Small Scar Research Articles

The correlation between left atrium voltage mapping and 3D late gadolinium enhancement cardiac magnetic resonance imaging findings in naive AF ablation candidate

Abstract Introduction The extent of the efficacy of late gadolinium enhancement cardiac MR (LGE-CMR) in depicting left atrial (LA) fibrosis in atrial fibrillation (AF) patients, compared to invasive Electroanatomical Mapping (EAM), is ongoing research field, while the highest degree of accuracy found when using ADAS program. Earlier studies focused mainly on post-ablation patients, employing segmentation (quality) and point-by-point (PBP) comparison methods. The non-invasive LGE-CMR-based fibrosis map shows promise for preprocedural planning and real-time guidance. Aim Evaluate LGE-CMR-based LA fibrosis precision in ablation-naïve AF patients using ADAS software, comparing it to the gold standard EAM using CARTO-3, in both qualitative and quantitative methods. Methods Patients planned for first CARTO-based AF ablation, undergoing pre-ablation LGE-CMR. 3D substrate atrial maps were generated via ADAS based on LGE-CMR (CMR-fib) and via CARTO as EAM. Normal range LA voltage was defined by Image Intensity Ratio of 1.2-1.32 on ADAS and by 0.2-0.5mV on Carto. Comparison methods, qualitative segmentation and PBP quantitative, with EAM serving as the gold standard. Results 24 naive patients included in the study (mean age 63.5 ± 10.9 yrs; 7 females, 15 paroxysmal AF, 17 maps during sinus). Segmental qualitative analysis (384 segments) showed 77% scarred segments, predominantly small scars (up to ⅓ segment). Compared with EAM, the CMR had 68.4% agreement, with 80.4% sensitivity, 78% PPV, 36.6% specificity, 32.6% NPV , kappa 0.139 AUC 0.567. Better agreement was found for dense scar. PBP quantitative comparison (41,345 points) demonstrated 50% scarred points, with 89% accuracy between EAM and CMR, with 49.6% sensitivity, 99.7% specificity, 99.5% PPV, and 73.5% NPV kappa 0.53, AUC 0.747. In both methods, agreement was worse for LA roof and best for AP and septal wall. Conclusion LGE-CMR tends to underestimate scar presence in naive patients compared to EAM, potentially due to baseline voltage scars, which are less dense compared to iatrogenic scar, the voltage criteria for scar in literature. Sensitivity is higher in segmental comparison, while specificity is superior in PBP, consistent with expectations of minimizing the size of comparison (from a segment to point). Hence, qualitative segmental method is better when assessing overall scarring, while PBP for assessing smaller specific areas. PBP comparisons exhibit less bias than segmental comparisons, which are overly sensitive to small scars. The diminished reliability of the LA roof is probably due to the margin of the CMR scan. Our study result regarding low sensitivity and high specificity of PBP aligns with a prior study investigating naïve patients through PBP comparisons, highlighting the need for a larger-scale study to assess LGE-CMR accuracy, considering various wall thicknesses and establishing scar thresholds on ADAS and CARTO software, for ablation-naïve patients with LA body scars.PBP projection on LA bodyAUC for PBP comprasion

Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study.

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.

Size-frequency distribution of submarine mass movements on the Palomares continental slope (W Mediterranean)

In this work, over 3620 km2 from the Palomares continental slope, which is located in the W. Mediterranean Sea, was analysed to quantify the impact of recent mass movements on this margin. A total of 936 landslides were identified, mapped and characterised by defining several morphometric variables that outline the accumulated impact of landslides equivalent to 918 km2 and 10.34 km3 of eroded sediment on the continental slope. The smallest event area was 0.0014 km2, whereas the largest event area was 32.48 km2. Smaller scars with a higher headwall gradient tend to dominate when the environment is steeper, and major mass movements are located on open slopes and structural highs. However, the slight or null correlations between variables indicate that a wide range of sizes may occur on any slope gradient and at any depth.The Palomares continental slope is intensively affected by mass movements. Compared with other passive margins (e.g., the U.S. Atlantic continental margin), landslides mobilised a limited amount of sediment, although it is comparable to other Mediterranean areas where small- to moderate-sized events are characteristic.The cumulative size distribution can be defined by a power-law function that describes events larger than 0.7 km2 with an exponent of α = 1.269. These results are consistent with those of other published inventories, including onshore cases. This result allows us to assume that the scale-invariant properties of the events are mapped. Scale-invariant properties can be explained by different models; self-organised criticality (SOC) is probably the most assumed by the scientific community, although alternative models may be nominated. Each model has important implications in terms of the landslide distribution and long-term landslide history of any slope. Alternative scenarios, such as submarine slopes, with more precise landslide inventories may contribute to new hazard assessment models that consider scaling exponents derived from size–frequency distributions.

