Standard Incision Research Articles

Superficial temporal artery injury and delayed post-cranioplasty infection

ObjectiveComplications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication. MethodsA retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups. ResultsFifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26). ConclusionsThere is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh.

The management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients. A retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence. A majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm 2 ). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group ( P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate ( P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications. In complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.

A Comparison Between Comma Incision and Ward's Incision in Third Molar Extraction in Terms of Postoperative Sequel.

Aim We aim to look at the differences between the standard Ward's incision and the comma-shaped incision and how they affect complications after surgery to remove an impacted mandibular third molar. Materials and methods Mandibular third molars had to be carefully extracted from a total of 40 patients who were randomly divided into two groups of 20 patients each. At first, patients were evaluated before surgery. In group A, a standard Ward's incision was made, and in group B, a comma incision was made to match the mucoperiosteal fold. Afterward, the impacted third molars were carefully removed. The evaluation criteria for pain, swelling, lockjaw, and healing of wounds were done before surgery, after three hours, and on the first, third, and seventh dayafter surgery. Result The pain scores that were recorded right after surgery, three hours later, and on days 1, 3, and 7 in the surgical area with comma-shaped incision were all lower than the pain scores that were recorded in the area where standard incisions were made. Enlarging was less with comma entry point than with standard Ward's incision. After surgery, there was a big difference between the two entry points in how the mouth opened and how the wounds were fixed. These findings showed that the comma incisionis better than the standard Ward's incision when it comes to pain, enlargement, lockjaw, and healing of wounds. Conclusion The study results showed that the comma-shaped incision was better than the traditional method (Ward's incision) because there were fewer problems after surgery.

Outcomes of the facelift incisional approach to neck dissection without endoscopic or robotic assistance

<h2>Abstract</h2><h3>Objective</h3> : The facelift incisional approach to neck dissection offers several advantages including improved cosmesis, increased patient satisfaction, and decreased morbidity. This approach has been previously described using robotic or endoscopic instrumentation, but the clinical outcomes of this approach using standard instrumentation have not been reported. The objective of this study was to determine if the facelift incisional approach to neck dissection can be performed without endoscopic or robotic assistance and achieve improved oncologic and cosmetic outcomes. <h3>Study Design</h3> : Retrospective cohort study over 4 years. <h3>Setting</h3> : A national comprehensive cancer center. <h3>Methods</h3> <b>:</b> 104 subjects received 113 oncologic neck dissections, of which 35 were performed using a facelift approach. Primary outcomes included rate of negative margins, recurrence, incidence of nerve weakness, and incidence of lymphedema. <h3>Results</h3> : The mean age of the cohort was 60.1 ± 12.7 years and 72.6% were male. Mean follow up was 23.1 ± 19.1 months (p=0.21). 104 subjects (92.9%) had negative margins on final pathology, with no difference between approaches (88.2% vs 94.9% respectively, p=0.24). 34 subjects (97.1%) in the facelift group had no evidence of disease at study conclusion. There was no difference in marginal mandibular nerve weakness (p=0.10) nor shoulder weakness (p=0.59) between groups. There was no difference between post-operative lymphedema (38.2% vs 29.2% for the facelift vs standard incision groups, p=0.35). <h3>Conclusion</h3> : A facelift approach to neck dissection using standard instrumentation without robotic or endoscopic assistance achieves acceptable clinical and oncologic outcomes compared to the standard incisional approach with an additional benefit of improved cosmesis.

Minimally invasive aortic valve neocuspidization using autologous pericardium – first experience

Highlights. Conducting minimally invasive aortic valve neocuspidization using autologous pericardium is a difficult task due to pericardial harvesting. Thoracoscopic harvesting of the pericardium provides a pericardial patch of sufficient size under visual control. Thus, thoracoscopic pericardial harvesting can transfer all advantages of minimally invasive cardiac surgery to aortic valve neocuspidization using autologous pericardium.Abstract. Minimally invasive aortic valve (AV) replacement is associated with a decrease in the traumatic nature of the procedure, the length of hospital stay, severity of pain, and provides faster rehabilitation and better cosmetic look compared to the gold standard incision in cardiac surgery –median sternotomy. AV neocuspidization using autologous pericardium is safe, associated with excellent hemodynamic parameters in short- and medium-term follow up. However, this technique requires a large pericardial patch to later form new leaflets, thus complicating the use of minimally invasive approach with this type of intervention. We have addressed this issue by introducing thoracoscopic pericardial harvesting. We report two successful cases of minimally invasive AV neocuspidization using autologous pericardium harvested through a thoracoscopic approach with peripheral cardiopulmonary bypass.

