Posterior Incision Research Articles

Repair of a Reverse HAGL: A 2-Portal Technique

Background: Glenohumeral joint stability is reliant on a combination of static and dynamic constraints. Humeral avulsion of the posterior band of the inferior glenohumeral ligament (HAGL) is an exceedingly rare injury. These injuries can be difficult to diagnose and can lead to continued pain, dysfunction, and recurrent instability. There is a paucity of literature regarding surgical management of reverse HAGL lesions. Indications: Many intrasubstance reverse HAGL lesions can be managed nonoperatively with rehabilitation focused on improving shoulder stability. Although the incidence of recurrent instability in patients with reverse HAGL lesions is unknown, the acute detached humeral lesions in athletes are often treated surgically to restore normal shoulder. Technique Description: The patient was placed in a standard beach chair position, and the standard portals were made for a diagnostic shoulder arthroscopy. The anterior portal was the primary viewing portal. Using the initial posterior skin incision, instruments were introduced through the defect from the retracted posterior band of the inferior glenohumeral ligament. Using a combination of the 30° and 70° arthroscope, the HAGL was mobilized from the infraspinatus musculature. Two knotless suture devices (1.8-mm suture anchor, 2.6-mm suture anchor) were used to reduce the reverse HAGL lesion to an anatomical position, and the posterior capsule was closed thereafter. Results: Only case studies and a single case series have been published pertaining to reverse HAGL repair techniques and related outcomes. When diagnosed and treated appropriately, arthroscopic repairs yield promising results with a high percentage of patients returning to prior level of activity or returning to prior participation level in sport. However, outcome data are limited given the rare occurrence of this injury pattern. Discussion/Conclusion: Reverse HAGL pathology can be treated effectively with arthroscopic surgical repair to restore the normal capsular anatomy and prevent recurrent instability and persistent posterior shoulder pain. Using a 2-portal approach with posterior capsular closure is a minimally invasive operation that allows for appropriate management of these rare injuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

V04-03 COMBINED ROBOTIC TRANSPERITONEAL AND TRANSVAGINAL PULL-THROUGH FOR REPAIR OF DISTAL VAGINAL ATRESIA: A VIDEO CASE REPORT

You have accessJournal of UrologyCME1 Apr 2023V04-03 COMBINED ROBOTIC TRANSPERITONEAL AND TRANSVAGINAL PULL-THROUGH FOR REPAIR OF DISTAL VAGINAL ATRESIA: A VIDEO CASE REPORT Jeremiah Dallmer, Peris Castaneda, Andrew Freedman, and Paul Kokorowski Jeremiah DallmerJeremiah Dallmer More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , Andrew FreedmanAndrew Freedman More articles by this author , and Paul KokorowskiPaul Kokorowski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Distal vaginal atresia is a unique Mullerian pathology where the urogenital sinus, responsible for the lower 1/3 of the vagina, fails to cannulate during development. Unlike Meyer-Rokitansky-Kuster-Hauser syndrome, which is characterized by agenesis of the upper vagina and uterus, patients with distal vaginal atresia have normal Mullerian development including the uterus and proximal vagina. METHODS: We present the case of a 12 yo female with a three month history of cyclical abdominal pain. Upon outside workup, she was found to have a short, blind ending vagina. MRI showed a 9 cm x 8 cm dilated uterus, open cervix and proximal vagina filled with blood products. She was taken to the operating room for combined perineal and robotic transperitoneal pull-through. RESULTS: An 8.5 mm camera port was placed in the umbilicus and three 8.5 mm working ports were placed using a hidden incision approach below the belt line. We incised the peritoneum and dissected as distally as feasible along the rectovaginal space. At the blind-ending introitus, a U-shaped incision was made to create an anterior flap. This space was dissected proximally, monitoring the correct plane via a finger in the rectum and with direct visualization with the robotic camera. The two planes were connected. A 0-silk was robotically placed to manipulate the vagina. As the vagina was severely dilated from menstrual products, mobility was insufficient to reach the introitus. A small posterior incision on the proximal vagina was made and blood products were partially evacuated. The vesicovaginal space was then dissected robotically, maintaining the lateral attachments as blood supply and avoiding ureteral injury. The vaginal apex was then pulled to the introitus and anastomosed to the anteriorly based flap from the introitus. The patient remained hospitalized for two days with vaginal packing in place. She was trained in the use of vaginal dilators and has been progressively increasing the size without difficulty. CONCLUSIONS: Robotic dissection of the proximal vagina in the setting of distal vaginal atresia using a hidden incision approach allows for orthotopic reconstruction, and superior aesthetics as compared to traditional port placement. This approach obviated the need for the use of tissue grafting or more extensive open dissection. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e338 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremiah Dallmer More articles by this author Peris Castaneda More articles by this author Andrew Freedman More articles by this author Paul Kokorowski More articles by this author Expand All Advertisement PDF downloadLoading ...

