Primary Reconstructive Surgery Research Articles

The Clinical Efficacy and Risk Factors after Revision and Reconstruction of Anterior Cruciate Ligament.

The aim of this study was to study the clinical efficacy and prognostic factors after revision and reconstruction of anterior cruciate ligament. All the patients who underwent the first revision of anterior cruciate ligament (ACL) reconstruction in the department of sports medicine from January 2001 to December 2015 were collected. The demographic information, the first revision and reconstruction information of ACL, and the information during the first ACL reconstruction were collected. A total of 335 cases were included. Lysholm score, Tegner activity score, and IKDC subjective score at the last follow-up were significantly higher than those before operation. Compared with graft failure caused by sports injury, the postoperative scores of patients with revision due to life accidents or initial reconstruction techniques were significantly lower (P < 0.05). The postoperative Lysholm score of patients with femoral canal drilling through the tibial canal was lower than that of patients with anterior internal approach. The postoperative IKDC score of patients who underwent medial meniscus suture at the same time was higher than that of patients without meniscus combined injury. ACL revision can improve the stability and function of knee joint. Compared with the revision caused by life accident or technical reasons of primary reconstruction surgery, the patients with graft failure caused by sports injury have better postoperative recovery. Medial meniscus suture and anterior internal approach drilling of the femoral bone canal have a statistically protective effect on the clinical function after ACL revision.

Breast Shape Evaluation After Free Flap Breast Reconstruction After More Than 10 Years Follow-up Using 3-Dimensional Imaging Device.

Breast reconstruction using autologous tissue has been widely performed, and its safety and usefulness have been reported. However, there are few reports on the long-term morphological evaluation of autologous breast reconstruction cases. We evaluated long-term change of breast shape using Vectra, a 3-dimensional imaging device, for breast reconstruction cases with more than 10 years of follow-up. The subjects had undergone autologous tissue breast reconstruction between 2007 and 2009. Sixteen deep inferior epigastric perforator flap cases were included in this study. For each patient, 4 items were measured as indicators: breast width, distance from the sternal notch to the nipple, distance from the nipple to the inframammary fold, and breast volume. The ratio of reconstructed breast to healthy breast was calculated for these 4 items. The long-term average ratio of breast width was 0.99, that of distance from the sternal notch to the nipple was 0.98, that of distance from the nipple to the inframammary fold was 0.94, and that of breast volume was 1.13. We evaluated the influence of body mass index and age at the time of the primary reconstructive surgery, but there was no significant difference in 2 body mass index groups (obese and nonobese groups) and 2 age groups (less than and more than 50 years old). We assumed that the balance between the reconstructed breast and the contralateral native breast would become worse over time because of breast sagging and changes in breast elasticity. According to our study, the shape balance of left and right breasts was maintained over time. Limitation of this study is the fact that more than half of the cases included in this study had undergone small to moderate revision surgery during the course of follow-up.

Relationship Between Timing of Anterior Cruciate Ligament Reconstruction and Chondral Injuries: A Systematic Review and Meta-analysis

Background: After anterior cruciate ligament (ACL) injury, the optimal timing of ACL reconstruction and the influence of this timing on chondral damage remain unclear. Purpose: To assess the effect of timing of ACL reconstruction on the presence of chondral injuries via a systematic review and meta-analysis. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Two reviewers independently performed systematic literature searches of 5 online databases using the Cochrane methodology for systematic reviews. Eligibility criteria were any comparative study of patients aged >16 years that assessed the relationship between timing of primary ACL reconstruction surgery and rates of chondral injuries. Meta-analysis was conducted using a random-effects model. Results: After screening, 14 studies (n = 3559 patients) out of 2363 titles met the inclusion criteria: 3 randomized controlled trials (n = 272), 3 prospective cohort studies (n = 398), and 8 retrospective cohort studies (n = 2889). In analysis of the studies, chondral injury rates were compared between ACL reconstructions performed before and after 3 time points: 3, 6, and 12 months after injury (eg, ≤3 vs >3 months). The rates of chondral injury increased with each time point. The increase was mostly due to low-grade injuries at 3 months (estimated odds ratio, 1.914; 95% CI, 1.242-2.949; P = .003), with the increase in high-grade injuries becoming predominant after 12 months (estimated odds ratio, 3.057; 95% CI, 1.460-6.40; P = .003). Conclusion: Our findings suggest that delaying ACL reconstruction surgery results in a higher rate of chondral injuries and the severity of these lesions worsens with time. These findings are comparable with those of our previously published study, which demonstrated a higher risk of meniscal tears associated with delayed ACL surgery. When ACL reconstruction is indicated, surgery ≤3 months after injury is associated with a lower risk of intra-articular damage. Registration: CRD42016032846 (PROSPERO).

