Surgical Treatment Research Articles

Examining the standalone efficacy and safety of tranexamic acid in chronic subdural hematoma: a comprehensive review and meta-analysis

BackgroundChronic subdural hematoma (CSDH) is an important medical condition characterized by the accumulation of blood in the subdural space. Several methods have been explored, including surgical intervention and administration of tranexamic acid, which is a conservative treatment option. This meta-analysis aimed to assess the effectiveness and safety of tranexamic acid in CSDH management.MethodsA systematic literature search was performed according to the PRISMA and MOOSE guidelines. This study included cohort and randomized controlled trials involving adults with chronic subdural hematoma (CSDH) who were treated with intravenous tranexamic acid. The primary outcome measures were recurrence and adverse events.ResultsSix studies encompassing 2024 participants were included. Studies have shown that tranexamic acid reduced recurrence rates (OR, 0.32; 95% CI: 0.27–0.38, p = 0.16; I2 = 0%), although the result was non-significant. However, the analysis of adverse events indicated a moderate level of heterogeneity (OR, 1.14; 95% CI: 0.60–2.15, p = 0.07; I2 = 57%), suggesting a potential safety concern.ConclusionIn conclusion, this meta-analysis suggests tranexamic acid (TXA) may reduce chronic subdural hematoma (CSDH) recurrence, though significance varied across studies. Adverse effects with TXA were similar to controls. Larger trials are needed to confirm TXA’s role in CSDH management.

Clinical features and prognostic factors of IV combined small cell lung cancer: A propensity score matching analysis

Background Nowadays, the characteristics and treatment of combined small-cell lung carcinoma (CSCLC) remain controversial. This study aimed to analyze the features of clinical demographics, survival outcomes and treatment modalities among IV CSCLC, IV SCLC and IV NSCLC, to provide more evidence for the study of IV CSCLC. Methods All CSCLC, SCLC and NSCLC patient data were obtained from the SEER database (2010–2020). Pearson’s χ2 test was used to compare the differences in clinical characteristics. Propensity score matching (PSM) was utilized to balance the bias of the variables between patients. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify prognostic factors. KM analysis was used to calculate survival. Adjusted analyses for the primary outcome of different treatment modalities of IV CSCLC, IV SCLC and IV NSCLC were performed using Cox regression models. Results A total of 493 patients with IV CSCLC, 35503 patients with SCLC, 122807 patients with IV NSCLC were included in this study. The demographic characteristics and tumor characteristics of the three groups were different. Before PSM, there were significant differences in OS and CSS among IV CSCLC, IV SCLC and IV NSCLC, After PSM, there was a significant difference in OS and CSS between the IV CSCLC and IV NSCLC. Risk/protective factors for OS and CSS were different in three groups. Chemotherapy, radiotherapy, and surgery can improve IV CSCLC’s survival time. The combination of surgery and chemoradiotherapy treatment group for patients with IV CSCLC demonstrated best OS compared to control treatment groups, and the surgery combined chemotherapy treatment group exhibited the best CSS. Additionally, for select patients with stage IV CSCLC who have missed the window for surgical intervention at the time of initial diagnosis, chemoradiotherapy presents a viable and effective treatment option. Conclusions The clinical characteristics IV CSCLC, IV SCLC and IV NSCLC were significantly different. The prognosis for IV CSCLC is notably poorer than IV NSCLC, similar to IV SCLC. Surgery combined therapy emerged as the preferred treatment modalities and chemoradiotherapy was a good choice for patients who have lost the indication of surgery for patients diagnosed with IV CSCLC.

