Single-stage Surgical Treatment Research Articles

Single-Stage Surgical Treatment of Acute Type A Aortic Dissection and Blunt Abdominal Trauma: A Case Report.

A 53-year-old man suddenly developed chest and back pain while driving, resulting in an accident. Computed tomography revealed acute type A aortic dissection with malperfusion of the left lower extremity, retroperitoneal extravasation, hematoma in the anterior mediastinum, and ascites in the rectovesical pouch. Exploratory laparotomy before aortic repair revealed intestinal perforation and retroperitoneal bleeding, which were repaired, and an ascending aortic replacement was performed. Visceral trauma with active bleeding should be treated with priority, even if the need for systemic heparinization accompanies acute type A aortic dissection during surgery for aortic dissection.

Surgical intervention on the wound channels of gunshot non-penetrating craniocerebral injuries

Objective – to optimize of surgical approaches to damaged tissues of the head and methods of primary surgical treatment for gunshot non-penetrating gunshot craniocerebral injuries in accordance with the principles of comprehensive and single-stage surgical treatment accepted in military field surgery. Materials and methods. An analysis of the surgical treatment of 155 wounded people with non-penetrating gunshot wounds of the skull vault and brain for the period from 2014 to 2020 was carried out. Anatomical and morphological features of wound canals were studied depending on the traumatic agent. Variants of surgical approaches for the primary surgical treatment of non-penetrable gunshot wounds of the skull and brainwere developed based on the clinical X-ray and computed tomography characteristics of the affected head tissues. Results. The choice of surgical approaches depends on the nature of the wound canals (single fragment blind, multiple fragment blind, ball and fragment tangent) and the presence of concomitant epidural and subdural hematomas. Primary plasty of the skull defect with a titanium plate during primary surgical treatment is indicated for gunshot impenetrable craniocerebral injuries with a single fragmental blind wound channel. Such plastic surgery was performed in 33.5% of cases with a favorable postoperative course. Peculiarities of surgical approaches to damaged tissues of the head in case of single fragmentary, blind wound canal; with multiple blind fragmental wound canals, the adjacent wound canal and the sequence of their surgical treatment were established. Conclusions. Planning of surgical approaches to damaged tissues of the head in case of gunshot impenetrable craniocerebral wounds in modern local wars should be carried out taking into account clinical and computed tomography data. The high proportion of comprehensive and one-time early primary surgical treatments (92.9%) performed on the first day after the injury testifies to the high efficiency of the system of providing specialized medical care during the local war.

Arthroscopic Repair of a 360° Labrum and Full-Thickness Rotator Cuff Tear After Shoulder Dislocation

Background: Rotator cuff tears after anterior shoulder instability are more common in patients >40 years of age and rare in younger patients where shoulder instability is most common. Although infrequent, little data exist on the evaluation of combined labral and rotator cuff tears in athletes. Indications: Combined rotator cuff and labral tears in the young patient population have a high risk of recurrent instability and require unique intraoperative and postoperative considerations. This patient is a Division 1 collegiate wrestler who sustained a 360° labral and full-thickness rotator cuff tear after an acute traumatic anterior shoulder dislocation. Technique Description: The lateral decubitus position is utilized and a posterior viewing portal is established along with anterior and accessory lateral portals. The 360° labral tear is first addressed by appropriately preparing the glenoid creating a quality healing surface. Tape sutures are then utilized to perform a knotless anterior labral repair. The superior labrum, anterior to posterior (SLAP) and then posterior labral repair are sequentially performed. The posterior portal is closed with a polydioxanone (PDS) suture to prevent a stress riser in the capsule. The rotator cuff tear is then repaired in a knotless double row configuration after appropriate greater tuberosity preparation. Results: Recent studies evaluating athletes with combined rotator cuff and labral pathology who underwent arthroscopic repair reported 90% good to excellent satisfaction with 77% returning to pre-injury level of athletics. Although few studies have evaluated combined labral and rotator cuff repair and concerns with stiffness exist, the current literature and the authors own experience have found good outcomes following single-stage repair. Discussion/Conclusion: Combined labral and rotator cuff tears after anterior shoulder dislocation in the young athletic population are rare and can be challenging to treat. Although there is limited data on these combined injuries in young athletic populations, the current literature and authors’ experience support single stage surgical treatment of combined labral and rotator cuff tears which typically result in improved patient reported outcomes and return to sport. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Single-Stage Surgical Treatment of Multi-ligament Knee Injuries Results in Lower Cost and Fewer Complications and Unplanned Reoperations Compared With Staged Treatment

