Combined Reconstruction Technique Research Articles

Urinary continence following extraperitoneal radical prostatectomy: impact of surgical technique and pelvic fascial spaces reconstruction

Introduction. Urinary incontinence is a common complication of radical prostatectomy. The development of surgical techniques when performing radical prostatectomy that improve the function of urinary continence after surgery is actual.Objective. To compare urinary continence functions in long-term follow-up after open and laparoscopic radical prostatectomy when only posterior or combined (anterior + posterior) reconstruction of the pelvic fascial spaces is performed.Materials & methods. The study included 130 patients aged 63.0 [59.0; 68.0] years with local prostate cancer (сT1a-2сN0-xM0; 1 – 4 ISUP groups), subjected to non-nerve-sparing retropubic radical prostatectomy with posterior reconstruction and non-nerve-sparing extraperitoneal laparoscopic radical prostatectomy with isolated posterior or combined (anterior + posterior) fascial reconstruction of the pelvic fascial spaces. Postoperative continence function was studied at 1, 3, 6, and 12 months following surgery using a standard pad test.Results. The incidence of urinary continence was higher at all follow-up periods during laparoscopic surgery. From the 6-months follow-up, these patients did not have severe urinary incontinence. At the same time, the rate of growth of some patients who began to retain urine did not depend on the method of reconstruction of the pelvic fascial spaces. The use of combined reconstruction of the pelvic fascial spaces at 12-months follow-up showed an advantage in urinary continence over performing only posterior reconstruction. Such patients achieved urinary continence in 90% of cases compared to 80.0% of cases. At the same time, the restoration of urinary continence at all periods of observation had a relatively uniform linear rate of increase in the indicator.Conclusion. Reconstruction of the pelvic fascial spaces during open and laparoscopic radical prostatectomy allows one to achieve satisfactory continuation in the postoperative period. However, higher efficiency is achieved when using a combined reconstruction technique.

Differences between Coracoclavicular, Acromioclavicular, or Combined Reconstruction Techniques on the Kinematics of the Shoulder Girdle

Background: Although the coracoclavicular (CC) ligaments are classically reconstructed after acromioclavicular (AC) joint injuries, biomechanical studies over the past decade have indicated the importance of an additional reconstruction of the AC ligaments. To date, no kinematic study has investigated the kinematic differences between these reconstruction strategies. Purpose: To evaluate the restoration of shoulder motion after an AC injury using a CC ligament, an AC ligament, or a combined reconstruction technique. Study Design: Controlled laboratory study. Methods: After creating a Rockwood grade V lesion in 14 cadaveric shoulders, the AC joint injury was treated with either a CC ligament reconstruction using a suspension device, an in situ AC ligament reconstruction using 2 coupled soft tissue anchors, or a combination of these 2 techniques. Joint motions were registered during humerothoracic elevation in the coronal plane and protraction in the intact shoulder in a Rockwood V lesion and after the 3 reconstruction strategies. An optical navigation system measured 3-dimensional rotation in the sternoclavicular and scapulothoracic joints, and both rotation and translation were analyzed in the AC joint. Results: In the sternoclavicular joint, the CC and combined reconstruction techniques adequately restored clavicular axial rotation, while the AC reconstruction technique showed a better correction of clavicular elevation. Scapulothoracic joint rotations were best restored by reconstructing the AC ligaments. In the AC joint, the relative tilting position and the lateral rotation of the scapula compared with the clavicle were best restored by the suspension device and combined reconstruction. The AC ligament reconstruction technique demonstrated a better restoration of the relative protracted position and resulted in a better correction of the translation of the scapula relative to the clavicle. Conclusion: This study illustrates that there are kinematic differences between AC, CC, or combined ligament reconstruction strategies. Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. Clinical Relevance: Humerothoracic movements after Rockwood V lesions are best restored using the CC reconstruction technique, and scapulothoracic movements are best restored using the AC ligament reconstruction technique.

Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis

BackgroundIt is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims systematically to compare the clinical effectiveness of ACL reconstruction and combined reconstruction.MethodsElectronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis were performed to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test.ResultsTwelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83–0.94) and grade 2 (RR = 0.95, 95% CI: 0.91–0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90–1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89–1.05) and grade 2 (RR = 0.96, 95% CI: 0.90–1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89–0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86–1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = − 6.38, 95% CI: − 9.66 to − 3.10), 24-month (WMD = − 5.60, 95% CI: − 8.54 to − 2.66) and 36-month follow-ups (WMD = − 4.71, 95% CI: − 7.59 to − 1.83) and the Tegner score at the 36-month follow-up (WMD = − 0.53, 95% CI: − 0.97 to − 0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = − 0.84, 95% CI: − 2.02 to 0.34).ConclusionWith the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.

Combined Reconstruction of the Medial Patellofemoral Ligament (MPFL) and Medial Quadriceps Tendon-Femoral Ligament (MQTFL) for Patellar Instability in Children and Adolescents: Surgical Technique and Outcomes.

A variety of surgical options exist to treat the challenging problem of recurrent patellar instability in children and adolescents. The goal of the current study is to describe a novel combined reconstruction technique of both the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon-femoral ligament (MQTFL) and report patient outcomes of a single-surgeon series. All patients studied underwent simultaneous MPFL and MQTFL reconstruction for patellar instability using gracilis allograft. Demographic, clinical, and radiographic data were collected. Subjective outcomes were assessed for a minimum of 1 year postoperatively. Twenty-five patients (27 knees), including 15 female and 10 male individuals with an average age of 15.0±2.2 years (range, 10.3 to 18.9), were included. Prior ipsilateral patellofemoral surgery had been performed in 6 of 25 (24%) patients. Simultaneous hemiepiphysiodesis for valgus deformity at the time of combined reconstruction was performed in 5 of 25 (20%) patients. Preoperative imaging showed a mean tibial tubercle-trochlear groove of 17.2±3.8, Caton-Deschamps Index (CDI) of 1.13±0.16, and trochlear dysplasia Dejour A/B [22/26 (85%)] or Dejour C/D [4/26 (15%)]. A total of 18 patients (19 knees, 72%) returned outcomes questionnaires at a mean 2.0±0.5 years after surgery. Mean Kujala, Pedi-IKDC, and Lysholm scores were 85.9±13.9, 81.5±15.2, and 84.3±13.5, respectively. Later revision procedure (tibial tubercle osteotomy) for recurrent patellar instability was required in 2 of 25 patients (8%) patients, and another patient reported persistent instability not requiring revision. Return to sports was possible in 10 of 13 self-reported athletes (77%) at a mean of 5.8±3.9 months (range, 2 to 15). The present study describes a combined MPFL-MQTFL reconstruction technique with favorable short-term results. Although particularly useful in the skeletally immature patient where tibial tubercle osteotomy should be avoided and patellar fixation minimized, combined reconstruction may potentially be appropriate for older patients with patellofemoral instability as well. This technique more closely recreates the native anatomy of both the MPFL and MQTFL, may decrease the risk of patellar fracture, and can be useful in the revision setting. Level IV.

Bone and parietal anterior iliac crest reconstruction for trans-iliac hernia after tricortical graft harvesting: An original technique

Tricortical cortico-cancellous bone allografts from the anterior iliac crest are routinely used in revision arthroplasty and to treat non-union. Trans-iliac herniation (TIH) has been reported as an exceptional complication after extensive graft harvesting. The various reconstruction techniques include isolated parietal reconstruction and combined parietal and bone reconstruction using allografts or a spacer to reconstruct the bone defect. No previous study has evaluated a combined reconstruction technique involving both bone reconstruction with a titanium plate and abdominal wall reconstruction with a parietal reinforcement prosthesis. This technical note describes the evaluation of an original combined reconstruction technique used after failure of isolated parietal reconstruction to treat TIH. Through a direct approach to the anterior iliac crest, the bone defect was repaired using a flexible titanium cranio-facial reconstruction plate and the abdominal wall defect using a polypropylene/poliglecaprone parietal reinforcement prosthesis. This original technique was demonstrated to be effective for treating TIH, with no recurrence after 2.5 years of follow-up. In addition, this technique involves no added morbidity related, for instance, to allograft using or spacer migration.

