Required Revision Surgery Research Articles

The Crane Technique in Cortical Bone Trajectory Screw Lumbar Fusion: Efficacy and Predictors of Spondylolisthesis Reduction.

To evaluate the efficacy of the Crane reduction technique in midline lumbar fusion (MIDLF) with cortical bone trajectory screws for treating degenerative spondylolisthesis, and to identify factors affecting the reduction rate. A retrospective analysis was conducted on 87 patients (64 female and 23 male) with L4-5 degenerative spondylolisthesis who underwent MIDLF and the Crane technique. Patients were categorizing using the spondylolisthesis Meyerding classification system into Grade I (59 patients) and Grade II (28 patients) groups and compared for demographics, radiographic parameters, and the spondylolisthesis reduction rate. Data were analyzed to identify factors influencing the reduction rate. Grade II patients showed higher preoperative spondylolisthesis slip ratio (SR) (29.8 ± 3.7% vs. 19.9 ± 3.2%, p < 0.01) and a lower segmental lordosis (SL) than Grade I patients. Postoperatively, Grade II patients achieved higher reduction rates (92.6% [90.8-93.8] vs. 89.9% [86.8-91.4] in Grade I, p < 0.01) and a greater SL increase (+2.4° [-0.2-5.5] vs. -1.2° [-3.5-1.6], p < 0.01). Multivariable analysis revealed vacuum disc phenomenon had a negative impact (β = -0.070, p < 0.01) and SR had a positive impact (β = 0.612, p < 0.01) on the slip reduction rate. Complications occurred in 4.6% of cases, including three intraoperative durotomy and one nut loosening requiring revision surgery. The Crane technique combined with MIDLF is an effective and safe surgical approach for treating L4-5 degenerative spondylolisthesis, demonstrating high reduction rates with consistent minimal residual slip, particularly in Grade II cases.

What Happens to Weight Following Abdominoplasty: An Analysis of 188 Consecutive Cases.

Abdominoplasty may be considered a procedure performed after a patient has already lost weight, but many surgeons have clinically observed that patients continue to lose weight in the postoperative period. This study sought to quantify continued weight loss after abdominoplasty procedures. A retrospective chart review was conducted on all abdominoplasty cases performed by the senior author between 2018 and 2022. Patient demographics, surgical information, and postoperative weights were all obtained. Independent samples t-tests were used for comparisons between groups. One-hundred eighty-eight patients were included with an average age of 42.5 years and follow-up of 26.5 months. Average preoperative weight and BMI were 167.8 lbs and 27.7, respectively. Average weight loss and percentage of body weight following surgery was -5.77 lbs (-3.15%) at 3 months, -5.28 lbs (-2.77%) at 6 months, -4.02 lbs (-2.17%) at 12 months, -4.18 lbs (-2.23%) at 2 years, -4.16 lbs (-2.20%) at 3 years, and -9.8 lbs (-5.29%) at 5 years. No patient who lost weight required revision surgery for additional skin removal. Patients undergoing abdominoplasty experienced maintenance of surgical weight reduction and continued weight loss up to 5 years postoperatively. Those with higher BMIs had significantly greater weight loss that increased at later time intervals.

Surgical and patient-reported outcomes of staged urethroplasty for anterior urethral strictures: A comprehensive analysis.

To evaluate the efficacy of staged urethroplasty for complex anterior urethral strictures from both surgical and patient-reported outcome perspectives. This retrospective study included 100 patients who underwent staged urethroplasty for anterior urethral strictures between May 2011 and June 2023. Anatomical success was defined as the ability to pass cystourethroscopy without resistance and the patient's ability to void without additional interventions. Patient-reported outcomes were evaluated using validated questionnaires, including the urethral stricture surgery patient-reported outcome measure, sexual health inventory for men (SHIM), and EuroQol 5-dimension (EQ-5D), administered pre-and postoperatively. At a median follow-up of 53 months, the anatomical success rate was 89.0%. Seventeen (17.0%) required revision surgery between stages. Perioperative complications occurred in 13 (13.0%). Significant improvements were observed in maximum flow rate (p < 0.0001), postvoid residual volume (p = 0.0006), total lower urinary tract symptoms (LUTS) scores (p < 0.0001), LUTS-specific quality of life (QOL) score (p < 0.0001), EQ-5D index score (p < 0.0001), and EQ-5D visual analog scale score (p < 0.0001). SHIM scores showed no significant change (p = 0.59). Overall, 93.5% of patients reported being either "satisfied" or "very satisfied" with the outcomes. Staged urethroplasty demonstrates high anatomical success rates and significant improvements in urinary function and QOL without compromising erectile function. The high patient satisfaction rate supports its efficacy in treating complex anterior urethral strictures.

