Relaxing Incisions Research Articles

Comparative Study on Toric Intraocular Lens vs Peripheral Corneal Relaxing Incisions to Correct Astigmatism in Eyes Undergoing Cataract Surgery

Comparative Study on Toric Intraocular Lens vs Peripheral Corneal Relaxing Incisions to Correct Astigmatism in Eyes Undergoing Cataract Surgery

How does a toric intraocular lens (IOL) compare with a limbal relaxing incision (LRI) for people with corneal astigmatism after phacoemulsification?

How does a toric intraocular lens (IOL) compare with a limbal relaxing incision (LRI) for people with corneal astigmatism after phacoemulsification?

Palatal fistula rate after Huaxi Sommerlad-Furlow palatoplasty

This study aimed to determine the palatal fistula rate, explore the influencing factors of Huaxi Sommerlad-Furlow (SF) palatoplasty. A retrospective review of 385 consecutive cleft-palate cases was performed to determine the incidence of postoperative fistula and assess the possible contributing factors, such as sex, weight, age, cleft type, operator skills, preoperative white blood cell, preventive antibiotic use, and postoperative temperature. Fistulas occurred in 15/385 patients (3.9%). Among them, 1 fistula was located at the junction of the hard and soft palates, 12 fistulas in hard palate, and 2 fistulas in alveolar near the hard palate. No evidence suggested that sex, weight, age, preoperative white blood cell, preventive antibiotic use, and postoperative temperature are associated with fistula formation. The incidences of cleft palate fistulas as encountered by senior professors (3.03%) and associate senior professors (2.23%) were significantly lower than those by attending doctors (14.29%, P<0.05). The incidences of cleft palate fistulas in bilateral completely cleft palate cases (20.6%) were significantly higher than those in hard and soft (3.6%) and unilateral cleft palate cases (2.6%, P< 0.05). Huaxi SF palatoplasty can avoid the inhibited maxillary growth without requiring lateral relaxing incision, which poses an acceptable risk of fistula formation. The palatal fistula rate is not related to the sex, weight, age of operation, prophylactic use of antibiotics before operation, infection before operation, temperature after operation and other factors. The occurrence of the fistula is related mainly to cleft type and experience level of the surgeon.

Temporo-Parietal Flap Incorporated Into a Modified Osteo-Odonto Keratoprostheses Protocol for Longevity of the Dental Lamina.

To describe a novel pedicled temporo-parietal flap to delay laminar resorption in a modified osteo-odonto keratoprosthesis (MOOKP) and measure resorption of the dental lamina by an objective method. A retrospective case series was performed on patients who received an osteo-odontokeratoprosthesis for Steven-Johnson-Syndrome. Surgeries were performed between October 2016 and November 2017 by the same surgical team (G.M. and S.W.). A modified temporo-parietal flap was incorporated into stage 1 of the MOOKP procedure. CT Scans were performed post op and on follow up. Volumetric evaluation was achieved by automated software analysis of 3D reconstructed CT images (Vitrea, Software Version 6.7.6, Cannon Medical Systems ANZ Pty Ltd). The procedure was performed in 3 eyes from 3 patients. Patients were followed up for stage 2 review at 9.6 months on average (22-55 weeks). One case was complicated by early postoperative hematoma of the buccal graft; however, this was managed conservatively. Another case required relaxing incisions at the time of flap creation due to increased vascularized collagenous tissue. On follow up, volume changes in the dental lamina were minimal. Loss of laminar volume can potentially jeopardize the success of the MOOKP, and consequently cause significant visual, graft or globe complications. The long-term success of this method needs further evaluation; however, initial results suggest a possible role for pedicle grafts in maintenance of the dental lamina. Furthermore, objective CT-based calculation of laminar volume may reduce inter-study variability and standardize comparison of techniques.

Peripheral nerve block for pain control in lower leg compartment syndrome after relaxing incision and acute lower limb arterial occlusion

Peripheral nerve block for pain control in lower leg compartment syndrome after relaxing incision and acute lower limb arterial occlusion

Toric intraocular lens versus limbal relaxing incisions for corneal astigmatism after phacoemulsification.