Intestinal malrotation in newborns and infants: comparative possibilities of ultrasound and radiologic methods of investigation

BACKGROUND: Intestinal malrotation is a congenital pathology that results from abnormal fixation and rotation of the midgut during fetal development. This pathological condition is most often diagnosed during the first month of life and is often manifested by the presence of regurgitation, restlessness, vomiting with an admixture of bile, low weight gain. The narrow root of the mesentery facilitates the formation of midgut ingestion, which can lead to ischemia and necrosis and requires urgent surgical intervention. Ultrasound and radiologic examination with contrast are currently used to diagnose malrotation. AIM: To improve the diagnosis of intestinal malrotation in newborns and infants by carrying out a comparative analysis of the capabilities of radiologic and ultrasound methods of investigation when they are used in combination. MATERIALS AND METHODS: Data from 112 patients aged from 1 day from birth to 3 months 26 days between 2016 and 2024 with ultrasound signs of malrotation detected by microconvex and linear transducers were analyzed. 50 children were further followed up with this provisional or final diagnosis. Contrast agent passages and irrigographs were performed on an AXIOM Luminos DRF (Siemens), with 1 to 15 radiographs and up to 8 X-ray examination series obtained. RESULTS: The most common ultrasound sign of malrotation was atypical location of mesenteric vessels, and the most common radiologic sign was left-sided location of the colon and high standing of the cecum. Assessment of the location of the duodenojejunal junction was complicated in most cases. Surgery was performed in 17 children, one of them for suspected intestinal obstruction, and a ring-shaped pancreas was found in 4 patients. The diagnosis of malrotation was made in 40 children out of 50, in 4 cases this was discordant with the radiologic findings. Concomitant abnormal location of internal organs was detected in 12 patients. CONCLUSION: Screening ultrasound examination of all newborns should be considered as the pathology may be asymptomatic. It is important to include suspicion of malrotation in the diagnosis because of the possible manifestation of the pathology at a later age. It is currently not possible to completely abandon radiologic examination with contrast in the diagnosis of malrotation.

Unveiling the influence of tumor and immune signatures on immune checkpoint therapy in advanced lung cancer

This study investigates the variability among patients with non-small cell lung cancer (NSCLC) in their responses to immune checkpoint inhibitors (ICIs). Recognizing that patients with advanced-stage NSCLC rarely qualify for surgical interventions, it becomes crucial to identify biomarkers that influence responses to ICI therapy. We conducted an analysis of single-cell transcriptomes from 33 lung cancer biopsy samples, with a particular focus on 14 core samples taken before the initiation of palliative ICI treatment. Our objective was to link tumor and immune cell profiles with patient responses to ICI. We discovered that ICI non-responders exhibited a higher presence of CD4+ regulatory T cells, resident memory T cells, and TH17 cells. This contrasts with the diverse activated CD8+ T cells found in responders. Furthermore, tumor cells in non-responders frequently showed heightened transcriptional activity in the NF-kB and STAT3 pathways, suggesting a potential inherent resistance to ICI therapy. Through the integration of immune cell profiles and tumor molecular signatures, we achieved an discriminative power (area under the curve [AUC]) exceeding 95% in identifying patient responses to ICI treatment. These results underscore the crucial importance of the interplay between tumor and immune microenvironment, including within metastatic sites, in affecting the effectiveness of ICIs in NSCLC.

Fixing of intertrochanteric fractures with proximal femoral nail antirotation 2 by a double incision technique: a retrospective analysis

Background: The incidence of hip fractures is projected to rise from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most prevalent surgical intervention for intertrochanteric fractures. Hip fractures represent a significant healthcare issue amongst the elderly. The aim of this study is to evaluate a double incision technique in comparison to the conventional incision for fixing intertrochanteric fractures using the standard proximal femoral nail antirotation (PFNA2). Methods: This study took place at Dr. D. Y. Patil hospital in Navi Mumbai, India, from May 2023 to May 2024 employing an open-label, retrospective, randomized, and comparative methodology. A total of 100 patients with proven radiographic intertrochanteric fracture having undergone fixation with PFNA2 were analysed, with 50 undergoing the double incision and 50 serving as the stand control group. Results: The minimally invasive technique with a modified incision using the standard proximal femoral nail A2 can reduce bleeding, enhance precision for the entry point of the guidewire, shorten the time required for the entry, decrease soft tissue injuries, and provide better aesthetic outcomes. Conclusions: The current study delineates a minimally invasive surgical technique employing a double incision for the fixation of intertrochanteric fractures using the proximal femoral nail A2, underscoring its benefits.

