New Surgical Technique For Treatment Research Articles

A new technique in surgical treatment of congenital and spontaneous extensor tendon snapping: Dorsalization-ulnarization of the metacarpal head

The present study reports results of a metacarpal transposition technique we have developed for congenital and spontaneous extensor tendon snapping. Six patients with a mean age of 14 years (range: 12–19 years) were included and evaluated retrospectively. They had Rayan–Murray type-3 atraumatic chronic extensor tendon instability: 2 on the middle finger, 3 on the ring finger, and 1 on the index and middle fingers. In selecting the cases, preoperative examination included elevation of the metacarpals to check whether this decreased the tendon snapping, and patients in whom no snapping persisted were scheduled for surgery. Pre- and post-operative pain at rest and in activity was assessed on visual analog scale (VAS), and the QuickDASH test was administered. Pre- and post-operative active and passive ranges of metacarpophalangeal motion were measured, as was grip strength on a Jamar dynamometer. Mean follow-up was 38 months (range: 26–42 months). Postoperatively, pain during activity and QuickDASH score showed significant improvement. No wound problems or recurrence were encountered. There were no significant postoperative changes in active and passive joint range of motion. At follow-up examination, no physical therapy needed to be prescribed and no limitation of motion was observed. For tendon snapping, in which treatment is technically difficult and may lead to problems, we believe that our easily applicable minimally traumatizing technique does not restrict joint motion and is an appropriate solution for patients with positive elevation test.

A new surgical technique for treatment of neuropathic pain conceived by compressed inferior alveolar nerve.

A new surgical technique for treatment of neuropathic pain conceived by compressed inferior alveolar nerve.

Клинический случай хирургического лечения первичной закрытоугольной глаукомы у собаки методом имплантации антиглаукомного мини-шунта Ex-PRESS R50

A clinical case of surgical treatment of PAGC is presented with implantation of Ex-PRESS R50 mini-shunt in an 8-year-old mixed breed dog. This method of treatment was chosen as a result of patient's resistance to drug therapy. Postoperative follow-up period was 210 days from time of surgery. IOP over entire period remained within physiological norm. Article describes in detail a new technique for surgical treatment of refractory glaucoma with a long follow-up period.

Lateral Rectus-Medial Rectus Union: A New Surgical Technique for Treatment of Complete Third Nerve Palsy.

To describe a new surgical technique for the treatment of complete third nerve palsy. This study included patients with chronic complete third nerve palsy. The lateral rectus muscle was split, followed by disinsertion of the superior and inferior halves, which were passed between the sclera and superior and inferior rectus muscles, respectively. Then the medial rectus muscle was sutured as posteriorly as possible from its insertion and cut. Next, the distal stump of the medial rectus muscle was split into two halves and united with the superior and inferior halves of the lateral rectus muscle. Finally, the proximal portion of the medial rectus muscle was sutured back to its original insertion. In cases with hypotropia and a functional superior oblique muscle, superior oblique tenectomy was also performed. Success was defined as postoperative horizontal deviation of 10 prism diopters (PD) or less and vertical deviation of 5 PD or less. Ten patients with a mean age of 32.4 ± 18.4 years had surgery using this technique; 2 of them had a history of strabismus surgery. Mean exotropia was 84 ± 14.9 PD, which reduced to 6.5 ± 8.2 PD. Mean vertical deviation was 16.5 ± 10 PD, which reduced to 2.5 ± 3.5 PD. Mean follow-up was 13.2 ± 7.9 months, and the success rate was 70% and 90% for horizontal and vertical deviations, respectively. The lateral rectus-medial rectus union technique is an effective and long-lasting procedure to overcome large-angle exotropia associated with complete third nerve palsy. This method can also be employed as a reoperation procedure. [J Pediatr Ophthalmol Strabismus. 2019;56(1):10-18.].

Finite Element Analysis in Lumbar Vertebrae after Pedicular Subtraction

Abstract Lumbar Spinal Stenosis is the most prevalent disease in patients above 65-years-old affecting the lumbar spine. It is a condition leading to a tight vertebral canal. Surgery is the definitive treatment, but has high failure levels. We are studying a new technique for surgical treatment, in which the pedicle structure is lost, in terms of fixation. To regain stability, it is necessary to use Pedicle Screws (PS). However, it is unknown how the PS will have their fixation strength without the pedicle. We studied 5 types of PS inserted into a cylinder with two portions, representing the pedicle and vertebral body, and performed a pullout with 500N. Our end results showed the stress and the strain at the bone-screw interfaces, comparing the intact with subtraction of the pedicle model. In general, the results showed 5 screws have a loss of 47% in fixation, in the terms of displacement. Many PS obtained a lower stress when the pedicle was subtracted. This was further supported by the trabecular bone being more deformable (lower elastic modulus) and likely to generate lower stress for the same displacement. In the end, this study successfully reported that the removal of the vertebral pedicles brings a large fault capacity, shown by an average increase of almost 50% in the PS displacement when the load of 500N is applied in the form of pullout.

Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles

Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment. Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis. The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery. The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results. Level of Evidence: Level IV, therapeutic study.

Ventriculoportal Shunt, a New Transomphalic Extraperitoneal Surgical Technique in Treatment of Hydrocephalus.

The aim of this article was to report a new transomphalic extraperitoneal surgical technique for treatment of hydrocephalus, called ventriculoportal shunt. We performed ventriculoportal shunt on an experimental animal (pig). The particularity of ventriculoportal shunt consists in the fact that the distal end of the catheter is inserted transomphalic extraperitoneally in the portal system through reopened umbilical vein. We present technical details regarding this new surgical technique. The animal had favorable outcome, without any postoperative early or late morbidity. We discuss indications, contraindications, possible complications in humans and advantages of ventriculoportal shunt compared with ventriculocardiac and ventriculoperitoneal drainages and possibilities to avoid complications specific to classic shunt procedures. Ventriculoportal shunt is a new surgical technique for treatment of hydrocephalus. The distal end of the catheter introduced into reopened umbilical vein, drains cerebrospinal fluid into the portal system. Ventriculoportal shunt is safe and easy to perform. With ventriculoportal shunt specific complications of ventriculoperitoneal or ventriculocardiac drainages can be potentially avoided. Ventriculoportal shunt combines advantages of vascular shunt with those of having an immunological barrier for cerebrospinal fluid before entering the systemic circulation. Theoretically, indications for surgery are extended, and ventriculoportal shunt can be performed in patients former contraindicated for ventriculoperitoneal shunt. Further research is needed and this surgical technique must be performed on human subjects with hydrocephalus.

PP167: New surgical technique for treatment of Oro/facial infection, swelling (abscess)

Introduction Patients that are being seen by Oral/Maxillofacial surgeons for treatment of Oro/facial swelling (abscess) with dental origin under local anesthesia, are being seen for 2 or 3 visits. First visit for Incision & drainage and placement of drain, second visit for the eradication of source of infection (extraction of infected tooth), sometime 3rd visit become necessary due to patient discomfort and pain, and percentage of patients even do not return for extraction. Purpose This clinical study fully discussed this new technique for the treatment of Oro/facial abscess, for this purpose, to reducing patient, pain, discomfort, anxiety, time and numbers of visit and decreasing the cost of treatment. Method This procedure is based on clinical experience and was developed and led to completion over the years, will discuss and differentiate the kind of local anesthesia, anesthetic agent, and vasoconstrictors and its relationship to the existing pathologic and anatomic condition of our operative field and nature of our surgical procedure that we want to perform. Result This procedure will allow us to eliminate the source of infection immediately and improve the systemic health of patient as soon as possible, as a result long term antibiotic and analgesic therapy will not be necessary and patient will be able to resume his or her routine daily life. Conclusion Reviewing the history of medicine will manifest this fact, that service to people and helping the suffering patients has been the goal of clinicians and medical experts from ancient days, however these days, the cost of medical care and economy are interconnected and inseparable parts and commodity. This procedure provide us with an opportunity and a tool to help patient and medical establishment and health organizations economically.

A New Technique for Surgical Treatment of Vaginal Agenesis Using Combined Abdominal-Perineal Approach

Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent.

Third Window Vibroplasty

To describe a new technique in surgical treatment of obliterative tympanosclerosis by applying a floating mass transducer (FMT) to a third window. A 64-year-old woman with a severe combined hearing loss due to tympanosclerosis received a third window vibroplasty. A mastoidectomy and a posterior tympanotomy via the large facial recess were performed. The promontory was exposed by a transcanal approach. The third window was performed anterior inferior to the round window. The membranous cochlea was left intact. The FMT was gently pushed into the perichondrium-coated cochlear window. All other surgical steps were the same as in conventional FMT application. Preliminary data of this report reveal that vibroplasty with coupling of the FMT directly to a third window leads to similar audiological results compared with the conventional coupling of the FMT on the round window niche. The presented case demonstrates the applicability of a third window vibroplasty in obliterative tympanosclerosis. Further studies will show if our assumption of a reduced risk for inner ear trauma is justified or not.

