Reproducible Surgical Technique Research Articles

Anatomic anterior cruciate ligament reconstruction using the quadriceps tendon

Bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) grafts are the most commonly used autografts in anterior cruciate ligament (ACL) reconstruction at present. However, they have considerable limitations. Recently, accumulating evidence from biomechanical and clinical data supports interest in the clinical feasibility of the quadriceps tendon (QT) autograft. The QT autograft is characterized by a greater cross-sectional area and provides better biomechanical properties than BPTB or HT. Herein, a single-bundle and modified transtibial anatomical ACL reconstruction technique using the QT graft is introduced in detail, and the clinical results and usefulness of anatomical ACL reconstruction using the QT graft are thoroughly reviewed. Single-bundle and modified transtibial anatomical ACL reconstruction using the QT autograft is a robust, reliable, and reproducible surgical technique and graft choice that can be considered in primary ACL reconstruction.

Investigation of Surgical Techniques for Optimization of Long-Term Outcomes of LCP-Based Retinal Prosthesis Implantation.

PurposeTo investigate reproducible surgical techniques to optimize the long-term safety of liquid crystal polymer (LCP)-based retinal prosthesis implantation.MethodsAn LCP-based retinal prosthesis is fabricated monolithically on a single-body LCP substrate with all components, including the package and electrode array. We implanted the electrode array into the suprachoroidal space and anchored the package and transition part to the sclera in rabbits (n = 11). The safety profile was assessed upon the completion of the surgery and postoperatively.ResultsThe surgical procedures for implantation of the entire system were easily performed in nine eyes (81.8%) without any intraoperative complications. In the other two eyes (18.2%), surgical complications related to electrode insertion, including optic nerve damage and retinal tear, arose. In 10 eyes (90.9%), the devices were well tolerated for at least 3 months. However, in most eyes (nine; 81.8%), two complications began to appear after 3 months, postoperatively, including conjunctival erosion or dehiscence over the package or transition part. The electrode arrays were maintained safely in the suprachoroidal space after surgery without any complications, regardless of the status of the extraocular components in all cases except two intraoperative complications.ConclusionsWe established safe and reproducible surgical techniques for implantation of our LCP-based retinal prosthesis into the suprachoroidal space. Although issues related to surgical technique or device configuration were identified, further technical solutions would improve the long-term safety of device implantation.Translational RelevanceThis study presents successful implantation of LCP-based retinal prosthesis. The technical solutions will permit an optimization of surgical techniques.

Extracorporeal septoplasty with internal nasal valve stabilisation.

SUMMARYAmong various septoplasty techniques, the extracorporeal one is used for severe deformities of the caudal septum and consists essentially in removal of the nasal septum followed by correction of deformities. Reconstruction of the neo-septum is carried out by repositioning the septal fragments in a straight position. The disadvantages of this surgical technique are the septal haematoma, oedema of the mucosa in the valve area and some types of abnormalities of the middle third of the nose such as saddling of the dorsum. All of these conditions can be associated with various degrees of functional disorders. To prevent these possible complications, we developed a suture technique to fix the caudal portion of the neo-septum and avoid alterations or narrowing of the internal nasal valve. The purpose of this study is to describe extracorporeal septoplasty results with this suture technique in stabilising the internal nasal valve. From January 2011 to December 2013, a retrospective review of adult patients treated with extracorporeal septoplasty was performed at the ENT department of Imola Hospital. Pre- and post-operative evaluations were carried out by rhinomanometry and acoustic rhinometry. Statistical analysis was performed with commercially available software (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). 133 cases fulfilled inclusion criteria and were enrolled. A significant improvement was evident after surgery based on the results of rhinomanometry and acoustic rhinology. Extracorporeal septoplasty with stabilisation of the internal nasal valve is an effective and reproducible surgical technique that yields optimal functional results.