Effects of trabeculectomy on the postoperative central visual field as revealed by refraction values

Abstract Purpose To evaluate the effects of trabeculectomy on the rate of deterioration of the central visual field (VF) in patients with normal-tension glaucoma (NTG), as revealed by refraction values. Study design Retrospective case series. Methods We retrospectively analyzed 28 eyes, including 12 high myopic (spherical equivalent [SE] < ˗ 6 diopters without pathological myopia) and 16 non-high myopic (SE ≥ – 6 diopters) eyes. The rate of VF deterioration (dB/year) was determined using linear regression analysis of 30 -2 and 10 -2 VF tests. The Wilcoxon signed-rank test was used to compare deterioration rates between groups. To assess the influence of initial post-surgery effects, statistical analyses were conducted with and without data from the initial postoperative VF exam. Results Trabeculectomy significantly reduced intraocular pressure (IOP) in myopic (14.1 to 9.0 mmHg, P ≤ 0.01) and non-myopic (13.4 to 9.5 mmHg, P ≤ 0.01) eyes. Postoperatively, the 10-2 VF deterioration rate significantly decreased in myopic (˗ 1.31 to ˗ 0.55 dB/year, P = 0.01) and non-myopic (– 0.80 to – 0.30 dB/year, P = 0.03) eyes. Excluding the first postoperative VF exam, the deterioration rates were – 0.51 ± 0.24 dB/year and – 0.54 ± 0.89 dB/year, respectively, indicating a minor impact on progression assessment. Conclusions Trabeculectomy may mitigate central VF deterioration in myopic NTG patients, emphasizing the potential benefits of timely surgical intervention. Further studies are needed to determine the optimal timing for surgery.

Surgical treatment options of displaced midshaft fractures of the clavicle in young adults: plate fixation versus intramedullary nailing

Background: This study aimed to compare the outcomes and complications of active young adults undergoing open reduction and plate fixation (ORPF) and intramedullary nailing (IMN) for displaced midshaft clavicle fractures (MCFs). Methods: A retrospective review was performed on all patients undergoing ORPF and IMN of complete MCFs at a single center between 2018 and 2022. Patients who were younger than 60 years with radiographic follow-up until union were included in the study. The mean age of the patients was 33.1 years. Outcome measures were achievement of union, time to healing, residual deformity, complications, and need for additional procedures.Results: Of 39 patients, 29 underwent ORPF and 10 underwent IMN. Plate fixation provided faster functional recovery in the first 6 months, but no difference was observed after 1 year. All fractures in the IMN group healed (100%), compared to 90% in the ORPF group (P=0.08). Mean time to union was 21±8.9 weeks and was significantly different between the two groups (P<0.01), with the ORPF group averaging 23.1 weeks and the IMN group 20.8 weeks. Nonunion rates were higher in the ORPF group (10.3%) than in the IMN group (0.0%), but the difference was not significant (P=0.10).Conclusions: Both methods restored patients to their pre-injury functional levels. However, IMN, with its higher healing rate, fewer required revision surgeries, and lower incisional numbness, appears to be the preferred method for treating MSFs without comminution in young adults.Level of evidence: III.

Recurrence rates after strictureplasty for small bowel Crohn's disease remain high in the era of biologics

