Routine Incision Research Articles

Treatment of Femoral Traumatic Fractures with a Custom Bridge Combined Fixation System

Background: With the development of transportation in modern China, the incidence of traumatic fracture and the global degree of fracture complexity are increasing. This study explored the use and curative effect of a novel custom-manufactured bridge combined fixation system for traumatic fractures of the femur. The bridge combined fixation system can be tailored to the specific patient's requirements by bending the rods and sliding the attachment modules. Methods: From May 2013 to August 2017, 14 patients with traumatic femur fractures were managed with the bridge combined fixation system. The operation was conducted according to the routine incision approach of femur fracture. The patients were given early postoperative functional rehabilitation exercise. The curative effect was evaluated according to clinical manifestations, postoperative imaging, and a self-developed standard for bone healing. Results: All patients were followed for 12–24 (median: 12.5) months. Fracture healing was assessed based on clinical symptoms and postoperative X-ray. After 3 months, complete weight-bearing on the affected leg was painless. X-ray showed that the fracture line had disappeared by 6–9 months postoperatively and showed bone healing. According to the self-developed standard for bone healing, 13/14 (92.8%) patients achieved excellent/good clinical outcomes. Bone union was achieved in all patients within 2 years. Conclusion: The custommanufactured bridge combined fixation system is simple and can effectively achieve tailored reduction of the fracture. The fixation was stable, with few complications after surgery and with good treatment effect for traumatic fractures.

Clinical value of vacuum sealing drainage in the treatment of oral and maxillofacial space infection

This study aims to observe the efficacy of vacuum sealing drainage (VSD) by continuous negative pressure drainage and saline irrigation in the treatment of oral and maxillofacial space infection. Retrospective analysis was conducted on 116 cases of maxillofacial space infection, and clinical data were collected to compare the therapeutic effects of routine incision with drainage treatment (traditional treatment group, 58 cases) and VSD treatment (VSD group, 58 cases). The length of hospital stay, white blood cell count, scar length, frequency of dressing change, and pain degree of patients in the VSD group were all lower than those in the traditional treatment group. Moreover, the improvement degree of mouth opening in the VSD groups was better than that in the traditional treatment group (P<0.05). VSD is a more effective method for the treatment of oral and maxillofacial space infection.

Orbital complications of acute rhinosinusitis: a study on clinical profile, surgical management and outcome

Objectives1. Evaluate the clinical signs and their correlation to Computed Tomography(CT) findings2. Assess the correlation between CT and intra-operative findings.3. To identify implicated micro-organisms.4. Evaluate the current practice in surgical management. MethodologyA descriptive retrospective study conducted at Lady Ridgeway Hospital (LRH) on 19 patients who underwent endoscopic sinus surgery, drainage of pus and orbital decompression for radiologically suspected orbital complications of acute rhinosinusitis from 01/01/2015 to 31/12/2018. ResultsClinical features were fever (73.7%), peri-orbital swelling (100%), chemosis(68.4%), proptosis(57.9%) and ophthalmoplegia(42.1%). Chemosis and ophthalmoplegia were found in 62% and 37% of the patients with intra-orbital abscesses, with only chemosis showing a statistically significant association. CT was suggestive of subperiosteal abscess or inflammation in all. Intra-operatively abscesses were found in 16 (84.2%). Of these 6 had both subperiosteal and intra-orbital abscesses. Eight had subperiosteal abscesses. Two had only intra-orbital abscesses. The CT scan failed to predict the presence of abscess within the orbital fat in 3 out of 8. The positive predictive value was 89.4% for CT to detect orbital abscesses. An Intra-operative bony defect was noted in 15.8%. The mean surgery duration was 2.04 hours. Cultures revealed MRSA(21.1%), MSSA(15.8%), Pseudomonas(10.5%), mixed growth(10.6%) and Streptococcus viridans(5.3%). ConclusionThe commonest presentations were peri-orbital swelling, fever, chemosis. MRSA and pseudomonas being the commonest organism, the appropriate empirical therapy needs further discussion. Endoscopic surgery is safe, reliable and cosmetic. As patients with intra-orbital abscesses may not be detected clinically or radiologically, we recommend routine incision of the orbital periosteum for suspected orbital complications of acute rhinosinusitis when undergoing endoscopic surgery.

