Skin Incision Technique Research Articles

The vertical midline incision is a safe and effective technique for primary total laryngectomy procedures

ObjectiveA total laryngectomy is used to resect laryngeal or hypopharyngeal cancer. Limited research exists on how incision location influences clinical outcomes. This study compares outcomes between two incision types; vertical midline (VMI) and apron-type incisions and determines whether this approach should be considered more frequently for primary total laryngectomy procedures. MethodsA retrospective analysis was undertaken at two tertiary specialist centres. The effect of skin incision technique on postoperative outcomes was analysed using regression modelling. ResultsOf the 79 patients included, 54 underwent an apron incision and 25 underwent a VMI. VMIs were significantly associated with reduced risk of lymphoedema(p=0.011) and pharyngocutaneous fistula (PCF)(p=0.031). Regression analysis demonstrated incision technique did not influence recurrence(HR2.28;95%CI 0.61-8.53;p=0.219) or survival(HR1.41;95%CI 0.55-3.65;p=0.477). However, apron incisions increased the odds of minor(OR9.59;95%CI 1.34-68.82;p=0.025) and major(OR3.59;95%CI 1.71-78.21;p=0.045) complications. ConclusionsVMI is a safe and effective approach for performing laryngectomies and does not have inferior outcomes with regard to complications, recurrence rate or survival. Additional morbidity from the routine use of flap reconstruction in salvage surgery can be avoided. A vertical approach should be considered for laryngectomy resections even in the presence of encapsulated lateral nodal disease.

Placebo Control and Blinding in Randomized Trials of Procedural Interventions

Unlike medications, procedural interventions are rarely trialed against placebo prior to becoming accepted in clinical practice. When placebo-controlled trials are eventually conducted, procedural interventions may be less effective than previously believed. To investigate the importance of including a placebo arm in trials of surgical and interventional procedures by comparing effect sizes from trials of the same procedure that do and do not include a placebo arm. Searches of MEDLINE and Embase identified all placebo-controlled trials for procedural interventions in any specialty of medicine and surgery from inception to March 31, 2019. A secondary search identified randomized clinical trials assessing the same intervention, condition, and end point but without a placebo arm for paired comparison. Placebo-controlled trials of anatomically site-specific procedures requiring skin incision or endoscopic techniques were eligible for inclusion; these were then matched to trials without placebo control that fell within prespecified limits of heterogeneity. Random-effects meta-regression, with placebo and blinding as a fixed effect and intervention and end point grouping as random effects, was used to calculate the impact of placebo control for each end point. Data were analyzed from March 2019 to March 2020. End points were examined in prespecified subgroups: patient-reported or health care professional-assessed outcomes, quality of life, pain, blood pressure, exercise-related outcomes, recurrent bleeding, and all-cause mortality. Ninety-seven end points were matched from 72 blinded, placebo-controlled trials (hereafter, blinded) and 55 unblinded trials without placebo control (hereafter, unblinded), including 111 500 individual patient end points. Unblinded trials had larger standardized effect sizes than blinded trials for exercise-related outcomes (standardized mean difference [SMD], 0.59; 95% CI, 0.29 to 0.89; P < .001) and quality-of-life (SMD, 0.32; 95% CI, 0.11 to 0.53; P = .003) and health care professional-assessed end points (SMD, 0.40; 95% CI, 0.18 to 0.61; P < .001). The placebo effect accounted for 88.1%, 55.2%, and 61.3% of the observed unblinded effect size for these end points, respectively. There was no significant difference between unblinded and blinded trials for patient-reported end points (SMD, 0.31; 95% CI, -0.02 to 0.64; P = .07), blood pressure (SMD, 0.26; 95% CI, -0.10 to 0.62; P = .15), all-cause mortality (odds ratio [OR], 0.23; 95% CI, -0.26 to 0.72; P = .36), pain (SMD, 0.03; 95% CI, -0.52 to 0.57; P = .91), or recurrent bleeding events (OR, -0.12; 95% CI, -1.11 to 0.88; P = .88). The magnitude of the placebo effect found in this systematic review and meta-regression was dependent on the end point. Placebo control in trials of procedural interventions had the greatest impact on exercise-related, quality-of-life, and health care professional-assessed end points. Randomized clinical trials of procedural interventions may consider placebo control accordingly.

Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches

BackgroundMinimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA (“Direct Anterior Approach with bikini incision”) are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes.MethodsThis is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded.ResultsFor each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05).ConclusionThe present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study.

Oblique versus Straight skin incision: The impact of incision type on postoperative outcomes in distal radiocephalic arteriovenous fistula creation

Aim: The type of skin incision utilized in arteriovenous (AV) fistula creation may significantly influence the patency, maturation, and overall outcomes of the fistulas. An oblique skin incision may offer distinct advantages in preventing early AV fistula failure by reducing skin tension and minimizing pressure on the newly formed anastomosis. This study aims to compare the postoperative early period outcomes of oblique versus straight skin incision techniques, with a focus on their impact on AV fistula success. Material and Methods: 2020 to 2023, all patients with created AV fistula via distal antebrachial vessels with oblique and straight skin incisions were enrolled. Retrospectively, the patients’ demographics, comorbidities were collated from the hospital data. All patients were operated with local anesthesia for radiocephalic AV fistula creation. The characteristics of the vessels were determined through preoperative Doppler ultrasonography mapping. Evaluations were conducted on primary patency, early maturation, and the incidence of early thrombosis. Results: In Total, 182 patients were operated for AV fistula creation. The mean age was 57±17 years and there was a male predominance with %68. We performed 74 patients AVF creation via straight skin incision and 108 via oblique skin incision. Despite there being no differences in comorbidities and demographic characteristics between the two groups, the group with a straight skin incision exhibited a higher incidence of early thrombosis (p=0.03), a lower maturation rate (p=0.03), and reduced primary patency (p=0.01). Conclusion: Oblique skin incision could be a feasible alternative to conventional straight incision with a higher early AVF patency and lower thrombosis rates. Reducing the pressure on and keeping the incision away from the new anastomosis may be crucial for achieving better outcomes.

A new incision in the correction of radial longitudinal deficiency: The double Y sliding flap approach

One concern in the surgical treatment of radial longitudinal deficiency (RLD) is certainly the skin incision. Over the years many different types have been proposed and used. We propose a new skin incision technique: a double Y sliding flap with the main body along the dorsal wrist crease, followed by raising a proximal and a distal flap providing wide access to the dorsal surface of the wrist joint. After correction of the wrist deformity, skin triangles are resected on the radial and ulnar sides of the incision. Then the skin of the distal flap is slid radially and proximally, filling the defect left by the resected radial triangle, while the proximal flap is slid in the opposite direction, enabling transverse closure along the ulnar side of the incision. The final scar comprises a central body along the dorsal wrist crease, and a radial branch. The aim of this study was to analyze the clinical results of this new double Y sliding flap approach for the surgical treatment of type III and IV RLD. We retrospectively reviewed medical records of surgical correction of RLD using our new incision, between January 2016 and December 2018 in our department of hand surgery. Endpoints comprised correction of redundant skin, scar appearance, and complications. Twelve limbs in 9 patients treated with this double Y sliding flap approach were reviewed: correction of redundant skin was systematic, only 2 limbs showed postoperative complications (1 case of notable edema and 1 of delayed wound healing), and scar aspect was graded good in 11 of the 12 cases. The double Y sliding flap was safe, with minimal complications, adequate skin restoration, wide exposure of the wrist, and esthetically good scar. Level of evidenceIV

Utility of a minimal skin incision technique for abdominal hysterectomy at a regional core hospital: a retrospective study

