Restoration Of Anatomy Research Articles

A COMPARATIVE STUDY OF OPERATIVE MANAGEMENT WITH CONSERVATIVE MANAGEMENT OF CALCANEUM FRACTURES

Background Calcaneal fractures account for approximately 2% of all fractures, with displaced intra-articular fractures comprising 60% to 75% of these injuries1. Studies in fracture patterns, soft-tissue management, and outcomes of calcaneal fractures have led to the debate on the optimal management of calcaneal fractures. Several Prospective randomized studies have shown equivocal outcomes with operative and nonoperative treatment. However, recent trends in the literature suggest that restoration of physiologic parameters of length, height, and alignment of the calcaneus may lead to better long-term results. Initial studies using extensile approaches showed higher rates of wound complications with operative treatment; however, recent studies have shown lower complication rates with sinus tarsi and other minimally invasive techniques. Regardless of the mode of treatment, calcaneal fractures are associated with numerous complications and guarded outcomes with signicant longterm morbidity. Objectives 1. To comparatively study the functional outcome of calcaneum fracture when treated conservatively with that of operative management 2. To study complication when treated conservatively with that of operative management METHODS Study was conducted in Department of Orthopedics, Basaveshwara Teaching and General Hospital, Kalaburagi.30 patients with 30 calcaneum fracture were included in the study. Outcome of conservative and operative management was compared using Creighton Nebrasaka health foundation scoring system. Pre treatment and post treatment (at follow up) Bohler's angle was also compared. Chisquare analysis and paired t test was done to compare the results of conservative and operative management. Restoration of the RESULTS Bohler's angle was better with operative management as compared to conservative management. Functional outcome for type I fractures was better with conservative management. For type II and type III functional outcome was relatively better with operative management for type IV fractures the outcome was signicantly better with operative management. A signicant correlation was seen between the post treatment Bohler's angle and C-N scores. Interpretation & Conclusion Conservative management has better functional outcome for undisplaced fractures. Where as displaced and comminuted fractures anatomical reduction and restoration of Bohler's angle is very important. Bohler's angle has a prognostic importance and correlates well with the functional outcome

Anatomic restoration of the articular deep layer is a definitive factor for repair status in delaminated rotator cuff tear.

Recent studies have focused on the deep layer in delaminated rotator cuff tears. However, no studies have discussed the relationship between repair success and the properties of the deep layer. Herein, we aimed to analyze the intraoperative repair tension of the deep layer with respect to clinical outcomes and repair integrity and to evaluate the clinical results of delaminated rotator cuff tears after dual layer-specific repair. A total of 202 patients with delaminated rotator cuff tears had undergone dual layer-specific suture bridge repair; the mean follow-up duration was 28.6 (24-72) months. Intraoperatively, the repair tension of the deep layer was measured using a tensiometer, and mobility was ranked as easy or tight. After repair of the deep layer, the superficial layer tension was measured and ranked in a similar fashion. Clinical outcomes were evaluated using the Constant score, American Shoulder and Elbow Surgeons score, and subjective shoulder values. The relationship between retear and intraoperative qualitative factors of tendons was investigated. Prognostic factors for retear were analyzed using multiple logistic regression analyses. Postoperative retears occurred in 11 (5.4%) patients. With regard to the deep layer, the tight mobility group had greater tear size, tendon retraction, and fatty infiltration of the supraspinatus and infraspinatus than the easy mobility group. No intergroup difference in postoperative retear rate was observed between the tight and easy deep-layer groups. Logistic regression analysis showed that fatty infiltration of the infraspinatus (odds ratio, 3.1; 95% confidence interval, 1.3-7.7; P=.013) and mobility of the superficial layer after deep layer repair (odds ratio, 8.1; 95% confidence interval, 1.7-38.1; P=.008) were predictors of retear. Intraoperative mobility in the deep layer was not directly related to postoperative retear. Conversely, the quality of the infraspinatus concomitant with mobility of the superficial layer after deep layer repair significantly influenced repair integrity. Good clinical results were obtained even in cases with high repair tension of the deep layer.

