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Sample records for vascular reconstructive surgery

  1. Reconstructive vascular surgery below the knee

    DEFF Research Database (Denmark)

    Rasmussen, L B; Jelnes, R; Sager, P

    1986-01-01

    In a series of 38 consecutive patients with advanced peripheral vascular disease (i.e. rest pain) reconstructive vascular surgery was performed with the distal anastomosis below the knee. Ankle/arm pressure index (AAI) was 0.28 (0.11-0.47) preoperatively; accumulated graft patency rate was 0.47 (SD...

  2. Twenty-four hour blood flow in the forefoot after reconstructive vascular surgery

    DEFF Research Database (Denmark)

    Jelnes, R

    1986-01-01

    during day activities. During sleep, however, SBF increased by 80% (p less than 0.001). The relative changes in SBF from day to night at the postoperative examination did not differ from that of the control group, i.e., the normal 24-hour blood flow pattern had been obtained. These changes in SBF......Local blood flow in the forefoot (SBF) was measured continuously during 24 hours by 133xenon clearance technique in 10 patients prior to and at least 1 year after successful reconstructive vascular surgery for severe arterial insufficiency (mean: 18 months, range: 12-36). A group of 10 patients...... that the long-term postreconstructive hyperemia merely is a reflection of the normal 24-hour blood flow pattern....

  3. VASCULAR SURGERY

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) is a complex and serious condition encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), usually in the lower extremities.1,2. Thromboses can result from venous stasis, vascular injury or hypercoagulability, and those involving the deep veins proximal to the knee are ...

  4. Reconstruction with vascularized composite tissue in patients with excessive injury following surgery and irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Serafin, D.; DeLand, M.; Lesesne, C.B.; Smith, P.J.; Noell, K.T.; Georgiade, N.

    1982-01-01

    The biological effects of a single high dose of radiation are examined. Both cellular injury and repair are reviewed during early, intermediate, and late phases. Anticipated composite tissue morbidity is detailed for therapeutic radiation doses administered to the head and neck, breast and thorax, and perineum. Patients who demonstrated excessive time-dose fractionation values were irradiated with lower x-ray energies. Those in whom there was an overlap of treatment fields presented a serious challenge to the reconstructive surgeon. Judicious selection of well-vascularized composite tissue outside the portals of irradiation, preferably with a long vascular pedicle, facilitated reconstruction. When possible, both donor and recipient vasculature should be outside the irradiated area to ensure uninterrupted blood flow to the transferred or transplanted tissue.

  5. Reconstructive vascular surgery in rotationplasty for malignant tumors of the femur.

    Science.gov (United States)

    Sidiropoulos, A; Tjan, T D; Soeparwata, R; Wuismann, P; Winkelmann, W; Scheld, H H

    1994-12-01

    The rotationplasty procedure of the femur, as first described by Borrgreve, is the functional improvement of an abnormally shortened lower limb. In the last 15 years this procedure has been used in its original form and as modification for tumors of the femur and proximal tibia. The reconstruction of the femoral vessels as an important part of the operation has not enough been accentuated. Principally two types of reconstructions can be performed: the vessels are dissected in the adductor canal or a segmental resection and reanastomosis are performed. Between January 1990 and April 1993 classical and modified rotationplasties were performed for malignant tumors in 34 patients in our institution. In all cases a segmental femoral vessel resection with end-to-end anastomosis were performed. No intra- and postoperative vascular related complications occurred. The authors emphasize the advantage of this method: reanastomosing resected femoral vessels by experienced vascular surgeons is a save, time-saving method. In addition, the radicality of the operation increases in order to obtain excellent long term results.

  6. An improvement of cerebral hemodynamics in a newly developed perfusion area evaluated by intra-arterial SPECT following vascular reconstructive surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nochide, Ichiro [Ehime Univ., Shigenobu (Japan). School of Medicine

    1999-06-01

    The purpose of this study was to evaluate the changes in regional cerebral blood flow (rCBF) and vascular reserve ({Delta}CBF) responding to acetazolamide loading by {sup 133}Xe SPECT. In combination, this study assessed the newly developed region of cerebral perfusion via bypass arteries after surgical vascular reconstruction in 11 hemispheres of 11 patients with atherosclerotic arterial occlusive disease and adult onset moyamoya disease. In patients with atherosclerotic occlusive disease, the cerebral perfusion from bypass arteries mainly developed in the preoperatively low {Delta}CBF territory. Although rCBF did not significantly alter after vascular reconstruction, preoperatively low {Delta}CBF was significantly improved to the normal range in the promotion of postoperatively newly born perfusion from bypass arteries. In 21 hemispheres of 13 patients with adult onset moyamoya disease, the postoperatively newly born perfusion from bypass arteries was significantly developed in the regions with either preoperative low rCBF or low {Delta}CBF. Although both rCBF and {Delta}CBF were significantly improved after the operation, {Delta}CBF was not restored satisfactorily up to the normal range in contrast to the sufficient increase of rCBF, even where the perfusion from the bypass artery was observed after the reconstructive surgeries. Vascular reconstructive surgeries were beneficial for the improvement of {Delta}CBF in the atherosclerotic arterial occlusive disease and rCBF in the adult-onset moyamoya disease, respectively. (author)

  7. Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial

    Science.gov (United States)

    2014-01-01

    Background Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome. Methods Twenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design. Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated. Results Computer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn’t change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001). Conclusions The presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity. Trial Registration DRKS00005181. PMID:24716651

  8. Vascular complications in orthopedic surgery.

    Science.gov (United States)

    Chervu, A; Quinones-Baldrich, W J

    1988-10-01

    Vascular complications may be seen secondary to trauma or in the perioperative period following elective surgery. Prompt recognition and correction of these problems are of utmost importance to assure functional viability of the affected extremity. Evaluation may be complicated by the presence of preexisting atherosclerotic occlusive disease in the elderly patient. Relevant points in the history and physical examination include mechanism of injury, preexisting disease, evaluation of motor and sensory function, and presence and character of pulses. Noninvasive vascular studies should be obtained in all patients. Absolute indications for angiography include absent pulses, signs and symptoms of ischemia, a bruit, and a posterior knee dislocation; decreased pulses, a significant hematoma, and proximity of the fracture fragment are relative indications. Controversial issues in the management of combined orthopedic and vascular injuries include the use of internal versus external fixation, the use of prosthetic versus autogenous material, and the need for venous reconstruction. Popliteal artery trauma is still associated with a high limb loss rate, and careful evaluation of knee injuries is necessary. Vascular compromise may also complicate joint replacement surgery. These complications are preventable, and management is greatly simplified by a detailed preoperative evaluation.

  9. Urogenital Reconstructive Surgery

    DEFF Research Database (Denmark)

    Jakobsen, Lotte Kaasgaard

    Urogenital reconstructive surgery Lotte Kaasgaard Jakobsen1 Professor Henning Olsen1 Overlæge Gitte Hvistendahl1 Professor Karl-Erik Andersson2 1 – Dept. of Urology, Aarhus University Hospital 2 – Dept. of Gynecology and Obstetrics, Aarhus University hospital Background: Congenital obstruction...

  10. Social media in vascular surgery.

    Science.gov (United States)

    Indes, Jeffrey E; Gates, Lindsay; Mitchell, Erica L; Muhs, Bart E

    2013-04-01

    There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  11. Beta-blocker use and clinical outcomes after primary vascular surgery

    DEFF Research Database (Denmark)

    Høgh, A.; Lindholt, J.S.; Nielsen, Henrik

    2013-01-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

  12. Enhanced Recovery after Vascular Surgery

    Directory of Open Access Journals (Sweden)

    Milena D. Stojanovic

    2018-01-01

    Full Text Available The beginnings of the enhanced recovery after surgery (ERAS program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients.

  13. Near-infraread spectroscopy during peripheral vascular surgery

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith; Eiberg, Jonas Peter; Vogt, Katja

    1997-01-01

    Original,Near-infraread spectroscopy,Vascular disease,Vascular by-pass surgery,Perioperative oxymetry......Original,Near-infraread spectroscopy,Vascular disease,Vascular by-pass surgery,Perioperative oxymetry...

  14. Bypass materials in vascular surgery

    Directory of Open Access Journals (Sweden)

    Willich, Stephan N.

    2006-03-01

    Full Text Available Introduction: Arteriosclerotic changes can lead to circulatory disturbances in various areas of the human vascular system. In addition to pharmacological therapy and the management of risk factors (e. g. hypertension, diabetes, lipid metabolism disorders, and lifestyle, surgical interventions also play an important role in the treatment of arteriosclerosis. Long-segment arterial occlusions, in particular, can be treated successfully with bypass sur-gery. A number of different materials are available for this type of operation, such as autologous vein or pros-thetic grafts comprised of polytetrafluoroethylene (PTFE or Dacron®. Prosthetic materials are used especially in the treatment of peripheral artery disease, such as in aortoiliac or femoropopliteal bypass surgery. The present report will thus focus on this area in order to examine the effectiveness of different bypass materials. Among the efforts being made to refine the newly introduced DRG system in Germany, analysing the different bypass materials used in vascular surgery is particularly important. Indeed, in its current version the German DRG system does not distinguish between bypass materials in terms of reimbursement rates. Differences in cost structures are thus of especial interest to hospitals in their budget calculations, whereas both private and statutory health insurance funds are primarily interested in long-term results and their costs. Objectives: The goal of this HTA is to compare the different bypass materials used in vascular surgery in terms of their medical efficiency and cost-effectiveness, as well as with regard to their ethical, social and legal implications. In addition, this report aims to point out the areas in which further medical, epidemiological and health economic research is still needed. Methods: Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information

  15. SAJS 1050 - Vascular surgery.indd

    African Journals Online (AJOL)

    Vascular Surgery. SAJS. Three randomised controlled trials have shown a significant reduction in peri-operative mortality when comparing endovascular aneurysm repair (EVAR) with ... surgery poses an unacceptably high risk to them, but unfavourable ... All patients who underwent elective AUI with FFBP for abdominal.

  16. Vascular surgery reduces the frequency of lower limb major amputations

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Bøvling, Søren; Fasting, H

    1994-01-01

    In June 1988 a Department of Vascular Surgery was established in the county of Viborg, Denmark. In this retrospective study of the periods 1986-87 and 1989-90, we have observed a significant rise in the number of patients evaluated by a vascular surgeon before amputation, from 19 to 49%. At the s......In June 1988 a Department of Vascular Surgery was established in the county of Viborg, Denmark. In this retrospective study of the periods 1986-87 and 1989-90, we have observed a significant rise in the number of patients evaluated by a vascular surgeon before amputation, from 19 to 49......%. At the same time the number of major lower limb amputations significantly decreased. This reduction was most marked in 1990 probably due to a rise of 43% in the number of distal reconstructions. The distribution between below knee, through knee and mid-thigh amputation was unaffected by the increased vascular...... surgical activity. The frequency of major amputations in the county in 1986-87 of 40.9 per 100,000 per year declined by 25% to 30.9 per 100,000 per year in 1989-90. We conclude that vascular surgery reduces the number of major lower limb amputations and consequently all patients threatened with amputation...

  17. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    Science.gov (United States)

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options. Georg Thieme Verlag KG Stuttgart · New York.

  18. Perioperative smoking cessation in vascular surgery

    DEFF Research Database (Denmark)

    Kehlet, M.; Heesemann, Sabine; Tonnesen, H.

    2015-01-01

    Background: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods: A single-blinded randomized clinical trial conducted at two vascular surgery...... departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According...... intervention and 21 as controls. There was no difference in 30-day complication rates or 6-week abstinence rates between the two groups. Conclusions: A trial assessing the effect of smoking cessation on postoperative complications on the day of soft tissue surgery is still needed. If another trial...

  19. Hypothenar Hammer Syndrome: Long-Term Results After Vascular Reconstruction.

    Science.gov (United States)

    Kitzinger, Hugo B; van Schoonhoven, Joerg; Schmitt, Rainer; Hacker, Stefan; Karle, Birgit

    2016-01-01

    Hypothenar hammer syndrome is a rare vascular lesion of the distal ulnar artery in Guyon tunnel caused by acute or repetitive blunt trauma to the hypothenar eminence. Described treatment options vary greatly, from nonoperative management treatments to surgical interventions. The aim of this study was to evaluate the long-term outcomes of patients after surgical reconstruction of the ulnar artery. In this retrospective study, the results of 12 patients treated for hypothenar hammer syndrome were evaluated. Preoperative and postoperative examinations of the hand were recorded. Function impairment was assessed with the "Disabilites of the Arm, Shoulder and Hand" questionnaire. Comparisons were also made based on ulnar artery patency versus occlusion. All patients were evaluated for ulnar artery patency as determined by Allen's test and magnetic resonance angiography. All patients were men with an average age of 42.8 years. In 3 patients, a direct end-to-end anastomosis of the ulnar artery was performed, and 9 patients received a reconstruction with a reverse interpositional vein graft. Nine vascular reconstructions remained patent after a mean follow-up period of 56.9 months. These patients had a complete or at least partial relief of their pain, dysesthesia, and cold intolerance compared with preoperatively. Patients with reoccluded ulnar arteries were statistically significant younger (P = 0.036) than patients with patent ulnar artery. They also had a higher pain level (P = 0.009) and a longer follow-up period (P = 0.036) than those with patent reconstruction. There was a trend for higher functional impairment in patients with reoccluded ulnar artery (P = 0.100). Smoking habits showed no influence on ulnar artery patency. For patients with symptomatic hypothenar hammer syndrome and failed nonoperative treatment, surgical intervention is a good option. After more than 4.5 years after surgery 9 of 12 vascular reconstructions remained patent (75% patency rate

  20. Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas

    DEFF Research Database (Denmark)

    Petersen, Michael Mørk; Hovgaard, Dorrit; Elberg, Jens Jørgen

    2010-01-01

    We evaluated the results of limb-sparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients (mean age at operation 13.6 years (range 4.1-24.2 years), female/male = 6/2) with bone sarcomas (BS) (osteosarcoma/Ewing's sarcoma/chondrosarcoma= 4/3/1) o...... (n = 2), and hip dislocation (n = 1). Limb-sparing surgery with reconstruction of bone defects using vascularized fibular grafts in BS cases is feasible with acceptable clinical results, but fractures should be expected in many patients....

  1. RECONSTRUCTIVE SURGERY IN ORAL CANCER

    Directory of Open Access Journals (Sweden)

    Brahman Pally Balkishan

    2016-10-01

    Full Text Available BACKGROUND To study the technical details involving commonly performed flap surgeries - Narayanan flap (forehead and scalp flap, Pectoralis Major Myocutaneous (PMMC flap and deltopectoral flap. MATERIALS AND METHODS It is a prospective study, which consisted of sample size of 30 in a period of 2 years. All the patients who presented to OGH with symptoms and signs of carcinoma cheek were diagnosed and confirmed by edge biopsy, FNAC of nodes in neck, x-ray mandible, orthopantomogram, liver function tests. RESULTS Out of the 30 patients, the malignant lesion was arising from alveolar ridge in 2 (6.7%, buccal mucosa in 16 (53.3%, floor of the mouth in 2 (6.7%, hard palate in 2 (6.7%, retromolar trigone in 1 (3.3%, lip in 3 (10% and tongue in 4 (13.3% patients. Highest number of patients were found to be in the age groups of 61-70 (40% and 51-60 (26.7% each. Median age is 64.3 years. Out of 30 cases in the study, 18 (60% were male and another 12 (40% were females. About 66.7% of the patients indulged in chewing tobacco, 13.35 in tobacco chewing and smoking and about 20% in tobacco chewing along with smoking and alcohol consumption. Out of 30 cases in the study, 20 (66.7% presented with ulcer, 8 (26.7% with ulcer and swelling while 2 (6.6% presented with trismus. Stage IV (40% were more in number. Histopathology report confirms well-differentiated SCC in 80% and in this sample no specimen is poorly differentiated. All patients underwent wide local excision. Out of the 30 cases, 6 patients were stage I who did not undergo neck dissection. Maximum number of patients underwent hemimandibulectomy (53.3%, 20% of the patients did not undergo mandibulectomy. Maximum number of reconstructions were done with pectoralis major myocutaneous flaps+deltopectoral flap (PMMC+DP in 18 (60% cases .Out of the 24 cases in our study who underwent reconstruction with the flaps described above, marginal necrosis occurred in 2 (8.3% patients with PMMC+DP flaps while

  2. Additive manufacturing technology in reconstructive surgery.

    Science.gov (United States)

    Fuller, Scott C; Moore, Michael G

    2016-10-01

    Technological advances have been part and parcel of modern reconstructive surgery, in that practitioners of this discipline are continually looking for innovative ways to perfect their craft and improve patient outcomes. We are currently in a technological climate wherein advances in computers, imaging, and science have coalesced with resulting innovative breakthroughs that are not merely limited to improved outcomes and enhanced patient care, but may provide novel approaches to training the next generation of reconstructive surgeons. New developments in software and modeling platforms, imaging modalities, tissue engineering, additive manufacturing, and customization of implants are poised to revolutionize the field of reconstructive surgery. The interface between technological advances and reconstructive surgery continues to expand. Additive manufacturing techniques continue to evolve in an effort to improve patient outcomes, decrease operative time, and serve as instructional tools for the training of reconstructive surgeons.

  3. PROBLEMS AND PITFALLS IN PELVIC RECONSTRUCTIVE SURGERY

    Directory of Open Access Journals (Sweden)

    Paul A. Riss

    2003-12-01

    Full Text Available Background. Pelvic reconstructive surgery requires a solid understanding of the anatomy of the small pelvis and the pelvic floor, in particular to avoid complications during and after pelvic reconstructive surgery.Methods. Possible complications of the pelvic floor reconstructive surgery are analised. There are 2 typical surgical problems encountered in pelvic reconstructive surgery: lesion of adjacent structures (rectum, bladder, ureter, small bowel and hemorrhage.Results. Postoperatively there is always a risk of pain, stenosis and dyspareunia, erosion of allograft, voiding problems, incontinence and prolapse.Conclusions. These complications can be reduced by insisting on an exact preoperative diagnosis and by choosing the correct procedure, by having a good knowledge of anatomy and by using meticulous surgical technique.

  4. [Vascular complications associated with lumbar spinal surgery].

    Science.gov (United States)

    Riedemann-Wistuba, M; Alonso-Pérez, M; Llaneza-Coto, J M

    2016-01-01

    Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Desktop Database Management in Vascular Surgery

    OpenAIRE

    Lewis, H. Michael; Wheeler, Jock R.; Gregory, Roger T.

    1980-01-01

    A low-cost patient database management system has been developed using a microcomputer for use in a vascular surgery practice. The system is self-instructional, and is designed for use by physicians and/or clerical personnel without specialized training. Although the program is written in BASIC major modifications in the database as well as user-defined database searches are made in English. The database represents over 4100 operations on 2500 patients over 13 years. Factors influencing the s...

  6. [Vascular injuries in joint replacement surgery].

    Science.gov (United States)

    Novotný, K; Pádr, R; Landor, I; Sosna, A

    2011-01-01

    Iatrogenic injuries to blood vessels in joint replacement surgery are rare events that occur as few per thousand. However, their sequelae are serious. The patient may either bleed to death, because vascular injury is not obvious and therefore difficult to diagnose, or lose the limb due to ischaemia. The highest risk of vascular injury is associated with repeat surgery and loosening of the acetabular component. We distinguish sharp and blunt force injuries. The former are caused by implants, sharp instruments, bone fragments or bone cement debris. The latter arise from stretching over a part of implanted material. Bleeding can be inapparent or apparent. Inapparent bleeding is difficult to diagnose and is recognized from the dynamics of blood losses. Haemodynamic instability or, in a worse case, even hypovolaemic shock may be the only signs of bleeding. Occlusion of an artery is manifested by limb ischaemia. The seriousness and progression of ischaemia depends on the rate of arterial occlusion, potential pathways for collateral circulation and the degree of atherosclerotic vascular disease. The patient with conduction anaesthesia does not feel pain and therefore the diagnosis must primarily be based on arterial pulsation in the limb and its skin colour. A pseudoaneurysm can develop due to a partially weakened vascular wall and its rupture is a life-threatening complication. Its presence is recognized as a pulsating mass in the groin. An arterio- venous fistula which arises from traumatic communication between the two vessels may lead to cardiac failure. The diagnosis is based on examination by sonography and digital subtraction angiography. The results of CT angiography and MR angiography are difficult to evaluate because of the presence of metal implants. In apparent bleeding it is sometimes difficult to locate the source. It is recommended to perform digital compression and gain access to the vessels from the extraperitoneal approach. When an expanding haematoma or

  7. Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas

    DEFF Research Database (Denmark)

    Petersen, Michael Mørk; Hovgaard, Dorrit; Elberg, Jens Jørgen

    2010-01-01

    We evaluated the results of limb-sparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients (mean age at operation 13.6 years (range 4.1-24.2 years), female/male = 6/2) with bone sarcomas (BS) (osteosarcoma/Ewing's sarcoma/chondrosarcoma= 4...

  8. Non-Vascularized Autogenous Bone Grafts for Reconstruction of Maxillofacial Osseous Defects.

    Science.gov (United States)

    Ahmed, Waseem; Asim, Muhammad Adil; Ehsan, Afeefa; Abbas, Qalab

    2018-01-01

    To determine the outcomes of non-vascularized bone grafts for reconstruction of maxillofacial defects. Case series. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from January 2013 to December 2015. Descriptive analyses of 30 patients, who underwent maxillofacial reconstruction with non-vascularized bone grafts, were conducted. The demographic information, diagnosis, and type of graft harvested to reconstruct the defect were statistically analyzed. Outcomes of reconstruction with non-vascularized bone grafts were analyzed in terms of mouth opening, success of dental rehabilitation, and postoperative complications, i.e. surgical site infection and hardware loosening. A total of 30 patients ranging from 8 to 60 years (33.57 ±14.74 years) had maxillofacial defects reconstructed mostly due to gunshot injuries, followed by post-resection defects. Overall 15 cases (50%) were reconstructed with iliac crest cortico-cancellous bone graft, 11 cases (36.7%) with rib; while in four cases (13.3%), costochondral graft was used for reconstruction. In 26 cases (86.7%), graft was found to be successful. In three cases, re-operation for onlay bone graft was required to provide optimal dental rehabilitation; while in just one case, postoperative surgical site infection was observed. Non-vascularized bone grafts provide a reasonable and effective modality for reconstruction of maxillofacial defects.

  9. Critical issues in vascular surgery: Education in Brazil.

    Science.gov (United States)

    Moreira, Ricardo C R

    2008-12-01

    Vascular surgery practice and education vary widely across the globe. In Brazil, the largest and most populated country of South America, vascular surgery is an independent specialty, with >3000 practicing specialists. Vascular surgery education in Brazil consists of 6 years of medical school, followed by a 4-year residency in vascular surgery. Endovascular surgery training is provided by part-time mini-fellowships after a residency program has been completed. The author of this report, who represents the Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) or Brazilian Society of Angiology and Vascular Surgery, presents the critical issues in vascular surgery education in Brazil. An informal survey was conducted among residency program directors and members of the SBACV National Board to identify the critical issues in vascular surgical education in Brazil. The 25 responders pointed to two issues as the most critical. The first is funding for vascular surgical education. Currently, 73 vascular residency programs are accredited, with 142 first-year positions and 288 residents in training. Vascular surgery residents are paid a meager stipend, but instructors receive no pay. Endovascular fellows have to pay for their training. This has led to endovascular training being financed by the industry, despite the potential conflicts of interest created by this situation. The second critical issue is endovascular surgery training. The vascular surgical community in Brazil faces the huge task of how to offer training in endovascular techniques to the 140 or so young vascular surgeons coming out of residency programs every year, as well as how to teach endovascular techniques to several hundred certified vascular surgeons already in practice. Funding vascular surgery educational programs and training surgeons in the new endovascular techniques are the critical issues faced by vascular surgical educators in Brazil.

  10. Reconstructive surgery for fibular deficiency.

    Science.gov (United States)

    Shatilov, O E; Rozkov, A V; Cheminova, T V

    1991-08-01

    Three types of fibular deficiency are described which determine the nature of the surgery and prosthesis required. The surgical management of 50 patients who had a total of 103 operations is described.

  11. [Significance of digital subtraction angiography (DSA) in the evaluation of reconstructive vascular interventions].

    Science.gov (United States)

    Schuler, M

    1983-12-01

    The author examined 160 patients by means of digital subtraction angiography (DSA) after reconstructive vascular surgery. The checkup aimed to controlling the functional capacity of arterial and venous bypasses, of thrombal endarterectomy (TEA) and percutaneous transluminal angioplasty (PTA). The image quality of the examinations was good or very good in 138 cases and satisfactory in 19 cases in respect of the questions to be solved. In 3 cases, no information of diagnostic value was obtained. Vascular wall irregularities, stenoses, occlusions, dissections and aneurysms could be assessed with satisfactory display of anatomic details. Evidently DSA yielded a higher percentage of better results in the assessment of reconstructive vascular surgery than was obtained by pretherapeutic diagnosis in the region of the vessels, head, trunk and body periphery.

  12. Vascular surgery research in the Gulf Cooperation Council countries

    Directory of Open Access Journals (Sweden)

    Ali Jawas

    2014-04-01

    Conclusion: The quality and quantity of vascular surgery research in the GCC countries should be improved to answer important local questions related to vascular diseases. This needs better strategic planning and more collaboration between various institutions.

  13. Inferior vena cava leiomyosarcoma: vascular reconstruction is not ...

    African Journals Online (AJOL)

    Leiomyosarcoma (LMS) of inferior vena cava is a rare and aggressive tumor, arising from the smooth muscle cells in the vessel wall. A large complete surgical resection is the essential treatment. The need of vascular reconstruction is not always mandatory. It's above all to understand the place of the reconstruction with ...

  14. Urologic surgery laparoscopic access: vascular complications.

    Science.gov (United States)

    Branco, Anibal Wood

    2017-01-01

    Vascular injury in accidental punctures may occur in large abdominal vessels, it is known that 76% of injuries occur during the development of pneumoperitoneum. The aim of this video is to demonstrate two cases of vascular injury occurring during access in laparoscopic urologic surgery. The first case presents a 60-year old female patient with a 3cm tumor in the superior pole of the right kidney who underwent a laparoscopic partial nephrectomy. After the Verres needle insertion, output of blood was verified. During the evaluation of the cavity, a significant hematoma in the inferior vena cava was noticed. After the dissection, a lesion in the inferior vena cava was identified and controlled with a prolene suture, the estimated bloos loss was 300ml. The second case presents a 42-year old female live donor patient who had her right kidney selected to laparoscopic live donor nephrectomy. After the insertion of the first trocar, during the introduction of the 10mm scope, an active bleeding from the mesentery was noticed. The right colon was dissected and an inferior vena cava perforation was identified; a prolene suture was used to control the bleeding, the estimated blood loss was 200mL, in both cases the patients had no previous abdominal surgery. Urologists must be aware of this uncommon, serious, and potentially lethal complication. Once recognized and in the hands of experienced surgeons, some lesions may be repaired laparoscopically. Whenever in doubt, the best alternative is the immediate conversion to open surgery to minimize morbidity and mortality. Copyright® by the International Brazilian Journal of Urology.

  15. Mesenchymal stem cells in oral reconstructive surgery

    DEFF Research Database (Denmark)

    Jakobsen, C; Sørensen, J A; Kassem, M

    2013-01-01

    This study evaluated clinical outcomes following intraoperative use of adult mesenchymal stem cells (MSCs) in various oral reconstructive procedures. PubMed was searched without language restrictions from 2000 to 2011 using the search words stem cell, oral surgery, tissue engineering, sinus lift...

  16. Vascular medicine and surgery in ancient Egypt.

    Science.gov (United States)

    Barr, Justin

    2014-07-01

    Lauded alike by ancient civilizations and modern society, pharaonic Egyptian medicine remains an object of fascination today. This article discusses its surprisingly sophisticated understanding of a cardiovascular system. The term "cardiovascular system," however, carries assumptions and meanings to a modern audience, especially readers of this journal, which simply do not apply when considering ancient conceptions of the heart and vessels. For lack of better language, this article will use "cardiovascular" and similar terms while recognizing the anachronistic inaccuracy. After briefly summarizing ancient Egyptian medicine generally, it will review the anatomy, pathology, and treatment of the vasculature. The practice of mummification in ancient Egypt provides a unique opportunity for paleopathology, and the conclusion will explore evidence of arterial disease from a modern scientific perspective. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  17. Ethical issues in plastic and reconstructive surgery.

    Science.gov (United States)

    Sterodimas, Aris; Radwanski, Henrique N; Pitanguy, Ivo

    2011-04-01

    Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal or to enhance a certain structure or anatomy that is already normal. Several ethical considerations such as a patient's right for autonomy, informed consent, beneficence, and nonmalfeasance need to be given careful consideration. The principal objective of the medical profession is to render services to humanity with full respect for human dignity. Plastic surgeons should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. They require an extensive amount of education and training. The increases in demand for aesthetic plastic surgery and the advocacy of practice in the media have raised concerns about the circumstances under which cosmetic surgery is ethical and permissible. Innovative research, and new technologies derived from such research, almost always raises ethical and policy concerns. Medical ethics regulate what is, and what is not, correct in promoting plastic surgery to the public. It is essential to create an educated and informed public about the ethical issues in the plastic and reconstructive surgery field. Plastic surgeons need to carefully evaluate the degree of deformity, physical and emotional maturity, and desired outcome of patients who request plastic surgery procedures. Science is a powerful force for change in modern society and plastic surgeons have a responsibility to shepherd that change with thoughtful advocacy and careful ethical scrutiny of their own behavior.

  18. Vascularized Spare Parts Reconstruction of Hand Gunshot Injury.

    Science.gov (United States)

    Patrick, Nathan; Payatakes, Alexander

    2017-09-01

    Reconstruction of extensive traumatic bone and soft tissue deficits in the hand often presents a significant challenge. We present a case of a gunshot wound managed with a resourceful "vascularized spare parts" reconstruction in which a single compromised digit provided two separate vascularized tissue transfers. A rarely reported pedicled phalanx restored osseous stability, a digital fillet flap achieved soft tissue coverage, and the flexor tendons reanimated the hand. An excellent functional and cosmetic result was obtained and the patient was able to return to manual labor within six months of injury.

  19. Outcomes in Anterior Cruciate Ligament Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Roman Mihai

    2016-11-01

    Full Text Available Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.

  20. A systematic review of functional outcome and quality of life following reconstruction of maxillofacial defects using vascularized free fibula flaps and dental rehabilitation reveals poor data quality

    NARCIS (Netherlands)

    Wijbenga, Johan G.; Schepers, Rutger H.; Werker, Paul M. N.; Witjes, Max J. H.; Dijkstra, Pieter U.

    Background: Reconstruction and oral rehabilitation of segmental maxillofacial defects resulting from ablative surgery is commonly achieved by osteocutaneous vascularized free fibula (VFFF) transplantation combined with implant-supported dental prostheses. We systematically reviewed the literature

  1. Vascularized Fibula Flaps for Mandibular Reconstruction: An ...

    African Journals Online (AJOL)

    For decades, osseous vascularised flaps have been used for reconstruction of the mandible with the vascularised fibula flap (VFF) remaining the commonly used osseous free flap, reasons ranging from its adequate bone and pedicle length to its receptive dental implant placement quality. This report considers a modest use ...