BackgroundWe present a minimal skin wound abdominal hysterectomy for patients with leiomyomas and describe the characteristics of this technique. The skin wound was made as small as possible, with a maximum length of 6 cm.MethodsIn addition to introducing minimal skin wound abdominal hysterectomy, we retrospectively analyzed the medical records of 82 patients treated with minimal skin wound abdominal hysterectomy exclusively by two experts at Maruyama Memorial General Hospital between January 2013 and December 2016. Relationships between the leiomyoma characteristics and the difficulty of this operation, as estimated by operation time and blood loss, were statistically investigated.ResultsFirst, we introduce a case in which we performed minimal skin wound abdominal hysterectomy on a 46-year-old Japanese patient with multiple leiomyomas (maximum 8 cm in diameter). Then, we assessed the impacts of the leiomyoma characteristics on the difficulty of this operation. On multivariate analysis, the number of leiomyomas significantly affected operation difficulty. Other characteristics of the target leiomyoma showed no effect. Additionally, higher body mass index also made the operation more difficult.ConclusionsAlthough multiple leiomyomas can make this procedure difficult, minimal skin wound abdominal hysterectomy is safe and effective for use in many cases.

Incision cutanée arciforme pour la transposition du nerf ulnaire dans le syndrome du tunnel cubital : étude cadavérique et clinique afin de prévenir les lésions du nerf cutané médial

IntroductionMedial skin incision is obligatory for ulnar nerve transposition in cubital tunnel syndrome. However, inadvertent surgical damage to the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) has been a concern in the current surgical approach. HypothesisWe hypothesized a modified curved skin incision to avoid the damage to the medial cutaneous nerve. Materials and methodsThe numbers and locations of MACN and MBCN terminal branches were investigated; also, the location of the posterior branch of MACN in ten fresh frozen cadaveric upper extremities. Using modified incision which is more anterior than classic approach and includes antegrade dissection of the cutaneous branches, same measurement was performed in clinical cases. We described the techniques. ResultsThe average number of MACN posterior terminal branches was 2.6±1.6 and 4.4±2.4 branches in the cadaveric specimens and clinical cases, respectively. The average number of MBCN terminal branches was 2.1±0.87 branches. The MACN posterior terminal branches were located at an average of 19mm proximal and 45mm distal from the medial epicondyle. In clinical cases, we could preserve all MBCN terminal branches and posterior terminal branches of MACN using the indexed skin incision. DiscussionOur modified medial skin incision technique with antegrade subcutaneous dissection exposed all the terminal branches of MACN and, thus, could reduce the risk of inadvertent injury. The medial epicondyle and the basilic vein are reliable anatomical landmarks to identify the posterior branch of the MACN. Level of proofIV, cadaveric and therapeutic study.

Complication rates and lymph node count between two different skin incisions at time of inguino-femoral lymph node dissection in vulvar cancer

IntroductionInguino-femoral lymph node dissection plays a crucial role in the management of vulvar cancer. The procedure is associated with high complication rates, including infection, lymphocysts/lymphoedema and wound dehiscence. Several skin...

Curved skin incision for Ulnar nerve transposition in Cubital Tunnel Syndrome: Cadaveric and clinical study to avoid injury of medial cutaneous nerve

IntroductionMedial skin incision is obligatory for ulnar nerve transposition in cubital tunnel syndrome. However, inadvertent surgical damage to the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) has been a concern in the current surgical approach. HypothesisWe hypothesized a modified curved skin incision to avoid the damage to the medial cutaneous nerve. Materials and methodsThe numbers and locations of MACN and MBCN terminal branches were investigated; also, the location of the posterior branch of MACN in ten fresh frozen cadaveric upper extremities. Using modified incision which is more anterior than classic approach and includes antegrade dissection of the cutaneous branches, same measurement was performed in clinical cases. We described the techniques. ResultsThe average number of MACN posterior terminal branches was 2.6±1.6 and 4.4±2.4 branches in the cadaveric specimens and clinical cases, respectively. The average number of MBCN terminal branches was 2.1±0.87 branches. The MACN posterior terminal branches were located at an average of 19mm proximal and 45mm distal from the medial epicondyle. In clinical cases, we could preserve all MBCN terminal branches and posterior terminal branches of MACN using the indexed skin incision. DiscussionOur modified medial skin incision technique with antegrade subcutaneous dissection exposed all the terminal branches of MACN and thus, could reduce the risk of inadvertent injury. The medial epicondyle and the basilic vein are reliable anatomical landmarks to identify the posterior branch of the MACN. Level of proofIV, Cadaveric and Therapeutic study.

