Simple Surgery Research Articles

Approach to bone procedure in fixed equinovarus deformity in cerebral palsy

Fixed equinovarus deformity in cerebral palsy requires bone procedures for surgical correction. We reported the outcome of surgical procedure establishing the approach to multiple osteotomy and fusion to this problem. Retrospectively, 55 feet were reviewed. Step of surgical evaluation were applied to all patients by addressing each component of equinovarus deformity. 31 feet achieved correction by multiple osteotomy. Overall 78% had good outcome and maintained plantigrade foot. This study had outlined a simple surgical step-approached procedure to address fixed equinovarus deformity in cerebral palsy with high success rates. We recommended multiple bone osteotomy to preserve joint motion.

Laryngo fiberscopy-guided suspension procedure for an ectopic lingual thyroid obstructing airway

BackgroundCurrently, there is no consensus regarding the optimal therapeutic strategy for the management of an ectopic lingual thyroid. A surgical approach is suggested when airway obstructive symptoms cannot be tolerated at all, or when bleeding or malignancy occurs. However, for patients in whom ectopic thyroid is the only functioning thyroid tissue, complete surgical excision needs to be followed by lifelong hormone replacement therapy. We report the case of an infant with ectopic lingual thyroid obstructing the airway that was treated using our novel surgical procedure.Case presentationA 10-day-old male infant presented with symptoms of airway obstruction and subclinical hypothyroidism. Imaging tests revealed an ectopic lingual thyroid and the absence of a normal pretracheal thyroid gland. We administered oral levothyroxine to lower his thyroid stimulating hormone (TSH) level and reduce the volume of the lingual mass; however, his airway symptoms did not improve. Subsequently, we performed a surgical intervention when he was 2 months old. We split the hyoid bone, and then suspended the lingual thyroid by suturing it to the hyoid bone to elevate the epiglottis. We confirmed the degree of suspension using intraoperative laryngo fiberscopy. After the surgery, the symptoms of airway obstruction were resolved and the patient was clinically euthyroid on low-dose oral levothyroxine.ConclusionsOur laryngo fiberscopy-guided suspension procedure can be an effective surgical procedure for the treatment of ectopic thyroid. This relatively simple surgical procedure could completely preserve the patient’s thyroid tissue and resolve airway obstruction.

A duplicated Gallbladder in a Patient Presenting with Acute Cholangitis. A Case Study and a Literature Review

Gallbladder duplication can present a clinical challenge primarily due to difficulties with diagnosis and identification. Recognition of this anomaly and its various types is important since it can complicate a gallbladder disease or a simple hepatobiliary surgical procedure. The case report of a 63-year-old woman who presented with cholangitis and underwent a successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Using ERCP, MRCP and 3D reconstructions the two cystic ducts with one common bile duct were identified. A review of the literature in referral of this variant, its anatomical classifications and significance to clinical and surgical practice is included. In conclusion, gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder when evaluating radiologic studies. In case of surgery, preoperative diagnosis is essential to prevent possible biliary injuries or reoperation if accessory gallbladder has been overlooked during initial surgery. Laparoscopic cholecystectomy remains feasible for intervention can be safely done and awareness is necessary to avoid complications or multiple procedures.

Morphology and kinematics studies of the upper extremity and its clinical application in deformity correction

Morphological and kinetic studies using computer-generated bone models are helpful for determining normal articular movements and various pathological conditions of the wrist joints, forearms, and elbow joints. Previous studies consisted of kinetic analyses that were carried out by superimposing three-dimensional bone models created on a computer on the basis of CT data obtained by scanning the limbs in several different positions. We applied the techniques used in such studies and have discovered a method for carrying out surgical procedure simulations aimed at correcting upper limb deformities. In addition, we have developed a system aimed at assisting surgical procedures conducted in accordance with simulations by using patient-matched guides (patient-matched instruments, PMI) and custom-made osteosynthesis plates. Our system has allowed for accurate anatomical corrections to be carried out three-dimensionally during a simple surgical procedure. The system was clinically used in the treatment of cubitus varus as well as malunited distal radial fractures and forearm fractures. As a result, accurate correction and favorable clinical outcomes have been achieved. Together with the development of therapeutic techniques, we have also simultaneously developed the related technological system, which consists of imaging protocols aimed at reducing the amount of radiation exposure and creating statistical shape models, as well as web-based tools for communication between physicians and engineers.