PurposeTo compare complications, unplanned reoperations, and costs between single-stage and 2-stage treatment of multi-ligament knee injuries.MethodsThe MarketScan database was queried (2007-2016), identifying patients undergoing surgery for a multi-ligament knee injury. The single-stage cohort was defined as having at least 2 Current Procedural Terminology codes for ligament reconstruction at the index procedure without a Current Procedural Terminology code for ligament reconstruction appearing in the database for the following 12 months. The 2-stage cohort was defined as undergoing multiple ligament reconstruction procedures within a 12-month period with subsequent ligament procedure codes that differed from the index ligament reconstruction codes. Propensity score matching was performed using a greedy nearest-neighbor algorithm to match specific injury patterns between the 2 cohorts. Baseline demographic characteristics, medical comorbidities, and the Charlson Comorbidity Index were recorded. Complications, unplanned reoperations, and total health care expenditures were recorded for up to 5-year follow-up. Two-sample t tests, χ2 tests, and Fisher exact tests were used with an α level of .05 set as significant.ResultsWe identified 1,150 patients who underwent surgery for multi-ligament knee injuries (1,080 with single-stage approach and 270 with 2-stage approach). No significant differences in baseline characteristics or medical comorbidities were found between the cohorts. After propensity score matching, the single-stage group had fewer complications at 30, 90, 180, and 365 days (P < .05). Two-stage treatment increased the risk of reoperation at 1 year (5.5 times) and 2 years (4.9 times) after the index procedure. Health care expenditures were lower in the first 9 months for the staged cohort, but from 9 months ($31,210 vs $22,252, P < .0001) through 5 years, total costs were higher in this group.ConclusionsSingle-stage surgical treatment of multi-ligament knee injuries results in fewer complications and reoperations and lower total costs compared with 2-stage treatment, even after controlling for the number and combination of ligaments injured.Level of EvidenceLevel III, retrospective cohort study.

Первинний коло-анальний степлерний анастомоз при хірургічному лікуванні хвороби Гіршпрунга в дітей

Hirschsprung’s disease (HD) belongs to group of severe congenital malformations of the colon that can be only treated surgically. Various methods of radical correction HD have been evolutionarily improved. The Soave–Boley technique is considered to be the most successful, physiological and technically acceptable. Purpose – to evaluate the effectiveness of the use of stapler for primary colo-anal anastomosis as an element of Soave-Boley surgery in the surgical treatment of HD in children. Materials and methods. The analysis of surgical treatment of 125 children with various forms of HD aged from 6 months to 18 years, the formation of the primary colo-anal anastomosis was done using the Soave–Boley technique by mechanical (stapler) method. Results. In 20 patients (16.00%) among 125 with complicated course of HD, it was difficult to do radical single stage surgical treatment they required twostage treatment (stage 1) formation of the protective intestinal stoma and (stage 2) radical surgery. In the remaining 105 (84.00%) patients, single stageradical correction of HD was performed. In 1 (0.80%) of 125 patients operated by the Soave–Boley method with a primary colo-anal stapler anastomosis, in the early postoperative period was diagnosed with hematoma between pull through colon and sero-mascular pouch, which was treated conservatively. Andin one patient (0.80%) of 125 children in the remote postoperative period there was surgical complication – residual agangliosis, which was corrected by sphincteromyectomy by Lynn technique. Conclusions. Soave–Boley surgery with stapler colo-anal anastomosis is an effective method of radical correction of HD in children of different ages with one-stage or two-stage interventions. The use of a stapler for primary colo-anal anastomosis as an element of Soave–Boley surgery for the surgical treatment of HD in children with the consideration of necessary technical precautions has significant advantages over its classic methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Hirschsprung’s disease, children, surgical treatment, results.

