Systematic Review Of Outcomes Research Articles

Single-visit versus multi-visit endodontic retreatment: A systematic review of outcomes in patients with secondary endodontic infection

Abstract Introduction: Secondary endodontic infections present intricate challenges in dental practice, necessitating effective retreatment strategies. The current systematic review aimed to critically evaluate the outcomes of single-visit versus multi-visit endodontic retreatment in patients with secondary endodontic infections. Materials and Methods: The current systematic review was registered in the Open Science Framework database and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in PubMed/Medline, Scopus, and Web of Science databases for articles published until April 2023. The inclusion criteria for the current systematic review were clinical trials reporting the comparison of nonsurgical single-visit versus multiple-visit endodontic retreatments with predictive outcome. The Cochrane scale was used to assess the risk of bias. Results: Six studies were included in the systematic review. Four studies reported the incidence of postoperative pain, and two studies reported the periapical lesion healing after single- and multiple-visit endodontic retreatments with an 18- and 24-month follow-up. Three studies showed a low risk of bias, one study showed unclear risk of bias, and two studies showed a high risk of bias. Conclusion: Comparative analyses indicated that single-visit endodontic retreatment yielded comparable postoperative pain levels and healing outcomes as retreatment conducted over multiple visits. Notably, the utilization of intracanal medicaments such as calcium hydroxide and triple antibiotic paste demonstrates promise in mitigating postoperative pain subsequent to retreatment procedures.

Endoscopic Transforaminal versus Interlaminar Discectomy in Management of Lumbar Disc Herniation: A Systematic Review of Outcomes and Complications

Abstract Background Lumbar herniated discs are common manifestations of degenerative spine diseases, being the main cause of radiated lower back pain. Aim of the Work The aim of this study is to compare between the transforaminal approach and the interlaminar approach in the incidence of complications and clinical prognosis scores in patients with lumbar disc herniation. Patients and Methods Literature searches was conducted using the following databases:” PubMed, Web of Science, ScienceDirect, Scopus, Cochrane Library, Google Scholar, Medline” using the following key words: “percutaneous transforaminal endoscopic discectomy, percutaneous interlaminar endoscopic discectomy, operative complications, minimally invasive, discectomy, endoscopic” from studies published after 2010. Results Although there is no significant difference between the two groups of comparison regarding percentage of postoperative complications, VAS scores, or ODI scores, However, PEID was superior to PETD regarding fluoroscopy times and operative time. The increased radiation exposure might be caused by the higher iliac crest, narrower foramina, or larger facet joints, which increased the difficulty of percutaneous puncture. Repeated fluoroscopy must be used to guide the puncture. In addition, the hypertrophy of ligamenta flava might also contribute to the difficulty of puncture and further increase radiation exposure in the PETD group. Conclusion This review provides evidence that both PEID and PETD are safe, effective, and minimally invasive surgical methods for the treatment of lumbar disc herniation, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed.

Endoscopic Versus Open Carpal Tunnel Release: A Systematic Review of Outcomes and Complications.

