Dissection Of Subcutaneous Tissue Research Articles

Peroperative Cooling in Rhinoplasty: Does it Differ?

The main causes of ecchymosis and edema are osteotomy (bone manipulation), dissection of subcutaneous tissue, and skin manipulation in the rhinoplasty procedure. Eyelid edema following surgery can potentially affect visual acuity, particularly during the initial twenty-four hours after the procedure. These may also delay the patient's return to their normal social life therefore hampering their quality of life. Various surgical and medical methods have been reported to address these issues. This study aimed to compare the effects of using cold saline (0-4°C) versus room temperature saline (20-25°C) irrigation throughout the surgery on postoperative edema, ecchymosis, and pain. Fifty patients who underwent open-approach primary rhinoplasty between August 2022 and August 2023 at a tertiary academic center were included. Fifty patients were randomly divided into two groups depending on using cold saline (0-4°C) (group 1) or room temperature saline (20-25°C) (group 2) during surgical site irrigation. Patients were assessed for pain, edema, and bruising using a VAS (Visual Analog Scale) on the second and seventh postoperative days. Visual analog score (VAS) was used for subjective outcome analyses. Each patient scored the severity of their periorbital ecchymosis on day two and seven. Periorbital ecchymosis was also evaluated on the second and seventh postoperative days using the SPREE (Surgeon Periorbital Rating of Edema and Ecchymosis) scale. On the second postoperative day, the VAS pain score in group 1, where cold water was used, was found to be statistically and significantly different from the control group (group 2) (p < 0.05). However, there was no statistically significant difference between both groups when comparing the VAS pain scores on the seventh postoperative day. Regarding the VAS ecchymosis score on the seventh postoperative day, there was a statistically significant difference favoring group 1 (p < 0.05). The SPREE scale data also indicated that group 1 had significantly lower scores on the seventh day (p < 0.05). While the SPREE scores on the second day were lower in group 1 than in group 2, this difference did not reach statistical significance (p = 0.061). The findings from our study show that cold saline irrigation may contribute to intraoperative hemostasis by inducing local vasoconstriction. We observed that intraoperative bleeding decreased with the use of cold saline. This approach has the potential to improve patient satisfaction and overall quality of life by reducing postoperative ecchymosis without significantly increasing the cost of the surgical procedure.Level of Evidence III 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 .

Needle-Arthroscopic Ankle Lateral Ligament Repair Using a Knotless Suture Anchor

Category:Arthroscopy; Ankle; Arthroscopy; SportsIntroduction/Purpose:Arthroscopic techniques have been increasingly used to repair the anterior talofibular ligament (ATFL) for lateral ankle instability, however there are still concerns on complications, such as nerve injury, iatrogenic cartilage damage and wound scar. Additionally, standard suture anchors can cause prominent knots. Recently, a novel needle-arthroscopic system (NanoScopeTM) has been introduced, with a 1.9-mm diameter arthroscope and semirigid frame, which can reduce conventional arthroscopic-related complications by minimizing the skin incisions and provide excellent visualization without ankle distraction due to its small and semirigid features. The purpose of this surgical technical note is to describe a new, very minimally invasive surgical technique for the ATFL repair using this needle-arthroscopy with a knotless suture anchor, which has the potential to reduce both conventional arthroscopic-related and knot-related complications.Methods:We have developed a novel surgical treatment of the ATFL repair for lateral ankle instability in a cadaveric model. The arthroscopic system (NanoScopeTM, Arthrex, Naples, FL) is used during the procedures. The handpiece tube is 9.5-cm long, semi-rigid and has a 1.9-mm outer diameter. The scope's direction of view is 0°, with a 120° field of view. The patient is placed in a supine position and no distraction is applied to the ankle joint. Standard anteromedial and anterolateral portals are first used. An accessory anterolateral (AAL) portal is then created around 1.5 cm anterior to the tip of the fibula, of which the portal position is determined under the visualization through the anterolateral portal.Results:Almost all of the talar and tibial surfaces are reachable without distraction, due to its small and semirigid features. There is no difficulty problem obtaining proper visualization of the ATFL and the surrounding structures during the whole procedures, due to a wide 120°-field of view. The major steps of the procedure are (1) suture anchor insertion into the distal fibula through the AAL portal using a Knotless SutureTak Anchor (Arthrex), (2) penetration of suture string into the ATFL remnant using a Micro SutureLassoTM (Arthrex), (3) capture of the ATFL remnant using a suture-relay technique, (4) reattachment of the ATFL remnant by pulling out the passing wire without knot-tying, in the dorsiflexed ankle position (Figure). All skin-incisions are tiny and require only paper skin closures. This method requires neither blunt dissection of subcutaneous tissue to pass the suture nor knot-tying to reattach the ATFL.Conclusion:Our technique is a simple, feasible, and very minimally invasive anatomic repair of the ATFL for lateral ankle instability using a 1.9-mm diameter needle-arthroscopy with a knotless suture anchor. However, the long-term clinical results need to be evaluated in future studies.