Classical morphology and DNA barcoding based identification of freshwater ectoparasite, Argulus foliaceus in rohu Labeo rohita

DNA barcoding coupled with classical morphological description have become promising approach for the species levelidentification. In the present study, 278 numbers of rohu Labeo rohita were screened, for Argulus infestation, amongwhich 167 fish (60.07%) were found infested with Argulus. Morphological attributes of the parasites were studied by lightmicroscope (LM) and Scanning Electron Microscope (SEM) which showed dorsoventrally flattened body comprising ofhead, thorax, abdomen, a pair of large compound eyes, suctorial organs with sclerotised support structures and two openingsof spermatheca at posterior end. Posterior incision of abdomen do not reach the mid-line and the cephalo-thoracic carapacehave not extended beyond the beginning of abdomen. Further validation was done using molecular tools for accurateparasite identification. The pair-wise genetic distance value, using Kimura-2 parameter showed a species level variationof 0.001 (1%) with that of A. foliaceus, while 0.083 and 0.052 (i.e. more than 2%) with that of A. indicus and A. japonicusrespectively. Phylogenetic tree generated using Neighbour-Joining (NJ) and Maximum-Likelihood (ML) methods, withKimura-2 parameter were also in agreement with pairwise distance values. The mitochondrial cytochrome c oxidase subunit1 (COI) sequences of A. foliaceus formed one cluster with the present studied samples, whereas sequences of A. japonicusformed a sister group. Integrating morphological and rapid DNA barcoding tools, the species was delineated as A. foliaceus. Keywords: Argulus foliaceus, COI gene, DNA barcoding, Labeo rohita, Morphology

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae.

The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off the posterior vaginal wall and out of the vestibule, the perineal body muscles, where the fistula had been, were reinforced and an anoplasty was then performed. Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.

Risk factors for incisional complications after lumbar internal fixation via posterior midline approach: A case-control study of 455 consecutive cases.

To analyse the clinical data of patients who developed incisional complications and those who did not develop incisional complications after lumbar internal fixation, and investigate the risk factors for incisional complications in patients after lumbar internal fixation with posterior midline incision. A standardised data collection form was used to collect the clinical data of patients who were admitted and underwent lumbar internal fixation in our hospital from July 2018 to July 2021. Patients who experienced any one of the incisional complications, such as incision exudates, swelling, blisters, bruising, superficial/deep incisional infections, poor healing and scarring, after surgery were included in the incisional complication group, and patients who did not develop the above-mentioned incisional complications were included in the control group. Univariate logistic regression analysis was first performed to identify potential risk factors, significant factors from univariate analysis were then included in multivariable logistic regression analysis to identify independent risk factors for incisional complications after lumbar spine surgery. Among 455 patients included in the study, postoperative incision complications occurred in 82 patients, with an incidence rate of 18.02%. Multivariate regression analysis identified seven independent risk factors for incisional complications: age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time and local anaesthetic infiltration at the incision site after surgery. Our findings documented that age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time, and postoperative local anaesthetic infiltration at the incision site were risk factors for incisional complications after lumbar internal fixation with posterior median incision. Awareness of these risk factors can enable surgeons to develop a more appropriate perioperative management plan for patients undergoing lumbar internal fixation, thus helping them recover faster.

Clinical effect of limited posterior decompression and 13-mm titanium mesh implantation onsevere thoracolumbar burst fractures: A case series.

