Variety Of Operations Research Articles

Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player

Background: Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible. Case Presentation: We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free. Conclusion: Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.

A comparative study of endoscopic Septoplasty versus conventional Septoplasty

Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologists. A variety of surgical procedures have been tried in the treatment of the same. This study was conducted to evaluate the outcomes and complications of endoscopic and conventional septoplasty. This is a prospective, randomized study. Fifty patients with symptomatic deviated nasal septum were included in the study, 25 of them underwent conventional septoplasty and the rest underwent endoscopic septoplasty. The difference in the functional outcome of both the surgeries was insignificant. There was a significant difference with respect to complications. Endoscopic septoplasty had better outcome with respect to complications. It is easier to correct posterior deviations and isolated spurs with endoscopic septoplasty. Complications are lesser with endoscopic septoplasty.

Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate: A pilot study

BackgroundAcromioclavicular (AC) joint dislocation is common in sportsmen and physically active population. Its management depends upon the grade of injury and functional demands of the patient. A variety of surgical procedures have been described with different limitations and advantages. The present study has assessed the clinical and radiological outcome of acute AC joint dislocation managed with a 3.5 mm Titanium suture anchor and 2 mm miniplate construct which requires lesser dissection, surgical time and thus contact with the patient as mandated by COVID-19 pandemic. MethodsWe enrolled 10 patients of Rockwood type-III, IV and V acute AC joint injury (<3 weeks old) reporting at this hospital from Feb 2020 to May 2021. All were tested for COVID-19 using reverse transcriptase polymer chain reaction test (RTPCR) and managed by closed/open reduction and fixation with a 3.5 mm Titanium Suture Anchor and a 2 mm Titanium miniplate construct. Follow-up was done at 3, 6 and 9 month post-operatively. ResultsThe average age of patients was 31 yrs. RTPCR test for COVID-19 was negative in all patients. Median surgical time was 25 min (Interquartile Range[IQR] = 16–34 min) and median follow-up duration was 36 weeks (IQR = 33–39 weeks). Median visual analogue scale score and IQR at pre-operative, 3 month, 6 month and 9 month follow-up was 7(IQR = 6–8), 3.5(IQR = 2.5–4.5), 2(IQR = 0) and 1(IQR = 0), respectively. Median constant score at pre-operative, 3 month, 6 month and 9 month follow-up were 34(IQR = 25–43), 65.5(IQR = 60.5–70.5), 82.5(IQR = 77.5–87.5) and 88(IQR = 81–95). There was significant improvement in clinical status (non parametric-Friedman test p < 0.001). Radiographs showed no loss of reduction, fracture or implant failure till last follow-up. ConclusionsMinimally invasive technique with a 3.5 mm Ti-suture anchor and 2 mm plate is an easy, fast and reliable construct for the management of acute AC dislocation in physically active population.

Compare Mean Blood Loss in Patients Undergoing Tonsillectomy with and without Tranexamic Acid

Introduction: Tonsillectomy is one of the most common surgeries in ENT department and bleeding is one of the most serious complications related to tonsillectomy. Tranexamic acid is a plasminogen inhibitor which has been successfully used to control bleeding in a variety of surgeries. Objective: The objective of this study is to compare mean blood loss in patients undergoing tonsillectomy with and without Tranexamic acid. Study Design: Randomized controlled trail Setting: This study was carried out at the Department of ENT Jinnah Hospital Lahore Sample Technique: Non-probability, consecutive sampling Study Duration: The study was done in 6 months after the approval of synopsis [March 8, 2017 till September 8, 2017] Materials and Methods: Sixty Patients were randomly divided into 2 equal groups using lottery method in group-A and group-B. Patients in Group-A received tranexamic acid after induction intravenously as 15 mg/kg (single bolus dose) over 10 min. Patients in group B were served as control group and they did not receive tranexamic acid before tonsillectomy. All surgeries were carried out by a single consultant having more than 5 years of experience after post-graduation. Blood loss was measured by researcher himself as per operational definition. Results: The mean age of cases in Tranexamic group was 19.70 ± 12.12 years while in control group was 21.53 ± 15.44 years. In Tranexamic acid group there were 18(60%) male and 12(40%) female cases while in control group there were 21(70%) male and 9(30%) female cases. The mean blood loss in Tranexamic acid group were 30.27 ±8.85 ml and in control group was 67.67 ± 14.91 ml. The mean blood loss was significantly less in Tranexamic acid group as compared to control group, p-value &lt; 0.05. Conclusion: The mean blood loos in cases with Tranexamic acid were significantly lower as compared to control group. So in future every patient selected for tonsillectomy must be given TXA to reduce the blood transfusion and related complications of the patients. Keywords: ENT, Tonsillectomy, Bleeding, blood transfusion, Tranexamic acid