  2. Impact of Integrated Vascular Residencies on Academic Productivity within Vascular Surgery Divisions.

    Science.gov (United States)

    Kim, Bradford J; Valsangkar, Nakul P; Liang, Tiffany W; Murphy, Michael P; Zimmers, Teresa A; Bell, Teresa M; Davies, Mark G; Koniaris, Leonidas G

    2017-02-01

    Changing training paradigms in vascular surgery have been introduced to reduce overall training time. Herein, we sought to examine how shortened training for vascular surgeons may have influenced overall divisional academic productivity. Faculty from the top 55 surgery departments were identified according to National Institutes of Health (NIH) funding. Academic metrics of 315 vascular surgery, 1,132 general surgery, and 2,403 other surgical specialties faculty were examined using institutional Web sites, Scopus, and NIH Research Portfolio Online Reporting Tools from September 1, 2014, to January 31, 2015. Individual-level and aggregate numbers of publications, citations, and NIH funding were determined. The mean size of the vascular divisions was 5 faculty. There was no correlation between department size and academic productivity of individual faculty members (R(2) = 0.68, P = 0.2). Overall percentage of vascular surgery faculty with current or former NIH funding was 20%, of which 10.8% had major NIH grants (R01/U01/P01). Vascular surgery faculty associated with integrated vascular training programs demonstrated significantly greater academic productivity. Publications and citations were higher for vascular surgery faculty from institutions with both integrated and traditional training programs (48 of 1,051) compared to those from programs with integrated training alone (37 of 485) or traditional fellowships alone (26 of 439; P productivity was improved within vascular surgery divisions with integrated training programs or both program types. These data suggest that the earlier specialization of integrated residencies in addition to increasing dedicated vascular training time may actually help promote research within the field of vascular surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications

    Directory of Open Access Journals (Sweden)

    George Kokosis

    2016-01-01

    Full Text Available The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, including non-vascularized bone grafts, vascularized bone grafts, and approaches related to tissue engineering. This review summarizes different modifications of the free vascularized fibula graft, which, since its introduction by Hidalgo in 1989, has become the first option for mandibular reconstruction. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction. Osteocutaneous flaps can be harvested for reconstruction of composite defects. 'Double-barreling' of the fibula can, for instance, enable enhanced aesthetic and functional results, as well as immediate one-stage osseointegrated dental implantation. Recently described preoperative virtual surgery planning to facilitate neomandible remodeling could guarantee good results. To conclude, the free fibula bone graft can currently be regarded as the "gold standard" for mandibular reconstruction in case of composite (inside and outside oral cavity defects as well as a way of enabling the performance of one-stage dental implantation.

  4. New Options for Vascularized Bone Reconstruction in the Upper Extremity

    Science.gov (United States)

    Houdek, Matthew T.; Wagner, Eric R.; Wyles, Cody C.; Nanos, George P.; Moran, Steven L.

    2015-01-01

    Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction. PMID:25685100

  5. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    Science.gov (United States)

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

  6. Endovascular Management of Vascular Injury during Transsphenoidal Surgery.

    Science.gov (United States)

    Cinar, C; Bozkaya, H; Parildar, M; Oran, I

    2013-03-01

    Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery. During the last ten-year period, we retrospectively evaluated nine patients with vascular injury after transsphenoidal surgery. Eight patients were symptomatic due to vascular injury, while one had only suspicion of vascular injury during surgery. Four patients presented with epistaxis, two with subarachnoid hemorrhage, one with exophthalmos, and one with hemiparesia. Emergency angiography revealed a pseudoaneurysm in four patients, contrast extravasation in two, vessel dissection in one, vessel wall irregularity in one, and arteriovenous fistula in one. All patients but one were treated successfully with parent artery occlusion, with one covered stent implantation, one stent-assisted coiling method, while one patient was managed conservatively. One patient died due to complications related to the primary insult without rebleeding. Vascular injuries suspected intra or postoperatively must be investigated rapidly after transsphenoidal surgery. Endovascular treatment with parent artery occlusion is feasible with acceptable morbidity and mortality rates in the treatment of vascular injuries occurring in transsphenoidal surgery.

  7. Three-dimensional virtual technology in reconstruction of mandibular defect including condyle using double-barrel vascularized fibula flap.

    Science.gov (United States)

    Wang, W H; Zhu, J; Deng, J Y; Xia, B; Xu, B

    2013-07-01

    The aim of this study is to demonstrate the reconstruction of mandibular defects including the condyle using a double-barrel vascularized fibula flap aided by three-dimensional virtual technology. Ten patients with the type H mandibular defects, who had undergone mandibular reconstruction using a double-barrel vascularized fibula flap, were reviewed for this study. Prior to the surgery, the patients CT scan data were analyzed virtually using SimPlant Pro™ software (version 11.04). The simulation allowed construction of an individual mandibular model serving to guide the clinical operation. The preoperative virtual surgery greatly benefitted the actual surgery. The vertical height of the neomandible and facial contour were precisely predicted. Some minor complications were encountered. Postoperative three-dimensional reconstruction revealed a close match with the simulated condyle. A double-barrel vascularized fibula flap can provide sufficient bone, both in length and vertical height, for the reconstruction of a type H mandibular condylar defect. Combined virtual three-dimensional reconstruction and rapid prototyping can improve postoperative outcomes in mandibular reconstruction. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Functional reconstruction of subtotal thumb metacarpal defect with a vascularized medial femoral condyle flap: case report.

    Science.gov (United States)

    Wong, Victor W; Higgins, James P; Katz, Ryan D

    2014-10-01

    Devastating hand injuries require customized reconstructive strategies to maximize functional outcomes. We report a case of thumb metacarpal reconstruction using a vascularized medial femoral condyle osteocutaneous flap in the setting of nearly complete metacarpal loss. In addition to achieving the traditional goals of reconstructing thumb length and providing stability, the medial femoral condyle flap allowed motion at the carpometacarpal joint. The patient's hand function was further optimized by a component transfer of a proximally injured but distally preserved index finger to the amputated middle finger position. The patient regained satisfactory grip and thumb function with minimal donor site morbidity. This case highlights the role of both creative and established approaches to reconstruct composite tissues following devastating hand injury. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. [The da Vinci robot in the field of vascular surgery].

    Science.gov (United States)

    Štádler, P; Dvořáček, L; Vitásek, P; Matouš, P

    2017-01-01

    The aim of this study was to evaluate the clinical experience with 379 robot-assisted vascular procedures performed from November 2005 to December 2016 at our institution. A total of 366 cases (96.6%) were successfully completed using the robotic surgical systems da Vinci Standard and da Vinci Xi. Conversion was necessary in 13 patients (3.4%). The 30-day mortality was 0.26% and 2 (0.5%) late prosthetic infections occurred. From a practical point of view, the greatest advantage of robot-assisted procedures has been the speed and relative simplicity of vascular anastomosis construction. Our experience with robot-assisted surgery has demonstrated the safety and feasibility of this technique in different areas of vascular surgery.Key words: robotic vascular surgery aortic and non-aortic surgery.

  10. Reconstructive bladder surgery in genitourinary tuberculosis

    Directory of Open Access Journals (Sweden)

    Narmada Prasad Gupta

    2008-01-01

    Full Text Available Genitourinary tuberculosis (GUTB occurs in 15-20% cases of pulmonary tuberculosis with a prevalence of 400 per 100,000 population. Reconstructive surgery for GUTB is required for cases with grossly distorted and dysfunctional anatomy that are unlikely to regress with chemotherapy alone. In the recent past, there has been a tremendous increase in the variety of reconstructive procedures for the urinary bladder, used in the management of GUTB. Augmentation cystoplasty includes the goals of increasing bladder capacity, while retaining as much of bladder as possible. Various bowel segments (from the stomach to the sigmoid colon have been used for bladder reconstruction. The choice of material for reconstruction is purely the surgeon′s prerogative--his skill, the ease, the mobility and length of mesentery (allowing bowel to reach the bladder neck without tension and maintaining an adequate blood supply. The presence or absence of concomitant reflux is of considerable importance. In the former, an ileocystoplasty with implantation of ureter to the proximal end of the isolated ileal loop and anastomosis of the distal end of the ileal loop to the bladder neck and trigone is advocated. In the latter case, the ureterovesical valve is preserved and colocystoplasty is preferred, wherein the sigmoid colon on being opened along its antimesentric border is joined to the trigone and bladder neck and then to itself to form a capacious pouch. Gastrocystoplasty reduces the risk of acidosis but is associated with complications like hypochloremic alkalosis and ′hematuria-dysuria′ syndrome. Orthotopic neobladder reconstruction is a feasible option, suitable in cases of tubercular thimble bladder with a markedly reduced capacity (as little as 15 ml, where an augmentation alone may be associated with anastomatic narrowing or poor relief of symptoms. In this article, we review the various bladder reconstruction options used for the surgical management of GUTB

  11. Improving cost efficiency on a vascular surgery service.

    Science.gov (United States)

    Skillman, J J; Paras, C; Rosen, M; Davis, R B; Kim, D; Kent, K C

    2000-03-01

    A vascular task force (VTF) consisting of two vascular surgeons and other key personnel was established to reduce costs and improve efficiency in the management of patients on a vascular surgery service. The VTF met monthly beginning in 1994 to study and implement changes in the management of patients with (1) abdominal vascular, (2), carotid endarterectomy (3) distal bypass, and (4) other vascular procedures, including amputations. Length of stay, and fixed and variable costs were assessed for change over time using Pearson correlation coefficients. Improvements in efficiency (length of stay) and decreases in costs (fixed and variable costs) from fiscal year 1993 to fiscal year 1996 were significant for the total group of vascular patients (P Management of distal bypass and other vascular surgery patients showed less striking improvement. Vascular surgeons in collaboration with other dedicated personnel involved in the care of vascular patients can improve efficiency and reduce costs. Advances were greatest in patients who required operations for carotid and abdominal vascular disorders and least for patients who required distal bypasses and other vascular procedures.

  12. Iatrogenic Vascular Injuries Due to Spinal Surgeries: Endovascular Perspective.

    Science.gov (United States)

    Gok, Mustafa; Aydin, Elcin; Guneyli, Serkan; Akay, Ali; Cinar, Celal; Oran, Ismail

    2017-01-17

    Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Surgical management of these injuries is challenging with high morbidity rates. In this study we aim to present the results of endovascular management of iatrogenic vascular injuries due to spinal surgeries. We retrospectively reviewed 11 patients (5 male, 6 female) who had vascular injuries due to cervical and lumbar spinal surgeries. Clinical findings were bleeding (n=5), leg edema (n=6) and right heart failure with severe dyspnea (n=1). The age range of the patients were between 42-67 (mean: 57.1). Six patients were reviewed with imaging before the procedures and the rest of the patients (n=5) were directly referred to the angiography unit for diagnosis and possible endovascular treatment. The types of surgeries were; cervical surgery (n=5) and lumbar disc operation (n=6). The type of vascular injuries were; vertebral artery stenosis (n=1), vertebral artery pseudoaneurysm (n=3), vertebral artery occlusion (n=1) and iliac arteriovenous fistula (n=6). The type of endovascular treatments were; parent artery occlusion (PAO) (n=2), covered stent graft implantation (n=6) and intrasaccular coil embolization of pseudoaneurysm (n=1). The remaining 2 patients were managed conservatively. No major complications or mortality occured during endovascular interventions. No bleeding or ischemia occured in the follow-up period. Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Endovascular interventions are safe and effective in the diagnosis and treatment of such vascular injuries.

  13. Rotationplasty with vascular reconstruction for prosthetic knee joint infection.

    Science.gov (United States)

    Fujiki, Masahide; Miyamoto, Shimpei; Nakatani, Fumihiko; Kawai, Akira; Sakuraba, Minoru

    2015-01-01

    Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.

  14. Rotationplasty with Vascular Reconstruction for Prosthetic Knee Joint Infection

    Directory of Open Access Journals (Sweden)

    Masahide Fujiki

    2015-01-01

    Full Text Available Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.

  15. Total hepatectomy model in pigs: Revised method for vascular reconstruction using a rigid vascular prosthesis

    NARCIS (Netherlands)

    Sosef, M. N.; van Gulik, T. M.

    2004-01-01

    Total hepatectomy in animals provides an irreversible model of acute liver failure. Vascular reconstruction in this model of acute liver failure was modified and characterized for the use of assessment of liver support systems. Pigs underwent total hepatectomy and a rigid three-way transparent

  16. Career in vascular surgery - the medical student's perspective.

    Science.gov (United States)

    Grobelna, Malwina K; Stępak, Hubert; Kołodziejczak, Barbara; Dzieciuchowicz, Łukasz; Oszkinis, Grzegorz

    2017-02-28

    Under the supervision of the Department of General and Vascular Surgery of Poznan University of Medical Sciences, a questionnaire was distributed online or as a paper version to medical students (MSs) in order to better understand the attitudes towards surgery as a specialty and to determine the reasons why students do and do not choose vascular surgery as their career path. The questionnaire was distributed online or as a paper version to MSs in the 3rd, 5th, and 6th year of the PUMS 6-year M.D. It provided the data on the year of study, grade point average (GPA), sex, age, respondent's specialty choice, 33 questions with responses on a 1-5 Likert scale (1 was the least important reason and 5 was the most important reason), and 2 questions with socres between 0 and 4. A total of 136 Polish MSs of PUMS completed the survey. For MSs who choose vascular surgery as their career path, "endovascular capabilities of vascular surgery" and "higher income possibilities than a general surgeon" were the most important reasons. The "poor availability of work in other places than the vascular surgery department of your choice, few such clinics in the region" was the most important reason not to choose vascular surgery. A role of gender was also noted - 13% of male MSs classified gender as an "important factor", in contrast to 60% of female MSs. The findings of this study might help to develop better strategies to attract future trainees to surgical specialties, particularly vascular surgery, and improve work environment.

  17. 3D Reconstruction of Coronary Artery Vascular Smooth Muscle Cells

    OpenAIRE

    Tong Luo; Huan Chen; Kassab, Ghassan S.

    2016-01-01

    Aims The 3D geometry of individual vascular smooth muscle cells (VSMCs), which are essential for understanding the mechanical function of blood vessels, are currently not available. This paper introduces a new 3D segmentation algorithm to determine VSMC morphology and orientation. Methods and Results A total of 112 VSMCs from six porcine coronary arteries were used in the analysis. A 3D semi-automatic segmentation method was developed to reconstruct individual VSMCs from cell clumps as well a...

  18. Recruiting women to vascular surgery and other surgical specialties.

    Science.gov (United States)

    Dageforde, Leigh Anne; Kibbe, Melina; Jackson, Gretchen Purcell

    2013-01-01

    Vascular surgery is a subspecialty that attracts future surgeons with challenging technical procedures and complex decision making. Despite its appeal, continued promotion of the field is necessary to recruit and retain the best and brightest candidates. Recruitment of medical students and residents may be limited by the lifestyle inherent to vascular surgery and the length of residency training. The young adults of the current applicant and resident pool differ from prior generations in their desire for hands-on mentoring, aspirations to affect change daily, a penchant for technology, and strong emphasis on work-life balance. Furthermore, the percentage of women pursuing careers in vascular surgery is not representative of the eligible workforce. Women are now the majority of graduates in all of higher education, and thus, vascular surgery may need to make a concerted effort to appeal to women in order to attract the most talented young professionals to the field. Recruiting strategies for both men and women of Generation Y should target a diverse group of potential candidates with an awareness of the unique characteristics and needs of this generation of rising surgeons. Copyright © 2013 Society for Vascular Surgery. All rights reserved.

  19. Penile vascular surgery for treating erectile dysfunction: Current role and future direction

    Science.gov (United States)

    Molodysky, Eugen; Liu, Shi-Ping; Huang, Sheng-Jean; Hsu, Geng-Long

    2013-01-01

    Penile vascular surgery for treating erectile dysfunction (ED) is still regarded cautiously. Thus we reviewed relevant publications from the last decade, summarising evidence-based reports consistent with the pessimistic consensus and, by contrast, the optimistically viable options for vascular reconstruction for ED published after 2003. Recent studies support a revised model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat. Additional studies show a more sophisticated venous drainage system than previously understood, and most significantly, that the emissary veins can be easily occluded by the shearing action elicited by the inner and outer layers of the tunica albuginea. Pascal’s law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity. Reports on revascularisation surgery support its utility in treating arterial trauma in young males, and with localised arterial occlusive disease in the older man. Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually eliminated, with the venous ligation technique superseding venous cautery. Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is appropriate using a sound method. It should be a promising option in the near future. PMID:26558090

  20. Nanotechnology applications in plastic and reconstructive surgery: a review.

    Science.gov (United States)

    Parks, Joe; Kath, Melissa; Gabrick, Kyle; Ver Halen, Jon Peter

    2012-01-01

    Although nanotechnology is a relatively young field, there are already countless biomedical applications. Plastic and reconstructive surgery has significantly benefited from nanoscale refinements of diagnostic and therapeutic techniques. Plastic surgery is an incredibly diverse specialty, encompassing craniofacial surgery, hand surgery, cancer/trauma/congenital reconstruction, burn care, and aesthetic surgery. In particular, wound care, topical skin care, implant and prosthetic design, tissue engineering, regenerative medicine, and drug delivery have all been influenced by advances in nanotechnology. Nanotechnology will continue to witness growth and expansion of its biomedical applications, especially those in plastic surgery.

  1. Changes of low back pain after vascular reconstruction for abdominal aortic aneurysm and high aortic occlusion: a retrospective study.

    Science.gov (United States)

    Takeyachi, Yoshiaki; Yabuki, Shoji; Arai, Itaru; Midorikawa, Hirofumi; Hoshino, Shunichi; Chiba, Katsumi; Kikuchi, Shinichi

    2006-08-01

    The purpose of the present study is to clarify the influence of acute and chronic interruption of blood flow from lumbar arteries as well as the influence of vascular reconstruction on low back pain, back muscles, and lumbar discs. Subjects were 34 patients with AAA in whom vascular reconstruction was performed. A second group was comprised of 9 patients with HAO. The presence of low back pain before surgery and at follow-up examination was retrospectively examined in the AAA group and the HAO group to investigate postoperative changes. The CSA and degeneration of the multifidus muscle and the lumbar discs on magnetic resonance imaging were assessed in the AAA group and control group. Low back pain, significant atrophy, or degeneration of the multifidus muscle or degeneration of the lumbar disc did not newly develop after surgery in the AAA group. These results indicated that acute interruption of lumbar arteries did not induce the development or deterioration of low back pain and organic changes in the back muscles or lumbar discs. The frequency of low back pain before surgery was significantly higher in the HAO group than that in the AAA group. However, the frequency of low back pain after surgery did not differ significantly between the 2 groups because low back pain in the HAO group was improved after surgery. The finding that low back pain was improved by merely performing treatment for the vascular system might provide support for the presence of vascular backache.

  2. Parietal Peritoneum as an Autologous Substitute for Venous Reconstruction in Hepatopancreatobiliary Surgery.

    Science.gov (United States)

    Dokmak, Safi; Aussilhou, Béatrice; Sauvanet, Alain; Nagarajan, Ganesh; Farges, Olivier; Belghiti, Jacques

    2015-08-01

    To evaluate the parietal peritoneum (PP) as an autologous substitute for venous reconstruction during hepatopancreatobiliary (HPB) surgery. Venous resection during liver or pancreatic resection may require a rapidly available substitute especially when the need for venous resection is unforeseen. The PP was used as an autologous substitute during complex liver and pancreatic resections. Postoperative anticoagulation was standard and venous patency was assessed by routine computed tomographic scans. Thirty patients underwent vascular resection during pancreatic (n = 18) or liver (n = 12) resection, mainly for malignant tumors (n = 29). Venous resection was an emergency procedure in 4 patients due to prolonged vascular occlusion. The PP, with a mean length of 22 mm (15-70), was quickly harvested and used as a lateral (n = 28) or a tubular (n = 2) substitute for reconstruction of the mesentericoportal vein (n = 24), vena cava (n = 3), or hepatic vein (n = 3). Severe morbidity included Clavien grade-III complications in 4 (13%) patients but there was no PP-related or hemorrhagic complications. Histological vascular invasion was present in 18 (62%) patients, and all had an R0 resection (100%). After a mean follow-up of 14 (7-33) months, all venous reconstructions were patent except for 1 tubular graft (97%). A PP can be safely used as a lateral patch for venous reconstruction during HPB surgery; this could help reduce reluctance to perform vascular resection when oncologically required. Clinical trials identification: NCT02121886.

  3. Reconstruction of Mandibular Defect by Free Re-Vascularized Fibula Graft: A Case Report

    Directory of Open Access Journals (Sweden)

    Quazi Billur Rahman

    2009-11-01

    Full Text Available Background: In maxillofacial surgery tumor ablation often causes continuity defect of mandible which results anatomical and functional morbidity of the patient. The reconstruction of the mandibular defect is mandatory to restore the oral function and speech. Various methods of immediate reconstruction are implemented by different authors time to time including autogenous non vascularized bone graft, allogenic bone graft , auto frozen mandible or reconstruction plates and others. Each has its own advantages and disadvantages including donor site morbidity, failure and others. The purpose of the present case report is to establish micorvascular free fiblula is as a better option to other methods in immediate reconstruction of mandibular continuity defect. Objective: Anatomical, functional and esthetic rehabilitation of patients after mandibular resection Method: Revascularization of free fibula graft by microvascular anastomosis of paroneal artery with facial artery at the segmental defect site of mandible. Result: Remarkable contour, cosmesis and early functional rehabilatation of the patient. Conclusion: Microvascular reconstruction with fibula is the better option for defect correction and early rehabilitation in patients with mandibular continuity defect. Key words: Mandible, defect; reconstruction; microvascular technique; fibula graftDOI: 10.3329/bsmmuj.v1i1.3698 BSMMU J 2008; 1(1: 35-38

  4. Regional cerebral blood flow before and after vascular surgery in patients with transient ischemic attacks with 133-xenon inhalation tomography

    DEFF Research Database (Denmark)

    Vorstrup, S; Hemmingsen, Ralf; Lindewald, H

    1982-01-01

    with no abnormality on the CT-scan. The abnormal blood flow pattern was found to be unchanged after clinically successful reconstructive vascular surgery. This suggests the presence of irreversible ischemic tissue damage without gross emollition (incomplete infarction). It is concluded, that TIAs are often harmful...

  5. Low vs. high haemoglobin trigger for transfusion in vascular surgery

    DEFF Research Database (Denmark)

    Møller, A; Nielsen, H B; Wetterslev, J

    2017-01-01

    for Vascular Surgery. Restricting RBC transfusion may affect blood O2 transport with a risk for development of tissue ischaemia and postoperative complications. METHODS: In a single-centre, open-label, assessor blinded trial, 58 vascular surgical patients (> 40 years of age) awaiting open surgery...... of the infrarenal aorta or infrainguinal arterial bypass surgery undergo a web-based randomisation to one of two groups: perioperative RBC transfusion triggered by hb ...-infrared spectroscopy determines tissue oxygenation. Serious adverse event rates are: myocardial injury (troponin-I ≥ 45 ng/l or ischaemic electrocardiographic findings at day 30), acute kidney injury, death, stroke and severe transfusion reactions. A follow-up visit takes place 30 days after surgery and a follow...

  6. Near-infrared spectroscopy during peripheral vascular surgery

    DEFF Research Database (Denmark)

    Eiberg, J P; Schroeder, T V; Vogt, K C

    1997-01-01

    Near-infrared spectroscopy was performed perioperatively on the dorsum of the foot in 14 patients who underwent infrainguinal bypass surgery using a prosthesis or the greater saphenous vein. Dual-wavelength continuous light spectroscopy was used to assess changes in tissue saturation before, during...... that near-infrared spectroscopy is appropriate for perioperative monitoring during vascular grafting....

  7. Non-invasive vascular imaging in perforator flap surgery

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Dept. of Radiology, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)], e-mail: lucasaba@tiscali.it; Atzeni, Matteo; Ribuffo, Diego [Dept. of Surgery, Section of Plastic Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy); Rozen, Warren Matthew [Jack Brockhov Reconstructive Plastic Surgery Research Unit, Dept. of Anatomy and Cell Biology, The Univ. of Melbourne, Parkville, Victoria (Australia); Alonso-Burgos, Alberto [Dept. of Radiology, Clinica Univ., Univ. de Navarra, Pamplona (Spain); Bura, Raffaella [Dept. of Surgery, Section of Vascular Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)

    2013-02-15

    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered.

  8. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction.

    Science.gov (United States)

    Innocenti, Marco; Delcroix, Luca; Manfrini, Marco; Ceruso, Massimo; Capanna, Rodolfo

    2005-09-01

    Treatment of the loss of the distal part of the radius, including the physis and epiphysis, in a skeletally immature patient requires both replacement of the osseous defect and restoration of longitudinal growth. Autologous vascularized epiphyseal transfer is the only possible procedure that can meet both requirements. Between 1993 and 2002, six patients with a mean age of 8.4 years (range, six to eleven years) who had a malignant bone tumor in the distal part of the radius underwent microsurgical reconstruction of the distal part of the radius with a vascularized proximal fibular transfer, including the physis and a variable length of the diaphysis. All of the grafts were supplied by the anterior tibial vascular network. The rate of survival and bone union of the graft, the growth rate per year, the ratio between the lengths of the ulna and the reconstructed radius, and the range of motion of the wrist were evaluated for five of the six patients who had been followed for three years or more. The mean duration of follow-up of the six patients was 4.4 years (range, eight months to nine years). All six transfers survived and united with the host bone within two months postoperatively. The five patients who were followed for three years or more had consistent and predictable longitudinal growth. Serial radiographs revealed remodeling of the articular surface. The functional result was rated as excellent for all but one patient, in whom the distal part of the ulna had also been resected because of neoplastic involvement. No major complication occurred at the recipient site, whereas a peroneal nerve palsy occurred at the donor site in three patients. The palsy was transient in two patients, but it persisted in one. No instability of the knee joint was observed. After radical resection of the distal part of the radius because of a neoplasm in children, vascularized proximal fibular transfer, based on the anterior tibial artery, permits a one-stage skeletal and joint

  9. Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment.

    Science.gov (United States)

    Ranieri, M; Wohlgemuth, W; Müller-Wille, R; Prantl, L; Kehrer, A; Geis, S; Klein, S; Lamby, P; Schiltz, D; Uller, W; Aung, T; Dolderer, J H

    2017-01-01

    This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and

  10. Trends in open vascular surgery for trauma: implications for the future of acute care surgery.

    Science.gov (United States)

    Forrester, Joseph D; Weiser, Thomas G; Maggio, Paul; Browder, Timothy; Tennakoon, Lakshika; Spain, David; Staudenmayer, Kristan

    2016-09-01

    Trauma patients with vascular injuries have historically been within a general surgeon's operative ability. Changes in training and decline in operative trauma have decreased trainees' exposure to these injuries. We sought to determine how frequently vascular procedures are performed at US trauma centers to quantify the need for general surgeons trained to manage vascular injuries. We conducted a retrospective analysis of the National Trauma Data Base (NTDB) from 2012 compared with 2002. Patients with general surgical and vascular procedures were identified using International Classification of Diseases, Ninth Revision, procedure codes 38.0-39.99, excluding 38.9-38.99. General surgery or vascular operations were performed on 12,099 (24%) of 50,248 severely injured adult patients in 2002 and 21,854 (16%) of 138,009 injured patients in 2012. Nineteen percent to 26% of all patients underwent vascular procedures. Patients with combined general surgery and vascular procedures were less likely to be discharged home and more likely to die. In 2002, 6% of severely injured adult trauma patients underwent open vascular procedures at level III/IV trauma centers; by 2012, only 1% of vascular surgery procedures were performed at level III/IV centers (P surgery remains common for severely injured patients. Future trauma systems and surgical training programs will need to account for the need for open vascular skills. The findings suggest that there is already a trend away from open vascular procedures at level III/IV trauma centers, which may be a sign of system compensation for changes in the workforce. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Clinical characteristics associated with readmission among patients undergoing vascular surgery.

    Science.gov (United States)

    Engelbert, Travis L; Fernandes-Taylor, Sara; Gupta, Prateek K; Kent, K Craig; Matsumura, Jon

    2014-05-01

    Readmission after a vascular surgery intervention is frequent, costly, and often considered preventable. Vascular surgery outcomes have recently been scrutinized by Medicare because of the high rates of readmission. We determined patient and clinical characteristics associated with readmission in a cohort of vascular surgery patients. From 2009 to 2013, the medical records of all patients (n = 2505) undergoing interventions by the vascular surgery service at a single tertiary care institution were retrospectively reviewed. Sociodemographic and clinical characteristics were examined for association with 30-day readmission to the same institution. The 30-day readmission rate to the same institution was 9.7 % (n = 244). Procedures most likely to result in readmission were below-knee (25%), foot (22%), and toe amputations (19%), as well as lower extremity revascularization (22%). Patients covered by Medicaid (16.8%) and Medicare (10.0%) were most likely to be readmitted, followed by fee-for-service (9.5%), self-pay (8.0%), and health maintenance organizations (5.5%; P vs 6.2% low severity; P vs 6.1 days, respectively; P vs 9.5% without intensive care unit stay; P institutions must identify high-risk patients. Efforts should focus on subgroups undergoing selected interventions (amputations, lower extremity revascularization), those with urgent admissions, and patients with extended hospital stays. Patients in need of postacute care upon discharge are especially prone to readmission, requiring special attention to discharge planning and coordination of postdischarge care. By focusing on subgroups at risk for readmission, preventative resources can be efficiently targeted. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  12. Author disclosure of conflict of interest in vascular surgery journals.

    Science.gov (United States)

    Forbes, Thomas L

    2011-09-01

    Advances in vascular surgery are increasingly technology-driven, and the relationships between surgeons and the medical device industry can be complex. This study reviewed conflict of interest (COI) disclosure in the vascular surgery journals regarding several selected technology-driven topics, including endovascular stent grafts (EV), carotid artery stenting (CAS), and peripheral arterial interventions (PI), to suggest further directions. Authors' COI disclosures were reviewed from all clinical papers published in 2008 and 2009 in each of six vascular surgery journals, and pertaining to three selected topics (EV, CAS, and PI). Rate of COI disclosure was evaluated as a function of journal, topic, article type (randomized trial, case series, case report, review, or meta-analysis), and authors' region of origin. Secondarily, consistency of authors' disclosure was evaluated by reviewing papers by the same author and of the same topic. Six hundred thirty-five papers were reviewed from the six journals. A COI was declared in 125 (19.7%) of these papers. This rate differed between journals (range, 3.2%-34.1%; P author writing papers describing the same general topic. COI disclosure was consistent in the majority of these instances (72.4%), but inconsistent in 32 cases (27.6%). The most common (P = .006) inconsistencies involved the same type of article in different journals (46.9%), or in the same journal (25%). Rates of disclosure of COI, and inconsistencies in disclosure in the vascular surgery literature are at least partially due to differences in journals' reporting policies, while a smaller proportion of these inconsistencies are due to individual author behavior. Journals should adopt a consistent requirement for a separate COI declaration where all relevant financial arrangements are disclosed. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  13. Single-specialty versus multispecialty vascular surgery group model.

    Science.gov (United States)

    Wixon, Christopher L; Jain, Krishna M; Satiani, Bhagwan

    2013-06-01

    The shift in employment options for vascular surgeons in the current era of major health care reform is being widely debated. After the decision to seek hospital employment or independent practice, the choice of then practicing in a single-specialty or a multispecialty practice remains a difficult decision. Although the trend is toward medium-sized to large-sized groups, only 1.2% of medical practices currently have >11 physicians. Barring the large multispecialty groups, such as Kaiser Permanente, Cleveland Clinic, or Mayo Clinic, most vascular practices are constituted as small groups. Which format prospers will depend on adroit management of financial and intellectual capital and nimbleness in adapting to rapidly changing market conditions. In this report, two practicing vascular surgeons debate the merits of single or multispecialty practice, with a commentary to follow. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  14. PREGNANCY IN CARDIO-VASCULAR SURGERY

    Directory of Open Access Journals (Sweden)

    D. Kazemi

    1968-01-01

    Full Text Available The Evol uulan 0 f pregnancy in Cardia V modern. Pertaining Literatu' - asculare Surgery discussed and re revlsed ?4 pe I C thought that any Pregnant . - . rsona ases arc analysed and it was f f . woman suffering fro M' I o allure in the pregnancy sho Id h . III itra stenosis with a history Meanwhilie the causes of our utwo dave hMitral C. omml.ssurotcmy as soon as possible minwhile the causes of our two deaths are discussed.