Posterior incision with 270° spinal canal decompression and reconstruction surgery is a treatment option for thoracolumbar burst fractures (TLBF), but the large diameter titanium mesh placement is difficult. This study evaluated the characteristics and clinical effects of limited posterior decompression and 13-mm titanium mesh implantation to treat TLBF. 13-mm titanium meshes could be used to fix thoracolumbar burst fractures. This case series included patients who underwent limited posterior decompression and 13-mm titanium mesh implantation at China Medical University Shaoxing Hospital (01/2015-12/2019). The Cobb angle, injury vertebral anterior edge height loss percentage, and spinal canal occupancy rate were analyzed. The degree of spinal cord injury was evaluated according to the ASIA grade. Fifteen patients were included (eight males and seven females). The patients were 32.2 ± 4.6 years of age. The American Association of Spinal Injury improved after surgery (A/B/C/D/E: from 2/6/5/2/0 to 0/0/2/8/5, P < 0.001). The Cobb angle decreased after surgery (from 20.1 ± 4.8° to 7.1 ± 1.4°, P < 0.001) but increased to 8.2 ± 0.9° at 1 year (P = 0.003). The percentage of loss of the anterior edge height of the injured vertebrae decreased after surgery (from 40.9% ± 6.1% to 7.5% ± 1.8%, P < 0.001) and decreased at 1 year (7.0% ± 1.5%, P = 0.044). The spinal canal occupancy rate decreased after surgery (from 64.8% ± 7.8% to 20.1% ± 4.2%, P < 0.001) but did not decrease further at 1 year (19.4% ± 3.4%, P = 0.166). Spinal canal limited posterior decompression, and 13-mm titanium mesh implantation in the treatment of TLBF can achieve one-stage spinal canal decompression and three-column reconstruction. The curative effect was satisfying. Level IV; case series.

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae.

The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off the posterior vaginal wall and out of the vestibule, the perineal body muscles, where the fistula had been, were reinforced and an anoplasty was then performed. Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.

Anatomical Study of Cross-Transfer of the Contralateral C7 Nerve Through the Posterior Epidural Pathway of the Cervical Spine for the Treatment of Spastic Paralysis of the Upper Limbs

This study explored the safety and feasibility of surgical treatment of spastic paralysis of the central upper extremity by contralateral cervical 7 nerve transfer via the posterior epidural pathway of the cervical spine. Five fresh head and neck anatomical specimens were employed to simulate contralateral cervical 7 nerve transfer through the posterior epidural pathway of the cervical spine. The relevant anatomical landmarks and surrounding anatomical relationships were observed under a microscope, and the relevant anatomical data were measured and analysed. The posterior cervical incision revealed the cervical 6 and 7 laminae, and lateral exploration revealed the cervical 7 nerve. The length of the cervical 7 nerve outside the intervertebral foramen was measured to be 6.4 ± 0.5 cm. The cervical 6 and cervical 7 laminae were opened with a milling cutter. The cervical 7 nerve was extracted from the inner mouth of the intervertebral foramen, and its length was 7.8 ± 0.3 cm. The shortest distance of the cervical 7 nerve transfer via the posterior epidural pathway of the cervical spine was 3.3 ± 0.3 cm. Cross-transfer surgery of the contralateral cervical 7 nerve via the posterior epidural pathway of the cervical spine can effectively avoid the risk of nerve and blood vessel damage in anterior cervical nerve 7 transfer surgery; the nerve transfer distance is short, and nerve transplantation is not required. This approach may become a safe and effective procedure for the treatment of central upper limb spastic paralysis.

