Soft Tissue Release Research Articles

FISIOTERAPIA NO ZUMBIDO SOMATOSENSSORIAL: REVISÃO SISTEMÁTICA

Somatosensory tinnitus is a type of tinnitus that can be influenced by musculoskeletal and somatic factors, such as cervical or temporomandibular disorders. Physiotherapy has emerged as a noninvasive treatment option with the aim of addressing these musculoskeletal abnormalities to reduce tinnitus intensity and improve patients' quality of life. This review aims to evaluate the effectiveness of physiotherapeutic approaches in the management of somatosensory tinnitus, exploring different treatment modalities and the results obtained in clinical studies. The article was analyzed through clinical trials and observational studies were conducted, focusing on the impact of physiotherapy on somatosensory tinnitus, using outcome measures such as the Visual Analog Scale (VAS) for tinnitus intensity and the Tinnitus Handicap Inventory (THI) for quality of life. Most studies reported significant improvements in tinnitus severity and functional well-being of patients after physiotherapy interventions. Techniques such as manual therapy and myofascial release have been particularly effective in reducing symptoms in patients with cervical or temporomandibular disorders. However, a major limitation identified was the lack of standardized treatment protocols, which makes it difficult to generalize the results. Physiotherapy appears to be a promising therapeutic option for somatosensory tinnitus, particularly for patients with associated cervical and temporomandibular disorders. Future research should aim to standardize treatment protocols and include larger randomized controlled trials to further validate these findings and establish evidence-based clinical guidelines.

Comparative Analysis of Suboccipital Muscle Inhibition Technique and Static Hamstring Stretching in Normal Healthy Individuals with Hamstring Tightness: A Randomised Clinical Trial

BACKGROUNDHamstring tightness is a major contributing factor for lower back pain, lumbar spine disorders and sports related injuries. Many studies has been done to improve the flexibility of hamstring muscle by various techniques such as different stretching techniques myofascial Release Therapy, neuro-muscular therapy and Muscle Energy Technique etc. All of these technique mentioned act at the hamstring muscle level to provide its effectiveness. In a present study we aimed at to find out the effectiveness of suboccipital muscle inhibition technique for improving tightness in hamstring muscle. Hence this study is done to find out the effectiveness of applying suboccipital muscle inhibition technique on distant muscle flexibility in turn to prove the distant muscle relationship. Study is done with the aim to find whether suboccipital muscle inhibition technique can be used along with conventional methods for improving tightness of hamstring muscle.AIMTo compare the effectiveness of suboccipital muscle inhibition technique and static hamstring stretching in normal individuals with hamstring tightness.MethodsIn this comparative study total 165 individuals were screened for tightness of hamstring. Individuals who satisfied the inclusion criteria were selected from the normal healthy population. A total of 100 healthy subjects of both genders between the age of 18 and 25 were recruited in this trial. After doing block randomization subjects were assigned to two groups ,in Group A 50 subjects were given suboccipital muscle inhibition technique for 5 sessions for 5 consecutive days. Another group 50 subjects were given static stretching to both the lower limbs for 30 seconds followed by 15 seconds relaxation, for 5 sessions for 5 consecutive days.RESULTSActive knee extension test using Mann Whitney U test in both suboccipital muscle inhibition technique and static hamstring stretching group shows no difference(p=0.623) for pretreatment, while significant result immediately post treatment (0.002) and statistically significant result in baseline parameters after 5 sessions of treatment (0.000)Forward flexion distance test using Mann Whitney U test in both suboccipital muscle inhibition technique and static hamstring stretching group shows no significant difference(p=0.088) for pretreatment and also for immediately post treatment (0.893) but shows statistically significant result in baseline parameters after 5 sessions of treatment (0.009)CONCLUSIONSuboccipital muscle inhibition technique and static hamstring stretching are both effective in improving the flexibility of hamstring muscle. The Suboccipital muscle inhibition technique is more effective compared to static hamstring stretching in normal healthy individuals with hamstring tightness.

