Short Incision Research Articles

Minimally Invasive Approach for the Reconstruction of the Peroneal Brevis Tendon Using Semitendinosus Autograft: An Alternative Technique to Avoid Soft Tissue Complications

Surgical treatment of irreparable tears of the peroneal brevis tendon has been widely performed with reconstruction of the tendon using semitendinosus tendon allograft or autograft. However, it is carried out through a long lateral curved incision prone to soft tissue complications such as scar tenderness, sural nerve lesion, wound dehiscence, and swelling. We present a less invasive approach through 2 short incisions, preserving the lateral soft tissues of the hindfoot. It represents an effective and safe alternative to the long lateral curved approach. Besides that, it can be useful to treat patients at risk of wound healing complications such as smokers, vasculopaths and diabetics. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle

BackgroundA 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management.MethodWe performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and “en bloc” resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma.ConclusionMISA can be safely used when confronted to a lesion of the lower fourth ventricle.

Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. In the first phase: mean incision size was 32mm, and mean operative time was 28.5min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.

Brachio-brachial arteriovenous fistula combined with superficialization of the brachial artery using a short skin incision for hemodialysis.

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2-3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.

Short or Minimum Incision Deep Plane/Extended Deep Plane Facelift/Rhytidectomy.

The mini facelift, often referred to as short scar or minimum incision facelift or rhytidectomy, is a facial rejuvenation procedure with limited incisions. It aims to lift and tighten the superficial musculo-aponeurotic system to restore the lower midface and the mandibular contour, thus eliminating undesirable jowls. By performing the deep plane or extended deep plane facelift with short incisions, the midface and upper neck can also be improved without the full face and neck incisions as in the typical rhytidectomy. With its decreased operative time and expense, rapid recovery, less complications, as well as more limited incisions with resultant less evidence of scars, mini facelift techniques have boomed over a decade for younger patients who seek facial rejuvenation. We describe our concept of the short or minimum incision deep plane/extended deep plane facelift or rhytidectomy and address what results can be expected.

A Simple and Quick Tendon Transfer Technique to Restore Thumb Extension.

Abstract Extensor pollicis longus (EPL), the long extensor tendon for the thumb, is one of the commonest tendon to rupture and require treatment. In case of closed rupture of EPL, direct repair is usually not possible, requiring tendon reconstruction to restore function. Traditionally, extensor indicis proprius (EIP) tendon is transferred under general or regional anaesthesia through two (or more) incisions. The author proposes and demonstrates that it is possible to carry out this transfer through one short incision under local anaesthesia with good outcome and minimal complications.

An analysis of the \u201cHalf-Perc\u201d versus open surgical placement method for a peritoneal dialysis catheter: a non-inferiority cohort study

BackgroundMost end-stage renal disease (ESRD) patients undergo open surgical techniques for peritoneal dialysis (PD) catheter placement. An alternative method to PD catheter implantation is the half-percutaneous (“Half-Perc”) technique based on a modified trocar that is performed by a nephrologist. The single-center, retrospective, observational, cohort study presented here aimed to compare the effects of the “Half-Perc” technique with the traditional open surgery on peritoneal catheter insertion.MethodsFrom January 2015 to January 2018, 240 ESRD patients who received initial PD catheter placement were divided into two groups based on the “Half-Perc” technique or open surgery. All patients were followed up for 365 days or until loss of initial PD catheter or death. Prism 5 software was used to analyze baseline characteristics, operation-related parameters, mechanical complications and clinical outcomes.ResultsThe “Half-Perc” technique showed shorter operation time, shorter incision length, lower postoperative pain scores and quick initiation of the PD program compared to the open surgery. After the 365-day follow-up, the “Half-Perc” group showed a higher rate of catheter dysfunction (4% versus 0.9%) that was corrected by conservative treatment in most patients and a lower rate of peritonitis (4% versus 9.6%) but mechanical complications and clinical outcomes did not differ between the two groups. There was also no significant difference based on overall patient mortality or catheter removal. One-year initial catheter survival and true catheter survival were not statistically different between the groups.ConclusionThe “Half-Perc” placement of the PD catheter using a modified metal trocar appears to be a non-inferior alternative method and carries minimal invasiveness and risk compared to open surgical placement.