Pectoralis Major Transfer for Medial Scapular Winging

Background: Scapular winging is a rare and often misdiagnosed disorder, which can be painful and functionally limited. Medial scapular winging is often due to serratus anterior dysfunction in the setting of a long thoracic nerve palsy. While nonoperative management can be successful, transfer of the pectoralis major with autograft hamstring augmentation to the inferior scapula is an effective operative means of relieving pain and restoring shoulder function in those who fail conservative management. Indications: The patient is a 16-year-old woman with symptomatic medial scapular winging who had a complete workup and 6-month course of conservative treatment, including physical therapy. Thus, we elected to proceed with a 2-incision transfer of the sternal head of pectoralis major transfer with autograft hamstring augmentation to the inferior scapular angle. Technique Description: A 2-incision transfer of the sternal head of pectoralis major with autograft hamstring to the inferior scapular angle is a strong and reliable method of operatively treating medial scapular winging. In addition, performing this operation in the lateral position allows for ease of access to both the anterior and posterior incisions. Results: At 1-year follow-up, the patient had full, painless range of motion of the shoulder with 5/5 strength in all tested planes. She also had returned to all activities, including softball, without restrictions. Discussion/Conclusions: A 2-incision transfer of the sternal head of the pectoralis major with autograft hamstring augmentation to the inferior scapular angle is an effective means of operatively treating medial scapular winging. Multiple studies have shown that this operation improves motion, pain, and function for those who have failed an appropriate course of conservative treatment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Lipoblastome de la nuque chez un enfant

abstract We report the case of a male child aged 3 years who was consulted for a right deviated neck tumor, movable with the superficial plane and fixed with the deep plane, measuring 8 cm in length. It was firm, painless, without associated inflammatory signs (A), Cervical scan showed a tumoral process of the right nuchal parts, lobulated contour, with double fatty component containing fine partitions and tissue enhanced after injection of iodinated contrast (ICP), measuring 50*43*55mm in diameter (B), Patient admitted to the operating room: posterior transverse incision of the neck. Surgical exploration revealed an encapsulated mass very much adherent to the different musculoaponeurotic planes that it was pushing back without invading them. The mass was completely resected without capsular opening, following the cleavage planes between it and the planes (C). It measured 6.5 cm in length and contained several fatty lobules grouped in clusters (D). Anatomopathological examination confirmed a lipoblastoma.

Does posterior approach always lead to poor functional and cosmetic outcomes in displaced pediatric supracondylar humeral fractures?

Supracondylar humerus fractures (SCHFs) are the most common types of elbow fractures in children. Closed reduction percutaneous pinning (CRPP) is the primary surgical treatment of SCHFs. In cases that cannot be managed with closed reduction, treatment with open reduction and internal fixation (ORIF) is necessary. We aimed to compare CRPP and ORIF through a posterior approach regarding clinical and functional outcomes in pediatric SCHF cases. Patients with Gartland type III SCHF who underwent CRPP or ORIF with posterior approach at our clinic between January 2013 and December 2016 were included in this retrospective study. A total of 60 patients who underwent surgical treatment and had available data on our hospital database and no additional injuries were included in the study. We analyzed their data concerning age, gender, fracture type, neurovascular damage, and surgical treatment. In addition, we inspected the patients' anteroposterior and lateral radiographs at 1-year follow-up visits for Baumann (humerocapitellar) angle (BA) and carrying angle (CA) and checked their go-niometer assessments of elbow range of motion (ROM). The cosmetic and functional outcomes were determined using Flynn's criteria. Demographic, preoperative, and post-operative data of 60 patients between the ages of 2-15 were analyzed. 46 of these patients had CRPP, and 14 had posterior ORIF. CA, Baumann angle, and lateral capitello-humeral angle were measured for fractured elbow and contralateral elbow and compared statistically. There was no statistically significant difference between the two surgical ap-proaches in terms of CA (p=0.288), Baumann's angle (p=0.951) and LHCA (p=0.578). At the end of 1-year follow-up, elbow ROM was measured, and there was no statistically significant difference between the two groups (p=0.190). Furthermore, there is no statistically significant difference between the two surgical approaches in terms of both cosmetic (p=0.814) and functional (p=0.319) outcomes. A comprehensive literature review of pediatric SCHF shows that surgeons do not frequently prefer posterior incisions in Gartland type III fracture that cannot be managed with closed reduction. However, posterior open reduction is a safe and effective method since it provides more control over the distal humerus, allows for a complete anatomical reduction involving both cortices, reduces the risk of ulnar nerve injury, thanks to the nerve exploration, and yields positive cosmetic and functional outcomes.