Percutaneous surgery for overlapping fifth toe

Category: Lesser Toes Introduction/Purpose: Overlapping fifth toe is an unusual disease in which the fifth toe is adducted, rotated, and hyperextended. This pathology is often asymptomatic, however pain may occur with footwear. Although there are many surgical techniques available, there is yet no gold standard. While old techniques were aggressive and cosmetically inappropriate, newest techniques involve large surgical incisions and risk of neurovascular damage. Percutaneous surgery is a novel approach which avoids the disadvantages that old and new techniques present. It was originally described by De Prado but no case series have been reported in adults up to date. The aim of this study is to describe a percutaneous corrective technique of the overlapping fifth toe and to evaluate its functional results and patient satisfaction. Methods: We performed a retrospective review of 12 feet in 10 adult patients who were surgically treated between 2008 and 2016. The percutaneous surgical technique consisted in a dorsal capsulotomy and extensor tenotomy followed by an osteotomy of the proximal phalanx (as described by De Prado). We added to his procedure the use of a K-wire to stabilize the osteotomies. In 6 of these feet a percutaneous oblique osteotomy of the fifth metatarsal was also performed. This osteotomy was stabilized using the same K-wire, which was removed 1 month after surgery. All patients were clinically rated prior to surgery and at the final follow-up visit using the AOFAS Score for lesser toes. In addition, patients were asked to provide a subjective qualification of the results (pain/cosmetic) as “excellent”, “good”, “regular” and “poor” and to state if they would recommend the surgical procedure to one of their peers. Results: The average follow up was 48 months (104 - 9). Osteotomy consolidation was completely achieved in all patients. There were no infections or wound complications. Mean preoperative AOFAS score was 38 (20-55) and postoperative score was 84 (62-95). Patient subjective qualification after surgery was: excellent for 7 feet, good for 3 and regular and poor for the remaining 2 feet. Nine of the ten patients stated that they would recommend the procedure. Conclusion: Percutaneous treatment of the overlapping fifth toe is a reproducible surgical technique with good functional results, low postoperative complications and good cosmetic acceptance by the patients.

Screw Distraction Technique For Gaining Fibular Length

Category: Trauma Introduction/Purpose: A shortened fibula may be caused by several conditions like tumors, premature closure of the growth plate and most frequently, malunion. Biomechanically a shortened fibula causes a lateral shift of the talus, widening of the ankle mortise, decreased tibiotalar contact area and eventually could lead to osteoarthritis. Even in a posttraumatic scenario, with moderate or severe osteoarthritis, fibular lengthening has shown to be beneficial in terms of pain reduction and improved function.Several osteotomies have been described with their advantages and disadvantages in terms of technical difficulty, need for bone graft and the ability to correct length and rotation.We present an easy and reproducible surgical technique on a case, that allow restoring length and rotation independently and it does not require complex distractor devices. Methods: Case report: A 34 year old female patient who presented 8 months status post initial open reduction internal fixation (ORIF). She developed a fibular nonunion, broken distal fixation with a shortened fibula and non-anatomic mortise and presented for revision surgery.Surgical technique: The fibula is exposed in standard fashion. A fully-threaded cortical screw is placed across the tibia, distal to the fibula fracture and parallel to the plafond. Next, a second screw is placed into the fibula bicortically from anterior to posterior and approximately 12 mm distal to the tibial screw. A toothed laminar spreader is then placed in-between the screws and distracted resulting in a lengthening of the fibula. A 2 mm Kirschner wire is placed to hold reduction once fibular length is restored and ORIF continues in standard fashion. Results: The technique we present has several advantages. The technique is straightforward, easy to reproduce, and cost effective. Since the anchoring points used for distraction are not both in the fibula, rotation is not implicitly locked in as in the case when both anchoring points are in the fibula, allowing for independent and progressive adjustment of both length and rotation. There is also less risk of proximal migration of the fibular head as no force is applied directly to the proximal fibula. There is also less risk of proximal migration of the fibular head as no force is applied directly to the proximal fibula. Conclusion: Fibular lengthening can achieve improved function, pain relief and decrease the risk of osteoarthritis in selected patients. Several techniques with different degrees of difficulty have been described to treat this condition, but most are not versatile enough in correcting the length and rotation independently. The technique that we present has the advantage of correcting the length and rotation as needed, without requiring complex devices.