A Current Perspective on the Effects of Flavonoids in the Treatment of Acne

Abstract: Pimples, blackheads, whiteheads, etc., are common types of acne that pop up on the skin each time, whenever dead cells and oils obstruct the outgrowth of hair from the hair follicle. It is very common to observe this condition in teenagers, but regardless of age, if the causing condition is met, acne can occur at any point in life. The characteristic feature of all types of acne is it starts with inflammation of the skin. These inflammatory marks (like black spots, pores, small scars, etc.) leave behind even when acne disappears. Plants like vegetables and flowers are naturally rich in different types of polyphenolic compounds called flavonoids. These flavonoids have various key functions, from guiding cell movement to maintaining oxidative pressure in the body. In this study, we discuss six types of flavonoids that have the potential to be used as med-icine for the treatment of different kinds of skin breakouts. Moreover, the result of molecular docking of different proteins that have an association with acne is also discussed.

ADVANCES AND CHALLENGES IN MINIMALLY INVASIVE SURGERY FOR THE TREATMENT OF HERNIAS

Minimally invasive surgery has revolutionized the treatment of various medical conditions, offering significant benefits in terms of recovery and fewer complications. In the field of hernia surgery, technological advances and innovative techniques have provided a less invasive approach that minimizes pain, reduces recovery time and improves aesthetic results. However, despite notable advances, there are still challenges and limitations that need to be addressed in order to optimize results and expand the use of these techniques. This summary examines the main advances in minimally invasive surgery for the treatment of hernias and discusses the challenges that remain in this field. The aim of this paper is to review recent advances in minimally invasive surgery for the treatment of hernias, highlighting technological innovations, improved techniques and clinical benefits. It also aims to identify the challenges and limitations associated with these techniques, providing a comprehensive overview of the positive and negative aspects of minimally invasive surgery in current clinical practice. This is a bibliographic review, using qualitative and quantitative assumptions, using the PubMed, Scopus and Web of Science databases. The health descriptors “Abdominal Hernia”, “Minimally Invasive Surgery”, “Hernia Repair”, “Hernia Mesh” and “Technological Advances” were used to refine the research. The time frame covers the years 2015 to 2021. Advances in minimally invasive hernia surgery have been driven by the development of advanced technologies such as laparoscopy and robotics. Laparoscopy, which uses small incisions and a camera to guide the surgery, has established itself as the standard technique for treating inguinal and umbilical hernias. This approach offers several advantages over traditional open surgery, including less post-operative pain, a lower risk of infection, reduced hospitalization time and a faster recovery. Laparoscopy allows the surgeon to accurately visualize and repair the hernia, while the small incisions result in smaller scars and a better aesthetic appearance. Recently, robotic surgery has emerged as a significant innovation in the field of minimally invasive surgery. Robotic systems offer a three-dimensional view and greater precision during the operation, allowing for more delicate and complex maneuvers. This technology is particularly useful in cases of complex or recurrent hernias, where precision and control are critical. Studies have shown that robotic surgery can further reduce post-operative pain and recovery time, although the high cost and need for specialized training are challenges associated with this technology. However, the adoption and effectiveness of minimally invasive techniques for hernias face several challenges. One of the main challenges is the learning curve associated with new technologies. Laparoscopy and robotic surgery require advanced technical skills and extensive training, which can limit access to these techniques in some medical centers and regions. Furthermore, although minimally invasive surgery offers significant advantages, patient selection is crucial. Patients with very large hernias, additional complications or medical conditions that increase surgical risk may not benefit as much from these techniques. Another challenge is cost. The advanced technologies and equipment required for minimally invasive surgery are generally more expensive than traditional approaches. These costs can be a barrier to widespread adoption, especially in settings with limited budgets or where access to cutting-edge technologies is restricted. It is concluded that advances in minimally invasive surgery for the treatment of hernias have provided significant benefits, including less post-operative pain, faster recovery and better aesthetic results. Technologies such as laparoscopy and robotic surgery have revolutionized the surgical approach, offering new opportunities for treatment with less impact on the patient. However, challenges such as the learning curve, high cost and the need for careful patient selection need to be addressed in order to optimize practice and expand access to these techniques. As technology continues to evolve and more data becomes available, minimally invasive surgery is expected to become even more effective and affordable, offering continuous improvements in care and outcomes for hernia patients.