Modified incision to prevent the postoperative spinal lateral angulation in surgery via anterior approach for lumbar fracture

To explore a method of modified incision to prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture. A total 40 patients with lumbar fracture from January 2016 to Jun 2017 were internalized in the study. Including 28 males and 12 females, aged from 27 to 68 years with an average of (39.5±14.9) years. Among them, 28 cases caused by high fall, 9 cases by heavy injury, 3 cases by traffic accidents; and 35 fractures were located at L₁,4 at L₂,1 at L₃. All the fractures were type A based on AO classification. According to Frankel classify of spinal cord injury, 5 cases were grade A, 1 case was B, 10 cases were C, 15 cases were D, 9 cases were E. The patients were divided randomly into modified incision groups and routine incision groups. All patients were treated with decompression, internal fixation and titanium mesh supported bone graft fusion via anterior approach. All the internal fixation materials were ANTERIOR (Medtronic Inc). Incision direction and incision plane were improved in modified incision groups. The coronal Cobb angle and the angle between the vertebral screw and the corresponding endplate were analyzed before and after operation. Pre-and post-operative coronal Cobb angles were (1.20±3.26) °, ( 2.16±3.55)° in modified incision groups and(1.22±4.42)°, (3.91±3.78)° in routine incision groups respectively. And there was no statistical difference before operation, and there was statistical difference after operation between two groups(P=0.017). There was no lateral angulation of more than 5 degrees in modified incision group, but there was lateral angulation of 5 to 10 degrees in routine incision group in 6 cases. The incidence of lateral angulation about 5 degrees after operation was significantly different between two groups (P=0.010). There was significant difference in the angle between the proximal two vertebral screws and the corresponding endplate between two groups (P<0.05), but there was no significant difference in the angle between the distal two vertebral screws and the corresponding endplate (P>0.05). The improvement of incision direction and plane can effectively prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.

Analysis of postoperative recurrence of varicose veins of lower extremity in 81 cases

Objective To discuss the cause of relapse after the first surgery of varicose veins of lower limb, and corresponding prevention and treatment methods. Methods The data of 81 cases of recurrence varicose veins of lower limb in Department of Vascular Surgery, Yanzhou First People′s Hospital from September 2010 to October 2016 were analyzed retrospectively, all patients receded ascending phlebography for deep veins Postoperative follow-up of 6 to 48 months was followed by the combination of outpatient and telephone follow-up, with the symptoms, signs and blood vessels of the lower extremities as the follow-up. Results Remnant of the main trunk or tributaries of great saphenous vein in 19 cases, 31 limbs of deep venous incompetent, incompetent perforator veins 25 limbs, the residual of small saphenous vein were 3 cases, crockett’s syndrome 10 cases, sequelae of deep venous thrombosis belongs to the residual 5 limbs, Klippel-Trenaunay syndrome 1 limbs. There were some patients who suffered from 2 reasons or more than two reasons simultaneously.After surgery again, the cure vate was 100% and no serious complications such as deep vein throm-bosis.During the follow-up, 12 patients showed different degrees of subcutaneous stasis, oral drug observation, and later regression. Local subcutaneous hematoma was 5 cases, 2 cases of pure syringe were treated with pressure after suction, 3 routine local incision was removed to remove stitches, drainage change and delayed healing. Six patients showed the sensory impairment of skin numbness in the leg boot area, and oral related neurotrophic drugs improved within 1 to 6 months after surgery. The remaining patients recovered well after operation. Conclusions Various causes can lead to the varicose vein of lower limb, a varicose vein of lower limb is a common clinical symptoms of many different diseases. Preoperative comprehensive examination to clarify the cause, this will help to reduce the probability of recurrence of lower extremity varicose veins. Key words: Recurrence, cause; Angiography; Varicose veins

Reliability of Incision Biopsy for Diagnosis of Oral Verrucous Carcinoma: A Multivariate Clinicopathological Study.

Studies have reported 20% of conventional squamous cell carcinoma in patients with verrucous carcinoma (VC), later these cancers were termed as hybrid VC. It is important to distinguish both while planning treatment since hybrid VC requires addressing regional lymphatics in addition to respective surgery. Information on odds of missing the foci of invasion on routine incision biopsy might be useful in this regard. Records of all the patients surgically treated for oral cancer from Jan 2010 to Oct 2013 in a Tertiary Cancer Centre was analyzed. Patients diagnosed with primary VC or Verrucous Hyperplasia on incision biopsy were included in the study. Proportion of patients undiagnosed for invasive component on incision biopsy was calculated, multivariate analysis of the sample was performed to find associated cofounders. Fifty-five patients who reported with the diagnosis of VC (n=53) or Verrucous Hyperplasia (n=2) on incision biopsy were included in the study. Twenty-seven were diagnosed as VC and 28 as hybrid VC after excision. This corresponded to 51% (n=28) of cases missing invasive component on incision biopsy. VC was significantly more commonly seen in lip and in buccal mucosa, hybrid VC was more commonly seen in tongue and gingiva and this association was statistically significant (p=0.031) in our study. Incision biopsy is extremely unreliable to diagnose and differentiate oral Hybrid VC from VC or Verrucous Hyperplasia. Caution is required while planning treatment of these patients regarding possibility of presence of conventional squamous cell carcinoma within these tumors.

Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions

ObjectiveWe wished to determine the reduction in the rate of wound complications that would render the use of prophylactic negative pressure wound vacuum therapy (NPWT) cost saving compared to routine incision care (RC) following laparotomy for gynecologic malignancy. MethodsA decision tree was designed from a payer perspective to compare strategies for incision management following laparotomy for gynecologic malignancy: (1) RC; (2) prophylactic NPWT. Rates of wound complication, antibiotic use, re-hospitalization, re-operation, and home health use were obtained from a published cohort of 431 women who underwent laparotomy for endometrial cancer 2002–2007. Costs were estimated using Medicare reimbursements; cost of NPWT ($200) was obtained from hospital financial department. A 50% reduction in wound complications using NPWT was assigned initially and varied for sensitivity analysis. ResultsThe mean BMI was 36. The wound complication rate was 31% (37% for BMI>30, 41% for BMI>40). The overall cost of incision care was $104 lower for NPWT than for RC. At the lowest cost of NPWT ($200), the risk of wound complication must be reduced by 33% (relative risk=0.67) for NPWT to achieve cost savings in this cohort. Modeling obese and morbidly obese cohorts, the NPWT resulted in overall cost savings of $163 and $203, respectively, and the risk of wound complication must be reduced by 28% and 25%, respectively, for NPWT to achieve cost savings. ConclusionIf the wound complication rate can be reduced by one-third, prophylactic NPWT is potentially cost saving in high-risk women undergoing laparotomy for gynecologic malignancy.

Treatment outcomes of auricular hematoma using corrugated rubber drains: A pilot study

Background:Hematoma of the auricle which is a collection of blood beneath the perichondrial layer of the pinna usually poses a challenge to the otolaryngologist due to its high rate of recurrence after treatment and lack of appropriate material for use as stitch dressing especially, in the developing world. This is a Pilot study in which corrugated rubber drain was used as a stitch dressing after routine incision and drainage (I and D) in patients who presented with auricular hematoma.Aim:To determine the effectiveness of corrugated rubber drain in the treatment of auricular hematoma.Subjects and Methods:A total of seven patients were seen within a 2 year period in an ENT Ear, nose and throat clinic. Two patients had simple I and D done, one patient had suturing of the auricle between improvised plastic material used for stitch dressing after I and D, while four patients had I and D done and subsequently, a corrugated rubber drain was used as the stitch dressing.Results:Two patients treated with simple I and D had recurrence of hematoma, the patient treated with improvised plastic material had pressure necrosis of areas of the pinna which however improved when dressing was removed as soon as symptoms were noticed 2 days post-operatively. Four patients who had I and D and subsequent use of rubber-drain as stitch dressing, had un-eventful recoveries.Conclusion:Corrugated rubber tubing drains which are readily available in a developing country like ours has been found very useful as stitch dressing in the management of auricular hematoma.

Anterior chest wall abscess—an unusual complication of an odontogenic infection

A majority of odontogenic infections can be successfully managed with routine incision and drainage and empirical antibiotics. Sometimes an odontogenic infection may spread to contiguous spaces and descend along the neck causing significant morbidity and rarely even mortality. We report a case of an odontogenic infection which had an unusual spread to the anterior chest wall.

Bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for central lung cancer: a report of 139 cases

To evaluate the efficacy and practicability between bronchial sleeve resection or reconstruction of the pulmonary artery by video-assisted thoracic small incision and routine posterolateral incision for lung cancer. The clinic data was analyzed retrospectively, including 139 cases in our hospital underwent sleeve lobectomy and bronchoplasty by video-assisted thoracic small incision surgery for lung cancer from January 1995 to July 2007 and 99 cases in the HUAXI Hospital of SICHUAN University underwent routine posterolateral incision from April 2000 to December 2005. All patients whose bronchus and/or pulmonary artery were involved underwent the operation and experienced the bronchial sleeve resection or reconstruction of the pulmonary artery. All patients were done operation successfully with no perioperative mortality and no occurrence of anastomosis stenosis as well as fistula. The median survival period of video-assisted thoracic small incision patients and the posterolateral incision patients were 63.17 months and 42.00 months, respectively (P > 0.05). There was no sign of reperfusion injury in the reconstruction of the pulmonary artery patients. The small incisions' length was from 8 to 13 cm and the mean length was 10 cm. The routine posterolateral incisions' mean length was 30 cm. Compared to the patients underwent the routine posterolateral incision, patients underwent the operation of video assisted thoracic small incision had less operation time, less chest tube time, less hospitalization time and less postoperative shoulder joint dysfunction. The bronchial sleeve resection and reconstruction of the pulmonary artery by video-assisted thoracic small incision surgery for lung cancer can finish the same work as the traditional thoracic lateral incision with less trauma and recovery time.