The value of a standardized and reproducible surgical technique in treatment of Vancouver B2 periprosthetic fractures: our experience.

To retrospectively review results and complications of our standardized surgical technique addressed exclusively to Vancouver B2 fractures. From January 2006 to July 2016, we treated 235 consecutive patients, 47 males and 188 females, mean age at surgery of 71 ± 10 years, with periprosthetic B2 fractures. Exclusion criteria were other kind of periprosthetic fractures and other femoral fractures. The patients were assessed clinically and radiographically following our standard protocol at the last available follow-up. The mean follow-up time was 6.4years. Radiographic evaluation was performed according to Beals and Tower's criteria and clinical evaluation was performed using the Harris Hip Score and clinical exam. From the starter cohort of 235, 207 patients (88.1%) were fully evaluated, while 28 were lost to follow-up. According to Beal and Tower's criteria, we found excellent results in 72 patients (34.8%), good results in 133 patients (64.3%), and poor results in 2 patients (0.9%). Mean HHS was 75 ± 9 points, with a statistically significant correlation between good functional results and better radiographic assessment (p = 0.001). The use of support plate (p = 0.008) and the acetabular revision (p = 0.002) showed a statistically significant distribution with worse radiographic results. Late complications detected were ten dislocations. Our experience suggests that using a standardized and reproducible surgical technique, as our technique proposed, can surely reduce surgical time, the complication rate, and the mortality rate. During acetabular evaluation, the choice of performing a cup revision must be weighed on overall patient's assessment.

A PERIPHERAL NERVE INJURY MODEL UTILIZING A SIMPLE TISSUE SPARING APPROACH TO THE RABBIT SCIATIC NERVE

Background & Aims: Peripheral nerve injury models require a reproducible surgical technique that provides a simple and extensile peripheral nerve exposure. We present a muscle sparing apprach to the sciatic nerve in a rabbit model. A combination of general anestheia, sedative and perioperative analgesics was given to minimize animal discomfort. Methods: A posterior lateral dissection of the rabbit hind leg was performed to expose the proximal sciatic nerve. This facilitated an extensile dissection of both the proximal and distal sciatic nerve. Results: The described dissection is atraumatic, bloodless, and yields minimal postoperative morbidity on the rabbit. All rabbits received standard postoperative care in compliance with all regulatory agencies. A full vetinarian staff was available to manage the animals postoperatively. Conclusion: We found that our technique is a reproducible and easy to perform surgical approach with basic surgical setup. Our animal model provides an opportunity to evaluate and study peripheral nerve injuries peripheral nerve injuries.

Scroll Reconstruction: Fine Tuning of the Interface Between Middle and Lower Thirds in Rhinoplasty.

The junction between upper and lower lateral cartilages, known as "the scroll area," is an important determinant of the spatial relationship between the middle and lower nasal thirds. We offer a graduated and reproducible surgical technique of scroll area management that takes into consideration anatomic, functional, and aesthetic relationships. This study was a retrospective review of the recorded intraoperative information to investigate the frequency of the use of scroll reconstruction techniques and perioperative parameters that relate to unintended component alterations in the scroll area. A total of 364 consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between July 2011 and September 2015 were included in the study. Of the 364 cases who underwent primary open approach rhinoplasty, 329 received some form of scroll reconstruction. Scroll reconstruction was performed in all deviated cases, and 88% of straight noses. The most common technique for scroll reconstruction was overlapping repair (88.3%). As expected, both alar rim and alar crease asymmetries were very frequent in the deviated nose group, 89.4% and 75% respectively. Alar rim and alar crease asymmetries were frequent enough in the straight nose group to deserve special attention, 14.2% and 10.4% respectively. With careful attention to anatomic details of the scroll area, nasal tip refinements can be performed with predictable safety and accuracy. Our approach is a graduated, reproducible, and individualized way of scroll area management that aims to create the ideal cartilage configuration while preventing unintended component alterations.