Клинический случай хирургического лечения рецидивирующего макулярного разрыва на глазу с высокой степенью миопии

Purpose. To present a clinical case of surgical treatment of recurrence of a more than once operated full-thikness macular hole in an eye with a high myopia. Material and methods. Patient L., born in 1948, with high myopia in both eyes (–9.00D), was previously operated on at another medical institution for a full-thikness macular hole in the right eye. From the anamnesis it is known that 3 unsuccessful surgical interventions were sequentially performed for a penetrating macular rupture of the right eye without achieving anatomical closure and relapses in the early postoperative period. In connection with the recurrence of a penetrating macular rupture, the patient underwent reoperation, taking into account the anatomical and morphological features of the myopic eye. Results. The study of clinical and morphofunctional results in the postoperative period revealed complete closure of the macular hole, anatomical restoration of the foveolar contour according to OCT data, and an increase in the objective vision of the operated eye. Conclusions. In the surgical treatment of the full-thikness macular hole in patients with a high myopia, it is necessary to take into account the anatomical and morphological features of the myopic eye. Improvement in the technique of macular surgery, the use of special tools and techniques for the complete removal of epiretinal membranes, peeling of the inner limiting membrane allows to achieve closure of the macular hole and obtain good anatomical and functional results in this category of patients. Keywords: full-thikness macular hole, platelet-rich plasma, internal limiting membrane

Cleft lip and palate : One of the most frequent congenital malformations

With afrequency of1 per 500 live births, a cleft lip and palate is one of the most frequent congenital malformations. Untreated, it leads to disturbances in feeding, speech, hearing, tooth position and esthetics. Amultifactorial genesis is assumed. The fusion of the different facial processes takes place in the first 3 months of pregnancy and acleft can develop during this time. Surgical treatment includes the early anatomical and functional restoration of the affected structures within the first year of life in order to enable normal intake of food, articulation, nasal breathing and middle ear ventilation. Breastfeeding is possible in children with acleft formation but alternative feeding methods, such as finger feeding, often have to be used. In addition to the surgery for primary closure of the cleft, otorhinolaryngological (ENT) interventions, speech therapy, orthodontic treatment as well as other surgical interventions are part of the interdisciplinary treatment concept.

Long-Term Outcomes and Return to Work After Isolated Coronal Shear Fractures of the Capitellum

The purpose of this study was to analyze the ability of patients to return to work after ORIF of isolated capitellar shear fractures and assess long-term functional outcomes. We retrospectively reviewed the cases of 18 patients with isolated capitellar shear fractures with or without lateral trochlear extension and investigated demographic data, occupation, worker's compensation status, injury characteristics, surgical details, motion, radiographic appearance at final in-person follow-up, complications, and return to work status via in-person and long-term telemedicine follow-ups. Final follow-up was at an average of 76.6 (7-222.6) months or 6.4 (0.58-18.6) years. Of the 14 patients working at the time of injury, 13 patients had returned to work at final clinical follow-up. The work status of the remaining patient was not documented. Mean elbow motion at final follow-up was 4° (range, 0-30) to 138° (range, 130-145) of flexion, 83° of supination, 83° of pronation. Two patients had complications that required reoperation but had no further complications. For the 13 of 18 patients with long-term telemedicine follow-up, the average Quick Disabilities of the Arm, Shoulder, and Hand score was 6.8 (0-25). In our series, rates of return to work were high after ORIF of coronal shear fractures of the capitellum with or without lateral trochlear extension. This was true across all occupational classes including manual labor, clerical, and professional. With anatomic restoration of articular congruity, stable internal fixation, and postoperative rehabilitation, these patients had excellent ROM and functional scores at an average of 7.9 years of follow-up. After ORIF of isolated capitellar shear fractures with or without lateral trochlear extension, patients can expect a high rate of return to work with excellent ROM and functionality and low long-term disability.