Cataract is the leading cause of blindness in the world, and clinically significant astigmatism may affect up to approximately 20% of people undergoing cataract surgery. Pre-existing astigmatism in people undergoing cataract surgery may be treated, among other techniques,by placing corneal incisions near the limbus (limbal relaxing incisions or LRIs) or by toric intraocular lens (IOLs) specially designed to reduce or treat the effect of corneal astigmatism on unaided visual acuity. To assess the effects of toric IOLscompared with LRIs in the management of astigmatism during phacoemulsification cataract surgery. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2019, Issue 9); Ovid MEDLINE; Ovid Embase and four other databases. The date of the search was 27 September 2019. We included randomised controlled trials (RCTs) comparing toric IOLs with LRIs during phacoemulsification cataract surgery. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. We graded the certainty of the evidence using GRADE. Our primary outcome was the proportion of participants with postoperative residual refractive astigmatism of less than 0.50 dioptres (D) six months or more after surgery. We also collected data on mean residual refractive astigmatism. Secondary outcomes included: uncorrected distance visual acuity, vision-related quality of life, spectacle independenceand adverse effects including postoperative lens rotation requiring re-alignment. To supplement the main systematic review assessing the effects of toric IOLs compared with LRIs in the management of astigmatism during phacoemulsification cataract surgery, we sought to identify economic evaluations on the subject. We identified 10 relevant studies including 517 people (626 eyes).These studies took place in China (three studies), UK (three), Brazil (one), India (one), Italy (one)andSpain (one). The median age of participants was 71 years. The level of corneal astigmatism specified in the inclusion criteria of these studies ranged from 0.75 D to 3 D. A variety of toric IOLs were used in these studies, in all but one study, these were monofocal. Studies used three different nomograms to determine the size and placement of the LRI. Two studies did not specify this.None of the studies were at low risk of bias in all domains, but two studies were at low risk of bias in all domains except selective outcome reporting, which was unclear. The remaining studies were at a mixture of low, unclear or high risk of bias. People receiving toric IOLs were probably more likely to achieve a postoperative residual refractive astigmatism of less than 0.5 Dsix months or more after surgery(risk ratio (RR)1.40, 95% confidence interval (CI)1.10 to1.78; 5 RCTs, 262 eyes). We judged this to be moderate-certainty evidence, downgrading for risk of bias. In the included studies, approximately 500 eyes per 1000 achieved postoperative astigmatism less than 0.5 D in the LRI group compared with 700 per 1000 in the toric IOLs group.There was a small difference in residual astigmatism between the two groups, favouring toric IOLs (mean difference (MD) -0.32 D, 95% CI -0.48 to -0.15 D; 10 RCTs, 620 eyes). Although all studies favoured toric IOLs, the results of individual studies were inconsistent (range of effects -0.02 D to -0.71 D; I² = 89%). We considered this to be low-certainty evidence, downgrading for risk of bias and inconsistency. People receiving a toric IOL probably have a small improvement in visual acuity at six months or more after surgery compared to people receiving LRI, but the difference issmall and probably clinically insignificant (MD -0.04 logMAR, 95% CI -0.07 to -0.02; 8 RCTs, 474 eyes; moderate-certainty evidence). Low-certainty evidence from one study of 40 people suggested little difference in vision-related quality of life measured using the Visual Function Index (VF-14) (MD -3.01, 95% CI -8.56 to 2.54). Two studies reported spectacle independence and suggested that people receiving toric IOLs may be more likely to be spectacle independent (RR 1.56, 95% CI 1.14 to 2.15; 100 people; low-certainty evidence). There were no cases of lens rotation requiring surgery (very low-certainty evidence). Five studies (320 eyes) commented on a range of other adverse effects including corneal oedema, endophthalmitis andcorneal ectasia. All these studies reported that there were no adverse events with the exception of one study (40 eyes) where one participant in the LRI group had a central de-epithelisation which recovered over 10 days. We found no economic studies that compared toric IOLs with LRIs. Toric IOLs probably provide a higherchance of achieving astigmatism within 0.5 D after cataract surgery compared with LRIs. There may be a smallmean difference in postoperative astigmatism, favouring toric IOLs,but this difference is likely to be clinically unimportant. Therewas no evidence of an important difference in postoperative visual acuity or quality of life between the techniques. Evidence on adverse effects was uncertain.The apparent shortage of relevant economic evaluations indicates that economic evidence regarding the costs and consequence of these two procedures is currently lacking.