Scroll Reconstruction: Fine Tuning of the Interface Between Middle and Lower Thirds in Rhinoplasty

The junction between upper and lower lateral cartilages, known as “the scroll area,” is an important determinant of the spatial relationship between the middle and lower nasal thirds. We offer a graduated and reproducible surgical technique of scroll area management that takes into consideration anatomic, functional, and aesthetic relationships. This study was a retrospective review of the recorded intraoperative information to investigate the frequency of the use of scroll reconstruction techniques and perioperative parameters that relate to unintended component alterations in the scroll area. A total of 364 consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between July 2011 and September 2015 were included in the study. Of the 364 cases who underwent primary open approach rhinoplasty, 329 received some form of scroll reconstruction. Scroll reconstruction was performed in all deviated cases, and 88% of straight noses. The most common technique for scroll reconstruction was overlapping repair (88.3%). As expected, both alar rim and alar crease asymmetries were very frequent in the deviated nose group, 89.4% and 75% respectively. Alar rim and alar crease asymmetries were frequent enough in the straight nose group to deserve special attention, 14.2% and 10.4% respectively. With careful attention to anatomic details of the scroll area, nasal tip refinements can be performed with predictable safety and accuracy. Our approach is a graduated, reproducible, and individualized way of scroll area management that aims to create the ideal cartilage configuration while preventing unintended component alterations.

Multiligament Reconstruction of the Knee in the Setting of Knee Dislocation With a Medial-Sided Injury

Multiple ligament knee injuries are complex pathologies that often result from traumatic knee dislocations. Both a high level of suspicion and a thorough clinical and radiographic examination are mandatory to diagnose and identify all injured structures. Reconstruction of all injured ligaments is recommended to aid in early mobilization and to avoid joint stiffness or graft failure. For knee dislocations involving injury to the anterior cruciate ligament, posterior cruciate ligament, and medial-sided structures, a repair and augmentation of the medial collateral ligament, together with an anatomic reconstruction of the anterior cruciate ligament and double-bundle posterior cruciate ligament, is recommended. In the setting of these complex reconstructions, there are several technical aspects that require consideration to ensure concise and efficient treatment of these injuries. Graft choice, sequence of reconstruction, tunnel position and orientation, and graft tensioning all pose surgical challenges, and require dedicated preoperative preparation and planning. The purpose of this Technical Note is to report a safe, effective, and reproducible surgical technique for treatment of multiligament injuries in the setting of a knee dislocation with a medial-sided component (classified as KD-III-M in the Schenck classification system).