Posterior Pillar Flap Palatoplasty: A New Surgical Technique for Treatment of Snoring: Initial Experience

Posterior Pillar Flap Palatoplasty: A New Surgical Technique for Treatment of Snoring: Initial Experience

A new surgical technique for treatment of preauricular sinus

The objectives of this paper are to describe the shortcomings of current techniques for treatment of preauricular sinus (PAS) and to introduce a new surgical technique. PAS is a common congenital abnormality. Usually these lesions are asymptomatic. However, some patients complain of discharge and/or (recurrent) infections, and require excision. Surgical treatment of PAS is characterized by high recurrence rates. This paper describes a single institution's experience with the operative management of PAS and introduces a new technique. Data on PAS procedures were collected from a retrospective review of patients' charts and interviews by questionnaire of all patients treated operatively for PAS in the Leiden University Medical Centre from 1984 to 2003. Thirty-nine patients (21 male, 18 female) with PAS underwent 40 procedures for PAS. These procedures included 17 classic operations (in 16 patients) and the "inside-out technique" in 23 patients. In the patient group treated "classically," 2 patients developed a recurrence; one underwent successful reoperation; the other patient has been lost to follow-up. Another patient developed wound breakdown postoperatively, resulting in an ugly scar. Two patients had postoperative infections requiring treatment. Neither recurrences nor complications requiring treatment occurred in the group who underwent the inside-out technique. The inside-out technique provides an easy solution for patients with PAS. However, further study on a larger patient group is necessary.

ON SURGICAL TREATMENT OF PATIENTS WITH VERTEBROBASILAR INSUFFICIENCY ASSOCIATED WITH KIMMERLE ANOMALY

Patients with vertebrobasilar insufficiency, which are frequent in neurological and neurosurgical practice, require a complex examination to reveal its ethiology and to perform a differential diagnostics. The study objective was to develop a diagnostic algorithm for detection of clinically significant forms of Kimmerle anomaly, and to introduce a new technique for surgical treatment under intraoperative monitoring of the vertebral artery decompression. When a patient with the Kimmerle anomaly shows a vertebrobasilar insufficiency, a comprehensive surgical policy includes a complex clinicalphysiological assessment of the vertebrobasilar basin (from vertebral arteries entrances up to the basilar artery and its branches). If any other pathology is excluded, the Kimmerle rings (foramen arcuale) are removed and hemodynamics in the vertebrobasilar basin is estimated by clinical and graphical Doppler methods.

Nova técnica para o tratamento cirúrgico da cabeça do pterígio - Exérese com álcool absoluto diluído a 50%

OBJETIVO: Descrever nova técnica cirúrgica para o tratamento do pterígio utilizando álcool absoluto diluído 50%. MÉTODO: A cabeça do pterígio foi submetida à exposição de gotas de álcool absoluto, diluído a 50% em água destilada, durante 40 segundos e posteriormente removida com espátula de divulsão. RESULTADOS: A excisão da cabeça do pterígio foi facilitada por plano de clivagem epitelial promovido pela aplicação do álcool diluído. O exame biomicroscópico evidenciou, após a cirurgia, superfície corneana com aspecto regular e homogêneo, o que pode contribuir para melhor qualidade de visão. CONCLUSÃO: O uso do álcool absoluto diluído a 50% com água destilada pode ser utilizado como nova técnica cirúrgica para a exérese da cabeça do pterígio da região corneana.

LAPAROSCOPIC BLADDER NECK SUSPENSION FAILS THE TEST OF TIME

Initial reports on laparoscopic bladder neck suspension have suggested success rates similar to those of traditional bladder neck suspension. We compare long-term success rates of laparoscopic and transvaginal Raz bladder neck suspension. A total of 100 patients with anatomical stress urinary incontinence underwent extraperitoneal laparoscopic bladder neck suspension with securing of the endopelvic fascia to Cooper's ligament (58, laparoscopy group) or transvaginal Raz bladder neck suspension (42, transvaginal group). Patients were evaluated by chart review and telephone questionnaire to determine whether they had urinary incontinence. The 2 groups were similar in terms of age, mean body mass index, preoperative bladder capacity and post-void residual. Mean followup was 45 months (range 14 to 71) in 50 laparoscopy group (86%) and 59 months (range 35 to 72) in 29 transvaginal group (70%) patients. Only 15 of 50 laparoscopy group (30%) and 10 of 29 transvaginal group (35%) patients were completely continent at followup. There was no statistically significant difference in the success rates for the 2 groups. Mean time to failure for both groups was 18 to 24 months. With long-term followup laparoscopic bladder neck suspension demonstrated poor success rates similar to other minimally invasive surgical therapies for stress urinary incontinence. Any new surgical technique for treatment of stress urinary incontinence should have a mean followup of more than 2 years to determine true clinical efficacy.