Acute Effects of Myofascial Release on Foot Mobility and Performance in Basketball Players with Hypomobile Feet—A Randomized Controlled Trial

Hypomobility in the foot structure causes functional limitations. These functional limitations affect sportive performance negatively, especially in basketball, where dynamic movements such as jumping and sudden changes in direction are very intense. In this context, reducing hypomobility is important in terms of eliminating performance disorders caused by hypomobility. The purpose of this study was to investigate the acute effects of myofascial release on foot mobility and sportive performance in basketball players with hypomobile feet. This study was designed as randomized controlled experimental research. Twenty-four male basketball players (23.46 ± 2.81 years) participated in this study. The athletes were first subjected to foot mobility, balance and vertical jump tests. Then, the participants were divided into two groups: myofascial release (MR) and placebo myofascial release (PMR). Myofascial release (Graston technique) was applied to the MR group, and placebo myofascial release was applied to the PMR group. After application, foot mobility and performance measurements were performed again, and the results were analyzed. It was observed that there was a significant difference in right foot mobility (d = 4), left foot mobility (d = 6), vertical jump (d = 1.13) and dynamic balance (d = 1.03) parameters after application in the MR group. It was also determined that the acute effects of the intervention on foot mobility lasted for at least two hours (p < 0.001). There was no change in any parameter after application in the PMR group (p > 0.05). The results of this study show that a single session of myofascial release applied to the plantar sole temporarily increased foot mobility and improved vertical jump and dynamic balance performance in basketball players with chronic hypomobility.

Effect of Iliotibial Band Myofascial Release Combined with Valgus Correction Exercise on Pain, Range of Motion, Balance, and Quality of Life in Patients with Grade II Knee Osteoarthritis: A Randomized Clinical Trial

The objective of this study was to find out the effect of the myofascial release technique combined with valgus correction exercise on the pain, range of motion, balance, and quality of life in participants with grade II knee osteoarthritis. Forty participants with grade II knee osteoarthritis were randomly assigned into two treatment groups in the present clinical trial; group A was the myofascial release group, and group B was the myofascial release with valgus correction exercises group. Measurement included pain, balance, range of motion, and quality of life, as measured through the visual analog scale (VAS), Berg balance scale (BBS), goniometer, and knee injury and osteoarthritis outcome score (KOOS), respectively. The data were collected at the baseline and 3rd and 6th weeks. The between-groups comparison at the end of the 6th week showed significant results in the iliotibial band myofascial release with the valgus correction exercise group (p < 0.001). The within-group difference showed improvement in both groups individually, with more significant values in group B. The current study showed that the myofascial release combined with valgus correction exercises can effectively improve the pain, range of motion, balance, and quality of life in participants with grade II knee osteoarthritis. Trial Registration: IRCT20230216057434N3.

LIBERAÇÃO MIOFASCIAL COMO RECURSO NO TRATAMENTO DAS ALGIAS NA COLUNA VERTEBRAL - UMA REVISÃO DE LITERATURA

Myofascial release is a manual technique widely used in the treatment of musculoskeletal pain, including sciatica, back pain and low back pain. This study aims to review the existing literature on the effectiveness of myofascial release in the management of spinal pain, highlighting its applications, benefits and limitations. Scientific articles were analyzed that discuss the use of the technique alone or in conjunction with other therapeutic approaches, such as stabilization exercises, dry needling and joint manipulation. The results indicate that myofascial release can significantly reduce pain and improve patients' mobility, although effectiveness varies depending on the protocol used and the patient's profile. The combination of the technique with other therapies proved to be particularly effective in cases of chronic pain. However, little data was found on its application in the treatment of back pain, suggesting the need for more research focused on this condition. Furthermore, the lack of standardization in application methods and the limitation in the number of studies reviewed are critical points that must be considered. It is concluded that myofascial release is a promising approach, but requires greater methodological rigor in future research to consolidate its use in the management of spinal pain.