Trifecta St. Jude medical® aortic valve in pulmonary position

ABSTRACTIntroduction: To evaluate an aortic pericardial valve for pulmonary valve (PV) regurgitation after repair of congenital heart defects.Methods: From July 2012 to June 2016 71 patients, mean age 24 ± 13 years (four to years) underwent PV implantation of aortic pericardial valve, mean interval after previous repair = 21 ± 10 years (two to 47 years). Previous surgery at mean age 3.2 ± 7.2 years (one day to 49 years): tetralogy of Fallot repair in 83% (59/71), pulmonary valvotomy in 11% (8/71), relief of right ventricular outflow tract (RVOT) obstruction in 6% (4/71). Pre-operative echocardiography and MRI showed severe PV regurgitation in 97% (69/71), moderate in 3% (2/71) with associated RVOT obstruction. MRI and knowledge-based reconstruction 3D volumetry (KBR-3D-volumetry) showed mean PV regurgitation = 42 ± 9% (20–58%), mean indexed RV end-diastolic volume = 169 ± 33 (130–265) ml m–2 BSA and mean ejection fraction (EF) = 46 ± 8% (33–61%). Cardio-pulmonary exercise showed mean peak O2/uptake = 24 ± 8 ml kg–1 min–1 (14–45 ml kg–1 min–1), predicted max O2/uptake 66 ± 17% (26–97%). Pre-operative NYHA class was I in 17% (12/71) patients, II in 70% (50/71) and III in 13% (9/71).Results: Mean cardio-pulmonary bypass duration was 95 ± 30ʹ (38–190ʹ), mean aortic cross-clamp in 23% (16/71) 46 ± 31ʹ (8–95ʹ), with 77% (55/71) implantations without aortic cross-clamp. Size of implanted PV: 21 mm in seven patients, 23 mm in 33, 25 mm in 23, and 27 mm in eight. The z-score of the implanted PV was −0.16 ± 0.80 (−1.6 to 2.5), effective orifice area indexed (for BSA) of native PV was 1.5 ± 0.2 (1.2 to –2.1) vs. implanted PV 1.2 ± 0.3 (0.76 to –2.5) (p = ns). In 76% (54/71) patients surgical RV modelling was associated. Mean duration of mechanical ventilation was 6 ± 5 h (0–26 h), mean ICU stay 21 ± 11 h (12–64 h), mean hospital stay 6 ± 3 days (three to 19 days). In mean follow-up = 25 ± 14 months (six to 53 months) there were no early/late deaths, no need for cardiac intervention/re-operation, no valve-related complications, thrombosis or endocarditis. Last echocardiography showed absent PV regurgitation in 87.3% (62/71) patients, trivial/mild degree in 11.3% (8/71), moderate degree in 1.45% (1/71), mean max peak velocity through RVOT 1.6 ± 0.4 (1.0–2.4) m s–1. Mean indexed RV end-diastolic volume at MRI/KBR-3D-volumetry was 96 ± 20 (63–151) ml m–2 BSA, lower than pre-operatively (p < 0.001), and mean EF = 55 ± 4% (49–61%), higher than pre-operatively (p < 0.05). Almost all patients (99% = 70/71) remain in NYHA class I, 1.45% = 1/71 in class II.Conclusion: (a) Aortic pericardial valve is implantable in PV position with an easy and reproducible surgical technique; (b) valve size adequate for patient BSA can be implanted with simultaneous RV remodelling; (c) medium-term outcomes are good with maintained PV function, RV dimensions significantly reduced and EF significantly improved; (d) adequate valve size will allow later percutaneous valve-in-valve implantation.

Technique to avoid left ventricular outflow tract obstruction

Preserving the subvalvular mitral valve apparatus during mitral valve replacement is extremely important to minimize progressive postoperative left ventricular remodeling and dysfunction. We describe a simple and reproducible surgical technique that prevents the complications that can occur after total mitral anterior leaflet preservation.

Prospective Analysis and Technical Recommendations for Repair of Small Ventral/Umbilical Hernias Using the Ventralex Hernia Patch

Background: Mesh reinforcement of small ventral/umbilical hernias has become increasingly popular over the last decade. The Ventralex TM hernia patch has been evaluated for this purpose in a small number of studies with equivocal results, particularly in relation to post-operative hernia recurrence and mesh-related complications. The aim of this study was to examine the short- and long-term clinical outcomes of the technique, and to address the possible limiting factors. Methods: Open mesh repair following strict surgical methodology was performed on 100 consecutive patients with small ventral/ umbilical hernia defects of 1-3cm in diameter between April 2007 and December 2012. Short-term clinical outcome was obtained at 2- and 6-week post-operative visits, and long-term results were assessed by telephone interview with subsequent clinical review if judged necessary. Immediate post-operative complications, hernia recurrence, pain and Quality-of-Life (QoL) were also evaluated. Results: There were no major short-term complications; minor complications including superficial wound infection and haemoserous wound discharge occurred in 9 patients (9%). The mean long-term follow-up was 37.9 months (range 6-75 months), with no hernia recurrences. No pain or mild pain was reported in 93.6% of patients, and 96.1% reported being satisfied or very satisfied with their repair. Conclusions: This study demonstrates that open repair of small ventral/umbilical hernias using the Ventralex TM patch can be extremely safe and effective, with excellent long-term clinical outcome, when following a meticulous but easily reproducible surgical technique. Those main clinical steps include avoidance of large-sized patches, placing the mesh extraperitoneally (sublay) wherever possible, fixing the positioning straps with minimum tension, and always closing the abdominal fascia defect in front of the hernia patch.