Is the Capanna Technique a Reliable Method for Revision Surgery after Failure of Previous Limb-Salvage Surgery?

Reconstruction of a massive bone defect caused by previous failed limb-salvage surgery in patients with bone sarcoma is challenging. Many procedures have been used, but they all have their inherent disadvantages. The Capanna technique has demonstrated good functional outcomes and a low incidence of complications in primary reconstructive surgery of massive bone defect. However, few studies have focused on its usage in revision surgery after failed primary limb-salvage surgery. Between June 2011 and January 2017, 13 patients underwent revision surgery with the Capanna technique for reconstruction of a secondary segmental bone defect caused by a previous failed surgical procedure. The demographics, operating procedures, graft union, functional outcomes, oncologic outcomes, and postoperative complications of each patient were recorded. The current study investigated 13 patients. The rate of limb salvage was 100 %. Bone union was achieved for all patients during a mean time of 8.54 ± 2.15 months (range 4-11 months) at the fibula-host bone junction and 14.92 ± 2.33 months (range 12-21 months) at the allograft-host bone junction. The postoperative complications included wound healing issues and internal fixation loosening. Allograft fracture, nonunion, and infection were not observed. All the patients achieved good functional outcomes, with a Musculoskeletal Tumor Society (MSTS) score of 0.86 ± 0.03 at the latest follow-up visit. The Capanna technique is a reliable alternative method for revision reconstruction of a segmental bone defect caused by a previous failed surgical procedure. Level IV, therapeutic study.

Cleft Lip/Nasal Deformities After Plastic Surgery for Unilateral Cleft Lip/Palate: A Prospective Study at a Large Hospital in Vietnam.

IntroductionCongenital cleft lip, with or without cleft palate, is the most common deformity of the face. Primary plastic surgery for rehabilitation and esthetics is important for patients and their parents; however, secondary deformities of the lip and nose can occur after the primary surgery. Therefore, we performed assessment of secondary cleft lip/nasal deformities to aid in planning of surgical repair of these deformities.Materials and MethodsForty-six patients with unilateral cleft lip, with or without cleft palate, were operated with different techniques and examined post-surgery at the Department of Maxillofacial Surgery, University of Medicine and Pharmacy Hospital and Center of Odonto-Stomatology, Hue Central Hospital. They were assessed according to Motier’s post-operative evaluation scale (1997), including the red lip, white lip, scars, and nose.ResultsV notch and defect on the shift line were the most common deformities on the red lip (52.2%). About 34.8% of the patients had a short white lip on the cleft side. Straight and prominent scars were observed in 52.2% of the patients. The most common deformities of the nose were septal deviation (78.3%), followed by defects in the upper part of the nostril contour (78.3%), narrow sill (52.2%), and low position of the ala (47.8%).ConclusionSecondary cleft lip/nasal deformities are unavoidable. It is necessary to develop a plan for surgical repair of these deformities. There is no single method of cleft lip surgery that gives perfect results. Therefore, clinicians choose a combination of methods to bring optimal results for each patient.

To the anniversary of Krasovitov plastic surgery with detached skin flaps – from creating a method to current relevance

The article describes the life path of a famous Kuban surgeon Vkadimir K. Krasovitov. The historical aspects of the creation of full-layer skin plasty technique according to Krasovitov are presented, the relevance of its use in our days is analyzed, and the development of new types of skin autoplastics is presented. In addition, the author describes the history of candidate dissertation of V.K. Krasovitov's, as well as the monograph ‘Primary plastic surgery with rejected skin flaps’.

Three-Dimensional Nasolabial Changes After Nasoalveolar Molding and Primary Lip/Nose Surgery in Infants With Bilateral Cleft Lip and Palate.