Theoretical and methodological foundations of the use of myofascial release in higher education students in physical education classes

The purpose of the study: to consider the theoretical and methodological foundations of the myofascial release method and to study the effectiveness of its use in higher education students in physical education classes. Research methods: theoretical analysis and generalisation of scientific and methodological literature. Results of the study. The definition of the concept of ’myofascial release’ is given, the characteristics and means of this method are described, and the methodological aspects of its application are presented. The effectiveness of the use of myofascial release in physical education classes for higher education students is revealed. Conclusions. The myofascial release method, based on the research of doctors. Janet Travell, Robert Ward and John F. Barnes, demonstrates significant effectiveness in reducing muscle tension, pain and restoring muscle and fascia function through manual action on trigger points. The myofascial release technique is based on an understanding of the integrity of the fascial system, which performs protective and support functions, and disorders in which can lead to mobility restrictions and pain, which emphasises the importance of timely intervention. The use of myofascial release in physical education classes for higher education students helps to improve health, blood circulation; relieve muscle spasms; reduce muscle pain; increase joint mobility; accelerate recovery from physical activity; increase the level of endurance and flexibility; reduce the likelihood of injury. The combination of myofascial release with stretching increases its effectiveness, helping to reduce pain, improve flexibility and reduce the risk of injury. The method of myofascial release is an effective means of improving the physical condition of students, which emphasises the importance of its implementation in the system of physical education of higher education institutions.

Methodology for improving the physical fitness of qualified goalkeepers in football through fitness means

The article substantiates a methodology for improving the physical fitness of qualified football goalkeepers using health- related fitness. The need for developing alternative training programs for goalkeepers in football has been clarified. The methodology for enhancing the physical fitness of qualified goalkeepers in football includes health-related fitness means and prioritizes an individual approach. The use of fitness tools allows for conducting individual sessions aimed at improving the functional and physical fitness of goalkeepers in football. Thus, the foundation of the methodology consists of exercises using Stick Mobility gymnastic sticks, which have replaced traditional exercises from the Pilates and yoga systems; exercises aimed at activating the myofascial lines of the body; exercises for developing explosive strength; and myofascial release exercises, which have replaced traditional stretching exercises. The author's methodology for the individual training of qualified goalkeepers in football was designed for 4 morphocycles during the preparatory period by the training camp schedule based on the competition calendar. The use of fitness means allowed for conducting individual sessions to improve goalkeepers' functional and physical fitness in football.

Investigating the influence of Bowen technique with retro-walking on hamstring flexibility and dynamic balance in young college-going students

Abstract: BACKGROUND: Hamstring tightness is a common issue affecting individuals, leading to discomfort, pain, and increased risk of injury. The Bowen technique, a gentle myofascial release technique, and retro-walking have been suggested as potential interventions to improve hamstring flexibility and dynamic balance. This study aimed to assess the impact of combining the Bowen technique with retro-walking on hamstring flexibility and dynamic balance in college students. METHODOLOGY: A pre–post-experimental study was conducted among 50 college students aged 17–25 years. Participants were randomly allocated to either the experimental group (n = 25) receiving Bowen technique and retro-walking intervention or the control group (n = 25). Hamstring flexibility was assessed using the active knee extension test, and dynamic balance was evaluated using the Y-Balance test. The data were analyzed using paired and unpaired t-tests. RESULTS: Intragroup analysis revealed significant improvements in hamstring flexibility and dynamic balance posttreatment in the experimental group (P < 0.05), with no significant changes observed in the control group (P > 0.05). Intergroup analysis demonstrated statistically significant improvements in hamstring flexibility (P < 0.05) and dynamic balance (P < 0.05) between the experimental and control groups postintervention. DISCUSSION: The results indicate that the combination of the Bowen technique and retro-walking effectively improves hamstring flexibility and dynamic balance in college students. The Bowen technique likely enhances muscle extensibility and tissue repair, while retro-walking optimizes muscle length utilization and proprioception. These findings underscore the potential utility of these interventions in clinical practice for managing hamstring tightness and improving overall musculoskeletal health. CONCLUSION: The integration of the Bowen technique with retro-walking holds promise as a noninvasive and effective approach to enhance hamstring flexibility and dynamic balance in college students.

Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study.

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.

Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study.

Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Medial joint gap significantly increased from stages 1 to 3 by 3.2mm, 6.8mm, and 7.2mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5mm and 8.2mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.