Personalized Computational Modeling of Mitral Valve Prolapse: Virtual Leaflet Resection.

Posterior leaflet prolapse following chordal elongation or rupture is one of the primary valvular diseases in patients with degenerative mitral valves (MVs). Quadrangular resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of posterior leaflet prolapse. Virtual MV repair simulation of leaflet resection in association with patient-specific 3D echocardiographic data can provide quantitative biomechanical and physiologic characteristics of pre- and post-resection MV function. We have developed a solid personalized computational simulation protocol to perform virtual MV repair using standard clinical guidelines of posterior leaflet resection with annuloplasty ring implantation. A virtual MV model was created using 3D echocardiographic data of a patient with posterior chordal rupture and severe mitral regurgitation. A quadrangle-shaped leaflet portion in the prolapsed posterior leaflet was removed, and virtual plication and suturing were performed. An annuloplasty ring of proper size was reconstructed and virtual ring annuloplasty was performed by superimposing the ring and the mitral annulus. Following the quadrangular resection and ring annuloplasty simulations, patient-specific annular motion and physiologic transvalvular pressure gradient were implemented and dynamic finite element simulation of MV function was performed. The pre-resection MV demonstrated a substantial lack of leaflet coaptation which directly correlated with the severe mitral regurgitation. Excessive stress concentration was found along the free marginal edge of the posterior leaflet involving the chordal rupture. Following the virtual resection and ring annuloplasty, the severity of the posterior leaflet prolapse markedly decreased. Excessive stress concentration disappeared over both anterior and posterior leaflets, and complete leaflet coaptation was effectively restored. This novel personalized virtual MV repair strategy has great potential to help with preoperative selection of the patient-specific optimal MV repair techniques, allow innovative surgical planning to expect improved efficacy of MV repair with more predictable outcomes, and ultimately provide more effective medical care for the patient.

Early experience with microsurgical spermatic cord denervation for chronic orchialgia at a Canadian centre

Microsurgical spermatic cord denervation (MSCD) is an effective surgical technique to manage chronic orchalgia, but it has not been readily adopted by Canadian urosurgeons. This paper reviews the early experience of a single urosurgeon in Canada. Nine consecutive testicular units underwent MSCD over a 24 month period. These patients underwent MSCD after ruling out reversible causes and after a successful diagnostic spermatic cord block. Of these patients, 77% (7/9) had a complete resolution and 22% (2/9) had a partial resolution of their pain symptoms following MSCD. There were no failures or complications. MSCD is an effective, safe, and reproducible surgical technique that should be included in the treatment armamentarium for chronic orchalgia.

Horizontal posterior hamstring harvest

Harvesting of the gracilis and semi-tendinosus (ST) hamstring tendons is usually performed by anteromedial approach. Harvesting by a horizontal posterior approach is possible. Based on a series of 90 patients, this technical note describes the perioperative difficulties and the characteristics of the harvested tendon(s) as well as any complications. Only one unsuccessful harvest was reported. Posterior harvesting of the gracilis and ST hamstring tendons is a reliable, reproducible surgical technique with a low rate of complications.

