Single-stage Surgery Research Articles

Preoperative management comprising tube irrigation using a trans-anal indwelling tube for infants with hirschsprung disease can allow single-stage radical surgery

BackgroundPreoperative management of Hirschsprung’s disease (HD) is currently being conducted with the goal of performing single-stage radical surgery without ileostomy.MethodsWe retrospectively reviewed HD cases between 2013 and 2022, as well as their outcomes related to preoperative management.ResultsThirty-nine patients with HD were included in this study, including short-segment HD (30 cases), long-segment HD (4 cases), and total colonic aganglionosis (5 cases). Among these 39 patients, 95% (37 of 39 patients) underwent single-stage radical surgery after management with glycerin enema use (n = 13), irrigation with tube insertion each time irrigation was performed (n = 13), and irrigation using a tube placed in the bowel (n = 11).ConclusionsPreoperative management of patients with HD allowed for single-stage surgery of long-segment HD and total colonic aganglionosis. Cases that could be managed without performing an emergency enterostomy during the neonatal period were managed with irrigation until radical surgery was performed.

A case of Aspergillus empyema successfully treated by a single-stage cavernostomy and a covering procedure using both fat pad and muscle flap

BackgroundAspergillus empyema due to rupture of a pulmonary cavity including an aspergilloma is a serious condition especially in immunocompromised patients with various co-morbidities. Open window thoracotomy is usually performed to control infection, followed by secondary myoplasty. However, such a two-stage strategy requires long treatment period and accompanies the invasiveness of multiple operations. On the other hand, single-stage surgery is minimally invasive, and patients’ activities of daily living are less impaired. We present a single-stage surgery consisting of cavernostomy and a covering procedure using both fat pad and muscle flap.Case presentationA 28-year-old man taking 20 mg of prednisone for rheumatoid arthritis presented with right-sided chest pain. A chest computed tomography and thoracoscopy showed a perforated pulmonary cavity including an aspergilloma in the right apex of the lung. Antifungal medication was started, but the thoracic and pulmonary cavities persisted. Therefore, surgical intervention was indicated, and considering the patient’s general condition and anticipated length of treatment period, we decided to conduct a single-stage operation. A cavernostomy was performed on the ruptured cavity. To reliably close the air leak and to occlude the air space to prevent recurrence of infection, a subcutaneous free fat pad was harvested and filled into the cavity. A pedicled latissimus dorsi muscle flap was further introduced into the thoracic space to cover the fat pad. There was no postoperative air leak and the patient was discharged on postoperative day 20 with no adverse events and no limitation of movement in the arm. A series of post-operative CT showed that the pedicled latissimus dorsi muscle flap and free fat pad gradually shrank with lung re-expansion, but they were still present and filled the thoracic and pulmonary cavities 10 months after surgery.ConclusionA single-stage surgery consisting of cavernostomy and a covering procedure using both a fat pad and muscle flap was effective in sealing air leaks, filling the air space, and preventing recurrence of infection. The fat pad and muscle flap appear to have worked in a complementary way.

Influence of Body Mass Index on Surgical and Patient Outcomes for Cervical Spine Surgery.