Esthetic concerns in the planning of parotidectomy incisions

Background Surgeons have utilized the traditional Blair’s incision (or a variation of it) to conduct parotidectomy. A variety of esthetic deformities, including hollowed-out preauricular and infra-auricular abnormalities and visible scars, can arise. The Appiani and Delfino standard facelift incision was then changed to facilitate exposure of parotid gland lesions, which ranged in size from minor to moderate. Patients and methods A total of 50 consecutive patients who were scheduled for parotidectomy due to benign disease were included in this research. Included were patients with benign parotid illness recommended for either a superficial or complete conservative parotidectomy. Using the closed envelope procedure, all eligible patients were randomly divided into two groups: group A and group B (25 each). For a total of 3 months, the patients were monitored weekly for the first 4 weeks and then every 2 weeks to identify any early and late postoperative problems. Results In group A, the mean age was 42.6±8.65 years, while in group B, it was 44±10.1 years (P=0.126). In group A, the mean operating time was 140±18.8, but in group B, it was 164±26.9 (P=0.089). There was no discernible statistical difference between the two groups in terms of postoperative discomfort, operational hematoma, hospital stay, facial nerve palsy, or hypertrophic scars. Patients in group B were substantially happier with their esthetic results than those in group A (P=0.05). Conclusion It is safe to do the parotidectomy using the modified facelift incision and it allows good exposure of the parotid gland comparable to the conventional Blair’s incision. It provides a significantly better cosmetic outcome.

Surgical Technique of Direct Anterior Approach for Primary Total Hip Arthroplasty Using a Leg Positioning Traction System.

Through the use of a natural intramuscular and internervous interval, the direct anterior approach (DAA) for total hip arthroplasty (THA) has been suggested to have several advantages over other popular arthroplasty approaches. The usage of DAA for THA has considerably grown in the West in recent years due to the emphasis on tissue preservation and minimally invasive joint replacements. However, due to the long learning curve, literature on this approach originating from India has been inadequate, suggesting a limited adoption of this surgical technique by the Indian diaspora of practicing surgeons. The DAA for THA is reliable and suitable to all conventional primary and revision THA cases. In the surgical procedure, the patient is positioned supine on the standard operating room (OR) table with the legs positioned in the Leg Positioning Traction System. The OR table may rotate, which enables the surgeon to perform the surgery more conveniently as it covers the majority of the patient's center of gravity. The incision is made over the tensor fascia lata. After femoral neck osteotomy, the head is removed, and traction is applied to the operative leg followed by acetabular cup insertion. The femoral stem is inserted after releasing soft tissues around the proximal femur using the leg positioning traction system. Using traction, flexion, and internal rotation, the femoral head is pushed into the acetabulum at the same time, and reduction is achieved. DAA for THA technique offers patients the advantage of minimally invasive surgery compared to other approaches. Many authors have published their experiences and technical keys to successfully completing this procedure, and several variations of the procedure have been described. The approach described is implemented utilizing specifically developed instruments, including a specialized table and intraoperative fluoroscopy while employing the standard surgical incision. This article attempts to outline the authors' technique for performing the DAA in the supine position for a primary THA using a Leg Positioning Traction System, with a focus on technical details in assisting an early DAA convert in making a safe transition.