  15. Vascular Trauma Operative Experience is Inadequate in General Surgery Programs.

    Science.gov (United States)

    Yan, Huan; Maximus, Steven; Koopmann, Matthew; Keeley, Jessica; Smith, Brian; Virgilio, Christian de; Kim, Dennis Y

    2016-05-01

    Vascular injuries may be challenging, particularly for surgeons who have not received formal vascular surgery fellowship training. Lack of experience and improper technique can result in significant complications. The objective of this study was to examine changes in resident experience with operative vascular trauma over time. A retrospective review was performed using Accreditation Council for Graduate Medical Education (ACGME) case logs of general surgery residents graduating between 2004 and 2014 at 2 academic, university-affiliated institutions associated with level 1 trauma centers. The primary outcome was number of reported vascular trauma operations, stratified by year of graduation and institution. A total of 112 residents graduated in the study period with a median 7 (interquartile range 4.5-13.5) vascular trauma cases per resident. Fasciotomy and exposure and/or repair of peripheral vessels constituted the bulk of the operative volume. Linear regression showed no significant trend in cases with respect to year of graduation (P = 0.266). Residents from program A (n = 53) reported a significantly higher number of vascular trauma cases when compared with program B (n = 59): 12.0 vs. 5.0 cases, respectively (P < 0.001). Level 1 trauma center verification does not guarantee sufficient exposure to vascular trauma. The operative exposure in program B is reflective of the national average of 4.0 cases per resident as reported by the ACGME, and this trend is unlikely to change in the near future. Fellowship training may be critical for surgeons who plan to work in a trauma setting, particularly in areas lacking vascular surgeons. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Vena cava filter practices of a regional vascular surgery society.

    Science.gov (United States)

    Friedell, Mark L; Nelson, Peter R; Cheatham, Michael L

    2012-07-01

    Vena cava filter (VCF) use in the United States has increased dramatically with prophylactic indications for placement and the availability of low-profile retrievable devices, which are overtaking the filter market. We surveyed the practice patterns of a large group of vascular surgeons from a regional vascular surgery society to see whether they mirrored current national trends. A 17-question online VCF survey was offered to all members of the Southern Association of Vascular Surgery. The responses were analyzed using the χ(2) goodness of fit tests. Of the 276 members surveyed, 126 (46%) responded, with 118 (93%) indicating that they placed filters during their practice. Highly significant differences were identified with each question (at least P biconical and certain retrievable filters. Given the low removal rate and lack of long-term experience with retrievable filters, routine use of these devices as permanent filters should be questioned. If used on a temporary basis, there should be a plan for filter removal at the time of implantation. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  17. Raising the issue of DNAR orders in vascular surgery patients.

    Science.gov (United States)

    McIntosh, Rachel; Webb, Hannah; Hartley, Matthew; Brooks, Marcus

    2016-01-01

    The Tracey Report has recently raised the status of Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) orders in the hospital setting.[1] Guidelines are in place both nationally and locally to provide advice to clinicians on when to discuss DNACPR, and the approach to be taken. There was concern that on a busy regional vascular surgery unit, discussion of resuscitation status was not regular practice. Consequently, some patients were at risk of being inappropriately resuscitated, particularly out of hours. The North Bristol Somerset and Gloucester DNAR decision tree[2] was the tool used to decide whether a patient should have a documented discussion and/or a DNACPR form completed. We correlated the outcome of the decision tree with the presence of a DNACPR form or documented resuscitation discussion. Baseline measurements from all vascular inpatients on the vascular surgery unit demonstrated that only 27% had a DNACPR form or documented discussion in concordance with the DNACPR Decision Tree outcome. The aim of this project was to increase the proportion of patients with concordance of the DNACPR decision tree outcome with documented discussion or DNACPR form. The following three simple interventions raised concordance from 27% to 64% of patients on the vascular surgery unit. 1. Including resuscitation status of each patient as a column in the doctors daily handover. 2. Posters in staff only areas to highlight the meaning of DNACPR and raise awareness of the DNACPR decision tree. 3. Educational meeting surrounding DNACPR with the vascular surgery consultants, led by a care of the elderly consultant . This project has highlighted how raising awareness around DNACPR increases discussion amongst the clinical team surrounding resuscitation status of a patient. Consequently, this enables discussion to be had with patient and their family.

  18. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    Directory of Open Access Journals (Sweden)

    Huizhuang Xie

    2014-01-01

    CONCLUSION: Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.

  19. Measurement of Outcomes of Upper Limb Reconstructive Surgery for Tetraplegia

    NARCIS (Netherlands)

    Sinnott, K. Anne; Dunn, Jennifer A.; Wangdell, Johanna; Johanson, M. Elise; Hall, Andrew S.; Post, Marcel W.

    Reconstructive arm/hand surgery for tetraplegia is performed to improve arm/hand function and therefore personal well-being for individuals who accept such elective surgeries. However, changes at an impairment level do not always translate into functional or quality of life changes. Therefore,

  20. Contrast-Enhanced Ultrasound in Vascular Surgery: Review and Update

    DEFF Research Database (Denmark)

    Bredahl, Kim; Mestre, Xavier Marti; Coll, Ramon Vila

    2017-01-01

    are easy to use, manageable, and safe. This topical review attempts to summarize and highlight the current evidence and future prospects for contrast-enhanced ultrasound in vascular surgery, with a particular focus on opportunities in carotid and lower limb arteriosclerotic disease and surveillance after......Accurate imaging methods associated with minimum patient risk are important tools for clinical decision-making in vascular surgery. Today, traditional imaging methods, such as computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography are the preferred...... modalities. Ultrasound has only challenged these methods in assessment of carotid disease, aortic aneurysms, venous insufficiency, and thromboembolism and in surveillance of in situ bypasses. These practice patterns may change with the introduction of second-generation ultrasound contrast agents which...

  1. Beta-blocker use and clinical outcomes after primary vascular surgery: a nationwide propensity score-matched study.

    Science.gov (United States)

    Høgh, A; Lindholt, J S; Nielsen, H; Jensen, L P; Johnsen, S P

    2013-07-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction. Patients who had primary vascular surgical or endovascular reconstruction due to symptomatic peripheral arterial disease, in Denmark between 1996 and 2007 were included. We obtained data on filled prescriptions, clinical outcomes and confounding factors from population-based healthcare registries. Beta-blocker users were matched to non-users by propensity score, and Cox-regression was performed. All medications were included as time-dependent variables. We studied 16,945 matched patients (7828 beta-blocker users and 9117 non-users) with a median follow-up period of 582 days (range, 30-4379 days). The cumulative risks were as follows: all-cause mortality, 17.9%; MI, 5.3%; stroke, 5.6%; major amputation, 9.1%; and recurrent vascular surgery, 23.1%. When comparing beta-blocker users with non-users: adjusted hazard ratio: MI, 1.52 (95% CI, 1.31-1.78); stroke, 1.21 (95% CI, 1.03-1.43); and major amputation, 0.80 (95% CI, 0.70-0.93). Beta-blocker use after primary vascular surgery was associated with a lower risk of major amputation but an increased risk of hospitalisation with MI and stroke. No associations were found between beta-blocker use and all-cause mortality or the risk of recurrent vascular surgery. However, our results are not sufficient to alter the indication for beta-blocker use among symptomatic peripheral arterial disease patients. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  2. Laparoscopic reconstructive surgery is superior to vaginal reconstruction in the pelvic organ prolapse

    National Research Council Canada - National Science Library

    Park, Young-Han; Yang, Seong Cheon; Park, Sung Taek; Park, Sung Ho; Kim, Hong Bae

    2014-01-01

    ...) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade...

  3. Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation. Report of a case.

    Science.gov (United States)

    Cho-Lee, Gui-Youn; Naval-Gías, Luis; Martos-Díaz, Pedro L; González-García, Raúl; Rodríguez-Campo, Francisco J

    2011-01-01

    Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects (over 6 centimeters) resulting from trauma, infections or tumor resections. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it does not offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma, for optimization of the implant prosthetic rehabilitation. The distraction device was applied intraorally. After 10 days of latency period, distraction protocol was performed at a distraction rate of 0.5 mm per day. A consolidation period of 3 months followed. Afterwards the distraction device was removed and 3 osseointegrated dental implants were placed in the distracted area. As a result, the vertical discrepancy between the fibula and the native hemimandible was corrected. The amount of vertical height achieved after distraction was 17 milimeters. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. In conclusion, we consider that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumor surgery.

  4. 3D Reconstruction of Coronary Artery Vascular Smooth Muscle Cells.

    Science.gov (United States)

    Luo, Tong; Chen, Huan; Kassab, Ghassan S

    2016-01-01

    The 3D geometry of individual vascular smooth muscle cells (VSMCs), which are essential for understanding the mechanical function of blood vessels, are currently not available. This paper introduces a new 3D segmentation algorithm to determine VSMC morphology and orientation. A total of 112 VSMCs from six porcine coronary arteries were used in the analysis. A 3D semi-automatic segmentation method was developed to reconstruct individual VSMCs from cell clumps as well as to extract the 3D geometry of VSMCs. A new edge blocking model was introduced to recognize cell boundary while an edge growing was developed for optimal interpolation and edge verification. The proposed methods were designed based on Region of Interest (ROI) selected by user and interactive responses of limited key edges. Enhanced cell boundary features were used to construct the cell's initial boundary for further edge growing. A unified framework of morphological parameters (dimensions and orientations) was proposed for the 3D volume data. Virtual phantom was designed to validate the tilt angle measurements, while other parameters extracted from 3D segmentations were compared with manual measurements to assess the accuracy of the algorithm. The length, width and thickness of VSMCs were 62.9±14.9 μm, 4.6±0.6 μm and 6.2±1.8 μm (mean±SD). In longitudinal-circumferential plane of blood vessel, VSMCs align off the circumferential direction with two mean angles of -19.4±9.3° and 10.9±4.7°, while an out-of-plane angle (i.e., radial tilt angle) was found to be 8±7.6° with median as 5.7°. A 3D segmentation algorithm was developed to reconstruct individual VSMCs of blood vessel walls based on optical image stacks. The results were validated by a virtual phantom and manual measurement. The obtained 3D geometries can be utilized in mathematical models and leads a better understanding of vascular mechanical properties and function.

  5. 3D Reconstruction of Coronary Artery Vascular Smooth Muscle Cells.

    Directory of Open Access Journals (Sweden)

    Tong Luo

    Full Text Available The 3D geometry of individual vascular smooth muscle cells (VSMCs, which are essential for understanding the mechanical function of blood vessels, are currently not available. This paper introduces a new 3D segmentation algorithm to determine VSMC morphology and orientation.A total of 112 VSMCs from six porcine coronary arteries were used in the analysis. A 3D semi-automatic segmentation method was developed to reconstruct individual VSMCs from cell clumps as well as to extract the 3D geometry of VSMCs. A new edge blocking model was introduced to recognize cell boundary while an edge growing was developed for optimal interpolation and edge verification. The proposed methods were designed based on Region of Interest (ROI selected by user and interactive responses of limited key edges. Enhanced cell boundary features were used to construct the cell's initial boundary for further edge growing. A unified framework of morphological parameters (dimensions and orientations was proposed for the 3D volume data. Virtual phantom was designed to validate the tilt angle measurements, while other parameters extracted from 3D segmentations were compared with manual measurements to assess the accuracy of the algorithm. The length, width and thickness of VSMCs were 62.9±14.9 μm, 4.6±0.6 μm and 6.2±1.8 μm (mean±SD. In longitudinal-circumferential plane of blood vessel, VSMCs align off the circumferential direction with two mean angles of -19.4±9.3° and 10.9±4.7°, while an out-of-plane angle (i.e., radial tilt angle was found to be 8±7.6° with median as 5.7°.A 3D segmentation algorithm was developed to reconstruct individual VSMCs of blood vessel walls based on optical image stacks. The results were validated by a virtual phantom and manual measurement. The obtained 3D geometries can be utilized in mathematical models and leads a better understanding of vascular mechanical properties and function.

  6. [Anterolateral thigh perforator flaps for facial reconstruction after tumour surgery].

    Science.gov (United States)

    Gaggl, Alexander; Bürger, Heinz; Lesnik, Gerald; Müller, Ernst; Chiari, Friedrich

    2006-09-01

    Individual flap design and minor donor site morbidity are main criteria in the treatment of facial defects after tumour surgery. Microvascular perforator flaps seem to follow these criteria well. In the following study our experiences with microvascular anterolateral thigh perforator flaps (ALTPF) in reconstruction of the face following ablative tumour surgery are described and discussed in comparison to the present literature. In 19 patients with squamous cell carcinomas of the floor of the mouth (8), the cheek (6) or the mandible (5) of stadium T3 or T4 ablative tumour surgery followed by reconstruction was performed. For covering the soft tissue defects 19 ALTPF were used. In the five patients with carcinomas of the mandible a microvascular iliac crest transplant was combined with the anterolateral thigh perforator flap for complete chin reconstruction. In one patient an intraoperative dissection of the perforator vessels happened. In all other patients surgery and postoperative period was free of complications. Five patients had minor second surgery for aesthetic of functional reasons. At the end there were good aesthetic and functional results in every patient. The anterolateral thigh perforator flap is of great advantage in reconstruction of the face after tumour surgery. Individual designing, central and save perfusion, easy to be controlled, and a low incidence of donor site morbidity are their main advantages.

  7. Biomaterials and tissue engineering in reconstructive surgery

    Indian Academy of Sciences (India)

    In spite of some good successes and excellent materials, there are still serious limitations to the performance of implants today, and the paper explains these limitations and develops this theme in order to describe the recent innovations in tissue engineering, which involves a different approach to reconstruction of the body.

  8. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    Science.gov (United States)

    Dunda, Sebastian E.; Bozkurt, Ahmet; Pallua, Norbert; Krapohl, Björn Dirk

    2015-01-01

    Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures. Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma. Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment. Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases. PMID:26734539

  9. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    Directory of Open Access Journals (Sweden)

    Dunda, Sebastian E.

    2015-12-01

    Full Text Available Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures.Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma.Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment.Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases.

  10. Plastic surgery in chest wall reconstruction: relevant aspects - case series

    Directory of Open Access Journals (Sweden)

    Diogo Franco

    Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

  11. Reconstructive surgery training: increased operative volume in plastic surgery residency programs.

    Science.gov (United States)

    Tanna, Neil; Boyd, J Brian; Kawamoto, Henry K; Miller, Timothy A; Da Lio, Andrew L; Azhar, Hamdan; Bradley, James P

    2012-03-01

    Practitioners in other surgical specialties have increasingly advanced their volume of reconstructive procedures traditionally served by plastic surgeons. Because there has not been a previous specialty training comparison, the average operative reconstructive volume of graduating plastic surgery residents was formally compared with that of other specialties. The authors review the case log statistical reports of the Accreditation Council for Graduate Medical Education. For each specialty, this annual report highlights the average number of cases performed for all graduating residents. The national case log reports were reviewed for orthopedic surgery, otolaryngology, and plastic surgery. Six procedures were compared for residents graduating in the 2006 to 2010 academic years and are reviewed. A two-sample Welch-Satterthwaite t test for independent samples with heterogeneous variance was conducted to compare the average number of procedures performed per graduating resident. Graduates of plastic surgery residencies compared with graduates of other specialties performed more cleft lip and palate repairs, hand amputation, hand fracture, and nasal fracture procedures. This difference showed statistical significance for all years examined (2006 to 2010). For repair of mandible fractures, plastic surgery trainees had significantly more cases for 2006 to 2009 but not 2010. The quantitative operative experience of graduating plastic surgery residents for selected reconstructive cases is above that of the average graduating trainee outside of plastic surgery. Given the exposure and strength of plastic surgery training, plastic surgeons should remain at the forefront of reconstructive surgery.

  12. Scintigraphic evaluation of reconstructive surgery in gastrectomy for gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Yozo; Kawaguchi, Tomiji; Sugimoto, Yoshihiro

    1987-05-01

    Scintigraphic evaluation of reconstruction in 87 patients who received gastrectomy with dissection of regional lymphnodes is presented. The patients who underwent Roux-Y reconstruction had postcibal asynchronism for 56 - 59 min, while those who underwent reconstructive surgery by jejunal interposition had less postcibal asynchronism for 8 - 33 min (p < 0.001). In the subtotal gastrectomy cases, the bile reflux into the gastric remnant was not observed in those who underwent reconstruction by Roux-Y or jejunal interposition, while it was seen at high frequency in those who underwent Billroth I (p < 0.05) or Billroth II (p < 0.01). These findings indicated that jejunal interposition was more physiological than other methods for reconstruction.

  13. Combined Massive Allograft and Intramedullary Vascularized Fibula Transfer: The Capanna Technique for Lower-Limb Reconstruction

    National Research Council Canada - National Science Library

    Bakri, Karim; Stans, Anthony; Mardini, Samir; Moran, Steven

    2008-01-01

    .... Recently, a novel approach to limb salvage has been described by Capanna and colleagues whereby a massive bone allograft and intramedullary vascularized fibula are combined to reconstruct large, segmental bone defects...

  14. Early Active Rehabilitation After Grip Reconstructive Surgery in Tetraplegia.

    Science.gov (United States)

    Wangdell, Johanna; Bunketorp-Käll, Lina; Koch-Borner, Sabrina; Fridén, Jan

    2016-06-01

    To describe and evaluate the concept of early active rehabilitation after tendon transfer to restore grip function in tetraplegia. Retrospective cohort study. Two nonprofit rehabilitation units in Sweden and Switzerland. All patients with tetraplegia who underwent tendon transfer to restore grip ability during 2009 to 2013 (N=49). Reconstructive tendon transfer surgery with early active rehabilitation to restore grip ability in tetraplegia. Grip and pinch strength, grip ability test, and outcome of prioritized activities. In the 49 surgeries performed, postoperative complications included 2 patients with bleeding and 2 infections related to the surgery. There were no reported ruptures or lengthening of transferred tendons. Within 24 hours after surgery, all 47 patients (100%) with finger flexion reconstruction succeeded to activate their finger flexion. All but 1 patient with reconstructed thumb flexion sucessfully activated their thumb flexion (n=40). Three weeks after surgery, all patients (100%) were able to perform basic activities of daily living, and instrumental activities of daily living were achieved by 74%. One year after surgery, the maximum grip strength in restored finger flexion was on average 6.9kg (range, 1.5-15kg; n=29). The maximum pinch strength in restored thumb flexion was on average 3.7kg (range, 1-20; n=29). On average, grip ability improved from 33 to 101 (n=19) according to the COPM. Prioritized activity limitations, as measured with the COPM, equated to an average of 3.5 steps (2.5 steps preoperatively to 6 steps postoperatively). Patients' perceived satisfaction with this improvement was 4 steps (increasing from 2 steps preoperatively to 6 steps postoperatively). Grip reconstructive surgery followed by early active rehabilitation can be considered a reliable procedure that leads to substantial improvements in grip and pinch strength and activity performance among patients with tetraplegia. Copyright © 2016 American Congress of

  15. Canadian vascular surgery residents' perceptions regarding future job opportunities.

    Science.gov (United States)

    Cooper, Joel A; Dubois, Luc; Power, Adam H; DeRose, Guy; MacKenzie, Kent S; Forbes, Thomas L

    2015-06-01

    The objective was to determine the employment environment for graduates of Canadian vascular surgery training programs. A cross-sectional survey of residents and graduates (2011-2012) was used. Thirty-seven residents were invited with a response rate of 57%, and 14 graduates with a response rate of 71%; 70% of graduates felt the job market played an important role in their decision to pursue vascular surgery as a career compared to 43% of trainees. The top three concerns were the lack of surgeons retiring, the overproduction of trainees, and saturation of the job market. The majority (62%) of trainees see themselves extending their training due to lack of employment. All of the graduates obtained employment, with 50% during their second year (of two years) of training and 30% after training was completed. Graduates spent an average of 12 ± 10.6 months seeking a position and applied to 3.3 ± 1.5 positions, with a mean of 1.9 ± 1.3 interviews and 2 ± 1.2 offers. There was a discrepancy between the favorable employment climate experienced by graduates and the pessimistic outlook of trainees. We must be progressive in balancing the employment opportunities with the number of graduates. Number and timing of job offers is a possible future metric of the optimal number of residents. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  16. Combined Massive Allograft and Intramedullary Vascularized Fibula Transfer: The Capanna Technique for Lower-Limb Reconstruction

    OpenAIRE

    Bakri, Karim; Stans, Anthony A.; Mardini, Samir; Moran, Steven L.

    2008-01-01

    Limb salvage has now replaced amputation as the standard treatment for primary bone tumors and can usually be offered to more than 85% of patients. Recently, a novel approach to limb salvage has been described by Capanna and colleagues whereby a massive bone allograft and intramedullary vascularized fibula are combined to reconstruct large, segmental bone defects. This produces a structurally competent reconstruction with enhanced vascular and osteogenic capabilities and the potential to achi...

  17. Outcomes of Reconstructive Surgery of Tuberculosis Affecting the ...

    African Journals Online (AJOL)

    jen

    Outcomes of Reconstructive Surgery of Tuberculosis Affecting the Ureter and Bladder. G.M. Getahun1, S. Prasad2, N. Chako2, G. Goplakrishnan2. 1 University of Gondar, Ethiopia. 2Department Of Urology, Christian Medical College Vellore, India. Correspondence to: Dr. Gashaw M Getahun Email: messeleg@yahoo.com.

  18. Principles of reconstructive surgery for the tumor patient.

    Science.gov (United States)

    Szentimrey, D

    1998-02-01

    Small animal oncologic surgery is a relatively new and rapidly expanding field of veterinary science. Many exciting and innovative techniques for surgical resection of invasive tumors have been developed and published in the last decade. Paralleling these developments have been major advancements in the frontiers of reconstructive options to close the defects after major ablative surgery. A more thorough understanding of the biologic behavior of tumors in our patients has permitted us to rationally approach selected patients with high doses of surgery with curative intent, palliation, or as part of a multimodality treatment plan. Invasive oncologic procedures require thorough preoperative planning and staging to accomplish the goal of tumor-free margins. Patient factors, specifically tumor type, grade, anatomic location, and extent of local invasion, will subsequently dictate the appropriate resection and reconstructive options available. Resection of the tumor with a wide margin of normal tissue is the surgeon's primary objective. The reconstructive phase of the surgery endeavors to restore functional and cosmetic integrity to the regional anatomy. Each resection and reconstruction procedure must be customized for the patient's disease. Thoughtful preoperative planning, timing, and intraoperative flexibility to unforeseen circumstances will minimize complications. Armed with a number of reconstructive options for each case, the surgeon develops intraoperative flexibility and latitude to be more aggressive during the primary resection. If the surgeon self-imposes limitations on the aggressive removal of the primary tumor by virtue of tissue closure concerns, the completeness of resection and patient survival may well be jeopardized. As familiarity and experience with different reconstructive options increases, the surgeon will have greater confidence in removing large volumes of diseased tissue.

  19. Measurement of Outcomes of Upper Limb Reconstructive Surgery for Tetraplegia.

    Science.gov (United States)

    Sinnott, K Anne; Dunn, Jennifer A; Wangdell, Johanna; Johanson, M Elise; Hall, Andrew S; Post, Marcel W

    2016-06-01

    Reconstructive arm/hand surgery for tetraplegia is performed to improve arm/hand function and therefore personal well-being for individuals who accept such elective surgeries. However, changes at an impairment level do not always translate into functional or quality of life changes. Therefore, multiple outcome tools should be used that incorporate sufficient responsiveness to detect changes in arm/hand function, activity and participation, and quality of life of the individuals involved. This narrative review aims to assist clinicians to choose the most appropriate tools to assess the need for reconstructive surgery and to evaluate its outcomes. Our specific objectives are (1) to describe aspects to consider when choosing a measure and (2) to describe the measures advised by an international therapist consensus group established in 2007. All advised measures are appraised in terms of the underlying construct, administration, and clinical relevance to arm/hand reconstructions. Essentially there are currently no criterion standard measures to evaluate the consequences of reconstructive arm/hand surgery. However, with judicious use of available measures it is possible to ensure the questions asked or tasks completed are relevant to the surgical reconstruction(s) undertaken. Further work in this field is required. This would be best met by immediate collaboration between 2 outcome's tool developers and by analysis of pre- and postoperative data already held in various international sites, which would allow further evaluation of the measures already in use, or components thereof. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Three-dimensional reconstruction of port wine stain vascular anatomy from serial histological sections

    NARCIS (Netherlands)

    Smithies, D. J.; van Gemert, M. J.; Hansen, M. K.; Milner, T. E.; Nelson, J. S.

    1997-01-01

    Port wine stains (PWSs) treated with a flashlamp-pumped pulsed dye laser show a variability in clinical response that is incompletely understood. To identify any vascular structure that might adversely affect treatment response, we obtained a three-dimensional reconstruction of the vascular anatomy

  1. Near infrared spectroscopy for frontal lobe oxygenation during non-vascular abdominal surgery

    DEFF Research Database (Denmark)

    Sørensen, Henrik; Grocott, Hilary P; Secher, Niels H

    2016-01-01

    PURPOSE: Cerebral deoxygenation, as determined by near infrared spectroscopy (NIRS), seems to predict postoperative complications following cardiac surgery. We identify the type of non-vascular abdominal surgery associated with cerebral deoxygenation and/or hyperoxygenation, how such deviations a...

  2. Limb-saving surgery by intraoperative radiation and vascularized fibular graft for osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Osamu; Arakaki, Akira; Asato, Jun; Shimabukuro, Hiroyuki; Shingaki, Yoshisada; Asato, Hideki; Ibaraki, Kunio; Nakano, Masao (University of the Ryukyus, Okinawa (Japan))

    1992-03-01

    Various limb-saving surgeries for osteosarcomas have been performed owing to the high survival rate achieved by chemotherapy. However, reconstruction by endoprosthesis after radical resection of the tumor in the distal femur or proximal tibia was often complicated by early or late severe problems. The radicality of intraoperative radiation by Lineac 50 Gy for osteosarcoma has been proved clinically by Yamamuro et al, while radiation therapy often ensued pathological fractures. Therefore, for osteosarcomas in four distal femurs and one proximal tibia, we have adopted a vascularized fibular graft to reinforce the irradiated bone and to prevent the collapse of the joint surface. Resected osseous parts were irradiated in four cases with resultant infections in two cases. Intraoperative irradiation without resection was performed on one case with an uneventful short course. Although the ranges of motion in three survivous were limited, the prospect of limb-saving surgery by intraoperative irradiation and incorporated vascularized fibular grafts seem favorable as they promise longer durability. (author).

  3. Acceptable results after venous reconstructive surgery following iatrogenic injuries to the iliofemoral vein segment

    DEFF Research Database (Denmark)

    Larsen, Morten Bo; Bækgaard, Niels

    2012-01-01

    Venous reconstructions after iatrogenic injuries are rarely performed and are associated with a relatively high risk of complications. We present our experiences with venous reconstructive surgery to the iliofemoral vein segment.......Venous reconstructions after iatrogenic injuries are rarely performed and are associated with a relatively high risk of complications. We present our experiences with venous reconstructive surgery to the iliofemoral vein segment....

  4. The social media: its impact on a vascular surgery practice.

    Science.gov (United States)

    Turnipseed, William D

    2013-04-01

    Social media has revolutionized interpersonal communication and has become a commonly used public informational resource. This study evaluates the impact of intranet informatics on a specialty practice of vascular surgery. Referral patterns for patients with chronic compartment syndrome (CCS) and popliteal entrapment syndrome (PAES) between 2008 and 2011 were analyzed. Demographics included referral source (physicians, nonphysicians), media resource, and case volume change. Prior to 2008, referrals came from local or regional sports medicine practices (100%). Since 2008 this pattern has changed; local/regional (80%), national (15%), and international (5%). Physician referrals dropped from 97% to 70%, and nonphysician referrals increased from 3% to 30%. Both CCS procedures and PAES procedures increased as remote geographic and public referrals increased. Referral change was associated with social media searches using applications such as PubMed and Google. Social media is an evolving source of medical information and patient referrals which physicians should cautiously embrace.

  5. Capturing Plastic Surgery on Film—Making Reconstruction Visible

    Directory of Open Access Journals (Sweden)

    Alexander Lunger, MD

    2017-09-01

    Full Text Available Summary:. The Swiss Plastic Surgery Association (https://plasticsurgery.ch/en/ decided to produce a corporate video to illustrate the concept of "plastic surgery of confidence" to the public. We show the diversity of specializations and the vast range of tasks that surgeons passionately handle day in and day out. We wanted to convey 2 main messages: first, that plastic surgery is more than just cosmetic surgery, and second, that plastic surgery in Switzerland is synonymous with quality and confidence. We selected 17 topics that we felt had good filmic potential and would best explain to the public what plastic surgery is about. This included the selection of appropriate patients, experts, and locations from all over the country. We thought it crucial to show the initial preoperative situation, as only in this case would the achievement of reconstruction be evident and comprehensive to the layman audience. The actual production was filmed in 5 different locations and took 5 days of shooting. We recorded 17 surgeons, 9 patients, and about 30 voluntary background actors. From 23 hours of footage, we created a 7 minute, 22 second corporate video, recorded in 3 of the Swiss national languages. The video was presented to the public online in June 2016, on the same day as the National Open Day of Plastic Surgery in Switzerland. The video is available online. We evaluated the impact of the video using a questionnaire for lay people and observed that it could substantially improve the perception of our specialty, especially regarding the reconstructive aspect. We feel that a freely available corporate video is a very useful means to promote plastic surgery and help patients better understand what it is all about.

  6. Non-cardiogenic pulmonary oedema in vascular surgery.

    Science.gov (United States)

    Pararajasingam, R; Nicholson, M L; Bell, P R; Sayers, R D

    1999-02-01

    Non-cardiogenic pulmonary oedema, an early manifestation of the adult respiratory disease syndrome, is a serious complication following major vascular surgery. Hypovolaemia, ischaemia-reperfusion injury, massive blood transfusion, transient sepsis and transient endotoxaemia are insults responsible for initiating the process in vascular surgical patients. Free radicals, cytokines and humoral factors released secondary to the above insults activate neutrophils and facilitate their interaction with the endothelium. Activated neutrophils marginate through the endothelium where they are responsible for tissue injury by the release of free-radicals and proteases. The lungs are a large reservoir of neutrophils and bear a significant part of the injury. Conventional therapy includes treating the underlying condition and providing respiratory support. A better understanding of the pathophysiology of this process has led to new experimental treatment options. Novel therapeutic interventions have included the use of compounds to scavenge free radicals, anti-cytokine antibodies, extracorporeal lung support, nitric oxide and artificial surfactant therapy. The multifactorial nature of this process makes it unlikely that a single "magic bullet" will solve this problem. It is more likely that a combination of preventative, prophylactic and therapeutic modalities may reduce the mortality of this condition.

  7. Role of adipose-derived stem cells in fat grafting and reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Shaun S Tan

    2016-01-01

    Full Text Available Autologous fat grafting is commonly utilised to reconstruct soft tissue defects caused by ageing, trauma, chronic wounds and cancer resection. The benefits of fat grafting are minimal donor site morbidity and ease of availability through liposuction or lipectomy. Nonetheless, survival and longevity of fat grafts remain poor post-engraftment. Various methods to enhance fat graft survival are currently under investigation and its stem cell constituents are of particular interest. Cell-assisted lipotransfer refers to the addition of adipose-derived stem cell (ASC rich component of stromal vascular fraction to lipoaspirate, the results of which have proven promising. This article aims to review the role of ASCs in fat grafting and reconstructive surgery.