Secondary analysis of prospectively collected registry. We aim to investigate the effects of body mass index (BMI) on postsurgical cervical spine surgery outcomes and identify a potential substratification of obesity with worse outcomes. The impact of BMI on cervical spine surgery is unknown, with controversial outcomes for patients high and low BMI. The cervical spine Quality Outcomes Database was queried for a total of 10,381 patients who underwent single-stage cervical spine surgery. Patients were substratified into 6 groups based on BMI. Surgical outcomes, complications, hospitalization outcomes, and patient-reported outcomes for each cohort, including modified Japanese Orthopedic Association Score, Numeric Rating Scale arm pain, Numeric Rating Scale neck pain, Neck Disability Index, and EuroQol Health Survey, were assessed. Univariate analysis was performed for 3- and 12-month follow-up after surgical intervention. Obese patients (class I, II, and III) requiring spine surgery were statistically younger than nonobese patients and had higher rates of diabetes compared with normal BMI patients. The surgical length was found to be longer for overweight and all classes of obese patients ( P < 0.01). Class III obese patients had higher odds of postoperative complications. Patients with class II and III obesity had lower odds of achieving optimal modified Japanese Orthopedic Association Score at 3 months [OR = 0.8 (0.67-0.94), P < 0.01, OR = 0.68 (0.56-0.82), P < 0.001, respectively] and 12 months [OR = 0.82 (0.68-0.98), P = 0.03, OR = 0.79 (0.64-0.98), P = 0.03, respectively]. This study investigates the relationship between substratified BMI and postoperative outcomes of cervical spine surgery. Class II and III obese patients have substantially greater risk factors and poor outcomes postoperatively. In addition, low BMI also presents unique challenges for patients. Further research is needed for comprehensive analysis on outcomes of cervical spine surgery after correcting BMI.

Comparison of Surgical Procedures in the Treatment of Hip Periprosthetic Infection.

Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients. Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents. Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%). Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.

Mini approaches fasciotomy combined with vacuum sealing drainage for acute compartment syndrome caused by fractures in children.

Acute compartment syndrome (ACS) is an urgent, critical condition that requires immediate fasciotomy once diagnosed. Traditionally, fasciotomy of the forearms and lower leg involves one or two long approaches. Our previous study demonstrated that mini approaches fasciotomy was an effective method to treat ACS. This study is aimed at further evaluating the limb functions and complications of mini approaches combined with vacuum sealing drainage (VSD) for treating ACS caused by fractures in the forearms and lower legs. This was a retrospective cross-sectional study, and after applying the inclusion and exclusion criteria, we reviewed 126 children who underwent mini treatment approaches for ACS from Jan 2008 to Jan 2022. The selected patients were divided into two groups: group A (ACS group; 58 patients aged 7.77±3.45 years) and group B (ACS combined with VSD; 68 patients aged 7.17±3.55 years). Patients' clinical data were collected. The patients were followed up, and muscle function in the forearms and lower legs was evaluated. The overall incidence of lower legs and forearmsACS was 126/29642 (0.425%). The most common mechanisms of injury were fractures of the forearm (39/74, 52.7%), supracondylar humerus (31/74 41.9%), and elbow (4/74, 5.4%), while those for the lower legs were fractures of the proximal tibia (19/52, 36.5%), midshaft of tibia (25/52, 48.1%), and distal tibia (7/52, 13.5%). According to Flynn's assessment, no significant difference was observed between the two groups (p=0.151). However, the two groups showed significant differences in the hospitalization time (p=0.002) and incision infection rate (0.043). Mini approaches fasciotomy combined with VSD is an effective and safe method to treat ACS of the forearms and lower legs caused by fractures in children. This method involves a single-stage surgery and is associated with shorter hospitalization time and incision infection.

Complications Associated with Alloplastic Materials in Rhinoplasty and Their Operative Management.

Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound. LEVEL OF EVIDENCE: N/A.

219 Post-Skin Cancer Scalp Defect Reconstruction with Integra® as Single Stage Surgery: A Case Series

Abstract Aim Large post-surgical scalp defects represent a common challenge in skin cancer surgery reconstruction. Despite the multiple options available the patients, often elderly, may prefer to have the least amount of surgery done and/or have comorbidities that may impair adequate wound healing. In order to reduce the number of hospital appointments and the risks of COVID19 exposure for the frail patients we used Integra®, a very versatile Dermal Regeneration Template for the treatment of skin defects. Originally, Integra® was designed to be followed by a second-stage surgery with a full thickness skin graft (FTSG). We retrospectively collected, in our busy OMFS Unit, a 40-case series of post-skin cancer scalp defects reconstructed using Integra® as single-stage approach without any further surgery. Method We have carried out a literature review of its use on the scalp and examined a series of parameters from our experience including:defect sizedressing appointments and total healing timeanticoagulation, peri-operative antibiotics prescribingcomplications Results The total healing time for the scalp wounds treated with Integra® averages 3.8 months, requiring 7.8 hospital appointments for dressings and checkups. Two infections, 3 significant bleeds and 4 failures were reported. Conclusions The Integra® is a valid and optimal substitute for local flaps and FTSG in patients that may prefer a single-staged approach wishing to avoid a second surgical site and minimising hospital attendance. The drawbacks are the longer time to heal compared to flaps/FTSG, the costs and the risk of delaying radiotherapy if complete epithelialisation is not achieved.

