Single-stage Surgical Reconstruction Research Articles

Single-Stage Surgical Reconstruction in a Case of Rare Isolated Periorbital Cutaneous Sarcoidosis without Systemic or Orbital Involvement.

Single-Stage Surgical Reconstruction in a Case of Rare Isolated Periorbital Cutaneous Sarcoidosis without Systemic or Orbital Involvement.

Design and In Vivo Testing of Novel Single-Stage Tendon Graft Using Polyurethane Nanocomposite Polymer for Tendon Reconstruction

Severe trauma, failure of prior surgical repair, delayed presentation and excessive scarring around the flexor tendon bed often necessitate a two-stage surgical reconstruction, where a silicone spacer is used in the first stage to recreate the fibro-osseous tunnel through which the tendon graft can glide in the second stage. This staged procedure involves great commitment on the part of both patient and surgeon, over the course of several months, involving a prolonged period of rehabilitation that can be quite disruptive to the patient's life and work. Reducing this from a two-stage into a single-stage procedure, therefore, has the potential to reduce rehabilitation time and cost, expedite return to work, and improve outcomes. To address this, we developed polyurethane (PU) nanocomposite, as an engineered tendon sheath, for treatment of delayed flexor tendon division as a single-stage procedure. The clinically conformant tubular grafts were tested for their efficacy in the peroneus tertius tendon of 6 Mule sheep for 3 months. Semi-quantitative histological assessment was carried out by analysing four descriptive layers: tendon, tendon/polymer sheath interface, polymer sheath, and polymer sheath/surrounding tissue. Four (out of 6) of the implanted PU nanocomposites showed moderate to substantial healing of the injured tendons, with minimal adhesion after repair, ensuring good gliding movement. No statistical differences were observed in tendon repair based on intra-regional variation in the explanted grafts, indicating homogeneity in tendon repair. Overall, the PU nanocomposite bears morphological stability and functionality for tendon repair, in single-stage surgical reconstruction, demonstrating promising evidence for clinical translation.

Risk factors for decannulation failure after single-stage reconstruction of adult post-intubation tracheal stenosis: 10-year experience at a tertiary center

Background: Although the risk factors for decannulation failure have been discussed in the literature, there are many unclear points on this issue.Aims and objectives: To identify risk factors for developing decannulation failure after single-stage surgical reconstruction of post-intubation tracheal stenosis (TS).Material and methods: A total of 45 adult patients with post-intubation TS admitted to our institution and underwent single-stage surgical reconstruction between April 2008 and May 2018. Nine patients developed decannulation failure by postoperative 6 months (Failed Decannulation Group), and 36 patients were decannulated successfully (Successful Decannulation Group). Causal factors of intubation were noted. Patient-related risk factors of decannulation failure were compared between two groups.Results: Failed Decannulation Group had a significantly higher body mass index (p = .034) and were more likely to have diabetes (p = .025). Patients who were previously intubated for more than 48 h (p = .043) were significantly more likely to have decannulation failure. The presence of comorbid diseases did not place a patient under statistically significant risk of decannulation failure.Conclusion: Patients with high body mass index, the ones with diabetes, and patients who were previously intubated for more than 48 h were more likely to develop decannulation failure.

Repair of Anterior Ear Defects Using Transcartilage Island Pedicle Flaps.

Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin. This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear. Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed. The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management. Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.

Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia.

Reconstructive upper extremity surgeries in tetraplegia are technically challenging because of the many complicated real-time decisions that need to be made, e.g. extent of release of donor muscle-tendon complex, routing of donor muscles, tissue preparation and optimization, tensioning of muscle-tendon units, balancing joints and suturing tendon-to-tendon attachments. Nerve transfer surgeries can add functionality but also make the reconstruction planning more complex. In this overview, we present some of the fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function as well as early postoperative activity-based training in patients with cervical spinal cord injuries. We foresee an increased need for studies addressing combined nerve and tendon transfer reconstructions in parallel with patient-perceived outcome investigations. These should be combined with implementation of assistive technology such as functional electrical stimulation for diagnostic, prognostic and training purposes.

Single-Stage Surgical Reconstruction of Posttraumatic Compound Complex Fronto-Basal Cranial Vault Fracture in a Resource-Limited Practice.

