Surgeon's Practice Research Articles

The Gliding Browlift: An Analysis of Outcomes and Maintenance of Lift in a Single Surgeon's Practice.

Efforts in browlifting longevity, desire for minimally invasive procedures, patient individualization, and minimization of complications led to the development of the gliding brow lift (GBL). The GBL has proven to be a successful, minimally invasive technique targeting brow elevation in combination with the hemostatic net. To evaluate maintenance of cutaneous brow elevation with the GBL technique at specific post-operative time points. A retrospective review was conducted of 63 patients (59 females; 4 males) who underwent a GBL by the senior author (JCG) between 2019 and 2022 for co-morbidities, maintenance of brow lift, and incidence of complications at four post-operative time points: 3, 6, 9, and 12 months. Pre- and postoperative photographs were analyzed at four anatomic locations: supraorbital rim, lateral canthus, mid pupil, and medial canthus. The cohort consisted of 59 female-only patients; male patients were excluded due to small sample size. The average age of 62.8 years old (SD ±7.01) and a mean BMI of 24. Only one patient required return to the operating room for hematoma evacuation; this was a result of a concomitant rhytidectomy and not involving the brow. All locations maintained a statistically significant lift (p<0.01). The most significant lift was at the lateral canthus (3.09 mm) and tail of the brow (2.74 mm) at 1 year post-operatively. The GBL is a successful innovation in aesthetic brow surgery. Depending on patient needs, it is an excellent choice for selective and long-term elevation of the lateral brow.

Most Carpal Tunnel Releases Address Moderate or Severe Median Neuropathy.

The role of surgery in normal or very mild median neuropathy can be questioned given that surgery in the absence of pathophysiology may offer only nonspecific effects that can be achieved without surgery, which raises ethical concerns. It's also important to avoid misdiagnosis: given that mild median neuropathy is prevalent and generally well-accommodated, notable symptoms from mild median neuropathy can signal unhelpful thoughts and feelings of distress that are a more pressing health priority. We identified 38 studies that categorized electrodiagnostic (EDX) measured median neuropathy severity among people being evaluated for carpal tunnel syndrome. We converted the different EDX grades used into one general grading classification. The Kruskal-Wallis test was used to compare the ratio of moderate/severe to mild/normal EDX findings between tests ordered by a surgeon or a nonoperative clinician. The median (interquartile range) ratio of moderate/severe to mild/normal EDX findings of median neuropathy at the carpal tunnel was 1.2 (0.91 to 1.8) among tests ordered by nonoperative clinicians and 3.3 (1.5 to 5.3) among tests ordered by surgeons (P = .0023). Only 4.1% of the patients who had EDX testing ordered by a surgeon had no measurable neuropathy. There were zero patients with normal EDX findings in 10 of the 17 (59%) studies in surgeon practices and in 10 of the 21 (48%) in the practices of nonoperative clinicians. The observation that in case series documenting EDX severities of median neuropathy, surgeons are mostly treating and operating on moderate to severe pathophysiology, emphasizes that while mild median neuropathy is highly prevalent it is uncommonly considered for surgery. Level II, Prognostic study.

Current issues of using metronidazole in clinical practice. Effects and directions of clinical application

Metronidazole is an important drug in clinical and outpatient practice due to its broad antibacterial and antiprotozoal properties. Metronidazole is effective against anaerobic bacteria and some protozoa such as Trichomonas vaginalis and Giardia lamblia. This makes it indispensable in the treatment of infections of various etiologies. The review article contains current information about the clinical pharmacology of metronidazole and its place in the pharmacotherapy of infectious diseases. General and specific issues of the use of metronidazole in the practice of GPs, surgeons, obstetrician-gynecologists, and other specialists are considered. Information is provided on the possibilities and indications for the use of metronidazole in the eradication of Helicobacter pylori, in radiation therapy for cancer patients, dermatovenereology, dentistry, treatment of protozoal infections, as well as in alcoholism. Metronidazole is often used in combination with other antibiotics to enhance the antimicrobial effect, especially in cases of mixed infections or when it is necessary to cover a wider range of pathogens. In surgical practice, metronidazole is used to prevent infectious complications after operations on the abdominal and pelvic organs, where the risk of anaerobic infection is high. In an environment of increasing antibiotic resistance, metronidazole remains an effective treatment against many anaerobic pathogens, highlighting its place in modern practice.