Revizyon Yapılan Enfekte Kalça Artroplastilerinde İntraoperatif Hipokloröz Asit Kullanımı

Aim: Arthroplasty infections are serious and difficult to treat complications. Hypochlorous acid (HOCl) is an oxidant produced endogenously in the body as a physiological part of the inflammatory process, with the aim of eliminating pathogens activated by neutrophils. The aim of this study was to evaluate the positive and negative effects on clinical results of HOCl used as an irrigation solution during surgical treatment. Material and Methods: The study included 37 patients who underwent single- or two-stage revision surgery at the University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital Orthopedics and Traumatology Clinic between January 2017 and December 2021. Treatment was applied according to our standard protocol of irrigation with 450 cc HOCl following implant removal and an additional 50 cc HOCl to the subcutaneous tissue after closing the fascia. The patients were evaluated during follow-up in respect of infections. Results: While single-stage revision surgery applied to 20 patients, two-stage revision surgery applied to 17 patients. 17 (45.9%) of the patients were male and 20 (54.1%) were female with a mean age of 72.8±11.1 years. The mean follow-up period was 25.8±14.1 months. Revision surgery was performed on one patient in each of the single and two-stage surgery groups. A success rate of 94.6% (n=37) was obtained when all patients were evaluated. Conclusion: The HOCl solution can be considered to make a positive contribution to the eradication of infections in revision hip arthroplasty and can be an effective and safe alternative to other irrigation solutions.

Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias.

The recurrence of ventricular arrhythmias (VAs) in patients who have already undergone treatment with antiarrhythmic medication, catheter ablation, and the insertion of implantable cardioverter defibrillators is not uncommon. Recent studies have shown that bilateral cardiac sympathetic denervation (BCSD) effectively treats VAs. However, only a limited number of studies have confirmed the safety of BCSD as a viable therapeutic option for VAs. This single-center study included 10 patients, who had a median age of 54 years (interquartile range [IQR], 45-65 years) and a median ejection fraction of 58.5% (IQR, 56.2%-60.8%), with VAs who underwent video-assisted BCSD. BCSD was executed as a single-stage surgery for 8 patients, while the remaining 2 patients initially underwent left cardiac sympathetic denervation followed by right cardiac sympathetic denervation. We evaluated postoperative complications, the duration of hospital stays, and VA-related symptoms before and after surgery. The median hospital stay after surgery was 2 days (IQR, 2-3 days). The median surgical time for BCSD was 113 minutes (IQR, 104-126 minutes). No significant complications occurred during hospitalization or after discharge. During the median follow-up period of 13.5 months (IQR, 10.5-28.0 months) from surgery, no VA-related symptoms were observed in 70% of patients. The benefits of a short postoperative hospitalization and negligible complications make BCSD a safe, alternative therapeutic option for patients suffering from refractory VAs.