Full SMAS: Endoscopic-Assisted Full Facial Rejuvenation.

Every region of the face may bear the signs of aging. Treating isolated areas without adequate anatomical knowledge can lead to incomplete or artificial-looking results and decrease patient satisfaction. Here, we describe a technique for complete rejuvenation, coined the "Full SMAS" technique, by addressing the anatomical continuity of the SMAS-Platysma to the deep-plane suspension of the face. This study aims to evaluate the contribution of endoscopic techniques combined with traditional facelift and neck lift procedures. The evaluation is conducted on procedures treating from the frontal and temporal regions of the superior part of the face to its mid and lower parts, including the cervical region. The treatment of the three sub-SMAS layers of the face was performed using endoscopy for repositioning the frontal region and midface. This procedure involves frontal and zygomatic-masseter ligament release, open treatment of the lower subplatysmal section, and the complete release of the retaining ligaments of the face and approach to the jowl. One hundred sixty-one patients underwent the Full SMAS technique, leading to long-lasting results, low complication rates, and high patient satisfaction. The Full SMAS is a systematic technique that provides complete facial rejuvenation by combining an endoscopic approach for the temporal and midface regions with traditional open approaches for the lower face and neck. Treating the temporal and midface regions using minimally invasive techniques (endoscopy) reduces the possibility of permanent nerve injuries, provides smaller scars, and creates more natural, long-lasting results.

CITED4 gene therapy protects against maladaptive cardiac remodeling after ischemia/reperfusion injury in mice

Cardiac signaling pathways functionally important in the heart's response to exercise often protect the heart against pathological stress, potentially providing novel therapeutic targets. However, it is important to determine which of these pathways can be feasibly targeted invivo. Transgenic overexpression of exercise-induced CITED4 has been shown to protect against adverse remodeling after ischemia/reperfusion injury (IRI). Here we investigated whether somatic gene transfer of CITED4 in a clinically relevant time frame could promote recovery after IRI. Cardiac CITED4 gene delivery via intravenous AAV9 injections in wild type mice led to an approximately 3-fold increase in cardiac CITED4 expression. After 4weeks, CITED4-treated animals developed physiological cardiac hypertrophy without adverse remodeling. In IRI, delivery of AAV9-CITED4 after reperfusion resulted in a 6-fold increase in CITED4 expression 1week after surgery, as well as decreased apoptosis, fibrosis, and inflammatory markers, culminating in a smaller scar and improved cardiac function 8weeks after IRI, compared with control mice receiving AAV9-GFP. Somatic gene transfer of CITED4 induced a phenotype suggestive of physiological cardiac growth and mitigated adverse remodeling after ischemic injury. These studies support the feasibility of CITED4 gene therapy delivered in a clinically relevant time frame to mitigate adverse ventricular remodeling after ischemic injury.

Efficacy of Superselective Intra-arterial Recanalization of Embolized Arteries Resulting from Facial Hyaluronic Acid Injection.

Arterial embolism is a rare complication caused by hyaluronic acid (HA) injection. However, it is one of the most serious complications. Once it happens, the complication would have a great and long-term impact on patients. Intra-arterial recanalization has been reported for recovering the visual acuity in patients with visual loss caused by hyaluronic acid. There is little report about the benefits of superselective intra-arterial recanalization therapy for skin wounds caused by hyaluronic acid vascular embolization. Eight patients who had received the superselective intra-arterial recanalization therapy were retrospectively reviewed. Hyaluronidasewasinjected into the facialartery by superselective intra-arterial recanalization therapy, followed by symptomatic treatment. The facial artery recanalization was successfully performed and no interventional procedure-related adverse events happened. Arterial embolization accompanies by the interruption or reduction of blood supply, followed by ochrodermia, pain, numbness, swelling, yellowish white secreta and even necrosis on skin wound area. Early detection of skin blood supply disorders and early recovery of blood supply areverycritical to treatfacial artery embolization caused byHA. After superselective intra-arterial recanalization therapy, the blood supply to facial skin was restored and skin wounds recovered in all patients. Only 1 patient was left with small and superficial scars. Superselective intra-arterial recanalization therapy is an effective and safe methodthat can alleviateskin wounds caused by HA vascular embolization. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical application of middle descending colon-double lumen ostomy with distal stoma narrowing in the treatment of anorectal malformation