OSTEOPOROTIC DISTAL RADIUS FRACTURE: COMPARATIVE STUDY OF SURGICAL OUTCOME TREATED BY EXTERNAL FIXATOR AND VOLAR PLATING

Background and Objective: Distal radius fractures are one of the most common fragility fractures among the osteoporotic population. The management of distal radius fracture has evolved so much from cast providing neutralization to bridging external xator later by buttress plates. There is still no clear consensus for management of distal radius fractures among osteoporotic age group. A randomized comparative study was undertaken to study functional outcome between closed reduction external xations over volar lock plating. 40 patients of distal radius Methods: fracture belong to the osteoporotic age group admitted in Assam medical college, Dibrugarh were selected. The patients were randomized into two groups one group treated with closed reduction external xation and other group with open reduction and plating, 20 patients in each group. The patients were followed up for 6 months and functional outcome was assessed using Green and O'brien scoring. The study comprised of 16 Results: males and 24 females aged between 50 to 75 years, with mean age of 58 years. The functional outcome score using Green and O'brien scoring on follow up we got 40% excellent results, 40% good results, 15% fair results and 5% poor results with plating and 20% excellent results, 30% good results, 40% fair results and 10% poor results with external xation. Open reduction w Conclusion: ith volar locking plate provided stable anatomical construct, restoration of anatomy, early mobilization and complications were minimal. External xation provide stable xation in par with open reduction and plating but had more complications such as wrist stiffness, pin tract infections.

Distal Biceps Tendon Repair Using a Single Incision, Dual Anchor Technique

Background: Distal biceps tendon ruptures commonly present in the middle-aged population resulting in deficits of strength and endurance. Operative management has shown improved functional outcome; however, there is not a clear consensus on an ideal surgical method. Indications: Distal biceps tendon repair is indicated for patients with clinical evidence and supporting magnetic resonance imaging confirmation of complete or partial rupture of the biceps tendon. Ideally, surgery is performed within 1 to 2 weeks of the injury to minimize the amount of scar tissue that is formed and the severity of the tendon retraction. Technique Description: A single incision is created on the volar surface of the forearm approximately 15 mm distal to the main flexor crease. After dissection to and retrieval of the biceps tendon, a #2 FiberTag stitch is placed distally and secured in a standard looped, locking fashion. An anchor is then placed in the most proximal aspect of the radial tuberosity and preliminarily placed around the tendon. An all-suture intramedullary cortical button is then placed in the distal aspect of the radial tuberosity. The FiberTag sutures are then shuttled through the button and tightened to anatomically reduce the distal biceps. The sutures on the proximal anchor are then used as supplemental fixation. Results: An anterior, single incision technique provides exposure necessary for dual anchor fixation and anatomic restoration of the distal biceps tendon. Utilizing this approach, patients are found to have improved flexion and pronation at 1 year, lower rates of heterotopic ossification, and lower rates of reoperation. Conclusion: Distal biceps tendon repair through an anterior, single incision provides excellent exposure for surgical repair. Utilizing a dual anchor technique, the distal button allows for anatomic fixation while the proximal suture anchor provides secondary fixation and increases the bone-tendon interface. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Comprehensive outcome analysis in two composite face transplants in Helsinki: Have we succeeded?

There is a need to define what is success after face transplantation (FT). We have previously created a four-component criteria tool to define indications for FT. In this study, we used the same criteria to evaluate the overall outcome of our first two patients after FT. Preoperative analysis of our two bimaxillary FT patients was compared to the results at four and six years post-transplantation. The facial deficiency impact was divided into four categories: (1) anatomical regions, (2) facial functions (mimic muscles, sensation, oral functions, speech, breathing, periorbital functions), (3) esthetics, and (4) impact on health-related quality of life (HRQoL). Immunological status and complications were also evaluated. For both patients, near-normal anatomical restoration of almost all the facial regions (except the periorbital and intraoral regions) was achieved. The majority of the facial function parameters improved in both patients (patient 2 to a near-normal level). The esthetic score improved from severely disfigured to impaired (patient 1) and to near to normal (patient 2). Quality of life was severely lowered prior to FT and improved after FT but was still affected. Neither patient has experienced acute rejection episodes during follow-up. We conclude that our patients have benefitted from FT, and we have succeeded. Time will reveal whether we have achieved long-term success.