  8. Risk stratification for the development of respiratory adverse events following vascular surgery using the Society of Vascular Surgery's Vascular Quality Initiative.

    Science.gov (United States)

    Genovese, Elizabeth A; Fish, Larry; Chaer, Rabih A; Makaroun, Michel S; Baril, Donald T

    2017-02-01

    Postoperative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however, little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication, and the overall impact of RAEs on patient outcomes. The Vascular Quality Initiative was queried (2003-2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm repair, thoracic endovascular aortic repair, suprainguinal bypass, or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created, and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables, and other postoperative adverse events. The cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (9.9%), chronic obstructive pulmonary disease requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open abdominal aortic aneurysm repairs (17.6%), in situ suprainguinal bypasses (9.68%), and thoracic endovascular aortic repairs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, congestive heart failure severity, chronic obstructive pulmonary

  9. Indigo carmine extravasation to upper limb after pelvic reconstructive surgery.

    Science.gov (United States)

    Lindo, Fiona M; Chung, Christopher P; Yandell, Paul M

    2013-02-01

    The use of dyes during cystoscopy to visualize the ureters adequately is prevalent in gynecologic surgery. Observing ureteral patency after procedures such as a hysterectomy or pelvic reconstruction is important for identifying injury to the upper urinary tract. Indigo carmine is commonly used. Knowing the possible adverse effects and being aware of unusual presentations with the use of indigo carmine are important in managing and counseling patients. We present a case in which a patient developed indigo carmine extravasation to her upper limb after pelvic reconstructive surgery. The blue discoloration disappeared after 1 day. Indigo carmine extravasation to other parts of the body can occur without long-term complications. It takes 24-48 hours for the dye to clear subcutaneously.

  10. Rotationplasty with Vascular Reconstruction for Prosthetic Knee Joint Infection

    OpenAIRE

    Masahide Fujiki; Shimpei Miyamoto; Fumihiko Nakatani; Akira Kawai; Minoru Sakuraba

    2015-01-01

    Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infect...

  11. Complications of delayed reconstructive and plastic surgery after radical mastectomy

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhaev

    2015-01-01

    Full Text Available Objective: to assess the nature and frequency of complications due to different types of delayed reconstructive and plastic surgery (DRPS after radical mastectomy (RME.Subjects and methods. The investigators analyzed the results of treating 31 patients after RME in 2001 to 2014. DRPS was performed 4 months to 15.5 years (more frequently 1 to 3 years following RME. To choose an optimal reconstructive method, it should be kept in mind the following factors: breast size and ptosis, the patients’ somatic status, the presence of scars in the donor area, and radiotherapy to the chest. The breast was repaired using a TRAM flap in 22 patients. Eight cases underwent two-step reconstruction, by setting a tissue expander at Step 1 and replacing it by a silicone implant at Step 2. In one patient, a Becker expander/implant was used as a plastic component for delayed breast reconstructionin order to make a bed with a latissimus dorsi fragment.Results. Complications were observed in 8 (25.8 % patients. The largest number of complications occurred in 6 cases after breast reconstruction using a TRAM flap. There were complications, such as inferior epigastric arterial thrombosis; marginal necroses of a displaced TRAM flap; hematoma in the postoperative wound region; implant bed infection; and wound edge diastasis in the donor area. In virtually all complicated cases, the patients received multimodality (75 % and combined (12.5 % treatments before DRPS.Conclusion. Beam radiotherapy and chemotherapy increase the risk of complications after both reconstructive plastic surgery with implants and the use of autologous tissues. Two-step reconstruction applying implants provided a good cosmetic effect and the least rate of complications.

  12. Pediatric Vascular Surgery Review with a 30-Year-Experience in a Tertiary Referral Center

    Science.gov (United States)

    Min, Seung-Kee; Cho, Sungsin; Kim, Hyun-Young; Kim, Sang Joon

    2017-01-01

    Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases. PMID:28690995

  13. Transcutaneous oxygen tension exercise profile. A method for objectively assessing the results after reconstructive peripheral arterial surgery.

    Science.gov (United States)

    Larsen, J F; Christensen, K S; Egeblad, K

    1988-12-01

    Transcutaneous oxygen tension during exercise (TcPo2 exercise profile) was measured on the foot in 10 patients before reconstructive vascular surgery and 9 and 18 months later. The preoperative TcPo2 exercise profiles were abnormal in all 10 patients. In 9 of the patients the reconstructions were successful. In these patients the TcPo2 exercise profiles reverted to normal. In a control group of six healthy persons no significant changes in TcPo2 were observed during the follow-up period of 18 months. The reproducibility determined as the total week-to-week variation of claudicants and controls was 8%. The TcPo2 exercise test is suitable for monitoring the patient after reconstructive surgery, because it is based exclusively on objective data is non-invasive and the measurements are reproducible.

  14. Society for Vascular Surgery Vascular Registry evaluation of stent cell design on carotid artery stenting outcomes.

    Science.gov (United States)

    Jim, Jeffrey; Rubin, Brian G; Landis, Gregg S; Kenwood, Christopher T; Siami, Flora S; Sicard, Gregorio A

    2011-07-01

    The Society for Vascular Surgery (SVS) Vascular Registry (VR) collects data on outcomes of carotid endarterectomy and carotid artery stenting (CAS). The purpose of this study was to evaluate the impact of open vs closed cell stent design on the in-hospital and 30-day outcome of CAS. The VR collects provider-reported data on patients using a Web-based database. Data were analyzed both in-hospital and at 30 days postprocedure. The primary outcome is combined death/stroke/myocardial infarction (MI). As of October 14, 2009, there were 4337 CAS with discharge data and 2397 with 30-day data. Open cell stents (OPEN) were used in 3451 patients (79.6%), and closed cell stents (CLOSED) were used in 866 patients (20.4%). Baseline demographics showed no differences in age, gender, race, and ethnicity. However, the OPEN group had more patients with atherosclerosis (74.5% vs 67.4%; P = .0003) as the etiology of carotid artery disease. The OPEN group also had a higher prevalence of preprocedural stroke (25.8% vs 21.4%; P = .0079), chronic obstructive pulmonary disease (COPD; 21.0% vs 17.6%; P = .0277), cardiac arrhythmia (14.7% vs 11.4%; P = .0108), valvular heart disease (7.4% vs 3.7%; P differences in the in-hospital or 30-day outcomes between the OPEN and CLOSED patients. Further subgroup analyses demonstrated symptomatic patients had a higher event rate than the asymptomatic cohort in both the OPEN and CLOSED groups. Among symptomatic patients, the OPEN patients had a lower (0.43% vs 1.41%; P = .0349) rate of in-hospital mortality with no difference in stroke or transient ischemic attack (TIA). There were no differences in 30-day event rates. In asymptomatic patients, there were also no statistically significant differences between the OPEN and CLOSED groups. After risk adjustment, there remained no statistically significant differences between groups of the primary endpoint (death/stroke/MI) during in-hospital or 30 days. In-hospital and 30-day outcomes after CAS were not

  15. Defining the burden, scope, and future of vascular acute care surgery.

    Science.gov (United States)

    Harris, Donald G; Herrera, Anthony; Drucker, Charles B; Kalsi, Richa; Menon, Nandakumar; Toursavadkohi, Shahab; Diaz, Jose J; Crawford, Robert S

    2017-11-01

    The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland. A retrospective analysis of a statewide inpatient database was performed to identify patients undergoing noncardiac vascular procedures in Maryland from 2009 to 2013. Patients were stratified by admission acuity as elective, urgent, or emergent, with the last two groups defined as acute. The primary outcome was inpatient mortality, and secondary outcomes were critical care and hospital resource requirements. Groups were compared by univariate analyses, with multivariable analysis of mortality based on acuity level and other potential risk factors for death. Of 3,157,499 adult hospital admissions, 154,004 (5%) patients underwent a vascular procedure; most were acute (54% emergent, 13% urgent), whereas 33% were elective. Acute patients had higher rates of critical care morbidity and required more hospital resource utilization. Admission for acute vascular surgery was independently associated with mortality (urgent odds ratio, 2.1; emergent odds ratio, 3.0). The majority of inpatient vascular care in Maryland is for acute vascular surgery, which is an independent risk factor for mortality. Acute vascular surgical care entails greater critical care and hospital resource utilization and-similar to emergency general surgery-may benefit from dedicated training and practice models. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  16. Vaginal Symptoms after Reconstructive Surgery for Prolapsed Pelvic Organ

    Directory of Open Access Journals (Sweden)

    Tahereh Eftekhar

    2010-09-01

    Full Text Available Objective: Pelvic organ prolapse is a common disorder in women over the world and its general treatment is surgery. Therefore it is important to consider if vaginal symptoms, quality of life and sexual function after surgery improve. The purpose of this study was to assess vaginal symptoms in women 3 months after surgery for pelvic organ prolapse.Materials and methods: In this study 50 eligible women were evaluated between March 2007 and May 2008. These women underwent physical examination for prolapse staging and medical status and completed the ICIQ–VS questionnaire pre– and post operation 3 months later.Results: Mean age was 44.86 (31–74 years and %72 were premenopausal. Vaginal symptoms, sexual function and quality of life scores improved in order (8.88 Vs 18.04, 17.16 Vs 34.48, 2.76 Vs 4.8, all P<0.05.Conclusion: Vaginal symptoms, sexual function and quality of life after surgery improved. It appears that in Iranian patients, the performance of reconstruction surgery alone results in satisfaction.

  17. Laparoscopic Reconstructive Surgery is Superior to Vaginal Reconstruction in the Pelvic Organ Prolapse

    OpenAIRE

    Park, Young-Han; Yang, Seong Cheon; Park, Sung Taek; Park, Sung Ho; Kim, Hong Bae

    2014-01-01

    Background: Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse. Methods: Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker ...

  18. Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

    Science.gov (United States)

    Cavadas, P C; Pérez-García, A; Thione, A; Lorca-García, C

    2015-03-01

    The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established. © The Author(s) 2014.

  19. [Perineal reconstruction: Salvage surgery with 2flaps technique].

    Science.gov (United States)

    Jiménez Gómez, Marta; Navarro-Sánchez, Antonio; Lima Sánchez, Jaime; Hernández Hernández, Juan Ramón

    2017-03-06

    The principles of perineal reconstructive surgery comprise adequate filling of the defect along with stable and durable skin coverage, with a low morbidity rate. Two-flap perineal reconstruction is a simple, fast and reliable technique that uses a single donor site. This improves scar position with low morbidity. It is based in the use of 2flaps; one flap fills the defect with a «turn over» technique and the other is a rotation - advancement flap for skin coverage. A 52-year-old male diagnosed with Lynch syndrome who underwent laparoscopic abdominoperineal amputation for adenocarcinoma of the lower rectum and developed recurrence 2years later over the perineal scar that required radical resection and perineal reconstruction. The use of this approach facilitates perineal reconstruction and enables treatment of patients with large and complex defects in frequently irradiated tissues where wound dehiscence and infection are common. Copyright © 2017 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Temporary worsening of kidney function following aortic reconstructive surgery.

    Science.gov (United States)

    Ghaheri, Hafez; Kazemzadeh, Gholam Hossein; Beigi, Ali Akbar

    2008-07-01

    Little is known about the incidence of temporary kidney dysfunction following major vascular surgeries. We aimed to assess the frequency of temporary decreased kidney function following aortic surgeries. In a retrospective study, we assessed 108 hospital records of the patients who had undergone elective open abdominal surgery of aortic aneurysm. Preoperative and postoperative (days 1, 2, and 3) data on estimated glomerular filtration rate (GFR) were collected and evaluated in relation to the patients' clinical characteristics and outcomes. A decline greater than 10% in GFR on day 1 or 2, and then, an increase of GFR to a level of maximum 10% below the baseline value on the third postoperative day was considered as temporary worsening of kidney function. Postoperative alterations of GFR not greater than 10% in relation to the baseline were considered as improved or unchanged kidney function. Two patients with persistent decrease in GFR were excluded. Temporary worsening of kidney function was seen in 25 patients (23.6%). Short-term mortality rate was 44.0% in this group of patients, while it was 17.3% in those without decreased GFR (P = .006). According to the regression analysis, the only predictor of mortality was temporary worsening of kidney function, with a hazard ratio of 4.03 (95% confidence interval, 1.44 to 11.31; P = .008). Nearly 1 out of 4 aortic surgeries results in kidney dysfunction. Albeit temporary in most cases, it seems to be associated with a higher short-term mortality rate.

  1. AN EXPERIMENT IN FACIAL RECONSTRUCTIVE SURGERY IN A PRISON POPULATION.

    Science.gov (United States)

    LEWISON, E

    1965-02-06

    A 10-year study of the effects of reconstructive surgery on selected inmates in a British Columbia provincial prison is described. It is proposed that physical defects can be dominant causes of crime, and that the correction of facial defects in inmates of a penal institution can effect a striking improvement in their conduct during imprisonment, and make them more confident on re-entry into society. This survey, covering 450 patients operated on in a 10-year period, demonstrates a marked decrease in the rate of criminal recidivism.

  2. Feasibility of microvascular head and neck reconstruction in the setting of calcified arteriosclerosis of the vascular pedicle.

    Science.gov (United States)

    Lee, Matthew K; Blackwell, Keith E; Kim, Brandon; Nabili, Vishad

    2013-03-01

    OBJECTIVE To report outcomes in free flap reconstructive surgery in the setting of calcified arteriosclerosis affecting the flap pedicle. DESIGN Retrospective review, including a detailed analysis of medical records, histopathologic findings, and a comprehensive review of the literature. METHODS A total of 1329 consecutive microvascular free tissue transfers were performed by 2 reconstructive surgeons at a university-affiliated tertiary care medical center from January 1, 1996, through December 31, 2011. Clinical notes, operative notes, and pathology reports were systematically reviewed to identify 44 patients (3%) with calcified arteriosclerosis involving the flap vascular pedicle. A comprehensive medical record review was performed for the included patients, detailing patient-related characteristics, flap survival, and incidence of perioperative complications. RESULTS A history of arteriosclerosis was identified preoperatively in 18 patients (41%). Eight patients (18%) were specifically recognized clinically and histologically to have a variant of arteriosclerosis known as Mönckeberg medial calcific sclerosis. In total, fibula osteocutaneous free flap was performed in 30 patients, radial forearm in 8 patients, rectus abdominus in 3 patients, latissimus dorsi in 2 patients, and parascapular in 1 patient. Perioperative complications occurred in 17 patients (39%), with the most common being pulmonary (14%) and cardiac (9%). Patient follow-up ranged from 3 to 137 months, with a mean postoperative follow-up of 21 months. The mean length of hospital stay was 12 days. There was a 0% incidence of total flap failure and a 7% incidence of partial flap necrosis. CONCLUSION Although technically challenging, successful microvascular free flap reconstruction can be achieved despite the presence of vascular calcifications affecting the flap vascular pedicle.

  3. Opioid use following gynecologic and pelvic reconstructive surgery.

    Science.gov (United States)

    Hota, Lekha S; Warda, Hussein A; Haviland, Miriam J; Searle, Frances M; Hacker, Michele R

    2017-09-09

    Opioid use, addiction, and overdose are a growing epidemic in the USA. Our objective was to determine whether the amount of opioid medication prescribed following gynecologic and pelvic reconstructive surgery is insufficient, adequate, or in excess. We hypothesized that we were overprescribing postoperative opioids. Participants who were at least 18 years old and underwent gynecologic and/or pelvic reconstructive surgery from April through August 2016 were eligible to participate. Routine practice for pain management is to prescribe 30 tablets of opioids for major procedures and ten to 15 tablets for minor procedures. At the 2-week postoperative visit, participants completed a questionnaire regarding the number of tablets prescribed and used, postoperative pain control, and relevant medical history. Fisher's exact test was used to compare data. Sixty-five participants completed questionnaires. Half (49.1%) reported being prescribed more opioids than needed, while two (3.5%) felt the amount was less than needed. Though not significant, participants who underwent major surgeries were more likely to report being prescribed more than needed (53.5%) compared with participants who underwent minor surgeries (35.7%; p = 0.47). Though not significant, participants with anxiety were less likely to report being prescribed more tablets than needed compared with participants without anxiety (44.4% vs. 57.1%; p = 0.38). This was also true of participants with depression compared with those without (37.5% vs. 58.3%; p = 0.17), and those with chronic pain compared with those without (33.3% vs. 60.0%; p = 0.10). Our current opioid prescription practice for postoperative pain management may exceed what patients need.

  4. Application of a Penrose drain guide for vascular stapling during hepatic surgery: how I do it.

    Science.gov (United States)

    Hicks, Caitlin W; Choti, Michael A

    2014-02-01

    The use of stapling devices to manage vascular pedicles during hepatic surgery has been a significant advance in the field. However, insertion and application of the stapler in vascular dissection planes can be associated with injury to adjacent structures. We describe a five-step technique using a silicone Penrose drain to aid in the positioning of an endovascular stapling device to obtain vascular control during hepatectomy. The use is described here for hepatic vein management during right hepatectomy. The technique can be also used for other applications when transecting major vessels during major liver surgery. The use of this silicone Penrose-guided endovascular stapler technique is a simple, cost-effective maneuver that can be used to improve control and prevent vascular injury during the division of major vascular structures when performing hepatic surgery.

  5. Reconstruction of the urethra with a Surgisis® onlay patch in urethral reconstructive surgery: two case reports

    Directory of Open Access Journals (Sweden)

    Ecke Thorsten H

    2009-03-01

    Full Text Available Abstract Introduction We present two case reports of patients with recurrent stricture of the urethra. We used Surgisis® for reconstruction. Case presentation In these two case reports, we show the positive results of reconstructive surgery with Surgisis® as an alternative surgical approach to common onlay patch surgery of the urethra performed on two Caucasian patients: a 48-year-old man and a 55-year-old man. Conclusion Compared to buccal mucosa flap or foreskin graft surgeries for urethral reconstruction, reconstructive surgery with Surgisis® is considered a relevant therapeutic alternative because of the shorter operation time and the preventable surgery of the buccal cavity or foreskin.

  6. Reconstruction of the lateral malleolus using a reverse-flow vascularized fibular head: a case report.

    Science.gov (United States)

    Rajacic, N; Dashti, H

    1996-01-01

    We report a case of a 7-year-old girl in whom a vascularized fibular head with preserved epiphyseal and metaphyseal blood supply was used to reconstruct the missing lateral malleolus. Two-year follow-up showed good bony stability and growth potential of the transplanted epiphyseal plate.

  7. Vascular fluorescence casting and imaging cryomicrotomy for computerized three-dimensional renal arterial reconstruction

    NARCIS (Netherlands)

    Lagerveld, Brunolf W.; ter Wee, Rene D.; de La Rosette, Jean J. M. C. H.; Spaan, Jos A. E.; Wijkstra, Hessel

    2007-01-01

    OBJECTIVES To assess the combined use of a casting technique, cryomicrotomy imaging, and three-dimensional (3D) computer analysis as a method for visualizing and reconstructing the arterial vascular tree in a porcine renal model. MATERIAL AND METHODS The arterial branches of two porcine kidneys were

  8. Variability in 2-year training programs in vascular surgery based on results of an Association of Program Directors in Vascular Surgery survey.

    Science.gov (United States)

    Calligaro, Keith D; Pineda, Danielle M; Tyagi, Sam; Zheng, Hong; Troutman, Douglas A; Dougherty, Matthew J

    2017-06-01

    Although a great deal of attention has recently focused on 5-year integrated (0+5) training programs in vascular surgery, a paucity of data exists concerning variability of daily assignments in 2-year (5+2) vascular fellowships. We polled Association of Program Directors in Vascular Surgery members with 2-year vascular fellowships to determine the number of days in a 5-day work week that first- and second-year fellows were assigned to open vascular operations, endovascular procedures (hospital vs nonhospital facility), arterial clinic, venous clinic, noninvasive vascular laboratory (NIVL), and research. Of the 103 program directors from 5+2 vascular training programs, 102 (99%) responded. The most common schedule for both first- and second-year fellows was performing both open and endovascular procedures in the hospital on the same day 4 days of the week and spending time in combined artery and vein clinic 1 day of the week. Program directors developed different schedules for each year of the 2-year fellowship in about half (55% [56]) of the programs. A small minority of programs devoted days to only open surgical cases (13% [13]), a separate venous clinic (17% [17]), or a separate arterial clinic (11% [11]) and performed endovascular procedures in a nonhospital facility (15% [15]). All but three programs had mandatory time in clinic both years. Approximately one-third (30% [31]) of programs designated time devoted to research, whereas the others expected fellows to find time on their own. Although passing the Registered Physician in Vascular Interpretation examination is required, there was devoted time in the NIVL in only 60% (61) of programs. Training assignments in terms of time spent performing open and endovascular procedures and participating in clinic, the NIVL, and research varied widely among Accreditation Council for Graduate Medical Education-accredited 5+2 vascular fellowships and did not always fulfill Accreditation Council for Graduate Medical

  9. External Mechanical Devices and Vascular Surgery for Erectile Dysfunction.

    Science.gov (United States)

    Trost, Landon W; Munarriz, Ricardo; Wang, Run; Morey, Allen; Levine, Laurence

    2016-11-01

    The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices. To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection devices, and penile revascularization. A consensus panel was held with leading sexual medicine experts during the 2015 International Consultation on Sexual Medicine (ICSM). Relevant literature was reviewed and graded based on Oxford criteria to develop evidence-based guideline and consensus statements. The development of clinically relevant guidelines. Penile traction therapy is a viable therapy to modestly improve penile length as a primary therapy, before penile prosthesis placement in men with decreased penile length or after surgery for Peyronie's disease. It also might have a role in the acute phase of Peyronie's disease but has inconsistent outcomes in the long-term phase. Vacuum erection devices are effective in creating an erection satisfactory for intercourse, even in difficult-to-treat populations. They also might be used in the post-prostatectomy setting to maintain penile length but have insufficient evidence as a penile rehabilitation therapy. For vasculogenic erectile dysfunction, men with suspected arterial insufficiency can be evaluated with penile Duplex Doppler ultrasonography and confirmatory angiography. Penile revascularization procedures have consistently demonstrated benefits in very select patient populations; however, inadequate data exists to suggest the superiority of one technique. Men with vascular risk factors are likely poor candidates for penile revascularization, although veno-occlusive dysfunction and age are less significant. Therapies for treating primary veno-occlusive dysfunction are not recommended and should be reserved for clinical trials. Since the prior ICSM meeting, multiple developments have

  10. Mycoplasma in urine and blood following catheterisation of patients undergoing vascular surgery

    DEFF Research Database (Denmark)

    Levi, N; Eiberg, J; Skov Jensen, J

    1997-01-01

    The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment.......The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment....

  11. Cell based therapeutic approach in vascular surgery: application and review

    Directory of Open Access Journals (Sweden)

    Rocca Aldo

    2017-10-01

    Full Text Available Multipotent stem cells - such as mesenchymal stem/stromal cells and stem cells derived from different sources like vascular wall are intensely studied to try to rapidly translate their discovered features from bench to bedside. Vascular wall resident stem cells recruitment, differentiation, survival, proliferation, growth factor production, and signaling pathways transduced were analyzed. We studied biological properties of vascular resident stem cells and explored the relationship from several factors as Matrix Metalloproteinases (MMPs and regulations of biological, translational and clinical features of these cells. In this review we described a translational and clinical approach to Adult Vascular Wall Resident Multipotent Vascular Stem Cells (VW-SCs and reported their involvement in alternative clinical approach as cells based therapy in vascular disease like arterial aneurysms or peripheral arterial obstructive disease.

  12. Combined massive allograft and intramedullary vascularized fibula transfer: the capanna technique for lower-limb reconstruction.

    Science.gov (United States)

    Bakri, Karim; Stans, Anthony A; Mardini, Samir; Moran, Steven L

    2008-08-01

    Limb salvage has now replaced amputation as the standard treatment for primary bone tumors and can usually be offered to more than 85% of patients. Recently, a novel approach to limb salvage has been described by Capanna and colleagues whereby a massive bone allograft and intramedullary vascularized fibula are combined to reconstruct large, segmental bone defects. This produces a structurally competent reconstruction with enhanced vascular and osteogenic capabilities and the potential to achieve lower rates of infection, fracture, and nonunion. The Capanna technique has become a well-established means of long bone reconstruction and limb salvage in cases of large bony resection. The operative technique and reported outcomes of the Capanna technique are reviewed, and cases are presented.

  13. Limb salvage after vascular reconstruction followed by tissue transfer during the Global War on Terror.

    Science.gov (United States)

    Casey, Kevin; Sabino, Jennifer; Weiss, Jeffrey S; Kumar, Anand; Valerio, Ian

    2015-03-01

    Combat extremity wounds are complex and frequently require an immediate vascular reconstruction in the operational environment followed by delayed tissue coverage at a stateside medical treatment facility. The purpose of this study was to evaluate limb salvage outcomes after combat-related vascular reconstruction that subsequently required delayed soft tissue coverage during the Global War on Terror. Patients who incurred a war-related extremity injury necessitating an immediate vascular intervention followed by definitive limb reconstruction requiring flap coverage from combat injuries were reviewed. Patient demographics, types of vascular and extremity injuries, and surgical interventions were examined. Outcomes included limb salvage, primary and secondary graft patency, flap outcomes, and complications. Differences between upper extremities (UEs) and lower extremities (LEs) were compared. From 2003 to 2012, 27 patients were treated for combat-related extremity injuries with an immediate vascular reconstruction followed by delayed tissue coverage. Fifteen LEs and 12 UEs were treated. The mean age was 24 years. An explosion was the cause in 77% of patients, with a mean Injury Severity Score (ISS) of 19. An autogenous vein bypass was the most common reconstruction performed in 20 patients (74%). Other vascular repairs included a primary repair, a patch angioplasty with bovine pericardium, and a bypass with use of a prosthetic graft. Eight patients (30%) had a concomitant venous injury, and 23 (85%) had a bone fracture. Thirty flaps were performed at a mean of 33 days from the original injury. Pedicle flaps were used in 24 limbs and free tissue flaps in six limbs. Muscle, fasciocutaneous, bone, and composite flaps were used for tissue coverage. At a mean follow-up of 16 months, primary patency rates of all arterial reconstructions were 66% in the UE and 53% in the LE (P = .69). Secondary patency rates were 100% in the UE and 86% in the LE (P = .48). The overall limb

  14. POST-OPERATIVE REHABILITATION PROGRAM AFTER SURGERY ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Zoran Đokić

    2013-07-01

    Full Text Available ACL (anterior cruciate ligament are small ligaments inside the knee capsule that connect the femur tibia, main function is to prevent movement of the femur in front of tibia and to provide stability, it also helps in controlling the movement of the knee, in direction back-forward. Injuries of ACL appear in an increasing number of athletes. Per year, from 100,000 people who have an injury of the knee joint, 30% have the reconstruction surgery of ACL. ACL injury accounts about 40% of all sports injuries. The greatest number of injuries just happens in the most popular sports, such as: basketball, football and handball, often in female athlete. After the injury, about 25% of athletes fail to return to the sport. Recovery time after surgery is usually 6-12 months, depending on individual characteristics, as well as technical and tactical demands of specific sports activities. Choosing an appropriate and efficient rehabilitation protocols, and training is of great importance. The aim of this paper is to present training protocol of 60 days, 3 months after ACL reconstruction surgery, of top handball female athletes. In the first 30 days, a total of 74 training sessions were done, 39 trainings and 21 EMS (Electrical Muscle Stimulation treatments, at the end of each workout. Functional abilities and morphological status were measured at the beginning and end of the treatment program. After the training protocol athlete got individual exercise program of 26 days (30 training sessions. After 20 days began with normal training, the 26th day of the first game played. The applied protocol has proven successful, as the third competition season there is no problem with an injury.

  15. Open abdominal surgical training differences experienced by integrated vascular and general surgery residents.

    Science.gov (United States)

    Tanious, Adam; Wooster, Mathew; Jung, Andrew; Nelson, Peter R; Armstrong, Paul A; Shames, Murray L

    2017-10-01

    As the integrated vascular residency program reaches almost a decade of maturity, a common area of concern among trainees is the adequacy of open abdominal surgical training. It is our belief that although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have an adequate and focused exposure to open aortic surgery during training. National operative case log data supplied by the Accreditation Council for Graduate Medical Education were compiled for both graduating integrated vascular surgery residents (IVSRs) and graduating categorical general surgery residents (GSRs) for the years 2012 to 2014. Mean total and open abdominal case numbers were compared between the IVSRs and GSRs, with more in-depth exploration into open abdominal procedures by organ system. Overall, the mean total 5-year case volume of IVSRs was 1168 compared with 980 for GSRs during the same time frame (P surgery, representing 57% of all open abdominal cases. GSRs completed an average of 116 open alimentary tract surgeries during their training. Open abdominal surgery represented an average of 7.1% of the total vascular case volume for the vascular residents, whereas open abdominal surgery represented 21% of a GSR's total surgical experience. IVSRs reported almost double the number of total cases during their training, with double chief-level cases. Sixty-five percent of open abdominal surgeries performed by IVSRs involved the aorta or its renovisceral branches. Whereas open abdominal surgery represented 7.1% of an IVSR's surgical training, GSRs had a far broader scope of open abdominal procedures, completing nearly double those of IVSRs. The differences in open abdominal procedures pertain to the differing diseases treated by GSRs and IVSRs. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  16. Thermal depth profiling of vascular lesions: automated regularization of reconstruction algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Verkruysse, Wim; Choi, Bernard; Zhang, Jenny R; Kim, Jeehyun; Nelson, J Stuart [Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612 (United States)], E-mail: wverkruy@uci.edu

    2008-03-07

    Pulsed photo-thermal radiometry (PPTR) is a non-invasive, non-contact diagnostic technique used to locate cutaneous chromophores such as melanin (epidermis) and hemoglobin (vascular structures). Clinical utility of PPTR is limited because it typically requires trained user intervention to regularize the inversion solution. Herein, the feasibility of automated regularization was studied. A second objective of this study was to depart from modeling port wine stain PWS, a vascular skin lesion frequently studied with PPTR, as strictly layered structures since this may influence conclusions regarding PPTR reconstruction quality. Average blood vessel depths, diameters and densities derived from histology of 30 PWS patients were used to generate 15 randomized lesion geometries for which we simulated PPTR signals. Reconstruction accuracy for subjective regularization was compared with that for automated regularization methods. The objective regularization approach performed better. However, the average difference was much smaller than the variation between the 15 simulated profiles. Reconstruction quality depended more on the actual profile to be reconstructed than on the reconstruction algorithm or regularization method. Similar, or better, accuracy reconstructions can be achieved with an automated regularization procedure which enhances prospects for user friendly implementation of PPTR to optimize laser therapy on an individual patient basis.

  17. Experimental autologous substitute vascular graft for transplantation surgery

    NARCIS (Netherlands)

    Kobori, L; Dallos, G; Gouw, ASH; Nemeth, T; Nemes, B; Fehervari, I; Tegzess, Adam; Slooff, MJH; Perner, F; De Jong, KP

    2000-01-01

    Vascular complications in fiver transplantation are a major cause of graft failure and mortality. The aim of the study was to create autologous vascular graft without risk of rejection. Posterior rectus fascia sheath lined with peritoneum was used for iliac artery replacement in seven mongrel dogs.

