One-stage Procedure Research Articles

Adipose tissue harvesting for microfragmented adipose tissue injection: A pilot study to evaluate safety and learning curve for orthopedic surgeons

Objectives The objective of this study is to compare the complication rate between plastic and orthopedics surgeons on harvesting adipose tissue for osteoarthritic knee mFAT injections. Methods We evaluated patients with knee osteoarthritis who were submitted to a one-stage procedure that included the harvesting of abdominal adipose fat tissue, the processing of the adipose tissue using a single-use device Lipogems®, and the injection of the processed micro fragmented adipose tissue (mFAT) into the knee. One group of patients had the adipose tissue harvested by a plastic surgeon and the other group had the procedure performed by a recently trained orthopedic surgeon. We compared the adverse effects, minor and major complications related to the adipose tissue harvesting during the procedure and after 15 days. Results Both groups showed no major complications such as fat embolism, thromboembolic event, abdominal perforation, wound infection, dehiscence or cosmetic changes. Minor complications, such as abdominal discomfort during the harvesting showed no statistical difference. Adverse effects such as abdominal ecchymosis and abdominal discomfort after the procedure were prevalent in both groups and were solved within 15 days of the procedure Conclusion For small adipose tissue volume harvesting, our study supports that low complication rates can be achieved by an orthopedic surgeon with adequate training.

Two-stage pseudo maximum likelihood estimation of semiparametric copula-based regression models for semi-competing risks data.

We propose a two-stage estimation procedure for a copula-based model with semi-competing risks data, where the non-terminal event is subject to dependent censoring by the terminal event, and both events are subject to independent censoring. With a copula-based model, the marginal survival functions of individual event times are specified by semiparametric transformation models, and the dependence between the bivariate event times is specified by a parametric copula function. For the estimation procedure, in the first stage, the parameters associated with the marginal of the terminal event are estimated using only the corresponding observed outcomes, and in the second stage, the marginal parameters for the non-terminal event time and the copula parameter are estimated together via maximizing a pseudo-likelihood function based on the joint distribution of the bivariate event times. We derived the asymptotic properties of the proposed estimator and provided an analytic variance estimator for inference. Through simulation studies, we showed that our approach leads to consistent estimates with less computational cost and more robustness than the one-stage procedure developed in Chen YH (Lifetime Data Anal 18:36-57, 2012), where all parameters were estimated simultaneously. In addition, our approach demonstrates more desirable finite-sample performances over another existing two-stage estimation method proposed in Zhu H et al., (Commu Statistics-Theory Methods 51(22):7830-7845, 2021) . An R package PMLE4SCR is developed to implement our proposed method.

The free style “Twin V/Y Nasal Perforator Flaps”. An alternative to the forehead flap for nasal tip reconstruction. A case control study

IntroductionReplacing the skin along the nasal tip remains a challenge.Depending on the extent of the skin loss different local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully. However, it requires a multi-stage procedure and can leave considerable scarring on the patient’s forehead. As an alternative, the authors present the free style “Twin V/Y Nasal Perforator Flaps” (TVYNPF), which can be used as a one-stage procedure for nasal tip reconstruction. Material and MethodsA series of five patients aged between 69 and 89 years with extensive basal cell carcinomas (BCC) at the nasal tip are presented (Table 1). The surgical procedure is explained in detail. Follow up ranged from 8 to 12 months. ResultsHealing was uneventful for all five patients and the shape, symmetry and aesthetical unity of the nasal tip and the alae of the nose were preserved in all patients without any functional impairment. All scars presented inconspicuous. ConclusionIn selected patients the free style TVYNPF proved to be a good alternative to the forehead flap for one-stage reconstruction of significant skin loss along the nasal tip, while preserving the aesthetics and function of the nose.

Antibiotic-Loaded Hydrogel for the Treatment of Lower-Limb Fracture-Related Infections: A Single Center's Multidisciplinary Experience.

