Surgeons In Preoperative Planning Research Articles

Surgical Outcomes and Complications of Custom-Made Prostheses in Upper Limb Oncological Reconstruction: A Systematic Review.

Bone tumors of the upper limb are a common cause of bone pain and pathological fractures in both old and young populations. Surgical reconstruction and limb salvage have become valid options for these patients despite this kind of surgery being challenging due to the need for wide bone resection and the involvement of surrounding soft tissues. Computer-assisted technology helps the surgeon in pre-operative planning and in designing customized implants. The aim of this study was to investigate the surgical outcomes and complications of custom-made prostheses in oncologic reconstruction of the upper limb and if they are reliable options for patients suffering from aggressive tumors. An electronic search on PubMed, Google Scholar, and Web of Knowledge was conducted to identify all available articles on the use of custom-made prostheses in oncological resections of the upper limb. Twenty-one studies were included in the review, comprising a total of 145 patients with a mean age of 33.68 years. The bone involved was the humerus in 93 patients, and the radius was involved in 36 patients. There were only six cases involving proximal ulna, three cases involving the scapula, and seven cases involving the elbow as well as soft tissues around it. The most frequent primary tumor was the giant cell tumor, with 36 cases, followed by osteosarcoma with 25 cases, Ewing Sarcoma with 17 cases, and Chondrosarcoma with 7 total cases. Forty patients were affected by bone metastases (such as renal cell cancer, breast cancer, melanoma, and rectal cancer) or hematologic diseases involving bone (lymphoma, myeloma, or non-Hodgkin disease). Custom-made prostheses are a viable option for patients who suffer from malignant tumors in their upper limbs. They are a reliable aid for surgeons in cases of extensive resections.

1st to 2nd metatarsal base cross-screw in the modified Lapidus proc

First tarsometatarsal (TMT) arthrodesis or the modified Lapidus (ML) is a common procedure utilized by foot and ankle surgeons for the management large bunion deformities, particularly in the presence of medial column instability. The purpose of the present anatomic study was to assist surgeons in preoperative planning for ML procedure utilizing the first metatarsal to second metatarsal cross-screw technique by assessing the average length of screw guidewire placed bi-cortically through the first metatarsal and second metatarsal at a location specific to the ML procedure with metatarsal to second metatarsal cross-screw technique. This was a cadaveric study utilizing 20 fresh-frozen below-the-knee specimens. After dissection, joint preparation, and stabilization, a cannulated 4.0 screw was then placed across the first and second metatarsal bases from medial to lateral starting 1 cm distal to the 1st TMT joint. Once appropriate length and orientation was achieved the guidewire was measured using a cannulated depth gage and values were then recorded on a spreadsheet and analyzed. Amongst the 20 specimens the mean guidewire length was found to be 34 mm +/- 3.2 mm. The median guidewire length was found to be 34 mm (range: 29 – 41 mm). The present anatomic study defined the mean and median lengths of a first metatarsal to second metatarsal screw utilized for medial column stabilization and spot weld arthrodesis in the ML procedure.

Automatic pulmonary artery-vein separation in CT images using a twin-pipe network and topology reconstruction.

With the wide application of CT scanning, the separation of pulmonary arteries and veins (A/V) based on CT images plays an important role for assisting surgeons in preoperative planning of lung cancer surgery. However, distinguishing between arteries and veins in chest CT images remains challenging due to the complex structure and the presence of their similarities. We proposed a novel method for automatically separating pulmonary arteries and veins based on vessel topology information and a twin-pipe deep learning network. First, vessel tree topology is constructed by combining scale-space particles and multi-stencils fast marching (MSFM) methods to ensure the continuity and authenticity of the topology. Second, a twin-pipe network is designed to learn the multiscale differences between arteries and veins and the characteristics of the small arteries that closely accompany bronchi. Finally, we designed a topology optimizer that considers interbranch and intrabranch topological relationships to optimize the results of arteries and veins classification. The proposed approach is validated on the public dataset CARVE14 and our private dataset. Compared with ground truth, the proposed method achieves an average accuracy of 90.1% on the CARVE14 dataset, and 96.2% on our local dataset. The method can effectively separate pulmonary arteries and veins and has good generalization for chest CT images from different devices, as well as enhanced and noncontrast CT image sequences from the same device.