Training Surgeons in Minimally Invasive Mitral Valve Repair: A Single Institution Experience

We aimed to study the results of minimally invasive mitral valve repair performed by 5 young surgeons who were trained in mitral valve repair directly through a minimally invasive approach, and a senior surgeon who introduced the technique at our institution and was responsible for the training program. This was a retrospective, observational cohort study of prospectively collected data from 595 consecutive patients who underwent minimally invasive mitral repair performed by 5 trainees (n = 240, 40.3%) and by our lead consultant (n = 355, 59.7%) between 2007 and 2013. Treatment selection bias was controlled by constructing a propensity score from core patient characteristics and it was included along with the comparison variable in the multivariable analyses of outcome. Patients operated on by trainees were more likely to be female (p = 0.04), older (p = 0.001), and with history of atrial fibrillation (p = 0.001). Trainees required a significant longer cardiopulmonary bypass (137 ± 56 vs 123 ± 52 minutes; p = 0.003) and aortic clamp time (97 ± 41 vs 83 ± 40 minutes; p = 0.001). I-hospital mortalities were 1.3% in the trainees group and 0.8% in the senior surgeon group (p = 0.6). The incidence of stroke (1.7% vs 2.5%; p = 0.5), conversion to sternotomy (2.6% vs 3.5%; p = 0.5), and conversion to mitral valve replacement (12.5% vs 10.9%; p = 0.6) were similar between groups. No differences were found regarding other complications. Five-year survival (88.9% vs 89.5%; p = 0.4) and freedom from reoperation (94.5% vs 95.1; p = 0.6) were similar between groups. Minimally invasive mitral valve repair is a safe and reproducible surgical technique that can be taught successfully to cardiac trainees.

Patellofemoral joint replacement, an evolving concept

Isolated patellofemoral arthritis is a rare disease, whose management is challenging and controversial. Patellofemoral joint replacement can be an effective treatment for this condition. The very concept of a patellofemoral implant has evolved throughout the years, resulting in more anatomic designs and reproducible surgical techniques. The clinical outcomes of this procedure are strictly related to surgical indications, implant design and appropriate surgical technique.

A Simple and Reproducible Surgical Technique for the Management of Preauricular Sinuses

Preauricular sinus is a relatively common congenital anomaly that mainly exists on the anterior aspect of the anterior limb of the ascending helix. Although many surgical techniques have been developed, extirpation of the sinus is not easy because of the ramifications of the sinus, remnants of the sinus wall, and infection with or without formation of abscesses, which can all lead to disease recurrence. In our institution, we have surgically treated a total of 141 cases of congenital preauricular sinuses. Instead of using the conventional lacrimal probe and methylene blue method, we used a gentian violet-soaked Cottonoid, which has antibacterial effects against the main pathogen responsible for causing infection of the preauricular sinus. Results have been very favorable, with a zero recurrence rate. We present here a simple and reproducible surgical technique using a gentian violet-soaked Cottonoid that even beginning surgeons can easily follow.

Culture of Olfactory Ensheathing Cells for Central Nerve Repair

Autotransplantation of olfactory ensheathing cells (OECs) into the damaged central nervous system is a potential therapeutic strategy for spinal cord and root cord injuries. One limiting factor has been the poor OEC yields from human mucosal biopsies. Previous studies have only commented on their success in obtaining mucosal specimens containing olfactory mucosa, but have not commented on the yield of OECs from those specimens. To describe a reproducible and safe surgical technique for obtaining human olfactory mucosa and identify patient factors that possibly affect the yield of OEC cultures from the human olfactory mucosa. We obtained mucosal biopsies from 43 consecutive patients by using a novel reproducible surgical technique and our laboratory culture protocol. The Spearman rank correlation coefficient was used to assess the relationship between OECs and fibroblast yield with patient characteristics and specimen factors. A greater yield of OECs was obtained from patients of younger age. In addition, patients with worse mucosal disease yielded poorer cell cultures. Greatest yields were found in patients with absence of mucosal disease. Furthermore, a higher yield of OECs was obtained from specimens harvested from the more caudal portions of the superior turbinate, and OEC yield did not correlate with the ventroposterior location of the biopsy. We have provided evidence that biopsies closer to the cribriform plate can produce larger yields of OECs, and that patient factors like age and mucosal disease adversely affect the culture yield.