Composite material consisting of microporous beta-TCP ceramic and alginate-dialdehyde-gelatin for controlled dual release of clindamycin and bone morphogenetic protein 2

The aim of this study was to produce a composite of microporous β-TCP filled with alginate-gelatin crosslinked hydrogel, clindamycin and bone morphogenetic protein (BMP-2) to prolong the drug-release behaviour for up to 28 days. The most promising alginate-di-aldehyde(ADA)-gelatin gel for drug release from microcapsules was used to fill microporous β-TCP ceramics under directional flow in a special loading chamber. Dual release of clindamycin and BMP-2 was measured on days 1, 2, 3, 6, 9, 14, 21 and 28 by high performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay (ELISA). After release, the microbial efficacy of the clindamycin was checked and the biocompatibility of the composite was tested in cell culture. Clindamycin and the model substance FITC-protein A were released from microcapsules over 28 days. The clindamycin burst release was 43 ± 1%. For the loaded ceramics, a clindamycin release above the minimal inhibitory concentration (MIC) until day 9 and a burst release of 90.56 ± 2.96% were detected. BMP-2 was released from the loaded ceramics in low concentrations over 28 days. The release of active substances from β-TCP and hydrogel have already been extensively studied. Directional flow loading is a special procedure in which the ceramic could act as a stabilizer in the bone and, as a biodegradable system, enables a single-stage surgical procedure. Whether ADA-gelatin gel is suitable for this procedure as a more biodegradable alternative to pure alginate or whether a dual release is possible in this composite has not yet been investigated.Graphical

An enhanced recovery after surgery protocol for facial feminization surgery reduces perioperative opioid usage, pain, and hospital stay

Prescription drug misuse in transgender individuals is estimated to be three times higher than that of the general population in the United States, suggesting that opioid-reduction strategies deserve significant consideration in gender-affirming surgeries. In this work, we describe the implementation of an enhanced recovery after surgery (ERAS) protocol to reduce opioid use after facial feminization surgery. A total of 79 patients who underwent single-stage facial feminization surgery before (n=38) or after (n=41) ERAS protocol implementation were included. Primary outcomes assessed were perioperative opioid consumption (morphine equivalent dose/kilogram, MED/kg), average patient-reported pain scores, and length of hospital stay. Comparisons between groups and multivariable linear regression analyses were conducted to define the contribution of the ERAS protocol to each of the three primary outcomes. Age, body mass index, mental health diagnoses, and length of surgery did not differ between pre-ERAS and ERAS groups. Compared to pre-ERAS patients, patients treated under the ERAS protocol consumed less opioids (median [interquartile range, IQR], 0.8 [0.5-1.1] versus 1.5 [1.0-2.1] MED/kg, p<0.001), reported lower pain scores (2.5±1.8 versus 3.7±1.6, p=0.002), and required a shorter hospital stay (median [IQR], 27.3 [26.3-49.8] versus 32.4 [24.8-39.1]h, p<0.001). When controlling for other contributing variables such as previous gender-affirming surgeries, mental health diagnoses, and length of surgery using multivariable linear regression analyses, ERAS protocol implementation independently predicted reduced opioid use, lower pain scores, and shorter hospital stay after facial feminization surgery. The current work details an ERAS protocol for facial feminization surgery that reduces perioperative opioid consumption, patient-reported pain scores, and hospital stays.

A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome.

Compartment syndrome in tibial plateau fractures presents a formidable challenge for treating orthopedic surgeons. The most common strategy is early fasciotomy and external fixation, followed by a second stage definitive fixation. We conducted a prospective study of tibial plateau fractures of Schatzker Type V and VI with impending compartment syndrome treated by single-stage double incision fasciotomy and dual internal fixation and Vacuum-Assisted Closure (VAC). The study was between May 2014 and February 2019. 21 patients with impending compartment syndrome who underwent single-stage double incision fasciotomy and Open Reduction and Internal Fixation (ORIF) with dual plate were included in the study. The functional and radiological outcome was measured using the modified Rasmussen functional and radiological scoring and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). The mean age of patients was 38.7years (Standard deviation of ± 9.48). The mean follow-up period was 27months (Standard deviation of ± 6.51). The mean functional and radiological modified Rasmussen score was 27.28 (range 21 to 29) & 8 (range 7 to 10), respectively. 4 patients had excellent outcomes, and 17 patients had good results. The mean WOMAC score was 8.04 (Standard deviation of ± 5.35). Five patients had a score of 0, 14 patients had a score of 1-10 and 2 had a score of 11-20. The early double incision fasciotomy and definitive internal fixation with dual plate and VAC as single-stage surgery in patients with impending compartment syndrome help to obtain excellent to good functional outcomes with reduced complications.