BackgroundAnorectal malformations (ARMs) are the most common congenital anomaly of the digestive tract. And colostomy should be performed as the first-stage procedure in neonates diagnosed with intermediate- or high-type ARMs. However, the most classic Pe˜na’s colostomy still has some disadvantages such as complicated operation procedure, susceptibility to infection, a greater possibility of postoperative incision dehiscence, difficulty of nursing and large surgical trauma and incision scarring when closing the stoma. We aimed to explore the effectiveness of middle descending colon-double lumen ostomy (MDCDLO) in the treatment of high and intermediate types of anorectal malformations.MethodsWe retrospectively reviewed the data of patients who underwent MDCDLO for high or intermediate types of ARMs between June 2016 and December 2021 in our hospital. The basic characteristics were recorded. All patients were followed up monthly to determine if any complication happen.ResultsThere were 17 boys and 6 girls diagnosed with high or intermediate types of ARMs in our hospital between June 2016 and December 2021. All 23 patients were cured without complications such as abdominal incision infection, stoma stenosis, incisional hernia, and urinary tract infection in the postoperative follow-up time of 6 months to 6 years except one case of proximal intestinal prolapse was restored under anesthesia.ConclusionMDCDLO offers the advantages of simplicity, efficiency, safety, mild trauma, and small scarring in the treatment of high and intermediate types of anorectal malformations.

Surgical Treatment of Keloid Scars on the Ear: The Usefulness of the Fillet Flap

Background: Keloid scars occur idiopathically, and the ear is a common site of keloid scar formation after ear-piercing. Management is always challenging because of the high likelihood of recurrence. When treating a large keloid scar, surgical debulking is inevitable. Among various surgical options, the fillet flap is useful for very large scars with broad stalks that cannot be removed by simple excision and primary closure.Methods: From April 2016 to June 2021, scar revision with a fillet flap was performed on 24 auricular keloid scars. The operation was performed to debulk the scar as much as possible, while retaining a thin envelope of scar tissue. The patients were observed for 1 year postoperatively. Oral tranilast (a transforming growth factor-β suppressor) was administered to reduce the risk of recurrence during follow-up. When recurrence was observed, triamcinolone was injected into the scar.Results: All 24 cases were successfully treated without major problems such as flap loss. The postoperative contour and volume of the scars were appropriate when recurrence did not occur. During the follow-up period, there were nine cases of keloid recurrence, and the mean number of triamcinolone injections was 2.7. One patient experienced a second recurrence 10 months after the first recurrence and needed two more injections.Conclusion: The fillet flap is an appropriate option for removing a large keloid scar with a broad stalk. Although it does not guarantee that recurrence will not take place, it provides a small and flat scar into which triamcinolone can be injected if the keloid scar recurs.

Strong and Tough Biofibers Designed by Dual Crosslinking for Sutures

AbstractHigh‐performance bio‐based fibers have unique advantages in biocompatibility for biomedical applications, such as sutures, hernia patches, and blood vessels. Herein, strong and tough biofibers based on regenerated silk fibroins (RSFs) are designed by a dual‐crosslinking strategy and prepared continuously in situ via a single‐channel microfluidic device. During the wet spinning process, covalent bonds between tyrosines are introduced by photo crosslinking and coordination interactions of Zn2+ ions with serines are built between RSFs, forming a dual‐crosslinked, and inter‐connected network and effectively improving the mechanical performances of RSF fibers. By optimizing the wet spinning parameters and applying an optimal post‐stretching treatment, dual‐crosslinked RSF fibers exhibit an excellent tensile strength of 891 MPa, a remarkable Young's modulus of 15.0 GPa, a large tensile strain of 20.1%, and an outstanding toughness of 114 MJ m−3, which are superior to other regenerated biofibers. In addition to the outstanding mechanical performances, dual‐crosslinked RSF fibers also possess excellent temperature adaptability, fatigue resistance, biocompatibility, and biodegradability, making them ideal candidates for biomedical applications. In vivo tests of dual‐crosslinked RSF fibers as sutures demonstrate a good wound healing performance with smaller scar and lower inflammation.