Bringing Medical Model Scans into Reality through 3D Printing: Materials and Manufacturing Parameters

3D printing is emerging in the healthcare field. Being able to reproduce organ models with low-cost and sustainable technology is generating a big impact on professionals working in the medical industry. This work aims to illustrate the potential of the material extrusion technique by replicating 3D models used for helping surgeons in pre-operative planning. The properties of a standard thermoplastic PLA for 3D printing are compared with other thermoplastics with elastomeric properties whose application is arising nowadays in this field, namely PEBA, TPO, and TPU. This research covers three real cases of study: a pulmonary fistula, a bone tumor, and a replication of the spinal column. The cases helped anticipate potential problems during surgery and achieve good quality in educating and training new professionals. Finally, an optimal printing configuration is presented. The settings of the printing parameters selected are the ones that maximize the inter and intra-layer bonding, which is important to achieve good shape results and consistency of the models. Although the printed parts are not meant to support a big mechanical effort, it is important to relate the selection of the printing parameters to the adhesion of filaments in order to reduce the quantity of material deposited during the manufacturing process, and consequently, reduce the printing time. Also, to achieve a realistic model that can be of effective help for the medical faculty when preparing their interventions and during their diagnostic process.

An evaluative study to find the correlation between semitendinosus graft dimension with respect to patient’s anthropometry

Background: A prospective study of a cohort of anterior cruciate ligament (ACL) reconstructed patients 7 years after surgery revealed degenerative radiographic changes in 95% of patients, and only 47% were able to return to their previous activity level following ACL reconstruction. Aims and Objectives: The aims of this study were to find the correlation between Semitendinosus graft dimension with respect to patients anthropometry such as age, height, weight, body mass index (BMI), and true leg length (TLL). Materials and Methods: The proposed study was the patients coming to orthopedics-outpatient department and emergency with30 complete thickness ACL tears which were screened and recruited based on fulfillment of inclusion and exclusion criteria from January 2020 to August 2021 (20 months duration). The sample size was sufficient to draw conclusive findings. Correlation was calculated by Pearson correlation analysis. The Pearson product-moment correlation coefficient was a measure of the linear dependence between two variables X and Y. P≤0.05 was considered for statistically significant. Results: The age has positive correlation with graft length (r=0.11) and relatively strong positive correlation with graft diameter (r=0.437). Height has relatively strong positive correlation with graft length (r=0.4258) and graft diameter (r=0.1375). Weights have strong positive correlation with graft length (r=0.604). TLL also had positive correlation with graft length (0.23) and graft diameter (r=0.1). Conclusion: In selective cases, graft may be reinforced with additional Hamstring tendon harvest like gracilis or any alternative graft such as Bone–patellar tendon–bone (BPB) and Peroneus longus tendon autograft that may be taken to prevent graft failure and future complications. This current data can be a reference for surgeons in preoperative planning and counseling to patients about alternative autograft selection.

Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study

Background: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon–femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients. Purpose: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens. Study Design: Descriptive laboratory study. Methods: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface. Results: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts (P < .047) and the younger and older cohorts (P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. Conclusion: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens. Clinical Relevance: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

Obesity and Reverse Total Shoulder Arthroplasty.

Rates of obesity and reverse total shoulder arthroplasty (rTSA) in the USA have both escalated with time. Obese patients experience arthritis at higher rates than normal weight patients; therefore, these numbers go hand in hand. Obesity has been correlated with health comorbidities such as anxiety, cardiovascular disease, diabetes, and metabolic syndrome as well as poorer outcomes and higher complication rates following lower extremity arthroplasty. The current review investigates these comorbidities as they relate to obese patients undergoing rTSA. Functional outcomes are similar to normal weight counterparts. Although longer operative times and a large soft tissue envelope would intuitively predispose these patients to higher risk for infection or other complications, this has not been reliably demonstrated. Technical considerations and awareness of potential risks in the obese patient demographic may aid the surgeon in preoperative planning and counseling of their patient. Obese patients undergoing rTSA have been shown to have higher risks specifically for infection, revision, and medical complications; however, this has not been consistently demonstrated in the single surgeon series where, more often, no difference in these metrics has been found. Outcomes measures and satisfaction are reliably improved, even when considering superobese patients, and majority of studies find their improvements and absolute values to be in line with their normal weight counterparts. Thus, rTSA does not seem to carry the same level of adverse risk associated with lower joint arthroplasty but potential for higher risk still bears consideration when counseling obese patients. Attention to factors that may negatively affect prosthesis positioning may optimize retention rates and limit early failure.

Three-Dimensional Perioral Assessment Following Subnasal Lip Lift.