Functional performance and impact on the quality of life of three treatment strategies for mandibular edentulism: Results of a parallel 3-group cross-sectional study

ObjectivesThis parallel cross-sectional study compared masticatory function and patient-centered outcomes among 3 removable treatment strategies for mandibular edentulism. MethodsThirty-six edentulous participants rehabilitated using 3 removable treatment strategies for mandibular edentulism were allocated to one of the three groups (n=12): CCD (control), 2-IMO, and 3-IMO. Narrow diameter implants were installed using single-stage surgery and conventionally loaded with stud abutments. After 3 months of usage, the quality of life, maximum bite force, and masticatory function were evaluated. Data were analyzed with the Kruskal-Wallis test and post hoc pairwise Mann–Whitney tests with Bonferroni correction (α=0.05). ResultsThe 2-IMO and 3-IMO wearers did not show significant differences in any outcome, except for the 2 domains of 3-IMO wearers quality of life that obtained better Pain and General Performance scores. Both IMO groups presented significantly higher maximum bite force than CCD wearers. The 2-IMO wearers showed superior outcomes to the CCD group in all outcomes of the masticatory performance test and the X50, B and ME5.6 outcomes of the swallowing threshold test (p = 0.01), while 3-IMO participants only showed superior masticatory performance in terms of lower X50 values (19.86%, p = 0.02) and higher ME 2.8 (141.15%, p = 0.04) than CCD wearers. ConclusionsCompared to 2-IMO wearers, 3-IMO wearers report superior impact of treatment on daily living activities in the Pain and General Performance domains. 2-IMO and 3-IMO wearers showed no significant differences between them for all evaluated bite force and masticatory function parameters. Clinical SignificanceAlthough overdentures retained by 3 implants (3-IMO) provide biomechanical advantages over those retained by 2 implants (2-IMO), superior clinical and functional effectiveness is not yet proven.

A comparison of clinical and radiological outcomes between two different biodegradable local antibiotic carriers used in the single-stage surgical management of long bone osteomyelitis.

Dead-space management, following dead bone resection, is an important element of successful chronic osteomyelitis treatment. This study compared two different biodegradable antibiotic carriers used for dead-space management, and reviewed clinical and radiological outcomes. All cases underwent single-stage surgery and had a minimum one-year follow-up. A total of 179 patients received preformed calcium sulphate pellets containing 4% tobramycin (Group OT), and 180 patients had an injectable calcium sulphate/nanocrystalline hydroxyapatite ceramic containing gentamicin (Group CG). Outcome measures were infection recurrence, wound leakage, and subsequent fracture involving the treated segment. Bone-void filling was assessed radiologically at a minimum of six months post-surgery. The median follow-up was 4.6 years (interquartile range (IQR) 3.2 to 5.4; range 1.3 to 10.5) in Group OT compared to 4.9 years (IQR 2.1 to 6.0; range 1.0 to 8.3) in Group CG. The groups had similar defect sizes following excision (both mean 10.9 cm3 (1 to 30)). Infection recurrence was higher in Group OT (20/179 (11.2%) vs 8/180 (4.4%), p = 0.019) than Group CG, as was early wound leakage (33/179 (18.4%) vs 18/180 (10.0%), p = 0.024) and subsequent fracture (11/179 (6.1%) vs 1.7% (3/180), p = 0.032). Group OT cases had an odds ratio 2.9-times higher of developing any one of these complications, compared to Group CG (95% confidence interval 1.74 to 4.81, p < 0.001). The mean bone-void healing in Group CG was better than in Group OT, in those with ≥ six-month radiological follow-up (73.9% vs 40.0%, p < 0.001). Local antibiotic carrier choice affects outcome in chronic osteomyelitis surgery. A biphasic injectable carrier with a slower dissolution time was associated with better radiological and clinical outcomes compared to a preformed calcium sulphate pellet carrier.