A PROSPECTIVE COMPARATIVESTUDY OF OPEN VERSUS LAPAROSCOPIC APPENDECTOMY: A SINGLE UNIT STUDY

Introduction: Acute appendicitis is the most common general surgical emergency. Appendicectomy is the treatment of choice for acute appendicitis and the most commonly performed emergency abdominal operation. Open appendectomy is found safe and effective operation with low morbidity but found to be associated with post operative pain, wound infection and complications like intestinal obstruction which may delay recovery. Laparoscopic appendectomy emerged as a good option for treatment of appendicitis. The purpose of this study was to compare the laparoscopic versus open approach among patients with appendicitis in our centre. Materials And Methods: This study was a prospective study of 100 patients with clinically diagnosed as appendicitis admitted in the department of General Surgery, Unit II, Zoram Medical College for a period of two years during November 2019 to October 2021. They were divided into two groups - Open Appendectomy (OA) group and Laparoscopic Appendectomy (LA) group of 50 patients each. Age ranges from 10yrs to 75yrs. Exclusion criteria were pregnant female, chronic medical problems, haemodynamically unstable or psychiatric illness, cirrhosis, coagulation disorders, patients on steroid, immuno-compromised patients, patients on chemotherapy for malignancy and those who are not willing to participate. OA was performed through standard Mc Burney incision. LA was performed through a standard 3 ports technique. Results: The most common presentation of appendicitis is abdominal pain followed by nausea/vomiting and common in younger age group of 10-20 years. Laparoscopic Appendectomy was found as safe and effective as Open Appendectomy. LA has more acceptable cosmetic result, shorter hospital stay and less postoperative pain. The pain score was significantly reduced in LA group (3.2+-1.4) and in OA (4.1+-1.8). Conclusion: LA was found as safe and effective as OA. LA has more acceptable cosmetic result, shorter hospital stay and less postoperative pain.

Minimally-Invasive Radical Nephrectomy and Left-Sided Level II Caval Thrombectomy: A New Combined Technique

To present a combined multiport robotic and open approach for left radical nephrectomy and inferior vena cava thrombectomy in patients with a primary left renal mass and level II inferior vena cava (IVC) tumor thrombus. A 69-year-old female was diagnosed with an 8.9cm left renal neoplasm with level II IVC thrombus. She was placed in the left-side-up flank position. The descending colon was mobilized and the left gonadal vein was identified. The left renal vein was identified and fully dissected. The left renal artery was dissected and stapled. The kidney was dissected and left detached with exception of the renal vein. The robot was undocked and the patient was positioned supine. Through a supra-umbilical midline incision, the ascending colon and duodenum were mobilized medially. The right renal vein and IVC were identified and dissected to the level of hepatic veins. The IVC was clamped using a Satinsky clamp. The right renal artery and vein remained patent during thrombectomy. The IVC was opened, the thrombus was evacuated, and IVC was closed. Clamps were removed and the kidney was removed. Operative time was 405 minutes. IVC clamp time was 14 minutes. Estimated blood loss was 500cc. Recovery was uncomplicated. Length of stay was 4 days. Pathology showed clear cell carcinoma with negative margins. IVC thrombectomy is challenging on left sided tumors. Combining a robotic and open technique together is feasible and allows a smaller supra-umbilical midline incision compared to standard open incision.

Retrospective study of the temporal approach in cataract surgery at Evangelical Church Winning All Hospital

Background: According to the World Health Organization, cataracts are one of the leading causes of visual impairment. On a global scale, at least 2.2 billion people have near or distance vision impairment, with cataracts accounting for 94 million of these cases. This poses a significant health risk.Aim: The purpose of this study was to determine the indications for temporal approach cataract surgery, as well as the effects of surgically induced astigmatism on the temporal approach in cataract surgeries performed at the Evangelical Church Winning All (ECWA) Eye Hospital in Kano, Nigeria.Setting: Temporal approach in cataract surgery at Evangelical Church Winning All (ECWA) Kano: indications and surgically induced astigmatism.Methods: A retrospective study of patients who underwent cataract surgery at ECWA Eye Hospital, Kano, a tertiary specialist eye care centre, between January 2019 and December 2020. The patients underwent standard manual small incision cataract surgery on the temporal side of the eye. Biodata, previous ocular surgery, type and time of last ocular surgery, pre-operative and postoperative astigmatism, indications for temporal approach, immediate surgical complications and postoperative visual acuity were extracted from the patients’ clinical notes.Results: There were 63 eyes from 44 patients who had temporal approach manual small incision cataract surgery. Thirty (68.2%) of the 44 patients were male, while 14 (31.8%) were female. Cataracts were most common between the ages of 61 and 70 years, and most of the patients (n = 61, 96.8%) required temporal surgery. Astigmatism caused by surgery was minimal. The visual outcome was good, with a postoperative visual acuity of 6/18 – 6/60.Conclusion: Post-trabeculectomy cataract was the major indication for temporal approach cataract surgeries in the patients. The procedure was both safe and effective, resulting in improved visual outcomes.Contribution: Temporal approach manual small incision cataract surgery (MSICS) was indicated mainly after trabeculectomy. The technique is safe, and patients had better visual outcomes.