Modification of retraction technique for better visibility during mandibular sagittal split ramus osteotomy

ntraoral sagittal split ramus osteotomy is one of the most idely used, versatile but sensitive procedures for mandibuar deformities, and requires considerable skill. The posterior ite of the osteotomy cut makes visibility difficult; many soluions have been tried to improve it, but most, like channel etractors, are not cost-effective. To improve visibility for he osteotomy we have devised the following modification: fter routine incision and dissection, the coronoid process is eld with the help of a Kocher’s forceps to retract the soft issue, and to aid in lateral positioning of the mandible for he lingual cut.1,2 With the help of the cuff of an autoclaved love or an autoclaved rubber band, a fibreoptic light source s stabilised on the dorsal aspect of the Kocher’s forceps proiding retraction, illumination, and visibility (Figs. 1 and 2). ur experience of this technique shows that it gives not only

Enveloping of periosteum on the hamstring tendon graft in anterior cruciate ligament reconstruction

Tendon-bone incorporation of a tendon graft within the bone tunnel is a major concern when using tendon graft for ligament reconstruction. Periosteum consists of multipotent mesodermal cells to form all varieties of connective tissue, including osteogenic and chondrogenic tissues. From our histologic and biomechanical studies in animals, a superior healing process and stronger healing strength can be achieved when periosteum is sutured onto the tendon inserted within a bone tunnel. We applied this idea to anterior cruciate ligament reconstruction to enhance tendon-bone healing. A quadruple-stranded hamstring tendon graft is used. A piece of periosteum, 3 × 3 cm, harvested from the anterior cortex of proximal tibia, is split into 2 rectangle flaps (1.5 × 3 cm each). The periosteum flaps are wrapped and sutured around the tendon graft at the portions near the femoral and tibial tunnel openings. The cambium layer is faced outside to the bone tunnel. Periosteum is easy to harvest from proximal tibia, where is a routine incision for harvesting hamstring tendons. Besides the potential for enhancement of tendon-bone healing, periosteum may be able to seal off the intra-articular opening in a very early period to avoid synovial fluid reflux into the tunnel.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: E27

Surgical Creation of a Chin Dimple

Introduction: The purpose of this case report is to present the methods used to surgically create a chin dimple in a 23-year-old man and to document the results of the surgical technique. Materials and Methods: The method used begins in a manner similar to a routine incision and dissection down the symphysis for a genioplasty. Then bur holes are created in the anterior portion of the symphysis at desired level for the chin dimple. The midline is dissected between the 2 mentalis muscles with a scissors to the subcutaneous tissue, and a defect is created by removing a tissue amount approximately 2 times the anticipated width of the desired dimple using sharp instrumentation or an electrocautery cutting unit. The dermis at the desired level for the chin dimple is sutured to the bony symphysis near the previously made bur holes. Results: The aesthetic results are stable and pleasing. Conclusions: Creation of the surgical chin dimple must take into account all the paired muscle origins and insertions that compose the anatomy of the lower perioral and neck tissue in the midline region at the desired level of the dimple. Anchoring this to the symphyseal prominence creates a resistance to the workings of the muscles and thus creates a more aesthetic and natural chin dimple during facial function.

Transconjunctival sub-orbicularis oculi fat (SOOF) pad lift blepharoplasty: a new technique for the effacement of nasojugal deformity.

Transconjunctival sub-orbicularis oculi fat (SOOF) pad lift blepharoplasty: a new technique for the effacement of nasojugal deformity.

Prevention and correction of temporal hair loss in rhytidectomy.

Routine incisions in the temporal area for rhytidectomy often remove hair-bearing skin anterior to the ear. This results in a cosmetic deformity, making the surgical intervention clearly visible. This is especially problematic for revision rhytidectomy or for patients with naturally high hairlines. This article describes a systematic approach to the temporal hairline and introduces a novel, hair-bearing, transposition flap that corrects iatrogenic loss of the preauricular tuft of hair.