Outcomes of Endoscopic Versus Open Spring Assisted Surgery for Sagittal Craniosynostosis.

Spring-assisted surgery (SAS) has been shown to be an effective technique for correction of isolated sagittal craniosynostosis in patients less than 6 months of age. At their institution, the authors adopted a minimally invasive technique in 2010, using a shorter incision and an endoscope. A retrospective chart review of 101 patients with isolated, nonsyndromic, sagittal craniosynostosis, who underwent SAS, was performed in order to compare perioperative and clinical outcomes of the open (n = 51) and minimally-invasive (n = 50) approaches. Surgeries were performed by 2 neurosurgeons and 3 plastic surgeons, between 2005 and 2018. The pre and postoperative cephalic indices were not significantly different in both groups. Minimally-invasive spring placement required a longer operative time than the open approach, with the mean minimally-invasive operative time at 65 minutes, compared to 53 minutes (P < 0.0001). Spring removal operative time was not significantly different, with the minimally-invasive operative time at 31 minutes versus 29 minutes (P = 0.48). There were no significant differences in major or minor complications when comparing the open and minimally-invasive approaches. In conclusion, both the open and the minimally-invasive SAS techniques are effective for early correction of isolated sagittal craniosynostosis, although the minimally-invasive approach requires a longer operative time for spring placement.

Short-term efficacy of totally laparoscopic left colon cancer radical resection with overlapped delta-shaped anastomosis technique

Objective: To evaluate the safety, feasibility and short-term efficacy of totally laparoscopic left colectomy for left colon cancer by using overlapped delta-shaped anastomosis technique for digestive tract reconstruction. Methods: A retrospective cohort study was conducted to collect the clinical data of 86 patients with left colon cancer who underwent laparoscopic surgery in Cancer Hospital of Chinese Academy of Medical Sciences from October, 2017 to February, 2019. The patients were divided into totally laparoscopic left-sided colectomy (TLLC) (treatment group, n=25 cases) and laparoscopic-assisted left-sided colectomy (LALC) (control group, n=61 cases). The intraoperative and postoperative data were compared between the two groups. Results: There were no surgical-related deaths in both groups. All the patients in the TLLC group underwent laparoscopic resection, while one patient in the LALC group transfer to open surgery. The operation time in TLLC group and LALC group were (164.5±42.3) min and (171.0±43.1) min, respectively, without statistically significant difference (P=0.516). However, the intraoperative blood loss of patients in the TLLC group was (36.4±22.7) ml, which was significantly less than (52.9±32.2) ml in the LALC group (P=0.026). The anastomosis time in the TLLC group was (39.1±6.5) min, which was significantly longer than (24.9±5.4) min in the LALC group (P<0.001). Postoperative exhaust time in the TLLC group was (2.6±0.5) days, which was significantly shorter than (3.3±0.8) days in the LALC group (P<0.001). The incision length in the TLLC group was (4.2±2.2) cm, significantly shorter than (7.0±2.5) cm in the LALC group (P<0.001). The length of the resected bowel was (21.0±7.3) cm in the TLLC group, which was significantly longer than (17.5±5.4) cm in the LALC group (P=0.037). The length of hospital stay in the TLLC group was (6.2±1.9) days, which was significantly shorter than (7.9±1.5) days in the LALC group (P<0.001). The incidences of postoperative complications in the TLLC group and LALC group were 0 and 4.9% (3/61), respectively, without statistically significant (P=0.553). No anastomotic complications occurred in both groups. During the follow-up period, neither group of patients was hospitalized again, and no tumor metastasis or recurrence occurred. Conclusions: It is safe and feasible to apply the TLLC with overlapped delta-shaped anastomosis in patients with left colon cancer. It has better short-term effects such as shorter incisions, faster recovery, and shorter postoperative hospital stays, and is worthy of further promotion.