A fracture-related infection (FRI) is a severe complication of an orthopedic trauma, often leading to challenging treatments and poor outcomes. The surgical strategies are typically categorized into one-stage or two-stage procedures, with the use of systemic and local antibiotics being crucial for infection management. This study assessed the efficacy of an antibiotic-loaded hydrogel (ALH) applied over the internal fixation devices for treating FRIs, comparing the outcomes between the one-stage (OS) and two-stage (TS) reconstructions. This retrospective study included 17 patients with an FRI treated using the ALH at a single center. The patients were divided into OS and TS reconstruction groups. The data on demographics, surgical procedures, antibiotic regimens, and outcomes were collected. The primary and secondary outcomes included the infection cure rate, bone union, complications, and reoperation rates. Among the 17 patients (mean age 48.5 years, 16 males), infections were predominantly in the tibia, with 12 chronic and 5 acute cases. Seven patients had monomicrobial infections, and nine had multidrug-resistant pathogens. No significant differences were found between the OS and TS groups in terms of the infection cure rate, bone union, or complications. One patient in the OS group experienced an infection recurrence, and bone healing was achieved in all but one case. Additional complications included delayed wound closure in two cases and implant failure in one case, requiring a reoperation. The ALH demonstrated potential as an effective local antibiotic treatment for FRIs, particularly in the one-stage reconstructions, allowing for a safe application of internal fixation devices. However, further research with larger sample sizes and longer follow-ups is needed to validate these findings.

Bilateral Total Knee Arthroplasty (TKA) in a One-Stage Procedure Versus Two-Stage Procedure: A Retrospective Study.

Background/Objectives: This retrospective study aims to evaluate the safety and functional outcomes of simultaneous bilateral total knee arthroplasty (TKA) compared to two-stage bilateral TKA procedures. Osteoarthritis is the leading cause of knee joint replacement globally, so we sought to determine whether the one-stage approach could be deemed non-inferior to the two-stage method in terms of perioperative complications and postoperative recovery. Methods: We analyzed two cohorts: 43 patients underwent one-stage bilateral TKA, while 66 patients received two-stage TKA. The data collected included demographic details, comorbidities, postoperative complications, and functional outcomes assessed by the Oxford Knee Score (OKS), European Quality of Life, and Visual Analogue Scale scores at preoperative and five years postoperative follow-ups. Results: The results showed statistically significant improvements in quality-of-life measures for both groups, with the one-stage group exhibiting greater enhancement in OKS (p < 0.05). Complication rates were similar across both procedures, with no significant differences in infection rates or other adverse events. Conclusions: This study suggests that the one-stage approach to treat bilateral knee arthritis could reduce subjective stress and healthcare costs, presenting a safe alternative for appropriately selected patients. However, the findings highlight the necessity of considering patients' overall health status when planning surgical interventions. Further research involving larger populations is recommended to validate our conclusions.

Management of Acute Hand Burns: A Survey of American Burn Association-Verified Burn Centers.

Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. This cross-sectional study investigates the preferred current management of acute hand burns and the role of dermal substitutes in treatment. A 10-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers. A total of 51.6% (n=33) directors of ABA-verified burn centers responded to the survey. For the treatment of superficial partial-thickness hand burns, 90.9% preferred a non-operative approach. Conversely, most respondents chose a single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons prefer a two-stage reconstruction involving excision and placement of a skin substitute (27.3%) or allograft (9.1%), followed by a skin graft. Only 6.1% would utilize a three-stage reconstruction involving excision and allograft, excision and skin substitute, followed by skin grafting. Among surgeons who used skin substitutes (n=26), Integra (42.3%) and Novosorb Biodegradable Temporising Matrix (BTM) (23.1%) were preferred. The top reasons for choosing one specific dermal substitute were surgeon's preference (n=20; 76.9%) and cost (n=9; 34.6%). While a conservative non-operative approach is preferred for superficial partial-thickness hand burns, excision and skin grafting as a one-stage procedure remains the most common strategy for deep partial-thickness and full-thickness hand burns.

Not bitten by Ixodes ticks or bitten without symptoms, why still to worry?