Implant Cost Awareness Among Orthopaedic Surgeons at a Single Academic Institution

Introduction Despite the increasing costs of implants, surgeons’ awareness of these costs varies widely. The purpose of this study is to determine baseline awareness of sports-medicine-related implant cost among orthopaedic surgeons. Methods A survey including images of 10 different orthopaedic implants related to sports medicine was sent to 18 surgeons. All included surgeons practice in a single ambulatory surgery center and routinely perform sports-medicine-related procedures. Surgeons were asked to estimate the cost of each implant and answer questions about surgeon characteristics. Cost estimates were compared with implant cost found in the institutional charge master database. Results Cost estimates varied widely among providers regardless of fellowship training. The average percent error among all providers was 54.3%. Surgeons that rated knowledge of implant cost to be important most or all of the time had an average cost estimate error of 60.7% versus 48.0% error in their counterparts that stated that knowledge of cost was important to them only some of the time, though this did not reach statistical significance. Low-cost implants were more likely to be overestimated while high-cost implants were more often underestimated. Years of experience, sports medicine fellowship training, and involvement in contract negotiations had no effect on implant cost accuracy. Conclusion Implant cost awareness is dishearteningly low sports medicine orthopaedists despite the large economic impact of these devices. There is considerable room for improving cost awareness in sports medicine.

Dry Eye Syndrome in the Practice of a Cataract Surgeon: A Clinical Case

Dry Eye Syndrome in the Practice of a Cataract Surgeon: A Clinical Case

Research progress on the distribution patterns and surgical dissection of central lymph nodes in left-sided colon cancer

Lymphatic metastasis is one of the main pathways of colorectal cancer spread and also a crucial factor in patient long-term prognosis. Lymph node dissection in the possible tumor drainage area, particularly the central group of lymph nodes at the root of the tumor-associated supplying artery, is a key and challenging aspect of surgical techniques. Currently, the patterns of lymphatic drainage and the distribution of central lymph nodes in left-sided colon cancer are not well illustrated, and there is no consensus on the necessity and extent of central lymph node dissection. This has led to significant variability in the extent of lymph node dissection among different surgeons in clinical practice, a lack of quality control standards for surgical procedures, and impacts on postoperative treatment strategy and long-term outcomes. Moreover, current research on lymphatic drainage and metastasis is primarily based on traditional anatomy, whereas individualized, precise approaches to lymph node dissection have not been realized. The application of preoperative and intraoperative lymph node imaging techniques based on functional anatomy in colorectal cancer patients is still under exploration.

Anterior Subtenon Triamcinolone Injection for Refractory Macular Edema: A Retrospective Case Series.

To evaluate the effectiveness of anterior subtenon triamcinolone (AST) injections in the management of refractory macular edema. This is a retrospective case series of consecutive eyes with refractory macular edema treated with AST at a single vitreoretinal surgeon's practice at Toronto Western Hospital, University of Toronto, Canada in 2018-2023. Refractory was defined as persistent macular edema with a central subfield thickness of 250μm or greater over a 24-week period, receiving at least four intravitreal anti-VEGF injections. Vision outcomes and optical coherence tomography features for all eyes were compared for three visits pre-AST treatment and two visits post-AST treatment. Ninety-three patients (119 eyes; diabetic macular edema (26%), and pseudophakic CME (74%), with a mean follow-up duration of 161 days were included. The presence of subretinal fluid (p=0.0013), central subfield macular thickness (p<0.0001), cube average thickness (p=0.0024) and macular cube volume (p= 0.0017) significantly improved from pre-AST to post-AST treatment. Visual acuity also significantly improved from pre-AST treatment to post-AST treatment (p<0.0001). There was no significant change in the intraocular pressures from pre-AST to post-AST (p=0.7920) and no complications were noted throughout the follow-up period. The findings from this study suggest that AST injections show modest improvement in anatomical and functional outcomes, and are safe for the treatment and management of refractory macular edema.