Application of Platelet-Rich Gel in Repairing Scalp Defects Combined with Skull Exposure: A Case Series Analysis

Abstract Clinical treatment of exposed skull injuries becomes extremely challenging. The current treatment methods for exposed skull injuries are mainly surgical treatments. However, these treatments are not suitable for elderly patients who cannot tolerate anaesthesia. This research aimed to assess the effectiveness of platelet-rich gel (PRG) as a non-surgical option for repairing exposed skull injuries. In this study, twelve patients who presented to our hospital with scalp defects between September 2018 and March 2022 were included. Patients were evaluated before and three days after treatment using the Visual Analog Scale (VAS) score, inflammatory markers, and topical skin temperature. Additionally, the length of the platelet-rich gel, number of dressing changes, wound-healing time, local scarring, and hair growth were recorded. The average wound area was 17.08 SD5.49 cm2. The platelet-rich gel exhibited a length of 3.09 SD0.09 cm and showed a significant increase in platelet concentration by a factor of 2.43 SD0.07. all 12 patients achieved complete healing, requiring average number of 8.3 SD2.0 dressing changes and resulting in an average wound healing time of 25.0 SD5.8 days. There were no statistically significant differences in the Visual Analog Scale scores, inflammatory markers, or topical skin temperatures before and after treatment. Follow-up assessments conducted 4–10 months after treatment revealed minimal local scars and sparse hair growth. The one-step preparation of platelet-rich gel in reconstructing scalp defects is a simple, safe, and effective non-surgical method. Its advantages include speedy preparation, painless treatment, and small local scars.

Laparoscopic-Assisted Scrotal Approach for the Treatment of Inguinal Cryptorchidism with Patent Processus Vaginalis: Clinical Efficacy Analysis.

Objective: This study aimed to compare the clinical outcomes of two surgical approaches, laparoscopic-assisted scrotal incision and conventional inguinal-scrotal incision, for treating cryptorchidism with unobliterated processus vaginalis. Methods: Clinical data from 60 pediatric patients with inguinal cryptorchidism who were admitted to our institution between January 2018 and January 2022 were retrospectively analyzed. Depending on the surgical technique used, the patients were split into two groups: the laparoscopic group (n = 30) underwent a laparoscopic-assisted scrotal incision, whereas the conventional group (n = 30) underwent a conventional inguinal-scrotal incision for testicular descent and fixation. The length of the procedure, intraoperative blood loss, and the typical hospital stay following the procedure were compared between the two groups. Also assessed was the frequency of postoperative complications including wound infection and hematoma development. Results: The laparoscopic group demonstrated a notably shortened average surgical duration compared with the traditional group, and this discrepancy held statistical significance (P = .017). Moreover, the laparoscopic approach resulted in a reduced volume of intraoperative blood loss, with a statistically significant distinction (P = .002), along with a decreased average length of hospital stay after surgery, also statistically significant (P = .009). Testicular retraction, atrophy, inguinal hernias, or hydrocele were not present in any group. Although the difference between the laparoscopic and open groups was not statistically significant (P > .05), the laparoscopic group saw a reduced frequency of scrotal hematoma. The frequency of wound infection was also decreased in the laparoscopic group compared with the open group, although there was no statistically significant difference (P > .05). Conclusion: The laparoscopic-assisted scrotal incision approach for testicular descent and fixation offers precise localization of cryptorchidism, reduced surgical trauma, shorter postoperative recovery time, and results in smaller scars with minimal tissue damage. The procedure showcases enhanced overall clinical effectiveness, fewer postoperative complications, heightened safety, and superior cosmetic outcomes.

Osteology of the axial skeleton of Aucasaurus garridoi: phylogenetic and paleobiological inferences.