  18. EXPERIENCE OF USING INDIVIDUAL TITAN IMPLANTS IN NASAL RECONSTRUCTION SURGERY

    Directory of Open Access Journals (Sweden)

    V. V. Epishev

    2016-01-01

    Full Text Available Aim. Clinical use of implants based on patient’s individual topographic anatomical features. Materials and methods. The paper describes two case reports involving the correction of nasal anatomical structure affected during the surgery for facial cancer. Using selective laser sintering technology we manufactured 2 intricate 3D-deformed individual implants from Ti70V30 alloy powders. Implant design was based on CAT/MRT data. Clinical use was conducted on the premises of the department of head and neck surgery in Chelyabinsk Regional Oncological Dispensary. Results. In the fi rst case we obtained an impressive functional result – huge and wide nasal cavity, nose skeleton, and easy nasal breathing. In 30 days we performed endoscopic video-analysis (via nasal passages which showed that 65% of implant surface was covered with mucosa. In the second case, the designed implant allowed the combined surgery including excision of soft tissues, atypical resection of the upper jaw (left part and the left cheek, left maxillary sinusotomy and reconstruction of the left part of the nose and the left cheek with implant and skin fl ap. Conclusion. Clinical use revealed pros and contras of the applied technology. Among contras there are relatively high cost of technology, high standards of competency of a surgeon, a programmer and engineers. Pros include free modeling and setting the implant parameters before operation, exact match between implant size/shape and topographic anatomical data of a certain patient. 

  19. Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

    Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a

  20. Reconstruction of lower end of radius using vascularized upper end of fibula

    Directory of Open Access Journals (Sweden)

    Koul Ashok

    2007-01-01

    Full Text Available Background: Giant cell tumor is a fairly common locally invasive tumor in young adults. The lower end of the radius is the second commonest site for this tumor. The most common treatment for this tumor is curettage with or without bone grafting but it carries a significant rate of recurrence. Excision is the treatment of choice, especially for cases in which the cortex has been breached. After excision of the distal end of the radius, different procedures have been described to reconstruct the defect of distal radius. These include partial arthrodesis and hemiarthroplasty using the upper end of the fibula. The upper end of the fibula has a morphological resemblance to the lower end of the radius and has been used to replace the latter. Traditionally it was used as a ′free′ (non-vascularized graft. More recently the upper end of the fibula has been transferred as a vascularized transfer for the same purpose. Though vascularized transfer should be expected to be more physiological, its superiority over the technically simpler non-vascularized transfer has not been conclusively proven. Materials and Methods: Two patients are presented who had giant cell tumor of distal radius. They underwent wide local excision and reconstruction with free vascularized upper end of the fibula. Result: Follow-up period was two and a half years and 12 months respectively. Both patients have returned to routine work. One patient has excellent functional result and the other has a good result. Conclusion: Vascularized upper end of fibula transfer is a reliable method of reconstruction for loss of the distal end of the radius that restores local anatomy and physiology.

  1. Vastus lateralis vascularized nerve graft in facial nerve reconstruction: an anatomical cadaveric study and clinical implications.

    Science.gov (United States)

    Agrogiannis, Nikolaos; Rozen, Shai; Reddy, Gangadasu; Audolfsson, Thorir; Rodriguez-Lorenzo, Andres

    2015-02-01

    The present study investigates the vascular anatomy of the vastus lateralis motor nerve (VLMN) to be used as a vascularized nerve graft in facial nerve reconstruction. We evaluated the maximum length of the nerve that can be included in the flap and its vascular pedicle. In addition, we discuss its adequacy for use in early reconstruction of the facial nerve both as ipsilateral facial nerve reconstruction and as cross-facial nerve graft. Five fresh cadavers were used in this study. In all specimens, the VLMN and its vascular pedicle were dissected, photodocumented and measured using calipers. In addition, two vascularized VLMN were injected with a radiopaque contrast and underwent CT angiography and three dimensional reconstructions were scanned to illustrate the vascular supply of the nerve using OsiriX Software. The VLMN was divided into two divisions, an oblique proximal and a descending distal, in 70% of the dissections with a mean maximal length of 8.4 ± 4.5 cm for the oblique division and 15.03 ± 3.87 cm for the descending division. The length of the oblique division, when present, was shorter than the length of the descending branch in all specimens. The mean length of the pedicle was 2.93 ± 1.69 cm, and 3.27 ± 1.49 cm until crossing the oblique and the descending division of the nerve respectively. The mean caliber of the nerve was 2.4 ± 0.62 mm. Three-dimensional computed tomography angiography demonstrated perfusion throughout the entire VLMN by branches from the descending branch of the lateral femoral circumflex artery which ran parallel to the descending division of the VLMN. Additionally, we observed that technically it was possible to preserve the oblique branch of the VLMN. This study confirms that VLMN presents adequate anatomic features to be used as a vascularized nerve graft for facial nerve reconstruction in terms of length, pedicle, and caliber. © 2014 Wiley Periodicals, Inc.

  2. A new method of morphological comparison for bony reconstructive surgery: maxillary reconstruction using scapular tip bone

    Science.gov (United States)

    Chan, Harley; Gilbert, Ralph W.; Pagedar, Nitin A.; Daly, Michael J.; Irish, Jonathan C.; Siewerdsen, Jeffrey H.

    2010-02-01

    esthetic appearance is one of the most important factors for reconstructive surgery. The current practice of maxillary reconstruction chooses radial forearm, fibula or iliac rest osteocutaneous to recreate three-dimensional complex structures of the palate and maxilla. However, these bone flaps lack shape similarity to the palate and result in a less satisfactory esthetic. Considering similarity factors and vasculature advantages, reconstructive surgeons recently explored the use of scapular tip myo-osseous free flaps to restore the excised site. We have developed a new method that quantitatively evaluates the morphological similarity of the scapula tip bone and palate based on a diagnostic volumetric computed tomography (CT) image. This quantitative result was further interpreted as a color map that rendered on the surface of a three-dimensional computer model. For surgical planning, this color interpretation could potentially assist the surgeon to maximize the orientation of the bone flaps for best fit of the reconstruction site. With approval from the Research Ethics Board (REB) of the University Health Network, we conducted a retrospective analysis with CT image obtained from 10 patients. Each patient had a CT scans including the maxilla and chest on the same day. Based on this image set, we simulated total, subtotal and hemi palate reconstruction. The procedure of simulation included volume segmentation, conversing the segmented volume to a stereo lithography (STL) model, manual registration, computation of minimum geometric distances and curvature between STL model. Across the 10 patients data, we found the overall root-mean-square (RMS) conformance was 3.71+/- 0.16 mm

  3. A National Survey on Teaching and Assessing Technical Proficiency in Vascular Surgery in Canada.

    Science.gov (United States)

    Drudi, Laura; Hossain, Sajjid; Mackenzie, Kent S; Corriveau, Marc-Michel; Abraham, Cherrie Z; Obrand, Daniel I; Vassiliou, Melina; Gill, Heather; Steinmetz, Oren K

    2016-05-01

    This survey aims to explore trainees' perspectives on how Canadian vascular surgery training programs are using simulation in teaching and assessing technical skills through a cross-sectional national survey. A 10-min online questionnaire was sent to Program Directors of Canada's Royal College of Physicians and Surgeons' of Canada approved training programs in vascular surgery. This survey was distributed among residents and fellows who were studying in the 2013-2014 academic year. Twenty-eight (58%) of the 48 Canadian vascular surgery trainees completed the survey. A total of 68% of the respondents were part of the 0 + 5 integrated vascular surgery training program. The use of simulation in the assessment of technical skills at the beginning of training was reported by only 3 (11%) respondents, whereas 43% reported that simulation was used in their programs in the assessment of technical skills at some time during their training. Training programs most often provided simulation as a method of teaching and learning endovascular abdominal aortic or thoracic aneurysm repair (64%). Furthermore, 96% of trainees reported the most common resource to learn and enhance technical skills was dialog with vascular surgery staff. Surveyed vascular surgery trainees in Canada report that simulation is rarely used as a tool to assess baseline technical skills at the beginning of training. Less than half of surveyed trainees in vascular surgery programs in Canada report that simulation is being used for skills acquisition. Currently, in Canadian training programs, simulation is most commonly used to teach endovascular skills. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Tissue-engineering as an adjunct to pelvic reconstructive surgery

    DEFF Research Database (Denmark)

    Jangö, Hanna

    functional tissue using stem cells, scaffolds and trophic factors. The aim of this thesis was to investigate the potential adjunctive use of a tissue-engineering technique for pelvic reconstructive surgery using two synthetic biodegradable materials; methoxypolyethyleneglycol-poly(lactic-co-glycolic acid......) (MPEG-PLGA) and electrospun polycaprolactone (PCL) - with or without seeded muscle stem cells in the form of autologous fresh muscle fiber fragments (MFFs).To simulate different POP repair scenarios different animal models were used. In Study 1 and 2, MPEG-PLGA was evaluated in a native tissue repair...... model and a partial defect model of the rat abdominal wall. We found that the scaffold was fully degraded after eight weeks. Cells from added MFFs could be traced and had resulted in the formation of new striated muscle fibers. Also, biomechanical changes were found in the groups with added MFFs...

  5. The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap.

    Science.gov (United States)

    Modabber, Ali; Ayoub, Nassim; Möhlhenrich, Stephan Christian; Goloborodko, Evgeny; Sönmez, Tolga Taha; Ghassemi, Mehrangiz; Loberg, Christina; Lethaus, Bernd; Ghassemi, Alireza; Hölzle, Frank

    2014-01-01

    The intention of mandibular reconstruction is to restore the complex anatomy with maximum possible functionality and high accuracy. The aim of this study was to evaluate the accuracy of computer-assisted surgery in primary mandibular reconstruction with an iliac crest bone flap compared with an osteomyocutaneous fibula flap. Preoperative computed tomography data of the mandible and the iliac crest or fibula donor site were imported into a specific surgical planning software program. Surgical guides were manufactured using a rapid prototyping technique for translating the virtual plan, including information on the transplant dimensions and shape, into real-time surgery. Using postoperative computed tomography scans and an automatic surface-comparison algorithm, the actual postoperative situation was compared with the preoperative virtual simulation. The actual flap position showed a mean difference from the virtual plan of 2.43 mm (standard deviation [SD] ±1.26) and a surface deviation of 39% virtual plan of 1.25 mm (SD ±1.31) and a surface deviation of 82% Virtual surgical planning is an effective method for mandibular reconstruction with vascularized bone flaps, and can help to restore the anatomy of the mandible with high accuracy in position and shape. It seems that primary mandibular reconstruction with the osteomyocutaneous fibula flap is more accurate compared with the vascularized iliac crest bone flap.

  6. Survey of Attitudes on Professionalism in Plastic and Reconstructive Surgery

    Directory of Open Access Journals (Sweden)

    Jin Yong Kim

    2013-03-01

    Full Text Available Background The purpose of this study is to analyze the current attitudes toward professionalism,the core values, and the type of professionalism among plastic surgeons in Korea to establish acode of ethics regarding the role of professionalism for plastic and reconstructive surgeons.Methods From March 9, to July 1, 2012, face-to-face and mail surveys were conductedtargeting the 325 participants (256 specialists and 69 residents who are registered membersof the Korean Society of Plastic and Reconstructive Surgeons. The proportion of each responsegiven to an item was obtained through statistical processing through frequency analysis. TheMann–Whitney U test was used to compare the differences in the responses between theresident group and the specialist group.Results The survey results on the perception of professionalism in plastic surgery showed thata high proportion (90.5% of the respondents viewed the future of plastic surgeons as bright.Through evaluation of the importance of the value items,”professional dominance” (4.58 pts,”autonomy” (4.45 pts, ”lifestyle” (4.34 pts, and ”commercialism” (4.31 pts were assessed ascritical values. ”Altruism” (3.84 pts, “interpersonal competence” (3.79 pts, and ”social justice”(3.61 pts were viewed as lesser values. This difference showed the characteristics of anentrepreneurial outlook.Conclusions Plastic surgeons should pursue excellence, humanism, accountability, andaltruism in order to overcome the crisis of professionalism in plastic surgery. In order todevelop the necessary competencies of professionals, vocational education should be arrangedby the Korean Society of Plastic Surgeons, and an appropriate code of ethics should beestablished.

  7. Survey of Attitudes on Professionalism in Plastic and Reconstructive Surgery

    Directory of Open Access Journals (Sweden)

    Jin Yong Kim

    2013-03-01

    Full Text Available BackgroundThe purpose of this study is to analyze the current attitudes toward professionalism, the core values, and the type of professionalism among plastic surgeons in Korea to establish a code of ethics regarding the role of professionalism for plastic and reconstructive surgeons.MethodsFrom March 9, to July 1, 2012, face-to-face and mail surveys were conducted targeting the 325 participants (256 specialists and 69 residents who are registered members of the Korean Society of Plastic and Reconstructive Surgeons. The proportion of each response given to an item was obtained through statistical processing through frequency analysis. The Mann-Whitney U test was used to compare the differences in the responses between the resident group and the specialist group.ResultsThe survey results on the perception of professionalism in plastic surgery showed that a high proportion (90.5% of the respondents viewed the future of plastic surgeons as bright. Through evaluation of the importance of the value items,"professional dominance" (4.58 pts, "autonomy" (4.45 pts, "lifestyle" (4.34 pts, and "commercialism" (4.31 pts were assessed as critical values. "Altruism" (3.84 pts, "interpersonal competence" (3.79 pts, and "social justice" (3.61 pts were viewed as lesser values. This difference showed the characteristics of an entrepreneurial outlook.ConclusionsPlastic surgeons should pursue excellence, humanism, accountability, and altruism in order to overcome the crisis of professionalism in plastic surgery. In order to develop the necessary competencies of professionals, vocational education should be arranged by the Korean Society of Plastic Surgeons, and an appropriate code of ethics should be established.

  8. Indian-ink perfusion based method for reconstructing continuous vascular networks in whole mouse brain.

    Directory of Open Access Journals (Sweden)

    Songchao Xue

    Full Text Available The topology of the cerebral vasculature, which is the energy transport corridor of the brain, can be used to study cerebral circulatory pathways. Limited by the restrictions of the vascular markers and imaging methods, studies on cerebral vascular structure now mainly focus on either observation of the macro vessels in a whole brain or imaging of the micro vessels in a small region. Simultaneous vascular studies of arteries, veins and capillaries have not been achieved in the whole brain of mammals. Here, we have combined the improved gelatin-Indian ink vessel perfusion process with Micro-Optical Sectioning Tomography for imaging the vessel network of an entire mouse brain. With 17 days of work, an integral dataset for the entire cerebral vessels was acquired. The voxel resolution is 0.35×0.4×2.0 µm(3 for the whole brain. Besides the observations of fine and complex vascular networks in the reconstructed slices and entire brain views, a representative continuous vascular tracking has been demonstrated in the deep thalamus. This study provided an effective method for studying the entire macro and micro vascular networks of mouse brain simultaneously.

  9. The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap

    Directory of Open Access Journals (Sweden)

    Modabber A

    2014-06-01

    reconstruction with an iliac crest bone flap. For shape analysis, a similarly high accuracy could be calculated for both flaps. Conclusion: Virtual surgical planning is an effective method for mandibular reconstruction with vascularized bone flaps, and can help to restore the anatomy of the mandible with high accuracy in position and shape. It seems that primary mandibular reconstruction with the osteomyocutaneous fibula flap is more accurate compared with the vascularized iliac crest bone flap. Keywords: computer-assisted surgery, virtual planning, vascularized bone flaps, surgical guide, primary mandibular reconstruction

  10. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery.

    Science.gov (United States)

    Andrés-Cano, P; Godino, M; Vides, M; Guerado, E

    2015-01-01

    To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruction performed as an outpatient compared with same surgery performed as a regular admission (inpatient). A study was conducted on a historical cohort of 342 patients (115 outpatients vs 227 inpatients) who underwent arthroscopic ACL primary ligamentoplasty (2004-2012). A review was performed on the demographic, surgical and hospital variables. A study was made of early complications (60 days postoperative) including visits to emergency department and readmissions. A descriptive and bivariate distribution analysis was performed between groups, with the grouping criterion: performing of the surgery with or without admission. The Chi-square test was used for qualitative variables and Mann-Whitney U test for quantitative. Limit significance p<0.05. Overall, there were 13.2% emergency department visits (mean of 1.24 visits) with an average delay of 8.22 days after discharge. pain not controlled with analgesia (6.7%), hemarthrosis that required arthrocentesis (4.4%), fever (3.2%), deep vein thrombosis (0.6%), cellulitis (0.6%), septic arthritis that required arthroscopic debridement (0.3%), and others (1.2%) including problems with immobilization. The hospital readmissions (2.3%) were for surveillance and monitoring of the surgical wound. In the bivariate analysis no statistically significant differences were found between groups as regards the sociodemographic characteristics of the patients or the complications recorded. The most frequent complications recorded were acute pain, hemarthrosis and fever. Serious complications (deep vein thrombosis, septic arthritis or need for hospital readmission) were rare. Outpatient arthroscopic ACL repair is a common technique that can be performed safely by surgery without admission, with an overall low complication rate with no differences between outpatients and inpatients. Copyright © 2014 SECOT. Published by Elsevier Espana. All

  11. Our vascular surgery experiences in Syrian civil war

    Directory of Open Access Journals (Sweden)

    İyad Fansa

    2014-12-01

    Full Text Available Objective: Due to the ongoing civil war in Syria, numerous vascular injured patients are admitted to our hospital with gunshot wounds. In this study, patients who admitted our hospital, diagnosed with vascular trauma due to gunshot were evaluated with the respect of injury site, additional injuries, surgical interventions and outcomes. Methods: The study included 58 patients wounded in Syrian war and admitted to our hospital between 01.01.2012 and 01.09.2014. Results= There were 5.1% (n=3 female and 94.9% (n=55 male patients. Age range is 5-75 years and the average of age was identified as 28.61. In 12.1% (n=7 of patients with extensive tissue defects of the muscle-nerve-bone injury has been identified, despite the vascular interventions in these patients, 8.6% (n=5 of patients, the limb has been amputated. Totally 15.5% (n=9 of 58 operated patients died. Two patients died because of major vascular injury with intra-abdominal organ injuries. In one patient; infection induced sepsis and multi organ failure was detected. Six patients were lost due to hypovolemic shock as a result of late arriving. Conclusion: In patients admitted with gunshot vascular injury arrival time, the presence of additional injuries and the location of injury affect mortality rates.

  12. Does breast reconstruction impact the decision of patients to pursue cosmetic surgery?

    Science.gov (United States)

    Hsu, Vivian M; Tahiri, Youssef; Wes, Ari M; Yan, Chen; Selber, Jesse C; Nelson, Jonas A; Kovach, Stephen J; Serletti, Joseph M; Wu, Liza C

    2014-12-01

    Breast reconstruction is an integral component of breast cancer treatment, often aiding in restoring a patient's sense of femininity. However, many patients choose to have subsequent cosmetic surgery. The purpose of this study is to investigate the reasons that motivate patients to have cosmetic surgery after breast reconstruction. The authors performed a retrospective study examining patients who had breast reconstruction and subsequent cosmetic surgery at the University of Pennsylvania Health System between January 2005 and June 2012. This cohort received a questionnaire assessing the influences and impact of their reconstructive and cosmetic procedures. A total of 1,214 patients had breast reconstruction, with 113 patients (9.3%) undergoing cosmetic surgery after reconstruction. Of 42 survey respondents, 35 had autologous breast reconstruction (83.3%). Fifty-two cosmetic procedures were performed in survey respondents, including liposuction (26.9%) and facelift (15.4%). The most common reason for pursuing cosmetic surgery was the desire to improve self-image (n = 26, 61.9%), with 29 (69.0%) patients feeling more self-conscious of appearance after reconstruction. Body image satisfaction was significantly higher after cosmetic surgery (P = 0.0081). Interestingly, a multivariate analysis revealed that patients who experienced an improvement in body image after breast reconstruction were more likely to experience a further improvement after a cosmetic procedure (P = 0.031, OR = 17.83). Patients who were interested in cosmetic surgery prior to reconstruction were also more likely to experience an improvement in body image after cosmetic surgery (P = 0.012, OR = 22.63). Cosmetic surgery may improve body image satisfaction of breast reconstruction patients and help to further meet their expectations.

  13. THE APPLICATION OF 3D PRINTING IN PLASTIC AND RECONSTRUCTIVE SURGERY: CASE-CONTROL STUDY IN FACIAL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Luigi Di Rosa

    2017-10-01

    Full Text Available The aim of this study was to explore the efficiency and usefulness of tridimensional printing in plastic and reconstructive surgery for lesions of the maxillofacial region. This was comparison study between two groups of patients. Six patients underwent surgical reconstruction, using a three-dimensional model built on the basis of CT scans (group 1; and six patients underwent surgical reconstruction, without the use of a three-dimensional model (group 2. The following variables were evaluated: age, gender, histological diagnosis, cancer location, size of bone lesion, type of reconstruction, complications and surgical timing. A statistically significant difference was found in microsurgical flap survival (p = 0.019, with a survival rate higher in group 1 than in the controls. This study provides preliminary evidence and partially confirms the validity of three-dimensional technology in plastic and reconstructive surgery. The results so far obtained, however, lead to hope for future uses of this ever-increasing technique.

  14. Risk Factors for Complications after Peripheral Vascular Surgery in 3,202 Patient Procedures

    DEFF Research Database (Denmark)

    Kehlet, Mette; Jensen, Leif Panduro; Schroeder, Torben V.

    2016-01-01

    with postoperative complications after open vascular surgery for infrainguinal occlusive disease in an 8-year cohort using the Danish National Vascular Registry (Karbase), which gathers information on all vascular procedures in Denmark. Methods This study is a retrospective cohort study. The Karbase was searched...... for the predefined procedures from January 1, 2005 through December 31, 2012 at our 2 vascular departments. Both elective and urgent surgeries were included. Complications were defined as wound, surgical, or general complication according to Karbase. Results Three thousand two hundred two procedures were identified......, high American Society of Anesthesiologists score, and general anesthetics. The 30-day mortality was 5% (1% for claudicants and 8% for acute ischemia) and the 30-day amputation rate was 7% (0.5% for claudicants and 21% for gangrene). Conclusions There is a high risk of complication in peripheral...

  15. Optimizing Personalized Management and Cost-Effectiveness in Vascular Surgery

    NARCIS (Netherlands)

    Hogendoorn, W.

    2014-01-01

    The general aim of the studies described in this thesis is to evaluate the cost-effectiveness and to select the preferred treatment for different clinical patient groups for several vascular surgical diseases by means of decision analysis. This thesis consists of 2 parts. In PART 1, several new

  16. 0 + 5 Vascular Surgery Residents' Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs.

    Science.gov (United States)

    Smith, Brigitte K; Kang, P Chulhi; McAninch, Chris; Leverson, Glen; Sullivan, Sarah; Mitchell, Erica L

    2016-01-01

    Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. Assessment of open operative vascular surgical experience among general surgery residents.

    Science.gov (United States)

    Krafcik, Brianna M; Sachs, Teviah E; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Shah, Nishant K; Peacock, Matthew R; Siracuse, Jeffrey J

    2016-04-01

    General surgeons have traditionally performed open vascular operations. However, endovascular interventions, vascular residencies, and work-hour limitations may have had an impact on open vascular surgery training among general surgery residents. We evaluated the temporal trend of open vascular operations performed by general surgery residents to assess any changes that have occurred. The Accreditation Council for Graduate Medical Education's database was used to evaluate graduating general surgery residents' cases from 1999 to 2013. Mean and median case volumes were analyzed for carotid endarterectomy, open aortoiliac aneurysm repair, and lower extremity bypass. Significance of temporal trends were identified using the R(2) test. The average number of carotid endarterectomies performed by general surgery residents decreased from 23.1 ± 14 (11.6 ± 9 chief, 11.4 + 10 junior) cases per resident in 1999 to 10.7 ± 9 (3.4 ± 5 chief, 7.3 ± 6 junior) in 2012 (R(2) = 0.98). Similarly, elective open aortoiliac aneurysm repairs decreased from 7.4 ± 5 (4 ± 4 chief, 3.4 ± 4 junior) in 1999 to 1.3 ± 2 (0.4 ± 1 chief, 0.8 ± 1 junior) in 2012 (R(2) = 0.98). The number of lower extremity bypasses decreased from 21 ± 12 (9.5 ± 7 chief, 11.8 ± 9 junior) in 1999 to 7.6 ± 2.6 (2.4 ± 1.3 chief, 5.2 + 1.8 junior) in 2012 (R(2) = 0.94). Infrapopliteal bypasses decreased from 8.1 ± 3.8 (3.5 ± 2.2 chief, 4.5 ± 2.9 junior) in 2001 to 3 ± 2.2 (1 ± 1.6 chief, 2 ± 1.6 junior) in 2012 (R(2) = 0.94). General surgery resident exposure to open vascular surgery has significantly decreased. Current and future graduates may not have adequate exposure to open vascular operations to be safely credentialed to perform these procedures in future practice without advanced vascular surgical training. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  18. The role of peripheral vascular resistance in determining the infrainguinal arterial reconstruction patency.

    Science.gov (United States)

    Cheshmedzhiev, Mihail V; Knyazhev, Victor V; Radev, Radoslav S; Yordanov, Emil D

    2011-01-01

    To find if there is any correlation between the peripheral vascular resistance, its change following an intragraft prostaglandin infusion and the infrainguinal reconstruction patency. Ninety-seven patients with infrainguinal reconstructions were included in the study: in 48 patients they were compromised (32 with graft thrombosis and 16 with stenosis of the distal anastomoses); 49 patients had their bypasses patent for no less than 12 months. Intraoperative flowmetry was performed on the target artery under the distal anastomosis, after declamping, and after a five-minute intragraft prostaglandin infusion. We measured the peripheral vascular resistance (PVR) by two methods - as a ratio of the invasively measured average pressure to the average blood flow volume (mmHg/ml/min. = peripheral resistance unit [PRU]) and by using the readings by the flowmeter (ohms). The decrease of peripheral resistance was calculated in the functioning and the compromised reconstructions after administration of prostaglandin. We found that if PVR decreases 4.5 times (in ohms) the prognosis is good; we can make the same positive prognosis when the ratio of the mean invasively measured pressure to the mean blood flow volume (Pmean/Qmean) decreases more than four times. Values greater than 1.07 ohms, after peripheral vasodilatation, are indicative of high peripheral vascular resistance, at a level of specificity of 86%, and values greater than 0.57 PRU - at a level of specificity of 87%. Although PVR measurements cannot predict with absolute certainty that bypasses under the inguinal ligament shall stay patent for a long time, it is a valuable indicator showing the immediate outcome of reconstruction work carried out with the patient on the operating table. Finding Any technical errors and dealing with them saves time and money, as well as prevents the stress on the part of patients caused by the required additional revisions and multiple operations.

  19. American Academy of Facial Plastic and Reconstructive Surgery

    Science.gov (United States)

    ... is the world's largest specialty association for facial plastic surgery. It represents more than 2,700 facial plastic ... the American Board of Otolaryngology , which includes facial plastic surgery. Others are certified in plastic surgery, ophthalmology, and ...

  20. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery

    OpenAIRE

    Partridge, J S L; Harari, D; Martin, Finbarr; Peacock, J L; Bell, R; Mohammed, A.; Dhesi, J K

    2017-01-01

    BACKGROUND: Increasing numbers of older patients are undergoing vascular surgery. Inadequate preoperative assessment and optimization may contribute to increased postoperative morbidity and mortality.METHODS: Patients aged at least 65 years scheduled for elective aortic aneurysm repair or lower-limb arterial surgery were enrolled in an RCT of standard preoperative assessment or preoperative comprehensive geriatric assessment and optimization. Randomization was stratified by sex and surgical s...

  1. Novel Zero-Heat-Flux Deep Body Temperature Measurement in Lower Extremity Vascular and Cardiac Surgery.

    Science.gov (United States)

    Mäkinen, Marja-Tellervo; Pesonen, Anne; Jousela, Irma; Päivärinta, Janne; Poikajärvi, Satu; Albäck, Anders; Salminen, Ulla-Stina; Pesonen, Eero

    2016-08-01

    The aim of this study was to compare deep body temperature obtained using a novel noninvasive continuous zero-heat-flux temperature measurement system with core temperatures obtained using conventional methods. A prospective, observational study. Operating room of a university hospital. The study comprised 15 patients undergoing vascular surgery of the lower extremities and 15 patients undergoing cardiac surgery with cardiopulmonary bypass. Zero-heat-flux thermometry on the forehead and standard core temperature measurements. Body temperature was measured using a new thermometry system (SpotOn; 3M, St. Paul, MN) on the forehead and with conventional methods in the esophagus during vascular surgery (n = 15), and in the nasopharynx and pulmonary artery during cardiac surgery (n = 15). The agreement between SpotOn and the conventional methods was assessed using the Bland-Altman random-effects approach for repeated measures. The mean difference between SpotOn and the esophageal temperature during vascular surgery was+0.08°C (95% limit of agreement -0.25 to+0.40°C). During cardiac surgery, during off CPB, the mean difference between SpotOn and the pulmonary arterial temperature was -0.05°C (95% limits of agreement -0.56 to+0.47°C). Throughout cardiac surgery (on and off CPB), the mean difference between SpotOn and the nasopharyngeal temperature was -0.12°C (95% limits of agreement -0.94 to+0.71°C). Poor agreement between the SpotOn and nasopharyngeal temperatures was detected in hypothermia below approximately 32°C. According to this preliminary study, the deep body temperature measured using the zero-heat-flux system was in good agreement with standard core temperatures during lower extremity vascular and cardiac surgery. However, agreement was questionable during hypothermia below 32°C. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [Major vascular complications following surgery for a herniated lumbar disk].

    Science.gov (United States)

    Abad, C; Martel, D; Feijóo, J J; Carreira, L

    1993-01-01

    Two cases of arterial injury of the iliac arteries during surgery of the lumbar disc are presented. Both patients were successfully operated, in the first case a primary repair was accomplished, the second patient was treated by means of an ileo-femoral bypass graft. A comment of the pathophysiology, diagnostic and surgical management of this unusual complication is presented.

  3. Incidence and hospital mortality of vascular surgery patients with ...

    African Journals Online (AJOL)

    early sepsis or postoperative inotropic requirements may, however, result in early troponin release, .... failure. Emergency surgery was performed in 17.8% of the patients and this was associated with a ... septic shock.17 There were four patients (11.4%) in our MINS group that had coexisting sepsis during the first three days ...

  4. Preoperative antihypertensive medication intake and acute kidney injury after major vascular surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Lussier, Anne-Renee; Beaulieu-Dore, Roxane; LeManach, Yannick; Laskine, Mikhael; Fafard, Josee; Durand, Madeleine

    2018-01-27

    Postoperative acute kidney injury (AKI) is frequent after major vascular surgery and is associated with significant morbidity and mortality. It remains unclear whether the administration of combined oral antihypertensive medications on the day of surgery can increase the risk of postoperative AKI. We performed a retrospective cohort study of hypertensive patients undergoing elective major vascular surgery to determine the association between the number of antihypertensive medications continued on the morning of surgery and AKI at 48 hours postoperatively. A total of 406 patients who had undergone suprainguinal vascular surgery were included, and 10.3% suffered postoperative AKI. In multivariable analysis, the number of antihypertensive medications taken on the morning of surgery was independently associated with AKI (P = .026). Compared with patients who took no medication, taking one medication (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 0.68-3.75) and taking two or more medications (aOR, 2.70; 95% CI, 1.13-6.44) were associated with a 1.6-fold and 2.7-fold increased risk of postoperative AKI, respectively. Other predictors of AKI were suprarenal surgery (aOR, 3.37; 95% CI, 1.53-7.44), age (aOR, 2.29 per 10 years; 95% CI, 1.40-3.74), length of surgery (aOR, 1.40 per 1 hour; 95% CI, 1.10-1.76), hemoglobin drop (aOR, 1.37 per 10 g/L; 95% CI, 1.10-1.74), and history of coronary artery disease (aOR, 2.33; 95% CI, 1.08-5.00). In patients undergoing major vascular surgery who are treated with chronic antihypertensive therapy, the administration of antihypertensive drugs on the morning of surgery is independently associated with an increased risk of postoperative AKI. Further prospective studies are needed to confirm this finding. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  5. Vascularized Composite Tissue Spare Part Transfer for Central Hand Defect Reconstruction: Case Report.