Modified double-opposing Z-plasty for patients with Veau I cleft palate: Are lateral relaxing incisions necessary?

Low fistula rate and a satisfactory speech outcome were previously reported by adopting a modified Furlow palatoplasty using small double-opposing Z-plasty (DOZ). The purposes of this study were to (1) describe the technical standardization of further modification of this small DOZ using the medial incision (MIDOZ) approach for Veau I cleft repair; (2) assess the early postoperative outcomes of a single surgeon's experience using this technique; and (3) evaluate the temporal association of this standardization with the necessity of lateral relaxing incisions.A prospective study (n = 24) was performed consecutively to non-syndromic patients with Veau I cleft palate who underwent MIDOZ approach. Patients with similar characteristics who underwent small DOZ were included as a retrospective group (n = 25) to control for the potential effect of the standardization of surgical maneuvers (including the hamulus fracture) on the rate of lateral relaxing incisions. Six-month complication rate was collected.No postoperative complications, such as bleeding, flap necrosis, dehiscence or fistula were observed. The prospective group had a significantly (all P < .05) higher rate of hamulus fractures (n = 48, 100%) and a lower rate of lateral relaxing incisions (n = 1, 2%) than the retrospective group (n = 16, 32%; n = 26, 52%).This technical standardization for performing palatoplasty using MIDOZ approach provided adequate Veau I cleft palate closure, without fistula formation, and with a low need of lateral relaxing incisions.

Modified two-flaps palatoplasty with lateral mucus relaxing incision in cleft repair: A STROBE-compliant retrospective study.

Study Design:clinical results of A STROBE-compliant retrospective studyObjective:To achieving adequate pharyngeal closure and improve the pharyngeal function by a modified two-flap palatoplasty.Summary of Background:Excessive tension in soft palate is the main factor causing the dysphonia after cleft palate. The tension-free suture of the soft palate is the key to achieving adequate pharyngeal closure. In this paper, a modified two-flap palatoplasty improved the pharyngeal functionMethods:From August 2016 to December 2017, 20 patients with cleft palate were treated with a modified two-flap palatoplasty of the posterolateral symmetrical mucosal relaxation incision. The mucosal relaxation incision was performed on both posterolateral sides of the soft palate.Results:All cases had good healing of mucosal flap and the palate. All patients underwent endoscopic examination at 6 months after operation. The postoperative results were satisfactory, with no complications. Twelve patients had bilateral exudative otitis media before operation, 4 patients returned to normal postoperatively, and 8 patients underwent bilateral tympanic membrane catheterization; 2 patients had abnormal function of bilateral eustachian tube before operation and returned to normal postoperatively; 3 patients had unilateral exudative otitis media before operation, and all of them returned to normal; the acoustic impedance test was normal in 3 children before operation. Most children begin to learn to speak, parents are satisfied with their pronunciation, and 3 children are in speech rehabilitation due to unclear pronunciation.Conclusions:We propose a technique to improve the function of the velopharyngeal closure which effectively reduces the incidence of pharyngeal insufficiency and occurrence of operative correction of pharyngeal closure dysfunction. The modifed two-flap palatoplasty with posterior lateral symmetric mucosal relaxation incision is beneficial for better velopharyngeal closure.

The Application of Multilayer Direct Closure With a Longitudinal Relaxing Incision in Urethrocutaneous Fistula Repair.