Customized incision cataract surgery: Astigmatism modulation techniques in manual small-incision cataract surgery.

Advanced instrumentation and intraocular lenses (IOL) allow great refractive and visual outcome control to permit excellent correction of refractive aberrations. Residual astigmatism can be modified to provide depth of focus using an appropriate incision in the steepest meridian in manual small-incision cataract surgery (MSICS). The authors describe the nomogram for surgically correcting astigmatism (SCA). This technique can handle preoperative astigmatism of about 2.25 DCyl with the standard incisions-straight incision of 5, 6, and 7 mm in length, the minimally curved frown incision, the frown incision, the frown incision with an accentuated frown, and the U incision placed on the steep axis in the superior or the temporal quadrant depending on the axis of pre-operative astigmatism.

Tarsometatarsal Joint Preparation using a Modified Dorsal Approach vs Standard Approach: A Cadaver Study

Category: Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries are a relatively common midfoot injury involving the tarsometatarsal (TMT) joint. Surgical fixation typically involves open reduction with internal fixation or primary arthrodesis of the joint(s). The standard surgical approach to the TMT joint involves two dorsal incisions however, a recent study has suggested the use of a modified single dorsal incision approach. The goal of this paper is to compare the total surface area of the joint that can be prepared for primary arthrodesis of the TMT using the standard vs modified single dorsal approach. Methods: Ten fresh frozen below-the-knee cadaver specimens were randomly assigned to receive either the standard or modified dorsal single incision operative approach to the TMT joint. Prior to initiating the study, specimens were inspected with fluoroscopic radiographs for preexisting pathology or prior surgical intervention. The joint surface was visualized and then underwent articular preparation as for a joint fusion. After adequate joint preparation, the TMT joint was disarticulated and the surface was photographed for image analysis. Using ImageJ, articular joint surface preparation areas were measured by two blinded reviewers. to assess the joint surface preparation and this was compared by surgical approach. Results: After ImageJ and Mann-Whitney U statistical analysis, there was no significant difference in the amount of joint prepared when comparing the standard versus modified dorsal approach for the first three TMT joints (p= 0.548, p=0.310, p= 0.548). The percentage of joint preparation utilizing the standard dorsal approach versus the modified dorsal approach for TMT joints one through three are as follows (percentages utilized are listed as the median value with its correlating range): First TMT- 67.6% (range 26%) by the standard approach versus 71.7% (range 9%) by the modified dorsal approach, second TMT- 67.9% (range 24%) versus 65.7% (range 12%), and third TMT- 65.9% (range 42%) versus 59.6% (range 24%). Table 1 summarizes our results between each operative approach. Conclusion: With our findings, we demonstrate that a modified single dorsal approach to the Lisfranc joint provided comparable joint preparation for primary arthrodesis as the standard dual incision approach. However, the modified dorsal approach may be beneficial in that it avoids creating a skin bridge which has potential for necrosis with the standard two incision approach. The authors believe the comparable joint preparation combined with its potential to alleviate soft tissue complications make the modified dorsal approach a viable surgical approach for a TMT arthrodesis.

Modified Mercedes Single Incision for Combined Liver Kidney Transplant: A Case Series Report

The traditional approach in combined liver-kidney transplantation involves 2 separate and sequential incisions. We describe a modification of the standard Mercedes incision that allows a single-incision operation while providing and maintaining adequate exposure to enable safe dual-allograft transplantation. Modification of the standard Mercedes incision includes bilateral, subcostal, muscle splitting incision 4 fingerbreadths below the rib edge with a midline, cephalad incision and inferior ± medial ipsilateral extension on the side of intended iliac fossa laterality for renovascular and ureteroneocystostomy anastomosis. Five consecutive patients (3 women/2 men; mean age, 49 years; median body mass index, 29.8 kg/m2) underwent combined liver-kidney transplantation for end-stage liver disease and progressive hepatorenal syndrome via a modified Mercedes single-incision approach (at a median Model for End-stage Liver Disease of 37) without an additional kidney transplant incision, extraperitoneal exposure, or addition of wound retractors. Two out of the 5 patients experienced postoperative wound complications, including 1 with delayed wound healing and 1 with superficial dehiscence. All patients have normal dual-allograft function at or beyond 6 months posttransplantation. The modified Mercedes single-incision technique is safe and feasible. Lowering the subcostal incisions with unilateral, inferomedial extension allows adequate visualization of the lower abdominopelvic area without compromising exposure of the upper abdomen for both renal and liver allograft implantation. Further studies are needed to prove the theoretical benefits of this technique.