AbstractAimDespite advancements in therapeutic options for Crohn's disease (CD), strictureplasty is a mainstay bowel‐preserving technique for small bowel CD. We sought to audit international practice across three high‐volume centres since the widespread use of biologic medication.MethodsA retrospective audit was performed for all strictureplasties undertaken for small bowel CD, over a 15‐year period (2006–2021), in three high‐volume centres in the United Kingdom and Italy. Primary endpoints were clinical recurrence and reoperation for recurrence.ResultsIn all, 123 patients were included; 58% were men, 25% smoked and 60% had previous abdominal surgery for CD. Median age was 40 years (interquartile range 30–52 years), mean body mass index 22 (15–31) and median disease duration 138 months (81–255 months). 42% had been treated with biologics preoperatively. In total 338 strictureplasties were performed in 123 patients, with a median of two per patient (interquartile range 1–3). Complications occurred in 35%, with 8% scoring Clavien–Dindo Grade 3. There were no Grade 4/5 complications. Postoperative biologic treatment was administered to 84/123 patients (68.3%). Median follow‐up was 54 months. 41/123 patients (33.3%) developed clinical recurrence. Reoperation for recurrent stricturing was performed in 26/123 patients (21%). Clinical recurrence and reoperation rates were significantly higher in patients who continued to smoke after their index surgery.ConclusionStrictureplasty remains a safe and effective surgical treatment for small bowel CD. Recurrence and reoperation rates remain high, regardless of postoperative biologic therapy. Smoking significantly increases the risk of recurrence.

Influence of Preoperative Disability on Outcomes Following Primary Surgical Treatment of Cervical Disc Herniation

Influence of Preoperative Disability on Outcomes Following Primary Surgical Treatment of Cervical Disc Herniation

Treatment for acute alcoholic-alimentary pancreatitis with peritoneal syndrome

A large number of publications on surgical treatment of acute alcohol-induced pancreatitis (AAP) with peritonitis indicates the importance of the problem and the need for a differentiated approach to treatment. The aim of this study is to determine the optimal treatment policy for acute alcohol-associated pancreatitis with peritonitis. The study included 114 male patients diagnosed with acute alcoholic pancreatitis and peritoneal sepsis, with an average age of 48.6 ± 6.4 years. They were admitted to the surgical departments of clinical hospitals between 2013 and 2023. The diagnosis of AAP was confi med based on clinical, laboratory, and instrumental findings. The classification of acute pancreatitis recommended by the National Clinical Guidelines of the Ministry of Health of the Russian Federation (2015 and 2020) has been applied. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scale has been used to assess the severity and prognosis of the disease, while the Sequential Organ Failure Assessment (SOFA) scale has been used to evaluate organ failure. Based on the results, an algorithm for the treatment of acute alcoholic and alimentary pancreatitis with peritoneal syndrome has been proposed, taking into account the type of pancreatic necrosis, the extent of pancreatic damage, and the nature of fl uid accumulation. For patients with edematous pancreatitis, small-focal sterile pancreatic necrosis, and enzymatic peritonitis, percutaneous ultrasound-guided abdominal and omental drainage is recommended. In severe and moderate acute alcoholic-alimentary pancreatitis, with enzymatic peritonitis (more than 8 points on the APACHE II scale), which is manifested during diagnostic and sanitation laparoscopy by the presence of a hemorrhagic effusion and a large number of plaques of steatonecrosis on the parietal peritoneum and the large omentum, we should use an endovisual method of draining the abdominal cavity and the omentum to minimize anesthesiological and surgical aggression and to form and maintain general cavities, as well as to create good access to the pancreatic area. For patients with large-focal, infected subtotal or total pancreatic necrosis and purulent peritonitis, it is advisable to perform laparotomy, abdominalization of the pancreas, necrectomy, omentobursostomy, and drainage of purulent foci in the abdominal cavity and retroperitoneal tissue.

Efficacy of the Rezūm System for lower urinary tract symptoms in patients with benign prostatic hyperplasia: Long term results from a single centre prospective study

Introduction: Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. Methods: We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS ( p < 0.001), Qmax ( p < 0.001), PVR ( p < 0.001) and IPSS-QoL ( p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. Conclusions: In conclusion, the study’s findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment.