Clinical outcome of first hundred consecutive therapeutic penetrating keratoplasties done at a tertiary eye care centre in Eastern India

ABSTRACT Aim: To analyze the clinical outcome of first 100 consecutive cases of therapeutic penetrating keratoplasty (TPK) done at a tertiary eye care centre in Eastern India. Materials and Methods: A retrospective analytical observational study of first 100 consecutive patients of TPK was done at RIO, IGIMS, Patna, Bihar for nonhealing keratitis with or without perforation with a minimum 1 year follow up examination. Patients with vitreous exudates were excluded from the study. Results: Organisms were isolated in 60% of cases of which 65% were fungi (Aspergillus), 20% were bacteria, (Staphylococcus aureus) and 15% had mixed infection. 17 cases required lens removal during surgery. Repeat graft infection was noticed in 23 cases of which 9 had fungi, 2 had bacterial isolate and rest was inconclusive preoperatively. A repeat TPK was performed in 7 patients out of the reinfected cases. Anatomical restoration could be achieved in 96% of cases. Graft clarity allowing clear view of anterior chamber could be seen in 26 cases. 4 cases of graft infection with posterior segment involvement finally required evisceration. 47 out of 100 TPK cases had raised intraocular pressure (IOP) of which 10 underwent glaucoma surgery for uncontrolled IOP despite medications. Conclusion: TPK is a challenging surgery still having definite role in management of nonresponding progressive keratitis. Maintaining graft clarity postoperatively is a difficult task in these cases therefore success should be measured in terms of infection eradication and anatomical restoration.

Arthroscopic-Assisted Anterior Glenoid Reconstruction Using Nonrigid Fixation With Distal Tibia Osteochondral Allograft

Introduction: Traumatic anterior glenohumeral instability events result in a capsulolabral (Bankart lesion) and/or osseous injury with subsequent attritional bone loss, particularly with recurrence. Up to 88% of patients with recurrent instability experience glenoid bone loss, which predisposes to future dislocations and subluxations, even with arthroscopic capsulolabral repair. The surgical management of glenoid bone loss includes a number of different techniques such as the Latarjet or coracoid transfer as well as other osseous and osteoarticular autografts and allografts. However, operative management of shoulder instability has increasingly shifted toward arthroscopic approaches with preservation of anatomy when possible. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the anterior glenoid is indicated for revision anterior glenohumeral instability procedures with anterior bone loss and in primary cases of anterior instability with critical bone loss. Technique: Our technique for nonrigid arthroscopic anterior glenoid reconstruction with allograft distal tibia and anterior labral repair is performed preferentially in the lateral position without necessitating patient repositioning. The preplanned tibial bone block is prepared on a back table prior to the arthroscopic procedure. After creation of portals and elevation of labral tissue, a guide and drill are used to introduce a retrograde reamer which is deployed to create a perpendicular edge for apposition of the allograft tibia. The bone block is then introduced through a rotator interval portal by pulling sutures retrograde through glenoid bone tunnels and is secured to the prepared surface medial to the liberated labrum. The articular surface of the graft and glenoid are aligned and suture-based fixation is used to compress the bone block against the native glenoid. The anterior labral tissue is then mobilized over the graft and repaired to the native glenoid when possible. Description/Conclusion: The benefits of allograft tibia augmentation for anterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive arthroscopic approach. When performed arthroscopically and with nonrigid fixation, this technique permits concurrent anterior labral repair and anatomic reconstruction, safe graft passage without necessity of a far medial portal, and expeditious return to function.

ДИАГНОСТИКА И ЛЕЧЕНИЕ СВЕЖИХ РАЗРЫВОВ ДИСТАЛЬ-НОГО СУХОЖИЛИЯ ДВУГЛАВОЙ МЫШЦЫ ПЛЕЧА

Distal biceps ruptures occur mostly in 40–60 y. o. men during rapid elbow flexion against significant external force. Clinical examination remains the mainstay of the diagnostics of the distal biceps tendon rupture (“Popeye” deformity, ecchymosis, and hook-test), ultra-sound and MR investigations may be used in doubtful cases. Non-operative treatment leads to the decrease of flexion and external rota-tion forces, thus surgical treatment is preferable in most cases. The choice of surgical approach depends on the fixation method. Transos-seous fixation with bone tunnels and two-incision technique is valid and pro-vides low level of re-ruptures with more anatomic restoration of the insertion point, but is associated with higher rate of heterotopic ossification. Newer methods of fixation (buttons, anchors, interferential screws) may allow the sin-gle approach, but not always provide anatomic reinsertion and may lead to higher rate of complications at the site of surgical approach in the elbow crease. Functional post-operative care in majority of cases leads to the restoration of range of movements at 6 weeks, and muscle forces at 12 weeks. This usually allows full restoration of the physical activity at 3 to 6 months after the sur-gery.