Abdominal Wound Problem after Hysterectomy using Scalpel Versus Electrocautery for Skin and Subcutaneous Dissection

Objective: To evaluate the postoperative abdominal wound problem after hysterectomy with scalpel versus electrocautery for skin and subcutaneous dissection. Material and Methods: A total of 516 post-menopausal women having age 40 to 65 years who were planned for elective hysterectomy were included in this study. Patients having only benign disorders were included. In group E (N=258); Skin incision and tissue dissection was done using electrocautery by setting the electrocautery machine at cutting mode at 30 to 50 watts’ power. In group S (N=258); conventional scalpel was used for skin incision. Scalpel number 23 was used for skin and subcutaneous tissue dissection. Post-operative wound complications such as seroma, hematoma, wound dehiscence and wound infections were primary study endpoints. Results: Mean age was 48.6±6.9 years in electrocautery and 49.2±6.3 years in scalpel group (p-value 0.30). Seroma formation was diagnosed in 98 (37.98%) patients in electrocautery group and in 52 (20.1%) patients in scalpel group (p-value &lt;0.0001). Wound infections were diagnosed in 50 (19.3%) patients in electrocautery group versus in 87 (33.7%) patients in scalpel group (p-value 0.0002). Hematoma was diagnosed in 10 (3.87%) patients in electrocautery group and in 19 (7.4%) in scalpel group (p-value 0.08). Conclusion: The use of electrocautery is associated with lower rate of post-operative wound infections and hematoma formation. The present study advocates the use of electrocautery for skin and subcutaneous tissue dissection in patients undergoing abdominal hysterectomy. Keywords: Abdominal hysterectomy, electrocautery, scalpel, wound complications.

Comparison of frequency of seroma formation in flap fixation versus conventional closure after modified radical mastectomy.

Seroma formation is a known complication after any surgery where excessive dissection of subcutaneous tissue leads to disruption of lymphatic channels. Seroma formation, its sequelae and frequent visits to doctor for their management are a common source of discomfort for patients. Objectives: Comparison of frequency of seroma formation after flap fixation versus convetional closure after modified radical mastectomy. Study Design: Randomized control trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 6 months from May 1, 2016 to October 31, 2016. Material &amp; Methods: After permission from Hospital ethics committee and informed consent from patients, 70 patients were randomly divided into two groups (35 participants in each group). Findings were noted and data was analyzed statistically. Results: It was observed that incidence of seroma formation following modified radical mastectomy was lower with flap fixation technique (14.29%) as compared to conventional closure of wound margins (42.86%). Conclusion: Flap fixation technique is better approach compared to conventional method to prevent seroma formation.

Analysis of Risk Factors Associated With Drooping Deformity After Lower Eyelid Reconstruction: A Newly Developed Drooping Index.

Lower eyelid reconstruction is challenging because of the risk of severe postreconstruction deformities of the lower eyelid, such as drooping, entropion, and ectropion. However, the risk factors for these postreconstruction deformities are unclear. The present study aimed to quantify the drooping deformity of the lower eyelid after reconstruction using a cheek rotation flap and to identify risk factors associated with postreconstruction deformities. Our study group included 28 patients who underwent full-thickness lower eyelid reconstruction using a cheek rotation flap for anterior lamella reconstruction. We developed the drooping index to classify postreconstruction outcomes as good (index <1.2), fair (index between 1.2 and 1.5), and poor (index >1.5). We identified risk factors for a drooping deformity using univariate analyses (Mann-Whitney U or Spearman rank correlation, depending on data distribution). Overall, the drooping index ranged between 1.0 and 2.11, with an average value of 1.3. A good outcome was obtained in 11, a fair outcome in 12, and a poor outcome in 5 patients. Clinically severe ectropion was observed in five of the 17 patients in the fair and poor outcome groups, with four of these patients requiring revision surgery. Risk factors for postreconstruction drooping deformity included medial location of the tumor, resection involving more than 50% of the horizontal width of the lower eyelid, and dissection of subcutaneous tissue of the cheek extending below the zygomatic arch. A cheek rotation flap provides satisfactory outcomes for full-thickness reconstruction of the lower eyelid. Extension of dissection of subcutaneous tissue of the cheek below the zygomatic arch increases the risk of postsurgical drooping deformity. Our drooping index provides a quantitative measure of drooping deformity and is clinically useful to classify outcomes.