The purpose of the current study was to analyse the risks of Lyme borreliosis (LB) among 1,070 forestry workers, the influence of responsible behaviour (use of repellents, skin self-inspection) on Borrelia screening result status, and the occurrence of immediate and mid-term symptoms after tick bites and LB positive serological screening test. The questionnaire was conducted as well as blood tests for LB disease by one-stage serological screening procedure using ELISA for specific B. burgdorferi IgM and IgG antibodies (EuroImmun AG company, Germany). While 39.6% of foresters were LB positive among bitten foresters, as many as 27.0% were LB positive among those, who did not recall any tick attacks at all. Individuals with known history of tick bites had significantly higher odds (1.770×) of being LB positive (p < 0.05), while the use of repellents or skin self-inspection after visiting woods had no influence on LB results. The odds of skin discolouration after tick bites was significantly lower (0.682×) in case of LB positive test compared to LB negative test (p < 0.05), which can be explained by the fact that foresters could be unaware about erythema migrans appearance and timing, considering tick bite and developed later rash as completely separate events. Moreover, 69.1% of the bitten foresters with LB positive result developed no secondary symptoms (excluding those related to the skin), and the most frequent clinical symptoms were arthralgia (24.9%), followed by myalgia (7.6%), headache (5.7%), and damage to facial nerve (2.7%), which are non-specific and can be present in other illnesses. Therefore, the recommendations proposed would be the regular laboratory testing for LB of sensitive and at-risk population, who visits endemic woody areas, irrespective of all other factors involved.

Recovery of copper from ammonia–ammonium chloride leach liquor using sterically hindered beta-diketone

In this study, the recovery of copper from ammonia–ammonium chloride (NH3–NH4Cl) leach liquor using sterically hindered beta-diketone (β-diketones), a well-known extractant, was investigated. The experimental approach entails studying how various factors, including extraction time, concentration of the extractant, pH, phase ratio, and temperature, impact the effectiveness of copper extraction. The most favourable conditions for extracting copper from ammoniacal solutions containing 871.27 mg/L Cu2+, 1.75 mol/L NH3, and 0.5 mol/L NH4Cl were determined. Optimal copper extraction was achieved through a one-stage solvent extraction process at a phase ratio of 1 : 1, utilising sulphonated kerosene containing 0.25 mol/L of β-diketones. This extraction process lasted for 10 min and yielded a copper extraction efficiency of 75.10%. Additionally, a stripping ratio of 98.52% was achieved from the loaded organic phase through a one-stage stripping procedure at a phase ratio of 1 : 1, conducted at a temperature of 298 ± 0.5 K.

Comparison of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization versus transarterial chemoembolization and portal vein embolization for planned hepatectomy with insufficient future liver remnant

BackgroundIn China, both percutaneous microwave/radiofrequency ablation liver partition plus portal vein embolization (PALPP) and transarterial chemoembolization (TACE) plus portal vein embolization (PVE) have been utilized in planned hepatectomy. However, there is a lack of comparative studies on the effectiveness of these two techniques for cases with insufficient future liver remnant (FLR).MethodsPatients were categorized into either the PALPP group or the TACE + PVE group. Clinical data, including FLR growth rate, complications, secondary resection rate, and overall survival rate, were compared and analyzed for both groups retrospectively.ResultsBetween December 2014 and October 2021, a total of 29 patients underwent TACE + PVE (n = 12) and PALPP (n = 17). In the TACE + PVE group, 7 patients successfully underwent two-stage hepatectomy, while in the PALPP group, 13 patients underwent the procedure (two-stage resection rate: 58.3% vs. 76.5%, P = 0.42). There were no significant differences in postoperative complications of one-stage procedures (11.8% vs. 8.3%, P > 0.05) and second-stage resection complication (0% vs. 46.2%, P = 0.05) between the TACE + PVE and PALPP groups. However, the PALPP group demonstrated a shorter time to FLR volume growth for second-stage resection (18.5 days vs. 66 days, P = 0.001) and KGR (58.5 ml/week vs. 7.7 ml/week, P = 0.001).ConclusionsCompared with TACE + PVE, PALPP results in a more significant increase in FLR volume and a higher rate of two-stage resection without increasing postoperative complications.

A Composite Application Technique of Single-stage Dermal Templates to Improve Handling and Ease of Use.