Utilize 3-dimensional (3D) photography to evaluate the nasolabial changes in infants with bilateral cleft lip and palate (BCLP) who underwent nasoalveolar molding (NAM) and primary reconstructive surgery. This is a retrospective serial longitudinal study of consecutively enrolled infants from September 2012 to July 2016 with BCLP who underwent NAM before primary lip and nose reconstructive surgery. It included infants who had digital 3dMD stereophotogrammetry records at initial presentation (T1), completion of NAM (T2), and 3 weeks following primary repair (T3). Twelve infants fulfilled the inclusion criteria. 3dMD Vultus software was used to orient images and plot 16 nasolabial points with x, y, z coordinates to obtain the linear and angular measurements. Nasal form changes were measured and analyzed between T1 (0.5 months old), T2 (5 months old), and T3 (6 months old). Intraclass correlation coefficient was performed for intrarater reliability. Averaged data from the 3D images was statistically analyzed from T1 to T2 and T2 to T3 with Wilcoxon tests. Unaffected infant norms from the Farkas publication were used as a control sample. After NAM therapy, statistically significant changes in the position of subnasale and labius superius improved nasolabial symmetry. Both retruded after NAM were displaced downward after NAM and surgical correction with respect to soft tissue nasion. The nasal tip's projection was maintained with NAM and surgical correction. The columella lengthened from 1.4 to 4.71 mm following NAM. There was a significant improvement in the nasolabial anatomy after NAM, and this was further enhanced after primary reconstructive surgery.

Causes of delay in surgical repair of primary cleft lip and palate

Background: Cleft lip and palate are the most common congenital malformations of the head and neck. These disorders have high economic cost for families and impose a heavy psychological burden on children. Performing early primary reconstructive surgery on cleft lip and palate is necessary to achieve the desired treatment results. The aim of this study was to evaluate the etiology of primary cleft lip and palate reconstructive surgery retardation. Methods: In this descriptive study, 516 infants referred to Tabriz Children’s Hospital and Sina Hospital to do primary cleft lip and palate reconstructive surgery from 2009 to 2014, were studied. Ages at surgery, sex, comorbidities, cause of delay in referring the patients were evaluated. SPSS version 22 was used for statistical analysis. Results: The mean age of patients at surgery was 16.20 ± 25.97 months. There was a delayed referral for primary reconstructive surgery in 27.13% of the patients. The low weight of the child for surgery (30%), late visit of the child (19.28%), and lack of awareness among parents about the time of the visit (17.85%) were the most common causes of delay of reconstructive surgery. Conclusion: Based on the findings of this study, the low weight of the child for surgery, late visit of the child, lack of parents’ awareness about the time of the visit, comorbidities, late diagnosis, and low level of socio-economic, were the most common causes of delay in referring to reconstructive surgery respectively.

Rekonstrukcja mięśni zwieraczy odbytu w pourazowym uszkodzeniu zwieraczy z nietrzymaniem stolca – opis przypadku

Extra-obstetric injuries to the anal area are rare. The cause of isolated damage is most often accidents when working with utility machines or impalement injuries caused by sharp objects, as well as transport accidents. The authors present a rare case of a young man who, 8 years ago, suffered an extensive pelvic fracture injury, with rectal detachment, and extensive injuries to the thigh and buttock area with skin-fat lobe detachment in the course of a transport accident. At the pediatric surgery center, fracture stabilization was performed and colostomy was created, which was closed when patient completed 15 years of age. Due to persistent symptoms of fecal incontinence, the man was qualified for a late reconstruction of sphincters. Prior to the operation, detailed imaging diagnostics were performed. 6 months after the procedure, the patient declared significant improvements in quality of life and fecal retention (3/20 points on the Wexner Faecal Incontinence Quality of Life Scale). After complete healing of the wound, the patient was prescribed sphincter electrostimulation. The authors conclude that there are no clear guidelines for the management of patients with rectal and anal injuries. Treatment should be individualized on a case-by-case basis. In the situation of supplying the acute damage to the sphincter apparatus, it is crucial to verify that the injury does not also include the intraperitoneal organs, as this determines further proceedings and a possibility of primary definitive reconstructive surgery. For the successful functionality of sphincters, it is also important to implement muscle-strengthening exercises, “biofeedback” therapy and electrostimulation.