Our Treatment Strategy for CMC-1 Osteoarthritis

Osteoarthritis of the carpometacarpal joint of the thumb ( CMC-1) is a common problem and many patients will seek medical attention and may eventually need surgical treatment. As no treatment option has shown consistent superiority, a variety of surgical procedures have been proposed. In this review paper we present our algorithm for the approach of symptomatic CMC-1 osteoarthritis, supported by scientific evidence and our personal experience. It is primarily based on patient demands, status of CMC-1 disease and associated problems around the thumb. The selection of a successful surgical treatment plan with restoration of a pain free and fully functional thumb is the goal. We'll outline the pro's and con's of the surgical procedures and although trapeziectomy has long been the gold standard, the advent of reliable total joint arthroplasties with good short and long-term outcome reports has changed our treatment protocol completely.

Dá sa včasným pooperačným DWI zistiť reziduálny cholesteatóm?

Residual cholesteatoma results from an incomplete surgical removal of the cholesteatoma matrix. A variety of surgical procedures are used to remove cholesteatomas with varying success rates. In extensive cholesteatomas with minimal possibility of conductive system reconstruction, subtotal petrosectomy with blind sac closure is an effective surgical procedure. Diffusion-weighted magnetic resonance imaging (DWI) and ADC maps are used in the dia­gnosis of recurrent cholesteatoma. We present the case of a 40-year-old man, who repeatedly underwent revision surgeries for extensive cholesteatoma recidivism. An early postoperative DWI in the first days after the revision intervention did not show residual cholesteatoma. Surprisingly, a follow-up DWI detected the presence of cholesteatoma a few months later. The goal of this paper is to open the discussion on early postoperative DW MRI. Key words recidivism – residual and recurrent cholesteatoma – DWI – ADC map – subtotal petrosectomy – blind sac closure

Preoperative leukocytosis and postoperative outcomes in geriatric hip fracture patients: a retrospective cohort study

Background: A growing amount of evidence has suggested an association between preoperative leukocytosis and postoperative complications across a variety of surgeries. The aim of this study was to evaluate the impact of preoperative leukocytosis on the prognosis of geriatric hip-fracture patients after surgery. Methods: This retrospective cohort included 1007 patients age 65 yr and older who underwent surgery for hip fracture between January 2016 and December 2019 at a district general hospital. Outcomes measured included surgical-site infection and 30-day and 1-year mortality. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality in hip-fracture patients. Results: After adjustment for covariates, leukocytosis was not found to be a significant independent predictor of poor outcome after geriatric hip-fracture surgery. Delay of surgery longer than 48 hr and dementia were found to be independent variables associated with increased risk of surgical-site infection. The predictors of 30-day mortality were male gender and the use of anticoagulant or antiaggregant medications, whereas male gender, delay of surgery more than 48 hr, dementia and hypoalbuminemia were associated with increased 1-year mortality. Conclusions: Preoperative leukocytosis was not associated with adverse postoperative outcome after geriatric hip-fracture surgery. The more reliable variables for prediction of surgical outcome in geriatric hip-fracture patients were delay in surgery, gender, hypoalbuminemia, dementia, and use of anticoagulant or antiaggregant medications. Level of Evidence: Level III.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82‐Year‐old Cadaver and Unilaterally in a 68‐Year‐old Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first‐year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82‐year‐old white female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68‐year‐old white female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is necessary in various medical specialties for its use in reconstructive surgery, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in a variety of surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many palmaris longus muscle anatomical variations and their possible contributions to pathological processes.

Lateral pedicle graft – A predictable treatment option for isolated gingival recession

Marginal gingival recession is a typical source of worry, especially when it occurs in the anterior teeth as a result of functional and esthetic issues. Recession can cause esthetic degeneration, dentin hypersensitivity, and the inability to undertake regular oral hygiene practices. Gingival recession problems have been treated with a variety of surgical procedures. This article discusses a case where the lateral pedicle technique was used to successfully cover the root of a single tooth. The soft tissue next to the recession is positioned over the defect in this approach. This resulted in a periodontium that was both esthetically and functionally healthy, as well as positive patient acceptability. A clinically substantial level of root coverage was achieved as a result of this operation.