The simple closure of a urethrocutaneous fistula is technically easy, but direct suture tension is associated with a higher urethral fistula recurrence rate. We describe a multilayer direct closure with a longitudinal relaxing incision in urethrocutaneous fistula repair, avoiding the tension associated with the direct suturing of the surgical skin wound. From March 2015 to January 2018, 46 urethrocutaneous fistulas in 34 patients were repaired at the Hypospadias Center of our hospital. During the operations, after the urethral fistula closure, a longitudinal penile skin incision was created 0.5 to 1.5 cm from the edge of the surgical wound. The penile skin wound was closed, and the longitudinal penile skin incision made during the operation was used as a relaxing incision to reduce the skin tension of the closed fistula area. The urethral fistula repairs were successful, and no signs of infection or poor healing were present at the closure sites of the penile skin wounds. The relaxing incisions gradually healed within 7 to 21 days after operation, and the residual scars were soft and did not significantly differ in color from normal skin. The key to increasing the success rate of urethrocutaneous fistula repair is creating a longitudinal relaxing penile skin incision. The technique aims to avoid the direct suture tension of the penile skin wound, thereby providing a favorable environment for the normal healing of the urethral fistula suture site.

Undermining the epidermis around the U-shaped skin incision preserves thick, well-vascularized tissue that effectively prevents posturethroplasty complications

PurposeWe modified the U-shaped skin incision technique (UIT) during urethroplasty (UP) to prevent post-UP complications (post-UPC). Patients and methodsOur modified UIT (mUIT) involves undermining the epidermis for 5–7 mm around the U-shaped incision to create a thicker, better vascularized tissue layer for suturing the neourethra compared with UIT. To prevent injury to underlying connective tissue and avoid compromising blood perfusion, the scalpel should be held at a more slanted angle than is conventional. After the urethral plate is incised in the midline, stay sutures are placed to the middle of the penile shaft as a landmark, and three to five sutures are placed through the thick layer created by undermining. To facilitate mobilizing connective tissue during neourethroplasty, relaxing incisions may be used on the edges of the connective tissue. We compared 207 hypospadias patients who had primary or staged UP using either mUIT (n = 110) or UIT (n = 97) between 2003 and 2017 for incidence of post-UPC. ResultsmUIT had significantly less post-UPC than UIT after a mean follow-up of 6.44 ± 0.26 years after final UP, 1/110 (0.9%) versus 15/97 (15.5%) (p < .0001). ConclusionsUndermining the edges of the U-shaped incision during mUIT would appear to prevent post-UPC. Level of evidenceLevel III.

Combination of Surgical Technique and Bioresorbable Mesh Reinforcement of the Crural Repair Leads to Low Early Hernia Recurrence Rates with Laparoscopic Paraesophageal Hernia Repair

IntroductionLaparoscopic paraesophageal hernia (PEH) is associated with a low morbidity and mortality but an objective hernia recurrence rate in excess of 50% at 5 years. Biologic mesh has not been shown to reduce hernia recurrence rates. Recently, a new bioresorbable mesh made with poly-4-hydroxybutyrate with a Sepra-Technology coating on one side (Phasix-ST mesh) has become available. The aim of this study was to evaluate the feasibility, safety, and short-term efficacy of Phasix-ST mesh for reinforcement of the primary crural closure in patients undergoing elective, laparoscopic PEH repair. MethodsA prospective database was initiated and maintained for all patients undergoing PEH repair with the use of Phasix-ST mesh. We retrospectively reviewed the records of consecutive patients who had an elective, first-time laparoscopic PEH repair with Phasix-ST mesh and who completed their 1-year objective follow-up study. Patients having a reoperation, non-laparoscopic repair, or who failed to comply with the objective follow-up were excluded. ResultsTo achieve the desired 50 patients with 1-year objective follow-up, we reviewed the records of 90 consecutive PEH patients. In the final cohort of 50 patients, there were 32 females (64%) and 18 males. The median age of the patients at surgery was 67 years (range 44–84). The operation was PEH repair with fundoplication alone in 29 patients (58%) and PEH repair with Collis gastroplasty and fundoplication in 21 patients (42%). Phasix-ST mesh was used for crural reinforcement in all patients, and there were no intraoperative issues with the mesh or any difficulty placing or fixating the mesh at the hiatus. A diaphragm relaxing incision was performed in 2 patients (4%). The mean length of hospital stay was 2.8 days, and there was no major morbidity or mortality. On the 1-year objective follow-up study (median 12 months) a recurrent hernia was found in 4 patients (8%). No patient that had a Collis gastroplasty or a relaxing incision had a recurrent hernia. No patient had a reoperation. No patient had a mesh infection or mesh erosion. ConclusionsPhasix-ST mesh reinforcement of the crural closure during laparoscopic primary, elective PEH repair was associated with no adverse mesh-related events such as infection or erosion. Phasix-ST crural reinforcement in combination with tension-reduction techniques when necessary resulted in a very low (8%) objective hernia recurrence rate at a median follow-up of 1 year. These results demonstrate the safety of Phasix-ST mesh for use at the hiatus for crural reinforcement. This safety, along with the encouraging short-term efficacy for reducing hernia recurrence, should encourage further studies using the combination of resorbable biosynthetic mesh crural reinforcement and tension-reducing techniques during repair of paraesophageal hernias.