Surgical extrusion: A reliable technique for saving compromised teeth. A 5-years follow-up case report

Aim: To present a long term follow up clinical case in which a compromised anterior tooth was saved by a surgical extrusion procedure. Summary: Although different techniques have been suggested for clinical crown lengthening in the anterior zone, some of them have limitations in terms of aesthetics and procedural requirements. The current case report demonstrates how a simplified surgical extrusion procedure was successfully performed for saving a severely damaged anterior tooth; furthermore, it is possible to apply the technique described in this case using minimum and simple armamentarium like a scalpel, elevators, forceps and splinting flexible cord. Key-learning points: Saving severely compromised anterior teeth is possible by applying surgical extrusion techniques when crown-root ratio allows it. Risk of root resorption or ankylosis is minimum.

Programmatic change leads to enhanced resource utilization and efficiency in port placement

BackgroundCentral venous port (CVP) placement is performed by a variety of surgeons in different subspecialties, and our previous work suggests that individual surgeons—regardless of training—are the strongest predictor of outcomes. We sought to prospectively evaluate a programmatic shift toward a resource-conscious, patient-focused algorithm for this common and simple surgical procedure. Materials and methodsAfter implementation of a systems-level program for efficient CVP placement, 78 CVPs were placed by a single surgeon. Primary outcomes were procedure time, total operating room (OR) time, total facility time, and procedure-related complications. These prospective data were compared with retrospective cohorts of surgically placed and interventional radiology–placed CVP. Demographic data were analyzed by chi-square analysis, whereas time data were analyzed by the Wilcoxon rank-sum test. ResultsThe programmatic delivery (prospective) set showed significantly shorter procedural (median 16 min versus 26-40, P <0.05), OR times (median 36 min versus 46-70, P <0.05), and facility times (median 235 min versus 299-319, P <0.05) except for the interventional radiology facility time (median 187 versus 235, P <0.05). The range of OR time savings with the prospective versus comparison groups was 10-34 min, representing 22%-49% reductions in OR time (P <0.05). Complication rates were not significantly different (P = 0.13). ConclusionsThrough a programmatic change emphasizing efficiency and patient-centered outcomes, procedural/OR/facility time can be reduced greatly without changing complication rates. These data provide compelling evidence that common and ostensibly simple operative procedures can be substantially improved upon with thoughtful, data-driven systems-level enhancements.

Unit Advancement Flap for Lower Lip Reconstruction.

Lower lip reconstruction requires consideration of esthetic and functional outcome in selecting a surgical procedure, and reconstruction with local tissue is useful. The authors reconstructed full-thickness defects with a unit advancement flap. Reconstruction was performed using this method in 4 patients with lower lip squamous cell carcinoma in whom tumor resection with preservation of the mouth angle was possible. The lower lip resection width was 30 to 45 mm, accounting for 50% to 68% of the entire width of the lower lip. The flap was prepared by lateral extension from above the mental unit and matched with the potential wrinkle line of the lower lip in order to design a unit morphology surrounded by the anterior margin of the depressor labii inferioris muscle. It was elevated as a full-thickness flap composed of the orbicularis oris muscle, skin, and mucosa of the residual lower lip from the bilateral sides, and advanced to the defect. Flap transfer was adjusted by small triangular resection of the skin on the lateral side of the mental unit. The postoperative scar was inconspicuous in all patients and there was no impairment of the mouth opening-closing or articulation functions. This was a relatively simple surgical procedure. A blood supply of the flap was stable, and continuity of the orbicularis oris muscle was reconstructed by transferred the residual lower lip advancement flap from the bilateral sides. The postoperative mouth opening-closing function was sufficient, and dentures could be placed from an early phase in elderly patients. The postoperative scar was consistent with the lip unit morphology, being esthetically superior. This procedure may be applicable for reconstruction of defects approximately 1/3 to 2/3 the width of the lower lip where the mouth angle is preserved.