Using Cranial Sutures in a Single-Step Frame-Guided Resection and Reconstruction for Intraosseous Meningiomas: Technical Note

Single-stage surgical treatment of cranial intraosseous meningiomas includes complete tumor resection followed by aesthetic reconstruction. Tailored tumor resection with a computer-aided design/computer-aided manufacturing custom-made implant for the defect has been advocated in recent years to achieve a satisfactory cosmetic result with reduced operative time and fewer complications. However, several technical nuances related to the area of osseous removal may compromise cranioplasty. We present 2 cases of intraosseous meningiomas (sphenoid wing and retromastoid) to illustrate a step-by-step approach, from preoperative planning to single-step surgery. For each case, a customized frame template delimiting bone removal was designed using cranial sutures as anatomical landmarks for precise placement of the cranioplasty template over the area of interest. Custom templates based in cranial sutures may benefit single-step frame-guided resection and reconstruction of intraosseous tumors with compelling results.

Single-Stage Treatment for Portal Biliopathy in Selected Cases

Symptomatic portal biliopathy requires two-staged treatment, portosystemic shunt in first stage and intervention for biliary obstruction in second stage if not resolved by the first stage. We present our series of single-stage treatment in form of portosystemic shunt with segment III duct Roux-en-Y hepaticojejunostomy. We retrospectively analysed 3 out of 20 patients who underwent single-stage surgical intervention for extrahepatic portal vein obstruction with portal biliopathy. Three out of 20 patients who underwent single-stage portosystemic shunt with segment III duct Roux-en-Y hepaticojejunostomy were older than the rest and had atrophied left lobe of the liver with dilated segment III duct easily approachable at liver surface. There was no increase in major morbidity or mortality due to combination of procedures. It took longer than expected to resolve jaundice. Selected patients with portal biliopathy having atrophied left lobe and dilated superficial segment III duct can be treated with single-stage surgical treatment. It ensures the relief of biliary obstruction and possibly averts the need of second intervention.

Functional and radiological outcome of single-stage surgical treatment of late presenting developmental dysplasia of the hip

Background: Developmental dysplasia of the hip (DDH) is the second-most common pediatric orthopedic condition in our country. The management of children presenting with DDH in the walking stage is primarily by surgical approach due to the changes in the femoral head, acetabulum, and other soft tissues surrounding the joint. This study evaluated the functional and radiological outcome of children with DDH in the walking age group who underwent open reduction with or without femur or pelvic osteotomy. Materials and Methods: Retro-prospective Cohort Study was conducted in tertiary care hospital. All children underwent open reduction through a standard anterior approach. The hip was reduced, and stability was assessed intraoperatively, and osteotomy was performed. The functional and radiological outcome was assessed at the end of follow-up; various variables which influence the outcome were looked. Chi-square test was used to measure the association between the types of surgery with the outcome, Tonnis grade with the outcome, and these are expressed as frequency and percentage. Results: Sixty-six percent of hips in our study had excellent functional outcomes, 27% had a good outcome. About 68% of hips in our study had excellent, and 2.5% of hips in our study had a poor radiological outcome. Conclusions: The assessment of outcomes suggested that appropriate surgery based on age and intraoperative assessment will give satisfactory functional outcome, irrespective of whether acetabular/femoral procedures are done. The re-surgeries rate in our study was low as all of them had single staged combined surgical intervention.

Effect of simultaneous surgical treatment in scoliosis associated with intraspinal abnormalities: A retrospective study.

To evaluate the outcomes of single-stage surgical treatment for spinal deformity and coexisting intraspinal pathologies, 12 patients who underwent single-stage surgical treatment for spinal deformity and co-existing intraspinal abnormalities between October 2016 and January 2017 were enrolled in the present study. Treatment for intraspinal abnormalities, posterior correction, osteotomy and internal fixation were performed simultaneously. The clinical and radiological outcomes, surgical details, complications and postoperative outcomes were evaluated. The mean fusion length was 11.0±2.8. Both scoliosis Cobb angle (pre-surgery 65.9±13.4 vs. post-surgery 21.7±9.4) and kyphosis (pre-surgery 71.1±19.5 vs. post-surgery 31.4±10.4) were significantly improved post-surgery. Tethered cords were released and epidermoid cysts, gangliogliomas, meningiomas and lipomas were resected. Muscle strength in all patients was improved. The muscular tone of 8 patients was improved. No severe complications occurred postoperatively. None of the patients experienced deterioration in their neurological status nor loss of correction during the 12-24 months' follow-up. The simultaneous surgical treatment for spinal deformity and intraspinal pathology seems to be a safe and effective approach. Neurological deficits were improved postoperatively. Osteotomy produces satisfactory correction results.