Modern view of surgical treatment of the lesion ileocecal zone in Crohn’s disease: when and how to operate

Crohn’s disease is an inflammatory bowel disease with a chronic recurrent course and a high risk of complications. Crohn’s disease prevalence has been increasing. Despite the era of biological therapy and new therapeutic approaches in the treatment of Crohn’s disease, the role of surgical treatment remains high. This study aimed to analyze the current trends and approaches of surgical treatment localized lesions of ileocecal zone in children with Crohn’s disease. The scientific databases eLibrary, GoogleScholar, MEDLINE, and Embase were searched. The search time interval was 2017–2024. In several recent articles, a trend toward early ileocecal resection in patients with Crohn’s disease was noted. According to some studies in adults, this approach is an alternative option for medical treatment. The advantages of early surgical approach includes decreased surgical complication level, improving the quality of life and reducing the cost of treatment. The timing of early surgical intervention varies. Notably, Crohn’s disease in children has more aggressive character, and early surgical intervention may not only create a therapeutic window of opportunity to control Crohn’s disease but also contribute to improving the long-term results of Crohn’s disease treatment. The role of surgical technique is being studied (the need to include a mesentery with fat wrapping into a resection area or not), the effect of the type of anastomosis on relapse of Crohn’s disease. Analysis of the safety of Kono-S anastomosis and its impact on development recurrence has shown a number of advantages over traditional anastomosis. However, its application in the practice of pediatric surgeons remains isolated. Similar studies are required in children to determine the optimal strategy for the treatment of Crohn’s disease in ileocecal region (determining the role of surgical treatment and type of anastomosis in achieving long-term and deep remission), preventing recurrence of Crohn’s disease and repeated intestinal resections.

Patient Selection, Outcome, and Unhappy Patients in Rhinoplasty.

This article discusses the process of patient selection for rhinoplasties and the many different psychological aspects that come into play. It is important to identify the warning signs and apply a multidisciplinary approach to the surgeons practice, in collaboration with specialist rhinoplasty psychologists. Patients' motivations and surgeon factors are also discussed, as this can lead to unhappy and unsatisfactory postoperative outcomes. Potential reasons for adverse outcomes throughout the pre- and postoperative periods are also described. Finally, a brief guide is provided to reduce the risks of an unhappy patient.

Breast Implant Rupture Surveillance Practices among Plastic Surgeons in Publicly Funded Healthcare Systems.

The United States Food and Drug Administration (FDA) recommends silicone breast implant rupture surveillance using MRI or ultrasound beginning at 5-6 years post-insertion and every 2-3 years thereafter. No surveillance guidelines exist in Canada or the UK. This study aims to identify surveillance practices and perceived barriers to surveillance among plastic surgeons in Canada and the UK and compare surgeon practices between public and private sectors. All active members of the Canadian Society of Plastic Surgeons (CSPS) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) with an interest in breast surgery were surveyed. Surgeon demographics, screening practices and perceived barriers to screening were analyzed. Fisher's exact test was used to detect significant associations. The survey response rate was 16%. Most surgeons (68%, n=58/85) were familiar with FDA guidelines; however, only 2.4% (n=2/85) followed them. Surgeons in private practice screened significantly more than surgeons in the public sector [45% (n=13/29) vs 13% (n=7/56), p<0.002]. Among surgeons, ultrasound and high-definition ultrasound were the most common screening modalities and a perceived lack of clinical necessity followed by a perceived lack of satisfactory evidence qualifying these guidelines was the most reported barrier to screening. Despite awareness of FDA guidelines, compliance among surgeons surveyed remains low, reportedly due to a perceived lack of necessity or evidence base. Most public sector surgeons opt not to screen and do not recommend surveillance, even without barriers. While governing bodies should consider current practices to shape guidelines, increasing surgeons' awareness on their evidentiary foundation and potential consequences of silent ruptures is imperative. 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.

