Obliteration Of Space Research Articles

Evaluation of surgical dead space obliteration in modified radical mastectomy for incidence of seroma formation, drain volume and duration of drain

Evaluation of surgical dead space obliteration in modified radical mastectomy for incidence of seroma formation, drain volume and duration of drain

Are there features that can predict the unresectability of pleural mesothelioma?

The current clinical staging of pleural mesothelioma (PM) is often discordant with the pathologic staging. This study aimed to identify clinical and radiological features that could help predict unresectability in PM. Twenty-two descriptive radiologic features were retrospectively evaluated on preoperative computed tomography (CT) and/or positron emission tomography/CT (PET/CT) performed in patients with presumably resectable PM who underwent surgery. Measurements of maximum and sum pleural thickness at three levels of the thorax (upper, middle, and lower) were taken and stratified based on the cutpoints provided by the International Association for the Study of Lung Cancer (IASLC). Clinical and radiological features, including clinical-stage, were compared between resectable and unresectable tumors by univariate analysis and logistic regression modeling. Of 133 patients, 69/133 (52%) had resectable and 64/133 (48%) had unresectable PM. Asbestos exposure (p = 0.005), neoadjuvant treatment (p = 0.001), clinical T-stage (p < 0.0001), all pleural thickness measurements (p < 0.05), pleural thickness pattern (p < 0.0001) and degree (p = 0.033), lung invasion (p = 0.004), extrapleural space obliteration (p < 0.0001), extension to subphrenic space (p = 0.0004), and two combination variables representing extensive diaphragmatic contact and/or chest wall involvement (p = 0.002) and mediastinal invasion (p < 0.0001) were significant predictors at univariate analysis. At multivariable analysis, all models achieved a strong diagnostic performance (area under the curve (AUC) > 0.8). The two best-performing models were one that included the upper-level maximum pleural thickness, extrapleural space obliteration, and mediastinal infiltration (AUC = 0.876), and another that integrated clinical variables and radiological assessment through the clinical T-stage (AUC = 0.879). Selected clinical and radiologic features, including pleural thickness measurements, appear to be strong predictors of unresectability in PM. A more accurate prediction of unresectability in the preoperative assessment of patients with pleural mesothelioma may avoid unnecessary surgery and prompt initiation of nonsurgical treatments. About half of pleural mesothelioma patients are reported to receive an incorrect disease stagepreoperatively. Eleven features identified as predictors of unresectability were included in strongly performing predictive models. More accurate preoperative staging will help clinicians and patients choose the most appropriate treatments.

Bilateral Superior Gluteal Artery Perforator (SGAP) Flap: Modified Concept in Perineal Reconstruction.

Background/Objectives: Perineal reconstruction after abdominoperineal excision often requires complex closures and is fraught with wound healing complications. Flap-based approaches introduce non-irradiated vascularized tissue to the area of resection to fill a large soft-tissue defect and dead space, reduce the risk of infection, and facilitate wound healing. Employing perforator flaps with their beneficial donor site properties, the authors have developed a concept of bilateral superior gluteal artery perforator (SGAP) flaps to restore extensive perineal defects. Methods: This retrospective case series was conducted between September 2015 and December 2019. We included three patients who received bilateral SGAP flap reconstruction after oncological resection. One deepithelialized SGAP flap was used for obliteration of dead space, combined with the contralateral SGAP flap for superficial defect reconstruction and wound closure. Results: Within this patient population, two male and one female patient, with a median age of 62 years (range, 52-76 years), were included. Six pedicled SGAP flaps were performed with average flap dimensions of 9 × 20 cm (range 7-9 × 19 × 21). No flap loss or no local recurrence were documented. In one case, partial tip necrosis with prolonged serous drainage was observed, which was managed by surgical debridement. No further complications were detected. Conclusions: The combination of two SGAP flaps provides maximal soft tissue for defect reconstruction and obliteration of dead space, while maintaining a very inconspicuous donor site, even with bilateral harvesting. Given these advantages, the authors recommend this promising approach for successful reconstruction of perineal defects.

Evolution of the Surgical Net.