The abdominoinguinal incision: the equivalent of thoracoabdominal incision for the lower quadrants of the abdomen.

In the past, tumors of the iliac fossa, those of the area of the external iliac vessels, and those fixed to the wall of the lesser pelvis with extension into and involvement of the pubic bone were often considered unresectable through the conventional surgical incisions or were treated with hemipelvectomy. For such tumors, although there was exposure of the cephalad aspect through routine incisions, there was lack of exposure on the caudal or lateral aspects, which often extended anteriorly to involve the lower abdominal wall or continued behind the inguinal ligament or through the obturator foramen into the thigh. The abdominoinguinal incision provides exposure for resection of the majority of these tumors with preservation of the extremity. It involves a lower midline incision, which is extended from the pubic symphysis transversely to the midinguinal point on the affected side and then vertically for a few centimeters in the femoral triangle. The femoral vessels are exposed, the ipsilateral rectus abdominis and anterior sheath are divided off the pubic crest, the inguinal ligament is divided off the pubic tubercle, the inferior epigastric vessels are ligated and divided near their origin from the vessels, and the lateral third of the inguinal ligament is detached from the iliac fascia. This incision provides full exposure of the lower abdominal aorta, inferior vena cava, and iliac vessels on the side of involvement in their continuity with the femoral vessels. With improved exposure and vascular control, the majority of tumors with lateral pelvic fixation become resectable.

Bacteraemia following incision and drainage of dento-alveolar abscesses

Twenty-five patients undergoing routine incision and drainage of dento-alveolar abscesses were screened for bacteraemia during the procedure. In 13 patients, the abscesses were aspirated with a needle prior to incision and drainage, while needle aspiration was omitted in the remaining 12. A blood sample was taken from all individuals immediately before the surgical procedures and at one-minute intervals for a period of 5 minutes after surgery. Needle aspiration of pus resulted in a significant reduction (P less than 0.05) in the bacteraemic episodes (0 out of 13) during subsequent surgery as compared with incision and drainage, without aspiration (3 out of 12). Bacteraemia appeared to be transient, although in one case it was detected at 5 minutes. It is concluded that bacteraemic episodes occur during incision and drainage of dento-alveolar abscesses and this may be reduced by aspiration of the abscess contents prior to incision and drainage. In addition, the aspirates could serve as excellent microbiological samples, uncontaminated with salivary flora. The need for antibiotic cover in at risk patients, however, needs to be established by further studies.

Calf implantation.

The process of calf implantation has been standardized by the author, who uses routine incisions and develops a subfascial pocket before inserting the oblong implants of different sizes. The evolution of the technique has led to a series of satisfactory results and a small percentage of complications. One-hundred and twenty-one patients with implantation had satisfactory increases in calf circumference. Complications included infections and capsule formation, which were dealt with in a satisfactory manner.

Clinical experience with a triradiate exposure of the hip for difficult total hip arthroplasty

A triradiate exposure of the hip was developed to facilitate the performance of certain difficult primary and revision total hip arthroplasties. Using this triradiate skin and fascial incision, complete anterior and posterior exposure of the hip capsule can be performed with relative ease. Between October 1980 and January 1985, this exposure was used 50 times in selected cases, including 9 of 320 (3%) primary total hip arthroplasties. All of these cases involved obesity, acetabular protrusion, and/or fragile femoral bone, conditions that would have made safe, adequate exposure without trochanteric osteotomy considerably more difficult through a routine anterolateral or posterior approach. Over this period, the majority of revision hip arthroplasties were performed using triradiate exposure; trochanteric osteotomy was routinely performed in these revision cases. Excellent wound healing was observed in every case, despite unfavorable factors such as advanced age, prednisone therapy, and the presence of prior incisional scars. The triradiate incision offers safe, controlled, and improved exposure in selected primary and revision total hip arthroplasties. It has become nearly the routine incision for the senior author for revision cases.

A simplified method for the routine determination of effective renal plasma flow.

Quantitative renal data (i.e., glomerular filtration rate or effective renal plasma flow) often would be useful ancillary information when radionuclide renography is carried out. The added time, and therefore cost, of obtaining quantitative information might be the main reason a department does not routinely perform a quantitative study, although there is no added radiation or risk to the patient. To simplify the procedure for determining effective renal plasma flow with I-123 orthoiodohippurate (OIH), the published methodology was modified to eliminate the repetitive preparation of a standard solution. This allows the routine incision of effective renal plasma flow (ERPF) determination in I-123 OIH renography with minimal impact on departmental operations.