Patient Selection, Outcome, and Unhappy Patients in Rhinoplasty.

This article discusses the process of patient selection for rhinoplasties and the many different psychological aspects that come into play. It is important to identify the warning signs and apply a multidisciplinary approach to the surgeons practice, in collaboration with specialist rhinoplasty psychologists. Patients' motivations and surgeon factors are also discussed, as this can lead to unhappy and unsatisfactory postoperative outcomes. Potential reasons for adverse outcomes throughout the pre- and postoperative periods are also described. Finally, a brief guide is provided to reduce the risks of an unhappy patient.

Full Thickness Nasal Reconstruction With Paired Pericranial and Paramedian Forehead Flaps.

The reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed. A retrospective review of a single surgeon practice was done between 2019 and 2024. Cases of nasal reconstruction with a paired PCF and PMF following oncologic resection were reviewed. Defect characteristics, reconstructive technique, and postoperative complications were evaluated. A literature review summarizing the evolution of this technique from inception to April 2024 was conducted using PubMed. The literature review identified 7 reports describing the use of a paired PCF and PMF for nasal reconstruction. The modifications and enhancements described in each study are summarized. The case series included 13 patients requiring oncologic resection for squamous cell carcinoma (8 patients) or basal cell carcinoma (5 patients). Every case required reconstruction of at least 2 nasal subunits, primarily involving the nasal tip, alae, and columella. Reconstruction was performed with the ipsilateral PCF, contralateral PMF, and structural grafts. Auricular cartilage grafts were universally used for structural support, with additional costal cartilage grafts and a split calvaria bone graft in select cases. The technique showed good functional and esthetic outcomes without any notable graft failures or donor site complications. The combination of an ipsilateral PCF and contralateral PMF is an effective strategy for reconstructing full-thickness nasal defects involving multiple nasal subunits.

WP7.5 - Primary Repair of Obstetric Anal Sphincter Injuries (OASIS): a Survey of Surgeons’ Experience

Abstract Purpose OASIS is associated with devastating consequences; namely incontinence. Timely, satisfactory repair of OASIS is necessary to mitigate the risk of maternal morbidity. Primary repair is typically undertaken by an obstetrician. In cases of profound anatomical disruption, the on-call surgeon may be called. The aim was to explore the experience and current practice of surgeons in the acute repair of OASIS. Methods A cross-sectional, observational study was performed. Registrars and consultants who participate in an on-call rota in the UK were included. The survey was disseminated to members of ASGBI and ACPGBI. It was also advertised via social media platforms, including Twitter and LinkedIn. A chain-sampling method was advocated. A descriptive analysis of the data was undertaken. Results 318 responses have been recorded so far. 32% of surgeons had been contacted to assist in an acute repair, of which 23% had a specialist interest in pelvic floor surgery. Of those who were contacted, 53% would typically be called for a 3c or 4 tear. Of these, 73% had not performed any primary repairs over the preceding year. 77% of all respondents had not received any training. Of those awarded the FRCS, 36% were not confident at all in performing an acute repair. Conclusion There remains a lack of consensus on who is responsible for the repair of these injuries. Surgeon involvement should only occur if adequate exposure and training is assured. Involvement may be reserved for cases where secondary repair is considered, when specialist pelvic floor opinion should be sought.