Carpal tunnel syndrome (CTS) is a condition that causes discomfort due to the compression of the median nerve in the wrist. Carpal tunnel release (CTR) is a surgical procedure that can help alleviate the symptoms of CTS. Two methods are commonly used for CTR: endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). The choice of method can impact surgical outcomes and potential complications. This review aims to compare the outcomes of both methods for individuals diagnosed with CTS. This systematic review analyzes the outcomes and potential complications of ECTR and OCTR for CTS. The study encompassed a comprehensive analysis of randomized controlled trials (RCTs) and meta-analyses comparing both methods. We searched for studies released between January 2012 and October 2023 on PubMed, Science Direct, and Google Scholar. The researchers assessed the quality of studies using the Cochrane risk of bias tool and the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool. The study's scope included a range of outcomes and complications, such as symptom relief, functional recovery, grip strength, return to work, patient satisfaction, scar sensitivity, pillar pain, wound complications, nerve-related issues, morphological changes, and recurrence. The review analyzed 11 studies, including seven RCTs and four meta-analyses. These studies evaluated 4367 ECTR and 4107 cases of OCTR. The patients' ages ranged from 46 to 58, and the follow-up periods ranged from three to 24 months. The findings reveal that ECTR has comparable or better outcomes than OCTR, particularly in postoperative discomfort, functional recovery, grip strength, resumption of work, and patient satisfaction. Additionally, ECTR has lower levels of scar sensitivity, pillar pain, and wound-related complications than OCTR. However, ECTR carries a higher risk of reversible nerve injury. There were no substantial differences between the two techniques regarding other potential complications. Both ECTR and OCTR are safe and effective interventions for CTS. ECTR has benefits like faster recovery and improved cosmetic outcomes but requires higher technical proficiency and carries the risk of nerve injury. The choice of technique should consider patient preference, cost-effectiveness, and surgeon expertise.

Advancements in Enhanced Recovery After Surgery (ERAS) Protocols: A Systematic Review of Outcomes.

The advent of Enhanced Recovery After Surgery (ERAS) has introduced a total reformation in perioperative care, replacing classic methods with a better, evidence-oriented approach, that focuses on the patient rather than their surgery. ERAS protocol applies the comprehensive approach to patient care by taking all stages before, during, and postoperatively into account. These schemes center on personalized treatments that are customized to the individual's individual needs. The vital constituents of ERAS include nutrition evaluation and improvement, patient education, minimally invasive procedures, and multimodal pain management. ERAS provides a wide range of benefits such as a reduction in postoperative complications, shorter hospital stay periods, better patient outcomes, and a decrease in cost to the medical industry. This paper will discuss systematically what are previous clinical outcomes in general surgery with EARS protocol as compared to traditional approaches.

Penile prosthesis in priapism: a systematic review of outcomes and complications.

Priapism is a rare condition characterized by persistent erection of the penis that lasts more than 4 hours in the absence of sexual stimulation and is associated with significant morbidity and complications, including erectile dysfunction and penile fibrosis. Surgical management of priapism can be extremely challenging. We herein provide a comprehensive review that aims to evaluate the role of penile prosthesis (PP) implantation in the management of priapism. A systematic literature search was performed using the following databases: PubMed, Embase, and Scopus to identify studies that evaluated the effectiveness of PP implantation in treating priapism and the long-term complications, outcomes, and patients' satisfaction rate. Out of 717 English-language studies published between 2002 and 2022, 17 were chosen for this review. Majority of patients had a malleable PP (MPP) implant, either early or delayed after the priapism episode. Early placement (EP) of PP is widely defined between studies ranging from less than 72 hours, within 1 week, and within 3 weeks. Most common causes of priapism were sickle cell anemia (SCA), medication-induced, and idiopathic. Studies show a higher satisfaction rate ranging between 80% and 100%, with sexual intercourse achievement ranging between 64.2% and 100%. Based on the GRADE system, included studies rated as very low quality of evidence. Commonly reported complications that arise after PP procedures, include device infection, erosion, curvature, and mechanical malfunction, such as auto-inflation. PP can be an effective treatment option for priapism, particularly in cases of ischemic priapism lasting more than 36 hours or recurrent priapism that is medically refractory. However, due to the very low quality of evidence, larger, well-designed studies are warranted where long-term outcomes, patients' satisfaction, and complications following priapism-related PP implantation are measured as endpoints.

Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes.

Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). Rhinoplasty. 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 .