Clinical application of myofascial therapy in the treatment of postpartum pain-related functional disorders: A review.

During pregnancy, fetal growth could lead to changes in human biomechanics. If postpartum recovery was not properly managed, it could be exacerbated, resulting in myofascial system disorders and various functional impairments. Among them, pain-related functional disorders were an important issue affecting quality of life in postpartum women. The pathogenesis of these disorders remained unclear but it was primarily associated with changes in biomechanics, the endocrine system, and nervous function. However, postpartum pain-related dysfunction had been considered a normal physiological response to childbirth, leading to a lack of attention. Therefore, many postpartum women failed to receive timely, effective, and standardized treatment, hindering their ability to reintegrate into family and society, and causing severe damage to their physical and mental health. In clinical practice, myofascial therapy could effectively alleviate postpartum pain and muscle spasms, improve excessive tension injuries in myofascial, and had a good therapeutic effect on postpartum pain-related functional disorders. The mechanism of myofascial therapy involved improving core muscle strength, restoring normal body alignment, and promoting the remodeling of myofascial mechanical structures. This article explored the positive effects of myofascial therapy on postpartum pain-related functional disorders from a biomechanical perspective, aiming to provide diverse treatment approaches for clinical practitioners.

Comparative evaluation of the efficacy of therapeutic exercise versus myofascial trigger point therapy in the treatment of shoulder tendinopathies: a randomised controlled trial

ObjectiveShoulder pain, primarily due to rotator cuff tendinopathy, significantly impacts function and quality of life, with considerable socioeconomic implications. Physiotherapy myofascial trigger point therapy (MPT) is traditionally used, but therapeutic...

Do Balance Scores Improve Due To Acute Myo-fascial Release In Collegiate Female Athletes

Do Balance Scores Improve Due To Acute Myo-fascial Release In Collegiate Female Athletes

Predictive factors for deep medial collateral ligament release in adjusted mechanical alignment total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) demands precision in achieving optimal alignment and soft tissue balance, especially in cases of medial compartment osteoarthritis where the need for medial soft tissue release is critical yet challenging to ascertain.ObjectiveThis study aims to systematically investigate the relationship between preoperative data, initial knee conditions and the necessity for deep collateral ligament (MCL) release in adjusted mechanical alignment total knee arthroplasty.MethodsWe conducted a retrospective study involving 61 TKA patients who underwent adjusted mechanical alignment robotic-assisted procedures. Soft tissue release was carried out when clinically indicated. We collected and statistically analyzed patient demographics, initial knee conditions, and surgical details.ResultsAmong the patients, 52% required deep MCL release. Notably, patients without soft tissue release exhibited lower initial hip-knee-ankle (HKA) angles, reduced varus-valgus stress test angles, and a greater range of flexion. We identified a predictive threshold HKA angle of 6.250 degrees, demonstrating high sensitivity and specificity for determining the need for deep MCL release.ConclusionThis study underscores the significance of the initial HKA angle and varus-valgus stress tests in predicting deep MCL release during TKA. The established HKA angle threshold simplifies surgical decision-making, reducing the likelihood of unnecessary soft tissue release.

Immediate effects of thoracic mobilization versus soft tissue release on trunk motion, pain, and lumbar muscle activity in patients with chronic low back pain

IntroductionThoracic mobilization and tissue release are common manual techniques in clinical practice. However, the relative effects of these two treatments on chronic low back pain (CLBP) have not yet been explored. Thus, this study aimed to investigate and compare the immediate effects of thoracic mobilization with those of soft tissue release on trunk movement, pain sensation, and muscle activity in patients with CLBP. Methods28 participants were randomly assigned to two intervention groups. The mobilization group received mobilization treatment at the hypomobile joints of the trunk segment, while the soft tissue release group received thoracolumbar fascia release and massage in the lumbar region. The trunk range of motion (ROM), tissue hardness, pressure pain threshold (PPT), and erector spinae activity during light-weight lifting tasks were measured before and immediately after both interventions. FindingsAll measured outcomes in both groups improved after intervention (p < 0.05). The mobilization technique significantly improved side bending and rotation, PPT, and tissue hardness compared to soft tissue release. However, lumbar muscle activation reduced to a greater extent in the soft-tissue release group. ConclusionBoth techniques improved trunk ROM and PPT and reduced tissue hardness and muscle activation. Therefore, both these techniques are recommended for patients with CLBP. Trial registrationISRCTN75190733.