Long-Term Clinical Efficacy of Arthroscopy with Limited Incision in the Treatment of Knee Dislocation with Multiple Ligament Injuries

This study retrospectively analyzes the long-term clinical efficacy of single-stage arthroscopy-assisted surgery with limited incision in the treatment of knee dislocation (KD) with multiple ligament injuries (MLI). A total of 19 patients diagnosed with MLI at the First Affiliated Hospital of Guangxi Medical University and the 923th Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China from March 2013 to May 2015 were included in this study. The functional levels were assessed using the Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner Activity Score, and range of knee motion preoperatively. Non-parametric and Friedman tests were employed to analyze the surgical outcomes. The Lysholm scores increased from a preoperative value of 43.00 (95% confidence interval: 31.00, 50.00) to 88.00 (82.00, 95.00) at the post-operative follow-up of 10–36 months, and further improved to 90.00 (78.00, 98.00) after 8-year follow-up period. The IKDC scores increased from a preoperative value of 32.20 (28.70, 35.60) to 80.50 (60.90, 86.20) at 10–36 months post-operatively and further improved to 86.90 (69.00, 93.10) after 8-year follow-up period. The Tegner scores showed improvement from a preoperative value of 0.00 (0.00, 1.00) to 5.00 (3.00, 5.00) at 10–36 months postoperatively and to 4.0 (3.00, 5.00) after 8-year follow-up period. The ranges of active knee motion increased from preoperative 35.00 (30.00, 40.00) to 130.00 (120.00, 135.00) at 10–36 months and 8 years postoperative follow-up. In conclusion, it is recommended to adopt arthroscopy with limited incision for restoring knee joint stability and motor function.

Outcome of Single-stage Multi-ligament Reconstruction: A Retrospective Observational Study

Introduction: Multi-ligament injuries of the knee can cause significant functional impairment. It is uncommon, and treatment is still controversial. The main controversies are around staged versus single-stage surgery. There is scanty literature on the functional outcome of the single-stage multi-ligament reconstruction. Moreover, less is known about the outcomes following single-stage multi-ligament reconstruction in the context of Nepal. We have been practicing single-stage reconstruction for multi-ligament injuries for the last few years at our center. This study was conducted to evaluate the functional outcome after single-stage multi-ligament reconstruction in our setup. Methods: The records of 75 patients who underwent single-stage multi-ligament reconstruction were retrospectively reviewed. All the patients were interviewed by telephone and face-to-face using set questionnaires. The KOOS QoL, Lysholm, and IKDC scores were used to evaluate outcomes. The data analysis was done using SPSS 20. Student’s t-test and Chisquared test were used to calculate the p-value for parametric and nonparametric variables. p-value of less than 0.05 was considered to be significant. Results: The mean age of patients who underwent multi-ligament reconstruction was 36.63 years. Among 75 patients, 51 were males, and 24 were females. 50 (66.7%) had RTA, 20 (26.7%) had fall injuries, 3 (4%) had a sports injury, and 2 (2.7%) had other injuries. The mean KOOS QoL, Lysholm, and IKDC scores were 71.19, 85.85, and 75.92, respectively. Conclusion: This study found that more than 77% of patients undergoing single-stage multi-ligament reconstruction have good to excellent outcomes. KeyWords: KOOS QOL score, Lysholm score, IKDC score, RTA.

Mid-Term Results of Single-Stage Surgery for Patients with Chronic Osteomyelitis Using Antibiotic-Loaded Resorbable PerOssal® Beads.