Moderization of Cortically Supported Individual Implants

Abstract Digital product processing, 3D and finite element analysis techniques, modern, tissue-friendly implants with adequate surface treatment and proper screw-fixing make it possible for a good idea to successfully treat patients who do not have a sufficient amount of bone tissue for the implantation of conventional cylindrical-shaped dental implants. The duration of the surgical procedure of a complete, toothless jawbone becomes much shorter. Complicated measurements and risky techniques that require substantial expertise become unnecessary. The implant can be placed precisely into position with a simple surgical procedure. Then, it can be fixed to the bone tissue with the help of pre-designed fixation points. After this, only the professional closing of the wound has to be carried out. We have designed and manufactured a titanium cortical implant that is novel both in the view of chemical composition and surgical procedure. The final connection shaping of the sleeve and abutment system of the personalized cortical-backup implants was designed with the help of finite element analysis methods after the healing process.

Stegmann Canal Expander for canaloplasty: A novel technique.

The concept of canaloplasty is to increase aqueous egress through all structures that control the aqueous outflow, such as the trabecular meshwork, Schlemm's canal, and collector channels, by viscomodulation and by placing of a suture stent into the canal. Clinical studies show canaloplasty to be safe and efficient in lowering the intraocular pressure; however, proper knotting of the tensioning suture is technically challenging and even impossible if circumferential cannulation cannot be achieved; furthermore, protrusion of the suture stent is a potential lifelong risk. The specific design of the Stegmann Canal Expander allows a permanent expansion of the canal and distension of the trabecular meshwork. Two expanders are implanted on either side of the surgically created ostium of Schlemm's canal to treat half of the circumferential outflow system. This article describes the technique step by step, provides the clinician with surgical pearls, and highlights the management of adverse events. Technically, implantation of the Stegmann Canal Expander is simple and does not require a long learning curve, compared to placing and knotting a tensioning suture. Most issues are related to the two-flap dissection technique (deep sclerectomy technique) and not to implantation of the Stegmann Canal Expander. Intraocular pressure reduction without medications to the low teens can be achieved. The Stegmann Canal Expander is a novel micro-device that has the potential to make canaloplasty a simplified, more controlled, and reproducible surgical procedure.

No effectiveness of anticoagulants for thromboprophylaxis after non-major knee arthroscopy: a systemic review and meta-analysis of randomized controlled trials.

Arthroscopic knee surgery is the most commonly performed orthopedic procedure worldwide and whether thromboprophylaxis should be undertaken after knee arthroscopy is still controversial. To evaluate the efficacy of thromboprophylaxis for deep venous thrombosis (DVT) and venous thromboembolism (VTE) after knee arthroscopic surgery. A meta-analysis was conducted using data from eight randomized trials (4148 patients) to compare thromboprophylaxis with placebo or no prophylactic treatment in patients undergoing knee arthroscopy. The benefits and harms of thromboprophylaxis were evaluated, including the incidence of asymptomatic DVT, symptomatic VTE, pulmonary embolism and anti-coagulation related adverse events. Thromboprophylaxis significantly decreased the incidence of DVT (95% CI 0.07-0.64, P = 0.006) and symptomatic VTE in patients undergoing knee arthroscopy (95% CI 0.23-0.76, P = 0.004), but not significantly decreased the incidence of pulmonary embolism (n.s.). Regarding to non-major knee arthroscopy surgery (simple surgical procedures without ligament reconstruction), no significant difference of the incidence of DVT or symptomatic VTE was noted between thromboprophylactic group and control group (n.s.). Thromboprophylactic treatment showed higher incidence rate of anti-coagulation related adverse events compared with the control group (95% CI 1.12-1.90, P = 0.005). There was no significant difference of the incidence of clinically relevant major bleeding between the two groups (n.s.). This meta-analysis indicates no effectiveness of thromboprophylaxis for preventing DVT or symptomatic VTE in patients undergoing non-major knee arthroscopy. Regarding to patient undergoing knee ligament construction, the thromboprophylactic strategy should mainly take into account the patient's risk factors.

Surgical Management of Migraine Headache.