Robotic-assisted Laparoscopic Supracervical Repair of a Chronic Puerperal Uterine Inversion

Surgical correction of a chronic puerperal uterine inversion traditionally requires an anterior or posterior cervical incision to relieve the constricting band. This case is only the second reported case of robotic-assisted correction of a chronic puerperal uterine inversion and the first to avoid a cervical incision. The patient was 5 months postpartum and desired future pregnancy. After a laparoscopic Huntington technique was unsuccessful, a vertical hysterotomy was created in the anterior lower uterine segment and extended toward the fundus until the inversion could be relieved. The incision was repaired in 3 layers and a round ligament plication was performed to provide additional support within the pelvis. The patient's symptoms gradually improved during her postoperative course, and ultrasound 2 weeks after the procedure revealed the uterus in anatomic position in the pelvis. With a paucity of reported cases of laparoscopic correction of chronic puerperal uterine inversion, the present case offers a novel surgical approach that maintains cervical integrity and thereby minimizes long-term effects of the procedure on future pregnancies.

V-007 LESSONS LEARNED DURING THE ABDOMINAL WALL RECONSUTRCTION FOR A MULTIRECURRENT LUMBAR HERNIA AFTER BONE GRAFT HARVESTING

Abstract The best approach for lateral incisional hernia is not known. Among these difficult hernias, those arising from iliac crest harvesting can be particularly challenging. The objective of this video is to illustrate the surgical approach of a multirecurrent case with the need of adding a posterior component separation A 70 years old woman with 2 previous attempts of repair was referred to our center. With the patient in a 45 degrees lateral decubitus, a posterior lumbar approach was initiated through the previous scar. The retromuscular preperitoneal plane was accessed with difficulty due to previous meshes in the subdiaphragmatic, iliac and posterior areas. A big tear on the medial peritoneum changed our plan to add a posterior component separation. As we did not want to enlarge the lumbar incision to denervate more the lateral abdominal wall, we decided to make an accessory midline incision. Probably, an ETEP approach could have been better even before making the posterior incision. Once the retromuscular plane was dissected, the hole in the peritoneum could be closed. The reconstructive phase consisted in making a taco configuration using the combination of a permanent and absorbable mesh. We have learned from this case, that an eTEP dissection of the retromuscular plane could have helped to avoid the accessory midline incision. It is also important to consider the potential iatrogenic denervation we could add in case of enlargement of the incision.

Pericardiotomy under clamshell approach for large posterior mediastinal sarcoma: a case report

BackgroundLarge mediastinal tumors are sometimes difficult to completely resect because they are surrounded by vital organs. We present the case of mediastinal liposarcoma successfully resected by the clamshell approach with a posterior pericardial wall incision.Case presentationAn 81-year-old man visited the hospital because of a prolonged cough. Imaging studies revealed a large tumor of the left posterior mediastinum. The tumor surrounded the left inferior pulmonary vein and was suspected of invading the left lower lobe and esophagus. Complete resection of a large mediastinal tumor invading the left inferior pulmonary vein and esophagus was achieved by adding a posterior pericardial wall incision to the clamshell approach under cardiopulmonary bypass. Histopathological diagnosis was well-differentiated liposarcoma. Postoperative course was good, and the patient is alive without any sign of recurrence for 53 months.ConclusionsThis approach could represent a novel method to safely and effectively remove large mediastinal tumors invading the lung and esophagus.

Taxonomic revision of the free-living marine nematode genus Deontostoma (Enoplida: Leptosomatidae) and inclusion of a new species from the Southern Ocean