    Science.gov (United States)

    Billig, Jessica; Johnson, Shepard P; Ogawa, Takeshi; Chung, Kevin C

    2016-01-01

    Injuries to the hand with loss of joints, tendons, nerves, and soft tissue may require complex, innovative reconstructive techniques to achieve a favorable functional and aesthetic outcome. We present a case of a manual laborer who sustained a multifaceted injury from a metal press machine with loss of composite structures including the middle and ring finger metacarpophalangeal joints, flexor and extensor tendons, digital nerves, and dorsal/volar soft tissues. Reconstruction included using the spare parts technique for transferring his ring finger proximal interphalangeal joint as a pedicle to reconstitute the missing metacarpophalangeal joint of his middle finger. The soft tissue from the ring finger was rearranged to provide aesthetic coverage of the hand with like-to-like reconstruction of the glabrous and nonglabrous skin. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Whole 3D shape reconstruction of vascular segments under pressure via fringe projection techniques

    Science.gov (United States)

    Genovese, Katia; Pappalettere, Carmine

    2006-12-01

    Understanding and modelling vascular wall mechanics is a primary issue in the study of circulatory diseases. Although theoretical and numerical studies on arteries compliance are continuously increasing, relatively little work has been documented on the use of non-invasive imaging techniques for monitoring 3D vascular wall deformations. Usually, 2D video dimension analyzer (VDA) systems recover diameter and length variations during inflation/extension tests by tracking position changes of few markers put on the blood vessel surface. Then, strain determination relies on the assumption of axisymmetric deformations. However, more rigorous evaluations of whole wall deformation map are required for properly modelling the highly anisotropic and inhomogeneous vascular tissue mechanical response. This paper describes the development and application of a fringe projection (FP)-based procedure for the 360° 3D shape reconstruction of tubular samples subjected to internal pressure. A specially designed fixture for mounting and inflating the tubular segment allows specimen rotation about its axis. Movement is controlled by a high-precision rotational stage. This yields accurate positioning of the surface to be investigated with respect to the viewing direction. Data point clouds obtained from multiple recorded images are then processed and merged in a CAD environment, thus providing the whole shape of the sample with very high spatial resolution. The entire procedure has successfully been applied to latex specimens and porcine vascular segments. Further improvements will make the present procedure suitable for in vitro tests under more closely reproduced physiological conditions.

  7. Perspective: carotid stenting and the history of disruptive technology in vascular surgery.

    Science.gov (United States)

    Veith, Frank J

    2008-06-01

    This article defines disruptive technology and discusses such technologies in Vascular Surgery. It considers the question: Is carotid artery stenting (CAS) a disruptive technology? Although CAS will impact positively on the treatment of carotid bifurcation disease, it will probably never displace carotid endarterectomy in the majority of patients. The precise role of CAS remains to be determined.

  8. Concise Review: Tissue-Engineered Vascular Grafts for Cardiac Surgery: Past, Present, and Future

    OpenAIRE

    Kurobe, Hirotsugu; Maxfield, Mark W.; Breuer, Christopher K.; Shinoka, Toshiharu

    2012-01-01

    Developing a durable material with the potential to function with child growth will eliminate the need for reoperation and significantly reduce morbidity and mortality in some types of congenital heart defects. Tissue-engineered vascular grafts offer the ability to drastically improve morbidity and mortality and drastically improve the quality of life of patients after congenital heart defect surgery.

  9. Quality of provided care in vascular surgery : outcome assessment & improvement strategies

    NARCIS (Netherlands)

    Flu, Hans Christiaan

    2010-01-01

    The aim of this thesis was to evaluate the quality of care in vascular surgery in end-stage renal disease (ESRD) and peripheral arterial occlusive disease (PAOD): intermittent claudication (IC) and critical lower limb ischaemia (CLI) patients. Therefore firstly it focused on the improvement of the

  10. [Indications, method and results of autotransfusion in trauma and vascular surgery (author's transl)].

    Science.gov (United States)

    Vereecken, L; de Mol, J; Derom, F; de Roose, J

    1975-03-01

    The authors have used the Bentley Ats 100 system, a disposable autotransfusion unit, in 31 cases of trauma and major vascular surgery. An original method of anticoagulation consisting in heparine (1 mg/kg bodyweight) and priming and flushing of the succion unit with ACD is described. The effect of the autotransfusion on the coagulation and the recent problems and advances are discussed.

  11. Indications and Contraindications to Reconstructive Surgery in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    David Johnston

    1995-01-01

    Full Text Available Surgical treatment is often needed for patients with ulcerative colitis because of toxic dilation, intractability or risk of cancer. Precise diagnosis is vital to exclude Crohn's disease and infective colitis, although patients with `indeterminate' colitis often do well after reconstructive surgery. Restorative proctocolectomy, in which the anal sphincter is preserved and a pelvic ileal reservoir is used as a substitute for the rectum, is the standard surgical procedure, supplanting panproctocolectomy with ileostomy. Ileorectal anastomosis should also be considered, but is only suitable for patients with relative rectal sparing, and meticulous sigmoidoscopic follow-up is essential. For toxic dilation, colectomy with ileostomy and mucous fistula is recommended, proctectomy and reconstruction being deferred until the patient is fitter. For most patients, the entire colon and rectum are removed and a pelvic ileal reservoir is anastomosed to the anus. Many types of reservoir have been proposed, but randomized trials are few, and it seems that the J pouch is as good as the S or W pouches, and technically is simpler. The operative mortality of restorative proctocolectomy worldwide has been about 1%, thanks largely to the routine use of a temporary defunctioning ileostomy. A one-stage procedure without ileostomy is permissible if the patient is relatively fit and the surgeon is in attendance for 10 days after operation, but omission of the ileostomy certainly increases the risk to life and the postoperative morbidity, and should thus not be done in debilitated patients or in those on high dose steroids. Resection of the mucosal lining of the anal canal above the dentate line (`mucosal proctectomy' was formerly routine, but leads to diminished sphincter pressure and sensation, such that preservation of the entire motor and sensory sphincteric complex is now advocated by many authors. Omission of mucosal stripping renders the procedure technically

  12. Data for the Oxford Abdominal Aortic Aneurysm Study international survey of vascular surgery professionals

    Directory of Open Access Journals (Sweden)

    Regent Lee

    2017-10-01

    This Data-in-Brief article contains a detailed method for the conduct of this survey and additional original data. In this survey, we also provided vascular surgery colleagues with contemporary epidemiologic and surgical outcome data. This was followed by a hypothetical scenario whereby a patient had just been diagnosed with a small (40 mm AAA and a novel biomarker predicted it to be fast growing in the coming years. We assessed the vascular professionals' perception of the patient's preference for management in this scenario, and their willingness to refer patients for a surgical trial that investigates the outcome of early versus late surgery in this setting. The survey then asked the vascular professionals to assume the role of the patient, and provided their own preferences in such a scenario.

  13. Cardiac safety in vascular access surgery and maintenance.

    Science.gov (United States)

    Malik, Jan; Kudlicka, Jaroslav; Tesar, Vladimir; Linhart, Ales

    2015-01-01

    More than 50% of all end-stage renal disease (ESRD) patients die from cardiovascular complications. Among them, heart failure and pulmonary hypertension play a major role, and published studies document significantly higher mortality rates in patients with these two states. Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred types of vascular access (VA). However, both AVF and AVG increase cardiac output and in turn could contribute to (the decompensation of) heart failure or pulmonary hypertension. No really safe access flow volume exists, and the ESRD patients' reactions to it vary considerably. We review the mechanisms involved in the cardiovascular consequences of increased cardiac output and available literary data. The link between access flow volume and increased mortality due to pulmonary hypertension or heart failure probably exists, but still has not been directly evidenced. Regular echocardiography is advisable especially in patients with symptoms or with high VA flow (>1,500 ml/min). © 2015 S. Karger AG, Basel.

  14. The Clinical Impact of Cardiology Consultation Prior to Major Vascular Surgery.

    Science.gov (United States)

    Davis, Frank M; Park, Yeo June; Grey, Scott F; Boniakowski, Anna E; Mansour, M Ashraf; Jain, Krishna M; Nypaver, Timothy; Grossman, Michael; Gurm, Hitinder; Henke, Peter K

    2018-01-01

    To understand statewide variation in preoperative cardiology consultation prior to major vascular surgery and to determine whether consultation was associated with differences in perioperative myocardial infarction (poMI). Medical consultation prior to major vascular surgery is obtained to reduce perioperative risk. Despite perceived benefit of preoperative consultation, evidence is lacking specifically for major vascular surgery on the effect of preoperative cardiac consultation. Patient and clinical data were obtained from a statewide vascular surgery registry between January 2012 and December 2014. Patients were risk stratified by revised cardiac risk index category and compared poMI between patients who did or did not receive a preoperative cardiology consultation. We then used logistic regression analysis to compare the rate of poMI across hospitals grouped into quartiles by rate of preoperative cardiology consultation. Our study population comprised 5191 patients undergoing open peripheral arterial bypass (n = 3037), open abdominal aortic aneurysm repair (n = 332), or endovascular aneurysm repair (n = 1822) at 29 hospitals. At the patient level, after risk-stratification by revised cardiac risk index category, there was no association between cardiac consultation and poMI. At the hospital level, preoperative cardiac consultation varied substantially between hospitals (6.9%-87.5%, P 66%) had a reduction in poMI (OR, 0.52; confidence interval: 0.28-0.98; P cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.

  15. Casuistry of physiotherapy care of patient after anterior cruciate ligament reconstruction surgery of knee

    OpenAIRE

    Škráčková, Barbora

    2017-01-01

    Title: Casuistry of physiotherapy care of patient after anterior cruciate ligament reconstruction surgery of knee Objectives: The purpose of the theoretical part of the thesis is to introduce the issue of soft tissue injury of the knee joint, especially anterior cruciate ligament. Acquaintance with conservative and surgical treatment, physical therapy and physiotherapeutical care after ligament reconstruction surgery. The special part of the thesis presents casuistry of physiotherapy care of ...

  16. The understanding of plastic and reconstructive surgery amongst Queensland medical students

    Directory of Open Access Journals (Sweden)

    Christopher Conyard

    2016-06-01

    This study has highlighted the gap between a medical student's perception and reality of the scope of Plastic and Reconstructive Surgery. It has emphasised the need for greater exposure and education in this surgical subspeciality if future medical practitioners are to better match the requirements of their patients to the skills of the specialist. If plastic surgeons wish to continue to be recognised as specialists in hand, craniofacial and reconstructive surgery, this gap between perception and reality needs to be addressed.

  17. The use of robotics in plastic and reconstructive surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    Jean Nehme

    2017-09-01

    Conclusions: Robot-assisted plastic and reconstructive surgery provides clinical outcomes comparable to conventional techniques. Advantages include reported improved cosmesis, functional outcomes and greater surgeon comfort. Disadvantages included longer operating and set-up times, a learning curve, breaking of microneedles, high monetary costs and authors consistently recommended improved end-effectors. All authors were optimistic about the use of robotics in plastic and reconstructive surgery.

  18. [Plastic Reconstruction with a Vascular Pedicle Latissimus Dorsi Flap after Sternal Osteomyelitis].

    Science.gov (United States)

    Spindler, N; Langer, S

    2017-10-01

    Objective: Sternal bone and soft tissue debridement after osteomyelitis of the sternum with simultaneous defect coverage using a vascular pedicle latissimus dorsi flap. Indication: Profound sternal wound healing disorders may be covered with various flap grafts. The latissimus dorsi flap provides a fast, sufficient and reliable option to cover sternal defects. If the bone and soft tissue debridement has been very radical, coverage may be performed in a one-stage procedure. Method: The individual surgical steps for sternal debridement with simultaneous defect coverage using a vascular pedicle latissimus dorsi flap are shown. Conclusion: The radicality of debridement is crucial to treatment success and allows debridement and flap graft coverage to be performed at the same time. If two surgeons work simultaneously, the duration of surgery may be significantly reduced. Georg Thieme Verlag KG Stuttgart · New York.

  19. Predictable dental rehabilitation in maxillomandibular reconstruction with free flaps. The role of implant guided surgery.

    Science.gov (United States)

    Cebrian-Carretero, José-Luis; Guiñales-Díaz de Cevallos, Jorge; Sobrino, José-Andrés; Yu, Tomás; Burgueño-García, Miguel

    2014-11-01

    The reconstruction of maxillomandibular defects secondary to oral cancer surgery, represent a great challenge for Maxillofacial surgeons. During the last decades the reconstructive surgery has experimented a big advance due to the development of the microsurgical techniques. At present, we are able to reconstruct complex defects using free flaps that provide both soft and bone tissue. Fibula, iliac crest and scapula free flaps have been the three classic options for the maxillomandibular reconstruction owing to the amount of bone that this flaps provide, allowing the posterior dental rehabilitation with implants. Today, our objective it is not only the aesthetic reconstruction, but also the functional reconstruction of the patients enhancing their life quality. Guided implant surgery in free flap reconstructed patients has become an essential tool, helping to define the exact position of the dental implant in the flap. In this way it is possible to look for the areas with better bone conditions, avoiding the osteosynthesis material used to fixate the flap with the native bone and deciding the best biomechanical option, in terms of number and situation of the implants, for the future dental prostheses. In summary, using the guided implant surgery, it is possible to design an exact and predictable dental implant rehabilitation in patients with oral cancer who are reconstructed with free microvascular flap, resulting in an optimal aesthetic and functional result.

  20. A Comparison of Training Experience, Training Satisfaction, and Job Search Experiences between Integrated Vascular Surgery Residency and Traditional Vascular Surgery Fellowship Graduates.

    Science.gov (United States)

    Colvard, Benjamin; Shames, Murray; Schanzer, Andres; Rectenwald, John; Chaer, Rabih; Lee, Jason T

    2015-10-01

    The first 2 integrated vascular residents in the United States graduated in 2012, and in 2013, 11 more entered the job market. The purpose of this study was to compare the job search experiences of the first cohort of integrated 0 + 5 graduates to their counterparts completing traditional 5 + 2 fellowship programs. An anonymous, Web-based, 15-question survey was sent to all 11 graduating integrated residents in 2013 and to the 25 corresponding 5 + 2 graduating fellows within the same institution. Questions focused on the following domains: training experience, job search timelines and outcomes, and overall satisfaction with each training paradigm. Survey response was nearly 81% for the 0 + 5 graduates and 64% for the 5 + 2 graduates. Overall, there was no significant difference between residents and fellows in the operative experience obtained as measured by the number of open and endovascular cases logged. Dedicated research time during the entire training period was similar between residents and fellows. Nearly all graduates were extremely satisfied with their training and had positive experiences during their job searches with respect to starting salaries, numbers of offers, and desired practice type. More 0 + 5 residents chose academic and mixed practices over private practices compared with 5 + 2 fellowship graduates. Although longer term data are needed to understand the impact of the addition of 0 + 5 graduating residents to the vascular surgery work force, preliminary survey results suggest that both training paradigms (0 + 5 and 5 + 2) provide positive training experiences that result in excellent job search experiences. Based on the current and future need for vascular surgeons in the work force, the continued growth and expansion of integrated 0 + 5 vascular surgery residency positions as an alternative to traditional fellowship training is thus far justified. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. The utility of endovascular simulation to improve technical performance and stimulate continued interest of preclinical medical students in vascular surgery.

    Science.gov (United States)

    Lee, Jason T; Qiu, Mary; Teshome, Mediget; Raghavan, Shyam S; Tedesco, Maureen M; Dalman, Ronald L

    2009-01-01

    New training paradigms in vascular surgery allow for early specialization out of medical school. Surgical simulation has emerged as an educational tool for trainees to practice procedures in a controlled environment allowing interested medical students to perform procedures without compromising patient safety. The purpose of this study is to assess the ability of a simulation-based curriculum to improve the technical performance and interest level of medical students in vascular surgery. Prospective observational cohort study of medical student performance. Academic medical center. Forty-one medical students (23 first year, 15 second year, 3 other) enrolled in a vascular surgery elective course. Students completed a survey of their interests and performed a renal stent procedure on an endovascular simulator (pretest). The curriculum consisted of didactic teaching and weekly mentored simulator sessions and concluded with a final renal stent procedure on the simulator (posttest). Objective procedural measures were determined during the pre- and posttest by the simulator, and subjective performance was graded by expert observers utilizing a structured global assessment scale. After the course, the students were surveyed as to their opinions about vascular surgery as a career option. Finally, 1 year after the course, all students were again surveyed to determine continued interest in vascular surgery. The objective and subjective criteria measured on the simulator and structured global assessment scale significantly improved from pre- to posttest in terms of performer technical skill, patient safety measures, and structured global assessments. Before beginning the course, 8.5% of the students expressed high interest in vascular surgery, and after completing the course 70% were seriously considering vascular surgery as a career option (p = 0.0001). More than 95% of the students responded that endovascular simulation increased their knowledge and interest in vascular

  2. Laparoscopic reconstructive surgery is superior to vaginal reconstruction in the pelvic organ prolapse.

    Science.gov (United States)

    Park, Young-Han; Yang, Seong Cheon; Park, Sung Taek; Park, Sung Ho; Kim, Hong Bae

    2014-01-01

    Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse. Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ≥ 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and χ(2)-test or the Fisher exact test as appropriate. There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, papproach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p laparoscopic approach group. Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy.

  3. Data for the Oxford Abdominal Aortic Aneurysm Study international survey of vascular surgery professionals.

    Science.gov (United States)

    Lee, Regent; Jones, Amy; Woodgate, Felicity; Killough, Nicholas; Bellamkonda, Kirthi; Williams, Matthew; Hurst, Katherine; Fulford-Smith, Lucy; Cassimjee, Ismail; Handa, Ashok

    2017-10-01

    As part of the Oxford Abdominal Aortic Aneurysm (OxAAA) Study, we conducted an international survey of vascular surgery professionals. One aspect of the survey is as published in the International Journal of Cardiology: "International Opinion on Priorities in Research for Small Abdominal Aortic Aneurysms and the Potential Path for Research to Impact Clinical Management". This Data-in-Brief article contains a detailed method for the conduct of this survey and additional original data. In this survey, we also provided vascular surgery colleagues with contemporary epidemiologic and surgical outcome data. This was followed by a hypothetical scenario whereby a patient had just been diagnosed with a small (40 mm) AAA and a novel biomarker predicted it to be fast growing in the coming years. We assessed the vascular professionals' perception of the patient's preference for management in this scenario, and their willingness to refer patients for a surgical trial that investigates the outcome of early versus late surgery in this setting. The survey then asked the vascular professionals to assume the role of the patient, and provided their own preferences in such a scenario.

  4. What do women want in breast reconstruction? Age-adhered surgery or rejuvenation?

    Directory of Open Access Journals (Sweden)

    Helga Henseler

    2015-06-01

    Conclusion: The majority of women desire to recreate their own natural and ptotic breast shape in reconstructive surgery without contralateral adjusting surgery. Younger women with smaller breasts and women of all ages with a family history of breast cancer more frequently prefer an operation on only the involved side. Women opted for good rather than excellent breast symmetry.

  5. Usefulness of the Paramedian Forehead Flap in Nasal Reconstructive Surgery: A Retrospective Series of 41 Patients.

    Science.gov (United States)

    Blázquez-Sánchez, N; Fernández-Canedo, I; Repiso-Jiménez, J B; Rivas-Ruiz, F; De Troya Martín, M

    2016-03-01

    Surgical reconstruction of the external nose, a common site for nonmelanoma skin cancer, is difficult. Oncologic surgery often leaves large skin defects, occasionally involving the underlying cartilage and nasal mucosa. We describe our experience with the paramedian forehead flap for reconstruction of nasal defects. We performed a retrospective study of consecutive patients in whom a paramedian forehead flap was used to repair surgical defects of the nose between July 2004 and March 2011. We describe the clinical and epidemiologic characteristics, the surgical technique, complications, secondary procedures, and cosmetic results. The series comprised 41 patients with a mean (SD) age of 67 (10.36) years. The majority were men (male to female ratio, 2.4:1). Associated risk factors included diabetes in 27% of patients, cardiovascular risk factors in 49%, and smoking or drinking in 19.5%. The tissue defects were distal in 80% of cases and nonpenetrating in 78%. The mean (SD) diameter was 21.6 (6.78) mm. Early postoperative complications occurred in 14.6% of patients and late complications in 31.7% (trap door effect in 22% and hair transposition in 19%), with a need for Readjustment in a second operation was needed in 19.5% of patients. The cosmetic results were considered acceptable or excellent in 90.2% of cases. The paramedian forehead flap is versatile and provides skin of a similar color and texture to that of the external nose. It has a reliable vascular pedicle that guarantees the viability not only of the flap but also of other tissues that may be used in combination, such as chondromucosal or chondrocutaneous grafts. Revision of the technique in a second operation may sometimes be required to achieve an optimal result. Copyright © 2015 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  6. Application status of three-dimensional CT reconstruction in hepatobiliary surgery

    Directory of Open Access Journals (Sweden)

    JIANG Chao

    2017-02-01

    Full Text Available With the development of imaging technology, three-dimensional CT reconstruction has been widely used in hepatobiliary surgery. Three-dimensional CT reconstruction can divide and reconstruct two-dimensional images into three-dimensional images and clearly show the location of lesion and its relationship with the intrahepatic bile duct system. It has an important value in the preoperative assessment of liver volume, diagnosis and treatment decision-making process, intraoperative precise operation, and postoperative individualized management, and promotes the constant development of hepatobiliary surgery and minimally invasive technology, and therefore, it holds promise for clinical application.

  7. Study of the Dynamics of Transcephalic Cerebral Impedance Data during Cardio-Vascular Surgery

    Science.gov (United States)

    Atefi, S. R.; Seoane, F.; Lindecrantz, K.

    2013-04-01

    Postoperative neurological deficits are one of the risks associated with cardio vascular surgery, necessitating development of new techniques for cerebral monitoring. In this study an experimental observation regarding the dynamics of transcephalic Electrical Bioimpedance (EBI) in patients undergoing cardiac surgery with and without extracorporeal circulation (ECC) was conducted to investigate the potential use of electrical Bioimpedance for cerebral monitoring in cardio vascular surgery. Tetrapolar transcephalic EBI measurements at single frequency of 50 kHz were recorded prior to and during cardio vascular surgery. The obtained results show that the transcephalic impedance decreases in both groups of patients as operation starts, however slight differences in these two groups were also observed with the cerebral impedance reduction in patients having no ECC being less common and not as pronounced as in the ECC group. Changes in the cerebral impedance were in agreement with changes of haematocrit and temperature. The origin of EBI changes is still unexplained however these results encourage us to continue investigating the application of electrical bioimpedance cerebral monitoring clinically.

  8. Orbital reconstruction: prefabricated implants, data transfer, and revision surgery.

    Science.gov (United States)

    Bittermann, Gido; Metzger, Marc Christian; Schlager, Stefan; Lagrèze, Wolf Alexander; Gross, Nikolai; Cornelius, Carl-Peter; Schmelzeisen, Rainer

    2014-10-01

    External impact to the orbit may cause a blowout or zygomatico-maxillary fractures. Diagnosis and treatment of orbital wall fractures are based on both physical examination and computed tomography scan of the orbit. Injuries of the orbit often require a reconstruction of its orbital walls. Using computer-assisted techniques, anatomically preformed orbital implants, and intraoperative imaging offers precise and predictable results of orbital reconstructions. Secondary reconstruction of the orbital cavity is challenging due to fractures healed in malposition, defects, scarring, and lack of anatomic landmarks, and should be avoided by precise primary reconstruction. The development of preformed orbital implants based on topographical analysis of the orbital cavity was a milestone for the improvement of primary orbital reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. [ITI dental implants immediately placed into vascularized iliac bone grafts for reconstruction of mandibular defect: analysis of 12 consecutive cases].

    Science.gov (United States)

    Wu, Yi-qun; Zhang, Zhi-yong; Zhang, Zhi-yuan; Huang, Wei; Lai, Hong-chang; Hu, Yong-jie; Zhang, Chen-ping

    2005-04-01

    Vascularized iliac bone graft combined implantation has become a routine procedure in the functional reconstruction of mandibular defects. The aim of this study was to assess the clinical outcomes of the implants immediately placed into the vascularized iliac bone grafts. In this study, 12 consecutive patients with 36 ITI dental implants who had reconstruction of mandibular defect between 2000 and 2004 were presented. All implants were inserted immediately after bone grafting and loaded after 3 to 5 months of submerged healing. In general, a primary stability for implants placed in vascularized iliac bone grafts were achieved. After 1 year of observation the mean vertical bone loss was less than 1mm. There was no implant failure in the observation period. The vascularized iliac bone grafts are safe implant-bearing areas and allows a reliable and predictable restoration with dental implants. Implant-supported bridges and overdentures can be used in this procedure.

  10. Current and future applications of nanotechnology in plastic and reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Dana K Petersen

    2014-09-01

    Full Text Available Although nanotechnology is a relatively young field, there are countless biomedical applications in use or under investigation. Many specialties have benefitted from nanoscale refinements of diagnostic and therapeutic techniques. Plastic and reconstructive surgery is an incredibly diverse specialty, encompassing craniofacial and hand surgery; trauma, oncologic and congenital reconstruction; burn care, and aesthetic surgery. Advances in nanotechnology have significantly impacted wound management, topical skin care, implant and prosthetic design, tissue engineering, and drug delivery systems. Currently, plastic surgeons are researching the utility of nanoscale tools for bone regeneration, bone prosthetics, and drug delivery. Nanotechnology will continue to build upon preceding discoveries, and its biomedical applications in the field of plastic and reconstructive surgery will expand significantly.

  11. [Selected pages of history of vascular surgery in Russia (contribution of Russian surgeons to world vascular surgery)].

    Science.gov (United States)

    Pokrovskiĭ, A V; Gliantsev, S P

    2014-01-01

    The article describes the most significant for Russian surgery personalities, facts, and events of the last 180years. An emphasis is placed upon those works, discoveries or operations made by Russians for the first timein the world's practice. To such we refer N.J. Pirogov's topographical anatomy of vessels (1837), N. V. Ekk's portocaval anastomosis (1877), A.A. Yanovsky's lateral arterial suture (1889), S.S. Bryukhonenko's artificial circulation unit (1923-1924), Yu. Yu. Voronoy's renal replantation onto femoral vessels (1933), V.P. Demikhov'stransplantation of vital organs (1946-1959), V.I. Kolesov's mammary-coronary anastomosis (1964),F.A. Serbinenko's endovascular neurosurgery ( 1979), E. I. Chasov's intracoronary thrombolysis by E.I. Chazov( 1974), endovascular prosthetic repair of the thoracic aorta by N.L. Volodos ( 1985) and a series of other facts.

  12. Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons.

    Science.gov (United States)

    McInnes, Colin W; Courtemanche, Douglas J; Verchere, Cynthia G; Bush, Kevin L; Arneja, Jugpal S

    2012-01-01

    Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada. An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery. The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements. The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.

  13. Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

    2017-02-01

    Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P < .001) and had less MLB experience (1.5 years vs. 5.0 years, P < .001). There is no specific number of pitches, innings, or games that place a pitcher at an increase risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

  14. Vascular Surgery in World War II: The Shift to Repairing Arteries.

    Science.gov (United States)

    Barr, Justin; Cherry, Kenneth J; Rich, Norman M

    2016-03-01

    Vascular surgery in World War II has long been defined by DeBakey and Simeone's classic 1946 article describing arterial repair as exceedingly rare. They argued ligation was and should be the standard surgical response to arterial trauma in war. We returned to and analyzed the original records of World War II military medical units housed in the National Archives and other repositories in addition to consulting published accounts to determine the American practice of vascular surgery in World War II. This research demonstrates a clear shift from ligation to arterial repair occurring among American military surgeons in the last 6 months of the war in the European Theater of Operations. These conclusions not only highlight the role of war as a catalyst for surgical change but also point to the dangers of inaccurate history in stymieing such advances.

  15. [Wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor].

    Science.gov (United States)

    Bi, Zhenggang; Pan, Qi; Fu, Chunjiang; Han, Xinguang

    2010-12-01

    To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size of tumor was 6.5 cm x 3.5 cm-8.0 cm x 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15 degrees (mean, 10.7 degrees), flexion 9-21 degrees (mean, 14.2 degrees), radial inclination 0-10 degrees (mean, 8.6 degrees), and ulnar inclination 0-15 degrees (mean, 7.9 degrees). The ROM of forearm was as follows: pronation 15-50 degrees (mean, 28.7 degrees) and supination 10-25 degrees (mean, 16.5 degrees). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. All patients achieved primary healing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone healing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 degrees (mean, 29.0 degrees), flexion 30-50 degrees (mean, 35.0 degrees), radial inclination 10-20 degrees (mean, 16.5 degrees), and ulnar inclination 20-25 degrees (mean, 23.5 degrees). The ROM of forearm was as follows: pronation 40-90 degrees (mean, 68.3 degrees) and supination 30-80 degrees (mean, 59.6 degrees). There were significant differences in the ROM between before operation and after operation (P wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Wrist joint reconstruction with vascularized fibular head graft can restore

  16. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training

    DEFF Research Database (Denmark)

    Nayahangan, Leizl Joy; Konge, Lars; Schroeder, T V

    2017-01-01

    a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. DESIGN AND METHODS: A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase...... to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved...... eliminated, resulting in a final prioritised list of 19 technical procedures. CONCLUSION: A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons...

  17. Smoking Cessation Rates among Patients Undergoing Vascular Surgery in a Canadian Center.

    Science.gov (United States)

    McHugh, Seamus Mark; Eisenberg, Naomi; Montbriand, Janice; Roche-Nagle, Graham

    2017-11-01

    Smoking is the single most important modifiable risk factor for patients with vascular disease. The aim of this study was to determine the prevalence of smoking and cessation rates among patients undergoing vascular surgery in a Canadian center. As part of the Vascular Quality Initiative, a prospectively maintained database was used to identify the patients undergoing vascular surgery between 2010 and 2013. Smoking prevalence data were collated preprocedure, postprocedure, and at year follow-up after intervention at a median of 13 months (mean = 14.4 ± 7.8 months). Cessation rates at 13-month follow-up were assessed to determine any statistically significant univariate factors. These factors were then used to build a model through backwards logistic regression. Multicollinearity was tested by assessing both variance inflation factors and tolerance. Overall, 624 patients had complete follow-up data. Of these, 209 (33.5%) were smokers presurgically. At 1-year follow-up, of those 209 patients who were smokers preoperatively, 87 (41.6%) had stopped smoking while 122 (58.4%) had not. Patients who were male and aged >70 years were more likely to be smokers preoperatively (P = 0.001 and P 70 years (P = 0.005) and in those with chronic obstructive pulmonary disease (P = 0.016). Gender was also statistically associated, with cessation rates higher in females (P = 0.011). More than one-third of patients who underwent surgery in a Canadian vascular center continue to smoke. Uniquely, we report a statistically significant association between gender and postoperative cessation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training.