(236) Does MDMA Have Treatment Potential in Sexual Dysfunction? A Systematic Review of Outcomes Across the Female and Male Sexual Response Cycles

Abstract Introduction Sexual health is a fundamental dimension of overall human well-being, deeply intertwined with physical health, interpersonal relationships, and the overall quality of life. However, sexual dysfunction is prevalent among both men and women. Despite it's common occurrence, it often remains underdiagnosed and undertreated. In an attempt to improve the treatment landscape and offer new hope for those suffering from sexual dysfunction, researchers have turned to explore unconventional therapies, examining substances beyond the traditional medicinal spectrum. Compounds typically associated with recreational use, like cannabis and LSD, have been subjects of recent studies, exploring their potential therapeutic value. Notably, 3,4-Methylenedioxymethamphetamine (MDMA), colloquially known as 'Ecstasy,' has been attracting significant scientific interest. This synthetic amphetamine is known for its psychostimulant and entactogenic properties, and anecdotally noted for its potential effects on the sexual response cycle. Objective To examine the existing literature on the effects of MDMA on male and female sexual responsiveness and the potential role of MDMA in treating sexual dysfunction of various etiologies. Methods We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms utilized were “MDMA” or “Ecstasy” in combination with “desire,” “arousal”, “lubrication”, “orgasm”, “pleasure”, “libido”, “erection” and “ejaculation”. Inclusion criteria for this review were MDMA use by study subjects, sexual outcomes in at least one domain of the female and/or male sexual response cycles were described and measured. Randomized control trials (RCT), cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. Results We identified 181 studies, of which six met criteria for assessment of the female sexual response cycle and eight met criteria for assessment of the male sexual response cycle. Four of six studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in three of four studies, but they were not affected in one randomized control study. In men, seven studies evaluated the effects of MDMA on desire and/or arousal, five studies measured impact on erection, three on orgasm, and two on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, two reported mixed effects, and one reported “fear of erection impairment.” In both men and women, all studies evaluating orgasm reported delay in achieving orgasm, but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative. Conclusions Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men. Disclosure No.

Liposuction-Only Breast Reduction: A Systematic Review of Outcomes.

Over the past few decades, there have been multiple reports of liposuction assisted breast reduction. This technique appeals to patients due to the limited scars and complication profile, compared to traditional reduction mammaplasty techniques. We aimed to systematically review the literature, to elucidate the outcomes and safety of liposuction-only breast reduction. A systematic review was performed using the Ovid (Medline/PubMed) database, in accordance with the PRISMA checklist. In total 7 articles were included within this systematic review. A total of 652 patients were included. Liposuction-only breast reduction appears to lead to improvements in subjective outcome measures, patient satisfaction, and objective outcomes such as moderate breast volume reduction and reduction in breast ptosis. Overall, the procedure had a low complication profile. Liposuction did not preclude further surgery. No evidence of malignancy or difficulty in future breast cancer screening was noted. Macromastia leads to a considerable health burden, especially in health-related costs. From the current evidence base, liposuction-only breast reduction appears to be a safe and effective procedure, especially in patients requiring a mild-moderate breast volume reduction and mild ptosis correction. More research is required, with standardised subjective and objective outcome measures, and longer follow-up periods to confirm the effectiveness and safety of this technique. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes

BackgroundTotal hip arthroplasty (THA) has become a common intervention for human immunodeficiency virus (HIV)–positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV. MethodsA comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 10 studies with 9,534 HIV-positive patients fulfilled the inclusion and exclusion criteria. Manuscript quality was assessed on 2 scales: the Coleman Methodology Score and the level of evidence derived from Center for Evidence-Based Medicine criteria. Data were extracted from studies in the 5 key areas of interest: survivorships, PROMs, infection rates, complications, and clusters of differentiation-4 (CD4+) counts and viral loads. ResultsImplant survivorship was between 95% and 100%. Postoperative Harris Hip Scores were significantly improved from preoperative values in HIV-positive patients. Postoperative PROMs and infections did not appear to be different between HIV-positive and HIV-negative patients. Many of the cohort studies demonstrate comparable complication rates to matched controls. Where described (7 reports), mean CD4+ counts ranged from 425 to 646 cells/mm3, with low viral loads (3 reports) and variations not found to influence outcomes. ConclusionsTHA is an effective treatment for HIV-positive patients, many of whom suffer from osteonecrosis of the femoral head. The results demonstrate excellent implant survivorship, improved quality of life, and a low risk of infections and complications.