459 Association Between Vitamin D Deficiency and Surgical Site Infection Following Elective Lumbar Fusions

INTRODUCTION: Vitamin D deficiency has been associated with higher rates of SSI following a variety of surgical procedures. However, this association has been under-investigated for spinal procedures. METHODS: Patients who underwent lumbar fusions between 2011-2014 were reviewed from the HCUP-NIS database. Propensity score matching was utilized to minimize the effect of confounding variables between the 2 groups (normal vitamin D vs vitamin D deficiency). RESULTS: A total of 238,875 cases of lumbar fusions met inclusion criteria for analysis. These included posterior/transforaminal lateral interbody fusions (PLIF/TLIF), Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF). 22,454 (9.4%) patients carried the diagnosis of vitamin D deficiency and were significantly more likely to be non-white (26.5% vs. 19.9%) and obese (21.1% vs. 15.4%) as compared to patients without deficiency. Other patient characteristics, socioeconomic factors, and hospital setting were comparable between two groups. SSI rates were compared between matched cohorts (18,350 patients in each). In patients without vitamin D deficiency, there were 202 (1.1%) cases of SSI recorded, while there were 1266 (6.9%) cases of SSI recorded in patients with vitamin D deficiency (P&lt;0.001). Patients with vitamin D deficiency had higher incidence of thromboembolic events (2.6% vs. 0.3%), length of hospital stay (5.7 vs. 3.4 days) as well as increased hospital charges (87,812$ vs. 79,650), (P &lt;0.05). CONCLUSION: Optimizing preoperative vitamin D level could be potentially a cost-effective strategy to reduce the rate of SSI, thromboembolic events and prolonged hospital stay in patients undergoing lumbar fusion. Further cost-effectiveness analyses are encouraged to make definitive claims regarding pre-operative vitamin D screening/supplementation in these patients.

Single-stage C6-7 ACDF with T1-2 Oblique Keyhole Transcorporeal Disectomy to Treat Cervico-thoracic Tandem Disc Herniation: A Case Report

Symptomatic cervico-thoracic tandem disc herniation occurs very rarely. On the other hand, cervical disc herniations are common and may be treated via a variety of surgical procedures. Symptomatic upper thoracic disc herniations are extremely rare, and use of a surgical approach in their treatment is controversial due to the narrow operative space within which surgical procedures must be performed. We report an extremely rare case of symptomatic tandem C6-7 and T1-2 disc herniation successfully treated via single-stage, single-incision, C6-7 anterior cervical decompression and fusion, and T1-2 oblique keyhole transcorporeal discectomy. This is the first symptomatic cervico-thoracic tandem disc herniation with its treatment.

Chapter 17 - Neurophysiology during peripheral nerve surgery

Electrophysiological monitoring of the peripheral nervous system during a variety of surgeries provides useful information that supplements and complements preoperative assessment. Monitoring improves localization and understanding of the underlying pathophysiology of peripheral nerve lesions leading to more rational treatment decisions and improved outcomes. Monitoring is accomplished by adaptation of routine electrodiagnostic techniques (i.e., nerve conduction studies, evoked potentials, and electromyography) with special attention to technical factors including electrical and movement artifact. These techniques have been successfully applied during surgery for entrapment neuropathies, traumatic nerve injury and repair, peripheral nerve tumors, and adjacent structure procedures that risk peripheral nerve injury. A clear understanding of the anatomy and neurophysiology is necessary, as is understanding and performing the difficult technical aspects of these studies to provide accurate information to enhance patient outcome and recovery. As in any intraoperative neurophysiologic monitoring (IONM) setting, constant and accurate communication between the IONM team, surgeon, and anesthesia team is critically important to meet these goals.

Beyond Liposuction: Evolving Applications for Tumescent Anesthesia.

Tumescent anesthesia was initially developed as a safer and more effective alternative to general anesthesia in performing liposuction. Today, it is used extensively for a wide variety of surgical procedures performed by various specialties. As more surgeons have become exposed to tumescent anesthesia with its associated advantages over general anesthesia, the number of applications for this unique form of local anesthesia has skyrocketed. In this article, we will briefly discuss the basics of tumescent anesthesia, followed by a discussion of the many applications that are now being performed by various specialties. J Drugs Dermatol. 2022;21(1):86-89. doi:10.36849/JDD.6279.