Influence of connective tissue differentiation on scar tissue formation in children

To study the immunohistochemical features of various scar tissues in children without connective tissue pathology and with undifferentiated connective tissue dysplasia syndrome. Tissue biopsy was performed in 217 children who underwent surgical treatment for various lesions, such as injuries, burns, as well as other procedures. There were 127 boys (58.5%) and 90 (41.5%) girls. The main group consisted of 98 (48.2%) children with scar tissue; group of UCTD syndrome - 65 (30.0%) children; control group - 43 (24.8%) patients without pathological scars. Histological examination of scar tissue and intact skin was carried out during primary or redo reconstructive surgery. Immunohistochemical study of antibodies against CD34, CD105, CD140b, PDGFs, COL types I, III and IV was performed. The study showed a quantitative characteristic of expression of COL type I in hypertrophic scar with predominance in the main group (77.5±5.4%; p<0.05), and decrease in COL type IV. Keloid form was associated with predominance of granulation tissue in all layers of dermis and high levels of all types of collagen. In the group of UCTD, COL type III prevailed in all pathological forms of the scar. We determined quantitative indicators of expression of vascularization factors (CD34; CD105) and fibroblastic activity (CD140b; PDGFs). Understanding the process of fibrinogenesis and analysis of stages of triggering mechanisms are essential for development of preventive algorithms. Individualized approach should be considered in the treatment. These studies are especially important in children with UCTD syndrome as high-risk group for pathological scarring. Thus, further research is required.

Association of Bacterial Biofilm with Tunnel Widening in Anterior Cruciate Ligament Revision Surgery

Revision Anterior Cruciate Ligament Reconstruction (rACLR) surgery demonstrates to be a challenging issue for both patients and their surgeons, where its long-term outcomes have proven to be poorer to primary ACL reconstruction surgery. Although tunnel lysis or enlargement after ACL reconstruction surgery is well documented, little is known about its mechanisms and etiology. Using novel microbial detection technologies, studies have not only shown the presence of biofilms in failed orthopedic procedures but also confirmed different bacterial cultures between failed reconstructions and the normal flora. The aim of the current study was to determine if there is a difference in tibial and femoral tunnel widening between cases with and without bacterial biofilm presence. This was a cross-sectional analysis of data collected from patients who underwent ACL reconstruction surgery between 2014 to 2018. This study included 62 rACLR cases and were evaluated for inclusion in the study through chart review. The tibial tunnel widening was assessed using magnetic resonance imaging (MRI) by examining the long, short, and diagonal measurements at an axial view. Femoral tunnel widening was assessed using MRI and measuring the diameter of the tunnel three consecutive times through a sagittal view. Bacterial biofilms were defined as a measurement of bacterial DNA >10 ng or a positive AGAR culture. Summary statistics and analysis was performed. The mean age for the cohort was 28.02 years (SD=10.34) with a mean of 5 .14 years till failure (SD=5.71). Of the patients who had their tibial tunnel measured, those who had biofilms observed (n=19) had a mean tibial tunnel measurement of 12.62 mm and those who had no biofilm present (n=42) had a mean tibial tunnel size of 11.25 mm (P=0.05). The mean femoral tunnel size for patients with biofilms present (n=19) was 10.69 mm compared to a mean of 9.69 mm for those without biofilms (n=42) (P=0.28). The current study suggests that patients with observed bacterial biofilms after ACL reconstructions have greater increase in tibial tunnel widening than those without infection. This study provides further evidence on the role bacteria may play in tunnel widening and prompts additional research on this association.