Lumbar Total Disc Replacements for Degenerative Disc Disease: A Systematic Review of Outcomes With a Minimum of 5 years Follow-Up.

Systematic Review. To systematically review the clinical outcomes, re-operation, and complication rates of lumbar TDR devices at mid-to long-term follow-up studies for the treatment of lumbar degenerative disc disease (DDD). A systematic search was conducted on PubMed, SCOPUS, and Google Scholar to identify follow-up studies that evaluated clinical outcomes of lumbar TDR in patients with DDD. The included studies met the following criteria: prospective or retrospective studies published from 2012 to 2022; a minimum of 5years post-operative follow-up; a study sample size >10 patients; patients >18years of age; containing clinical outcomes with Oswestry Disability Index (ODI), Visual Analog Scale (VAS), complication or reoperation rates. Twenty-two studies were included with data on 2284 patients. The mean follow-up time was 8.30 years, with a mean follow-up rate of 86.91%. The study population was 54.97% female, with a mean age of 42.34years. The mean VAS and ODI pain score improvements were 50.71 ± 6.91 and 30.39 ± 5.32 respectively. The mean clinical success and patient satisfaction rates were 74.79% ± 7.55% and 86.34% ± 5.64%, respectively. The mean complication and reoperation rates were 18.53% ± 6.33% and 13.6% ± 3.83%, respectively. There was no significant difference when comparing mid-term and long-term follow-up studies for all clinical outcomes. There were significant improvements in pain reduction at last follow-up in patients with TDRs. Mid-term follow-up data on clinical outcomes, complication and reoperation rates of lumbar TDRs were maintained longer term.

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes

BackgroundIron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia.MethodsWe searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted.ResultsOut of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92%) reported outcomes within the ‘blood and lymphatic system’ domain, followed by “adverse event” (77%) and “need for further resources” (77%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33%) of six prospective studies were registered prospectively of which one (17%) showed no signs of selective outcome reporting.ConclusionThis systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS.Systematic review registrationPROSPERO CRD42020214247

Unilateral laminotomy with bilateral spinal canal decompression: systematic review of outcomes and complications

BackgroundUnilateral laminotomy with bilateral spinal canal decompression has gained popularity recently.AimTo systematically review the literature of unilateral laminotomy with bilateral spinal canal decompression for lumbar spinal stenosis (LSS) aiming to assess outcomes and complications of the different techniques described in literature.MethodsOn August 7, 2022, Pubmed and EMBASE were searched by 2 reviewers independently, and all the relevant studies published up to date were considered based on predetermined inclusion and exclusion criteria. The subject headings “unilateral laminotomy”, “bilateral decompression” and their related key terms were used. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.ResultsA total of seven studies including 371 patients were included. The mean age of the patients was 69.0 years (range: 55–83 years). The follow up duration ranged from 1 to 3 years. Rate of postoperative pain and functional improvement was favorable based on VAS, JOA, JOABPEQ, RMDW, ODI and SF-36, for example improved from a range of 4.2–7.5 preoperatively on the VAS score to a range of 1.4–3.0 postoperatively at the final follow up. Insufficient decompression was noted in 3% of the reported cases. The overall complication rate was reported at 18–20%, with dural tear at 3.6–9% and hematoma at 0–4%.ConclusionUnilateral laminotomy with bilateral decompression has favorable short- and mid-term pain and functional outcomes with low recurrence and complication rates. This, however, needs to be further confirmed in larger, long-term follow-up, prospective, comparative studies between open, and minimally invasive techniques.