The Comparison of Scar Mobilization Techniques with and without Core Stability Exercises on Scar Tissue Mobility and Lumbopelvic Pain

Abdominal adhesions and lumbopelvic pain can occur after a caesarean section. Many treatment approaches, such as injections, massage, surgical release, soft tissue release, strengthening, stretching and core stability exercises are available for abdominal scars. Physiotherapy treatments are considered safer and more convenient. The study aims to compare the effects of scar mobilization techniques with and without core stability exercises on scar tissue mobility and lumbopelvic pain. The study was a randomized clinical trial conducted at the Rafiqa Hospital and Fatima Hospital, Sargodha, Pakistan. A sample of 30 participants was allocated in Group A and B. Group A received scar mobilization and core stability exercises, while Group B received only scar mobilization, with both groups undergoing 3 sessions per week for total three weeks. The groups were assessed at baseline after the 5th and 9th sessions, using Oswestry Low Back Pain Disability Questionnaire (ODI), Numeric Pain Rating Scale (NPRS), Manual Scar Mobility Testing (MSMT), and Vancouver Scar Scale (VSS). Moreover, the data were analyzed using SPSS 25. The mean age of participants was 27.22 ± 4.21, and their body mass index was 27.10 ± 3.53. Both groups showed significant differences within the subject’s scores of disability, pain and scar mobility (p&lt;0.05). Between-group comparison of both groups at post-treatment II showed considerable improvement in pain scores (NPRS score, p&lt;0.05). Whereas non-significant results were in other outcome measures (disability and scar mobility p&gt;0.05) in post-treatment II. Scar mobilization techniques with core stability exercises were more effective than scar mobilization techniques alone in the conservative treatment of females with lumbopelvic and scar pain after caesarean section.

Effect of adding diaphragmatic myofascial release to corrective exercise on the thoracic curvature angle and pulmonary function testing in hyperkyphotic adolescent girls: A randomized controlled trial.

To investigate whether adding diaphragmatic release to corrective exercise could improve the Cobb angle and pulmonary function more than corrective exercise alone in hyperkyphotic adolescent girls. Single-blinded, randomized, controlled trial. 118 adolescent hyperkyphotic girls were allocated randomly into two equal groups. Control group received only corrective exercise, while study group received diaphragmatic release in addition to corrective exercise. Primary outcome was Cobb angle, assessed by lateral radiographs. Secondary outcomes were pulmonary function testing, assessed by computerized spirometery. Outcomes were assessed pre- and post-treatment, after three months of interventions, in both groups. Two-way ANOVA revealed that both Cobb angle and pulmonary function testing significantly improved after treatment in both groups (p < 0.001). Time*group interaction revealed that the study group had a superior improvement in Cobb angle and pulmonary function testing compared to the control group (p < 0.003 and p < 0.001, respectively). Adding diaphragmatic release to three months of multimodal corrective exercise program showed superior improvements in Cobb angle and pulmonary function testing than corrective exercise alone in hyperkyphotic adolescent girls within a shorter timeframe compared to previous studies. These results strengthen the hypothesis of its potential as a beneficial addition to the treatment of thoracic hyperkyphosis.

Subvastus approach improves intraoperative patellofemoral tracking in total knee arthroplasty for varus deformities – An in vivo study