Retroperitoneal Laparoscopic Approach to Ureteral Primary and Reoperative Ureteral Reconstructive Surgery: A Case Series

Introduction: To improve the outcomes and extend the adaptation of salvage surgery for intractable urinary tract problems, this study retrospectively investigated indications and outcomes of retroperitoneal surgery based on retroperitoneal laparoscopic ureterolysis (RLU), in which the ureter is dissected with or without nephrolysis. Patients and Methods: Twenty-three salvage surgeries based on RLU were performed on 22 patients at our hospital between November 2002 and July 2017. Intractable urinary tract problems included lower urinary tract dysfunctions, refractory urinary fistulas, middle or lower ureter troubles, ureteroileal anastomotic strictures, and stomal stricture of cutaneous ureterostomy. After RLU, various urinary tract reconstructions were performed through minimal laparotomy under a retroperitoneal approach. Results: In all patients, RLU secured a sufficient length of ureter for subsequent urinary tract reconstructions, irrespective of intra-abdominal adhesions. Twelve cutaneous ureterostomies, one reconstruction of cutaneous ureterostomy, two ureteroileal reanastomoses, and five ureterovesicostomies were effectively performed after unilateral RLU. Three retroperitoneoscopic transureteroureterostomies with cutaneous ureterostomy were reconstructed after bilateral RLU. Over a median follow-up of 8 months (interquartile range, 2-80 months), two patients (8.7%) required additional procedures. Conclusions: Retroperitoneal salvage surgery based on RLU appears useful to salvage intractable urinary tract problems, avoiding intra-abdominal adhesions and securing a sufficient ureteral length for subsequent urinary tract reconstructions. This surgical procedure is minimally invasive and contributes to improving patient quality of life.

Radiographic and Clinical Outcomes of the Shoulder in Long-Term Follow-Up of Brachial Plexus Birth Injury

The purpose of this study was to examine radiographic and functional outcomes of the shoulder in brachial plexus birth injury (BPBI) patients at long-term follow-up. Medical records were reviewed at the Shriners Hospital in St. Louis to identify patients older than 18 years with a diagnosis of BPBI. Twenty-five patients were included in this study. Evaluations included radiographic examination, clinical examination, and outcome measures including the Mallet classification, visual analog scale (VAS) for shoulder pain, American Shoulder and Elbow Shoulder score (ASES), quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Simple Shoulder Test (SST), and Patient-Reported Outcomes Measurement Information System (PROMIS) domain measures. The mean age of the patients included was 44 years. Average follow-up was 37 years. No patient had primary nerve reconstruction surgery. Thirteen patients had a history of shoulder surgery at an average age of 6 years. There was a wide spectrum of deformity seen radiographically. Fifty-five percent of patients had evidence of glenoid retroversion, posterior humeraltranslation, or a biconcave glenoid. An additional 20% of patients had complete posterior dislocation of the humeral head. Despite the degenerative changes seen on radiographs, the mean VAS for pain was low, at 2. The mean ASES shoulder score was 54. The mean QuickDASH score was 30. Mean PROMIS Physical Function, Pain Interference, Depression, and Anxiety scores were near the means for the general population, with similar outcomes inpatients treated with shoulder surgery compared with those treated without surgery. Adult BPBI patients experience minimal shoulder pain despite deformity and degenerative changes on shoulder radiographs. Whereas there are significant deficits in range of motion and function, PROMIS scores in adult BPBI patients are normal. Therapeutic IV.

Pre-emptive digitally guided pudendal block after posterior vaginal repair

Introduction and hypothesisThe aim of this study was to establish if digitally guided pre-emptive pudendal block (PDB) reduces postoperative pain and facilitates recovery after posterior vaginal repair under local anesthesia and sedation.MethodsWe carried out a prospective, randomized, double-blind trial in an outpatient surgery facility. Forty-one women between 18 and 70 years of age, scheduled for primary posterior vaginal reconstructive outpatient surgery, completed the study. The surgery was performed using sedation and local anesthesia with bupivacaine/adrenaline. At the end of surgery, 20 ml of either ropivacaine 7.5 mg/ml or sodium chloride (placebo) was administered as a digitally guided PDB. The primary aim was to establish if PDB with ropivacaine compared with placebo reduced the maximal pain as reported by visual analog scale (VAS) during the first 24 h after surgery. Secondary aims were to compare the duration and experience of the hospital stay, nausea, need for additional opioids, and adverse events.ResultsPDB with ropivacaine after local infiltration with bupivacaine/adrenaline after outpatient posterior repair did not significantly reduce maximal postoperative pain, need for hospital admittance, nausea, or opioid use. Mild transient sensory loss occurred after ropivacaine in two women. Two women the placebo group were unable to void owing to severe postoperative pain, which was resolved by a rescue PDB.ConclusionsWhen bupivacaine/adrenaline is used for anesthesia in posterior vaginal repair, PDB with ropivacaine gives no benefit regarding postoperative pain, recovery or length of hospital stay. Rescue PDB can be useful for postoperative pain relief.