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 ± 6.3 episodes per month to 1.9 ± 2.4 episodes per month (P < 0.0001) postsurgery. The mean intensity of migraine headache also reduced from a preoperative 7.3 ± 3.5 to a postoperative of 1.3 ± 1.4 (P < 0.0001). Fourteen (46.7%) patients reported complete elimination of migraine after surgery while an equal number reported significant relief of symptoms. Two (6.6%) patients failed to notice any significant improvement after surgery. The mean follow-up period was 11.1 ± 2 months with no major surgical complications. Results of the authors' study confirm prior published results that surgical treatment of migraine is a reality. Surgeons can easily incorporate this simple surgical procedure in their armamentarium to offer relief to numerous migraine patients.

Subaxillary approach to cardiac electronic device implantation using a single surgical incision: a single-centre experience.

Pacemakers and implantable cardioverter defibrillators have become more common in younger individuals, owing to broader indications and technological advances. Our goal was to report our long-term experience of implanting cardiac devices in young adults via a subaxillary approach with a hidden single incision, to minimize the aesthetic impact of the device. From 2003 to 2012, 23 patients underwent cardiac device implantation via a subaxillary approach while they were under general anaesthesia. The axillary vein was punctured under contrast-medium radiological guidance. The devices were positioned into the pocket under the pectoralis major muscle and over the fascia that envelopes the pectoralis minor muscle, through a lateral surgical access along the midaxillary line. Twenty-two single- and dual-chamber implantable cardioverter defibrillator and 1 dual-chamber pacemaker were implanted (mean age 32.2 ± 13.4 years). All procedures were successfully performed without complications; overall hospitalization after implantation was 3.3 days. During mean a follow-up of 65 ± 18 months, no deaths, infections or device migrations occurred. Two ventricular lead dislodgements requiring repositioning occurred within 1 month, and 1 defibrillation lead fracture occurred 5 years after implantation. All patients were extremely satisfied with the aesthetic result. A mild increase in the pacing threshold (0.88 ± 0.6 V at 0.4/0.5 ms at implantation vs 1.00 ± 0.3 V at 0.4/0.5 ms at 2-year follow-up, P = 0.063) and a statistically significant decrease in the pacing impedance (637 ± 161 ohm at implantation vs 499 ± 81 ohm at 2-year follow-up, P = 0.001) were observed, without any consequences. The subaxillary approach is a safe, feasible technique that requires a simple surgical procedure. The implantable cardioverter defibrillator functions properly at implantation and at long-term follow-up.

Locking plate for treating traumatic sternoclavicular joint dislocation: a case series

BackgroundTraumatic sternoclavicular joint dislocations are rare; closed reduction is the primary treatment. The failure of closed reduction or a prominent insult to the skin may require surgery to ensure the best possible outcome.MethodsThe records of 5 patients operated at our institution for sternoclavicular joint dislocation were reviewed. All patients were treated with open reduction and single 3.5-mm locking plate was used for fixation. Outcomes were evaluated with the Constant Shoulder Score (CSS) and Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Intraoperative and postoperative complications were recorded.ResultsAll the patients had an average follow-up of 14 months (range, 11–16 months). At the final follow-up, the mean CSS score was 89.5 (range, 78–98) and the mean DASH score was 9.0 (range, 4–16). There were no early complications, including wound infection or neurologic or vascular deficits; there were also no broken or loosened screws or plates. No case of redislocation or arthrosis was observed.ConclusionOur study indicates that open reduction and fixation with a single locking plate for the treatment of traumatic sternoclavicular joint dislocation is a safe, relatively simple surgical procedure that can lead to satisfactory outcomes.

A cross-sectional study of confidence in minor surgical skills amongst junior dentists.