Menrath ulcers in cats: four cases (2014-2023).

To report the clinical presentation, treatment and outcomes of four cats diagnosed with Menrath ulcers causing significant oral haemorrhage. For all cats, data on signalment, history, physical examination, treatment and outcomes were collected by reviewing medical records. Information regarding outcomes was collected from communication logs between primary care veterinarians and owners, and the original case clinicians after discharge of the patient from the hospital. Four cats were included. All patients survived to discharge. Follow-up outcomes were available between 1 and 8.5 months post discharge. Post-operative complications were classified according to The Accordion Severity Classification of Post-operative Complications. Two of the four patients had recurrence of oral haemorrhage post-ligation originating from the major palatine artery. One classified as a severe complication, due to requiring revision surgery of the ipsilateral major palatine artery. The other classified as mild, since the patient was managed conservatively. Additionally, one patient was documented to have developed an acquired palatal defect post-operatively. This is the largest case series of Menrath ulcers to date and the first to describe post-operative complications including acquired palatal defect and recurrence of oral haemorrhage from the original ulcer despite ligation of the ipsilateral major palatine artery.

The Impact of Tibial Slope on Anterior Cruciate Ligament Reconstruction Outcomes – University Hospital Study

Anterior cruciate ligament (ACL) injuries are common knee injuries that often require surgical reconstruction to restore knee function and stability. Despite advances in surgical techniques, the failure rate for ACL reconstruction remains approximately 15%, emphasizing the need to understand factors contributing to suboptimal outcomes. One factor that has garnered attention is the tibial slope, particularly the posterior tibial slope (PTS), which may influence ACL injury and graft failure. Biomechanical studies suggest that an increased PTS can elevate anterior tibial translation, potentially increasing stress on the ACL and raising the risk of both primary ACL injury and graft failure. However, the clinical significance of tibial slope in ACL reconstruction outcomes remains debated. This retrospective study investigates whether an increased PTS is associated with a higher likelihood of revision surgery or poor surgical outcomes. A total of 152 patients who underwent primary ACL reconstruction or revision surgery between 2018 and 2022 with at least two years of follow-up were included. Tibial slope measurements were obtained from lateral tibial radiographs, and patients were categorized into three groups based on post-surgical outcomes: Group A (successful return to prior sport levels), Group B (stable knee without return to sport), and Group C (requiring revision surgery). The Mann-Whitney U test was used to compare tibial slope measurements across groups. No significant differences were found in tibial slope between the groups (p &gt; 0.05). Group A had a median tibial slope of 6.08°, Group B had 6.68°, and Group C had 5.85°. These findings suggest that tibial slope may not be a major factor influencing ACL reconstruction success or failure. Other factors, including surgical technique, rehabilitation, and patient-specific characteristics, may play more significant roles. Further research is needed to explore the relationship between tibial slope and ACL ...

Evaluating Utility of Allergy Testing in Management of Nasal Obstruction Following Inferior Turbinate Reduction