Assessing complex interventions: a systematic review of outcomes used in randomised controlled trials on STI partner notification in high-income countries

BackgroundPartner notification interventions are complex and assessing their effectiveness is challenging. By reviewing the literature on the effectiveness of partner notification interventions, our aim was to evaluate the choice, collection, and interpretation of outcomes and their impact on study findings.MethodsWe conducted a systematic review of individual-level randomised controlled trials evaluating the effectiveness of partner notification interventions for bacterial STIs, HIV or sexually transmitted HCV in high-income countries since 2000. Partner notification interventions included assisted patient referral interventions and expedited treatment. The content analysis was carried out through a narrative review.ResultsIn the 9 studies that met the inclusion criteria, 16 different outcomes were found. In most studies, one or two outcomes assessing partner notification practices were associated with an outcome reflecting STI circulation through index case reinfections. These outcomes assessed the main expected effects of partner notification interventions. However, partner notification is composed of a succession of actions between the intervention on the index case and the testing and/or treatment of the notified partners. Intermediate outcomes were missing so as to better understand levers and barriers throughout the process. Potential changes in participants’ sexual behaviour after partner notification, e.g. condom use, were outcomes reported in only two studies assessing interventions including counselling. Most outcomes were collected through interviews, some weeks after the intervention, which might lead to desirability and attrition biases, respectively. Assessment of the effectiveness of partner notification interventions on partner testing/treatment was limited by the collection of data from index cases. Few data describing index cases and their partners were provided in the studies. Additional data on the number and type of exposed partners and the proportion of partners already aware of their infection before being notified would help to interpret the results.ConclusionsThese insights would help to understand why and under what conditions the intervention is considered effective and therefore can be replicated or adapted to other populations and contexts.

586 A Systematic Review of Outcomes Following Pyrocarbon Hemiarthroplasty of the Shoulder

Abstract Aim Pyrocarbon (PyC) is increasingly used in shoulder hemiarthroplasty (HA) due to its favourable tribology in reducing glenoid erosion. This systematic review aims to evaluate the clinical and functional outcomes, along with the survivorship of PyC HA. Method PubMed (MEDLINE), Cochrane, Embase, and Google Scholar were systematically searched from inception in accordance with the PRISMA guidelines. Searched terms included ‘Pyrocarbon OR Pyrolytic Carbon’, ‘Hemiarthroplasty’, and ‘Shoulder’. Studies reporting clinical, functional outcomes, or survivorship of stemmed PyC shoulder HA were included. Quality of evidence was assessed using the MINORS criteria. Results Six studies met the inclusion criteria. 197 shoulders with PyC HAs were analysed at mean follow-up of 30.1±7.6 months. The Constant Score improved from 35.1±16.5 preoperatively to 74.3±15.6 at final follow-up (p<0.001). Patients with post-traumatic sequelae showed less of an improvement, from 25.4±15.4 to 50.5±20.7 (p<0.005). Subjective Shoulder Value was reported in two studies, showing an improvement from 35.0±21.9 to 81.1±12.9 (p<0.001). Statistically significant improvements in active range of motion were reported across five studies. Radiographic evidence of progressive glenoid erosion was observed in 24.6% of the shoulders, however only 1.7% were revised due to painful glenoid erosion. The overall revision rate was 7.4%. Conclusions The current literature suggests PyC HA provides promising clinical outcomes comparable to non-PyC alternatives. The rate of clinically significant glenoid erosion at short-term follow-up remains low. However, the paucity in the literature would benefit from larger and longer-term studies to validate the use of PyC HA over other forms of shoulder arthroplasty.