Natural outcome of hemoglobin and functional recovery after the direct anterior versus the posterolateral approach for total hip arthroplasty: a randomized study

BackgroundTotal hip arthroplasty (THA) is one of the most successful orthopedic surgeries. There are many common surgical approaches for THA. The direct anterior approach (DAA) and posterolateral approach (PLA) were compared, leading to controversial results.MethodsWe report on a prospective randomized study which compared the changes of perioperative hemoglobin (Hb), the Harris hip score (HHS) and a visual analog scale (VAS) pain score following THA using DAA or PLA. A total of 130 participants were randomly divided into two groups (65 DAA versus 65 PLA). Perioperative ΔHb and other clinical outcomes were recorded.ResultsA total of 130 participants completed follow-up, while 14 patients were not recorded in blood outcomes due to blood transfusions and complications. The average Hb decrease immediately after surgery in the DAA group was greater than that in the PLA group (21.1 versus 15.8 g/L, P < .001). However, post-operative Hb descent velocity was slower in the DAA group, and the lowest point was reached earlier. No significant differences in ΔHb levels could be observed after 1 month in the two groups. When compared with the PLA group, the DAA group had a shorter incision (9.1 versus 13.5 cm, P < .001) and shorter hospital stay (4.2 versus 4.7 days, P = .004). However, the operation time of the DAA group was longer (88.0 versus 66.8 min, P < .001). The DAA group had a better HHS and VAS pain score at 6 weeks post-surgery. However, no significant differences were observed at later time points.ConclusionWe concluded that DAA performed better on enhanced recovery after surgery (ERAS) than PLA in THA, while both DAA and PLA could result in a positive, similar result after 3 months.Trial registrationThe study was registered by the Chinese Clinical Trial Registry (ChiCTR1900020770, 19 January 2019).

Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With Robotic Latissimus Dorsi Flap Harvest: Technique and Results.

Introduction. Only few cases of robotic latissimus dorsi flap reconstruction (RLDFR) have been reported in indication of reconstruction for breast cancer (BC). We report our experience of combined robotic nipple-sparing mastectomy (R-NSM) and RLDFR, and analyze technique, indications, and reproducibility. Methods. All patients with R-NSM and RLDFR from November 2016 to August 2, 2018, were analyzed, and technics have been described. Complication rate with Clavien-Dindo grading and postoperative hospitalization length (days) are reported. Results. Thirty-five R-NSM with RLDFR were performed in 22 cases for primitive BC and 13 for local recurrence. In 12 patients, another surgical procedure was performed during the same time (axillary lymph node dissection or contralateral breast surgery). R-NSM was realized through a short axillar incision, with inside-only installation for 12 patients (34.3%): 18 nonautologous and 17 autologous RLDFR associated with implant in 9 patients. In logistic regression, mastectomy weight >330 g was significantly associated with the use of implant (odds ratio [OR] = 17, P = .015), and significant factor of the time of anesthesia ≥380 minutes was 2 installations (OR = 10.4, P = .049). The median duration of hospitalization stay was 4 days. Complications rates were 51.4% (18/35; 9 grade-1, 2 grade-2, and 7 grade-3). In logistic regression, associated other surgical procedure was predictive of grade-3 complications (OR = 6.87, P = .053). Conclusion. We confirmed the reproducibility and safety of R-NSM and RLDFR with a decreased complication rate. NSM was performed in 42.8% of our patients after previous radiotherapy. We observed an increase of grade-3 complications when R-NSM and RLDFR was combined to another surgical procedure.

