 digit hand. The authors retrospectively reviewed 15 years of Apert syndrome hand practice at our hospital. Demographic (patient sex and age at the time of the operation), surgical (eg, techniques used for webspace release, osteotomy, and various aspects of soft-tissue reconstruction), and outcome (perioperative and long-term complication and need for revision operation) data was verified through medical records, clinical photographs, radiographic images, and interviews with patients' families. Patients who had incomplete medical records and/or postoperative follow up <6 months in length were excluded from this study. A total of 93 Apert patients [50 male (56.1%) and 43 female (43.9%)] were treated at our hospital from 2007 to 2021. Stratification of Apert hand severity using Upton's classification system identified 34 patients with type I hands (36.4%), 19 patients with type II hands (20.6%), and 40 patients with type III hands (43%). Of the 40 patients with type III hands a 5 digit hand was achieved for 35 patients (87%), with an average of 3.37 operations per patient. The Upton type III hand is the most prevalent hand type among Apert syndrome patients. Following a three stage protocol, a surgical team can consistently achieve a 5 digit hand for the majority of Apert syndrome patients with type III hands.

Clinical and Patient-Reported Outcomes of 19 Patients Undergoing Clitoral and Labial Reconstruction After Female Genital Mutilation/Cutting.

Female genital mutilation/cutting (FGM/C) is the intentional alteration, removal, or injury of female genitalia for non-medical reasons. Approximately 200 million females have been victims of FGM/C, and genital reconstructive procedures are increasing in demand. The objectives of this study were to assess clinical and patient-reported outcomes after FGM/C reconstruction to help guide treatment practices. Adult patients undergoing anatomic reconstruction after FGM/C were retrospectively identified. Outcomes included clitoral, labial, and donor site surgical site occurrences (SSO) and the need for revision operations. Patient-reported outcomes were assessed using an adapted version of the Female Sexual Function Index (FSFI), a validated outcomes instrument that assesses sexual function through 6 domains, with each domain having a maximum score of 6. Nineteen patients were identified in our review. Patients presented for reconstruction due to dyspareunia, inability to orgasm, chronic infections, to normalize appearance, and/or to "feel normal." There were no SSOs and two revision operations for adhesions. 74% of patients completed the FSFI postoperatively. Despite most patients seeking repair for inability to orgasm and/or dyspareunia, the median scores for these domains were 4.6 and 5.2. Patients' desire to engage in sexual activity scored lowest (3.9), and patients reported concerns over the appearance of their genitalia (50%) that affected self-confidence (85.7%). FGM/C reconstruction is safe and contributes to improvements in physical sexual health. Psychological trauma may contribute to lessened sexual desire and self-confidence even after reconstruction. Multidisciplinary treatment is important to address the long-term psychological effects of this practice. 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 .

P88. Ahead of the curve: A systematic review of anterior vertebral body tethering in adolescent idiopathic scoliosis

<h3>BACKGROUND CONTEXT</h3> Current options for treatment of adolescent idiopathic scoliosis (AIS) include observation, bracing, growth-sparing rods and spinal fusion. The primary treatment for curves greater than 45 degrees at this time is posterior spinal fusion (PSF). Although effective in stabilizing these curves, it is associated with multiple identified morbidities. Thus, anterior vertebral body tethering (AVBT) has recently received growing interest as an effective fusion-less therapeutic option. AVBT harnesses a patient's growth potential to correct pathologic curvatures while preserving the underlying anatomy and structure of the spine, leading to multiple potential benefits. <h3>PURPOSE</h3> The purpose of this study was to perform a systematic review of the current literature regarding AVBT to determine the current rates of success and complications associated with the procedure. <h3>PATIENT SAMPLE</h3> Eight studies were identified with a total of 188 patients, 85% of which were female, with a mean follow-up of 34 months. The mean patient age was 12.3 years, with a mean preoperative Sanders age of 4.4 and Risser sign of 0.7. The mean number of vertebral levels tethered was 7.2. The mean main Cobb angle preoperatively, at first erect, and at last follow-up was 48.4°, 23.8°, and 19.1°, respectively. <h3>OUTCOME MEASURES</h3> The main outcome measure was clinical success, defined by patients who reached skeletal maturity with a remaining curve less than 35 ° without the need for revision operation or conversion to PSF. Additionally, complications were identified and recorded which include: broken tethers, tether revision surgery, curve overcorrection, progression of curve, pulmonary complication and need for revision surgery or PSF. <h3>METHODS</h3> A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Cochrane Reviews, Web of Science, and Medline databases were searched for studies that investigated AVBT. Search terms included "vertebral body tethering," "adolescent idiopathic scoliosis," "fusionless spine surgery", "growth modulation", "Hueter-Volkmann law," and "thoracoscopic." Studies were selected if they met the following criteria: (1) evaluate outcomes of AVBT for AIS, (2) minimum 2-year follow-up, (3) publication in peer-reviewed journal, (4) English language or translation readily available. <h3>RESULTS</h3> There were 74.2% (138/186) of patients who underwent AVBT achieved clinical success. Broken tethers occurred in 30% (57/190) of cases, requiring surgical tether revision in 11.1% (21/190). Posterior spinal fusion was required in 6.9% (13/188) of patients, with the overall rate of required revision surgery being 17% (32/188). The rates of curve overcorrection and progression were equal in this cohort at 7.4% (14/188). Pulmonary complications were noted in 8.0% of cases (15/188). <h3>CONCLUSIONS</h3> AVBT has the ability to modulate spinal growth with the potential for scoliosis correction while preventing the need of PSF in young patients with AIS. This study demonstrated successful results in 74.2% of patients, suggesting that AVBT may have a role in the future treatment algorithm of AIS. Identification of ideal candidates for AVBT will be critical to the success of the procedure moving forward in order to mitigate the complication rates and need for revision surgery. Future studies will need to investigate the optimal curve types and magnitudes as well as skeletal maturity at the time of surgery to optimize outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