The surgical net technique, originally conceptualized to mitigate postoperative hematomas, has evolved into a versatile tool, transcending its initial purpose, and signaling a new era of surgical innovation. This article provides a comprehensive overview of the surgical net's journey from a targeted solution to a multifaceted surgical asset and explores its burgeoning applications, challenges, and future trajectories. Despite early reluctance due to anatomical concerns and unfamiliarity with the novel technique, the surgical net's consistent success in various surgical contexts from facial surgeries to gynecological applications has catalyzed its widespread global adoption. The technique's integration of the progressive tension method and enhanced skin redraping capabilities underscores its contribution to optimal aesthetic outcomes and improved surgical control. Noteworthy is its role in the innovative concept of gliding surgery, marked by procedures like the gliding brow lift and Glidelift, demonstrating the surgical net's adaptability and effectiveness in diverse surgical environments.Contributions from international surgeons have expanded its applications to areas like axillary space obliteration after breast implant, postmastectomy closure, and the management of postpartum hemorrhage, showcasing the surgical net's global impact and universal commitment to optimizing surgical outcomes. The article delves into the anatomical considerations essential for adapting the surgical net technique to various surgical contexts, emphasizing the need for continuous research, clinical trials, and multidisciplinary collaboration to navigate emerging challenges and ensure its sustained efficacy and safety.In conclusion, the article highlights the surgical net technique's unwavering potential for further advancements, greater procedural efficiency, and the continued elevation of patient care standards. The consistent evolution of its applications, paired with a dedicated approach to addressing emergent challenges, reinforces the surgical net's enduring contribution to surgical innovation and global patient welfare.

Review On Biological Properties of Suture Materials

Suture is a general term for all materials used to stitch torn tissues. Surgical sutures are imperative in management of surgical and traumatic wounds. Sutures are primarily used to oppose tissues together to assist and accelerate the recovery process after an incident or surgical operation. In addition, sutures also aid in obliteration of dead space, even distribution of stress on the incision line, and maintenance of adequate tensile strength throughout the critical wound healing process until appropriate tissue strength is achieved. Considering availability of a wide variety of suture materials, it’s important to know the differences between various sutures before making an informed decision. Suture material's overall performance is influenced by its physical qualities, handling features, and biological factors. The aim of this seminar paper is to give highlights on the biological properties of suture materials. Suturing is not simply about closing a wound; it is a skill that requires finesse and can significantly impact the healing process, reduce complications, and even affect long-term results. Suture selection involves the choice of both the appropriate type and size of suture material. Sutures may cause different host reactions in living tissues. While the suture remains in the tissue, it can trigger the inflammation cascade through different pathways such as degradation, a foreign body reaction, an allergic reaction, or abrasion. Natural suture materials such as catgut and silk are more immunogenic than synthetic materials because they are degraded by proteolysis in contrast to synthetic suture materials, which are degraded by hydrolysis. Therefore, surgery professionals should choose a suture material with good tissue acceptance.

Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging. This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data. A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P<.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819-1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1-95.97%) and specificity of 92.9% (95% confidence interval, 66.1-99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714-0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4-97.0%) and specificity of 78.6% (95% confidence interval, 49.2-95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P<.001). Three-dimensional volume rendering ultrasound is a promising tool for effective discrimination between scar dehiscence with underlying nonadherent placenta and placenta accreta spectrum. It also shows potential in predicting the clinical severity with urinary bladder involvement in cases of placenta accreta spectrum.

Comparing Surgical Site Infection Rate Between Primary Closure and Rhomboid Flap After Stoma Reversal.

Primary closure (PC) is a common wound closure procedure after stoma reversal and is associated with a high rate of surgical site infection (SSI). This study introduced a new method of skin closure, a rhomboid flap (RF), for skin closure after stoma reversal and compared the SSI rate between the 2 techniques. This is a single-center retrospective study. Patients who underwent colostomy or ileostomy closure performed using either rotation flap (n = 33) or PC (n = 121) techniques for skin closure after stoma reversal between April 2019 and July 2022 were enrolled in this study. Medical records were retrospectively reviewed to obtain data. Both groups were followed up postoperatively at 1 month for wound infection. Wound infection within 30 days after surgery was indicated by the presence of purulent discharge, erythema, local heat, or positive culture for bacteria. In the PC group, the infection rate was 25.6% (n = 121) compared with 12.1% (n = 33) in the RF group (P = 0.158). Among the patients who underwent colostomy reversal, the infection rate of the RF group was significantly lower compared with that of the PC group (11.1% vs 36.9%, P = 0.045). Among the patients who underwent ileostomy reversal, no significant differences in the infection rates between the groups were found (13.3% vs 12.5%, P = 1.000). Although the RF technique requires slightly longer operative time for flap design in practice than the linear closure method, the technique can significantly reduce the SSI rate after colostomy reversal through the dissection of the surrounding inflammatory tissues and obliteration of the dead space. Additional studies are required to evaluate this technique, compare it with other existing methods, and explore long-term complications.