Revision Medial Ulnar Collateral Ligament Reconstruction in Baseball Pitchers: Review of Epidemiology, Surgical Techniques, and Outcomes.

The purposes of this review are to describe the epidemiology, treatment options, and clinical outcomes of revision medial ulnar collateral ligament reconstruction in baseball pitchers. Rates of revision UCL range from 1 to 15% and have slowly increased over the past several years. Revision UCL procedures are associated with higher complication rates, likely due to the distortion of innate anatomy after primary reconstruction. Techniques for reconstruction are largely influenced by the index surgery and integrity of the ulnar and humeral bone tunnels/sockets. Current literature reporting on the outcomes following revision UCL reconstruction is limited to case series and database studies. Mean time between primary reconstruction and revision surgery is approximately 5years and return to play rates range from 47 to 85%. Outcomes following revision UCL reconstruction are relatively guarded compared with those of primary UCL reconstruction with the most studies reporting lower return to play rates, decreased workloads compared with pre-injury levels of play, and shorter career longevity following revision surgery. Future research regarding optimal reconstruction techniques and post-operative rehabilitation are needed as the incidence and demand for this procedure is expected to increase.

ОПЫТ МУЛЬТИВИСЦЕРАЛЬНЫХ РЕЗЕКЦИЙ ПРИ МЕСТНОРАСПРОСТРАНЁННОМ И ПЕРВИЧНО-МНОЖЕСТВЕННОМ РАКЕ ПРЯМОЙ КИШКИ

Objective: Assessing short-term and long-term results of multivisceral resections (MVR) performed for rectal cancer (RC) with invasion into adjacent pelvic organs, as well as the effectiveness of bladder reconstruction with the formation of a urinary reservoir of «low» pressure. Methods: The work was based on the results of surgical treatment of 37 patients with locally advanced or primary multiple RC underwent MVR. Invasion of adjacent small organs was observed in 89.2%, primary multiple malignant tumors (PMMT) – in 10.8% of patients included in the study. Results: According to the preoperative examination of tumor infiltration of one adjacent organ was diagnosed in 20 (54.1%), two or more organs – in 17 (45.9%) observations; more often affected the bladder – in 18 (48.6%) cases. Volumes of performed operations: in 6 (16.2%) cases of complete pelvic organs evisceration, in 10 (27%) cases of MVR with rectal extirpation, in 21 (56.8%) cases of MVR with resection of the rectum and adjacent organs. More often in 27 (72.9%) patients, there was urinary tract resection, of which 11 (29.7%) patients underwent primary bladder repair with the formation of ortho- (n=3) or heterotopic (n=6) urinary reservoir of «low» pressure. Postoperative complications developed in 14 (37.8%) patients, what required re-surgery in 8 (21.6%) observed, of which urological complications occurred in 4 (10.8%) patients. Complications were not observed during the formation of the artificial bladder according to the presented method. Long-term results: RC – overall and disease-free 2-year survival – 78.1% and 65.6% respectively, PMMT – all patients are alive without signs of relapse, the timeline of observation is 24 months. Conclusions: The immediate results of MVR on locally advanced RC can be considered as satisfactory. The level of postoperative complications is primarily due to the prevalence of primary tumors. In case of urinary tract resection, primary plastic surgery is preferred. Long-term results allows to examine such operations as a method of choice in the treatment of RC with invasion in adjacent organs. Keywords: Rectal cancer, surgical treatment, multivisceral resection, bladder reconstruction, postoperative complications, disease-free survival.