The subnasal lip lift is a surgical technique that elevates the "lip line" (interface between vertical maxillary incisor height and upper lip) to achieve a more youthful aesthetic. The authors sought to offer the first ever definition, to their knowledge, of 3-dimensional (3D) changes to the upper lip due to subnasal lip lift. A lip lift procedure was performed (on cadaveric samples) in a sequential manner from 2.5- to 5.0-mm intervals (n = 13). 3D photographs were taken with the VECTRA H1 system (Canfield Scientific, Fairfield, NJ), and 3D analysis was performed including vermillion height and width, philtral height, sagittal lip projection, vermillion surface area, and incisor show. A subset of samples (n = 9) underwent a modification of the technique by undermining the upper lip subcutaneous tissue off the underlying muscular fascia. Vermillion surface area (baseline range, 1.45-5.52 cm2) increased by an average of 20.5% and 43.1% with 2.5-mm and 5.0-mm lip lift, respectively. Anterior projection of the vermillion increased in all cases by an average of 2.13 and 4.07 mm at 2.5 and 5.0 mm, respectively. Philtral height decreased in all cases by an average of 3.37 and 7.23 mm at 2.5 and 5.0 mm, whereas incisal show increased on average of 1.9 and 4.09 mm, respectively. This study is the first to our knowledge to define the 3D morphometric changes to the upper lip following subnasal lip lift. Quantifying these changes aids the surgeon in preoperative planning and guiding patient expectations.

Case Start Timing of Adult Spinal Deformity Surgeries: Does the Wait Matter?

Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures. It is unclear whether there is any effect of case start time on outcomes. We sought to evaluate the effects of case start time and day of the week on 90-day complication, readmission, and revision rates after ASD surgery. This is a retrospective study of 1040 ASD patients from a single institution. We collected start times and day of the week for cases from 2011 to 2018. Early start was designated as any case starting either before or at 7:30 am or between 7:30 and 11 am; late start was designated as any case starting at 11 am or later. Outcome measures include 90-day complication, revision, and readmission rates. A total of 1040 ASD patients (age, 46 ± 23 years; body mass index, 25 ± 7; American Society of Anesthesiologists classification, 2.5 ± 0.6; levels fused, 10 ± 4; three column osteotomy (3CO), 13%) were included. There was no association between surgery day of the week and length of stay, 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases had higher rates of 90-day readmission (10.5% vs 6.0%, P = 0.02), reoperation (11.9% vs 6.6%, P = 0.008), and neurologic injury (5.2% vs 2.1%, P = 0.019). Subanalysis of neurologic complications demonstrated that there was a higher rate of postoperative radiculopathy (P = 0.007) and residual central or foraminal stenosis (P = 0.029) in late start cases. A late start time was predictive of increased risk for 90-day readmission (OR 1.8, P = 0.02), unplanned reoperation (OR 1.9, P = 0.009), and neurologic complication (OR 2.1, P = 0.046). A late OR start time was predictive of increased risk for neurologic complication, 90-day readmission, and unplanned reoperation. The well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates. Understanding the impact of start time on outcomes and complications after ASD surgery is helpful for surgeons in preoperative planning and for institutions and hospitals' allocation of operating room staff and resources.

Intersegmental plane simulation based on the bronchus-vein-artery triad in pulmonary segmentectomy.

BackgroundFew reliable methods to simulate and evaluate the intersegmental plane have been reported. We introduce intersegmental plane simulation based on the bronchus-vein-artery triad in three-dimensionally reconstructed images from patients who underwent segmentectomy for early lung cancer.MethodsWe collected clinical data of consecutive patients with early-stage lung cancer who underwent three-dimensional imaging-guided single-port thoracoscopic segmentectomy at Department No. 1 of Thoracic Surgery at Fujian Medical University Fujian Union Hospital from January 2019 to July 2019. Patients were divided into two groups according to the application of intersegmental plane simulation and nodule analysis: the intersegmental plane group and the non-intersegmental plane group. General clinical characteristics, operation status, and postoperative recovery were compared between groups. The three-dimensional reconstruction results in the intersegmental plane group were analyzed and summarized.ResultsA total of 120 patients were included (61 in the intersegmental plane group and 59 in the non-intersegmental plane group). There were no significant differences between the two groups in general characteristics (all P>0.05). All target lesions were resected in both groups. There were no significant differences between groups in operation characteristics or postoperative recovery, with the exception of the duration of chest drainage and the rate of gross margin insufficiency. There were five cases of gross margin insufficiency in the non-intersegmental plane group. With three-dimensional imaging reconstruction, a total of 131 intersegmental veins could be used to evaluate the simulated intersegmental plane in 61 patients, with an average of 2.1±0.5 veins per patient. Two patients (3.3%) had one vein that could be used to evaluate the intersegmental plane, 50 patients (82.3%) had two, seven patients (11.3%) had three, and two patients (3.3%) had four. The total number of intersegmental veins located on the simulated intersegmental plane was 124 (94.7%), with an average of 2.0±0.6 veins per patient. The accuracy of intersegmental plane simulation was 91.8% (56/61).ConclusionsThe bronchus-vein-artery triad in intersegmental plane simulation can assist surgeons in preoperative planning and can facilitate complete resection of early lung cancer with sufficient surgical margins.