IntroductionAllergic rhinitis (AR) within the pediatric population affects more patients than any other chronic disease. Inferior turbinate hypertrophy (ITH) is a common cause of nasal obstruction in children and is strongly associated with AR. Inferior turbinate reduction (ITR) surgery is used in patients with ITH who have failed medical management. While surgery is curative for most, there remains a subset of patients who continue to have symptoms of nasal obstruction despite ITR, which can cause discomfort and significant impacts on quality of life. Additionally, some patients with persistent disease go on to require revision surgery. The objectives in this study were to assess the impact of allergy testing results in patients undergoing ITR and evaluate if they predict long-term durability of surgical outcome. MethodsA retrospective chart review of patients undergoing ITR between January and December of 2015 was performed. Data pertaining to demographics, allergy testing results, surgical technique, and medical management was collected. Patients who underwent concomitant procedures at the time of ITR were excluded. Data analysis included descriptive statistics, chi-squared tests, and t-test analyses. Results297 patients who underwent ITR were included for data analysis. Overall, 20.9% of patients had recurrent nasal obstruction after ITR and 5.4% required revision surgery. Among all included patients, 37.7% underwent allergy testing of which 53 (47.3%) tested positive and 54 (48.2%) tested negative; results were unknown for 5 (4.5%) patients. In patients with positive allergy tests, 36% had recurrent nasal obstruction and 11% required revision surgery. In patients with negative allergy tests, 41% had recurrent nasal obstruction and 13% required revision surgery. There were no significant associations among those with positive and negative allergy tests and recurrence of nasal obstruction or need for revision surgery. Patients with a documented clinical diagnosis of AR were more likely to have recurrence of nasal obstruction after surgery than those without (28% vs 12%, p=0.001) and were more likely to require revision surgery (9% vs 1%, p=0.001). ConclusionsITR is a reasonable choice for the treatment of nasal obstruction in children. However, there remains a subset of patients who have recurrent nasal obstruction following initial surgery. Allergy testing results do not appear to impact the rate of recurrent nasal obstruction or the need for revision surgery. Therefore, the utility of allergy testing may have a limited benefit in the management of nasal obstruction in children. However, a clinical diagnosis of allergic rhinitis does appear to be a prognostic factor for experiencing post-operative recurrent nasal obstruction and requiring revision surgery.

Perioperative Management, Complications, and Outcomes of Shoulder Arthroplasty in Patients with Diabetes Mellitus.

» Patients with diabetes mellitus (DM) undergoing shoulder arthroplasty (SA) have a unique risk profile, which must be considered by clinicians.» The presence of DM as a comorbidity is associated with longer length of stay following SA, greater likelihood of nonhome discharge, and a higher rate of 90-day readmission.» Though the incidence is low, patients with DM are at an increased risk of serious postoperative cardiovascular complications, such as pulmonary embolism, venous thromboembolism, and myocardial infarction.» DM has generally been associated with increased risk of postoperative infection. The optimal hemoglobin A1c threshold in patients undergoing SA remains inconclusive. When extrapolating from lower limb arthroplasty, the literature indicates that this threshold is most likely in the range of 7.5% to 8%.» Patients with DM are more likely to require revision surgery after SA and report lower postoperative satisfaction.

Evaluating Failure Rates of Primary Quadriceps Tendon Repairs Across Different Surgical Techniques.

Quadriceps tendon ruptures occur infrequently in the general population. Biomechanical data suggest advantages with the use of suture anchor fixation for major tendon repair. Clinical studies of quadriceps tendon repair have been limited to small case series. To evaluate clinical failure following primary quadriceps tendon repair with transosseous tunnel or suture anchor repair. Cohort study; Level of evidence, 3. The Military Health System Data Repository was queried to identify all adult patients who underwent primary quadriceps tendon repair in the Military Health System between 2014 and 2018. Patients were excluded if they had incomplete records, polytrauma, open injury, prior ipsilateral total knee arthroplasty did not undergo quadriceps tendon repair, or underwent revision repair. Follow-up was obtained by manual chart review of both orthopaedic and nonorthopaedic records, recording any evidence of ongoing knee issues. Univariate analysis was performed to determine associations between potential risk factors and repair failure. Multicollinearity was assessed between potential risk factors, and candidate variables were included in multivariate logistic regression models to determine independent risk factors for repair failure. Following application of inclusion/exclusion criteria, 245 knees in 234 patients were included. Mean age of the cohort was 52 years. Patients were predominantly male (223/234; 95%) and military retirees (143/234; 61%). Transosseous tunnel repair was the most frequently employed surgical technique (147/245; 60%), followed by suture anchor repair (78/245; 32%). Repair failure requiring revision surgery occurred in 11% of knees (27/245). Surgical-site infection following index surgery was associated with eventual rerupture (P = .02). There was no difference in failure rate between transosseous tunnel repair and suture anchor repair (12.2% vs 9.0%; P = .51). Among knees undergoing suture anchor repair, no difference in failure was found between knot-tying and knotless suture anchor fixation (P = .73). We observed no difference in failure of primary quadriceps tendon repair between transosseous tunnel and suture anchor repair types or between the 2 main suture anchor implant subtypes (knotless vs knot-tying anchors). A greater than previously reported rerupture rate was observed, indicating the need for continued investigation into optimal surgical techniques.

Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation

Objective: Anterior cervical discectomy and fusion (ACDF) with anterior plating is a commonly performed procedure for cervical disc diseases. While the clinical outcomes of most reported multilevel ACDF cases are excellent, symptomatic pseudarthrosis remains a challenge, often requiring revision surgeries. This study aims to present the radiological characteristics of multilevel ACDF constructs, which can be considered during intraoperative management to prevent pseudarthrosis.Methods: This retrospective cohort study included patients who underwent multilevel (3 or 4 levels) ACDF with anterior plating between June 2010 and August 2022. Patients were regularly followed at 4 months, 12 months, and then annually postoperation. Fusion rates and characteristic radiological patterns, such as the formation of bony buttresses underneath the anterior plate, were graded and evaluated.Results: A total of 163 patients were included in the study. Overall fusion rates were 26.38%, 64.34%, and 81.58% at 4-month, 1-year, and the final follow-up, respectively. Nonunions at 4-month follow-up with tightly engaged anterior plate with bony buttress formation were more likely to fuse in the later period (Buttress grade 0 vs. 1; p=0.01, odds ratio [OR], 5.70, Buttress grade 1 vs. &gt;2; p&lt;0.01, OR, 12.00).Conclusion: This study emphasizes the significance of pseudarthrosis following multilevel ACDF. Pseudarthrosis predominantly occurs in the caudal-most segment of the construct, particularly when it terminates at C7. Constructs that are not tightly engaged and lack bony buttress formation in the caudal part of multilevel ACDF are more likely to develop pseudarthrosis.

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Length of Hospital Stay, and Postoperative Complications in Reduction Mammaplasty.

Background: Reduction mammaplasty is a common, elective, and safe operation, usually executed in healthy patients. Nonetheless, postoperative complications like bleeding and seroma formation can occur and significantly complicate the postoperative course. Tranexamic acid (TXA), a commonly used antifibrinolytic drug, offers a novel approach to reduce these complications. This study aims to evaluate its effect on the rate of postoperative bleeding, drainage volume, length of hospital stay, and other postoperative complications in patients undergoing reduction mammaplasty. Method: A retrospective study on all patients undergoing reduction mammaplasty at the Department of Plastic, Reconstructive, and Aesthetic Surgery EOC between 2015 and 2022 was conducted. Patients were divided into the TXA group receiving systemic TXA for 48 h and the control group not receiving any TXA. All data were analyzed using nonparametric formulas. Results: A total of 209 breasts were included in the study, with 138 cases in the control group and 71 in the TXA group. Three cases requiring revision surgery due to bleeding were observed in the control group, whereas none were observed in the TXA group. Total drainage volume was significantly reduced in the TXA group compared to the control group (TXA: 41.6 mL vs. control: 53.8 mL; p = 0.012), resulting in a significant reduction in length of hospital stay (TXA: 1.6 days vs. control: 2.2 days; p = 0.0001). Conclusions: TXA is a well-tolerated drug that significantly reduces postoperative bleeding and drainage volume, resulting in earlier drain removal and reduced length of hospital stay. TXA should, therefore, be widely used in plastic surgery, especially as trends in healthcare systems necessitate more outpatient procedures and quicker postoperative recovery.

Curve Behavior of Distal Segments After Posterior-Only Hemivertebra Resection for Congenital Cervicothoracic Scoliosis.