Reconstruction of congenital stenosis of external auditory canal with a postauricular chondrocutaneous flap.

We describe here a new surgical technique for treatment of congenital stenosis of the external auditory canal using a postauricular chondrocutaneous flap. Our technique prevents recurring stenosis by cartilage support and provides a sufficient extension of the canal. The chondrocutaneous flap is safely elevated, easily reaches the canal, and has ample blood supply. It is beneficial for its self-cleaning function that the remnant canal, which contains cerumen glands, is used as part of the reconstructed canal. Six patients with congenital stenosis of the external auditory canal were treated by our procedure. In these patients, three patients were treated by a postauricular approach and the others were treated by an endaural approach. All patients had very satisfactory results.

The Failed Anti-Incontinence Mechanism: A Flap Valve or Cecal Wrap for Surgical Reconstruction

Purpose On a long-term basis patients with continent urinary diversions may have an acceptable number of complications, such as urinary incontinence. We report on a new surgical technique for treatment of the incompetent anti-incontinence segment. Materials and Methods Seven patients presented with a large capacity, low pressure reservoir and an incompetent anti-incontinence mechanism. The original anti-incontinence mechanism consisted of an intussuscepted reimplanted appendix (Mitrofanoff) in 2 patients, tapered ileum and reinforced ileocecal valve in 3, and tapered and reimplanted ileal segment in 2. Surgical reconstruction involved 2 stages: stage 1-lengthening and tubularizing the cecum with the anti-incontinence segment and stage 2-creation of the flap valve mechanism. Stage 2 required intraoperative modification when abundant peri-reservoir fibrosis, a thin-walled reservoir (cecal wrap) or an excessive thickened mesentery was encountered. Results After a mean followup of 7 months 6 of 7 patients performed catheterization every 4 hours and were continent. Several patients required a concomitant procedure with the incontinence revision. Conclusions We describe a 2-stage technique for correction of a variety of untoward anatomical conditions related to a failed anti-incontinence segment with continent urinary reservoirs. Concomitant repair of other coexisting structural abnormalities related to the continent reservoir may also be necessary.

Anaesthetic problems in ex situ resection of the liver

Ex-situ resection of the liver is a new surgical technique for treatment of liver tumours not amenable to conventional surgery. This paper describes the cardiovascular and metabolic changes that occurred in nine consecutive such patients. No severe haemodynamic or pulmonary complications occurred. Specific problems were encountered during the prolonged anhepatic period, which lasted an average of 5.96 (SD 1.46) hours. Significant metabolic and coagulation disorders occurred 2 to 3 hours after hepatectomy because of complete loss of hepatic function. The predominant findings during the anhepatic period were hypoglycaemia and severe metabolic acidosis, mainly from increased levels of lactic acid. Exogenous administration of dextrose 5% at an average rate of 188 ml/hour was necessary to maintain normoglycaemia, while correction of metabolic acidosis required 403 (SD 159.79) mmol of sodium bicarbonate, supplemented by hyperventilation. Tris-hydroxymethylaminomethane was used when sodium overload was thought to be a problem. There was a marked decrease of Factor V and fibrinogen, a moderate thrombocytopenia and fibrinolysis. The severity of these alterations was dependent on the duration of the anhepatic period and the primary function of the re-implanted liver.

The microsurgical drainage of the varicocele

A new technique for surgical treatment of primary and recurrent varicocele is proposed. The technique consists of direct anastomosis of two or three dilated veins of the pampiniform plexus with the great saphenous vein. A connection between a high venous pressure region and a lower pressure region is established. Twenty-five patients were operated on, 7 with recurrent varicocele and 18 with primary varicocele. The immediate and long-term results (6 year follow-up) have always been good.

COMMUNICATING CYSTS AND DIVERTICULA OF THE RENAL PELVIS

SUMMARY Sixteen cases of communicating cyst of the renal calyx are described. A new technique for surgical treatment of the condition is described.