Blood loss in hip reconstructive surgery in children with cerebral palsy: when do I need to be prepared for blood transfusion?

The hip is the second most common joint involved in pediatric patients with cerebral palsy (CP). Hip reconstructive procedures are performed to improve function and comfort level. Blood loss can occur leading to blood transfusion in close to 1/3 of children with CP undergoing hip reconstruction. The purpose of this study was to report the rate and risk factors for blood transfusion after hip reconstruction in a large cohort of children with CP. We conducted a retrospective chart review of pediatric patients at our tertiary referral children's hospital who underwent reconstructive hip osteotomy over an 8-year period. Binary logistic regression was employed to compare and model differences in transfusion between age greater than 4 or 6 years and the number of osteotomies. A total of 180 patients met our inclusion criteria. Thirty-seven patients (20.6%) received blood transfusion. Incidence of transfusion increased as number of osteotomies increased from 1 to 4 (3.7%, 7.3%, 34.0%, 58.3%, respectively). We did not find a significant effect of age greater than 4 or 6 years on the rate of blood transfusion (P = 0.676 and P = 0.323, respectively). The number of osteotomies was a significant factor in the rate of blood transfusion in both models (P < 0.001). Number of osteotomies and not age was a significant risk factor in the rate of blood transfusion. This data can help the orthopedic surgeons in preoperative planning for the possibility of blood transfusion in these patients.

Revue compréhensive de l’apport de l’impression 3D en médecine : mise en perspective des différentes applications en urologie

Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms.

Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk. Several mitigating techniques have arisen in recent years, ranging from lead protection to radiation-reducing protocols, although each technique has limits. A hitherto-problematic barrier has been the fact that efforts to diminish radiation emission come at the cost of reduced image quality. To describe new ultra-low radiation imaging modalities that have the potential to drastically reduce radiation risk and minimize unacceptable adverse effects. A literature review was performed of articles and studies that used either of 2 ultra-low radiation imaging modalities, the EOS system (EOS-Imaging S.A., Paris, France) and LessRay (NuVasive, San Diego, CA). Both ultra-low radiation imaging modalities reduce radiation exposure in the preoperative and perioperative settings. EOS provides 3-dimensional reconstructive capability, and LessRay offers intraoperative tools that facilitate spinal localization and proper visual alignment of the spine. These novel radiation-reducing technologies diminish patient and surgeon exposure, aid the surgeon in preoperative planning, and streamline intraoperative workflow.

Automatic planning of paediatric craniofacial deformities: new virtual facial-symmetry operative detection

Background: The correction of craniofacial deformities is an ongoing challenge in maxillofacial surgery. However, conventional measurement methods for treatment planning are not appropriate for craniofacial surgery. Computer-assisted approaches can improve surgical outcomes. A new, non-invasive, patient-specific automatic method, proposed here, has been tested for assisting the surgeon in preoperative planning. Case Presentation: In the case reported, the described method allows effective surgery planning that led to a significant decrease in asymmetries in the orbital region. Conclusion: The multidisciplinary collaborative approach is a central element for the construction of effective personalized procedures and for the conception of new surgical approaches. The here proposed technology offers a good level of feasibility and has an achievable potential for breakthroughs in the improvement of facial deformities surgical treatment, thus representing an overwhelmingly useful tool in a clinical setting.

Evaluation of computed tomography parameters in patients with facial nerve stimulation post-cochlear implantation.