A novel and easily reproducible technique for determining nipple placement in chest masculinization surgery

The rate of chest masculinization surgery for gender affirming purposes is increasing in the United States. This rise in popularity can be attributed to greater awareness of the needs of the transgender population and improved insurance coverage for gender affirming care. 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 2 Cohen W.A. Shah N.R. Iwanicki M. et al. Female-to-Male Transgender Chest Contouring: A Systematic Review of Outcomes and Knowledge Gaps. Ann Plast Surg. 2019; 83: 589-593https://doi.org/10.1097/SAP.0000000000001896 Crossref PubMed Scopus (21) Google Scholar Although there is a growing body of literature detailing techniques, algorithms, and outcomes of chest contouring, relatively little attention has been paid to management of the nipple-areolar complex (NAC). 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 3 Agarwal C.A. Wall V.T. Mehta S.T. et al. Creation of an Aesthetic Male Nipple Areolar Complex in Female-to-Male Transgender Chest Reconstruction. Aesthetic Plast Surg. 2017; 41: 1305-1310https://doi.org/10.1007/s00266-017-0935-7 Crossref Scopus (24) Google Scholar , 4 Canner J.K. Harfouch O. Kodadek L.M. et al. Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States. JAMA Surg. 2018; 153: 609https://doi.org/10.1001/jamasurg.2017.6231 Crossref PubMed Scopus (162) Google Scholar In comparison to surgery for cisgender males, the neo-NAC for transgender males is formed from a NAC which tends to have a larger areola, more prominent nipple, and different anatomic location. Incorrect positioning of the NAC (most often too high and too medial) is a common pitfall in chest masculinization surgery. 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 5 Lane M. Ives G.C. Sluiter E.C. et al. Trends in gender-affirming surgery in insured patients in the United States. Plast Reconstr Surg - Glob Open. 2018; 6https://doi.org/10.1097/GOX.0000000000001738 Crossref Scopus (93) Google Scholar Management of the NAC in chest masculinization surgery additionally requires understanding the dynamic response of the body to the chosen techniques. This is influenced by multiple factors including the breast size, excess skin, degree of ptosis, and pre-operative positioning of the NAC.

Displaced medial clavicle fractures: a systematic review of outcomes after nonoperative and operative management.

Fractures of the medial clavicle are uncommon. There is no consensus regarding the optimal treatment of displaced medial clavicle fractures. A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried using the terms medial clavicle and fracture to identify all studies reporting on outcomes following either nonoperative or operative treatment of displaced medial clavicle fractures. Data extracted included patient demographics, fracture classification, surgical technique, patient-reported outcomes, physical, and radiographic findings. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) scoring system. The analysis included 15 studies (mean MINORS score, 10±1.5) with a total of 135 patients (85% male, mean age 47±10.9 years [range, 15-87 years]). Five studies (39 patients) reported outcomes following nonoperative treatment. At a mean follow-up of 27 months, there were 5 (13%) symptomatic nonunions, 2 (5%) malunions, and 2 (5%) delayed unions. Eleven studies (96 patients) reported outcomes following surgical treatment with a mean follow-up of 23 months. There were no reported nonunions. Complications included plate prominence/ irritation (30%) and additional surgery was performed for plate removal (27%), fixation failure (3%), and wound débridement (1%). There is limited, low-quality evidence in the literature to guide treatment of displaced medial clavicle fractures. The available data suggest that surgical treatment is associated with good functional outcomes and a lower risk of nonunion and malunion, compared to nonoperative treatment but plate irritation and further surgery to remove the plate was common.

Closed Reduction and Percutaneous Fixation of Lisfranc Injury Using Suspensory Fixation.