One-stage repair of aortic coarctation and cardiac pathology via sternotomy

Background Aortic coarctation is a hereditary disease often accompanied by ascending aortic aneurysm and aortic valve disease. We introduce a single-stage surgical treatment option for patients with aortic coarctation, ascending aortic aneurysm, and aortic valve disease, with a comparative analysis of the results. Methods The study included six patients with aortic coarctation, ascending aortic aneurysm, and aortic valve disease. All operations were performed by a full median sternotomy. For a comparative analysis, the patients were divided into two groups: 3 patients underwent ascending-to-descending aortic bypass, and the other 3 underwent surgical aortic coarctation repair. The short- and medium-term postoperative periods were monitored. The mean duration of monitoring was 27 months. Results When comparing the 2 groups, we observed a tendency for improvement in all intraoperative parameters in the 2nd group. There was no mortality in the postoperative hospital period. One (16.7%) patient died of stroke in the medium-term postoperative period. The other 5 patents showed no signs of procedure-related complications. Conclusion We recommend performing a single-stage procedure for surgical treatment of coarctation of the aorta with concomitant aneurysm of the ascending aorta and aortic valve disease. Compared to ascending-to-descending aortic bypass, surgical repair of aortic coarctation is more physiological, feasible via a sternotomy, and tends to improve intraoperative factors.

239. Prospective analysis of functional outcome of single stage surgical treatment for symptomatic tandem spinal stenosis

BACKGROUND CONTEXT Tandem spinal stenosis (TSS) is a rare presentation leading to combined clinical features of upper motor neuron and lower motor neuron lesion which includes intermittent neurogenic claudication with or without neurological deficit, progressive gait imbalance and gait disturbances. Such presentation was usually treated with staged surgery in past and few studies have reported single stage surgical intervention. PURPOSE To discuss safety, efficacy and evaluate the outcome of single stage surgical intervention for TSS. STUDY DESIGN/SETTING A total of 82 patients with TSS were prospectively analysed in our study for clinical and functional outcome after single stage surgical intervention. PATIENT SAMPLE From June 2009 to November 2016 in a series of 1,381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed as having symptomatic OUTCOME MEASURES All patients were evaluated pre- and postoperatively at each follow-up with mJOA score, Nurick's grading, Oswestry Disability index (ODI) and Cooper scale. METHODS From June 2009 to November 2016 in a series of 1,381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed as having symptomatic TSS with an incidence of 5.93 %. All patients diagnosed with TSS underwent single stage surgical intervention by one surgical team. The peri-operative factors were recorded for each patient. All patients were evaluated pre- and postoperatively at each follow-up with mJOA score, Nurick's grading, ODI and Cooper scale. RESULTS In our study 82 patients including 70 males and 12 females underwent simultaneous surgical intervention for symptomatic TSS. The mean age of patients was 61.78 ± 10.48 years. There was significant improvement in mJOA score, nuricks grading, ODI and Coopers scale post-operatively as compared to preoperative values (p value CONCLUSIONS Symptomatic TSS can be safely managed by single stage surgical intervention with good post-operative results and without significant increase in complication rates. This helps in reducing the cost for hospitalisation, avoid need for repeated intubation as well as reducing patients morbidity by avoiding the need for second surgical procedure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Single-Stage Multiple-Ligament Knee Reconstructions for Sports-Related Injuries: Outcomes in 194 Patients