Effectiveness of sclerotherapy injection in haemangioma of the head and neck region

Link of Video Abstract: https://youtu.be/6NXSL59eReA Background: Hemangiomas are benign tumors that originate from blood vessels. Sclerotherapy effectively treats benign vascular lesions, especially small lesions located at sites with aesthetic impact. Polidocanol is the solution most commonly known to work by causing a local inflammatory reaction, thrombosis obliteration of the hemangiomatous space, and fibrosis of the endothelial space, leading to the lesion's regression. This study evaluated the effectiveness of polidocanol sclerotherapy injection therapy (Aethoxysklerol 3%) in patients with cavernous haemangioma at Dr. Soetomo general hospital. Method: This study is a cross-sectional correlative analysis study, with research samples derived from medical records of patients with cavernous type haemangioma who were indicated to undergo sclerotherapy injection therapy (Aethoxysklerol 3%) at Dr. Soetomo general hospital in the period 2017-2023 who met the inclusion and exclusion criteria. The data obtained will be processed using SPSS software version 25.0 for Windows. Statistical tests were significant if the p-value was &lt;0.05. Results: There were 26 samples in this study, with the gender of patients mostly female (65.4%) and aged &gt;20 years (38.5%). The most common location was buccal region hemangioma (34.2%). The results of the therapeutic response showed that 50% of the majority of patients not well responded, 34,2% showed no response, and only 15.4% responded well with a p-value = 0.000. Conclusion: Injection sclerotherapy using polidocanol (Aethoxysklerol) in 3x administration sessions is a treatment method that has not been effective in treating hemangioma.

Robotically-harvested, thoracoscopically-tunneled transdiaphragmatic omental pedicle flap for obliteration of radiated empyema cavity

Intra-thoracic defects continue to pose a challenge for the reconstructive surgeon. Stable soft tissue coverage and obliteration of dead space can be particularly challenging when complicated by infection or previous radiation. These cases may require a less conventional method of reconstruction. We describe a case in which vacuum-assisted closure followed by pedicled omental flap transposition was successfully used to reconstruct a complicated intra-thoracic wound following pneumonectomy, radiation therapy, and recurrent wound dehiscences secondary to chronic infection.

Clinical Assessment of Immediate Autotransplantation of Mandibular Third Molars: An In Vivo Study.

Transplanting a tooth from one area of the mouth to another is known as autogenous tooth transplantation. It is a great choice for restoring young patients' teeth with developing alveolar bone because it uses the patient's own tooth as the replacement rather than a false one. This study aims to evaluate pain, infection, mobility, resorption, ankylosis, and success rate in the replacement of mandibular non-restorable molars through an immediate autotransplantation of the nonfunctional impacted mandibular third molar. In this in vivo study, 20 patients between the ages of 22 and 50 were selected. The cases in which the first or second mandibular molar was nonrestorable and had an impacted third molar for transplantation were selected. In all the cases, the nonrestorable molar was extracted and replaced with a nonfunctional, impacted third molar. All the cases were evaluated for pain, infection, mobility, ankylosis, and resorption at the postoperative second week, one month, third month, and six months. The pain was assessed on the visual analog scale (VAS), infection was assessed by the presence of purulent discharges, mobility was assessed on a clinical examination of tooth movements, ankylosis was seen radiographically as the obliteration of the periodontal ligament space, and the absence of the lamina dura and resorption were seen radiographically as radiolucency on the root surface. All the readings were tabulated and statistically analyzed. Pain was seen to be maximal at two weeks and minimum at six months. Infection was not seen at all time intervals. Mobility was reduced with time. There was no significant ankylosis or resorption. Out of the 20 cases, four patients required extractions due to resorption and grade 3 mobility. One patient showed ankylosis. The success rate of the autotransplantation was 75%. Fifteen patients showed well-defined lamina dura without ankylosis or resorption. Autotransplantation is a valuable tooth replacement option and more economical, especially when provided with proper case selection.