How should we lengthen post-traumatic limb defects? a systematic review and comparison of motorized lengthening systems, combined internal and external fixation and external fixation alone.

Various external fixation systems for lower extremity long bone deformities have been used to various degrees of success, while newer mechanical lengthening nail (MLN) systems offer the potential for improved patient outcomes. Proponents of MLNs argue that they reduce the number of operations, infectious complications, and improve quality of life; however, the evidence to support these claims is scant. This systematic review aims to evaluate the optimal lengthening system for treating post-traumatic long bone deformity. The systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched for comparative studies of lengthening techniques among adult patients with axial deformities. Studies were screened and data extracted in duplicate. Treatment groups were pooled into external fixation (EF) alone, combined internal and external fixation (CIF), and mechanical lengthening nail (MLN). Outcomes were mean lengthening achieved, lengthening index, and reported complications. Thirteen studies with 725 patients (mean age: 29.6years, 74% male) were included. Nearly all of the studies were either prospective or retrospective cohort studies (n = 12), with one randomized controlled trial of moderate study quality. The mean limb lengthening achieved, lengthening index, and rate of reoperation were similar among the MLN, EF, and CIF groups. The purported decreased the duration of lengthening and the risk of reoperation associated with MLNs was not demonstrated in this review. Patients with post-traumatic leg length deformities remain a challenging patient population to treat, with intervention being associated with high rates of infectious complications and need for revision operations.

Surgical Outcomes for Speech Surgery in 22q11.2 Deletion Syndrome: The Dilemma of Persistent Velopharyngeal Insufficiency After Pharyngeal Flap Operation.

The majority of patients with 22q11.2 deletion syndrome suffer from velopharyngeal insufficiency (VPI). Patients with 22q11.2 deletion syndrome (22qDS) commonly present with a large central velopharyngeal gap in the setting of poor velar and pharyngeal wall motion. The posterior pharyngeal flap is considered the most effective technique to treat VPI in this complex patient group. This study aims to critically evaluate success rates of surgical management of VPI in 22qDS patients and discuss options for management of a failed posterior pharyngeal flap (PPF) with persistent VPI. A systematic review was performed through MEDLINE and Scopus to examine the outcomes of PPF surgery to treat VPI in patients with 22qDS. Complications were defined as persistent VPI, hyponasal speech, and obstructive sleep apnea. To demonstrate an approach to management, the authors outline a recent patient with a failed PPF in this patient population at the authors' institution. The authors comprehensively reviewed 58 articles, 13 of which contained relevant information with extractable data. Of the 159 patients with 22qDS who underwent PPF to treat VPI, successful outcomes were reported in 135 patients (80%; range: 0%-100%). Complications were reported in 14% of patients, with need for revision operations in 3%. Surgical management of VPI in patients with 22qDS is challenging, with variable success rates reported in the literature. If unsuccessful, the surgeon faces additional challenges with the revision surgery including a scarred PPF donor site, distorted palatal recipient site, and further medialization of internal carotid arteries. Surgical revision of a failed PPF requires meticulous preoperative planning and technical execution.

Anterior Cruciate Ligament Reconstruction of the Knee Using Double Bundle Hamstring Autograft - Is the Remnant Preservation Technique Superior to the Standard Procedure in Terms of Long-Term Graft Failure Rate, the Need for Revision Operation, and Associated Clinical Dysfunction?