Quadriceps angle as an outcome measure for structural integrity following total knee arthroplasty in individuals with severe knee osteoarthritis

PurposeTotal knee arthroplasty (TKA) is routinely performed for pain relief and to improve performance of the knee in individuals with severe knee osteoarthritis (OA). The quadriceps angle (Q-angle) is a key component of knee joint stability. However, there is a dearth of literature evaluating Q-angle as an outcome measure after TKA in individuals with severe knee OA. ObjectivesThe objective of the study was to assess the Q-angle as an outcome measure before and after TKA and to find the correlation of Q-angle with pain, quadriceps strength, and knee flexion range of motion (ROM) after TKA in individuals with severe knee OA. MethodsThe Q-angles of 34 individuals (male: female = 17:17) were measured using standardized procedures. Pain, quadriceps strength, and knee flexion ROM were measured. The measurements were taken preoperatively (one day before surgery), and postoperatively at the sixth week and third month after TKA. ResultsThe mean Q-angle was 19.17° (SD = 1.92°) before TKA, 16.06° (SD = 1.87°) at the sixth week and 13.43° (SD = 1.77°) at the third month after TKA. Significant linear correlations were noted between the Q-angle and pain, quadriceps strength, and knee flexion ROM following TKA. ConclusionThe Q-angle was measured before and after TKA using a standardized clinical goniometric method. Understanding the Q-angle before and after TKA and its relationship with various clinical and functional variables is imperative in clinical practice for orthopedic surgeons and rehabilitation professionals.

French Dentists’ knowledge, attitudes and practices toward oral cancer detection: A national survey

BackgroundFrance is ranked 6th in Europe in terms of oral cancer incidence. Dental surgeons are on the front line in examining the oral mucosa, but little is known about the knowledge, attitudes and practices of French dental surgeons with respect to lesions suspected of malignancy. MethodsAn online survey including 18 self-administered questions was widely shared on social media using major networks of French dentists. Items included socio-demographic characteristics of the respondents, their self-assessed knowledge, screening practices and training on oral cancer detection and care. ResultsA total of 676 dental surgeons participated in this survey. The vast majority, 92.8 %, were general dental surgeons, 83.9 % had a private practice and 49.1 % had less than 5 years of dental experience. Almost 55 % declared that they did not conduct systematic examinations of the oral mucosa and 45 % reported that they did conduct such examinations. In-hospital practice, lower patient age, dental surgeon experience, and specialty were all positively associated with systematic examination of the oral mucosa. Conversely, absence of a patient complaint, absence of an obvious lesion, lack of time, and lack of training/skills were all negatively associated. DiscussionThis is the first survey to analyze the practices of French dental surgeons in oral cancer screening. Only half of the respondents, the best trained, performed systematic oral mucosa examinations which objectively help to early detect mucosal cancer lesions. To improve oral cancer early detection, we recommend mandatory screening training programs for all dental students and dental surgeons.

Cyberchondria and the surgeon

We explore the myriad impacts of patient cyberchondria on a surgeon's practice and wellbeing and how to address this phenomenon.

Evaluation of the Dysfunctional Scapula.

Periscapular pain and dysfunction are relatively common complaints in the practice of upper extremity surgeons. However, evaluation of the dysfunctional scapula is intimidating for most. Physical examination of the periscapular muscles is very rich, and a systematic approach provides the opportunity to establish a diagnosis for most patients. Conditions underlying scapular dysfunction include trapezius palsy, serratus palsy, brachial plexus injuries, muscular dystrophy, snapping scapula, pectoralis minor syndrome, congenital undescended scapula, and functional scapular dyskinesis, among others. Patients should be examined with their torso uncovered and assessed from the front and back. Inspection, evaluation of motion, and strength testing may be followed by certain examination maneuvers specific for each condition. The scapular assistance test may help predict the outcome of treatment for certain conditions. Plain radiographs oftentimes need to be complemented with magnetic resonance of the chest to capture periscapular muscles as well as an electromyogram with nerve conduction studies. Computed tomography is particularly helpful for skeletal abnormalities. Ultrasound is used to assess certain peripheral nerve injuries and to guide diagnostic and therapeutic injections. A focused evaluation of the scapula followed by a more specific and directed approach for each condition suspected will allow upper extremity surgeons to approach the evaluation of the dysfunctional scapula with much more confidence.