Use of computed tomography volumetric measurements to predict operative techniques in paraesophageal hernia repair.

Despite advances in diagnostic imaging capabilities, little information exists concerning the impact of physical dimensions of a paraesophageal hernia (PEH) on intraoperative decision making. The authors hypothesized that computerized volumetric analysis and multidimensional visualization to measure hiatal defect area (HDA) and intrathoracic hernia sac volume (HSV) would correlate to operative findings and required surgical techniques performed. Using volumetric analysis software (Aquarius iNtuition, TeraRecon, Inc), HDA and HSV were measured in PEH patients with preoperative computerized tomography (CT) scans, and used to predict the likelihood of intraoperative variables. Multidimensional rotation of images enabled visualization of the entire hiatal defect in a plane mimicking the surgeon's view during repair. The intrathoracic hernia sac was outlined producing volume measurements based on a summation of exact dimensions. A total of 213 PEHR patients had preoperative CT imaging, with 14.1% performed emergently. Primary cruroplasty was performed in 89.2%, salvage gastropexy in 10.3%, and diaphragmatic relaxing incisions in 4.2%. Median HDA was 25.7cm2 (IQR17.8-35.6cm2); median HSV was 365.0cm3 (IQR150.0-611.0cm3). Incremental 5cm2 increase in HDA was associated with greater likelihood of presenting emergently (OR 1.27; 95%CI 1.124-1.428, p = 0.0001), incarceration (OR 1.27; 1.074-1.499, p = 0.005), gastric volvulus (OR 1.13; 1.021-1.248, p = 0.02), and requiring either relaxing incision (OR 1.43; 1.203-1.709, p < 0.0001) or salvage gastropexy (OR 1.13; 1.001-1.274, p = 0.04). Similarly, HSV increases of 100cm3 were associated with 23% greater likelihood of emergent repair (CI 1.121-1.353, p < 0.0001), and were more likely to require a relaxing incision (OR 1.18; 1.043-1.339, p = 0.009) or salvage gastropexy (1.19; 1.083-1.312, p = 0.0003). Utilization of CT volumetric measurements is a valuable adjunct in preoperative planning, allowing the surgeon to anticipate complexity of repair and operative approach, as incremental increases in HSV by 100cm3 and HDA by 5cm2 are more likely to require complex techniques or bailout procedures and/or present emergently.

Minimally invasive surgery for large hiatal hernia.