Power system frequency estimation based on an orthogonal decomposition method

In recent years, several frequency estimation techniques have been proposed by which to estimate the frequency variations in power systems. In order to properly identify power quality issues under asynchronously-sampled signals that are contaminated with noise, flicker, and harmonic and inter-harmonic components, a good frequency estimator that is able to estimate the frequency as well as the rate of frequency changes precisely is needed. However, accurately estimating the fundamental frequency becomes a very difficult task without a priori information about the sampling frequency. In this paper, a better frequency evaluation scheme for power systems is proposed. This method employs a reconstruction technique in combination with orthogonal filters, which may maintain the required frequency characteristics of the orthogonal filters and improve the overall efficiency of power system monitoring through two-stage sliding discrete Fourier transforms. The results showed that this method can accurately estimate the power system frequency under different conditions, including asynchronously sampled signals contaminated by noise, flicker, and harmonic and inter-harmonic components. The proposed approach also provides high computational efficiency.

Combined Reconstruction of the Medial Patellofemoral Ligament (MPFL) and Medial Quadriceps Tendon - Femoral Ligament (MQTFL) for Patellar Instability in Children and Adolescents: Surgical Technique and Outcomes

Objectives:A variety of surgical options exist to treat the challenging problem of recurrent patellar instability in skeletally immature patients. The current study describes a combined reconstruction technique involving both the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon - femoral ligament (MQTFL) and reports patient outcomes of a single-surgeon series.Methods:All patients studied underwent combined MPFL and MQTFL reconstruction for patellar instability. Demographic data, pre- and post-operative radiographic data were collected. Reconstruction was performed using gracilis allograft. The graft midportion was fixed to the MPFL insertion on the femur via suture anchor. One arm of the graft (MPFL) was tunneled under medial retinaculum to the medial border of the patella and fixed there via suture anchor, while the other (MQTFL) arm was tunneled, delivered under the VMO and brought through the medial distal quadriceps tendon and sutured in place. Subjective outcome scores (Kujala, Pedi-IKDC, Lysholm) were collected via questionnaires mailed to patients more than one year from surgery.Results:A total of 25 patients (27 knees), including 15 females and 10 males with an average age of 15.0 ± 2.2 years (range 10.3-18.9), underwent combined MPFL and MQTFL reconstruction. 6/25 (24%) had undergone prior ipsilateral patellofemoral surgery for instability. 5/25 (20%) underwent simultaneous guided growth via hemiepiphysiodesis for valgus deformity at the time of combined reconstruction. Preoperative imaging showed a mean TT-TG of 17.2 ± 3.8, Caton-Deschamps Index (CDI) of 1.13 ± 0.16, and trochlear dysplasia Dejour A/B (22/26 (85%)) or Dejour C/D (4/26 (15%)). A total of 18 patients (19 knees, 72%) returned outcomes questionnaires at a mean 2.0 ± 0.5 years after surgery. Mean Kujala, Pedi-IKDC, and Lysholm scores were 85.9 ± 13.9, 81.5 ± 15.2, and 84.3 ± 13.5, respectively. 2/25 patients (8%) later required a revision procedure (tibial tubercle osteotomy) for recurrent patellar instability, and another patient reported persistent instability not requiring revision. 10/13 patients (77%) were able to return to sports at a mean of 5.8 +/- 3.9 months (range 2-15).Conclusion:The current study describes a novel anatomically-validated surgical technique involving the simultaneous reconstruction of both the MPFL and MQTFL in a pediatric patient population. Follow-up data presented demonstrates overall positive results in treating this challenging problem in a young patient population.

Three-layer reconstruction of lower third nasal defects using forehead flap, reversed nasolabial flap, and auricular cartilage

The reconstruction of a full-thickness defect of the distal third of the nose requires the restoration of all three anatomical layers. A practical method for three-layer reconstruction of the lower third of the nose and the long-term results of this technique are presented herein. A combined reconstruction technique was utilized, including a reverse subcutaneous pedicled nasolabial flap to restore the nasal mucosa, an auricular cartilage graft for structural support, and a forehead flap for cutaneous coverage of the defect. This technique was applied in 21 patients following the full-thickness excision of basal cell carcinoma of the lower part of the nose. All patients (12 male and nine female; mean age 59.8 years) were treated successfully and were satisfied with the aesthetic and functional outcomes. The wound had to be further revised in three cases for the correction of contour or residual deformities; however, no further complications were experienced. One patient had a wound infection and the cartilage had to be removed. The grafting procedure was repeated successfully after resolution of the infection. Donor site morbidity was unremarkable. Combined flaps from the forehead and nasolabial regions with an incorporated auricular cartilage graft can be used to reconstruct full-thickness defects of the lower third of the nose.