Objectives: The subvastus approach has the theoretical advantages of protecting the extensor mechanism while securing the patellar blood supply, enhanced patellofemoral tracking, faster recovery, decreased post-operative pain, and shortened length of hospital stay at the expense of longer operative and tourniquet times. This study aimed to evaluate the effect of the subvastus approach on patellofemoral tracking. We hypothesize that being a more anatomical approach, the subvastus approach may improve patellofemoral tracking intraoperatively and decrease the necessity to release the lateral retinaculum during total knee replacement (TKR). Methods: In 54 consecutive cases presented with advanced varus osteoarthritis knee in a high-volume arthroplasty hospital from January 2022 to April 2022 and scheduled for cemented posterior stabilized TKR, patellofemoral tracking and the tightness of lateral retinaculum were evaluated intra-operatively all through the whole range of motion (ROM) of the knee by “No thumb test” and “Vertical patella test” subsequent doing the whole tibial and femoral bony cuts, proper sizing, completing soft-tissue release and gap balancing, and reaching the full ROM. Results: The “No thumb test” and “Vertical patella test” were negative in all the patients, and there was no intra-operative dislocation or subluxation. In addition, there was no need to release the lateral retinaculum in any of them. Conclusion: Implementing the subvastus approach during TKR surgeries, with subsequent preservation of the patellar attachment of the vastus medialis oblique muscle, allows for better tracking of the patella over the femur during surgery, resulting in a reduction in the necessity of performing lateral retinaculum release intraoperatively.

Open versus robotic retromuscular ventral hernia repair: outcomes of the ORREO prospective randomized controlled trial.

Robotic retromuscular ventral hernia repair (rRMVHR) potentially combines the best features of open and minimally invasive VHR: myofascial release with abdominal wall reconstruction (AWR) with the lower wound morbidity of laparoscopic VHR. Proliferation of this technique has outpaced the data supporting this claim. We report 2-year outcomes of the first randomized controlled trial of oRMVHR vs rRMVHR. Single-center randomized control trial of open vs rRMVHR. 100 patients were randomized (50 open, 50 robotic). We included patients > 18 y/o with hernias 7-15cm with at least one of the following: diabetes, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥ 30, or current smokers. Primary outcome was occurrence of a composite outcome of surgical site infection (SSI), non-seroma surgical site occurrence (SSO), readmission, or hernia recurrence. Secondary outcomes were length of stay, any SSI or SSO, SSI/SSOPI, operative time, patient reported quality of life, and cost. Analysis was performed in an intention-to-treat fashion. Study was funded by a grant from Society of American Gastrointestinal and Endoscopic Surgeons. 90 patients were available for 30-day and 62 for 2-year analysis (rRMVHR = 46 and 32, oRMVHR = 44 and 30). Hernias in the open group were slightly larger (10 vs 8cm, p = 0.024) and more likely to have prior mesh (36.4 vs 15.2%; p = 0.030), but were similar in length, prior hernia repairs, mesh use, and myofascial release. There was no difference in primary composite outcome between oRMVHR and rRMVHR (20.5 vs 19.6%, p = 1.000). Median length of stay was shorter for rRMVHR (1 vs 2days; p < 0.001). All patients had significant improvement in quality of life at 1 and 2years. Other secondary outcomes were similar. There is no difference in a composite outcome including SSI, SSOPI, readmission, and hernia recurrence between open and robotic RMVHR.

Complications after cosmetic limb lengthening, a specialized center experience

BackgroundCosmetic limb lengthening has been rapidly growing ever since the advent of the external fixators magnetic lengthening nails. Similar to all surgical procedures, cosmetic limb lengthening is not risk free. This paper presents a series of complications encountered and treated at a specialized limb lengthening and deformity correction center, along with an analysis of potential risk factors. MethodsA series of referred patients for complications after limb lengthening using IM nails were identified. Collected variables included demographics, place of index surgery, complication, and treatment of choice and outcome of treatment. Results22 limb lengthening procedures were identified. Most of these cases were done outside of the U.S. Hardware failure occurred in 23 % of index surgeries, primarily affecting femurs. Mal/nonunion rates were high (45 %), with femurs most affected. Iatrogenic deformities, primarily tibial, and soft tissue complications including contractures and nerve entrapment were observed. Treatment strategies included hardware exchange, bone grafting, and soft tissue release. All patients were successfully treated without any patients suffering from serious long term irreversible outcomes. ConclusionThis study examines the surgical management of complications arising from cosmetic limb lengthening procedures at a single institution. We provide insights into effective treatment strategies and highlight the risks associated with medical tourism for these procedures. Our findings demonstrate a rising incidence of complications linked to international limb lengthening centers.