The majority of large hiatal hernias are paraesophageal hiatal hernias (PEH). Once prolapse of the stomach to the chest cavity reaches a high degree, it is called an intrathoracic stomach. More than 25 years have elapsed since laparoscopic surgery was carried out as minimally invasive surgery for PEH. The feasibility and safety thereof has nearly been established. PEH may cause serious complications such as strangulation and perforation. The outcome of elective repair of PEH is better than emergent repair, so we should carry out elective repair as much as possible. Although not a major clinical problem, following PEH repair the rate of anatomical recurrence increases with age. In order to reduce the recurrence rate, mesh reinforcement by crural repair has been widely performed. Although this improves the short‐term outcomes, the long‐term outcomes are unclear. For PEH repair, fundoplication and gastropexy are believed desirable. We should select the procedure associated with a lower incidence of dysphagia and so on following surgery. While relaxing incision is useful for primary tension‐free closure, it has not contributed to improvement in the recurrence rate.

A single-institution retrospective evaluation of Mohs incision angles and histopathologic specimen quality.

Traditionally, Mohs layers are excised using a beveled incision to facilitate tissue flattening for tangential sectioning. Some surgeons perform non-beveled incisions; however, these specimens may be harder for the histotechnician to process. Limited data exist comparing slide quality between these techniques. Retrospective review of cases performed by two Mohs surgeons (surgeon 1=non-beveled incision; surgeon 2= beveled incision) using different incision angles between June 2014 and December 2016. Daily histopathologic slide quality assessment scores (maximum score=5, minimum score=1) of the day's first case were compared. About 536 slides (surgeon 1=277, surgeon 2=259) were evaluated from 2,825 cases. Mean quality assessment scores were similar between surgeons (4.89 and 4.86; P=0.31) with missing or folded epidermis being the most commonly reported issue for both surgeons. Similar slide quality can be achieved via both beveled and non-beveled Mohs cutting angles. While more relaxing incisions may be necessary to optimize tissue flattening with non-beveled incisions, there is no associated increased loss of epidermal margins. The potential benefits of non-beveled incisions, such as minimizing tangentially cut adnexal structures and creating vertical wound edges optimized for repair, may offer an alternative technique with positive clinical implications.

Comparison of Toric intraocular lenses and corneal incisional procedures for correction of low and moderate astigmatism during cataract surgery: A meta-analysis

Objective: To systematically compare the effects of Toric intraocular lens (IOL) implantation and corneal incisional procedures on the correction of astigmatism during cataract surgery. Methods: A peer-reviewed literature search was implemented in MEDLINE, EMBASE, EBSCO, ScienceDirect, Trip Database, Ovid, and the Chinese databases including CNKI and Wanfang Data. The inclusion criteria were randomized controlled trials (RCTs) that compared the Toric IOL implantation and the corneal incisional procedures to correct low and moderate astigmatism during cataract surgery. The mean difference (MD) and the relative risk were respectively used to describe the effect sizes of continuous data and nominal data with a confidence interval (CI) of 95%. The random effects model was applied to pool the data including postoperative uncorrected visual acuity, residual astigmatism and surgical complications by Review Manager 5.3. Results: A total of 12 RCTs were included in this study, including 330 eyes implanted with Toric IOLs and 336 eyes with non-Toric IOLs combined with corneal incisional procedures to correct astigmatism. According to the types of corneal incisions, the included RCTs were divided into three groups: limbal relaxing incision group, opposite clear corneal incision group, and astigmatic keratotomy group. Meta-analysis showed that postoperative logarithm of the minimum angle of resolution uncorrected visual acuity was significantly better in eyes implanted with Toric IOLs than those with corneal incisional procedures (MD, -0.05; 95% CI, -0.08 to -0.02; P<0.01), and the residual astigmatism was significantly lower in eyes implanted with Toric IOLs (MD, -0.33 D; 95% CI, -0.48 to -0.18 D; P<0.01). There was no significant difference in the risk of surgical complications between the Toric IOL implantation and the corneal incision correction for astigmatism (relative risk, 0.45; 95% CI, 0.07 to 2.95; P=0.40). Conclusions: The current evidence suggests that Toric IOL implantation is more effective in correcting astigmatism than corneal incisional procedures during cataract surgery and shows better postoperative visual acuity. However, they are similar in the risk of postoperative complications. (Chin J Ophthalmol, 2019, 55: 522-530).