Multimodal Imaging of Dental Pulp Healing Patterns Following Tooth Autotransplantation and Regenerative Endodontic Treatment

IntroductionUnderstanding the healing process of dental pulp after tooth autotransplantation (TAT) and regenerative endodontic treatment (RET) of immature teeth is important both clinically and scientifically. This study aimed to characterize the pattern of dental pulp healing in human teeth that underwent TAT and RET using state-of-the-art imaging techniques. Materials and MethodsThis study examined 4 human teeth, 2 premolars that underwent TAT, and 2 central incisors that received RET. The premolars were extracted after 1 year (case 1) and 2 years (case 2) due to ankylosis, while the central incisors were extracted after 3 years (cases 3 and 4) for orthodontic reasons. Nanofocus x-ray computed tomography was used to image the samples before being processed for histological and immunohistochemical analysis. Laser scanning confocal second harmonic generation imaging (SHG) was used to examine the patterns of collagen deposition. A maturity-matched premolar was included as a negative control for the histological and SHG analysis. ResultsAnalysis of the 4 cases revealed different patterns of dental pulp healing. Similarities were observed in the progressive obliteration of the root canal space. However, a striking loss of typical pulpal architecture was observed in the TAT cases, while a pulp-like tissue was observed in one of the RET cases. Odontoblast-like cells were observed in cases 1 and 3. ConclusionsThis study provided insights into the patterns of dental pulp healing after TAT and RET. The SHG imaging sheds light on the patterns of collagen deposition during reparative dentin formation.

PC31. Splenius Capitis Muscle Flap for Treatment of Chiari I Malformation Decompression Reconstruction - A Case Series

PURPOSE: The purpose of this study is to report outcomes of patients who have undergone the splenius capitis muscle flap for posterior neck space obliteration after Chiari I malformation decompression procedures. METHODS: The Institutional Review Board exemption was obtained. Patients who underwent Chiari I malformation decompression with splenius capitis muscle flap reconstruction were evaluated. Patient demographics, prior surgical intervention; variations in surgical techniques, as well intraoperative and postoperative complications were analyzed between the years of 2009 and 2022. RESULTS: A total of 22 patients who had undergone Chiari I malformation decompression with splenius capitis muscle flap reconstruction were identified. Age ranged between 16 and 59, with 19 (86.4%) females and 3 (13.6%) males. Six complications were identified, with 2 patients experiencing a CSF leak, 2 with superficial wound infection, and 2 with incisional dehiscence. The CSF leak patients were treated with a lumbar drain placement and healed without compromising the reconstruction. Likewise the superficial wound dehiscence and infection did not compromise muscle coverage with successful healing outcomes. Finally, none of the patients experienced donor site functional morbidity. CONCLUSION: The splenius capitis flap is a safe and effective muscle flap for posterior neck space obliteration in Chiari I malformation decompression procedures. With six patients experiencing surgical site dehiscence/infection and CSF leak, all patients healed with minimal intervention and no reconstruction compromise. [1] Elsahy NI, Achecar FA. Use of the splenius capitis muscle flap for reconstruction of the posterior neck and skull in complicated Arnold-Chiari malformation. Plast Reconstr Surg. 1994;93(5):1082–1086.

The Vertical Rectus Abdominis Myocutaneous Flap for Complex Abdominal Wall Reconstruction on a Relapse Case of Monophasic Synovial Sarcoma

Introduction: Vertical Rectus Abdominis Myocutaneous (VRAM) flap is a chosen method for a large wound closure instead of Anterolateral Thigh (ALT) flap. Both versatile and highly vascularized flaps share almost similar advantages for large wound closure. In our case, the site and size of the wound are the points of consideration. Case Presentation: A 16-year-old girl with a chief complaint of a large progressive lower abdominal mass enlarged since January 2021 that has grown back from the same site. Abdominal CT-Scan shows a tumor in the right lower abdomen infiltrated to the pelvic cavity and spanning from the lower abdominal area all the way to the groin area. Histopathology interpretation suggests a Monophasic Synovial Sarcoma. The patient underwent a second tumor resection with VRAM flap as the wound closure. The benefits of this versatile flap are excellent dead space obliteration and low Surgical Site Occurrence (SSO’s). Conclusion: As postulated in many studies VRAM flap is an excellent flap for a CAWR procedure. The expected SSO’s is non-existence during the postoperative follow-up

Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas

(1) Background: Resection of soft-tissue sarcomas (STS) of the upper extremity can result in substantial functional impairment with limited options for functional reconstruction. Free functional latissimus flaps have been utilized to restore function of the thigh; however, there is limited data on the use of latissimus flaps for functional reconstruction in the upper extremity. As such, we sought to evaluate our institutional experience with these flaps. (2) Methods: We reviewed ten (seven male; three female; and a mean age of 63 years) patients undergoing soft-tissue sarcoma resection involving the triceps (n = 4), biceps (n = 4), and deltoid (n = 2) reconstructed with a pedicled functional latissimus flap. All surviving patients had at least 1 year of follow-up, with a mean follow-up of 5 years. (3) Results: The mean elbow range of motion and shoulder elevation were 105° and 150°. The mean Musculoskeletal Tumor Society score was 88%, and the muscle strength was four. Four patients had a recipient site wound complication. There were no flap losses. One patient sustained a radiation-associated humerus fracture 5 years postoperatively, treated nonoperatively. (4) Conclusions: Although early complications are high, pedicled functional latissimus flaps allow for wound coverage, potential space obliteration, and restoration of function in the upper extremity following resection of large soft tissue sarcomas.

Targeting ATP12A, a Nongastric Proton Pump α Subunit, for Idiopathic Pulmonary Fibrosis Treatment.

Idiopathic pulmonary fibrosis (IPF) is a pathological condition of unknown etiology that results from injury to the lung and an ensuing fibrotic response that leads to the thickening of the alveolar walls and obliteration of the alveolar space. The pathogenesis is not clear, and there are currently no effective therapies for IPF. Small airway disease and mucus accumulation are prominent features in IPF lungs, similar to cystic fibrosis lung disease. The ATP12A gene encodes the α-subunit of the nongastric H+, K+-ATPase, which functions to acidify the airway surface fluid and impairs mucociliary transport function in patients with cystic fibrosis. It is hypothesized that the ATP12A protein may play a role in the pathogenesis of IPF. The authors' studies demonstrate that ATP12A protein is overexpressed in distal small airways from the lungs of patients with IPF compared with normal human lungs. In addition, overexpression of the ATP12A protein in mouse lungs worsened bleomycin induced experimental pulmonary fibrosis. This was prevented by a potassium competitive proton pump blocker, vonoprazan. These data support the concept that the ATP12A protein plays an important role in the pathogenesis of lung fibrosis. Inhibition of the ATP12A protein has potential as a novel therapeutic strategy in IPF treatment.

Second surgery for complications of major pulmonary resection—the technique of thoracoplasty with muscle flap

: Second surgery for postoperative complications after lung resection is one of the important issues that thoracic surgeons must overcome. Chronic empyema after lung resection, which is caused by bronchopleural or pleural fistula remains a challenge in modern medicine. Especially in cases in which decortication is not indicated, treatment is difficult, hospitalization is prolonged, and the condition is sometimes life-threatening. Surgical treatment of chronic empyema requires not only decortication and debridement, but also closure of the bronchopleural fistula and obliteration of dead space. From this viewpoint, thoracoplasty and muscle flap transposition are important techniques that lead to complete and reliable closure of the empyema cavity. Although they are performed less frequently today, they are procedures with which every thoracic surgeon should be familiar. This clinical practice review focuses on the use of muscle flaps in thoracoplasty and describes the historical background, types of muscle flaps, tips on surgical techniques, and treatment results. There is a wide variety of types and utilization of muscle flaps. Since the selection of an appropriate muscle flap is directly related to the success of the treatment, careful preoperative planning is necessary. It is important to understand the characteristics of each type of muscle flap and to select the appropriate technique for the patient’s pathological and general condition.