Background: Outcomes after sports-related multiple-ligament knee reconstructions are limited. Purpose: To evaluate outcomes after single-stage surgical treatment of sports-related multiple-ligament knee injuries and to compare outcomes after anterior cruciate ligament (ACL)–based and posterior cruciate ligament (PCL)–based multiple-ligament knee reconstructions. Study Design: Case series; Level of evidence, 4. Methods: Skeletally mature patients with at least 2 major knee ligaments torn during a sporting activity that required surgery with a minimum of 2 years’ follow-up were included. The Lysholm score, Tegner activity scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-Item Short Form Health Survey Physical Component Summary were collected preoperatively and at a minimum of 2 years’ follow-up. Clinical data, including range of motion and knee stability, were also recorded at final follow-up. Results: A total of 276 patients with multiple-ligament knee injuries incurred during sport participation from 2010 to 2016 were identified. Of the 276 patients, 194 (70.5%) had complete follow-up at a mean 3.5 years (range, 2-8 years). There was a significant improvement in all outcome scores as compared with the preoperative scores (P < .001 for all scores). The median (first and third quartiles) Tegner activity score improved from 1 (0, 2) preoperatively to 6 (4, 7) postoperatively. Significant improvements were from 41 (22, 57) to 90 (78, 95) and 44 (24, 60) to 3 (1, 8) for median Lysholm and WOMAC scores, respectively. There was no significant difference in postoperative outcome scores between patients treated in the acute and chronic phases. Furthermore, there was no significant difference between PCL- and ACL-based multiple-ligament knee injuries. Eighteen (9.3%) patients developed arthrofibrosis requiring reintervention surgery. Conclusion: These results demonstrated that single-stage anatomic-based knee ligament reconstructions with immediate postoperative rehabilitation in the setting of sports-related multiligament injuries yielded significantly improved outcomes irrespective of the ligament injury pattern. In addition, there was no difference in outcomes between ACL- and PCL-based injuries in the setting of sports-related multiligament injuries.

Single-stage surgical treatment of condylar hyperplasia

Background: Unilateral Mandibular Condylar Hyperplasia (CH) is a rare idiopathic disorder which can cause both occlusal dysfunction and progressive facial deformity. Although there is a consensus in growing patients with active (CH) that the surgical treatment should be restricted to high condylectomy procedure which not only stop the aggravation of the hard and soft tissue asymmetry, but also can cause a regression of the deformity. The treatment of active (CH) in adult patients is still controversial. The level of condylectomy, the appropriate orthognathic surgical procedure, the treatment sequences, the number and diversity of surgeries are still debatable.

Prospective Analysis of Functional Outcome of Single-Stage Surgical Treatment for Symptomatic Tandem Spinal Stenosis.

Background:Tandem spinal stenosis (TSS) is a rare presentation leading to combined clinical features of upper motor neuron and lower motor neuron lesion which includes intermittent neurogenic claudication with or without neurological deficit, progressive gait imbalance and gait disturbances. In literature, there is controversy whether stage surgery or single-stage surgery should be done.Materials and Methods:From June 2009 to November 2016 in a series of 1381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed with having symptomatic TSS with an incidence of 5.93%. All patients diagnosed with TSS underwent single-stage surgical intervention by one surgical team. The perioperative factors were recorded for each patient. All patients were evaluated preoperatively and postoperatively at each followup with the modified Japanese Orthopaedic Association (mJOA) score, Nurick's grading, Oswestry disability index (ODI) and Cooper scale.Results:In this study, 82 patients including 70 males and 12 females underwent simultaneous surgical intervention for symptomatic TSS. The mean age of patients was 61.78 ± 10.48 years. There was a significant improvement in mJOA score, Nuricks grading, ODI and Coopers scale postoperatively as compared to preoperative values (P < 0.05).Conclusion:Symptomatic TSS can be safely managed by single-stage surgical intervention with good postoperative results or without a significant increase in complication rates. Single-stage surgical intervention helps to relieve the symptoms of both cervical and lumbar spinal cord compression, avoids the risk of repeated anesthesia, reduce the duration of surgery, repeated hospitalization hence, reducing the cost for hospitalization and also reducing the rehabilitation, recuperation time and early functional recovery justifies single-stage surgical intervention.

Simultaneous Surgical Treatment of Congenital Spinal Deformity Associated with Intraspinal Anomalies.