Long-Term Outcomes of the Minimal Skin Incision Technique for Correcting Severe Microform and Minor-Form Cleft Lip With Philtrum Reconstruction Through the Intraoral Incision.

Because the traditional technique is known to cause visible scarring, it is challenging to yield optimal outcomes while treating a severe type of microform and minor-form cleft lip. The authors present a new refined technique with minimal skin incision and philtrum formation through an intraoral incision. The surgical technique involves single Z-plasty or double or triple unilimb Z-plasty to restore an elevated cupid's bow peak and overlapping of an orbicularis oris muscle flap to create the philtrum through an intraoral incision. Cleft lip nasal deformity was corrected with reverse-U incision and V-Y plasty. Eighteen patients were operated between September 2008 and June 2017. Patient age at the time of surgery ranged from 3 to 12 months. The duration of follow-up ranged from 12 months to 7 years (mean, 36 months). The elevated cupid's bow was corrected by performing single Z-plasty in 6 patients, double unilimb Z-plasty in 7 patients, and triple unilimb Z-plasty in 5 patients. In all cases, the notch or elevated cupid's bow was corrected, the surgical scar was minimal, and philtrum reconstruction was satisfactory. Minor scar revision was performed in 4 patients. Cleft lip nasal deformity was corrected in fifteen patients. The technique adopted here causes minimal scarring, facilitates the formation of an anatomical philtrum, preserves the continuity and function of the muscle, and presents sufficient elevation of the philtral column.

Percutaneous Fasciotomies versus Traditional Keystone Flap: Evaluating Tension in Complex Wound Closure.

The keystone flap is a popular reconstructive option for closure of cutaneous defects. Traditionally, this is a perforator-based fasciocutaneous advancement flap that uses both skin incision and fascial release. We propose a limited skin incision technique that utilizes percutaneous fasciotomies to accomplish wound closure. Fresh cadavers were used to compare closure techniques in traditional keystone flaps versus percutaneous fasciotomy technique. Each cadaver served as its own control; traditional keystone flaps were performed on the right side, experimental fasciotomy technique on the left. Bilateral large wound defects were created in 6 anatomical locations: anterior leg, lateral thigh, buttocks, lower back, upper back, and brachium. These defects could not be closed primarily, as defined by tension >25 Newtons or rupture of a 2-0 nylon suture. Twenty-four flaps were created. Keystone flaps were designed on the right side using a 1:1 ratio of defect size to flap width, incorporating both skin and fascial incisions. On the left, percutaneous fasciotomies were drawn using a mirror template and performed through two small access incisions. If wound closure could not be achieved by fasciotomy alone, additional incisional release was performed incrementally until closure was obtained. The tension of closure was measured using a PESOLA (10 N, 25 N) tensiometer (Chandelle, Switzerland), and the average of three recordings was used. Tension was measured at various stages of flap development including: keystone flap (posterior fascia, lateral fascia, V-Y skin closure) versus percutaneous fasciotomy (posterior fascia, lateral fascia, posterior skin). Statistical analysis was completed using Wilcoxon Signed Rank test to compare the two techniques. Lower tension closures were achieved through release of the posterior fascia in the traditional keystone flap compared to the percutaneous fasciotomy technique. These differences in tension were statistically significant (P < 0.001). Release of the lateral fascia in the keystone flap resulted in a similar decrease in tension (P < 0.01). The percentage drop in tension before and after each particular intervention was measured. No significant difference was found between these 2 groups. When compared with the traditional keystone flap, the percutaneous fasciotomy technique displayed higher tensions in closure. However, this technique showed the ability to close defects in certain locations of the body without excessive tension and should be considered as an option in soft-tissue reconstruction.