Reconstruction of Moderate-Sized Scalp Defects: A 1–2–3 Rule

Background and objectiveExcision of cutaneous scalp tumors results in surgical defects that are difficult to repair because of poor distensibility in this area of the body. The main aim of this study was to develop a structured algorithm to help choose the best technique for reconstructing scalp defects. Material and methodsRetrospective study of patients who required surgical reconstruction following excision of a cutaneous scalp tumor. We excluded patients with defects that could be closed by simple direct suture and defects for which it was initially decided to use a skin graft or healing by secondary intention. The defects were classified into 5 groups according to the minimum distance between edges. The different reconstruction techniques used were evaluated in each group. The outcomes analyzed were complete defect closure, intraoperative and postoperative complications, and final aesthetic result. ResultsWe included 119 patients (102 men and 17 women) with a mean age of 71 years (range, 32–93 years). Mean follow-up was 42 months (range, 6–120 months). Sixty-eight patients had a moderate-sized defect with a distance between edges of 1 to 4cm. Reconstructions started with relaxation incisions in 43 defects and resulted in the successful closure of 22 of them. Defects with a distance of 1 to 2cm required a single relaxation incision. Two incisions were required for defects with a distance of 2 to 3cm, while 3 incisions were required for those with a distance of 3 to 4cm. In the 21 cases in which relaxation incisions were insufficient to close the defect, the incisions were extended to mobilize the flap to achieve closure. Relaxation incisions alone were insufficient for closing defects with a distance greater than 4cm. ConclusionsThe 1-2-3 rule can help in choosing the best reconstruction technique for moderate-sized defects based on the principle that 1, 2, or 3 initial relaxation incisions are needed depending on the minimum distance between edges (1-2cm, 2-3cm, or 3-4cm). In all cases, incision extension to mobilize the corresponding flaps remains an option.

Regla «1-2-3» para la reconstrucción de defectos de mediano tamaño del cuero cabelludo

Background and objectiveExcision of cutaneous scalp tumors results in surgical defects that are difficult to repair because of poor distensibility in this area of the body. The main aim of this study was to develop a structured algorithm to help choose the best technique for reconstructing scalp defects. Material and methodsRetrospective study of patients who required surgical reconstruction following excision of a cutaneous scalp tumor. We excluded patients with defects that could be closed by simple direct suture and defects for which it was initially decided to use a skin graft or healing by secondary intention. The defects were classified into 5 groups according to the minimum distance between edges. The different reconstruction techniques used were evaluated in each group. The outcomes analyzed were complete defect closure, intraoperative and postoperative complications, and final aesthetic result. ResultsWe included 119 patients (102 men and 17 women) with a mean age of 71 years (range, 32–93 years). Mean follow-up was 42 months (range, 6–120 months). Sixty-eight patients had a moderate-sized defect with a distance between edges of 1 to 4cm. Reconstructions started with relaxation incisions in 43 defects and resulted in the successful closure of 22 of them. Defects with a distance of 1 to 2cm required a single relaxation incision. Two incisions were required for defects with a distance of 2 to 3cm, while 3 incisions were required for those with a distance of 3 to 4cm. In the 21 cases in which relaxation incisions were insufficient to close the defect, the incisions were extended to mobilize the flap to achieve closure. Relaxation incisions alone were insufficient for closing defects with a distance greater than 4cm. ConclusionsThe 1-2-3 rule can help in choosing the best reconstruction technique for moderate-sized defects based on the principle that 1, 2, or 3 initial relaxation incisions are needed depending on the minimum distance between edges (1-2cm, 2-3cm, or 3-4cm). In all cases, incision extension to mobilize the corresponding flaps remains an option.