Management of post burn groin contracture: a case account

Similar to burns of the face, hands, and feet, groin and perineal burn injuries result in physical as well as psychosocial scarring for the patient. It often results in loss of functionality which is usually out of proportion to the percentage of burns. Hence, these burns are classified as major burns. Direct injury to the genitalia can lead to sexual dysfunction. In such circumstances, the treatment plan should comprehensively look into even psychosocial aspects of the patient. Both functional and cosmetic appearance should be the primary concern. With scarcely available burns unit and dedicated hospitals in India to treat burns, patients often develop severe contractures without proper post burns care. Most of the burn patients end up being treated by staff without special training in burn care. A variety of surgical procedures in post burn contractures of groin and perineum have been described all aimed to achieve satisfactory functional and cosmetic outcome. However, advantages of long-term care with regular physiotherapy, use of pressure garments, and massaging with emollient creams should not be overlooked and cannot be overemphasized. We present such a case of a young female with poor post burns care which resulted in post burn contracture of the groin and perineal area and had to endure with inconveniences. Patient was treated in our department adequately.

Liposomal Bupivacaine Versus Immediate-Release Bupivacaine for Postoperative Pain Control.

Liposomal bupivacaine (LB) is increasingly being used for postoperative pain control, but there are conflicting efficacy data when compared with immediate-release bupivacaine (IRB). To evaluate the comparative efficacies of LB and IRB for postoperative pain control in order to assess the formulary status of LB at our institution. A single-center, retrospective, institutional review board-approved, noninferiority matched cohort study at a tertiary care academic medical center. Adult surgical patients admitted for >24 hours who received LB or IRB were included. The primary outcome was total opioid consumption within 24 hours postoperatively. Secondary outcomes included total opioid consumption within 72 hours postoperatively, nonopioid analgesic use within 24 and 72 hours postoperatively, time to rescue analgesic use, and postoperative length of stay (LOS). A total of 326 patients were included in the matched cohort. Median 24-hour opioid consumption was significantly lower in the IRB group compared with the LB group (81 mg [30, 153] vs 103 mg [46, 241]; P = 0.01). Patients receiving IRB compared with LB also had a decrease in total opioid consumption 72 hours postoperatively (110 mg [45, 258] vs 165 mg [68, 402]; P = 0.005) and shorter postoperative LOS (2.8 days [1.7, 4] vs 3.3 days [2, 5.1]; P < 0.001). There was no difference in time to rescue analgesic use. Across a variety of surgical procedures, administration of IRB compared with LB was associated with a reduction in total opioid consumption within 24 and 72 hours postoperatively and shorter LOS in adult surgical patients.

The efficacy of WALANT technique in Hand Surgery

Background: Nowadays, Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has gained popularity among surgeons because of its use in variety of surgical procedures because it provides excellent hemostasis, eliminating the need of tourniquet, sedation and the risk and cost of general anesthesia. Aims and Objective: In this study, we wanted to evaluate its efficacy and the experiences of the patients and surgeons in different hand surgeries. Materials and Methods: We had 108 patients who underwent various hand surgeries under WALANT technique. Patients and surgeons were requested to fill a questionnaire after the procedure. The procedure was evaluated in terms of the pain compared to a dental procedure, duration of the anesthesia, amount of bleeding and patients’ satisfaction. Results: The mean age of our patients was 42.7 years. A variety of hand surgery was performed in our study. The mean local anaesthetic volume used was 16.5 ml. The Tang grading system was used to evaluate the levels of surgeon’s experience; 75% of surgeons were a Level 2, 18% Level 3 and 7% Level 4. Sixty-four patients experienced WALANT to be less than, 30 patients equivalent to and 8 had more pain compared to a dental procedure. There was a significant correlation between volume of local anesthetic used, duration of surgery and number of procedural components repaired. Both pain and anxiety levels were significantly less intra-operatively and postoperatively as compared to the level at the time of injection. Eighty-seven patients considered it to be better than expected, and would prefer it in the future in case they have to undergo surgery. Conclusion: We observed that our patients were satisfied with their experience on WALANT technique and the surgical procedures, and we recommend the use of this for a variety of hand surgery procedures.