Study DesignProspective case series.PurposeTo study the safety, efficacy, and long-term outcomes of single-stage surgical intervention for congenital spinal deformity and intraspinal anomalies.Overview of literatureCongenital spinal deformities associated with intraspinal anomalies are usually treated sequentially, first by treating the intraspinal anomalies followed by deformity correction after a period of 3–6 months. Recently, a single-stage approach has been reported to show better postoperative results and reduced complication rates.MethodsThirty patients (23 females and seven males) were prospectively evaluated for the simultaneous surgical treatment of congenital spinal deformity with concurrent intraspinal anomalies from May 2006 to October 2016. The average age at presentation was 9.8±3.7 years, with the average follow-up duration being 49.06±8.6 months. Clinical records were evaluated for clinical, radiological, perioperative, and postoperative data.ResultsThe average angle of deformity was 56.53°±25.22° preoperatively, 21.13°±14.34° postoperatively, and 23.93°±14.99° at the final follow-up. The average surgical time was 232.58±53.56 minutes (range, 100–330 minutes), with a mean blood loss of 1,587.09±439.09 mL (range, 100–2,300 mL).ConclusionsSingle stage surgical intervention for intraspinal anomalies with congenital spinal deformity correction, including adequate intra-operative wake-up test, is a viable option in appropriately selected patients and has minimum complication rates.

К вопросу о повышении эффективности отдалённых результатов одномоментного хирургического вмешательства у больных с первичной открытоугольной глаукомой и осложнённой катарактой

К вопросу о повышении эффективности отдалённых результатов одномоментного хирургического вмешательства у больных с первичной открытоугольной глаукомой и осложнённой катарактой

Superior calvarial bone regeneration using pentenoate-functionalized hyaluronic acid hydrogels with devitalized tendon particles

Traumatic brain injury (TBI) is a life-threatening condition defined by internal brain herniation. Severe TBI is commonly treated by a two-stage surgical intervention, where decompressive craniectomy is first conducted to remove a large portion of calvarial bone and allow unimpeded brain swelling. In the second surgery, spaced weeks to months after the first, cranioplasty is performed to restore the cranial bone. Hydrogels with paste-like precursor solutions for surgical placement may potentially revolutionize TBI treatment by permitting a single-stage surgical intervention, capable of being implanted with the initial surgery, remaining pliable during brain swelling, and tuned to regenerate calvarial bone after brain swelling has subsided. The current study evaluated the use of photocrosslinkable pentenoate-functionalized hyaluronic acid (PHA) and non-crosslinking hyaluronic acid (HA) hydrogels encapsulating naturally derived tissue particles of demineralized bone matrix (DBM), devitalized cartilage (DVC), devitalized meniscus (DVM), or devitalized tendon (DVT) for bone regeneration in critical-size rat calvarial defects. All hydrogel precursors exhibited a yield stress for placement and addition of particles increased the average material compressive modulus. The HA-DBM (4–30%), PHA (4%), and PHA-DVT (4–30%) groups had 5 (p < 0.0001), 3.1, and 3.2 (p < 0.05) times greater regenerated bone volume compared to the sham (untreated defect) group, respectively. In vitro cell studies suggested that the PHA-DVT (4–10%) group would have the most desirable performance. Overall, hydrogels containing DVT particles outperformed other materials in terms of bone regeneration in vivo and calcium deposition in vitro. Hydrogels containing DVT will be further evaluated in future rat TBI studies. Statement of SignificanceTraumatic brain injury (TBI) is a life-threatening condition characterized by severe brain swelling and is currently treated by a two-stage surgical procedure. Complications associated with the two-stage surgical intervention include the occurrence of the condition termed syndrome of the trephined; however, the condition is completely reversible once the secondary surgery is performed. A desirable TBI treatment would include a single surgical intervention to avoid syndrome of the trephined altogether. The first hurdle in reaching the overall goal is to develop a pliable hydrogel material that can regenerate the patient’s bone. The development of a pliable hydrogel technology would greatly impact the field of bone regeneration for TBI application and other areas of bone regeneration.

Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis

Hidradenitis suppurativa is a very debilitating disease, treated by antibiotics and excision. The reconstruction is usually done by secondary wound healing and/or split-thichness skin graft. The aim of this study was to evaluate the reconstruction of the axilla with local perforator flaps as a single stage surgical treatment. This was a monocentric retrospective study conducted between November 2013 and June 2015. We included the patients with a severe axillary localization of the disease. Between 6 months and 1 year postoperatively, we noted length of complete healing, complications, patients satisfaction score about the surgery, DASH functional score, maximum abduction angle of the arm, and recurrence of the disease. Thirteen patients were included, for a total of seventeen affected axillae. We performed seven thoracodorsal artery perforator flaps, seven lateral intercostal artery perforator flaps and three serratus anterior artery perforator flaps. The mean duration of follow-up was 279.1±84.1 days (180-365). The average complete healing time was 20.5±13.5 days (10-60). Six axillae were compounded (35%). The average recurrence rate of HS was 0%. The average score in the DASH questionnaire was 68.6±35.3 points (39-152) and the average maximum abduction angle of the arm was 160.6±18.5 degrees. The average score on the satisfaction questionnaire was 36.5±5.6 points (25-43). This is a single stage, reliable and effective surgical procedure. The results are very encouraging, with a good quality of life, a low functional disability and a shorter healing time.

Laparoscopy with nephroscopy in single-stage necrosectomy for the treatment of severe acute pancreatitis

Background: Severe acute pancreatitis (SAP) is difficult to manage despite the availability of different endoscopic techniques. The most beneficial protocol remains unclear. Objective: To explore the efficiency and safety of a combination of laparoscopy and nephroscopy in single-stage necrosectomy for the treatment of SAP. Methods: A 57-year-old woman with SAP underwent microinvasive surgery (combination of laparoscopy and nephroscopy for first necrosectomy) along with dual-catheter drainage. Results: The patient recovered uneventfully. She was followed up for 5 months. No surgery-related complications or other adverse events occurred. She was living a functional life at the time of this writing. Conclusion: The combination of laparoscopy and nephroscopy is accessible and safe for single-stage surgical treatment of conditions involving the abdomen and retroperitoneum. This technique reduces healthcare costs and shortens the hospital stay. It is a clinically valuable technique for surgeons to learn.

Treatment of Catastrophic Failures of Achilles Tendon Repairs Due to Deep Wound Complications

Category: Sports Introduction/Purpose: The Achilles tendon is the most commonly injured tendon in the lower extremity. Whether these ruptures are acute or chronic, a surgical Achilles repair or reconstruction is often needed to restore tendon integrity and function. Risks from such surgeries include superficial or deep wound infections and/or dehiscence. To date, there is scant literature regarding the treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound infection and dehiscence. The purpose of this study is to retrospectively examine clinical outcomes from uniform single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications. Methods: Between 2007 and 2016, 10 patients developed a deep wound infection and dehiscence after surgical treatment of an acute or chronic Achilles rupture. Medical co-morbidities included obesity in 4, diabetes in 3, and nicotine use in 2 patients. Six and 4 patients had a mid-substance and insertional Achilles rupture respectively. Three patients had an acute injury that received an end-to-end suture repair. Seven patients had a chronic injury with Achilles retraction, which necessitated proximal Achilles or gastrocnemius lengthening. These patients required surgery for their wound problem due to depth and involvement of their Achilles repair/reconstruction site. Surgery involved a single-stage wound irrigation and debridement, Achilles excisional debridement at the repair/reconstruction site, flexor hallucis longus transfer to the calcaneus to replace the compromised or failed Achilles repair/reconstruction, and primary or vacuum assisted wound closure. Patients were followed for 6 months after this surgery and invited for recent follow-up to collect data. Results: With uniform surgical treatment, full resolution of deep wound infection and dehiscence after Achilles repair/reconstruction was achieved in all 10 patients. No patients developed a recurrence of wound complications and/or infection to necessitate any further surgical debridements. All 10 patients presented for recent follow-up at a mean of 57.3 months. Mean Foot and Ankle Ability Measures increased from 36.3% at initial presentation before Achilles repair/reconstructive surgery to 84.2% at latest follow-up (P&lt;0.05). Mean Visual Analog Scores of pain decreased from 6.6 of 10 before the Achilles repair/reconstruction to 1.5 of 10 at latest follow-up (P&lt;0.05). All patients were able to return to normal gait and full activities at home, with 3 reporting difficulties with prolonged ankle activities at work. Conclusion: This study demonstrates that our method of single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications can achieve a high rate of improved patient function and pain relief. Clinical outcomes of treating patients with this particular complication of Achilles repair/reconstruction in this manner have not been previously reported in the orthopaedic literature. As catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications are studied further, our method of surgical care should be strongly considered as treatment.