Summary A new species of free-living marine nematode, Deontostoma quadridentatum sp. nov., is described from a deep-sea sediment sample collected off the South Orkney Islands, the Southern Ocean, during a cruise (KH-19-6-Leg 4) conducted on the R/V Hakuho-Maru. Deontostoma quadridentatum sp. nov. differs from its congeners by the possession of: i) a cephalic capsule with a smooth posterior edge and without intralobar lacunae; ii) interlobar fenestrae with two posterior incisions; iii) four odontia on each mandible; iv) three onchia; v) spicules with velum and lateral process; vi) gubernacula with a hollow triangular crus, vii) one ventromedian supplement; viii) two precloacal subventral rows consisting of 8-10 setae and 12-20 papillae; and ix) by the lack of ocelli. Partial 18S rRNA and cytochrome c oxidase subunit I gene sequences were determined for D. quadridentatum sp. nov., and the diagnosis of Deontostoma and the dichotomous keys to the subfamilies of Leptosomatidae, genera of Deontostomatinae, and species of Deontostoma were revised. Two known species, Triceratonema montredonense comb. nov. and Triceratonema papillosum comb. nov., were transferred from Deontostoma. Our molecular phylogenetic analysis did not clarify the position of Deontostoma quadridentatum sp. nov., but we placed this species into Deontostoma based on morphological observations. We also tried to find a relationship between distribution and morphological characteristic because it seems that there are two phylogenetic lineages that exist in Deontostoma based on the distribution of all species. However, no such relationships could be found from our literature survey.

201. Intraoperative placement of analgesic calcium sulfate beads improves functional outcomes in thoracolumbar spine surgery

201. Intraoperative placement of analgesic calcium sulfate beads improves functional outcomes in thoracolumbar spine surgery

9. Novel murine model of heterotopic ossification induced by spinal cord injury

<h3>BACKGROUND CONTEXT</h3> Heterotopic ossification (HO) is a painful and debilitating condition causing abnormal bone formation in the soft tissues reported in up to 50% of polytrauma patients with spinal cord injury (SCI) and limb damage. In the absence of knowledge regarding the pathogenesis of HO, prophylactic treatment with NSAIDs, bisphosphonates, and radiation therapy do little to relieve the chronic pain and joint contractures resulting from HO or prevent its recurrence after surgical intervention to remove ectopic bone. A lack of clinically relevant animal models has been a major obstacle to understanding the pathogenesis of SCI-induced HO. <h3>PURPOSE</h3> The goal of this research is to characterize a clinically relevant mouse model of SCI-induced HO based on the hypothesis that simultaneous SCI and musculotendinous injury (MTI) can cause HO. <h3>METHODS</h3> Four-week-old C57BL/6J wild type mice were subjected to spinal cord transection between T10 and T11 using a pair of spring scissors via posterior open incision. The quadriceps were then crushed using a surgical clamp and a No. 15 surgical blade used to induce a 2mm MTI at the quadriceps insertion into patella in the LEFT hindlimb. The RIGHT hindlimb remained intact as internal procedural control. During the postoperative course, urine was expelled from the paraplegic using twice daily bladder massage. Soft food and water were placed in petri dishes on the bottom of the cages. Buprenorphine SR at 1mg/kg was administered subcutaneously on Day 0 and Day 4 to provide postoperative analgesia. All mice were euthanized at postoperative Day 21 when both hindlegs were dis-articulated at hip and ankle and fixed in formaldehyde overnight. High resolution micro-CT scans of the specimens were captured at the spatial resolution of 8µm. The volume of ectopic bone around the knee joint was quantified in a 3D reconstructed model. Undecalcified samples were then dehydrated, infiltrated, and embedded in low temperature MMA, and sectioned at 5µm. Consecutive sections were assessed by Von Kossa and Toluidine Blue staining to show ossification of peri-articular soft tissues, alkaline phosphatase (ALP) staining for osteoblasts, and tartrate-resistant acid phosphatase (TRAP) staining for osteoclasts. Mann-Whitney U test was used for statistical analysis of ectopic bone volumes. <h3>RESULTS</h3> Of the seven mice euthanized at three weeks post SCI/MTI, two sustained patellar dislocation in the LEFT knee and were excluded from analyses. Quantitative microCT analysis of the remaining five revealed ectopic bone deposits in the peri-articular region of all LEFT knees but none in the RIGHT knees. The HO volume of the LEFT hindlimb was consistently higher than that of RIGHT hindlimb of each mouse (25th - 75th percentile 0.02 - 0.34 vs 0.00 - 0.00, P=0.09). Histological evaluation confirmed ectopic bone deposited in the peri-articular soft tissues of the LEFT knees while the musculotendinous tissue was intact on the RIGHT side. <h3>CONCLUSIONS</h3> This mouse model represents a novel, reproducible and clinically relevant preclinical model of SCI-induced HO that will facilitate investigation of pathogenic mechanisms and assessment of novel therapeutics for this condition. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Radial Nerve Fascicular Transfer Preserving Long Head through Anterior Incision for Transhumeral Targeted Muscle Reinnervation