The "work horse" for the treatment of full-thickness defects of any etiology, including chronic nonhealing wounds and traumatic injuries, is generally autologous split-thickness skin grafts (STSGs), meshed, hand-fenestrated, or a sheet graft. Advancements in skin tissue engineering have allowed for the integration of dermal substitutes to be combined with autologous STSGs, adding valuable options for restoring the skin's complex multilayered structure. Although dermal templates offer a promising avenue for more nuanced reconstruction in certain cases, their application is not without challenges, particularly when they are made from delicate materials. The following technique simplifies the application technique of single-stage dermal templates by using a composite approach. To demonstrate this technique, MatriDerm, a 1-mm-thick bovine collagen-elastin dermal template, is used to enable an STSG to be applied in a one-stage procedure.

The Efficacy of Active Fistulation in Duckett Procedure for Proximal Hypospadias in Children.

To explore the efficacy of active fistulation in the treatment of proximal hypospadias in children by comparing one-stage and two-stage Duckett procedure. A total of sixty-seven children who were diagnosed with proximal hypospadias and underwent Duckett operation at our hospital between January 2013 and January 2021 were selected for this study. These subjects were divided into two groups: the research group (n=36), using two-stage Duckett procedure with active fistulation, and the control group (n=31), using one-stage Duckett procedure.The incidence of postoperative complications and the score of pediatric penile perception Scale were compared between the two groups. The research group exhibits significantly lower incidence rate of urethral fistula (8.3% Vs 16.1%) and urethral stricture (5.6% Vs 12.9%) in comparison to the control group (P<0.01). Furthermore, the analysis of Pediatric Penile Perception Scale scores indicates that the research group achieves significantly higher scores in terms of urethral shape, penile skin shape, and overall appearance than the control group (P<0.05). Conclusion: In the treatment of proximal hypospadias in children, The active fistulation within the two-stage Duckett procedure significantly reduces the rate of stage 1 postoperative complications and improves parental satisfaction. The active fistulation may offer a more promising option for the treatment of proximal hypospadias in children.

A one-covariate-at-a-time multiple testing approach to variable selection in additive models

. This article proposes a One-Covariate-at-a-time Multiple Testing (OCMT) approach to choose significant variables in high-dimensional nonparametric additive regression models. Similarly to Chudik, Kapetanios, and Pesaran, we consider the statistical significance of individual nonparametric additive components one at a time and take into account the multiple testing nature of the problem. Both one-stage and multiple-stage procedures are considered. The former works well in terms of the true positive rate only if the net effects of all signals are strong enough; the latter helps to pick up hidden signals that have weak net effects. Simulations demonstrate the good finite-sample performance of the proposed procedures. As an empirical illustration, we apply the OCMT procedure to a dataset extracted from the Longitudinal Survey on Rural Urban Migration in China. We find that our procedure works well in terms of out-of-sample root mean square forecast errors, compared with competing methods such as adaptive group Lasso (AGLASSO).