To work in the National Health Service (NHS) as a dentist, the practitioner needs to be on the UK dental "performer's list". To apply for access to this list and work as a General Dental Practitioner (GDP), dentists must be qualified from the European Economic Area (EEA) or, those trained in the UK, must undertake Dental Foundation Training (DFT). Dentists interested in further taught learning or pursuing specialist training must continue working as "Dental Core Trainees" (DCTs). Most of these jobs are available in Oral and Maxillofacial Surgery (OMFS) Units and require dentists to undertake unsupervised surgical procedures. It is currently estimated that over 400 "junior dentists" undertake DCT a year. It is the aim of this study to ascertain whether confidence in simple surgical procedures improves when compared to GDPs of similar experience. One hundred and two junior dentists, 34 DFTs, 20 DCT1s, 21 DCT2s and 27second and third year post-DFT GDPs all working across the Midlands, UK, had Likert scale responses about confidence in 14 minor surgical skills assessed. Results were analysed to ascertain whether gender, year group and number of extractions had any effect on confidence. We conclude that confidence in minor surgical procedures improves significantly when undertaking DCT OMFS posts, with the most significant improvement in confidence occurring within the first 6months. Dental Core Trainees become significantly more confident in their surgical ability within the first 6months when compared to GDPs with longer postgraduate experience.

Technique of Localizing the Central Sulcus under Awake Anesthesia for Treatment of Gliomas in or near Motor Areas.

To study the protective effect on motor function of intraoperative awakening and localizing the central sulcus during surgery in patients with gliomas located in motor areas. A total of 68 patients with gliomas in motor areas were intubated with a laryngeal mask and rapidly underwent craniotomy without scalp clips and with surgical awakening, followed by localization of the central sulcus by somatosensory evoked potential. To protect brain function, we resected the greatest degree of tumor possible, and then finished by closing the skull with the patient in an awake state or under general anesthesia. All the patients underwent surgery successfully. Except for the emergence of new neurological dysfunction in six patients, most patients' neurological function did not deteriorate, or even showed improvement. In addition, there were no complications or postoperative painful memories for the patients. The resection of gliomas in motor areas with intraoperative awakening and localization of the central sulcus can ensure the largest possible resection of the tumor while protecting brain function. Here, we describe a simple and effective surgical procedure for patients with glioma. The technique involves localizing the central sulcus under awake anesthesia, which can improve the prognosis for patients with gliomas in motor areas.

Nail Biopsy: A User's Manual.

Nail biopsy is a procedure not routinely resorted to; but when indicated, it is often the only clue left for diagnosis. At such times, it pays to be conversant with it. It is an investigation that not only provides etiologic, diagnostic, and prognostic information but also aids in understanding the pathogenesis of nail diseases. It can be of therapeutic value, especially with respect to nail tumors. This article compiles the procedural techniques for nail biopsy of various types and attempts to summarize the evidence available in the literature. The objective of nail biopsy is to clinch a precise diagnosis of nail pathology with a simple and safe surgical procedure, avoiding pain or permanent nail damage. Patient selection is of utmost importance, wherein, the patient does not have typical skin lesions, yields inadequate information on routine nail investigations, and has no peripheral vascular compromise. The patient needs to be explained about the risks associated, the expected functional handicap, the time required for regrowth, a possibility of permanent nail dystrophy, and a possibility of not achieving a diagnosis even after the biopsy. Techniques and types of various nail biopsies are being discussed in this article. The specimen could be collected as an excision biopsy, punch biopsy, shave biopsy, or longitudinal biopsy. The trick lies in choosing the appropriate area for biopsy. Various biopsy types discussed in this article include nail plate biopsy (easiest and least scarring); nail bed biopsy (elliptical excision or punch); nail matrix biopsy (elliptical excision, punch excision (≤3 mm) or tangential/shave excision); and nail fold biopsy. Complications reported along with means to minimize them are also discussed.

Delayed paresthesia of inferior alveolar nerve after dental surgery: case report and related pathophysiology

Paresthesia is an altered sensation of the skin, manifesting as numbness, partial loss of local sensitivity, burning, or tingling. The inferior alveolar nerve (IAN) is the third branch of the trigeminal nerve and is very important in dental treatment. IAN paresthesia may occur after various dental procedures such as simple anesthetic injections, surgical procedures, and endodontic treatment, and is reported to range from 0.35% to 8.4%. The altered sensation usually follows immediately after the procedure, and reports of late onset of nerve involvement are rare. This report presents a rare case of delayed paresthesia after dental surgery and discusses the pathophysiology of IAN delayed paresthesia.