Determining the indications for funnel-assisted implant insertion using a short incision in reconstructive breast surgery

Determining the indications for funnel-assisted implant insertion using a short incision in reconstructive breast surgery

Patterns of opioid use in dialysis access procedures

BackgroundOverprescription of opioids after surgical procedures is recognized as an important contributor to opioid misuse. Dialysis access procedures are commonly performed outpatient operations with few data or guidelines to inform prescription pain management practices. We sought to characterize opioid pain medication use after dialysis access surgery to promote a conservative approach to postoperative opioid prescriptions. MethodsWe performed a retrospective review of patients who underwent surgical dialysis access procedures from August 2018 through January 2019. Patient-reported opioid use information was captured in a brief questionnaire administered during routine follow-up appointments or phone calls and recorded in the electronic medical record. The procedure, type of intraoperative anesthesia or analgesia, postoperative prescription provided, and patient factors (including age, sex, dialysis type, history of chronic pain, and preoperative opioid or benzodiazepine use) were recorded. All procedures were classified by type (arteriovenous fistula or graft with a short incision [AVF-S], arteriovenous fistula or graft with a long incision [AVF-L], or peritoneal dialysis [PD] catheter), and descriptive statistics were performed using R (R Foundation for Statistical Computing, Vienna, Austria). ResultsEighty-six patients underwent dialysis access procedures in the study time frame, of whom 63 were administered the pain questionnaire and 58 quantified opioid use; 85% of patients received a prescription, but 31% took no opioids and 71% used opioids for ≤2 days. Interquartile ranges (25th-75th percentile) of prescription and consumption quantities for patients who underwent AVF-L procedures were 10 to 28 pills and 2.5 to 20 pills; for patients who underwent AVF-S, quantities were 4.0 to 8.4 pills and 0 to 4.3 pills; and PD quantities were 10 pills and 3.3 to 9 pills. Thirty-one patients (53%) reported receiving more pain medication than they used, which resulted in a median of 8 excess pills per patient with an unused pill interquartile range of 0 to 22 pills for AVF-L procedures, 0 to 4.2 pills for AVF-S procedures, and 1.3 to 6.7 pills for PD procedures. Patients who were prescribed oxycodone or had a repeated operation had significantly increased opioid use. ConclusionsThis investigation of opioid use after surgical dialysis access procedures suggests that most patients use relatively few opioid pills after surgery, which translates into overprescription and leftover medication for >50% of patients. A conservative approach to postoperative prescription guidelines using lower prescription quantities would encourage opioid-related risk reduction while providing adequate postoperative analgesia. Recommended quantities for postoperative prescriptions were generated using the 80th percentile consumed and were 0 to 6 pills for brachiobasilic or brachiocephalic fistulas, 0 to 5 pills for basilic vein transposition, 0 to 5 pills for radiocephalic AVF, 0 to 15 pills for upper arm grafts, and 0 to 10 pills for PD catheter placement.

A novel surgical technique for neck neoplasms: endoscope-assisted resection of benign tumors via a small concealed incision

Objective: To introduce a new surgical procedure for the treatment of neck benign tumors by endoscopic techniques. Methods: Seventeen patients with neck benign tumor underwent surgery by endoscope through a concealed incision in Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University from January 2018 to August 2019 were analyzed, which included 3 cases of tumor in the submental area, 2 cases in submandibular region, 9 cases in lower pole region of parotid gland, 1 case in superior region of sternocleidomastoid muscle, 1 case in central region of sternocleidomastoid muscle, 1 case in inferior region of sternocleidomastoid muscle. All patients underwent routine preoperative examination and CT examination to evaluate tumor size, boundary, morphology and nature. According to the area where the tumor located, concealed incisions in different sites were designed. Lumps in the submental area and submandibular area were treated with oral vestibular sulcus incision. Benign tumors located in the lower pole region of parotid gland and the sternocleidomastoid muscle region were treated with approach of the short hidden postauricular incision. During the operation, the self-developed "maxillofacial suspension device" was used to provide the operating space. The tumors were completely removed with endoscope and all patients were followed up every 3 months. Results: All surgical procedures were performed as expected. Visual analogue scale (VAS) was 9.3 on average at 3 months after operation, all the patients were satisfied with the incision design and the cosmetic effect. No recurrences were found in patients with a follow-up period ranged from 1-15 months. Conclusions: These studies have shown that endoscope-assisted neck benign tumor resection is a surgical procedure with covert incision and good cosmetic results.