Undermining the epidermis around the U-shaped skin incision preserves thick, well-vascularized tissue that effectively prevents posturethroplasty complications

PurposeWe modified the U-shaped skin incision technique (UIT) during urethroplasty (UP) to prevent post-UP complications (post-UPC). Patients and methodsOur modified UIT (mUIT) involves undermining the epidermis for 5–7 mm around the U-shaped incision to create a thicker, better vascularized tissue layer for suturing the neourethra compared with UIT. To prevent injury to underlying connective tissue and avoid compromising blood perfusion, the scalpel should be held at a more slanted angle than is conventional. After the urethral plate is incised in the midline, stay sutures are placed to the middle of the penile shaft as a landmark, and three to five sutures are placed through the thick layer created by undermining. To facilitate mobilizing connective tissue during neourethroplasty, relaxing incisions may be used on the edges of the connective tissue. We compared 207 hypospadias patients who had primary or staged UP using either mUIT (n = 110) or UIT (n = 97) between 2003 and 2017 for incidence of post-UPC. ResultsmUIT had significantly less post-UPC than UIT after a mean follow-up of 6.44 ± 0.26 years after final UP, 1/110 (0.9%) versus 15/97 (15.5%) (p < .0001). ConclusionsUndermining the edges of the U-shaped incision during mUIT would appear to prevent post-UPC. Level of evidenceLevel III.

Aesthetic Outcomes of Intra-Umbilical Incision vs Infra-Umbilical Incision in Postpartum Tubal Sterilization: A Randomized Controlled Trial

Background: An incision inside the umbilicus is popular used in single port surgery intra-umbilical skin incision surgeries have been proven efficient and safe. When compared to infra-umbilical skin incisions, an incision wound was invisible after the operation. Why not use intra-umbilical skin incision in postpartum tubal sterilization.&#x0D; Objective: To compare aesthetic scores of an incision wound, surgical time and complications in postpartum sterilization under infra-umbilical and intra-umbilical skin incision.&#x0D; Methods: This was a randomized controlled trial conducted in Prapokkhlo Hospital, Chanthaburi, Thailand. Patients (n = 58) with informed consents were randomly assigned to one of the two skin incision techniques for postpartum sterilization (n = 29 for each arm). Surgical times were recorded. Both the patients and an independent physician made wound aesthetic assessments one week after the operation using the Patient and Observer Scar Assessment Scores (POSAS), which compares the wound to the nearby skin. T tests and exact probability statistical tests were used for statistical analysis.&#x0D; Results: The surgeon’s POSAS scores in intra-umbilical incisions were significantly closer to normal skin than those in infra-umbilical incisions (6.8 ± 1.5 vs 12.5 ± 5.0; P &lt; .001). A similar finding was observed for patient POSAS scores (6.5 ± 1.2 vs 15.4 ± 5.0; P &lt; .001). The operation times were also shorter (9.1 ± 2.8 vs 11.8 ± 4.7 minutes; P = .009). Neither intra-abdominal injuries nor wound infections were observed.&#x0D; Conclusions: Postpartum sterilization using intra-umbilical skin incision was more efficient in regard to aesthetic concerns and operation time.

Semivertical Incision: An Aesthetically and Electrophysiologically Effective Mini-Incision Technique for Carpal Tunnel Decompression.

BackgroundThe purpose of this study was to present the clinical results of our retrospective series of carpal tunnel release (CTR) operations. For these operations we used a unique type of incision, for the first time, for treatment of carpal tunnel syndrome (CTS) consisting of a 1-cm semi-vertical (SV) incision made into the wrist crease for macroscopic open CTR.Material/MethodsThis retrospective study included 114 patients (101 females and 13 males) with CTR who were operated upon in our neurosurgery clinic between December 2010 and June 2015. Patient ages ranged from 35 to 83 years (mean 55.05±12.04 years). In total, 127 hands (73 right and 54 left) were operated upon using the SV skin incision technique. After an average follow-up of 18 months (ranging from 6 to 30 months), clinical and electrophysiological (EP) evaluations were performed.ResultsA review of the English language literature published since 1957, when Phalen first popularised the diagnosis and treatment of this disease, determined that no previous reports of the mini-open incision technique as described in our study have been published. In our retrospective patient case review, we found that after operations using the SV incision technique, statistically significant differences were detected in electromyography (EMG) improvements (p<0.01). In addition, patients who showed improvement in EMG studies (n=90) were satisfied with the result of their surgery.ConclusionsOur study demonstrated that 1-cm skin SV incision was a cosmetically satisfying, fast, and safe approach to CTR that was not only clinically effective but also electrophysiologically effective.

Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction

ObjectiveTo compare the incidence of peri-incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction. MethodsThirty-three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2–14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale. ResultsThe total rate of dysesthesia was 42% (14 patients). Five patients (26%) on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients). On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%). No statistical differences between both groups were observed regarding patients’ weight, age, and height¸ as well as skin incision length. ConclusionPatients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri-incisional dysesthesia when compared with those in whom the vertical access technique was used.

Relação da disestesia peri‐incisional com os acessos vertical e oblíquo na retirada dos tendões flexores na reconstrução do ligamento cruzado anterior do joelho

ObjectiveTo compare the incidence of peri‐incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction. MethodsThirty‐three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2‐ 14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale. ResultsThe total rate of dysesthesia was 42% (14 patients). Five patients (26%) on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients). On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%). No statistical differences between both groups were observed regarding patients’ weight, age, and height¸ as well as skin incision length. ConclusionPatients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri‐incisional dysesthesia when compared with those in whom the vertical access technique was used.

Comparison of Minimal Skin Incision Technique in Living Kidney Transplantation and Conventional Kidney Transplantation

Background:Recently, the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the “hockey-stick.” However, demands for minimally invasive surgery in KT are increasing as in other various fields of surgery. Hence, we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT).Methods:Between June 2006 and March 2013, a total of 452 living kidney transplant patients were enrolled. The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation. The CKT group included 435 patients. The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed. We compared the baseline clinical characteristics and postoperative results between two groups. For proper comparison, propensity score matching was implemented.Results:There was no difference in graft function, survival, and postoperative complication rate between MIKT and CKT groups (all P > 0.05). The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups, respectively (P = 0.786).Conclusions:Our results indicated that MIKT showed more favorable cosmetic results, and there were no statistical differences in various postoperative factors including graft function, survival, and complications compared with CKT. Hence, we suggested that MIKT is an appropriate method for selected patients in living KT.

A Faster and Wider Skin Incision Technique for Decompressive Craniectomy: n-Shaped Incision for Decompressive Craniectomy.

ObjectiveDecompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety.MethodsIn the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery.ResultsThe decompressed area of craniectomy (389.1 cm2 vs. 318.7 cm2, p=0.041) and the protruded brain volume (151.8 cm3 vs. 116.2 cm3, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339).ConclusionDC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.

Neck Incision Planning for Total Laryngectomy with Pharyngectomy.

To investigate the effect of skin incision location for total laryngectomy with pharyngectomy (TLP) on postoperative outcomes including wound dehiscence and infection rate. Case series with chart review. Academic tertiary care center. A retrospective analysis was conducted of all patients undergoing TLP with flap closure at Johns Hopkins Medical Institutes between August 2005 and February 2013. The effects of patient characteristics and skin incision technique on postoperative wound dehiscence and infection were analyzed using cross-tabulations and multivariate regression modeling. A total of 49 patients were included in the analysis; 31 received low-neck apron (LNA) incisions with an incorporated tracheostoma, while the remaining 18 had mid-neck apron (MNA) incisions with separate tracheostoma fashioned inferior to their incisions. Of these patients, 17 experienced incisional wound dehiscence (35%), and 18 contracted postoperative infections (37%). Generalized linear regression models demonstrated a significantly increased odds of wound dehiscence for patients with LNA incisions (odds ratio 29.8; 95% CI, 1.4-631.5, P = .029). There were no significant predictive variables for postoperative infection. These results demonstrate that the use of a separately fashioned tracheostoma with MNA incision is associated with decreased rate of wound dehiscence in patients undergoing TLP.

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal artery Aneurysms with Unilateral Frontopterionel Skin Incision Technique

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal artery Aneurysms with Unilateral Frontopterionel Skin Incision Technique