A retrospective and consecutive study. To demonstrate the curve evolution of distal non-structural compensatory curves in patients with congenital cervicothoracic hemivertebra (CTH) scoliosis undergoing posterior-only hemivertebra resection and to propose the possible mechanisms of this specific phenomenon. Though the spinal alignment could be well corrected via posterior hemivertebra resection in CTH patients, the high prevalence of distal curve progression was remarkable. However, the curve behavior of distal non-structural compensatory curves and its possible mechanisms were unclear. This study retrospectively reviewed a consecutive series of CTH patients undergoing posterior-only hemivertebra resection with a minimum 24 months follow-up. The parameters measured in coronal plane included local scoliosis, clavicle angle, head shift, and the Cobb angle of distal unfused segments. The distal curve was considered as an emerging scoliosis (ES) if with more than 20° progression and the apex of distal curve no less than 2 levels away from the lower instrumented vertebra. A total of 51 CTH patients with a mean age of 8.5 ± 3.8 years at surgery and a mean 38.0 ± 5.3 months follow-up were recruited. The correction of local scoliosis and clavicle angle was statistically significant (p < 0.05 for all). The distal compensatory curve was 11.8 ± 5.3° before surgery and 6.5° ± 4.1° after surgery (p < 0.001), which was slightly increased to 11.6° ± 10.9° (p = 0.002) at the latest follow-up. During follow-up, the increase of distal compensatory curve was significantly correlated with the change in clavicle angle (r = 0.49, p = 0.038). The ES was observed in 10 patients (19.6%) with an average value of 28.0 ± 2.1° at diagnosis, including 7 patients within 6 months and 3 patients after 5 years postoperatively. The mean value of ES was 31.9° ± 3.1° at the latest follow-up, while no patients required revision surgery. The ES was classified into compensatory and idiopathic types according to the typical curve behaviors. The compensatory ES usually presented within 6 months after operation and was responsible for further reconstruction of head and shoulder balance. While the idiopathic ES occurred at adolescent which may be related to the rapid body growth. Distal compensatory curve had a tendency toward slight progression during follow-up in CTH patients with posterior hemivertebra resection surgery. The prevalence of emerging scoliosis was 19.6% and the typical compensatory and idiopathic curve behavior were firstly proposed. Close and longitudinal follow-up was thus highly recommended for CTH patients with posterior HV resection surgery.

Quality of life improvement in 3 dogs with sleep-disordered breathing managed by permanent (crico)tracheostomy.

To retrospectively describe the management of sleep-disordered breathing (SDB) via permanent (crico)tracheostomy (PT). The sample was 3 client-owned dogs. Each of the dogs had variable clinical signs related to their SDB with all having severely affected quality of sleep and experiencing multiple apneic episodes a night in the study period from January 1, 2019, to December 31, 2023. Two of the 3 dogs showed minimal daytime clinical signs, with 1 owner reporting no noticeable changes in breathing, activity, or alertness, while another noted only mild alterations. Despite previous brachycephalic airway surgery, clinical signs persisted or recurred, and all owners considered euthanasia secondary to nighttime signs. Permanent (crico)tracheostomy was elected in all cases. Medical records were reviewed, and a standardized survey was administered to owners. All cases demonstrated variable degrees of improvement in the severity and frequency of clinical signs relating to SDB following PT, and overall quality of life improved from poor to good in all cases. All cases experienced surgical complications ranging from moderate to severe following PT, with 2 of 3 dogs requiring revision surgeries for skin-fold occlusion and stenosis of the PT. Sleep-disordered breathing may be an underrecognized component of brachycephalic obstructive airway syndrome, with nighttime clinical signs significantly impacting quality of life. Permanent (crico)tracheostomy may be considered in cases that either do not respond to initial brachycephalic airway surgery or in cases where clinical signs recur years after initial surgery. Owners should be aware of the likelihood of revision surgeries to achieve optimal outcomes.

Perioperative complications and cervical malalignment requiring revision following cervical C3 laminectomy and C4-6 laminoplasty.

Degenerative cervical myelopathy is one of the most common causes of spinal cord dysfunction. Cervical laminoplasty is an excellent surgical procedure that address the underlying pathology along with motion preservation with various advantages over other surgical options. While the advantages are intuitive and are being proven in multiple recent studies, concerns regarding failure still remains precluding wider utilization despite evidence to the contrary. This study evaluated perioperative complication rate, one-year radiographic outcomes, and necessity for revision surgery for radiographic failure following Cervical C3 Laminectomy and C4-6 Laminoplasty. A retrospective review was conducted on adult patients who underwent Cervical C3 Laminectomy and C4-6 Laminoplasty from 2016 to 2023 at a high-volume institution. Exclusion criteria included cervical spine surgeries or neuromuscular disorders. Demographics and radiographic measurements were collected. Univariate and multivariate analyses were performed to assess associations between pre- and post-operative cervical measurement variables and revisions. The study included 46 patients, predominantly male (69.6 %), with an average age of 63.1 years. Comorbidities included diabetes (8.7 %) and smoking (13 %). The average BMI was 27.5. Two cases (4.3 %) required revision surgeries: one for postlaminoplasty kyphosis and the other for persistent spinal cord compression. No significant differences were found between pre- and post-operative C2-C7 sagittal vertical axis, C1-C2 lordosis, and C7 slope (p > 0.05). There was a significant difference between pre- and post-operative C2-C7 lordosis (p = 0.036). A univariate and multivariate analysis demonstrated that pre- and post-operative radiographic measurements had no significant association with revisions (p > 0.05). Cervical C3 Laminectomy and C4-6 Laminoplasty demonstrated excellent perioperative safety, maintenance of sagittal alignment, and low revision rates at one-year follow-up with proper patient selection. This study further supports the routine use of laminoplasty as a reliable, less restrictive surgical option for treating cervical myelopathy in appropriately selected patients.