Lower donor-site morbidity using QT autografts for ACL reconstruction.

Comparing scar cosmesis and regional hypoesthesia at the incision site between quadriceps tendon (QT), bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) for anterior cruciate ligament (ACL) reconstruction. Ninety patients undergoing ACL reconstruction with QT, HT or BPTB were evaluated at 1-year post-op. Scar cosmesis was assessed using the patient and observer scar assessment scale (POSAS) and length of the incision. Sensory outcome was analyzed by calculating the area of hypoesthesia around the scar. The classical ACL reconstruction functional follow-up was measured using the Lysholm score and KOOS. Concerning QT versus BPTB group, QT patients have a significantly lower mean POSAS (24.8 ± 6.3 vs. 39.6 ± 5.8; p < 0.0001), shorter mean incision (2.8 ± 0.4cm vs. 6.4 ± 1.3cm; p < 0.0001), lower extent of hypoesthesia (8.7 ± 5.1 cm2 vs. 88.2 ± 57 cm2; p < 0.0001), and better Lysholm score (90.1 ± 10.1 vs. 82.6 ± 13.5; n.s.). No significant difference was seen in KOOS (90.7 ± 7.2 vs. 88.4 ± 7.0; n.s.). Concerning QT versus HT group, no significant difference was found regarding mean POSAS score (24.8 ± 6.3 vs. 31.8 ± 6.2; n.s.), mean length of the incision (2.8 ± 0.4cm vs. 2.5 ± 0.6cm; n.s.), KOOS (90.7 ± 7.2 vs. 89.8 ± 8.2; n.s.) and mean Lysholm score (90.1 ± 10.1 vs. 87.8 ± 0.6; n.s.). The mean measured area of hypoesthesia was significantly higher in the HT group (70.3 ± 77.1 cm2 vs. 8.7 ± 5.1 cm2; p < 0.0001). Quadriceps tendon harvesting technique has the safest incision by causing less sensory loss compared to BPTB and HT. It also has the advantage of a short incision with more cosmetic scar compared to BPTB, with no difference compared to HT. However, no significant difference in terms of functional outcome was shown between the three autografts. These findings provide surgeons evidence about their clinical practice and help with graft choice decisions. III.

Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions.

Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA ( p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group ( p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

Robotic-assisted Latissimus Dorsi Muscle Flap for Autologous Breast Reconstruction