Burden of cleft surgery—a 21-year follow-up of patients with cleft lip and palate

The burden of cleft care throughout a patients’ life includes plastic surgery, otolaryngology (ENT), speech therapy and dental and orthodontic care, all of which are required to achieve an optimal outcome. We aimed to determine the burden of care across multiple specialties in babies born with cleft lip and/or palate up to the age of 21 years. We compare the outcomes to two larger multi-centre studies: the Americleft and Eurocleft studies. The regional database was used and all babies born between 1988 and 1995 were included. Medical records and the cleft database were used to determine cleft subtype, operations and outpatient appointments (plastics, ENT, dental, orthodontic, speech and language), hospital stay and length of follow-up. A total of 321 patients with cleft lip and/or palate were born between 1988 and 1995. Complete data was available for 106 (33%). Primary and secondary plastic surgery operations increased with increasing cleft severity. Secondary surgery was highest in unilateral cleft lip and palate (UCLP)—64%. Total inpatient stay for plastic surgery operations was highest for bilateral cleft lip and palate (BCLP) (16.4 days) compared with 7.7 for incomplete cleft palate (iCPO). The outpatient burden for all specialities was highest in complex cleft patients: 48.5 appointments compared with 25.5 for children with an incomplete cleft palate. Follow-up time increased from 14.2 to 20.5 years. Unsurprisingly, both the inpatient and outpatient burdens of care are influenced by the complexity of the cleft and increase with worsening severity. Our results will help inform parents of the likely trajectory their child will face when diagnosed with each subtype of cleft. The 2014 data shows that modern cleft care is changing; a combination of reduced hospital stay and the addition of streamlined outpatient appointments will both be of great benefit. The influence of modern day life will hopefully reduce the associated burden that has been highlighted in this paper and it is vital the benefits of modernisation are communicated to parents as well. Level of evidence: Level III, risk/prognostic study.

The Ultrasound-guided Multiple-injection Costotransverse Block for Mastectomy and Primary Reconstructive Surgery.

The Ultrasound-guided Multiple-injection Costotransverse Block for Mastectomy and Primary Reconstructive Surgery.

Risk factors and prevention of postmastectomic syndrome in breast cancer surgery

Postmastectomy syndrome (PMES) is considered one of the most frequent complications after radical operations in patients with breast cancer (BC).The aim of the study was to identify risk factors and develop preventive measures for PMES after radical operations in BC patients.Materials and methods. The immediate results of surgical treatment of 147 women with BC who underwent radical surgery were analyzed: the frequency of postoperative edema and PMES depending on the initial clinical and pathological parameters and treatment features using descriptive statistics, χ2 criterion, and correlation analysis.Results. PMES during the observation period was diagnosed in 17 (11.6 %) patients, including: I st. – in 7 (4.8 %); II st. – in 9 (6.1 %) and III st. in one case (0.7 %). In most cases, its development was associated with postoperative edema, which was detected in the early postoperative period in 15 (88 %) of these patients. The dependence of the incidence of PMES on BMI and the age of patients with a tendency to increase it with the use of adjuvant radiation therapy and decrease with primary breast plastic surgery has been established. The use of a complex of preventive measures led to a decrease in the frequency of PMES (from 17 % to 2 %).Conclusions. In patients with BC, a frequent complication of radical surgery is postoperative edema of the upper limb and / or PMES, the risk of which increases with increasing age and BMI, as well as with the use of adjuvant radiation therapy. The use of a complex of preventive measures helps to significantly reduce the frequency of these complications

Primary appendicular soft-tissue sarcoma resection: What tumour parameters affect wound closure planning?

Wound closure after wide, local excision of an appendicular soft-tissue sarcoma (STS) can be challenging. This study evaluates the value of magnetic resonance imaging (MRI)-based tumour parameters in planning wound closure. A total of 71 patients with a primary limb-based STS, excluding vascular or osseous involvement, excluding the shoulder or hand and hip or foot were included. Axial MRI images were used to measure the circumferences and cross-sectional areas of the limb, bone, and tumour. The tumour diameter, length, and depth at the level of maximal tumour dimension were measured to identify the tumour's relative contribution to the planning of optimal wound closure management through primary closure (PC) or reconstructive surgery (RS). Eighteen patients required planned wound RS. Wound complications occurred in 14% overall. Tumours, which were closed by PC, were of significantly greater depth, shorter radial diameter, and shorter tumour circumference relative to those closed by RS. On multivariate analysis, tumour depth was the greatest contributory factor in predicting type of wound closure. A quantitative analysis of MRI-based tumour parameters demonstrates tumour depth as the most predictive factor in planning for the type of wound closure and may prove beneficial in providing greater insight into planned wound management of sarcoma resection.