Internal Spermatic Vein to Superficial Epigastric Vein Microsurgical Bypass in Varicocele Treatment.

Identification and preservation of testicular artery and lymphatic vessels during microsurgical varicocelectomy can be tedious if adhered encompassing venous network is encountered. A venous bypass from internal spermatic to saphenous or inferior epigastric vein, that have been described for varicocele treatment, may be used in such situations. This paper describes a simplified modification of the venous bypass technique that reroutes the testicular blood to the superficial epigastric vein, which can easily be found in the incisional wound. Surgical technique and anastomotic patency test are described, and indications and results are discussed. During 2020 and 2021, 32 adolescent patients underwent microsurgical varicocelectomy. In eight patients additional microsurgical testicular vein-superficial epigastric vein microvascular bypass was done. The indication for bypass was difficult identification of testicular artery and/or lymphatic vessels due to adhered venous plexus. Varicocele resolution was noted in all eight patients with clinical and/or semen analysis improvement. There were no complications or recurrences. Average length of procedure was 65 minutes. All patients were discharged within 24 hours and no antiplatelet or anticoagulant therapy was used. Testicular vein to superficial epigastric vein anastomosis is a useful and simplified venous bypass technique that reroutes the blood from the pampiniform plexus to the femoral vein. It can be done as an adjunct to microsurgical varicocelectomy in selected patients through a standard incision.

The formation of lateral conical defects after radical mastectomy in patients with breast cancer

Aim to find the main causes of the lateral conical defects formation in obese patients after radical mastectomy for breast cancer.&#x0D; Material and methods. We analysed prospectively 82 breast cancer patients with various degrees of obesity. The patients were randomized into two groups. In the main group (43 patients), the original RME method (RU patent No. 2748639, dated May 28, 2021) was used; in the control group (39 patients), the standard RME method was applied.&#x0D; Results. The use of a standard elliptical incision for RME in obese patients leads to the formation of lateral conical defects, the frequency of which reaches 74%. There is a high correlation between the frequency of formation of lateral conical defects in radical mastectomy with expansion of the breast base (Spearman index 0.85 (p0.05), chest circumference (Spearman index 0.92(p0.05), fat pedicle thickness (Spearman index 0.94 (p 0.05) and degree of mammoptosis (Spearman index 0.98 (p 0.05).

Prospective Comparative Analysis Study of Minimally Invasive Surgical Decompressions versus Traditional Surgical Decompression of Carpal Tunnel Syndrome

Objective: Carpal tunnel syndrome (CTS) occurs when there is compression on the median nerve within the carpal tunnel in the wrist joint. It commonly affects those who make frequent, repetitive hand movements, with women being more affected than men. The present study was aimed at comparing minimally invasive and classical surgical decompression techniques for carpal tunnel syndrome. Materials and Methods: One hundred and four patients with CTS who were scheduled for carpal tunnel decompression were chosen at random. The patients were divided into two groups. Group A had standard classical long incision decompression, whereas Group B had minimally invasive decompression. The patients were evaluated with the Boston Functional Score Scale. Between the two groups, a comparison of visit reports was made at 3, 6, and 12 months after surgery. Results: There was no significant difference in patient age (Group A was 38 years old and Group B was 36 years old) and availability of bilateral CTS status (A was 34 and B was 31). The female-male ratios in groups A and B were 3.6 to 0.2 and 3.1 to 0.3, respectively, with a p-value of p&lt;0.05 indicating significant difference. Comparing both groups, the minimally invasive decompression technique showed a high rate of functional hand grip and a low rate of complications including early wound healing, rapid resumption of palmar strength grip, and rapid return to daily activities. Conclusion: The findings indicate that patients who underwent the minimally invasive surgical decompression one-stitch technique showed significant improvement over the traditional method.