This closed reduction and percutaneous fixation (CRPF) technique utilizing suspensory fixation is indicated for the treatment of Lisfranc injuries with displacement or instability of the tarsometatarsal joint complex-and typically only for low-energy, purely ligamentous Lisfranc injuries. The goal of this procedure is to restore joint stability and prevent common complications of Lisfranc injuries (e.g., midfoot arch collapse and posttraumatic arthritis) while avoiding the complications and risks associated with open reduction and internal fixation (ORIF) and primary arthrodesis. We recommend performing the procedure within 10 to 14 days of the injury; otherwise, an open debridement may be necessary to address scar tissue formation. We start with the patient in the supine position and perform a fluoroscopic stress examination of the joint. Next, the Lisfranc joint undergoes closed reduction, which is held in place with a clamp. Following reduction, a guidewire is drilled from the lateral border of the base of the 2nd metatarsal medially through the medial cuneiform, followed by a medial-to-lateral cannulated drill. The suspensory fixation is then passed lateral-to-medial, placing the suture button on the lateral cortex of the 2nd metatarsal base. The tape is then tensioned while a bioabsorbable interference screw is inserted to maintain tension. Prior studies have assessed both operative and nonoperative alternatives to CRPF with suspensory fixation for the treatment of Lisfranc injuries. Nonoperative treatment with closed reduction and cast immobilization of Lisfranc injuries is typically reserved for nondisplaced injuries; however, a number of studies have shown poor outcomes with use of this technique1-3. The 2 most common operative alternatives are ORIF and primary arthrodesis4. CRPF with suspensory fixation offers several benefits over both traditional surgical techniques such as ORIF and primary arthrodesis, as well as over percutaneous reduction and internal fixation (PRIF) with a screw. Compared with ORIF and primary arthrodesis, a number of studies have shown that percutaneous treatment of Lisfranc injuries minimizes soft-tissue trauma and reduces the risk of postoperative complications such as wound breakdown, infection, and complex regional pain syndrome, while allowing for earlier participation in rehabilitation5-10. A systematic review of outcomes following PRIF with screw fixation also showed that percutaneous treatment of Lisfranc injuries is a safe and effective technique with good functional outcomes11. When comparing PRIF with a screw to our technique of CRPF with suspensory fixation, CRPF has the added benefit of creating a nonrigid fixation in the Lisfranc joint, which allows for increased range of motion of the medial column and improved return to activity12,13. The rigid fixation in PRIF with a screw can also lead to metal irritation, intra-articular screw fracture, and impaired mobility, which often necessitate the need for screw removal13-15. This fixation-related drawback is not present with our technique, and also avoids the need for use of a biologic substitute such as tendon grafts13. Following CRPF with suspensory fixation, patients can expect to return to full activity at 12 to 16 weeks postoperatively. Postoperatively, patients are typically kept non-weight-bearing for 6 weeks. The operative foot is kept immobilized in a splint for the first 2 weeks, then transitioned to a boot. Between postoperative weeks 6 and 12, partial progressive weight-bearing is introduced with use of an arch support, progressing toward full weight-bearing13,16,17.For comparison, patients who underwent PRIF with screw fixation had a similar postoperative course, but almost all required screw removal at 4 to 6 months postoperatively13,16. Cho et al. retrospectively reviewed the results of 63 patients who underwent either PRIF with screw fixation (n = 32) or CRPF with a suture button (n = 31) and found that CRPF patients had significantly better American Orthopaedic Foot & Ankle Society midfoot scale scores (81 versus 74 points) and visual analog scale scores (3.1 versus 4.6 points) at 6 months postoperatively and prior to screw removal in the PRIF group (p < 0.001). There were no significant differences in these scores, radiographic outcomes, weight-bearing analysis, or complications at 1 year postoperatively. The authors concluded that both techniques provided comparable fixation stability and clinical outcomes. Of note, however, the PRIF group had 4 patients whose postoperative course was complicated by screw breakage13. Start with a fluoroscopic stress examination to identify all components of instability.Ensure that the reduction clamp does not interfere with or affect your guidewire path.If the joint cannot be reduced, convert to an open procedure and debride the obstruction. ORIF = open reduction and internal fixationPRIF = percutaneous reduction and internal fixationCRPF = closed reduction and percutaneous fixationNSAID = nonsteroidal anti-inflammatory drugOR = operating roomAP = anteroposteriorCT = computed tomographyMRI = magnetic resonance imagingAOFAS = American Orthopaedic Foot & Ankle SocietyVAS = visual analog scaleROM = range of motionPT = physical therapyASA = acetyl-salicylic acid (aspirin)BID = twice dailyPRN = as needed.

Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications.

In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening with a motorized intramedullary nail (MIN). We intend to assess the outcome and complications of this technique. A systematic review was performed in the following databases: PubMed, Embase, Web of Science, and the Journal of Limb Lengthening and Reconstruction. The inclusion criteria included limb lengthening of the humerus using an intramedullary nail, clinical studies, all levels of evidence, and no restriction to the date of publication. Our search yielded 239 journal articles. A total of nine articles remained relevant based on the inclusion and exclusion criteria. The total number of patients was 20, with 22 segments lengthened. The mean age of the patients was 20.8-year-old [standard deviation (SD), 12.0; range, 13-51]. The mean gained length was 5.7 cm (SD, 0.9; range, 5-7.5) with a mean distraction protocol of 0.82 mm/day (SD, 0.2; range, 0.6-1). The average duration of lengthening was 71.6 days (SD, 12.8; range, 50-93), and the mean duration of consolidation was 192.3 days (SD, 40.5; range, 120-228). Reported complications included a range of motion (ROM) limitation, hardware failure, and hypertrophic bone regeneration. Humeral lengthening with an MIN provides favourable outcomes with low complication rates. Future high-level studies should focus on comparing long-term outcomes of humeral lengthening utilising internal and external fixation techniques. Humeral lengthening using MIN can be used safely. Each surgical approach and type of nail have different risks and benefits. These should be carefully discussed when planning the surgery. Lorange JP, Alamiri N, Marwan Y, et al. Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. Strategies Trauma Limb Reconstr 2022;17(3):165-171.

Long-term outcomes of anterior shoulder instability treated with open latarjet procedure - a systematic review of outcomes at a minimum 15-year follow-up.

To systematically review the literature to evaluate the outcomes following an open Latarjet (OL) procedure at a minimum 15-year follow-up. Two independent reviewers performed a literature search using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using 3 databases. Only studies reporting outcomes of OL procedure with a minimum of 15 years of follow-up were included. Nine studies composed of 326 shoulders (78.2% males) in 313 patients were included (average age 26.9 ± 3.2 years (15-58)), with a mean follow-up of 271.9 ± 69.2 months (180-420) At a minimum 15-year follow-up, 93.5% (286 of 306) patients reported being satisfied with their OL procedure, whilst 86.8% (177 of 204) reported good/excellent outcomes at final follow-up. All nine of the included studies reported an overall rate of recurrent instability was 7.7%, with re-dislocations and subluxation at 3.4% and 5.8%, respectively. The rate of surgical revision was 5.15%; 3.5% of cases were revised for recurrent instability. Instability arthropathy was reported across all included studies as 41.0%. The OL procedure results in satisfactory clinical outcomes, low rates of recurrent instability and surgical revision at a minimum 15-year follow-up. Although high levels of radiological instability arthropathy and residual pain are found over the same period, these appear stable from a minimum of 10-year follow-up data. IV; a systematic review of all levels of evidence.

Systematic review of outcomes and patient heterogeneity in relapsed or refractory diffuse large B-cell lymphoma.

Aim: To evaluate trials of systemic therapies in transplant-ineligible or -experienced, relapsed/refractory diffuse large-B cell lymphomaand the impact of patient characteristics on overall response rate (ORR). Patients & methods: Systematically reviewed multiple databases through 22 July 2021. Analyzed variations in patient characteristics and their relationship with ORR across trials. Results: Among 17 included trials, key patient characteristics varied substantially: primary refractory (0-69%), refractory to last line of therapy (LOT) (12-100%), ≥2 prior LOTs (14-100%), ≥3 prior LOTs (0-64%), IPI ≥3 (23-73%), tumor stage III/IV (50-90%) and median age (56-74years). ORRs varied substantially (25-83%), correlating with these characteristics. Conclusion: Differences in patient characteristics significantly contribute to the variability in ORR across these trials and should be considered when contextualizing efficacy data.