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy.

Minimally invasive thoracic techniques often need to be converted to open thoracotomy. Thoracotomy is associated with severe postoperative pain in 50% of the patients, and this situation can be maintained for a prolonged period. Many efforts have been made to avoid this complication. We propose an easy and fast thoracotomy closure technique to avoid nerve entrapment at the time of chest closure suitable for cases of conversion to thoracotomy after a minimally invasive attempt. The proposed method effectively avoids interference with the intercostal nerve, which remains intact and restores the anatomy of the intercostal space. Efforts to decrease postoperative pain are vital. Thoracic surgeons are the principal health professionals able to deal with operative factors and postoperative pain management. We believe that the use of this easy and fast technique can facilitate excellent anatomic repositioning of the ribs alongside nerve sparing.

Experience in Oral Cancer Reconstruction in a Tertiary Care Center of Nepal

Introduction: Oral cancer is one of the most common malignancies in Nepal. Most patients have locally advanced disease during their initial presentation, necessitating substantial resection and leaving significant deformity. Functional and anatomical restoration of these defects is crucial. This study analyzed the clinical presentation of oral cancer, surgical management, and encountered complications in the Nepalese context. Methods: This was a single-center retrospective study of oral cancer reconstruction performed at Tribhuvan University Teaching Hospital, Kathmandu over four years period (September 2018 - September 2022). Demographics, clinical presentation, comorbidities, treatment, and complications were recorded and analyzed. Results: Out of the analysis of 36 cases of oral cancer, most of the patients were in the fifth decade of life with male to female ratio of 3:1. The most common primary site involved was buccal mucosa (38.88%). Twenty-two cases (61.11%) were in the locally advanced stage. Tobacco chewing was a common entity in personal habits. Surgery consisted of eighteen pedicled, sixteen free flaps, and five local flaps. Pectoralis major myocutaneous flap was the commonest flap performed (38.46%). The overall complication rate was 58.33%. Orocutaneous fistula was the commonest (22.22%). The partial flap loss occurred in 8.33% (15.1%) and the total flap loss occurred in three free flaps. Conclusion: The difficulties experienced in OC reconstruction were high complication rates, multiple redo surgeries, and extended hospital stays. Despite these challenges, all of our patients were released from the hospital with stable wound coverage. Furthermore, the study will provide a platform for a better understanding of the oral cancer reconstruction scenario in the context of Nepal.

Comparison of clinical and radiological outcomes between extended lateral and sinus tarsi approach in the surgical treatment of displaced intraarticular calcaneal fractures surgery

Purpose: The aim of this stud was to compare the clinical and radiological results between Sinus-tarsi (ST) and Extended-Lateral (EL) approaches in open reduction internal fixation of intra-articular calcaneal fractures.
 Materials and Methods: 51 calcaneal fractures of 48 patients surgically treated between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups. Preoperative CT, early postoperative and postoperative 1st-year radiographs, and The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score scores were evaluated.
 Results: According to the Sanders classification, nine patients in the EL group were type 2(36%), 16 patients type 3 (64%), 8 patients in ST group type 234.8%), 13 patients (56.5%) type 3, 2 patients (8.7%) type 4. The mean AOFAS-Hindfoot score was 85(63-100) in the ST group and 83(52-93) in the LE group at one year. Mean preoperative waiting time was shorter, with an average of 2(1-4) days in ST and 6(3-12) days in LE. 
 Conclusion: ST approach shortens the preoperative waiting time in intra-articular calcaneal fracture surgery, provides a sufficient vision for anatomical restoration, and effectively avoids complications.