Novel Technique for Sacral Alar-Iliac (S2AI) Fixation

To provide reasoning and steps for the placement of sacral alar-iliac (S2AI) screws for pelvic arthrodesis to aid osseous lumbosacral fusion. Studies support lower rates of screw breakage and need for revision surgery or hardware removal for S2AI screws compared with traditional iliac bolts, as well as low rates of pseudoarthrosis and arthritis associated with this hardware placement. A case video of S2AI placement demonstrates our operative technique and is accompanied by procedural description of surgical maneuvers. One patient underwent lumbosacral fusion surgery aided by S2AI-mediated pelvic fixation. The present technique utilizing S2AI screws provides for successful pelvic fixation to aid in lumbosacral fusion, with no need for subcutaneous tissue dissection and improved outcomes compared with traditional iliac bolts.

Robot-assisted radical perineal prostatectomy: first experience of 15 cases.

Minimally invasive techniques are increasingly evolving and preferred to reduce surgical induced morbidity and mortality and minimize the challenges of surgical techniques. Especially radical perineal prostatectomy (RPP) includes some challenges like working in a deep and narrow space and challenging ergonomics for the surgeons. Because of these issues open RPP is still performed in experienced centers. In order to reduce these difficulties, robot- assisted radical perineal prostatectomy (r-RPP) is developed. In this study, we report our first clinical results for r-RPP. Between November 2016 and February 2017, 15 patients underwent r-RPP in our center. Multiparametric magnetic resonance imaging was performed for all patients to exclude locally advanced disease. The patients with chronic obstructive pulmonary disease and locally advanced prostate cancer were not chosen for r-RPP method. The patient was positioned in the exaggerated lithotomy with 15 degrees of Trendelenburg position. After incision and dissection of subcutaneous tissue, dissection was advanced to the margin of posterior recto-urethral muscle fibers. Then a GelPOINT® device was placed and robotic system was docked. The mean age of the patients was 60.2±7.8 years. The mean body mass index of the patients was 28.8±1.9 kg/m2. Four patients had previous major abdominal surgeries. Preoperative mean prostate specific antigen value was 7.3±2.4 ng/mL. The mean prostate volume was 40.8±12.4 cc. Mean perineal dissection time was 60±10.1 minutes. Mean console time and total operation time was 95±11.3 and 167±37.4 minutes, respectively. The mean time of postoperative catheterization was 8.3±1.7 days. Early continence rate was 40% after urethral catheter removal and at 3rd month of the surgery mean continence rate was 94% for all patients. We demonstrate that r-RPP is a feasible and efficient method. But still this method needs for further studies in this area.

Minimum alveolar concentration of isoflurane in dogs administered two morphine doses

ABSTRACT: This study aimed to evaluate the effects of intramuscular 0.5mg kg-1 (MOR0.5) and 1.0mg kg-1 (MOR1.0) morphine premedication on the minimum alveolar concentration of isoflurane (ISOMAC) in dogs. Eighteen client-owned female dogs were scheduled for elective ovariohysterectomy. Dogs received intramuscular MOR0.5 or MOR1.0 as premedication and propofol IV for induction of anesthesia. Isoflurane was delivered for maintenance of anesthesia and dogs were maintained under normocapnia and normothermia. Determinations of the ISOMAC were conducted by use of the “up-and-down” method. Noxious stimulus (placement of Backhaus towel clamps, a midline skin incision and subcutaneous tissue dissection) was delivered approximately 50 minutes after premedication with MOR0.5 or MOR1.0. The calculated ISOMAC was 0.98±0.15% in MOR0.5 and 0.80±0.08% in MOR1.0. The ISOMAC was significantly lower in MOR1.0 compared with MOR0.5 (P=0.010). Results of this study suggested that intramuscular premedication with morphine 0.5 and 1.0mg kg-1 decreases the ISOMAC in a dose-related manner in dogs.