The Safety and Efficacy of the Anterior Approach Total Hip Arthroplasty as per Body Mass Index

BackgroundObesity is associated with component malpositioning and increased revision risk after total hip arthroplasty (THA). With anterior approaches (AAs) becoming increasingly popular, the goal of this study was to assess whether clinical outcome post-AA-THA is affected by body mass index (BMI). MethodsThis multicenter, multisurgeon, consecutive case series used a prospective database of 1,784 AA-THAs (1,597 patients) through bikini (n = 1,172) or standard (n = 612) incisions. Mean age was 63 years (range, 20-94 years) and there were 57.5% women, who had a mean follow-up of 2.7 years (range, 2.0-4.1 years). Patients were classified into the following BMI groups: normal (BMI < 25.0; n = 572); overweight (BMI: 25.0-29.9; n = 739); obese (BMI: 30.0-34.9; n = 330); and severely obese (BMI ≥ 35.0; n = 143). Outcomes evaluated included hip reconstruction (inclination/anteversion and leg-length, complications, and revision rates) and patient-reported outcomes including Oxford Hip Scores (OHS). ResultsMean postoperative leg-length difference was 2.0 mm (range: −17.5 to 39.0) with a mean cup inclination of 34.8° (range, 14.0-58.0°) and anteversion of 20.3° (range, 8.0-38.6°). Radiographic measurements were similar between BMI groups (P = .1-.7). Complication and revision rates were 2.5% and 1.7%, respectively. The most common complications were fracture (0.7%), periprosthetic joint infection (PJI) (0.5%), and dislocation (0.5%). There was no difference in dislocation (P = .885) or fracture rates (P = .588) between BMI groups. There was a higher rate of wound complications (1.8%; P = .053) and PJIs (2.1%; P = .029) among obese and severely obese patients. Wound complications were less common among obese patients with the ‘bikini’ incision (odds ratio 2.7). Preoperative OHS was worse among the severely obese (P < .001), which showed similar improvements (Change in OHS; P = .144). ConclusionAA-THA is a credible option for obese patients, with low dislocation or fracture risk and excellent ability to reconstruct the hip, leading to comparable functional improvements among BMI groups. Obese patients have a higher risk of PJIs. Bikini incision for AA-THA can help minimize the risk of wound complications.

The dawn of surgical treatment of aortic insufficiency.

The dawn of surgical treatment of aortic insufficiency.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature.

Background: Decompressive craniectomy (DC) is a lifesaving procedure, relieving intracranial hypertension. Conventionally, DCs are performed by a reverse question mark (RQM) incision. However, the use of the L. G. Kempe’s (LGK) incision has increased in the last decade. We aim to describe the surgical nuances of the LGK and the standard RQM incisions to treat patients with severe traumatic brain injury (TBI), intracranial hemorrhage (ICH), empyema, and malignant ischemic stroke. Furthermore, to describe, surgical limitations, wound healing, and neurological outcomes related to each technique.Methods: To describe a prospective acquired, case series including patients who underwent a DC using either an RQM or an LGK incision in our institution between 2019 and 2020.Results: A total of 27 patients underwent DC. Of those, ten patients were enrolled. The mean age was 42.1 years (26–71), and 60% were male. Five patients underwent DC using a large RQM incision; three had severe TBI, one ICH, and one ischemic stroke. The other five patients underwent DC using an LGK incision (one ICH, one subdural empyema, and one ischemic stroke). About 50% of patients presented severe headaches associated with vomiting, and six presented altered mental status (drowsy or stuporous). Motor deficits were present in four cases. In patients with ischemic or hemorrhagic stroke, symptoms were directly related to the stroke location. Hospital stays varied between 13 and 22 days. No readmissions were recorded, and no fatal outcome was documented during the follow-up.Conclusion: The utility of the LGK incision is comparable with the classic RQM incision to treat acute brain injuries, where an urgent decompression must be performed. Some of these cases include malignant ischemic strokes, ICH, and empyema. No differences were observed between both techniques in terms of prevention of scalp necrosis and general cosmetic outcomes.