To compare the preoperative computed tomography (CT) parameters, including the thickness and density of the bone separating the upper basal turn of the cochlea (UBTC) and the labyrinthine segment of the facial nerve (LSFN), in patients with and without facial nerve stimulation (FNS) in post-cochlear implants (CI). A retrospective case review of 1700 CI recipients in a tertiary referral center between January 2010 and January 2020 was performed; out of the 35 recipients who were found to have FNS, 29 were included in the study. The control group comprised the same number of randomly selected patients. CT parameters of the patients were measured independently by three fellowship-trained neuro-otologists blinded to the postoperative status of the patients. Thickness in axial and coronal views and density of the bone separating the UBTC and the LSFN were measured. There was satisfactory agreement between the readings of the three reviewers. The distances (in mm) between the UBTC and LSFN obtained from the coronal (0.43 ± 0.24 vs. 0.63 ± 0.2) and axial (0.42 ± 0.25 vs. 0.6 ± 0.18) views were statistically lower in the FNS group (p = 0.001 and 0.005, respectively). The density (in HU) of the bony partition was also statistically lower in the FNS group (1038 ± 821 vs. 1409 ± 519; p = 0.029). Patients who experienced FNS postoperatively had significantly lower distance and bone density between the UBTC and theLSFN. This finding can help surgeons in preoperative planning in an attemptto decrease the occurrence of FNS.

Anatomical and Volumetric Analysis of the Sphenoid Sinus by Semiautomatic Segmentation of Cone Beam Computed Tomography.

This investigation was performed to analyze and evaluate anatomical and volumetric data of the sphenoid sinus by semiautomatic segmentation of cone beam computed tomography (CBCT) datasets.This analysis was carried out on cone beam computed tomography images of 100 patients. By using the discretionary software "ITK-Snap", the volumetric investigation of 197 sphenoid sinuses was conducted. The statistical analyses were carried out by using the paired and independent Student t-test. In addition, the Pearsons chi-square test was performed. P values P < 0.05 were considered significant.The volumetric mean was 4.438 ± 2.434 cm3 for the right and 4.809 ± 3.000 for the left side. Results did not indicate statistically significant differences according to the side, irrespective of gender (P > 0.05). The further investigation of differences between male and female patients did assess significant results (P < 0.05), males (10.477 ± 3.851 cm3) present a larger total sinus volume than females (8.219 ± 3.574 cm3). In accordance to patients' age (median 54 years), smaller volumes were related to younger patients and larger volumes to older ones. But, no statistically significant results in accordance to age could be detected (χ2 = 1.258; P > 0.05).Endoscopic sinus surgery of the vulnerable and intricate anatomy of the sphenoid sinus requires an explicit knowledge and orientation about the anatomical variations such as septums and volumetric capacity. Concerning this matter, semiautomatic segmentation of CBCT images can aid the surgeon in preoperative planning. Our investigation shows that a small sinus volume, that is, affecting female patients and a complex sinus anatomy by the occurrence of a septum, especially located close to neurovascular structures could essentially aggravate endoscopic sphenoid sinus surgery. In this regard, volumetric analysis of the sphenoid sinus by CBCT images can provide presurgical information and facilitates an individualized treatment.

EVAR-eaSE: An Easy-to-Use Software for Planning Sac Embolization in EndoVascular Aneurysm Repair Procedure

Background: Endovascular aneurysm repair (EVAR) has become the primary choice of treatment for abdominal aortic aneurysm (AAA) and preventive intraoperative AAA sac embolization (SE) is an effective way to reduce endoleaks after EVAR. Preoperative planning of AAA SE has not been standardized yet, and typically requires a quite long and operator-dependent procedure using standard EVAR planning software. Methods: We introduce ‘EVAR-eaSE’, a software tool that we have developed to help vascular surgeons to plan the optimal SE procedure during EVAR, providing semi-automatic AAA segmentation and 3D modeling starting from patient scans, and then computing the aneurysm volumes. A preliminary accuracy evaluation on radiological phantoms, and a comparison with the commercial 3Mensio software for EVAR planning are carried out. Results: EVAR-eaSE software showed a good level of accuracy in aneurysm volume reconstruction and calculation (mean difference of 2.5% between real and segmented phantom volumes). A strong positive correlation (r = 0.940, r = 0.954, p &lt; 0.001) was found between EVAR-eaSE computation of AAA Lumen and AAA Total volumes and the same measurements obtained with 3Mensio, for a database of 26 AAA cases. Conclusions: EVAR-eaSE demonstrated to be an easy-to-use, objective and accurate tool to assist the vascular surgeons in preoperative planning of SE during EVAR.