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

PurposeThe purpose of this study was to examine the relationship between preoperative Ahlbäck radiographic classification grade and the clinical outcomes of double level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity.MethodsThe study population comprised a consecutive series of 99 knees (68 patients) for which DLO was performed and follow-up results for a minimum of two years were available. The Ahlbäck radiographic classification system was used to determine the osteoarthritic grade. The following radiological parameters for alignment and bone geometry were measured: mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line convergence angle (JLCA), and mechanical tibiofemoral angle (mTFA). Clinical results were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 2 years after surgery. Difference between preoperative and postoperative measurements as well as relationship between Ahlbäck grade and radiological/clinical results were statistically assessed.ResultsThe average age of the study participants was 60.9 ± 6.2 years and the mean follow-up period was 45.4 ± 15.2 months. Each of the radiological parameters exhibited preoperative abnormal values. Knees with Ahlbäck grade 3 and 4 osteoarthritis exhibited significantly greater JLCA and mTFA than grade 1 knees. Two years post-surgery, all radiological parameter values measured within a normal range. Clinical evaluation showed significant improvement in KOOS after surgery. Analysis of the relationship between Ahlbäck grade and clinical score showed that the 2-year postoperative KOOS scores in grade 3 and 4 osteoarthritic knees were significantly lower than grade 1 knees (with the mean 2-year KOOS scores of 350.0 ± 79.9, 317.9 ± 78.3, and 420.2 ± 42.9, respectively).ConclusionsWhile DLO may produce significant radiological and clinical improvement in knees with joint space obliteration, Ahlbäck grade 3 and 4 osteoarthritic knees associated with larger JLCA and mTFA showed less satisfactory clinical results compared to grade 1 knees. Level of Evidence: IV case series.

Pedicled chimeric muscle and anterolateral thigh fasciocutaneous flap reconstruction of trochanteric pressure wounds: Presentation of two cases

Abstract Trochanteric pressure wounds are a significant cause of morbidity among paraplegic and comorbid patients. Their surgical management requires femoral head ostectomy followed by robust soft tissue coverage both for dead space obliteration and for skin and subcutaneous tissue replacement. Many flap options and their variations have been presented for this purpose. We present a unique methodology utilizing a chimeric pedicled muscle and anterolateral thigh (ALT) flap for reconstruction. First, we present a paraplegic 39-year-old male who underwent a right Girdlestone procedure followed by a pedicled chimeric vastus lateralis and ALT flap for trochanteric pressure wound reconstruction. Secondly, we present a 55-year-old paraplegic male with a similar pathology on the left, who underwent a pedicled chimeric rectus femoris and ALT flap reconstruction. Both surgical courses were uncomplicated and with no wound recurrence. Our cases demonstrate that this modification of previously described reconstructions is a viable option for the reconstruction of trochanteric pressure wounds. The literature abounds with reconstructive options for trochanteric wound reconstruction, but none without limitations. We add another durable and robust coverage modality to the reconstructive surgeon’s armamentarium. The chimeric pedicle muscle and ALT flap surgical reconstruction is a viable technique in management of trochanteric pressure wound reconstruction. • Chimeric flap design provides benefits of both muscle and fasciocutaneous flaps. • Chimeric flap design is a viable technique for trochanteric pressure wounds. • There are many options for paddle selections. • Donor site morbidity is minimal and it creates nominally, if any, more scar burden.

VNOTES Under the Hood Technique of Hysterectomy in Obese Patient

<h3>Study Objective</h3> To demonstrate vaginal NOTES under the hood technique of hysterectomy in an obese patient. <h3>Design</h3> Stepwise description of the technique with narrated video. <h3>Setting</h3> Minimally invasive gynecological surgery department with experience in vNOTES at a tertiary care private hospital. <h3>Patients or Participants</h3> A 56-year-old female with post menopausal bleeding and simple atypical endometrial hyperplasia. She was nulliparous with a non-descending cervix and narrow vagina. Her BMI was 39.6 (Obesity grade 2). <h3>Interventions</h3> Vaginally assisted NOTES hysterectomy with bilateral salpingo-oophorectomy using a wet surgical mop. <h3>Measurements and Main Results</h3> The duration of the surgery was 51 minutes. The blood loss was about 15 ml. There were no intraoperative and postoperative complications. The patient was discharged on day two. <h3>Conclusion</h3> The hood made of a surgical mop retracts and protects the bowel and other viscera while hysterectomy is performed 'under the hood' using an energy device. This technique appears feasible and particularly helpful in an obese patient where the obliteration of space due to viscera is more common.

Isolated IgG4-related disease of the left maxillary antrum

A 48-year-old Dravidian Indian female (linguistically Tamil) presented to Saveetha Dental College and Hospitals (Chennai, India) in October, 2021, with a swelling on the left side of her face of six months duration. The swelling gradually increased in size with concomitant restriction in mouth opening. Additionally, there was mild tenderness over the affected area. However, the overlying skin appeared normal. Routine blood and urine values were unremarkable. The orthopantomogram revealed obliteration of left maxillary space by an ill-defined radiopacity suggestive of space occupying lesion (appendix).