Investigation of 3D SPECT Reconstruction with Multi-energy Photon Emitters

Parallel projection based Single Emission Computed Tomography is a widely used nuclear imaging technique. Non-homogeneous attenuation medium and the distance dependent spacial resolution (DDSR) of the parallel imaging cause serious artefacts during image reconstruction. Both effects are dependent on the energy of gamma photons used for imaging. In this paper an efficient parallel reconstruction algorithm is introduced that is executed on the Graphics Processing Unit. The aim of the presented study was to investigate the possibilities of reconstruction techniques when multi-energy photon emitters are used. An analytical 3D projector with attenuation and detector response modelling was used to generate projection sets for Gallium-67 isotope studies. Data were reconstructed from one photopeak only using the corresponding attenuation map. The projection data sets were added together and reconstructed using average attenuation and DDSR compensation values as well as simulating every photopeak individually. The third combined reconstruction technique was using every projection set as separate measurement. In this study we showed that all three strategies result in similar image quality, however the average attenuation correction method is computationally less demanding.

A comparison of duality and energy a posteriori estimates for $\mathrm {L}_{\infty }(0,T;\mathrm {L}_2(\varOmega ))$ in parabolic problems

We use the elliptic reconstruction technique in combination with a duality approach to prove aposteriori error estimates for fully discrete back- ward Euler scheme for linear parabolic equations. As an application, we com- bine our result with the residual based estimators from the aposteriori esti- mation for elliptic problems to derive space-error indicators and thus a fully practical version of the estimators bounding the error in the L \infty (0, T ; L2({\Omega})) norm. These estimators, which are of optimal order, extend those introduced by Eriksson and Johnson (1991) by taking into account the error induced by the mesh changes and allowing for a more flexible use of the elliptic estima- tors. For comparison with previous results we derive also an energy-based aposteriori estimate for the L \infty (0, T ; L2({\Omega}))-error which simplifies a previous one given in Lakkis and Makridakis (2006). We then compare both estimators (duality vs. energy) in practical situations and draw conclusions.

Combined submandibular gland flap and sternocleidomastoid musculocutaneous flap for postoperative reconstruction in older aged patients with oral cavity and oropharyngeal cancers.

BackgroundThe growth of aging populations in an increasing number of countries has led to a concomitant increase in the incidence of chronic diseases. Accordingly, the proportion of older aged patients with oral cavity and oropharyngeal cancers and comorbidities has also increased. Thus, improvements must be made in the tolerance and safety of surgical procedures for these patients with complex medical conditions. In this study, we investigated combined submandibular gland flap and sternocleidomastoid musculocutaneous flap for postoperative reconstruction in older aged patients with oral cavity and oropharyngeal cancers in terms of surgical methods, safety, and clinical outcome.MethodsBetween January 2011 and May 2012, 8 patients over the age of 65 years (7 men, 1 woman; aged 66 to 75 years (median, 69.6)) with oral cavity and oropharyngeal cancers underwent combined submandibular gland and sternocleidomastoid myocutaneous flaps for postoperative reconstruction at Ganzhou Tumor Hospital. All eight patients had comorbid cardiovascular, cerebrovascular, or chronic respiratory disease or diabetes. Clinical outcomes, complications, and tolerance to surgical treatment were observed.ResultsSurgical treatment was successful in all eight patients. All submandibular gland flaps survived with well-mucosalized surfaces and with no complications. During the postoperative follow-up period of 12 to 28 months, no patient developed local recurrence or distant metastasis, and all had good recovery of function and local contour.ConclusionsThis combined reconstruction technique enables appropriate restoration of oral function, facial aesthetics and improved quality of life. Further, this technique has several advantages: it is easier to perform, reduces operation time and surgical risk, causes less surgical injury, and has minor impact on contour. The technique provides a new and safe reconstruction option for older aged patients with oral cavity and oropharyngeal cancers.