    Science.gov (United States)

    Nayahangan, L J; Konge, L; Schroeder, T V; Paltved, C; Lindorff-Larsen, K G; Nielsen, B U; Eiberg, J P

    2017-04-01

    Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of "learning by doing." This change has established simulation as a cornerstone in providing trainees with the necessary skills and competences. However, the development of simulation based programs often evolves based on available resources and equipment, reflecting convenience rather than a systematic educational plan. The objective of the present study was to perform a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved elimination and ranking of procedures. The response rate for round 1 was 70%, with 36 procedures identified. Round 2 had a 76% response rate and resulted in a preliminary prioritised list after exploring the need for simulation based training. Round 3 had an 85% response rate; 17 procedures were eliminated, resulting in a final prioritised list of 19 technical procedures. A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons in training. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  19. Incidence of deep venous thrombosis and stratification of risk groups in a university hospital vascular surgery unit

    Directory of Open Access Journals (Sweden)

    Alberto Okuhara

    2015-06-01

    Full Text Available BACKGROUND: There is a knowledge gap with relation to the true incidence of deep vein thrombosis among patients undergoing vascular surgery procedures in Brazil. This study is designed to support the implementation of a surveillance system to control the quality of venous thromboembolism prophylaxis in our country. Investigations in specific institutions have determined the true incidence of deep vein thrombosis and identified risk groups, to enable measures to be taken to ensure adequate prophylaxis and treatment to prevent the condition.OBJECTIVE: To study the incidence of deep venous thrombosis in patients admitted to hospital for non-venous vascular surgery procedures and stratify them into risk groups.METHOD: This was a cross-sectional observational study that evaluated 202 patients from a university hospital vascular surgery clinic between March 2011 and July 2012. The incidence of deep venous thrombosis was determined using vascular ultrasound examinations and the Caprini scale.RESULTS: The mean incidence of deep venous thrombosis in vascular surgery patients was 8.5%. The frequency distribution of patients by venous thromboembolism risk groups was as follows: 8.4% were considered low risk, 17.3% moderate risk, 29.7% high risk and 44.6% were classified as very high risk.CONCLUSION: The incidence of deep venous thrombosis in vascular surgery patients was 8.5%, which is similar to figures reported in the international literature. Most vascular surgery patients were stratified into the high and very high risk for deep venous thrombosis groups.

  20. Medical student perceptions of the scope of plastic and reconstructive surgery.

    Science.gov (United States)

    Agarwal, Jayant P; Mendenhall, Shaun D; Moran, Linh A; Hopkins, Paul N

    2013-03-01

    The scope of plastic surgery is not well understood by people outside the field. Better educating medical students about plastic surgery may improve understanding of the field, establish appropriate referral patterns early on, and assist with career decision-making. The purpose of this study was to assess medical student understanding of plastic surgery and to analyze the impact of prior plastic surgery clinical exposure on this understanding. An online survey consisting of 24 clinical scenarios was administered to medical students of the University of Utah. After indicating their level of training and whether they had prior clinical exposure to plastic surgery or other surgical subspecialties, students selected one or more appropriate surgical subspecialties to manage each scenario. Of 408 students, 230 (56.4%) responded to the survey. Prior clinical exposure to plastic surgery was reported by 15.8% to 29.4% of students (first to fourth year). Overall, 92% of students chose at least one acceptable surgical specialty for referral. Plastic surgery was selected by only 54% of students for all conditions, and this did not improve throughout medical school. Senior students (third and fourth years) with prior plastic surgery exposure chose plastic surgery more often than those without prior exposure (71% vs. 51%, P Plastic surgery was chosen most frequently for rhinoplasty and breast reconstruction and less frequently for hand/peripheral nerve surgery and wound surgery. Improved medical student education about the scope of plastic surgery is needed, especially in the areas of hand/peripheral nerve surgery and general reconstructive surgery.

  1. National representation in the plastic and reconstructive surgery literature: a bibliometric analysis of highly cited journals.

    Science.gov (United States)

    Zhang, Wen-Jun; Ding, Wei; Jiang, Hua; Zhang, Yin-Fan; Zhang, Jian-Lin

    2013-02-01

    In recent years, significant growth has been observed in the field of plastic and reconstructive surgery. However, the national productivity to the field of plastic and reconstructive surgery remains unknown. We therefore intended to reveal national contributions in the field of plastic and reconstructive surgery. Articles published in the 6 highly cited journals in plastic and reconstructive surgery in 2005-2009 were retrieved from the Medline and Web of Science. The number of total articles, the per capita numbers, 5-year impact factors (5y-IF), and citations were tabulated to assess the contribution of different countries. A total number of 5745 articles were published in the 6 journals from 2005 to 2009 worldwide. North America, West Europe, and East Asia were the most productive regions. High-income countries published 79.72% of the total articles. United States (USA) published most of the articles during 2005 to 2009 (2015/5745, 35.07%), followed by United Kingdom, Turkey, Japan, and China. Besides, USA also had the highest total 5y-IF (5010.76), the highest mean 5y-IF (2.49), and the highest total citations (11,788). When normalized to population size, Sweden had the highest number of articles per million persons (12.26), followed by Switzerland (8.02) and Netherlands (7.77). USA is the most productive country in the field of plastic and reconstructive surgery. When normalized to population size, some European countries might be more productive.

  2. Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Tien Jin, E-mail: tien_jin_tan@cgh.com.sg [Department of Radiology, Vancouver General Hospital, Vancouver, BC (Canada); Aljefri, Ahmad M. [Department of Radiology, Vancouver General Hospital, Vancouver, BC (Canada); Clarkson, Paul W.; Masri, Bassam A. [Department of Orthopaedics, University of British Columbia, Vancouver, BC (Canada); Ouellette, Hugue A.; Munk, Peter L.; Mallinson, Paul I. [Department of Radiology, Vancouver General Hospital, Vancouver, BC (Canada)

    2015-09-15

    Highlights: • Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. • The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. • This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases. • By being aware of the various types of reconstructive techniques used in limb salvage surgery as well as the potential complications, the reporting radiologist should possess greater confidence in making an accurate assessment of the expected post-operative imaging findings in the management of such cases. - Abstract: Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases.

  3. Modern principles of reconstructive surgery for advanced head and neck tumors

    Science.gov (United States)

    Kulbakin, D. E.; Choinzonov, E. L.; Mukhamedov, M. R.; Garbukov, E. U.; Shtin, V. I.; Havkin, N. M.; Vasilev, R. V.

    2017-09-01

    Background: Surgery remains the mainstay of treatment for head and neck cancer. Reconstruction after cancer surgery can help to restore both the appearance and function of the affected areas. Materials and methods: From 2008 to 2016, a total of 120 reconstructive surgeries were performed at the Department of Head and Neck Tumors of Tomsk Cancer Research Institute. The majority of patients had locally advanced cancer (T3 stage in 49 patients and T4 stage in 41 patients). The localizations of the defects requiring reconstruction were as follows: oral cavity—26 cases; tongue—24 cases; skin (including defects of lower lip)—12 cases; maxilla—14 cases; larynx and hypopharynx—12 cases; lips—6 cases, cheek—11 cases, and mandibulla—5 cases. Various free flaps (83%) and pedicle flaps (17%) were used for the reconstruction of the large defects following extirpation of head and neck malignant tumors. In 15 cases (13%), the implants from titanium and titanium nickelide (TiNi) were used to restore the supporting and skeletal functions of the reconstructed region. We used 3D model of the patient's skull for a more precise planning of the reconstruction of maxillofacial bone defects. Results: Good functional results were achieved in most cases. Full flap necrosis was observed in 12 cases (10%). Fibular flap necroses were noted in 8 cases (7%). Conclusions: Single-stage reconstructions of the lost structures after tumor resection significantly improve survival of head and neck cancer patients without causing significant functional and aesthetic damage, as well as contribute to quick rehabilitation of these patients and improvement of their social status. To reduce postoperative complications after reconstructive surgery, it is necessary to carefully select the appropriate reconstructive implant materials.

  4. Early post-operative glucose levels are an independent risk factor for infection after peripheral vascular surgery. A retrospective study

    NARCIS (Netherlands)

    Vriesendorp, T. M.; Morélis, Q. J.; DeVries, J. H.; Legemate, D. A.; Hoekstra, J. B. L.

    2004-01-01

    Objective. To evaluate whether hyperglycaemia in the first 48 h after infrainguinal vascular surgery is a risk factor for postoperative infection, independent from factors associated with insulin resistance and surgical stress. Design. Retrospective cohort study. Patients and methods. Patients who

  5. Tourniquet-induced cardiovascular responses in anterior cruciate ligament reconstruction surgery under general anesthesia: Effect of preoperative oral amantadine

    Directory of Open Access Journals (Sweden)

    Ashraf Abd Elmawgood

    2015-01-01

    Conclusion: Preoperative oral amantadine reduced tourniquet induced hypertension and postoperative analgesic requirements in anterior cruciate ligament reconstruction surgery under general anesthesia.

  6. [Vascular Complications and Emergencies within Oncologic Abdominal Surgery - What Knowledge and Skills Are Essential for the Visceral Surgeon].

    Science.gov (United States)

    Matthaei, Hanno; Schmidt, Valeri; Branchi, Vittorio; Verrel, Frauke; Kalff, Jörg C; Koscielny, Arne

    2017-08-01

    Background Continuous improvements in perioperative and neoadjuvant therapy concepts nowadays permit more extensive tumor resections with curative intention. In patients with arterial or venous tumour involvement in preoperative imaging, physicians with expertise in vascular surgery should be involved in the planning phase of the operation. Unexpected vascular complications during abdominal surgery demand prompt management by the oncological surgeon. However, skills in vascular surgery are still not obligatory for the visceral surgeon in training. This topic is controversial and is therefore the focus of the present study. Patients and Methods From 2010 - 2015, a total of 126 patients underwent visceral operations involving vascular surgical interventions. Of these, 30 operations were performed as radical tumour resections. Retrospective data acquisition was performed with a minimum follow-up of 12 months. Aside from comprehensive characterisation of patients and their diseases, an outcome analysis was conducted. Furthermore, visceral surgery training programs in accordance with all 17 German federal medical associations were analysed and compared with respect to vascular surgery teaching. Results Vascular surgery was necessary in most patients, due to lesions of the mesentericoportal venous system (n = 11; 37%) and visceral arteries (n = 14; 47%). Techniques involved were mostly vascular sutures, reanastomosis or patch plastic surgery (n = 19; 63%) and venous thrombectomy/arterial embolectomy (n = 18; 60%). Hospital mortality was 3%. During follow-up, 33% of oncological patients died, whereas solely venous injury was an independent adverse prognostic variable (arterial vs. venous complications: HR 0.028; 95%-CI 0.002 - 0.442; p = 0.01). Skills in vascular surgery are optional for up to 12 months within visceral surgery training. Conclusions Intraoperative vascular complications in visceral surgical oncology are rare but pose severe

  7. Mechanical analysis of the vascularized fibular graft prosthetic composite (VFGPC) for internal hemipelvectomy reconstruction.

    Science.gov (United States)

    Morris, Jonathan; Yang, Rui; Roth, Michael; Gill, Jonathan; Gorlick, Richard; Lo, Yungtai; Hoang, Bang H; Garfein, Evan; Geller, David S

    2017-06-01

    The vascularized fibular graft prosthetic composite (VFGPC) is used for reconstruction after internal hemipelvectomy. The purpose of this study was to create a mathematical model that calculates the mechanical effects of the vascularized fibular graft on the VFGPC. The effects of the VFG positioning were calculated based on three-dimensional static analyzes to determine the direction, magnitude, and distribution of the forces through the prosthesis and VFG. The shear stress (SS) and cyclic loads to failure (CLF) were calculated. By varying the location of the VFG on the sacrum the zone of acceptable placement was calculated. Utilization of the VFG decreased the forces through the implant by 15-35% and decreased SS 20-54%, depending on stance. The CLF improved by 94%. The zone of acceptable placement for the VFG was found to be between 0° and 15° of the vertical axis in the sagittal plane and 0° and 30° of the posterior axis in coronal plane. Determining the position of the VFG pre-operatively allows for the creation of a customized cutting jig can be utilized to create graft allowing for accurate fibular osteotomies, minimization of ischemia time, and decreased intra-operative handling of the graft. © 2017 Wiley Periodicals, Inc.

  8. Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery.

    Science.gov (United States)

    Neves, José; Pereira, Hélder; Sousa Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José

    2015-11-01

    Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Reconstructive maxillofacial surgery in a resource poor setting ...

    African Journals Online (AJOL)

    Background: Facial reconstruction in a paediatric patient requires peculiar considerations. For optimal outcome, comprehensive pre-surgical evaluation, surgical expertise, appropriate tools and facilities, and serial outcome monitoring are essential. The aim of this study was to highlight some challenges militating against ...

  10. Exercise blood pressure response and perioperative complications after major vascular surgery.

    Science.gov (United States)

    de Liefde, Inge I; Welten, Gijs M J M; Verhagen, Hence J M; van Domburg, Ron T; Stolker, Robert Jan; Poldermans, Don

    2011-06-01

    Earlier studies have shown that hypertensive or hypotensive blood pressure (BP) response during a preoperative treadmill exercise test in patients with peripheral arterial disease is associated with a two-fold increased risk of cardiovascular events and mortality. However, it is unknown if these patients also experience an increased perioperative complication risk at major vascular surgery. In total 665 consecutive patients with peripheral arterial disease underwent elective major vascular surgery (carotid endarterectomy, abdominal aorta repair, or lower extremity revascularization). Perioperative complications (infection, myocardial infarction, angina pectoris, cardiac arrhythmia, heart failure, cerebrovascular accident or spinal cord ischemia, dialyses, amputation, thrombectomy, reoperation or death) were defined as occurring within 30 days after surgery and were collected using medical records. Hypertensive BP response was defined as a difference between exercise systolic BP and resting systolic BP of more than 55 mmHg. Hypotensive BP response was defined as a drop in exercise systolic BP below resting systolic BP. Patients with a hypertensive BP response during a preoperative exercise test (n = 66) showed a higher risk of early perioperative thrombectomy [hazard ratio (HR) 2.80 95% CI (1.24-6.33)] compared with patients with a normal BP response (n = 582). Patients with a hypotensive BP response (n = 18) showed an increased risk of perioperative myocardial infarction [HR 3.69 95% CI (1.08-12.64)] and cardiac complications [HR 2.90 95% CI (1.02-8.19)] compared with patients with a normal BP response. Patients with an abnormal BP response have more cardiovascular complications at elective major vascular surgery.

  11. VASCULAR SURGERY

    African Journals Online (AJOL)

    2016-06-02

    Jun 2, 2016 ... Aortic arch injuries. (2) were repaired operatively with cardiopulmonary bypass, descending aortic injuries (2) were treated by stent graft, and common carotid (1) and subclavian artery injuries (2) were treated by open repair at the quaternary centre. Of the 20 venous injuries that were managed operatively,.

  12. Feasibility of the Use of RapiGraft and Skin Grafting in Reconstructive Surgery

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2016-09-01

    Full Text Available BackgroundSkin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute.MethodsThis prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A, and RapiGraft and split-thickness skin grafting were used on the other side (group B. All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS, a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months.ResultsThe skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082. Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all. However, the groups did not differ significantly in pliability (P=0.155.ConclusionsThe present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

  13. OSSEOINTEGRATION IN RECONSTRUCTIVE SURGERY: CONTEMPORARY STATE AND PERSPECTIVES OF FURHTHER DEVELOPMENT (REVIEW

    Directory of Open Access Journals (Sweden)

    M. A. Shevtsov

    2012-01-01

    Full Text Available Method of intraosseous prosthesis based on the principle of osseointegration that was introduced by Prof. Per-Ingvar Branemark is one of the most perspective approaches in contemporary reconstructive surgery This method helps to achieve increased functional activity and to improve patients quality of life in comparison to conventional treatment. In presented article the results of prosthetic treatment of amputees of different localizations, application of this technology in cranio-fascial surgery, finger joint prostheses are discussed.

  14. [Reconstruction in plastic surgery using osmotic tissue expanders].

    Science.gov (United States)

    Gronovich, Yoav; Binenboym, Rami; Retchkiman, Meir; Eizenman, Nirit; Lotan, Adi; Stuchiner, Barak; Tuchman, Izhak

    2015-03-01

    Tissue expander is a major reconstructive modality. Its main disadvantages include: long and inconvenient period of inflation with temporary deformity of the surrounding tissue. Osmotic expander was developed in order to eliminate some of these limitations. It is a self-filling device which absorbs fluids in order to achieve tissue expansion faster. We present our experience with 28 consecutive cases of tissue reconstruction using osmotic expanders. We wish to emphasize the main advantages and limitations of this device. The present study was launched in May 2008, until April 2014, for twenty eight patients, median age 26 years with reconstructions using an osmotic expander (total of 35 expanders). The reasons for using tissue expander included large congenital nevi (75%) and scars. In all of the cases, the operative and post-operative management was uneventful. During the expansion period, there were 2 outpatient clinical visits. The average expansion time was 9 weeks. In 11% (three patients) there was partial extrusion of the expander. In all other cases there were no complications and the final aesthetic results were satisfying. Osmotic expander is an advanced modality for tissue reconstruction. The final shape and size are precisely predictable. Its initial small size allows for a small surgical incision and short overall operating time. The expansion period is shorter and more convenient for the patient. Its main disadvantage includes the inability to control the filling rate and the need to remove the expander in case of damage to the overlying tissue. Osmotic expander is a reliable tool for tissue expansion. It allows for a satisfying aesthetic result in a shorter period of time and with less inconvenience to the patient.

  15. Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program.

    Science.gov (United States)

    Causey, Marlin W; Ahmed, Ayman; Wu, Bian; Gasper, Warren J; Reyzelman, Alex; Vartanian, Shant M; Hiramoto, Jade S; Conte, Michael S

    2016-06-01

    Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization. This study was designed to prospectively assess limb and patient-based staging for predicting outcomes of hospitalized patients in an amputation prevention program. This study undertook a retrospective analysis of prospectively gathered registry data of consecutive patients with limb-threatening conditions admitted to a fully integrated vascular/podiatry service over a 16-month period. Upon admission, limb risk was stratified using the WIfI system and patient risk was categorized using PIII classification. Patients were assessed for perioperative and postdischarge outcomes, and their relationship to staging at admission was analyzed. There were 174 threatened limbs (143 hospitalized patients) stratified by WIfI stage (1%-12%, 2%-28%, 3%-24%, 4%-28%, 5%-3%, unstaged-5%) and PIII risk (34% low, 49% moderate, and 17% high risk). Diabetes and end-stage renal disease were associated with WIfI stage (P = .006 and P = .018) and PIII risk (P = .003 and P amputation. There were 119 limbs (71%) that underwent revascularization, including 108 infrainguinal reconstructions (endovascular or open revascularization). Rate of revascularization increased with WIfI stage (P procedures, minor amputations, and initial hospital duration of stay (all P procedures, there was a similar distribution of endovascular (46%) and surgical (54%) interventions. Freedom from major adverse limb events was best for

  16. The Value of Postconditioning in Plastic and Reconstructive Surgery: A Systematic Review.

    Science.gov (United States)

    Weng, Weidong; Zhang, Feng; Lineaweaver, William C; Gao, Weiyang; Yan, Hede

    2016-05-01

    Background Ischemia-reperfusion (I/R) injury by abrupt restoration of circulation after prolonged ischemia has still been an unsolved problem in plastic and reconstructive surgery. The concept of postconditioning (post-con), which has been well described in cardiovascular surgery, has been recently introduced in plastic and reconstructive surgery. As an "after-injury strategy," post-con may be a promising approach to reduce I/R injury and improve flap survival after ischemia. Methods A systematic review was performed by searching electronic databases of PubMed and web of science to identify all the studies regarding the application of the post-con technique in plastic and reconstructive surgery between 1950 and 2015. Inclusion criteria were English articles with clear reporting the post-con techniques and detailed outcomes. Results In total, 476 articles were identified and 18 studies reporting post-con in plastic and reconstructive surgery met the inclusion criteria in this review, including 11 studies of mechanical post-con, 3 studies of pharmacological post-con, 1 study of both mechanical and pharmacological post-con, and 3 studies of remote post-con. All these studies reported protective effects of any kind of post-con techniques in I/R injuries and could improve flap survivals. Conclusion In general, the strategy of post-con may effectively reduce I/R injury and improve the survival of flaps after ischemia in animal studies, yet no consensus regarding the exact technical details (intervention timing, cycles, intermittent duration, etc.) has been reached. Further studies aiming to explore its mechanisms as well as specific methodology are required before clinical application in plastic and reconstructive surgery. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery.

    Science.gov (United States)

    Kheterpal, Sachin; O'Reilly, Michael; Englesbe, Michael J; Rosenberg, Andrew L; Shanks, Amy M; Zhang, Lingling; Rothman, Edward D; Campbell, Darrell A; Tremper, Kevin K

    2009-01-01

    The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days. Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure 100 (22% vs. 34%, P = 0.05). In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.

  18. Uncooled infrared camera for the noninvasive visualization of the vascular flow in an anastomotic vessel during neurological surgery: technical note.

    Science.gov (United States)

    Otani, Naoki; Ishihara, Miya; Nakai, Kanji; Fujita, Masanori; Wada, Kojiro; Mori, Kentaro

    2014-06-17

    We herein present our experience to assess intraoperative confirmation of vascular patency with an uncooled infrared camera in extracranial-intracranial (EC-IC) bypass surgery. This camera had distinguishing characteristics, including its small size, light weight, and adequate temperature resolution (camera to assess the vascular flow of the end-to-side anastomosis model in rats. In addition, we evaluated the vascular flow in continuous clinical series using this infrared camera during EC-IC bypass in 14 patients (17 sides). This infrared camera offers real-time information on the vascular patency of end-to-side anastomosis vessels of all relevant diameters. The spatial resolution and image quality are satisfactory, and the procedure can be safely repeatable. We have shown that the infrared camera could be a new and feasible technology for intraoperative imaging of the vascular flow and is considered to be clinically useful during cerebrovascular surgery.

  19. Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery.

    Science.gov (United States)

    Sathyanarayana, Lakshmi Adalagere; Heggeri, Vijayakumar M; Simha, Parimala Prasanna; Narasimaiah, Satish; Narasimaiah, Manjunath; Subbarao, Bharathi Katheraguppa

    2016-01-01

    Levobupivacaine is the s-isomer of racemic Bupivacaine. It is less cardio, neurotoxic and equally potent local anaesthetic compared to its racemate. It is known to cause less Depression of myocardial contractility. Dexmeditomidine when used via epidural route has synergistic effect with local anaesthetics. Majority of patients presenting for vascular surgery are elderly and have associated co-morbidities like diabetes, hypertension, and coronary artery disease. We intend to study safety and efficacy of epidural Levoupivacaine and Dexmedetomidine in this group of patients. Sixty adult patients undergoing lower limb vascular surgery under lumbar epidural anaesthesia were randomly allocated to three groups. All groups were preloaded with 10ml/kg of crystalloid solution. B group was scheduled to receive 15 ml of racemic Bupivacaine, L-group was scheduled to receive 15ml of Levobupivacaine and LD-group received 15ml of Levobupivacaine with 0.5 mics/kg Dexmeditomedine. Time to onset of sensory block to T-10, maximum sensory level achieved, Bromage scale, time to two segment regression, time to total regression, sedation level achieved and patients assessment of quality of anaesthesia were assessed. Haemodynamic parameters were monitored throughout study period. Adverse effects were noted and treated appropriately. Baseline parameters were comparable among all the groups. Time to onset of sensory block to T-10 and maximum level of block achieved, was comparable among the groups. Time to two segment regression and time to total regression was significantly prolonged in LD group compared to other two groups. There was significant bradycardia noted in LD group which required treatment. Levobupivacaine can be safely used in elderly high risk patients undergoing vascular surgery. Addition of dexmedetomidine prolongs the duration of anaesthesia and postoperative analgesia.

  20. Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery.

    Science.gov (United States)

    Parnell, Brent A; Matthews, Catherine A

    2011-09-01

    Robotic-assisted surgery for the treatment of pelvic organ prolapse continues to grow in popularity as more surgeons adopt this technology. Encompassing all of the benefits of laparoscopic surgery, robotic-assisted techniques allow more surgeons the ability to perform complex tasks such as meticulous deep pelvic dissection and extensive suturing without having to resort to laparotomy. This chapter reviews the techniques involved in the robotic approach to pelvic reconstructive surgery and discusses the currently available information focusing on the outcomes of this procedure.

  1. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery.

    Science.gov (United States)

    Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam

    2015-09-01

    Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR 90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  2. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle.

    Science.gov (United States)

    Blondeel, Phillip N; Hijjawi, John; Depypere, Herman; Roche, Nathalie; Van Landuyt, Koenraad

    2009-02-01

    Creating or recreating an aesthetically pleasing breast shape in reconstructive and aesthetic breast surgery is an act that most experienced "breast" surgeons will find self-evident. We propose a simple three-step philosophical and hands-on approach that will make it easier for young and unexperienced plastic surgeons to not only analyze the problematic breast but also come up with an easy surgical strategy to create reproducible results.This is Part I of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the three main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. Part II deals with reconstructions after complete mastectomy and Part III covers reconstruction after breast conservation surgery. Finally, Part IV applies the same principles in the field of aesthetic breast surgery. Throughout these four parts, the three-step principle will be the red line to fall back on to define the problem and to propose a solution.

  3. Guideline proposal to reconstructive surgery for complex perineal sinus or rectal fistula.

    NARCIS (Netherlands)

    Oomen, J.W.; Spauwen, P.H.M.; Bleichrodt, R.P.; Goor, H. van

    2007-01-01

    AIM: To evaluate a guideline approach of reconstructive surgery for complex perineal sinus or rectal fistula. METHODS: pre-, per-, and postoperative data of 28 patients undergoing transposition of rectus abdominis muscle (TRAM), gracilis muscle (GM), gluteal thigh flap (GTF), or omentoplasty (OP)

  4. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    NARCIS (Netherlands)

    Lodders, J.N.; Parmar, S.; Stienen, N.L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

    2015-01-01

    BACKGROUND: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. MATERIAL AND METHODS: Desired data was retrieved

  5. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    NARCIS (Netherlands)

    Lodders, J.N.; Parmar, S.; Stienen, N.-L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

    2015-01-01

    Background: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods: Desired data was retrieved

  6. Three-Dimensional Printing: Custom-Made Implants for Craniomaxillofacial Reconstructive Surgery.

    Science.gov (United States)

    Matias, Mariana; Zenha, Horácio; Costa, Horácio

    2017-06-01

    Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. Craniomaxillofacial reconstructive surgery was one of the first areas to implement 3D printing technology in their practice. Biomodeling has been used in craniofacial reconstruction of traumatic injuries, congenital disorders, tumor removal, iatrogenic injuries (e.g., decompressive craniectomies), orthognathic surgery, and implantology. 3D printing has proven to improve and enable an optimization of preoperative planning, develop intraoperative guidance tools, reduce operative time, and significantly improve the biofunctional and the aesthetic outcome. This technology has also shown great potential in enriching the teaching of medical students and surgical residents. The aim of this review is to present the current status of 3D printing technology and its practical and innovative applications, specifically in craniomaxillofacial reconstructive surgery, illustrated with two clinical cases where the 3D printing technology was successfully used.

  7. Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

    NARCIS (Netherlands)

    Hofbauer, Marcus; Muller, Bart; Murawski, Christopher D.; Baraga, Michael; van Eck, Carola Franziska; Fu, Freddie H.

    2013-01-01

    The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. Based on the current literature of

  8. Microsurgical reconstruction of the head and neck region: Current concepts of maxillofacial surgery units worldwide.

    Science.gov (United States)

    Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Haers, Piet; Ghali, G E; Hoffmann, Jürgen

    2015-10-01

    Microvascular surgery following tumor resection has become an important field of oral maxillofacial surgery (OMFS). Following the surveys on current reconstructive practice in German-speaking countries and Europe, this paper presents the third phase of the project when the survey was conducted globally. The DOESAK questionnaire has been developed via a multicenter approach with maxillofacial surgeons from 19 different hospitals in Germany, Austria and Switzerland. It was distributed in three different phases to a growing number of maxillofacial units in German-speaking clinics, over Europe and then worldwide. Thirty-eight units from Germany, Austria and Switzerland, 65 remaining European OMFS-departments and 226 units worldwide responded to the survey. There is wide agreement on the most commonly used flaps, intraoperative rapid sections and a trend towards primary bony reconstruction. No uniform concepts can be identified concerning osteosynthesis of bone transplants, microsurgical techniques, administration of supportive medication and postoperative monitoring protocols. Microsurgical reconstruction is the gold standard for the majority of oncologic cases in Europe, but worldwide, only every second unit has access to this technique. The DOESAK questionnaire has proven to be a valid and well accepted tool for gathering information about current practice in reconstructive OMFS surgery. The questionnaire has been able to demonstrate similarities, differences and global inequalities. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Vacuum-assisted wound closure in vascular surgery - clinical and cost benefits in a developing country

    Directory of Open Access Journals (Sweden)

    Končar Igor

    2016-01-01

    Full Text Available Background/Aim. Surgical and chronic wounds in vascular patients might contribute to limb loss and death. Vacuum-assisted closure (VAC - Kinetic Concepts, Inc. (KCI, has been increasingly used in Western Europe and the USA clinical practice for 15 years. Advantages of this method are faster wound healing, wound approximation, lower wound related treatment costs and improved quality of life during treatment. Evidence related to the usage of VAC therapy in vascular patients and cost effectiveness of VAC therapy in a developing country are lacking. The aim of this study was to explore results of VAC therapy in vascular surgery comparing to conventional methods and to test cost effects in a developing country like Serbia. Methods. All patients with wound infection or dehiscence operated at the tertiary vascular university clinic in the period from January 2011 - January 2012, were treated with VAC therapy. The primary endpoint was wound closure, while secondary endpoints were hospital stay, the number of weekly dressings, costs of wound care, working time of medical personnel. The patients were divided into groups according to the wound type and location: wound with exposed synthetic vascular implant (25%, laparotomy (13%, foot amputation (29%, major limb amputation (21%, fasciotomy (13%. The results of primary and secondary endpoint were compared with the results of conventional treatment during the previous year. Results. There was one death (1/42, 2.38% and one limb loss (1/12, 2.38% in the VAC group, and 8 deaths (8/38, 21.05% and 5 (5/38, 13.15% limb losses in the patients treated with conventional therapy. In the VAC group there was one groin bleeding (1/12, 2.38%, one groin reinfection (1/12, 2.38% and one resistance to therapy with a consequent limb loss. Costs of hospital stay (p < 0.001 and nursing time (p < 0.001 were reduced with VAC therapy in the group with exposed graft. Conclusion. VAC therapy is the effective method for care of

  10. Self-citation rate and impact factor in the field of plastic and reconstructive surgery.

    Science.gov (United States)

    Miyamoto, Shimpei

    2018-02-01

    Journal ranking based on the impact factor (IF) can be distorted by self-citation. The aim of this study is to investigate the present status of self-citation in the plastic surgery journals and its effect on the journals' IFs. IF, IF without self-citations (corrected IF), self-cited rate, and self-citing rate for 11 plastic surgery journals were investigated from 2009-2015, by reviewing the Journal Citation Report ® . The correlations of the IF with the self-cited rate and the self-citing rate were statistically assessed. In addition, Plastic and Reconstructive Surgery was compared with 15 top journals from other surgical specialties in 2015. IF was significantly correlated with the self-cited rate (R: 0.594, p = 0.001) and the self-citing rate (R: 0.824, p < 0.001). The self-cited rate of Plastic and Reconstructive Surgery in 2015 was higher than that of top journals from other surgical specialties. The IFs of Microsurgery and Journal of Cranio-Maxillo-Facial Surgery increased greatly in recent years, but they were inflated by high self-cited and self-citing rates. The self-citation rate positively affects the IF in plastic surgery journals. A high concentration of self-citation of some journals could distort the ranking among plastic surgery journals in general.