The multi-ligament ankle fracture: Epidemiology, key anatomical findings and fixation strategies in unstable open injuries

BackgroundAnkle fracture surgery has traditionally focussed on restoration of bony anatomy, with fixation of the malleoli and syndesmotic stabilisation where applicable. However, high energy open fracture-dislocations can also result in periosteal stripping of the stabilising capsuloligamentous attachments. As such, restoration of osseous anatomy alone may not result in sufficient articular stability. ObjectivesIn this series from a level 1 trauma centre, we report a subset of highly unstable open ankle fractures with combined capsuloligamentous injuries, in which restoration of osseous anatomy did not result in a stable joint. Supplementary soft tissue reconstruction and other stabilisation techniques were required. MethodsRetrospective case series of eligible patients from a level 1 trauma centre. Inclusion criteria were open ankle fractures with tibial extrusion (AO 44) and persistent instability post-bony fixation, age over 18 years and non-diabetic. Analysis of injury pattern, mechanism, pathological anatomy, soft tissue and orthopaedic reconstruction methods was performed. Results16 patients were identified during the study period who met the eligibility criteria, out of 95 open ankle fractures treated between January 2017–December 2020. Most patients were under 65 (n = 13; 81.3%) and sustained combined or isolated injuries of the deltoid ligament, anterior capsule, lateral ligament complex (ATFL±CFL) and tibialis posterior retinaculum. The commonest injury pattern was tibial extrusion via a medial soft tissue defect with deltoid ligament and anteromedial capsule rupture. Associated syndesmotic instability and fixation was common (n = 10; 62.5%). Supplementary stabilisation methods to standard bony fixation included capsuloligamentous reconstruction or repair, “ORIF+” external fixation, or conversion to primary fusion or hindfoot nail. Six patients required either local or free flap soft tissue coverage. ConclusionsA subset of up to 20% of open ankle fractures require supplementary fixation beyond anatomical restoration of the bony anatomy due to persistent ligamentous instability. They are associated with capsuloligamentous and syndesmotic disruption, more commonly affecting the medial structures. These rare injuries can be defined as multi-ligament ankle fractures. Surgeons should be aware of this subset and be able to recognise where supplementary stabilisation strategies are required.

Modern technologies in thrombolysis therapy at the pre-hospital stage in the practice of medium staff emergency assistance

The use of thrombolytic drugs by ambulance teams is safe, it can significantly reduce the time from the onset of an ischemic attack to the effective anatomical restoration of blood flow in the affected coronary artery, which makes it possible to achieve a pronounced decrease in mortality and disability in acute coronary syndrome.

Use of a modified retrograde femoral rod as a custom length tibiotalocalcaneal nail.

There has been increasing interest in the use of hindfoot tibiotalocalcaneal (TTC) nails to treat ankle and distal tibia fractures in select patient populations who are at increased risk for soft tissue complications after open reduction and internal fixation with traditional plate and screw constructs. We describe a technique which uses a retrograde femoral nail as a custom length TTC nail. By using a simple modification of the insertion jig, we are able to achieve safe screw trajectories that allow for robust distal interlocking fixation. Review of implantation in multiple cadaveric specimens demonstrates safe placement of distal screw fixation in the calcaneus without risking injury to important neurovascular structures. Because of the 2-cm incremental length options of this particular device, we are able to achieve supraisthmal fixation in the tibia which may lessen the risk for fracture that may be more likely to occur at the tip of a short TTC nail option. Furthermore, a custom length TTC nail is more costly and also requires advanced notice to acquire for the case; retrograde femoral nails are readily stocked and accessible at our level 1 trauma center. This TTC technique offers anatomic restoration while also offering convenience, instrument familiarity, cost savings, and increased patient safety.

Changes in retinal thickness assessed by optical coherence tomography after successful rhegmatogenous retinal detachment surgery in 1 year follow up

AbstractPurpose: To study retinal thickness using optical coherence tomography (OCT) (Spectralis OCT) in patients after undergone pars plana vitrectomy to repair rhegmatogenous retinal detachment (RRD) during different time points over 1 year follow up. OCT can detect retinal thickness changes in RRD. These changes can modify in the follow up time. RRD by itself or due to the surgical procedure could induces macular thickness changes.Methods: We performed a single‐center cross‐sectional descriptive study including 49 eyes of patients with macula OFF RRD after 23 PPV + SF6 as tamponade; the contralateral eye was used as the control group. All participants underwent a complete ophthalmic examination that included refraction, axial length (AL), and Spectralis spectral‐domain (SD)‐OCT.Results: Thirty‐six of the patients were male and 16 female; 40.8% of the eyes were right one. Central foveal thickness was diminished in 1 month and 3 months time points. There were not differences in the 6‐ and 12‐months examination. The parafoveal ring was similar in both groups but there were statistically significant differences in the inferior and nasal outer ring of the ETDRS grid, in the 1 month follow up. After 1 year, differences were only found in the outer temporal and nasal rings.Conclusions: The findings of this study suggest that retinal thickness remains similar 1 year after RRD was successfully treated. These may indicate that there is a progressive anatomical restoration in the macular area.