Aucasaurus garridoi is an abelisaurid theropod from the Anacleto Formation (lower Campanian, Upper Cretaceous) of Patagonia, Argentina. The holotype of Aucasaurus garridoi includes cranial material, axial elements, and almost complete fore- and hind limbs. Here we present a detailed description of the axial skeleton of this taxon, along with some paleobiological and phylogenetic inferences. The presacral elements are somewhat fragmentary, although these show features shared with other abelisaurids. The caudal series, to date the most complete among brachyrostran abelisaurids, shows several autapomorphic features including the presence of pneumatic recesses on the dorsal surface of the anterior caudal neural arches, a tubercle lateral to the prezygapophysis of mid caudal vertebrae, a marked protuberance on the lateral rim of the transverse process of the caudal vertebrae, and the presence of a small ligamentous scar near the anterior edge of the dorsal surface in the anteriormost caudal transverse process. The detailed study of the axial skeleton of Aucasaurus garridoi has also allowed us to identify characters that could be useful for future studies attempting to resolve the internal phylogenetic relationships of Abelisauridae. Computed tomography scans of some caudal vertebrae show pneumatic traits in neural arches and centra, and thus the first reported case for an abelisaurid taxon. Moreover, some osteological correlates of soft tissues present in Aucasaurus and other abelisaurids, especially derived brachyrostrans, underscore a previously proposed increase in axial rigidity within Abelisauridae.

The Donut DIEP Flap: A Novel Scarless Technique.

Deep inferior epigastric perforator (DIEP) flap surgery is a common technique for breast reconstruction. However, the long and noticeable abdominal scarring is one of its greatest disadvantages. Here, we suggest a minimal scarring DIEP flap harvest with a novel abdominal design. The key to this method is to preserve more skin tissue with a circular design centered around the navel. Three circular incisions are made: (1) the smallest circle represents an incision around the umbilicus; (2) the middle circle with a radius of <3.5 cm indicates skin incision because the donut-like skin paddle between the small and middle circles is included in the flap; (3) the largest circle with a radius of >10 cm represents the extent of flap dissection that was done diagonally from the skin toward the Scarpa's fascia. Pedicle dissection is proceeded with the conventional method. For closure, a purse-string suture is performed with the umbilicus at its center leaving only a single small circular scar around the umbilicus as the final scar. Closure of the donor-site is possible with the patient in a supine or slightly flexed position due to less skin excision. LEVEL OF EVIDENCE: Therapeutic, V.

The Mini-Incision Technique Versus Conventional Open Approach for Carpal Tunnel Release: A Retrospective, Comparative Cohort Study.

Background and objective Open carpal tunnel release (OCTR) is the gold standard technique for treating carpal tunnel syndrome (CTS). While mini-incision carpal tunnel release (MCTR) has been introduced as an alternative approach, there have been some concerns over its effectiveness and risks. In light of this, the aim of the study was to compare the long-standing clinical outcomes after MCTR with those following OCTR. Methods We employed a retrospective cohort design for this study. Patients were classified into two surgery groups, followed up for two years, and compared in terms of the following variables: duration of symptoms; pinch strength; grip strength; 2-point discrimination; visual analog scale (VAS) score; Levine symptom score; Levine function score; quick disabilities of the arm, shoulder, and hand (QuickDASH) score; wound pain; and pillar pain. Results The study included data regarding 120 patients, 71.66% of whom were females. The MCTRand OCTRgroups were similar in terms of age, sex, duration of symptoms, and certain other aspects at baseline. The operation duration (15.15 ±2.20 vs. 25.01 ±2.15 minutes, p<0.01) and incision length (11.425 ±1.56vs. 20.35 ±2.43 mm, p<0.01) were significantly shorter in the MCTR group compared to the OCTR group. Wound pain and pillar pain were not documented in the MCTR group at three and six months. The OCTR group had pillar pain in 25% of the patients till two years postoperatively. Conclusion Based on our findings, we propose that MCTR is superior to OCTR. The mini-incision technique has the advantages of small incision and scar, low pain, and faster recovery. Moreover, the technique was also found to be safe with no major complications or recurrence of symptoms. Further randomized control trials may help to re-evaluate the technique andvalidate our findings.

Do Small Scars Lead to Better Results? Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Anchor-line Abdominoplasty Following Massive Weight Loss.