Summary:New developments in targeted muscle reinnervation promise better options for treatment of neuropathic pain and improved prosthetic control. For transhumeral amputations, the traditional approach involves an anterior incision to access the median and ulnar nerves and a second posterior incision to access the radial nerve. This is necessitated as exposure of motor branches of the radial nerve distal to the branch to the long head of the triceps is difficult from the anterior approach. Herein, we describe a technique for transferring the radial nerve proper distal to the long head branch to a motor branch to the medial or lateral head of the triceps through internal neurolysis and fascicular transfer. This allows all surgical steps to be performed through a single incision while preserving native motor branches to the biceps and triceps muscles.

Unavoidable Posterior Lower Segment Caesarean Incision Due To a 180-Degree Uterine Torsion Resulting From a Huge Anterior Uterine Fibroid: A Case Report

Background: Uterine rotation is a common occurrence in pregnancy. However, when the rotation is more than 45 degrees it is termed torsion. Uterine torsion is rare and can complicate pregnancy especially in association with uterine anatomical pathologies, pelvic masses and abnormalities and fetal anomalies. The presentation and management vary and depend on the cause, degree of torsion and age of the pregnancy. The rarity of this condition makes this case report worthwhile. Case Report: We report a case of a 30 year old primigravid woman who booked for antenatal care at 16 weeks gestational age following a 3-year history of primary infertility. The pregnancy was complicated with abdominal pain from red degeneration of uterine fibroids and was managed with pentazocine injection severally in the 2nd trimester. She presented in labour at 39 weeks but the labour was prolonged for 8 hours, having adequate contractions without any significant improvement in both descent and cervical status. She subsequently had an emergency caesarean delivery through a posterior lower segment incision due to an incidental finding of a 180-degree uterine torsion resulting from huge anterior fibroids; with an outcome of a live female neonate that weighed 3.1kg with good Apgar scores. Two pieces of fibroids were removed from the anterior surface that weighed 1.1kg. The post operative and puerperal periods were uneventful. Conclusion: Uterine torsion in pregnancy, a rare obstetric occurrence and infrequently reported complication occurs mainly in the third trimester and may complicate labour. In the presence of significant uterine fibroid, a possibility of uterine torsion may be entertained when the progress of labour is considered poor without any obvious mechanical cause. In such cases caesarean delivery with possible posterior uterine incision may be carried out. Article Details

Application of transvaginal morcellation within disposable extraction bag with traction wire in laparoscopic myomectomy

To investigate the effect and clinical value of morcellation within disposable extraction bag with traction wire through posterior vaginal fornix in laparoscopic myomectomy. A total of 42 patients who underwent laparoscopic myomectomy and morcellation through posterior vaginal fornix in the Second Affiliated Hospital of Soochow University from June 2019 to June 2021 were retrospectively analyzed. After the uterine fibroids were removed, the fibroids were placed into the extraction bag, tightening the mouth of the bag with a traction wire to make it airtight. After the uterine incisions were sutured, the extraction bag was taken out through the posterior fornix of the vagina, and the fibroids were broken up with a scalpel in the bag and taken out. The fibroids were successfully removed from the 42 patients through the posterior fornix of the vagina. There were no fibroids fragments found in the peritoneal cavity and vagina. There were no malignant cells or spindle cells found in the peritoneal lavage cytology before and after the operation. After filling the extraction bags with water, there was no leakage. There were 39 cases of uterine leiomyoma, 2 cases of cell-rich uterine leiomyoma, and 1 case of smooth muscle tumor of uncertain malignant potential in postoperative pathological diagnosis. Forty-two cases were followed up for 6 to 30 months. The posterior vaginal fornix incision healed well and there was no recurrence or metastasis. Morcellation within disposable extraction bag with traction wire through posterior vaginal fornix in laparoscopic myomectomy is a safe and feasible method for fibroids removal, which may help to reduce the dissemination of iatrogenic tumors.