Vertebral Bone Quality Score and Postoperative Lumbar Lordosis Associated with Need for Reoperation After Lumbar Fusion

Poor bone quality is a known risk factor for hardware failure and adjacent segment disease after lumbar fusion. One new method of analyzing bone quality is the vertebral bone quality (VBQ) score, which can be obtained from preoperative lumbar magnetic resonance imaging (MRI) scans. We decided to evaluate whether patients' VBQ scores were associated with reoperation after lumbar fusion. We queried records of patients who underwent elective lumbar fusion for degenerative conditions between 2012 and 2017. Patients who required reoperations after lumbar fusions because of symptomatic hardware failure or adjacent segment disease were combined into a case group and compared with a matched control group. Of the 46 patients who underwent elective lumbar fusions and required reoperation, 30 met the inclusion criteria. A 2:1 control group of 60 individually age-, body mass index-, and sex-matched patients who did not require reoperation was then created. The reoperation group had significantly lower degrees of postoperative lumbar lordosis. There were no significant differences regarding other spinopelvic parameters, adjacent Pfirrmann scores, or dual energy x-ray absorptiometry (DXA) T scores. There was, however, a significant difference in VBQ scores between the groups, with the reoperation group having a higher VBQ score. This study found that bone quality, according to the VBQ score rather than the DXA T score, is an important risk factor for reoperation after lumbar fusion surgery. Therefore, this MRI-based tool may be used to assist surgeons in preoperative planning for spine surgeries with the goal of reducing the risk of requiring reoperation.

Predictors of safety margin for coracoid transfer: a cadaveric morphometric analysis

BackgroundThe purpose of this study was to investigate the relationship between the bone length available for coracoid transfer without coracoclavicular ligament injury and the distance from the coracoid tip to the attachments of the coracoacromial ligament or pectoralis minor. We hypothesized that cadaver height and the soft tissue attachments on the coracoid process were predictive factors for sufficient bone length for coracoid transfer.MethodsThis study included 28 shoulders from Japanese cadavers: 19 male and 9 female. The distance from the coracoid tip to the distal attachment of the coracoclavicular ligament and the anterior and posterior margins of the coracoacromial ligament or pectoralis minor on the coracoid process were measured.ResultsThe mean available length for coracoid transfer was 24.8 ± 3.4 mm. There was a significant difference in length between male and female subjects, being 26.0 ± 2.9 mm and 22.2 ± 3.0 mm, respectively (p = 0.004). High positive correlations were found between the length of the coracoid transfer and cadaver’s height (r = 0.48, p = 0.009) and the distance from the coracoid tip to the anterior coracoacromial ligament attachment (r = 0.63, p < 0.001). The receiver operating characteristic curve area under the curve for cadaver height was 0.72 while that for distance from coracoid tip to anterior coracoacromial ligament was 0.88 when predicted for a sufficient length for coracoid transfer > 25 mm.ConclusionsOur findings will aid surgeons in preoperative planning and performing of osteotomy of the coracoid safely by predicting the available length of coracoid bone graft.

Cutaneous angiosome of the chimeric SLGA perforator flap: Anatomical study and clinical considerations

The superior lateral genicular artery (SLGA) is the basis for a chimeric perforator flap in the lateral knee region, which may include bone, cartilage, fascia, and/or skin. To the best of our knowledge, a detailed description of the corresponding perforator-based skin area is missing in the literature. The aim of this study was to describe the extent and possible variations of the cutaneous angiosome of the SLGA. In an anatomical study on 21 fresh frozen lower limbs, the SLGA was injected with toluidine blue. The anatomy of the vessel and its perforators was explored, and the skin containing the cutaneous angiosome was harvested and photo-documented. Evaluation of the images was performed using ImageJ software. In addition, the versatility of the SLGA perforator flap is illustrated as both a pedicled local and a free tissue transfer. For each vessel, there were 1.75 ± 0.9 (range 1-3) perforators at an average position of 47.3 ± 21.3 mm lateral to the superolateral patella and 42.5 ± 18.7 mm proximal to the knee joint. The angiosome area was 222.8 ± 57.6 cm2 with a length of 20.9 ± 3.0 cm and a width of 15.4 ± 3.0 cm. At the longitudinal axis of the highest perforator density, the proximal end and the distal end of perfusion averaged 13.4 ± 4.1 cm proximal and 2.5 ± 2.0 cm distal to the knee joint, respectively. Our results show that the SLGA supplies a constant angiosome over the anterolateral proximal knee joint. Its description and visualization will guide surgeons in preoperative planning and further extend the use of this versatile chimeric perforator flap.