Background:Anterior cruciate remnant preservation may be beneficial in Anterior Cruciate Ligament Reconstruction (ACLR). Gohil, Annear & Breidahl (Sept, 2007) used a grade 1 randomised controlled trial to compare the two methods and at short term follow-up, the minimal debridement technique demonstrated earlier revascularisation within the ACL graft at 2 months, and suggested improved strength at 6 months based on radiological imaging. Unfortunately, this did not translate through to clinical benefits in the early 12 month post operative period. Zhang, L et al. (May, 2013) and Naylor, AJ et al. (2013) reiterated that remnant preservation may improve graft revascularization and knee proprioception. Takazawa Y et al. (Sept, 2013) demonstrated that minimal debridement may facilitate recovery of function and decreased graft rupture at two years post primary reconstruction. However, studies have yet to show consistent significant clinical advantages and follow-up has only been analysed over 1-2 years.Purpose:This current study reported results over a long-term follow-up of 10 years post operation for the same participants from the Gohil, Annear & Breidahl (2007) study.Study Design:The review was based on level 1 randomised controlled trial chart review.Methods:All 49 participants (25 standard – group 1, and 24 remnant preserving group – group 2) from the previous study have been included for investigation. The chart review recorded demographic data, graft rupture, re-operation rates, and associated clinical failures of the ACLR. The review presents comparative data between the two groups.Results:At 10 year follow-up, the remnant retention ACLR group only had better outcomes for ipsilateral graft rupture (2 patients versus 3 patients). Standard ACLR group had improved outcomes for contralateral graft rupture (2 versus 3), ipsilateral other knee post operative surgery (5 versus 10), ipsilateral knee post operative complaints (7 versus 12), and other non-knee post operative issues (3 versus 4). Non of the differences were statistically significant.Conclusion:Overall our results suggested no statistically significant difference between the remnant retaining and standard technique for ACLR in these 49 subjects using chart review endpoints of graft revision and knee reoperation rates. The review is limited by a small study group and a chart only review. A larger study group with long term clinical outcome measures may offer more definitive conclusions as to the advantages of remnant sparing ACLR. In this 10 year follow-up post ACL reconstruction there has been no distinct advantage identified for either procedure.

Lateral Crural Transposition Flap in Tip Correction

This study aims to review the authors' experience with the lower lateral crura (LLC) transposition flap in an attempt to highlight its advantages, indications, and limitations. A retrospective study of 37 rhinoplasties (29 primary cases, 7 secondary cases, and 1 tertiary case) was performed. In all of these, an LLC transposition flap was used by inserting the cephalic portion of the LLCs into a subperichondrial pocket between the medial aspect of the remaining rim strip and the vestibular skin, based on the posterior pedicle. The most prevalent symptom among our patients was nasal external valve dysfunction. Concavity of the LLCs was very common. The LLC transposition flap can correct the LLC deformities with a high rate of patient satisfaction and no need for revision operations. The LLC transposition flap can overcome the common irregularities of the LLCs and could be applied to primary and secondary rhinoplasties, as well as ethnic noses.

Modified technique using allograft-prosthetic composite in the distal femur after bone tumor resection

BackgroundThe purpose of this retrospective study was to analyze the results of treatment of bone tumor resection of the distal femur with the modified technique of allograft-prosthetic composite. MethodsTwelve patients with distal femoral bone tumors were treated with deep-frozen cortical allograft struts and allograft-prosthesis composites. There were five males and seven females with a median age of 29.5y. The minimum follow-up time was 12mo (median, 45.7mo; range, 12–81mo). Diagnoses included osteosarcoma in five patients, chondrosarcoma in three patients, giant cell tumors in three patients, and malignant fibrous histiocytoma in one patient. Five osteosarcoma patients were treated with adjuvant chemotherapy. ResultsAt the latest follow-up examination, 11 patients were alive with no evidence of disease, and the limb was preserved in nine patients. One patient died of pulmonary metastases with no evidence of local recurrence. Seven healed without complications. A surgical procedure was performed in four patients because of complications, which included a fracture (one patient), deep infection (one patient), instability (one patient), and local recurrence (one patient). ConclusionThe modified technique of allograft-prosthetic composite is an effective treatment for bone tumor resection of the distal femur. This technique has many advantages, including augmentation of the bone stock, minimizing the risk of allograft fracture and nonunion, and decreasing the need for revision operations.

Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy

To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. Prospective, randomized, and single-blinded clinical trial. The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. Identical results in objective and subjective parameters were observed for both techniques.

Endoprosthetic replacement of the distal femur for bone tumours

We investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the distal femur after resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database, review of the design of the implant and case records. In total, 335 patients underwent a distal femoral replacement, 162 having a fixed-hinge design and 173 a rotating-hinge. The median age of the patients was 24 years (interquartile range 17 to 48). A total of 192 patients remained alive with a mean follow-up of 12 years (5 to 30). The risk of revision for any reason was 17% at five years, 33% at ten years and 58% at 20 years. Aseptic loosening was the main reason for revision of the fixed-hinge knees while infection and fracture of the stem were the most common for the rotating-hinge implant. The risk of revision for aseptic loosening was 35% at ten years with the fixed-hinge knee, which has, however, been replaced by the rotating-hinge knee with a hydroxyapatite collar. The overall risk of revision for any reason fell by 52% when the rotating-hinge implant was used. Improvements in the design of distal femoral endoprostheses have significantly decreased the need for revision operations, but infection remains a serious problem. We believe that a cemented, rotating-hinge prosthesis with a hydroxyapatite collar offers the best chance of long-term survival of the prosthesis.

The Costs and Benefits of Primary Total Hip Replacement:How Likely Are New Prostheses To Be Cost-effective?

Many new hip prostheses are now available for use in total hip replacement. The majority remain untested relative to standard prostheses; however, many new prostheses are substantially more costly. We examine how much more effective new prostheses must be, in terms of reducing the need for revision operations, in order to justify this increased cost.