Hands-On Robotic Microsurgery: Robotic-Assisted Free Flap Reconstruction of the Upper Extremity.

Background/Objectives: Robot-assisted microsurgery (RAMS) has been introduced into the field of plastic surgery in recent years. It potentially offers enhanced precision and control compared to traditional methods, which is crucial for complex microvascular tasks in free flap reconstructions. We aim to analyze our experiences with robotic-assisted microsurgery in the field of upper extremity free flap reconstruction. Methods: This prospective study evaluated the efficacy and safety of the Symani Surgical System for free flap reconstructions in 16 patients with upper extremity defects at our institution from February 2023 to March 2024. Operating times were compared to a matched, historical cohort. We collected data on surgical outcomes, operative times, and complication rates, following strict adherence to the Declaration of Helsinki. Results: Our cohort primarily involved male patients (81%) with defects mostly located on the hand (81%). The anterolateral thigh flap was the most commonly used free flap (14/16, 88%). The average operative time was 368 ± 89 min (range: 216-550 min). No complete or partial flap losses were observed, but one flap required revision surgery due to arterial thrombosis. Major complications occurred in 13% of the cases. The average anastomosis time was 31 ± 12 min (range: 20-35 min) for arterial end-to-end anastomoses and 33 ± 13 min (range: 20-60 min) for arterial end-to-side anastomoses. Venous anastomoses required, on average, 20 ± 6 min. Operating times were not significantly longer when compared to the historical cohort (p = 0.67). Conclusions: We were able to show comparable outcomes to conventional microsurgery, while requiring more time for the microsurgical anastomoses. The study highlights the need for larger, controlled trials to better understand the benefits and limitations of robotic assistance in microsurgical reconstruction of the upper extremity.

Hypothermia During Microsurgical Head and Neck Reconstruction and Incidence of Venous Thromboembolism

Venous thromboembolism (VTE) is a severe complication after microsurgical free tissue transfer (FTT) to the head and neck. Hypothermia during surgery is a modifiable risk factor, and avoiding it may reduce the postoperative VTE rate. To assess the association between hypothermia (temperature <36 °C) and postoperative VTE and free flap pedicle thrombosis rates after head and neck reconstruction with FTT. This retrospective cohort study in a tertiary academic referral center used prospective and retrospective database and medical record data collected for patients who underwent head and neck reconstruction with FTT between January 1, 2012, and August 31, 2023. Temperature over time was classified as normothermia (temperature ≥36 °C), hypothermia (<36 °C) for more than 30 minutes and less than 120 minutes, and hypothermia for 120 minutes or more. Venous thromboembolism. The study outcomes were VTE events and thrombosis of the free flap pedicle that required revision surgery. Univariable and multivariable regressions were used to test the association between the outcomes and clinical factors. A total of 1078 patients (mean [SD] age, 61.3 [12.6] years; 724 males [67.2%]; mean [SD] Caprini score, 6.4 [2.1]) were included. The VTE and pedicle thrombosis rates were 3.2% (35 patients) and 2.2% (24 patients), respectively. In a multivariable model controlled for Caprini score and chemoprophylaxis, VTE was associated with hypothermia of more than 30 minutes and less than 120 minutes (odds ratio [OR], 3.82; 95% CI, 0.99-14.07) and hypothermia of 120 minutes or longer (OR, 3.55; 95% CI, 1.05-11.95). Free flap pedicle thrombosis was not associated with hypothermia (OR, 0.61; 95% CI, 0.26-1.43). These findings suggest that preventing hypothermia during microsurgical FTT to the head and neck may decrease the postoperative rate of VTE. Future studies should explore the optimal intraoperative body temperature range that may prevent the development of VTE without compromising patient safety.

Long-term Outcomes of a Minimally Invasive Surgical Approach in Paediatric Patients with Congenital Dacryocystoceles.