Patient-Specific Rods in Adolescent and Adult Spinal Deformity Surgery: A Narrative Review.

Spinal deformity surgery often requires complex surgical interventions that can have a drastic effect on both patient quality of life and functional capacity. Modern-day corrective solutions for these deformities include spinal osteotomies, pedicle screw instrumentation, and dual/multirod constructs. These solutions are efficacious and are currently considered standard practice for spinal surgeons, but they lack individualization. Patient-specific rods (PSRs) are a novel technology that attempts to offer a personalized approach to spinal deformity correction based on preoperative computerized tomography scans. Moreover, PSRs may offer several advantages to conventional rods, which include achievement of desired rod contour angles according to surgical planning alignment goals, reduced operative time, and reduced blood loss. In adolescent idiopathic scoliosis, those instrumented with PSR have observed coronal Cobb reductions up to 74%. In adult spinal deformity, PSRs have offered superior correction in radiographic parameters such as sagittal vertical axis and pelvic incidence minus lumbar lordosis. However, there still remains a paucity of research in this area, mainly in health care expenditure, cost-effectiveness, and longitudinal clinical outcomes. The purpose of this article is to survey the current body of knowledge of PSR instrumentation in both adolescent and adult spinal deformity populations. The current strength, limitations, and future directions of PSRs are highlighted throughout this article.

A snapshot audit of global flexible endoscopy practice among European Association of Endoscopic Surgeons (EAES) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) surgeons from the EAES Flexible Endoscopy Subcommittee survey.

Endoscopy is an essential skill for all surgeons. However, endoscopic competency, training, and practice may vary widelyamong them. The EAES Flexible Endoscopy Subcommittee is working towards a standardized set of fundamental endoscopic knowledge and skills. To best advise on current practice patterns of flexible endoscopy among surgeons worldwide, a snapshot audit was conducted on the training, use, and limitations of flexible endoscopy in practice. An online survey was distributed via email distribution and social media platforms for EAES, SAGES, and WebSurg members. Respondent demographics, training, and practice patterns were assessed. The main outcome measure was theannual endoscopic volume. Multivariate regression and machine learning models analyzed relationships between outcomes and independent variables of age, geographic region, laparoscopic surgery practice, and surgical specialization. A total of1486 surgeons from 195 countries completed the survey. Respondents were mainly general (n = 894/1486, 60.2%), colorectal (n = 189/1486, 12.7%), bariatric (n = 117/1486, 7.9%), upper gastrointestinal (GI)/foregut (n = 108, 7.3%), hepatobiliopancreatic/HPB (n = 59/1486, 4%), and endocrine surgeons (n = 11/1486, 0.7%) in active practice. Eighty-two percent (n = 1,204) mentioned having used endoscopy in theirpractice, and 64.7% (n = 961/1486) received formal flexible endoscopy training. Of those performing endoscopyannually, 64.2% (n = 660/1486) performed between0and20endoscopies, 15.2% (n = 156/1486) performed between20and50endoscopies, 10.1% (n = 104/1486) performed between50and100endoscopies, and 10.5% (n = 108/1486) performed over 100 endoscopies. From the regression analysis, there was no statistical correlation between the annual endoscopy volume and age, geographic region, laparoscopic surgery practice, or surgical specialization. Performing advanced endoscopy was directly related to thebariatric subspecialty and toperforming over 50% of cases in aminimally invasivefashion. This international snapshot audit revealed significant heterogeneity in endoscopic practices among surgeons worldwide. There wasa nonindependent relationship between endoscopy volumes and other variables tested. Barriers to practicing and receiving endoscopy training were common among respondents. The EAES Flexible Endoscopy Subcommittee will consider such results when developing an equitable and effective standardized flexible endoscopy curriculum.

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.

Literature review with clinical recommendations. To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.