ОПЫТ ЛЕЧЕНИЯ ПАЦИЕНТОВ СО СВИЩАМИ ОБОДОЧНОЙ КИШКИ ДИВЕРТИКУЛЯРНОГО ПРОИСХОЖДЕНИЯ

Abstract. Introduction. In the 21st century, a massive increase was noted in the incidence of diverticular disease (DD) by more than 10 times with an increase in the frequency of its complications ranging from 5 to 25%. According to the literature, the colon fistulation frequency is 5-30%, over a half of such formations being colovesical fistulas. The problem of surgical approaches to the purulent-inflammatory complications of DD is far from being resolved. Despite the fact that diverticular disease is a benign pathology, inflammatory process often creates serious technical difficulties in surgery due to the violation of the anatomical relationship of the intestine with the surrounding organs, while surgeries often affect several organs with a high infection risk. Aim. Analysis of the results of the treatment of patients with diverticular colon fistulas in a specialized department of a multidisciplinary hospital. Materials and Methods. Treatment outcomes were analyzed retrospectively in 347 patients with diverticular colon disease complications for the period from 2013 to 2022. The study included 17 patients with diverticular fistulas: 14 (82.4%) patients with internal (intestinal-urinary (13) and intestinal-vaginal (1)) fistulas and 3 (17.6%) with external ones. Results and Discussion. The therapeutic and diagnostic algorithm for diverticular fistulas required a wide range of diagnostic methods and a multidisciplinary approach. Surgery remains the single treatment option for this pathology. The choice of the surgical procedure depended on the inflammatory process severity, its spread to the surrounding abdominal organs, and the largest diverticula accumulation in the gut. In the group of patients with intestinal-urinary fistulas, the resection was not limited to the removal of the colon segment only. In 9 (52.9%) cases, it was expanded to the anterior rectum resection due to the inflammation transition to its upper ampullary region. We are supporters of the one-stage surgical procedures with forming the primary anastomosis in patients with diverticular fistulas. We give preference to the Sigal-Ramazanov invagination anastomosis that allows avoiding the anastomosis due to creating a duplicate of the intestinal wall hiding the anastomosis zone. The paper identifies probable predictors of complicating diverticular disease with fistulation. Conclusions. Choosing the optimal treatment option for patients with diverticular disease complications is a difficult problem. It is better to operate on them in the coloproctology departments of multidisciplinary hospitals with the established good interaction among the members of a multidisciplinary team.

Novel Treatment Options for Knee Cartilage Defects in 2023.

Articular cartilage lesions are a common injury that have become increasingly treatable with joint preservation procedures. Well-documented allograft and cellular treatments for these lesions are detailed elsewhere in this volume. This article discusses three new unique options for addressing these defects taking three different paths to address these complex injuries. Agili-C is an existing FDA- and EMEA-approved option using an acellular aragonite-based scaffold to treat both chondral and osteochondral lesions, with or without concurrent arthritis. Cartistem is a stem-cell-based product composed of culture-expanded allogeneic human umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel, which is in its final clinical trial stages in the United States, but already has regulatory approval in Korea. IMPACT and RECLAIM studies have shown the safety and efficacy of a new one-stage procedure utilizing autologous chondrons combined with allogeneic mesenchymal stem cells (MSCs) that can provide another effective single-stage treatment option.

Improving the efficiency of research proposals evaluation: A two-stage procedure

Abstract An important share of research funding is allocated via competitive programs, which entail considerable direct and indirect costs, such as to develop and evaluate the proposals. The goal of this article is to explore whether adopting a two-stage evaluation procedure could improve the efficiency of the process. For this purpose, we study the evaluation system designed by the Foundation Dam (Stiftelsen Dam), one of the largest foundations in Norway supporting health research. In 2020, Foundation Dam adopted a new evaluation procedure consisting in a short proposal for a first stage of selection and, for those selected, a second-stage evaluation of a long proposal. We explore whether such a procedure reduces the evaluation costs and how the evaluation procedures compare in terms of reliability. Survey responses from 94 of the 594 applicants in the one-stage procedure (2018–19) and all the 668 applicants in the two-stage procedure (2020–21) show that the two-stage procedure reduced the average time that applicants spent in drafting the proposal(s) by 38%. According to the reviewers’ estimate, the two-stage procedure also reduced by 28% the time they spent on average to evaluate an applicant’s proposal(s). The analysis of the evaluation data of 594 long proposals in the one-stage procedure and 668 short proposals in the two-stage procedure shows that reviewers’ scores of short proposals display greater reliability and agreement than the reviewers’ scores of long proposals in the old one-stage procedure. Our findings suggest that a two-stage procedure can substantially improve the efficiency of grant writing and review, without harming the reliability of the evaluation.

Understanding and Managing Metabolic Deficiencies Post Bariatric and Esophagectomy Surgeries: A Narrative Review of the Literature.