Do smaller scars lead to higher patient satisfaction? The aim of this study is to analyze long-term satisfaction of patients who underwent abdominoplasty after massive weight loss. Patients inclusion criteria: no previous abdominal remodeling procedures, previous bariatric surgery followed by a weight loss of at least 30 kg, weight stability for at least one year, good understanding of the Italian language and standardized pre- and postoperative photographs. We divided the population in 2 groups based on the surgical procedure: group 1, conventional abdominoplasty, and group 2, anchor-line abdominoplasty. All patients presented scars in the epigastric and mesogastric region resulting from previous laparoscopic or laparotomic bariatric surgery and/or other laparoscopic or laparotomic procedures. At least 2 years after surgery, we administered the Italian version of the post-operative BODY-Q module and the SCAR-Q questionnaire. We enrolled 20 males and 69 females aged between 25 and 55 years, with a mean follow-up of 2 years. Analyzing the questionnaires, it resulted that patients undergoing anchor-line abdominoplasty were significantly more satisfied in the body perception of the result (p = 0.035) and in the satisfaction with abdomen domain (p = 0.0015) compared to the conventional abdominoplasty group. Scars assessment with the SCAR-Q did not show any significant differences between the groups. Despite its long scars, the anchor-line pattern shows an overall higher satisfaction, due to the possibility of reducing the abdomen both cranio-caudally and circumferentially. These findings might be an important guide when approaching abdominoplasty in post-bariatric patients, debunking the myth "shorter is better". This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Kite Mastopexy: Small Scar and Tissue-conserving Technique.

Breasts are considered one of the most physically and sexually appealing features of the female body. Reduction/augmentation techniques have greatly evolved in the last decades.We are reporting our experience with an innovative technique for mastopexy that recovers the aesthetics of the breast and avoids over-resection of its lower pole. Inclusion criteria were women who underwent kite mastopexy with or without implants between January 2018 and May 2022 in a single center (Bogota, Colombia). Exclusion criteria were patients with American Society of Anesthesiology score more than II, with any uncontrolled chronic illness and/or medical history of diabetic mellitus, metabolic syndrome, body mass index more than 32 kg per m2, and active smokers. We found 133 consecutive female patients. Age range was 18 and 67 years (median 39). Breast implants were used for the purpose of kite mastopexy in 52% cases. Patients were divided into two groups: implants (group 1) versus no implants (group 2). Procedure 1 involved mastopexy without implants; procedure 2 included current implant users who underwent either implant removal or in whom implants were not used for the sake of mastopexy. Procedures 3 and 4 included patients who underwent either new implant placement or implant exchange, respectively. Average time of surgery was 1.5 hours. Minor complications were mostly related to wound dehiscence. No major complications were reported. Kite mastopexy restores the breast aesthetics by following specific markings, a new plication of breast pillars, and a reduced scar. Our technique demonstrates a very low rate of complications while entailing natural and appealing results.

Repair of ischial tuberosity pressure ulcer with a perigluteal muscle flap

Background: Pressure ulcers are caused by long-term pressure on tissues. Hip pressure ulcers are the most common type. Pressure ulcers in the buttocks are classified into three types: sacrococcygeal, ischial tuberosity, and femoral tuberosity. Methods: We used perigluteal muscle tissue flaps to treat nine cases of grade IV pressure ulcers from January 2016 to August 2018. A retrospective study was conducted on all patients who had an ischial tuberosity pressure ulcer repaired with a perigluteal muscle flap. The gluteus maximus myocutaneous flap was combined with the gluteal fasciocutaneous flap, the biceps femoris myocutaneous flap was combined with the gluteal fasciocutaneous flap, the gracilis myocutaneous flap, the biceps femoris myocutaneous flap, and the semitendinosus and semimembranosus myocutaneous flap. Wounds of different sizes and depths were encountered, the details of which are discussed in treatment methods. Data from patients, including age, gender, cause of injury, wound dimensions, the timing of flap coverage, and complications, were analyzed. Results: The appearance of the skin flap was complete after muscular tissue flap repair, with no visible scar hyperplasia. However, after six to 12 months of follow-up, the flap was soft and left a small linear scar. Conclusions: In the repair of an ischial tuberosity pressure ulcer, a peri gluteal muscle flap provides both aesthetic and functional results. Before using muscle tissue flap transplantation, it is recommended to perform multiple debridement + VSD to improve the wound foundation.

Robotic Surgery: A Comprehensive Review of the Literature and Current Trends.

Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery.Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.