Evaluation of Transtibial Double-Bundle Posterior Cruciate Ligament Reconstruction Using a Single-Sling Method With a Tibialis Anterior Allograft

Background: The authors devised a double-bundle posterior cruciate ligament reconstruction technique in combination with a single-sling method. However, the double-bundle technique needs more simplicity and a decreased possibility of failure. Hypothesis: A novel surgical technique of transtibial double-bundle posterior cruciate ligament reconstruction using a single-sling method with a tibialis anterior allograft, previously introduced, produces satisfactory results. Study Design: Case series; Level of evidence, 4. Methods: Twenty-one patients who underwent double-bundle transtibial isolated posterior cruciate ligament reconstruction using a single-sling method between July 2003 and September 2007 were enrolled in this study. The exclusion criteria applied were (1) a multiligamentous injury, (2) posterior cruciate ligament reconstruction previously performed using another technique, and (3) the presence of any additional injury capable of affecting knee stability. The Lysholm and International Knee Documentation Committee (IKDC) knee scales were used for the clinical outcome evaluation. Stability was evaluated using a KT-2000 arthrometer. The evaluation was performed by comparing preoperative and last follow-up results. Results: Nineteen men and 2 women were enrolled, with a mean follow-up of 49.2 months (range, 25-73 months). The mean Lysholm score was 53 ± 5.3 (range, 34-68) preoperatively and improved to 83.5 ± 13 (range, 61-97) at the last follow-up after surgery (P < .001). The IKDC score also improved from preoperative (0 A, 0 B, 7 C, 14 D) to final follow-up (8 A, 9 B, 3 C, 1 D; P < .001). Mean side-to-side difference in posterior translation, measured using the KT-2000 arthrometer, was 13.5 ± 1.2 mm preoperatively and 3.4 ± 0.8 mm at last follow-up evaluations (mean 51.7 months postoperatively). Conclusion: After follow-up for longer than 24 months, the transtibial double-bundle posterior cruciate ligament reconstruction with a single sling was found to produce satisfactory clinical and stability results, which indicates that the described technique should be viewed as a viable alternative.

High-quality 3-D coronary artery imaging on an interventional C-arm x-ray system

Three-dimensional (3-D) reconstruction of the coronary arteries during a cardiac catheter-based intervention can be performed from a C-arm based rotational x-ray angiography sequence. It can support the diagnosis of coronary artery disease, treatment planning, and intervention guidance. 3-D reconstruction also enables quantitative vessel analysis, including vessel dynamics from a time-series of reconstructions. The strong angular undersampling and motion effects present in gated cardiac reconstruction necessitate the development of special reconstruction methods. This contribution presents a fully automatic method for creating high-quality coronary artery reconstructions. It employs a sparseness-prior based iterative reconstruction technique in combination with projection-based motion compensation. The method is tested on a dynamic software phantom, assessing reconstruction accuracy with respect to vessel radii and attenuation coefficients. Reconstructions from clinical cases are presented, displaying high contrast, sharpness, and level of detail. The presented method enables high-quality 3-D coronary artery imaging on an interventional C-arm system.

Assessment of Gastric Cancer: Value of Two-phase Multidetector-row Spiral CT Three-dimensional Reconstruction Technique

Objective: To evaluate the diagnostic value of two-phase multidetector-row spiral CT threedimensional reconstruction technique in TNM staging of gastric cancer. Methods: In 29 patients with gastric carcinoma pathologically conformed, plan scans were done firstly. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of anisodamine and effervescent granules. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase, and the source images were thin reconstructed. The stomach to three-dimension analysis was constructed by volume rendering (VR) multiplanar volume reconstruction (MPVR), shaded surface display (SSD) and CT virtual gastroscopy (CTVG) technique. In combination with the sources images, gastric tumour invasion and lymph node metastasis was assessed, and TNM staging was performed. Results: In 29 cases of gastric carcinoma, the sensitivity and specificity of two-phase multidetector-row spiral CT three-dimensional reconstruction technique in T1, T2, T3 and T4 staging, the sensitivity and specificity was 50% and 50%, 87.5% and 77.8%, 83.3% and 76.9% and 100% and 80% respectively. For the N staging, the sensitivity and specificity in N0, N1, and N2-N3 was 83.3% and 71.4%, 87.5% and 77.8% and 81.8% and 75% respectively. The sensitivity and the specificity for M1 staging was 100%. Conclusion: The reconstruction technique in combination with 16-slices spiral-CT can perform TNM staging well and effectively guide the choice of the surgical procedures for gastric cancer.