A step-by-step approach to a frozen pelvis

To demonstrate a step-by-step approach for restoration of pelvic anatomy in frozen pelvis using a systematic approach to make the steps reproducible, safe, and time efficient. Video presentation. Academic medical center. A 30-year-old nulliparous woman with lifelong dysmenorrhea and 4 years of infertility who presented for the surgical management of stage IV endometriosis. An abdominopelvic survey was first in a systematic fashion to assess the extent of adhesive disease and evalaute for normal anatomy. Dissection was then started on the patient's left side to mobilize the sigmoid colon at the pelvic brim. Subsequently, the ureters were identified and bilateral ureterolysis was performed as the retroperitoneal spaces were explored. Once the ureters were safely dissected, the adnexa were mobilized bilaterally. Attention was then turned to the dissection of the medial pararectal spaces (Okabayashi's space) before the dissection of the rectovaginal space. With the restoration of anatomy, the remaining planned surgery was completed. Restoration of pelvic anatomy, excision of endometriosis, and resolution of symptoms. The patient had an uncomplicated procedure with complete excision of endometriosis and an estimated blood loss of 45 mL. She was discharged on the same day and had an uneventful postoperative period. At her follow-up appointment, she had resolution of symptoms and was initiated on medical hormone suppression therapy until ready for invitro fertilization. A frozen pelvis is a condition in which the pelvic organs are distorted and tethered to each other as a result of adhesive processes. This can obscure normal anatomical landmarks and surgical planes making dissection extremely difficult, thus increasing the risk of interoperative and postoperative complications. Although an uncommon surgical condition, it is not rare to come across in clinical practices, thus creating a challenge to reproductive surgeons as it is commonly seen with endometriosis-associated infertility. It is important for surgeons to be able to recognize the relevant anatomy and have the knowledge to open proper pelvic avascular spaces in the pelvis to mitigate these risks. Following this video's step-by-step approach can help restore pelvic anatomy for planned surgical procedures.

Bicanalicular-nasal silicone stent for deep canalicular laceration management

We evaluated the efficacy and clinical outcomes of bicanalicular-nasal silicone stents for deep canalicular lacerations and their anatomical restoration advantages. This retrospective case series study included patients with deep canalicular lacerations who underwent bicanalicular-nasal silicone stent intubation between January 2010 and June 2021 at a Chinese tertiary hospital and two primary hospitals. Intra- and post-operative complications were recorded. Anatomical, functional, and cosmetic outcomes were evaluated as anatomical restoration assessments at the last follow-up. We defined anatomical success as a free passage with no reflux during irrigation. Functional success was evaluated using the Munk epiphora scale and fluorescein dye disappearance test. Cosmetic outcomes were evaluated by examining the eyelid, lacrimal punctum, and medial canthus for any structural abnormalities and recorded objectively using a grading scale. We evaluated 92 eyes of 92 patients (63 men and 29 women); the mean distance from the lateral lacerated end to the punctum was 7.74 mm (range 7-10 mm). Bicanalicular-nasal silicone stents were successfully used in all 92 eyes with no severe intra- or post-operative complications noted. The stent placement duration ranged from 12 to 16 weeks (mean, 13.18 weeks). The follow-up period after stent removal ranged from 3 to 12 months (mean, 6.04 months). The anatomical and functional restoration success rates were 96.74% (89/92) and 100% (92/92), respectively. Satisfactory eyelid position realignment was achieved in all patients. Bicanalicular-nasal silicone stent placement sufficiently relieved orbicularis muscle tension during deep canalicular laceration repair, providing good functional results and excellent cosmetic realignment and anatomical restoration of the eyelid.