Congenital dacryocystoceles are a rare condition caused by nasolacrimal duct obstruction. Symptoms include epiphora, nasal obstruction, and swelling in the medial canthus. Treatment usually entails probing Hasner's valve open and, if necessary, intubating the nasolacrimal duct. We present a minimally invasive, endoscopic procedure with marsupialisation of the endonasal portion of the cele. The operation avoids additional manipulation of the lacrimal duct to prevent iatrogenic injury. This retrospective analysis included a total of nineteen infants or young children (21 eyes) aged 3 days to 39 months. Two of the patients were suffering from acute respiratory distress, seven from recurrent infections with persistent epiphora, and twelve from acute dacryocystitis with orbital phlegmon. The endonasal portion of the dacryocele was detected in all cases and resected endonasally using an endoscope. Recurrences required revision surgery involving dacryocystorhinostomy after primary surgery in two patients aged of 22 and 39 months. All other seventeen patients were free of recurrence. Our results show endoscopic endonasal marsupialisation without additional intubation or probing of the lacrimal ducts to be a successful treatment strategy for congenital dacryocystoceles. This avoids iatrogenic scarring, false passages, or postoperative bacteraemia. The surgical technique presented here shows a lower success rate in older children with a history of inflammation.

Standalone Anterior Lumbar Interbody Fusion Without Supplementary Posterior Fixation Is Effective for Treatment of Symptomatic Grade 1 Isthmic Spondylolisthesis.

There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort. Retrospective analysis of prospectively collected data. Consecutive patients from 1 senior spine surgeon performing sa-ALIF or ALIF-PSF for management of low-grade IS. Patient-reported outcome measures (PROMs) were collected at baseline, then postoperatively at 6 weeks, 6 months, 12 months, and a final follow-up timepoint. Computed tomography was conducted at 6 months, 12 months, or until interbody fusion was confirmed. Two cohorts comprised 51 patients (sa-ALIF 22 and ALIF-PSF 29). Both cohorts' PROMs improved from baseline to 12 months postoperatively. There were no significant differences (P = 0.05) in PROMs between the 2 cohorts at 6 months postoperatively, 12 months postoperatively, or at a final follow-up timepoint. There were no significant differences in mean fusion rates 12 months postoperatively (sa-ALIF 82% and ALIF-PSF 88%). Compared with preoperative measurements in sa-ALIF and ALIF-PSF cohorts, listhesis and segmental lordosis showed no significant changes, while disc height significantly increased (P = 0.0001). There were no significant differences in disc L5/S1 radiographic measurements between the cohorts at 12 months. There were 12 complications (sa-ALIF 2 and ALIF-PSF 10). Only 1 patient in the ALIF-PSF cohort required revision surgery. In appropriately selected patients with normal bone density, sacral slope <40°, and a body mass index <35, sa-ALIF is a safe and effective treatment option for grade I IS. The additional morbidity and cost of PSF may not be justified given the satisfactory clinical and radiographic outcomes of sa-ALIF for grade I IS. Clinically, this research continues to suggest that sa-ALIF is a safe and effective method of treatment for low grade IS.

Platelet rich fibrin three-layer reconstruction of the sellar floor after endoscopic endonasal transsphenoidal approach: technical note and initial experience.

Cerebrospinal fluid (CSF) leakage frequently complicates endoscopic endonasal transsphenoidal pituitary resections, despite the use of lumbar drains, nasoseptal flaps, or commercial dura sealants. Managing this complication often requires revision surgery and increases the risk of infection. Platelet-rich fibrin (PRF), an affordable autologous biomaterial derived from the patient's blood through short, angulated centrifugation, contains growth factors and leukocytes embedded in a fibrin matrix. PRF exhibits regenerative properties in various surgical disciplines. This study assesses a three-layer sellar reconstruction method employing solid membranous (s-PRF) and high-viscosity injectable (i-PRF) forms of PRF. We present our initial experience on a series of 22 patients with pituitary macroadenomas. For all patients, an endoscopic transnasal transsphenoidal approach was selected. Following the resection of the pathology, sellar reconstruction was accomplished using a three-layer orthobiologic technique. A membranous s-PRF was utilized as an inlay inside the opened sellar floor, followed by a layer of injectable i-PRF finally covered with another s-PRF membrane over the top to the sellar corridor. In all cases the implementation of the proposed three-layer PRF reconstruction strategy was feasible and safe. During the 12-month follow-up period there were no adverse effects reported associated with the PRF application. 77% (17/22) of the patients demonstrated intraoperatively a cerebrospinal fluid (CSF) leak (Esposito Grade 1-3). In total, the proposed PRF reconstruction effectively prevented postoperative CSF leaks in 95% of the patients and in 94% of those with an Esposito Grade 1-3. One of the two patients with intraoperative Esposito Grade 3 developed a CSF leak on the first postoperative day, which was successfully managed with a lumbar drain for 5 days. Sellar reconstruction after endoscopic endonasal transsphenoidal resection of pituitary adenomas with PRF is feasible and safe. The three layer PRF augmentation is a novel technique to prevent CSF-leakage.