Correcting astigmatism at the time of cataract surgery: Toric IOLs and corneal relaxing incisions planned with an image-guidance system and intraoperative aberrometer versus manual planning and surgery

To compare the outcomes of the combination of an image-guided system and intraoperative aberrometer with the surgeon's standard of care in correcting astigmatism using toric intraocular lenses (IOLs) or corneal incisions. Single site in United States. Prospective case series. Contralateral eyes of patients having uncomplicated bilateral cataract surgery and astigmatism correction were randomly assigned to Group A or Group B. Group A received the surgeon's preferred standard of care. Group B had preoperative planning using an image-guidance system (VERION), intraoperative aberrometry (ORA System with VerifEye+), and femtosecond laser-assisted cataract surgery. The primary endpoint was the residual refractive astigmatism at 3months. Thirty-eight eyes were treated with toric IOLs and 40 eyes with corneal astigmatic incisions. On average, toric IOLs resulted in almost 0.25 diopter (D) less cylinder than corneal astigmatic incisions (P<.01), with no difference between groups (P=.41). There was no statistically significant difference in the mean spherical equivalent refraction by group (P=.51). At 3months, the IOL in 4 eyes (11%) (2 in Group A and Group B each) was more than 10 degrees of absolute orientation from the intended orientation. The mean keratometry was 0.16 D higher with the image-guided system compared with optical biometry (Lenstar). The vector difference between the 2 measurements was 0.5 D or lower in all eyes. The combined use of an image-guided system and intraoperative aberrometer did not significantly improve outcomes compared with the surgeon's standard of care. Based on keratometry, there was good agreement in corneal astigmatism measurements between the image-guided system and the optical biometer.

Influence of peripheral corneal relaxing incisions during cataract surgery for corneal astigmatism up to 2.5 dioptres on corneal densitometry.

To assess the effect of peripheral corneal relaxing incisions (PCRI) for astigmatism between 0.75 and 2.5 dioptres during cataract surgery on corneal densitometry (CD). In this prospective, randomised study, 80 eyes (80 patients), received either tIOL or PCRI. Assessment at pre-operative and 1, 3, 6, 12 months post-operative visit included uncorrected (UCDVA) and best-corrected distance visual acuity (BCDVA), spherical equivalent (SEQ) (only post-operatively), mean anterior and posterior keratometric astigmatism (KA) and CD with Schiempflug system. CD was analysed in four concentric radial zones from centre to periphery (Zone 1 to 4) and in 3 layers (anterior, mid-stromal and posterior). Comparing tIOLs vs. PCRIs, there was no significant difference in the UCDVA, BCDVA and SEQ. In PCRI group, anterior KA decreased at 1 month and remained stable thereafter. For zones 1, 2 and 3, CD significantly reduced after 3 months with tIOLs whereas with PCRIs, it reduced 1 month onwards. For zone 4, CD reduced only at 12 months with tIOLs compared to 3 months onwards with PCRIs. In both groups CD was higher in the zone 4 and anterior layer. Significant reduction in CD was found in all three layers of cornea after 3 months in tIOL and after first month in PCRI groups, respectively. Cataract surgery alone reduces the CD. Reducing keratometric astigmatism with PCRIs shows significant differences in CD from early post-operative period for central and anterior corneal layer.

Relaxation incisions and tensile strength in the abdominal wall of pigs.

PurposeTo analyze the resistance to medial traction of abdominal wall muscles, before and after performing relaxing incisions.MethodsSeventeen live pigs were used. After a median laparotomy, the handles were made in the rectus abdominis muscles (RAM) to fit the dynamometer. Step 1 (control phase): tensile strength measured without performing relaxant incisions. Step 2: A curvilinear relaxant incision was made on the anterior blade of the right RAM sheath and then the tensile strength was measured by the edge of the wound. The same procedure was adopted after incision of the left posterior blade. Step 3: Relaxing incisions were made in the right posterior and left anterior blade, so that both sides were left with a relaxing incision on both blades. Measurements of resistance were performed.ResultsThere was no statistically significant difference between the sides. On the right and left side, all treatments reduced the tensile strength when compared to each other and to the control. There was a reduction of 12% and 9.8% after incision of the anterior and posterior blade, respectively.ConclusionRelaxing incisions reduced tensile strength in the ventral abdominal wall.