Evaluation of anal shift procedure in management of anterior displaced anus in female children

Background Anterior displaced anus (ADA) is a common anomaly in female children. There are several operative techniques for its treatment. Aim The aim of this study was to present experience with anal shift procedure for the treatment of ADA in female children. Patients and methods This is a prospective study that was conducted at the Pediatric Surgical Unit, Al-Azhar University Hospital, Damietta, during the period from October 2015 to September 2017. Fifteen female children with ADA underwent surgical correction by anal shift procedure. The anus position index was measured before and after the operation. Medical records of all patients were reviewed regarding operative time, intraoperative or postoperative complications, and conversion to other procedure. Parents’ satisfaction about cosmetic results of the technique was evaluated using a subjective score ranging from 0 to 4, where 0=no satisfaction, 1=fair satisfaction, 2=good satisfaction, 3=very good satisfaction, and 4=excellent satisfaction. All cases were followed up for a mean follow-up period of 12±2 months (range: 8–18 months). Results A total of 15 female children with ADA were corrected with anal shift procedure. Their mean age was 3.06±1.03 years (range: 1–5 year). Anal functions were normal with acceptable anal position indices at the end of follow-up period for all patients. Complications were mild and treated conservatively. Only one case had superficial disruption of anterior incision, and secondary sutures were done with good result. Conclusion Anal shift procedure appears to be a safe, simple, and effective surgical procedure for correction of ADA in female children.

Medial displacement calcaneal osteotomy in treatment of stage II posterior tibial tendon deficiency

Background Medial displacement calcaneal osteotomy is indicated in individuals with stage 2 posterior tibial tendon deficiency (PTTD) with a supple hindfoot and the absence of clinical or radiographic arthritis. Patients and methods This prospective study evaluated the effects of medial displacement calcaneal osteotomy and flexor digitorum longus transfer to navicular bone on pedal realignment and function in 14 patients (15 feet) with a stage 2 PTTD. Results American College of Foot and Ankle Surgeons scoring scale module number 3 was measured before the reconstruction and at latest follow-up, and also patients’ satisfaction were reported, demonstrating a good realignment in short-term follow-up (15–18 months). The American College of Foot and Ankle Surgeons score improved postoperatively from average of 53.5 to 87.4 without progression of arthritis at adjacent joints. Conclusion This simple surgical procedure has an excellent effect on realignment and function of PTTD stage 2 without marked forefoot abduction.

Intraoperative cardiovascular response of natural orifice transluminal endoscopic surgery versus laparoscopy: A comparative animal study.

Background:Natural orifice transluminal endoscopic surgery (NOTES) emerged as a new alternative method in minimally invasive techniques. Although a very small number of studies have compared the physiologic response in NOTES to laparoscopy, the results remain controversial.Aim:This experimental animal study aims to evaluate the intraoperative cardiovascular and respiratory effects of pure transluminal natural orifice surgery and conventional laparoscopy.Materials and Methods:Twenty female pigs (Sus scrofa domesticus) equally divided into two study groups were assigned to either pure natural orifice transluminal endoscopic techniques (Group 1) or conventional laparoscopic surgery (Group 2) and monitored intraoperatively in terms of heart rate (HR), systolic blood pressure (SBP) and O2 saturation (SpO2) for 1 h. Both groups underwent simple surgical procedures such as gastrojejunostomy, oophorectomy and adnexectomy.Results:All procedures were successfully completed. The findings indicated statistically significant differences between SBP (P = 0.0065) and SpO2 (P = 0.027) in the two groups at the beginning of the interventions. HR showed significant differences during the last 20 min of the interventions (min 40 and 45; P < 0.001). For the whole procedure (from the beginning of the intervention to 60 min interval), HR, SBP and SpO2 values showed no statistical difference.Conclusions:Although significant differences in terms of HR, mean blood pressure and SpO2 were noted at specific intervals during surgery, no real variance of the cardiovascular parameters was observed when considering the entire procedure. Therefore, NOTES seems to be a safe approach with minimally intraoperative cardiovascular and respiratory implications.