Gastrectomy and esophagectomy are the most performed surgeries in the treatment of both esophageal and gastric cancers. The type of esophagectomy depends on the type of malignancy, site of the tumor, criteria of resection, and field of resection. The three standard approaches to esophagectomy are the transhiatal approach, the left thoracoabdominal approach, and a three-stage procedure. The transhiatal approach involves abdominal and cervical incisions, while the left thoracoabdominal approach is a one-stage procedure that utilizes a single incision exposing the dissection field. The Ivor Lewis and McKeown esophagectomies are two-stage and three-stage surgeries that includelaparotomy with right thoracotomy. Malabsorption often emerges as a significant postoperative complication following esophagectomy and gastrectomy surgeries. Malnutrition linked with these cancers has detrimental effects, including heightened rates of postoperative complications, elevated infection risks, delayed wound healing, reduced tolerance to treatment, diminished quality of life, and heightened mortality rates. Our narrative review summarizes and sheds light on solutions to treat malabsorption disorders and malnutrition after gastric bypass surgery. These solutions include methods such as adjustments, supplements, and treatment. Although more research is needed to confirm their effectiveness, these methods indicate potential for lowering the impact on patients' diets. By considering the beneficial implications of these effects and considering solutions, we aim to improve the management of these adverse effects, ultimately improving the overall health and postoperative outcomes of patients.

One-Stage Combined Open and Endovascular Treatment Using a Hybrid Operating Room is Safe and Effective for Distal Middle Cerebral Artery Aneurysms

BackgroundAneurysms located in the distal middle cerebral artery (MCA) are relatively rare and lack an established treatment strategy. For distal MCA (DMCA) aneurysms, we performed a one-stage combined procedure of endovascular parent artery occlusion (PAO) with coils and superficial temporal artery to middle cerebral artery (STA-MCA) bypass in a hybrid operating room (HOR). The aim of this study was to evaluate the safety and efficacy of this procedure. MethodsCases of unruptured DMCA aneurysms treated with the one-stage combined PAO and STA-MCA bypass in HOR were retrospectively examined, and patients’ and aneurysmal backgrounds, surgical procedures, and treatment outcomes were analyzed. ResultsSix patients were included in the study. The average maximum diameter of the aneurysms was 14.4 mm. One aneurysm was located at M2 and five at M3. All aneurysms had a fusiform shape. No cases were associated with infection, trauma, or malignant tumors. In all six cases, the combined PAO and STA-MCA bypass was successfully completed. No postoperative hemorrhagic complications occurred. A symptomatic ischemic complication occurred in one case whose symptom disappeared in a week. Three months after surgery, complete obliteration of the aneurysm and patency of the bypass were confirmed in all cases. ConclusionsThe one-stage combined PAO and STA-MCA bypass in the HOR is safe and effective for DMCA aneurysms, potentially serving as a treatment option for this complex aneurysm.

Surgical procedures to improve hand function in tetraplegic patients: patient satisfaction and outcomes over a 20-year period.

The aim of the present study was to report our experience in the evolution in surgical strategy and patient satisfaction after upper limb reconstruction in tetraplegic patients. A total of 72 patients (114 upper limbs) underwent surgery between 1997 and 2017. Since April 2003, tenodesis of the extensor digitorum communis tendons was no longer performed because it limited wrist flexion, and two-stage operations to restore active grasp were replaced by one-stage procedures. In total, 34 patients (58 upper limbs) completed questionnaires about function and satisfaction at a mean follow-up of 14 years (range 4-24) since their first operation; 26 were satisfied, 30 would have the operation again and 31 benefitted from the surgery. Surgical procedures, such as tendon transfers, arthrodesis and tenodesis, can have a positive effect on patient-perceived function and satisfaction in the long term in most of these patients.Level of evidence: IV.

One-stage secondary debulking procedure: A unique technique to restore the differential contour of digit after groin flap reconstruction

BackgroundPedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility and sensation especially while providing strict thin skin coverage still exist. Patients and MethodsA total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat was debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow up. ResultsThe average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5cm of digit was preserved for the non-replantatable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients’ satisfactory outcomes of the reconstructed digits was judged as “very satisfying” in 12 patients (75%) and “good results” in four (25%). ConclusionsOne-stage secondary debulking procedure resulted in excellent functional and aesthetic outcomes for digit according to different structure of dorsal and volar sides. Level of EvidenceIV, Retrospective

Brachymetatarsia.

Brachymetatarsia involves a reduction in length of one or more metatarsals. The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola. In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia. A possible association with genetic disorders needs to be investigated during clinical evaluation. Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.