Nice knots assistance in comminuted and displaced clavicle fractures reduce intraoperative blood and shorten operation time with a satisfactory postoperative clinical outcome

BackgroundThis study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures.MethodsA systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated.ResultsScreening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment.ConclusionThis study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

Correction of Severe Pterygium Colli with a Staged, Double, Posterior and Lateral Approach: A Case Report

AbstractPterygium colli is a rare congenital disorder characterized by excessive skin in the lateral and posterior neck, often associated with genetic syndromes such as Turner's syndrome or Klippel–Feil syndrome. Severe presentations present special challenges for surgeons since its diagnosis is not always evident and its treatment often results in important scaring. Surgical correction of the typical cases mostly involves a lateral approach, but in this “special” case, we used a double, posterior and lateral approach. A 15-month-old girl with prenatal diagnosis of a cystic lesion in the posterior neck presented with massive neck webbing at birth. Genetic studies ruled out chromosomal disorders and RASA 1 mutations. Surgical correction involved a modified posterior approach combined with a lateral approach 1 year later. The cervical tissue redundancy was successfully reduced achieving a good aesthetic outcome with very acceptable scars. At 1 year of follow-up, the patient continues with good neck appearance and mobility. The goal of surgical treatment of pterygium colli is achieving a harmonious neck contour with good function and minimal scarring while minimizing complications and sequelae. No consensus exists on the optimal approach for its correction, emphasizing the need for individualized treatment considering patient-specific characteristics, particularly in the severe cases.

Comprehensive treatment of the patient with venous trophic ulcer

Improving the results of treatment for patients with varicose veins in the lower extremities, complicated by trophic ulcers, is an urgent task for modern medicine. A long-term, recurrent course of the disease leads to a reduction in working capacity and deterioration in quality of life, as well as permanent disability for patients, whose treatment causes special economic problems. At present, there are virtually no effective methods for conservative therapy, leading to prolonged unsuccessful treatment of such patients. This article presents the clinical case of a 63-year-old patient undergoing complex treatment for chronic lower limb venous insufficiency of class C6 according to the CEAP classification. Conclusion. An effective complex method for treating trophic ulcers in patients with chronic venous disease involves the correction of venous hemodynamic disorders (in this case, through radiofrequency ablation), as well as primary surgical treatment for the ulcerative defect, and simultaneous autodermaplasty with a perforated skin flap.

A Programming Algorithm for Optimizing Hypoglossal Nerve Stimulator Respiratory Entrainment

Hypoglossal nerve stimulation (HNS) is a surgical treatment for obstructive sleep apnea that activates in a phasic manner. The most widely available HNS device has respiratory entrainment programming settings that are not widely utilized. We present an algorithm for office‐based respiratory sensing adjustments to optimize HNS respiratory entrainment. Laryngoscope, 2024

Physical justification of the safety of using a surgical laser with a wavelength of 445nm during stapedoplasty

Abstract Introduction. Surgical lasers with different wavelengths are used in the surgical treatment of patients with otosclerosis. There are undoubted advantages of using surgical lasers during stapedoplasty at its various stages. At the same time, there is a risk of negative consequences for the structures of the inner ear due to the transition of light energy into thermal energy. Currently, the search for modern optimal surgical lasers for stapedoplasty continues. Aim ofthe study. To substantiate the safety of using a laser beam with a wavelength of 445nm during stapedoplasty using an experimental physical model. Materials and methods. Together with physicists from the Russian Engineering Club LLC, a physical experimental model was created to theoretically substantiate the use of a surgical laser with a wavelength of 445nm during stapedoplasty at its various stages. Results. Based on the physical calculations carried out during our study, we came to important conclusions regarding the effect of laser radiation on the structures of the inner ear during the stapedoplasty process. It was found that even if the value of the parasitic (damaging) radiation energy is 10 W (maximum value) with an average pulse duration used for perforation of the footplate of the stirrup is 0.15 s, then its effect will not lead to any significant thermal effect on the perilymph. Conclusions. The obtained data serve as a basis for further research and improvement of laser technologies in the field of otosurgery. As part of our study, we anticipate the need for additional histological analysis based on the results obtained. Despite encouraging findings regarding the safety of parasitic laser radiation in the context of thermal exposure to perilymph, histological examination represents an important next step for a deeper understanding of structural changes in the tissues of the inner ear.