BACKGROUND: Latissimus dorsi (LD) muscle flap has been widely used for autologous breast reconstruction.1 Traditional open LD flap harvest requires a posterior donor site incision with a length of 15–45 cm. Although the scar can be camouflaged for women when wearing the bra, it tends to be long, frequently widens, and hypertrophies with time.2 Therefore, a minimally invasive technique to harvest LD muscle flap via endoscopic approach has been developed. Despite continuous improvements in surgical techniques and technologies, 2-dimensional view and nonflexible instruments are limitations of endoscopic harvest of the LD muscle flap.3 Meanwhile, a robotic-assisted LD muscle flap has been first introduced for autologous breast reconstruction after mastectomy.4 The authors has demonstrated a modified robotic surgical technique using a transaxillary gasless technique for robot-assisted LD muscle flaps in 2012.5 The purpose of this study was to introduce our 7-year experience with the robotic-assisted LD muscle flaps in autologous breast reconstruction. PATIENTS AND METHODS: Between October 2012 and February 2019, a total of 33 patients underwent autologous breast reconstructions using robotic-assisted LD muscle flap. Among 33 patients, 21 patients had Poland syndrome. Seven and 3 patients underwent robotic-assisted LD flap following immediate and delayed breast reconstruction after mastectomy, respectively. Two patients had capsular contracture of implant. Subjective assessment was performed to evaluate satisfaction of overall outcome, breast symmetry, and scar. Mean follow-up time was 29.8 ± 12.5 months (range, 3–61 months). RESULTS: All 33 flaps were successfully transferred without converting to open technique. As our experience with robotic-assisted LD flap increased steadily over the years, we have achieved improvements in surgical techniques and robotic instruments to comfort during surgery, optimize the results, and minimize complications and contour defects compared to the first time with robotic surgery. In addition, the time for robotic surgery system also markedly decreased after experience accumulation. Recently, the time for robotic docking and robotic surgery was about 30 and 60 minutes, respectively. At the last visit, patients’ average grading of satisfaction of overall outcome, breast symmetry, and scar were 4.75 ± 0.23, 4.32 ± 0.63, and 4.88 ± 0.15, respectively. No serious complications such as flap loss were recorded for any patient. CONCLUSION: Autologous breast reconstruction using robotic-assisted LD muscle flap might be effective and safe. REFERENCES: 1. Arslan E, Unal S, Demirkan F, et al. Poland’s syndrome with rare deformities: reconstruction with latissimus dorsi muscle through a single short incision. Scand J Plast Reconstr Surg Hand Surg. 2003;37:304–306. 2. Moore TS, Farrell LD. Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg. 1992;89:666–672; discussion 673–664. 3. Pomel C, Missana MC, Atallah D, et al. Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol. 2003;29:127–131. 4. Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg. 2012;129:1305–1312. 5. Chung JH, You HJ, Kim HS, et al. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg. 2015;68:966–972.

Supraorbital Keyhole Approach for Intracranial Aneurysms : Transitioning from Concerns to Confidence.

For surgical minimalism to reduce iatrogenic traumatization, a supraorbital keyhole approach has already been successfully applied to treat many unruptured anterior circulation aneurysms. However, using this minimal approach also raises several technical concerns due to the small cranial opening and cosmetic impact of a facial incision. Yet, such technical limitations can be overcome by using favorable surgical indications, slender surgical instruments, and optimized surgical techniques, while excellent cosmetic outcomes can be achieved using a short skin incision located <1 cm from the supraorbital margin, reconstruction of any bone defects around the bone flap, and meticulous wound closure. Thus, given such reassuring surgical results, in terms of the clipping status, neurological effects, and cosmetic outcomes, any concerns can be transitioned into confidence.

An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition &amp;amp; thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade. &lt;/p&gt;

Quand peut-on privilégier un abord mini-invasif pour une prothèse de hanche ?

The concept of minimally invasive surgery, which refers to percutaneous surgery, i.e. surgery performed through skin orifices without dissection and using arthroscopic instruments, has been misused for hip surgery, which remains a bloody open-focus surgery with direct vision to the implant bone sites. This type of technique, which is characterized by a short incision, is expected to reduce blood loss and postoperative pain, and accelerate functional recovery. These advantages remain theoretical and have never been demonstrated compared to conventional approaches. On the other hand, functional recovery has been significantly improved by a combination of extra-surgical measures including blood saving protocols, postoperative pain control, and shortened hospitalization times. There is no reason why these postoperative optimization protocols should not be generalized to all patients. They take a different form, of course, in scheduled surgery where the patient can be prepared, by correcting the factors of poor prognosis (chronic anemia, withdrawal from addictions, eradication of infectious foci) and in trauma surgery performed in relative urgency. Multidisciplinary management (nutritional, geriatric and functional rehabilitation), particularly in the immediate postoperative period, is necessary to improve the prognosis of this last surgery, which is still too often neglected.