Tumescent Anesthesia in Skin- and Nipple-sparing Mastectomy: Results of a Prospective Clinical Study.

The tumescent mastectomy technique has been used to facilitate dissection of subcutaneous tissue and mammary gland in order to reduce intraoperative bleeding and speed the operation. A prospective clinical study was performed on 30 female patients undergoing immediate breast reconstructions after skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) in order to assess early postoperative complications, pain, and final esthetic outcome of skin flaps related to tumescent anesthesia (TA). TA significantly speeded-up the operative procedure (131±49.99 vs. 180.5±67.15 min; p=0.03) achieving less skin damage compared to patients who did not have TA (p=0.045); moreover, no significant difference occurred with regard to the length of in-hospital stay and overall lymphatic drainage. The length of the operation as well as the final cosmetic outcome of skin flaps was significantly improved due to TA, with no appreciable side-effects.

The new focus on epicanthoplasty for Asian eyelids.

Purpose of review is to emphasize the clinical significance of the epicanthal fold when evaluating Asian eyelids. Advances in Asian eyelid research have improved the understanding of the epicanthal fold and highlighted key steps to performing successful epicanthoplasty. Up-to-date epicanthoplasty surgical techniques are also discussed. The epicanthal fold is common in the Asian population. It is composed of the preseptal part of the orbicularis oculi muscle. Various epicanthoplasty techniques have been described and can be broadly categorized into two types based on the type of skin flap created: the advancement flap and the transposition flap. The skin flap can be created in several ways depending on surgeon preference and the severity of the epicanthal fold but is not the key step in epicanthoplasty. Releasing all vertical tension by subcutaneous tissue dissection and orbicularis oculi myectomy are the main surgical steps to successful correction. Earlier described epicanthoplasty methods created obvious scarring, under correction, and recurrent deformity. Newer techniques offer improvements with a shorter skin incision, smaller flap creation, and minimal or no medial canthal ligament plication to lessen wound tension. For optimal surgical results in Asian upper eyelid surgery, presence of the epicanthal fold and surgical correction options should be discussed primarily.

Previously Complicated Nuss Procedure Does Not Preclude Blind Removal of the Bar

Nuss procedure has become the procedure of choice for well-selected patients with pectus excavatum. Perioperative complications may pose difficulty during the subsequent bar removal due to adhesions and tissue plane disruptions during the initial surgery and repair. This report describes bar removal experience in patients whose Nuss procedures were complicated by cardiac injury, pericardial breach, and lung parenchyma/diaphragm injury during the initial procedure. A total of 529 patients who underwent Nuss procedure between 2007 and 2014 were recorded in a prospective database. Twenty patients with complications (cardiac injury [n = 1], pericardial breach [n = 3], and lung parenchyma/diaphragm injury [n = 16]) were identified. All bars were removed via subcutaneous tissue dissection, without intrathoracic visualization. Average duration of bars was 36 months (±16 months). All bar removal procedures were completed without any need for extra interventions with negligible blood loss. Eighteen patients were able to be discharged within 2 postoperative days. Blind bar removal in patients with previously complicated Nuss procedure seems safe and no other interventions (videothoracoscopy, subxiphoid incision, etc.) during bar removal seem to be necessary.

Continuous Local Analgesia in Postoperative Treatment of Large Incisional Hernias – Preliminary Results

Abstract Background: The incisional hernias are frequent complications after laparotomy. Extended subcutaneous tissue dissection is often necessary for the treatment of large incisional hernias, and this procedure is frequently followed by a high intensity pain in the postoperative period. The aim of this study was to assess the postoperative patient comfort without using major analgesics. Material and method: we present the preliminary results of an ongoing study from Surgery Clinic 1 of Emergency Clinical County Hospital of Târgu Mures, University of Medicine and Pharmacy Târgu Mures. The study comprises in the intraoperative insertion of a subcutaneous catheter (Pajunk InfiltraLong) placed on lay, through which we administered continuously Ropivacaine 0,5%. Results: Ten patients have been included in the study by now. For 5 of the patients the wound infiltration was started with 7 ml/h in the first 6 postoperative hours, after which the rate decreased to 5 ml/h until the end of the 72 hours, when the catheter was removed. For 2 patients the wound infiltration was started with 10ml/h in the first 6 postoperative hours, after which the rate decreased to 7 ml/h in the first day, followed by 5 ml/h for the next two days. Two patients needed a minor analgesic in the immediate postoperative period and one patient needed major analgesia in the first 24 hours. Conclusions: By using this method, postoperative analgesia can be achieved without using major systemic analgesics and a superior patient comfort can be achieved simply by adjusting the infusion rate