Orthopaedic surgical treatment waiting time for acute musculoskeletal trauma patients attended at Muhimbili Orthopaedic Institute, Dar-Es-Salaam

Orthopaedic surgical treatment waiting time for acute musculoskeletal trauma patients attended at Muhimbili Orthopaedic Institute, Dar-Es-Salaam

Treatment of local purulent postoperative soft tissue complications in patients of older age groups with fractures of the proximal femur

BACKGROUND: Surgical treatment of fractures of the proximal femur in elderly patients makes it possible to put patients on their feet early and improve their quality of life. Local purulent complications in the postoperative period after hip fractures surgical treatment occur in 5–10% of cases. AIM: To improve the treatment outcomes of patients with local postoperative purulent complications of soft tissues by a comparative analysis of treatment methods with various antibacterial, antiseptic hydrogels and physical methods of wound treatment. MATERIALS AND METHODS: The article presents the nature of local purulent complications, their clinical picture, and diagnostic features. All the patients are divided into 2 groups. The main group included 53 patients, and the control group included 48. The patients of the main group underwent comprehensive treatment of local purulent complications using modern technologies (plasma scalpel) and dressings with hydrogel Argacol. The control group was treated with traditional bandages with dioxomethyltetrahydropyrimidine and chloramphenicol. RESULTS: The use of surgical wound treatment using a plasma scalpel and dressings with multifunctional hydrogel allows to accelerate the wound healing process by 2–3 weeks compared with the use of traditional techniques. CONCLUSIONS: The application of the proposed tactics of providing specialized care to elderly patients with a fracture of the proximal femur allows for a significant (p 0.05) improvement in treatment results.

Assessment of transfer-time and time-to-surgery as risk factors to survival in Gastroschisis (GS) in a LMIC; an eight-year review

BackgroundThe management of Gastroschisis in LMICs continues to be a challenge and is associated with very poor outcomes in contrast with HICs where survival rates near 100%. The purpose of this work is to provide an overview of survival over the past 8 years in a high-flow tertiary centre in Africa. It also investigates the effect of transfer-time and time-to-surgery on outcome.MethodsRetrospective case note review of all GS admissions. The variables assessed were gender, gestational age, weight, type of GS, transfer time, time to surgery and type of surgery. The primary outcome was survival.ResultsA total of 171 GS cases were identified: 148 simple, 23 complex. Seven died before surgery. The median age at surgical intervention was 8.5 h (range, 0–48). Closure options ranged from single-staged (primary fascial, skin, umbilical flap and sutureless closure) or a staged (silo) closure. Overall survival was 34.5%. Cases transferred under 8 h had a 46% survival. Surgery under 12 h of life had highest survival, 45%. Simple GS survived better than complex GS (40% vs 10%). Primary closure had a significantly better survival compared to staged closure (51% vs 18%).ConclusionsTransfer-time < 8 h plays a vital role in survival of GS cases. Surgical intervention within 12 h of birth showed a statistically significant improvement in outcome. Primary closure was associated with better survival rates.Level of EvidenceLevel III.

Walking Ability After Microsurgical Reconstruction of Pediatric Popliteal Pterygium Syndrome—A Case Report

Background: Popliteal pterygium syndrome (PPS) is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. Surgical interventions are necessary to address the severe knee flexion contracture and equinovarus deformity, but there are no established treatment guidelines. Methods: We present the case of a one-year-old patient with PPS and discuss the challenges in managing the knee deformity. The surgical option chosen for the unilateral knee contracture of 80° consisted of skin management by a large Z-plasty, lengthening of popliteal vessels by grafts, lengthening of the tibial and peroneal nerves by autografts and allografts, capsular releases, and tendon releases to improve mobility and preserve foot sensibility. Results: With a three-year follow-up, the surgical interventions resulted in proper ability to walk freely. Wearing of a foot orthesis was necessary to balance the leg length differences and support the midfoot deformity. Furthermore, sensation of the foot could be restored in terms of touch sensibility and perfusion was always stable during growth. Discussion: The treatment of PPS requires a multidisciplinary approach, considering the rarity and complexity of the syndrome. Surgical interventions aim to release contractures, correct deformities, and preserve foot sensibility. Each treatment option has its advantages and disadvantages, highlighting the need for individualized care.