The extant literature on the surgical treatment of posttraumatic compound, complex frontal basal calvarial skull fracture suggests that this be a staged procedure. There are many socioeconomic constraints in low-resource regions of the world to the feasibility of this standard practice. A single-stage operative procedure for the surgical treatment of these fractures in a neurosurgery practice in Nigeria is here annotated. In addition, an observational outcome analysis of this surgical technique in a prospective consecutive cohort of patients over a 6-year period is presented. Fourteen patients, all males, mean age 33.9 years (SD, 6.6) underwent this surgical procedure. Majority were late neurosurgical referrals, hence median time to surgery was 96 hours (range, 48-2160). Twelve patients (85.7%) had history of loss of consciousness, median duration of 34 hours; 7 (50%) had associated brain contusions; 6 (43%) significant pneumocephalus; and acute extradural and subdural haematoma in 4 and 2 patients respectively. The surgery was successful in all; 13 (93%) had normal outcome on the Glasgow outcome scale at hospital discharge; 12 have been followed up for 1 to 72 months, median 33. Seven of these were for 30 months or more. There was no patient of surgical site infection in the perioperative or the follow-up period to date. The aesthetic outcome was also acceptable. The pragmatic surgical technique herein annotated appears clinically and aesthetically effectual in the operative treatment of compound, complex frontal basal cranial vault fracture.

Tracheal Resection With Primary Anastomosis.

The aim of our study was to present our retrospective experience in the single-stage surgical reconstruction of 21 tracheal stenosis (TS) patients during the last 17 years, considering the characteristics of the treated stenosis, surgical procedures performed, and postoperative outcomes and complications. All demographic and clinical data were collected retrospectively. Chest and neck computed tomography (CT) scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Myer and Cotton grading scale. The aetiology of the (TS) was intubation related in 18 patients and idiopathic in three patients. The duration of intubation was 13.00 ± 6.83 days (range, 1 hour to 27 days). According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.33 ± 0.66 (range, 2-4). Mean length of the stenosis was 2.05 ± 0.80 (range, 1-3.5) cm. The mean number of stenotic segment involved was 3.67 ± 1.24 (range, 2-6). Mean follow-up for the study group, excluding two patients who died in the postoperative period, was 57 (range, 12-326) months. Of the 19 patients who survived, postoperative decannulation was achieved in 16 patients (76.19%), and decannulation was not achieved in 3 patients (14.29%) who are still on a T-tube. Of the 16 patients who are decannulated successfully, additional procedures were applied in 9 patients. Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected patients of (TS).

Cloacal exstrophy: A single center experience

ObjectiveCloacal exstrophy is an exceedingly rare and complex anomaly. The records of 23 patients treated in a tertiary care center with limited infrastructure were analyzed for anatomic types, associated anomalies, surgical procedures adopted, and the outcome. Materials and methodsThere were 14 males. Seventeen babies were preterm with an average weight of 1.92 kg. The time of presentation, gestational age, birth weight, position of the hemibladders and associated malformations were noted. Reconstruction procedures involved dismantling of the hemibladders and primary turn in, tubularization of the bowel with an end colostomy, and reconstruction of the abdominal wall. Results of the primary surgical repair, bowel function, and outcome of secondary procedures were analyzed. ResultsThe position of hemibladders was lateral in 11, upper confluent in 4 and lower confluent in 8. Associated anomalies were noted in 19 patients. Four patients presented late (>5 days). Five died preoperatively, all had major associated anomalies. Four of them were preterm with average weight of 1.4 kg. Two patients refused surgery. Single-stage surgical reconstruction was done in 15 patients. Five patients died postoperatively because of associated anomalies, prematurity, and sepsis. One patient is waiting for surgery. Six patients had follow-up at 3–42 months and are awaiting further reconstruction. Four patients were lost to follow-up. ConclusionsPrematurity, late presentation, and sepsis are the major causes of high mortality noted in this series. In our experience, single-stage reconstruction without osteotomy gives satisfactory results.

Single-Stage Surgical Reconstruction for Infants With Congenital Adrenal Hyperplasia

Single-Stage Surgical Reconstruction for Infants With Congenital Adrenal Hyperplasia