This retrospective study reports on the treatment of chronic osteomyelitis with local debridement combined with PerOssal®. The diagnosis of chronic osteomyelitis was confirmed in all cases and classified according to the Cierny-Mader (C-M) classification. The primary outcome was the eradication of infection at a minimum of one year after surgery. A total of 93 patients (median age: 40 years) were included. The most represented sites were the femur (24, 25.8%) and tibia (52, 55.9%). Twenty-six patients (28.0%) had significant local or systemic comorbidities (C-M Class B hosts). According to anatomic type, 31 cases were type I, 13 type II, 21 type III and 28 type IV. Vancomycin was added to PerOssal® in most cases (80, 86.0%). In 24 (25.8%) cases, Vancomycin and Rifampicin were combined. In 32 (34.4%) cases, intraoperative cultures were negative. Staphylococcus aureus was isolated in 39 (63.9%) patients, and Gram-negative bacteria were isolated in 12 cases. The median follow-up was 21 months (range 12-84). A total of 21 (22.6%) patients developed an infection recurrence (IR) after a median follow-up of 11 months (range: 1-47). PerOssal® holds several practical advantages compared to other bone void fillers. Thus, due to its good biocompatibility and sufficient antibiotic release, it represents a viable adjuvant treatment in chronic osteomyelitis.

Two Decadal Experiences in Managing Combined Obstetric Vesicovaginal and Rectovaginal Fistulas: A Study From Northern Indian Tertiary Hospital.

A retrospective study of 28 patients with obstetric combined vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) treated at our centre throughout the last two decades (2002 to 2022) has been conducted. In 12 patients, a preoperative diverting colostomy was performed. Six patients had single-stage surgery (both VVF and RVF repairin the same operation) of which two cases required transabdominal repair and four required transvaginal repair. All single-stage repairs (n=6) were successful in curing urine and faecal incontinence.In 22 patients, VVF was corrected initially via the transvaginal method with Martius flap interposition, followed by RVF repair three months later. In 2/22 patients, there was a leak after RVF repair; therefore, proximal diverting colostomy was performed, and RVF repair was repeated after six months. All cases had effective VVF and RVF repairs, and both urine and faecal incontinence were completely cured. This study suggests the collaborative engagement of aurologist and a surgical gastroenterologist results in an advantageous outcome for the surgical treatment of these intricate obstetric fistulas.

Gallstone Ileus With Persistent Cholelithiasis and Choledocholithiasis.

Gallstone ileus is an uncommon but well-described occurrence in general surgery. However, discrepancy regarding optimal surgical management with 1 or 2 stage operation is still debated. This case report presents a 73-year-old woman who presented to the emergency department (ED) with a small bowel obstruction due to a gallstone lodged in a portion of the proximal ileum. The patient was also noted to have persistent cholelithiasis and cholecystoduodenal fistula. A single-stage surgery involving enterolithotomy, cholecystectomy, fistula repair, and cholangioscopy was performed. The patient progressed well and was discharged home without recurrent symptoms. Therefore, in a hemodynamically stable patient with persistent cholelithiasis or choledocholithiasis, it is reasonable to perform a definitive single-stage operation.

An Endoscopic Approach for Frontal Sinus Cutaneous Fistula With Completely Ossified Frontal Recess.

A frontal sinus cutaneous fistula (FSCF) is a rare and challenging condition. Remarkable advancements in endonasal endoscopic surgery (EES) have enabled the treatment paradigm for a FSCF to gradually shift from open procedures to ESS. Nevertheless, the experience of EES for a post-trephination-related FSCF is rare, especially in patients with a pronounced frontal recess (FR) ossification. Here, we report an endoscopic strategy for successfully treating a post-trephination-related FSCF with complete ipsilateral FR neo-osteogenesis. Through two surgical corridors created by the modified mini-Lothrop procedure and an ipsilateral frontal osteotomy window, we established a patent drainage pathway from the affected side to the opposite side. This strategy may prevent potential orbital and cranial base injuries from affecting the ossified region of the ipsilateral FR. Moreover, in addition to the advantage of aesthetic outcomes, the procedure allows a single-stage surgery and facilitates the debridement and surveillance of the wound through the drainage pathway postoperatively. In conclusion, this technique could be a feasible endoscopic strategy for a FSCF, regardless of the severity of the FR ossification.