In vivo evaluation of temperature-responsive antimicrobial-loaded PNIPAAm hydrogels for prevention of surgical site infection.

Surgical site infections (SSIs) are a persistent clinical challenge. Local antimicrobial delivery may reduce the risk of SSI by increasing drug concentrations and distribution in vulnerable surgical sites compared to what is achieved using systemic antimicrobial prophylaxis alone. In this work, we describe a comprehensive in vivo evaluation of the safety and efficacy of poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylamide-co-Jeffamine M-1000 acrylamide) [PNDJ], an injectable temperature-responsive hydrogel carrier for antimicrobial delivery in surgical sites. Biodistribution data indicate that PNDJ is primarily cleared via the liver and kidneys following drug delivery. Antimicrobial-loaded PNDJ was generally well-tolerated locally and systemically when applied in bone, muscle, articulating joints, and intraperitoneal space, although mild renal toxicity consistent with the released antimicrobials was identified at high doses in rats. Dosing of PNDJ at bone-implant interfaces did not affect normal tissue healing and function of orthopedic implants in a transcortical plug model in rabbits and in canine total hip arthroplasty. Finally, PNDJ was effective at preventing recurrence of implant-associated MSSA and MRSA osteomyelitis in rabbits, showing a trend toward outperforming commercially available antimicrobial-loaded bone cement and systemic antimicrobial administration. These studies indicate that antimicrobial-loaded PNDJ hydrogels are well-tolerated and could reduce incidence of SSI in a variety of surgical procedures.

Intraoperative tranexamic acid use in patients undergoing excision of intracranial meningioma: Randomized, placebo-controlled trial.

Background: Intracranial meningioma resection is associated with substantial intraoperative bleeding. Intraoperative tranexamic acid (TXA) use can reduce bleeding in a variety of surgical procedures. The objective of this study was to evaluate the effects of TXA treatment on blood loss and transfusion requirements in patient undergoing resection of intracranial meningioma.Methods: We conducted a prospective, randomized double-blind clinical study. The patient scheduled to undergo excision of intracranial meningioma were randomly assigned to receive intraoperatively either intravenous TXA or placebo. Patients in the TXA group received intravenous bolus of 20 mg/kg over 20 min followed by an infusion of 1 mg/kg/h up to surgical wound closure. Efficacy was evaluated based on total blood loss and transfusion requirements. Postoperatively, thrombotic complications, convulsive seizure, and hematoma formation were noted.Results: Ninety-one patients were enrolled and randomized: 45 received TXA (TXA group) and 46 received placebo (group placebo). Total blood loss was significantly decreased in TXA group compared to placebo (283 ml vs. 576 ml; P < 0.001). Transfusion requirements were comparable in the two groups (P = 0.95). The incidence of thrombotic complications, convulsive seizure, and hematoma formation was similar in the two groups.Conclusion: TXA significantly reduces intraoperative blood loss, but did not significantly reduced transfusion requirements in adults undergoing resection of intracranial meningioma.

Jain point: an alternate laparoscopic non-umbilical first blind entry port to avoid vessel, viscera, adhesions and bowel (VVAB)

The Jain point entry is based on the concept of non-umbilical entry to avoid sudden catastrophic injury to major retroperitoneal vessels, viscera, adhesions and bowel which could happen before the start of procedure by blind umbilical entry. To study the safety and efficacy of a novel first non-umbilical blind entry port. Tertiary referral centre for advanced laparoscopic surgeries with active training and fellowship programs. A large retrospective study of 7802 cases done at Vardhman Infertility & Laparoscopy Centre from January 2011 to December 2020. In all cases, first blind entry was by veress needle and 5 mm trocar and telescope through a non-umbilical port, The Jain point, irrespective of BMI, large masses, lax abdomen, previous surgery and complex situations. Patients’ demographic profile, types of surgeries performed and entry-related complications were recorded and analysed. Mean age of patients was 33 years with BMI ranging from 12.66 to 54.41 kg/m2. Thus, Jain point can be applicable for all ranges of BMI, all types of surgeries from simple to complex and large masses. Entry related minor complications were in 3.4% cases while major complication involving bowel occurred in one case. No case of injury to major retro-peritoneal vessel was seen. Jain point entry is a novel, first blind 5 mm non-umbilical, entry technique in a variety of surgeries and previous scars and patients with wide range of BMI. It has a short learning curve and continues as main ergonomic working port.