Modern anatomical locking plates are associated with increased postoperative wound complications and unplanned surgical revisions compared to standard tubular plates in the management of unstable ankle fractures: a comparative cohort study in 595 patients

Abstract Background The clinical benefit of locking plates in distal fibula fractures has not yet been proven. In addition, the risk of wound complications appears to be higher than with conventional tubular plates. We hypothesize that the benefits of locking plates in terms of biomechanical properties are outweighed by a higher risk of wound complications. Methods We conducted a retrospective review of fibula fractures treated by osteosynthesis with either a conventional one-third tubular plate or an anatomically shaped locking plate from January 1, 2015 to December 31, 2021. We recorded baseline data and relevant comorbidities and defined the need for revision surgery due to wound-related or mechanical complications as primary endpoints. Results A total of 595 out of 727 patients were eligible for our study. Of these 595 fractures, 526 were fixed with a one-third tubular plate, 69 with a locking plate. Revision surgery was required in 54 patients, in 51 cases due to wound complications. Three patients required revision surgery for mechanical reasons and all of them were younger than 40 years of age, have not been diagnosed with osteoporosis, but experienced complex fracture types. As the third tubular plate and locking plate groups differed in terms of age and comorbidities, we performed a 2:1 matching based on age and gender, leaving data from 138 patients receiving a third tubular plate. While the two groups were comparable in many aspects, the rate of wound complications was significantly higher in the locking plate group. Although the locking plate group had a higher percentage of diabetes mellitus, there was no correlation between this comorbidity and the higher revision rate in this group. Conclusions Our data do not support the general use of locking plates in the treatment of distal fibular fractures. The risk of mechanical complications in osteoporotic ankle fractures seems to be overrated, as there were no mechanical revisions in the osteoporotic subgroup. The rate of wound-related revision surgery was significantly higher after the use of locking plates. This might be attributed to the greater thickness of locking plates.

Short-Term Outcomes of a Novel Non-Screw Based Expandable Posterior Interbody Fusion Cage

BackgroundLumbar interbody fusion is a well-established surgical technique for treating various lumbar degenerative pathologies. Expandable cages have been introduced to allow for insertion via the confined access and to improve disc height restoration, though concerns about the stability of the screw-based cages in the expanded state remains a concern. This study aims to evaluate the short-term clinical and radiographic outcomes of a novel non-screw based expandable TLIF cage. MethodsAdult patients who underwent posterior spinal fusion and were implanted the X-PAC TLIF-cage for degenerative lumbar conditions between September 2021 and April 2023 were retrospectively reviewed. Radiographic outcomes, including anterior disc height (ADH), posterior disc height (PDH), and segmental lordosis, were measured preoperatively, postoperatively, and at ≥6-month follow-up. Cage subsidence at follow-up was assessed according to the Marchi classification, along with cage collapse and complications requiring revision surgery. Radiographic outcomes were compared between timepoints using Wilcoxon signed-rank tests and paired t-test depending on distribution. ResultsThe study included 131 patients, implanted with 160 expandable cages. Significant increases in ADH and PDH were observed postoperatively and maintained at follow-up (ADH: 9.8 mm ± 5.4 versus 12.7 mm ± 4.0, and PDH: 3.1 mm (1.3 – 4.9) versus 5.0 mm (3.6 – 6.9) respectively, p < 0.001). Segmental lordosis showed an initial postoperative increase but was not significantly sustained at the 6-month follow-up. Cage subsidence was seen in 9.3% of cases, with no severe subsidence or complete cage collapse. Revision surgery was required in 6.1% of patients, none due to cage-related issues. ConclusionThe novel non-screw-based expandable cage effectively restored and maintained disc height with a low incidence of complications, suggesting it as a safe and effective alternative for lumbar interbody fusion. Further long-term studies are needed to confirm its efficacy and safety.