A new technique for percutaneous dilatational tracheostomy (G‐Trach): preliminary experience in pigs

Tracheostomies are currently used for airway management in patients requiring long-term respiratory assistance. The dilatational percutaneous technique of forming tracheostomies is a valuable alternative to traditional surgical 'open' techniques. In this study, we tested a new dilatational percutaneous tracheostomy device using a balloon dilator with a particular innovative shape (G-Trach). At the Autonomous University of Barcelona Veterinary Institute, eight pigs (weighing 20-40 kg) were anaesthetised and underwent tracheostomy using the novel G-Trach technique. The mean (SD) procedure time was 2.63 (0.64) min from tracheal puncture to ventilation through the tracheostomy tube, and the mean (SD) time from positioning the dilator balloon to introducing the cannula was 0.71 (0.38) min. Vital functions and oxygen saturation remained constant throughout the procedures. Postmortem examinations did not reveal any tracheal injury. The G-Trach seems to be a safe and easy new dilatational percutaneous technique for forming tracheostomies. The minimal subcutaneous tissue dissection could potentially decrease complications when compared with standard dilatational percutaneous tracheostomy methods. To confirm this hypothesis a human trial is ongoing.

Arthroscopic treatment of calcaneonavicular coalition in children

Calcaneonavicular coalition is a common source of pain and more or less severe flat and stiff foot in children. Classically, treatment consists in resecting the coalition using a dorsolateral approach. Good quality resection and interposition can prevent recurrence. The most common complications are infection, hematoma and neuroma. Arthroscopy offers a minimally invasive alternative, but the optimal approach remains undetermined. We describe a surgical technique with an approach based on the anterolateral process of the calcaneus, in three cases with 12 months' follow-up. Arthroscopic resection has certain advantages: recovery is quicker, and the esthetic result is better. For the instrumental portal, skin incision should be superficial, followed by blunt dissection of subcutaneous tissue to avoid superficial peroneal nerve injury. Although longer term follow-up is needed, arthroscopy seems to be an attractive minimally invasive technique in this kind of pathology.

Longitudinal Incision of the Umbilicus for Laparoendoscopic Single Site Adrenalectomy

We describe our initial clinical experience of laparoendoscopic single site (LESS) adrenalectomy. We describe a 49-year-old woman who was diagnosed with subclinical Cushing syndrome because of a left adrenal tumor and underwent LESS adrenalectomy. We everted the umbilical depression and made the longitudinal skin incision of the umbilicus at the mid-line. Then, the wider area of the subcutaneous tissue was dissected to accommodate the placement of the 3 trocars through the longitudinal umbilical skin incision. The procedure was performed in a standard manner with the use of the roticular instruments to overcome the lack of triangulation that occurs with a single access. There were no intraoperative or postoperative complications. The patient reported pain scores of 0 to 1 in the validated Visual Analog Pain Scale and postoperatively she required no narcotics. The scar receded into the umbilicus and was hardly visible. Herein we presented the "particular intraumbilical approach" for LESS adrenalectomy. Longitudinal incision of the umbilicus and the wider area of subcutaneous tissue dissection accommodate the multiple ports and seemed to solve the problem associated with crossover instrumentation. The incision length was within the depression of the umbilicus; therefore, this simple technique also preserves the normal umbilical appearance.

Balloon-Facilitated Percutaneous Dilational Tracheostomy Tube Placement: Preliminary Report of a Novel Technique

To describe a novel technique for percutaneous tracheotomy (PT) that could be an alternative to current dilational techniques.An observational animal study of PT was performed using the Seldinger guide wire technique with a tracheostomy tube preloaded onto a dilational balloon catheter. A small skin incision was done with an 11-blade scalpel, but no blunt subcutaneous tissue dissection was performed.Animal laboratory in a university hospital.Seven adult pigs (approximate weight, 16 to 21 kg).Successful tracheostomy was accomplished in all seven pigs without apparent complication. Vital signs and oximetry results remained unchanged throughout the procedure. The mean duration of the procedure was 5.5 min from tracheal puncture to ventilation.This novel procedure is a simple and effective means of PT tube placement without subcutaneous tissue dissection and could potentially have decreased complications when compared to the standard methods of PT currently employed in humans. Human studies are pending.