  11. Microsurgical reconstruction of the head and neck--current concepts of maxillofacial surgery in Europe.

    Science.gov (United States)

    Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Kopp, Jean-Baptiste; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Hoffmann, Jürgen

    2014-12-01

    Microvascular surgery following tumour resection has become an important field of oral maxillofacial surgery (OMFS). This paper aims to evaluate current microsurgical practice in Europe. The questionnaire of the DOESAK collaborative group for Microsurgical Reconstruction was translated into English, transformed into an online based survey and distributed to 200 OMFS units with the aid of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS). 65 complete and 72 incomplete questionnaires were returned. Hospitals from the United Kingdom, France, Italy, the Netherlands, Spain, Belgium, Greece, Slovenia and Lithuania participated. 71% of contributing centres were university hospitals, 87% out of these perform microvascular tumour surgery at least on a two-weekly base. Overall complication rate was at around five percent. Most frequently used transplants were the radial forearm flap and the fibular flap. The perioperative management varied widely. Success factors for flap survival, however, were uniformly rated, with the surgical skill being the most important factor, followed by the quality of postoperative management. Medication seems to play a less important role. Within Europe microvascular surgery is a common and safe procedure for maxillofacial reconstructive surgery in the field of OMFS. While there is a major accordance for the surgical procedure itself and the most frequently used flaps, perioperative management shows a wide variety of protocols with low presumed impact on surgical outcome. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  12. Vascular map combined with CT colonography for evaluating candidates for laparoscopic colorectal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Flor, Nicola; Ceretti, Andrea Pisani; Maroni, Nirvana; Opocher, Enrico; Cornalba, Gianpaolo [Azienda Ospedaliera San Paolo, Milan (Italy); Campari, Alessandro; Ravelli, Anna; Lombardi, Maria Antonietta [University degli Studi di Milano, Milan (Italy)

    2015-08-15

    Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.

  13. Surgical navigation in adult reconstruction surgery: techniques and clinical experience.

    Science.gov (United States)

    Rauh, Michael A; Munjal, Sandeep; Phillips, Matthew J; Krackow, Kenneth A

    2008-01-01

    A surgeon's first response to the concept of computer-assisted orthopaedic surgery may be a sense of lost autonomy. However, a system need not and should not be designed to this end. Using the computational ability of the computer system to see beyond the human eye to view the knee with full kinematic dimensions, surgeons have recently made progress in the areas of computer-assisted ligament balancing and in using smart tools for minimally invasive surgery. Full comprehension of the use of any navigational system must begin with the understanding that the system can provide feedback that is based on only specifically programmed computer code. In referring to or locating a point or axis, the computer programmer must create an absolutely reliable methodology for determining that point or axis. Expecting the computer to achieve certain functionalities when physicians have no ironclad method to achieve such functionalities exposes the true limitations of any computer-assisted process. Although the computer generates a methodology, the process of computer-assisted surgery requires that the surgeon be constantly vigilant in analyzing the feasibility of these responses. Those instrumental in the development and implementation of computer-assisted surgical techniques must ensure that measurements are valid, precise, and reproducible across subjects and users. Prospective users of computer-assisted techniques must ensure that each of these issues has been addressed before agreeing to use the system in standard practice. Once due consideration has been given to all aspects of use, and the limitations of the system are known, the benefits of computer assistance are easily understood.

  14. Acinic Cell Carcinoma of Minor Salivary Gland of the Base of Tongue That Required Reconstructive Surgery

    Directory of Open Access Journals (Sweden)

    Kota Wada

    2012-01-01

    Full Text Available Acinic cell carcinoma of minor salivary gland of the base of tongue is very rare. Squamous cell carcinoma is the most common tumor in the base of tongue. We present a patient with gigantic acinic cell carcinoma of the base of tongue. This patient required emergency tracheotomy before surgery, because he had dyspnea when he came to our hospital. We removed this tumor by pull-through method and performed reconstructive surgery using a rectus abdominis myocutaneous flap. It was a case that to preserved movement of the tongue and swallowing function by keeping lingual arteries and hypoglossal nerves. This case was an extremely rare case of ACC of the base of tongue that required reconstructive surgery.

  15. Application of Porter’s Five Forces Model and generic strategies for vascular surgery: should be stuck in the middle?

    Science.gov (United States)

    Sumpio, Bauer E

    2013-06-01

    There are many stakeholders in the vascular marketplace from clinicians to hospitals, third party payers, medical device manufacturers and the government. Economic stress, threats of policy reform and changing health-care delivery are adding to the challenges faced by vascular surgeons. Use of Porter's Five Forces analysis to identify the sources of competition, the strength and likelihood of that competition existing, and barriers to competition that affect vascular surgery will help our specialty understand both the strength of our current competition and the strength of a position that our specialty will need to move to. By understanding the nature of the Porter's Five Forces as it applies to vascular surgery, and by appreciating their relative importance, our society would be in a stronger position to defend itself against threats and perhaps influence the forces with a long-term strategy. Porter's generic strategies attempt to create effective links for business with customers and suppliers and create barriers to new entrants and substitute products. It brings an initial perspective that is convenient to adapt to vascular surgery in order to reveal opportunities.Vascular surgery is uniquely situated to pursue both a differentiation and high value leadership strategy.

  16. [Obstetric damage to the perineum and the anal sphincters. Reconstruction surgery].

    Science.gov (United States)

    Kościński, Tomasz

    2014-08-01

    Damage to the perineum, vulva, anal sphincters, rectal wall and the fascial structures of the pelvic floor may be caused by obstetric trauma. Emergency surgical treatment aims at control of the bleeding, anatomical reconstruction of the disrupted tissues and minimization of the risk of infection. Suturing of the rectal wall and mucosa of the anal canal is followed by reconstruction of the perineal body internal and external anal sphincters, vulva and the perineum. Delayed surgery is undertaken after the complete healing of the obstetric tear. All cicatricial fibers must be saved to reinforce sphincters and perineal body muscles suturing. Anal levators and perineal transvers muscles suturing is used for the rectovaginal septum and pelvic floor reconstruction. Anal sphincters are reconstructed by the 'overlapping' technique. X en Z suturing is used for a perineal skin plasty.

  17. One-stage treatment and reconstruction of Gustilo Type III open tibial shaft fractures with a vascularized fibular osteoseptocutaneous flap graft.

    Science.gov (United States)

    Zhen, Ping; Hu, Yun-Yu; Luo, Zhuo-Jing; Liu, Xing-Yan; Lu, Hao; Li, Xu-Sheng

    2010-12-01

    This study evaluated the usefulness of a single-stage, free-fibular vascularized osteoseptocutaneous flap transfer for Type III open tibial shaft fractures with segmental bone loss for the reconstruction of combined bone and soft tissue defects. Nonrandomized retrospective study. University Level I trauma center. All Gustilo Type III open tibial shaft fractures with segmental bone loss that were treated at one institution between 2000 and 2007 were identified from a trauma registry. The study group consisted of 28 patients with Type III open tibial fractures: 27 were Gustilo-Anderson Type IIIB and one was Grade IIIC. The cause of tibial injury included eight industrial accidents, seven motor vehicle accidents, five crushing injuries caused by heavy objects, five falls from a height, and three motorcycle crashes. The lengths of the preoperative segmental tibial bone loss ranged from 9 to 17 cm and the size of the associated soft tissue defects ranged from 8 × 6 cm to 15 × 7 cm. The free fibular vascularized osteoseptocutaneous flap was used to graft and reconstruct combined bone and soft tissue defects. The radical wound débridement, soft tissue and bone revision, fracture stabilization, and early soft tissue coverage were achieved by this technique in a one-stage procedure. The average duration from injury to one-stage reconstruction was 15.8 hours (range, 5.3 hours to 6.5 days). Radiographic and functional evaluation of the lower extremity. All free fibular osteoseptocutaneous flaps survived completely. The average time to overall union for the entire group was 32 weeks after surgery (range, 26-41 weeks). None of the patients in this series had a nonunion. Acceptable radiographic alignment, defined as 5° of angulation in any plane, was obtained in 22 patients (78.6%). Malunion affected six (21.4%) fractures. According to the lower extremity functional assessment, excellent and good results were achieved for 82.1% (23 of 28), fair results were seen in 14

  18. Kinetics of plasma SPB and RAGE during mechanical ventilation in patients undergoing major vascular surgery.

    Science.gov (United States)

    Agostoni, Piergiuseppe; Banfi, Cristina; Magrì, Damiano; Vignati, Carlo; Doria, Elisabetta; Salvioni, Elisabetta; Moliterni, Paola; Marenzi, Giancarlo; Tremoli, Elena; Sisillo, Erminio

    2011-09-15

    Receptor-of-Advanced-Glycation-End-products (RAGE) and Surfactant-Protein-type-B (SPB) are reported as lung injury markers. Unlike SPB, RAGE is secreted by several tissues, so that RAGE specificity as lung injury marker is questionable. We measured SPB and RAGE in 19 patients undergoing major vascular abdominal surgery. SPB and RAGE were measured before mechanical ventilation (T0), at 1st (T1), 2nd (T2) and, when present, 3rd (T3) hour of mechanical ventilation, and 1h after extubation (T(POST)). Last data during mechanical ventilation, either T2 or T3, are reported as T(END). SPB and RAGE values were normalized for total protein (SPB(N) and RAGE(N)). SPB(N) and RAGE(N) increments from T0 to T(END) were 56.2 [39.1] ng/mg (mean [75-25 percentile]) and 10.6[7.1] pg/mg, respectively. SPB values increased progressively during mechanical ventilation, whereas RAGE values increased at T(1) but not thereafter. SPB(N) increase (T(END)-T0), but not RAGE(N), was related to ΔPaO(2)/FiO2 changes during mechanical ventilation (r=0.575, p=0.01). Plasma RAGE(N) and SPB(N) kinetics in patients undergoing major vascular surgery are different. Copyright © 2011 Elsevier B.V. All rights reserved.

  19. 41. The myocardial protective effect of dexmedetomidine in high risk patients undergoing aortic vascular surgery

    Directory of Open Access Journals (Sweden)

    R. Soliman

    2016-07-01

    Full Text Available Dexmedetomidine provides perioperative cardiac protection in high risk patients assessment the effect of dexmedetomidine in high risk patients undergoing aortic vascular surgery. Arandomized study included 150 patients classified into two groups(n = 75. Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/hr to the end of the procedure. Group C: The patients received an equal volume of normalsaline. The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (p < 0.05. Also, it decreased the incidence of myocardial is chemia reflected by troponin I level and ECG changes(p < 0.05. Dexmedetomidine decreased the requirement for nitroglycerine and norepinephrine compared to control group (p < 0.05. The incidence of hypotension and bradycardia were significantly higher with dexmedetomidine (p < 0.05.The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provide scardiac protection in high risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia.

  20. New trends in breast reconstructive surgery: "Florentine Lily" reductive mastoplasty.

    Science.gov (United States)

    Rogliani, M; Gentile, P; Trimarco, A; Labardi, L; Brinci, L; Palla, L; Cervelli, V

    2010-06-01

    To describe a mammoplasty technique that we called "Florentine Lily" because of the shape of the pre-operative drawings similarity with the symbol lily Florentine. In a group of 190 women who underwent reductive mammoplasty, 23 women affected by severe enlarged breasts were selected. Main selection requirements were: 18-30 cm rising of the Areola-Nipple Complex (NAC). to obtain a functional and cosmetic result; preservation of mammary gland function; vitality of the areola-nipple complex and its sensitivity. We describe the case of 35 years old woman affected by severe enlargement of the breast and no pathologies. We didn't observe necrosis of the skin flaps and NAC in any case. In one case (rising of Nipple-Areola Complex >25 cm) NAC showed NAC 2 days post-surgery, which spontaneously resolved. Minor complications (edema and ematoma) developed in 20 cases. No infections were observed.

  1. Improving the productivity and efficiency of vascular surgery and radiology multidisciplinary meetings.

    Science.gov (United States)

    Dobson, Gary; Neeson, Declan

    2015-01-01

    Multidisciplinary team meetings are recognized as an important factor in driving quality of care. The Vascular Society of Great Britain and Northern Ireland recommend that all aspects of vascular surgery are suitable for discussion at multidisciplinary team (MDT) meetings, including carotid, peripheral, and aortic disease. The juniors doctors were tasked with preparing the patient list in our unit. This had become time consuming and somewhat unrewarding. The methods of preparation and information required on the patient list were reviewed. It was felt that typing a clinical summary for each patient on the list was the most time consuming factor. This was removed and patients were instead simply categorized into subgroups such as aneurysms, critical limb ischemia, and others. The information removed was substituted with the use on an electronic care record during the meeting to answer questions regarding comorbidities and previous interventions. Time spent preparing the meeting by the junior doctors was recorded before and after cycles of intervention. Prior to intervention this was found be a mean of 140 minutes (2.3 hours), and improved to a mean of 45 minutes (0.45 hours) with consequent cycles. The overall proportion of patients receiving definitive outcomes in each meeting after changes were implemented increased from 35 to 55%. This was not a primary outcome, but an unintended consequence of careful consideration of each cycle. In conclusion, the changes implemented have allowed junior doctors to spend more of their time with other activities such as the outpatient department (OPD) and theatre during their vascular surgery rotation. The proportion of cases discussed has increased due to more focused discussions during the MDT meeting, resulting in improved patient care. All stakeholders gave a largely positive reaction to the changes implemented.

  2. Reliability of the Center of Pressure Parameters after ACL Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Hoda Niknam

    2013-04-01

    Full Text Available Background: The elicited parameters from the center of pressure (COP of patients after surgery of the anterior cruciate ligament are proper indications for estimating balance after surgery and rehabilitation. Thus, making sure about repeatability of COP parameters which can determine the knee joint after the knee reconstruction surgery is very important. This study measures repeatability rate of some COP parameters after reconstructing anterior cruciate ligament in various positions.Materials and Methods: In this study, 15 athlete men (mean age: 27±5 after 4-6 months since repair of their anterior cruciate ligament were included; they have been selected through simple non-probability sampling method. The study was conducted in biomechanics lab of Tarbiat Modares University in 2010. Assessment of balance was done with open/closed eyes, with/without foam using force platform in two sessions with 48 hours interval. Results: The external-internal amplitude (0.86, external-internal standard deviation (0.86, phase plane (0.82 and area oscillation (0.81 were among parameters which showed the most repeatability. The average oscillation of anterior - posterior frequency (0.6 showed the lowest repeatability.Conclusion: A number of parameters caused by oscillation of COP show high rate of repeatability after reconstructing anterior cruciate ligament which can be used as an assessment of patients condition after reconstruction of the anterior cruciate ligament.

  3. [Reconstruction assisted by 3D printing in maxillofacial surgery].

    Science.gov (United States)

    Ernoult, C; Bouletreau, P; Meyer, C; Aubry, S; Breton, P; Bachelet, J-T

    2015-04-01

    3-dimensional models (3D) appeared in the medical field 20 years ago. The recent development of consumer 3D printers explains the renewed interest in this technology. We describe the technical and practical modalities of this surgical tool, illustrated by concrete examples. The OsiriX(®) software (version 5.8.5, Geneva, Switzerland) was used for 3D surface reconstruction of the area of interest, the generation and export of ".stl" file. The NetFabb(®) software (Basic version 5.1.1, Lupburg, Germany) provided the preparation of ".stl" file. The 3D-printer was an Up plus 2 Easy 120(®) (PP3DP, Beijing Technology Co. TierTime Ltd., Chine). The printer used fused deposition modeling. The softwar Up!(®) allowed the 3d impression as required. The first case illustrated the value of 3D printing in the upper (frontal sinus and orbital roof). The second case concerned the preconfiguration of the osteosynthesis material for a complex fracture of the midface through the "mirroring" system. The third case showed the conformation of a prereconstruction for segmental mandibulectomy. Current 3D-printers are easy to use and represent a promising solution for medical prototyping. The 3D printing will quickly become undeniable because of its advantages: information sharing, simulation, surgical guides, pedagogy. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. DYNAMICS OF COGNITIVE FUNCTION OF PATIENTS WITH DEFECTS OF THE SKULL AFTER RECONSTRUCTIVE SURGERY

    Directory of Open Access Journals (Sweden)

    E. V. Sinbukhova

    2017-01-01

    Full Text Available Due to  the  high social significance of traumatic  brain injury and its consequences,  dynamics of cognitive functions  at  the  background  of the reduction of reconstructive and plastic surgery is of interest to researchers in the world, but this topic is not sufficiently studied. A large number of patients with bone defects of the skull due to a traumatic  brain injury and skull defects after surgery for tumors, and as a consequence of possible cognitive deficits of these patients  makes it necessary to study and assess the possibility of its compensation  as a result of reconstructive  plastic surgery of the skull. Material and methods. In our study, we examined 54 patients  (12 women and 42 men in surgical treatment neurotrauma department (reconstructive  surgery after traumatic  brain injury or skull defect after surgical removal of tumors. The average age of patients  is33,09 years. All patients  were examined by a psychologist before surgery, and on the first, third, and seventh-eighth day after the surgery. MoCA, FAB, Schulte tables, HADS, Spielberger-Hanin anxiety test, a set of stimulus materials for neuropsychological diagnosis, all patients were asked to subjectively evaluate their appearance:  until defect acquisition prior to surgery after treatment (see questionnaire  by Sinbukhova E.[8], also was used projective drawing method, where patients were asked to perform a series of drawings on the given topics. In our study to reduce the high level of situational and personal anxiety of the patients they had Art-therapy sessions with a psychologist before surgery and from the second day after it. The purpose of research is to study the changes in cognitive function, level of depression, anxiety of patients  with postoperative bone defects of the skull after a reconstructive-plastic surgery. Keywords cognitive function, depression, anxiety, reconstructive  surgery. Results On the 3 days after surgery, a

  5. Operative variables are better predictors of postdischarge infections and unplanned readmissions in vascular surgery patients than patient characteristics.

    Science.gov (United States)

    Hicks, Caitlin W; Bronsert, Michael; Hammermeister, Karl E; Henderson, William G; Gibula, Douglas R; Black, James H; Glebova, Natalia O

    2017-04-01

    Although postoperative readmissions are frequent in vascular surgery patients, the reasons for these readmissions are not well characterized, and effective approaches to their reduction are unknown. Our aim was to analyze the reasons for vascular surgery readmissions and to report potential areas for focused efforts aimed at readmission reduction. The 2012 to 2013 American College of Surgeons National Quality Improvement Program (ACS NSQIP) data set was queried for vascular surgery patients. Multivariable models were developed to analyze risk factors for postdischarge infections, the major drivers of unplanned 30-day readmissions. We identified 86,403 vascular surgery patients for analysis. Thirty-day readmission occurred in 8827 (10%), of which 8054 (91%) were unplanned. Of the unplanned readmissions, 61% (n = 4951) were related to the index vascular surgery procedure. Infectious complications were the most common reason for a surgery-related readmission (1940 [39%]), with surgical site infection being the most common type of infection related to unplanned readmission. Multivariable analysis showed the top five preoperative risk factors for postdischarge infections were the presence of a preoperative open wound, inpatient operation, obesity, work relative value unit, and insulin-dependent diabetes (but not diabetes managed with oral medications). Cigarette smoking was a weak predictor and came in tenth in the mode (overall C index, 0.657). When operative and postoperative factors were included in the model, total operative time was the strongest predictor of postdischarge infectious complications (odds ratio [OR] 1.2 for each 1-hour increase in operative time), followed by presence of a preoperative open wound (OR, 1.5), inpatient operation (OR, 2), obesity (OR, 1.8), and discharge to rehabilitation facility (OR, 1.7; P complications dominate the reasons for unplanned 30-day readmissions in vascular surgery patients. We have identified preoperative, operative

  6. The place of reconstructive tubal surgery in the era of assisted reproductive techniques.

    Science.gov (United States)

    Gomel, Victor

    2015-12-01

    Assisted reproductive techniques yield high rates of success for women with tubal factor infertility. Because they are potentially effective for all categories of infertility, for two decades, clinical and basic research in infertility has been focused on IVF techniques and outcomes, rather than developing surgical techniques or training infertility subspecialists in tubal microsurgery. Nonetheless, in comparison with IVF, reconstructive tubal surgery is inexpensive and offers multiple opportunities to attempt conception. Performing laparoscopic salpingostomy prior to IVF in women with good prognosis tubal disease may improve the outcome of subsequent IVF, while offering the potential for spontaneous conception. Tubo-tubal anastomosis for reversal of tubal ligation, performed either by a microsurgical technique through a mini-laparotomy or by laparoscopy, is preferable to IVF in younger women with no other fertility factors, because it offers potentially higher cumulative pregnancy rates. Surgery is the only alternative for women with tubal factor infertility who for personal or other reasons are unable to undergo assisted reproductive techniques. Tubal reconstructive surgery and assisted reproductive techniques must be considered complementary forms of treatment for women with tubal factor infertility, and training in tubal reconstructive surgery should be an integral part of subspecialty training in reproductive endocrinology and infertility. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery.

    Science.gov (United States)

    Partridge, J S L; Harari, D; Martin, F C; Peacock, J L; Bell, R; Mohammed, A; Dhesi, J K

    2017-05-01

    Increasing numbers of older patients are undergoing vascular surgery. Inadequate preoperative assessment and optimization may contribute to increased postoperative morbidity and mortality. Patients aged at least 65 years scheduled for elective aortic aneurysm repair or lower-limb arterial surgery were enrolled in an RCT of standard preoperative assessment or preoperative comprehensive geriatric assessment and optimization. Randomization was stratified by sex and surgical site (aorta/lower limb). Primary outcome was length of hospital stay. Secondary outcome measures included new medical co-morbidities, postoperative medical or surgical complications, discharge to a higher level of dependency and 30-day readmission rate. A total of 176 patients were included in the final analysis (control 91, intervention 85). Geometric mean length of stay was 5·53 days in the control group and 3·32 days in the intervention group (ratio of geometric means 0·60, 95 per cent c.i. 0·46 to 0·79; P < 0·001). There was a lower incidence of delirium (11 versus 24 per cent; P = 0·018), cardiac complications (8 versus 27 per cent; P = 0·001) and bladder/bowel complications (33 versus 55 per cent; P = 0·003) in the intervention group compared with the control group. Patients in the intervention group were less likely to require discharge to a higher level of dependency (4 of 85 versus 12 of 91; P = 0·051). In this study of patients aged 65 years or older undergoing vascular surgery, preoperative comprehensive geriatric assessment was associated with a shorter length of hospital stay. Patients undergoing assessment and optimization had a lower incidence of complications and were less likely to be discharged to a higher level of dependency. Registration number: ISRCTN23142588 (http://www.controlled-trials.com). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  8. [Psychosocial effects of plastic surgery reconstruction of the female breast following amputation for malignant/benign tumor].

    Science.gov (United States)

    Frischenschlager, O; Balogh, B; Predovic, M

    1990-11-01

    A total of 98 woman (malignant/benign tumors of the breast, mastectomy with/without subsequent reconstructive surgery as well as healthy controls) were examined in terms of subjective well-being, psychosomatic reaction patterns, subjective impairment due to mastectomy and satisfaction with the outcome of reconstructive surgery in this empiric retrospective study. In addition, numerous sociographic data were obtained. On the average, the examined women were satisfied with the outcome of reconstructive surgery and tended to be disappointed with regard to the desired psychosocial improvement. Objective tests demonstrate that subjective well-being was less favorable after reconstructive breast surgery than in women without reconstruction. In the group "benign tumor with subsequent reconstruction" the reaction to emotional strain was significantly more characterized by regressive behavior and withdrawal than in the group "benign tumor without reconstruction". In the group "malignant tumor with reconstruction" this difference was less pronounced. On the basis of these results we cannot confirm the assumption that reconstructive surgery of the breast has a supportive function.

  9. Re- reconstructive surgery in failure of genitoplasty in male-to-female transsexuals

    Directory of Open Access Journals (Sweden)

    Kamyar Tavakkoli Tabassi

    2013-12-01

    Full Text Available Background: Various surgical procedures were described for the correction of the external genitalia in male-to-female transsexualism. In all these methods complications such as vaginal stenosis, unpleasant appearance of external genitalia and lack of consent are seen. This paper describes a method of surgery for repair of these complications and success rate of this surgery.Methods: Reconstructive surgery was performed by one surgeon in 16 patients from 2009 to 2011 in Imam Reza Hospital of Mashhad. Mean age 25.75 years of age from 21 to 31 years. Due to the condition of each patient appropriate reconstructive surgery was performed. These surgeries include: clitoroplasty, inverted U flap, labioplasty, urethroplasty, removal of excess skin and increasing depth of vagina. After the surgery, the patients admitted for complete bed rest up to 5 days. They received postoperative prophylaxis medication for anti-thromboembolic events.Results: Only 3 complications were seen in all 16 patients. One hematoma of surgery site, one infection of surgery site and a blood transfusion. Eleven patients had history of vaginoplasty using small intestine and 10 patients with penile and perineal skin. From 3 to 24 months follow up after discharge were done, no patient had a major complication in long-term follow up and were generally satisfied with their sexual intercourse.Conclusion: This study has some limitations. Follow-up of the patients was performed for about one year that longer follow-up for these patients is favorable. Also, evaluation of patients' satisfaction from their intercourse was not performed as systematically with using an standard questionnaire and by a person who is blind to the study. Using this method of restoring external genitalia in the hands of expert surgeon, aesthetic and functional result would be expected very well.

  10. Virtual surgery simulation in orbital wall reconstruction: integration of surgical navigation and stereolithographic models.

    Science.gov (United States)

    Novelli, Giorgio; Tonellini, Gabriele; Mazzoleni, Fabio; Bozzetti, Alberto; Sozzi, Davide

    2014-12-01

    Correction of post traumatic orbital and zygomatic deformity is a challenge for maxillofacial surgeons. Integration of different technologies, such as software planning, surgical navigation and stereolithographic models, opens new horizons in terms of the surgeons' ability to tailor reconstruction to individual patients. The purpose of this study was to analyze surgical results, in order to verify the suitability, effectiveness and reproducibility of this new protocol. Eleven patients were included in the study. Inclusion criteria were: unilateral orbital pathology; associated diplopia and enophthalmos or exophthalmos, and zygomatic deformities. Syndromic patients were excluded. Pre-surgical planning was performed with iPlan 3.0 CMF software and we used Vector Vision II (BrainLab, Feldkirchen, Germany) for surgical navigation. We used 1:1 skull stereolithographic models for all the patients. Orbital reconstructions were performed with a titanium orbital mesh. The results refer to: correction of the deformities, exophthalmos, enophthalmos and diplopia; correspondence between reconstruction mesh positioning and preoperative planning mirroring; and the difference between the reconstructed orbital volume and the healthy orbital volume. Correspondence between the post-operative reconstruction mesh position and the presurgical virtual planning has an average margin of error of less than 1.3 mm. In terms of en- and exophthalmos corrections, we have always had an adequate clinical outcome with a significant change in the projection of the eyeball. In all cases treated, there was a complete resolution of diplopia. The calculation of orbital volume highlighted that the volume of the reconstructed orbit, in most cases, was equal to the healthy orbital volume, with a positive or negative variation of less than 1 cm(3). The proposed protocol incorporates all the latest technologies to plan the virtual reconstruction surgery in detail. The results obtained from our experience

  11. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery.

    Science.gov (United States)

    Ardern, Clare L; Taylor, Nicholas F; Feller, Julian A; Whitehead, Timothy S; Webster, Kate E

    2013-07-01

    Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. Case control study; Level of evidence, 3. Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athlete's estimate of the number of months it would take to return to sport, as measured preoperatively (χ(2) 2 = 18.3, P Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months.

  12. Trismus Secondary Release Surgery and Microsurgical Free Flap Reconstruction After Surgical Treatment of Head and Neck Cancer.

    Science.gov (United States)

    Chang, Yang-Ming; Deek, Nidal Farhan Al; Wei, Fu-Chan

    2016-10-01

    This article addresses trismus following head and neck cancer ablation and free flap reconstruction whether or not radiotherapy has been utilized. The focus is to achieve durable and favorable outcomes and avoid untoward results. To aid surgeons in fulfilling these goals, key factors, including adequate release surgery, optimal free flap selection and reconstruction, long-lasting results, and the untoward outcomes specific to trismus release and reconstruction surgery and how to avoid them have been investigated and discussed based on the authors' experience in this surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. [Plastic surgery reconstruction of the adult buried penis : Option or obligation?

    Science.gov (United States)

    Mühlstädt, S; Anheuser, P; Mohammed, N; Bach, A D

    2017-08-11

    The adult buried penis afflicts the patient with shame and is also potentially associated with considerable urogenital complications. Due to obesity, chronic urogenital lymphedema or subsequent inflammatory urogenital conditions, such as a lichen sclerosus et atrophicus, the clinical appearance of the adult buried penis is extremely variable. Epidemiological data are non-existent. Therapeutically, a combination of various plastic surgery procedures is often necessary for the best esthetic and functional results. The therapeutic strategy is highly individual and the therapy itself is interdisciplinary. This article provides an overview of the plastic surgery reconstruction of the adult buried penis.

  14. Sexual outcomes after organ potency-sparing surgery and glans reconstruction in patients with penile carcinoma

    Directory of Open Access Journals (Sweden)

    Gaetano Gulino

    2013-01-01

    Full Text Available Introduction: Radical surgery is the "gold standard" for treatment of invasive penile carcinoma but very poor aesthetic, functional and psychological outcomes have been reported. Our purpose was to assess the impact of organ potency-sparing surgery in locally confined carcinoma of the penis. Materials and Methods: We evaluated retrospectively 42 patients with early penile cancer (Ta,T1,T2, treated with glandulectomy and glanduloplasty with urethral mucosa and sparing of cavernosal apexes, or glandulectomy and limited apical resection in cases of Stage T2. Sexual function, ejaculation and libido were evaluated with an IIEF-15 questionnaire before the appearance of neoplasia (about three months before the surgery and six months after surgery. Quality of life was evaluated by the Bigelow-Young questionnaire. The scores relating to two weeks prior to the surgery have been compared to those obtained six months after surgery. The statistical analysis was conducted using t-Student for repeated measures and analysis of variance. Results: Six months after surgery 73% of patients reported spontaneous rigid erections, 60% coital activity while 76% of the group treated with urethral glanduloplasty reported normal ejaculation and orgasm, regained an average of 35 days after surgery. The average IIEF-15 scores reported in the entire series in the domains of erection, libido and coital activity of the pre-cancer period were not statistically different than those recorded six months after surgery. In the group treated with glandular reconstruction, pre-and postoperative IIEF-15 mean scores related to ejaculation and orgasm domains were not significantly different. Mean scores of Bigelow-Young questionnaires related to sexual pleasure, familial, social and professional relationships showed significant improvement after surgery. Conclusions: Potency sparing-sparing surgical treatments have a positive impact on a wide spectrum of the patient′s life including

  15. Current aspects in reconstructive surgery for nasal cavity and paranasal sinus cancer

    Science.gov (United States)

    Shtin, V. I.; Novikov, V. A.; Gjunter, V. E.; Choinzonov, E. L.; Ryabova, A. I.; Sirkashev, V. A.; Surkova, P. V.; Vasilev, R. V.; Menkova, E. N.

    2017-09-01

    Tumors of the nasal cavity and paranasal sinuses present a challenge to treat them. A combination of surgery and radiation therapy can improve treatment outcomes in 49-56% [1, 2] of the patients with locally advanced nasal cavity and paranasal sinus cancer. The midface reconstruction poses a formidable challenge to the reconstructive surgeon due to the region's complex skeletal and soft-tissue anatomy. The rehabilitation program including the reconstruction of the resected orbital walls using the porous and mesh implants from titanium nickelid (TiNi) was developed at the Cancer Research institute jointly with the Research Institute of Medical Materials. The technique was proven effective, allowing the natural position of the eye and visual function to be preserved in 90% [1-3] of the patients. A long period of reparative processes and risk of developing inflammation in the implant area, as well as the need to decrease length of surgery, contributed to the development of a novel approach to repairing the midface bone structures using the implant based on the microporous wire and TiNi mesh. Eighteen patients with nasal cavity and paranasal sinus cancer were treated using the combined thin implants. The novel technique allowed the time of the implant installation to be reduced to 5-10 min. The structure of the implant contributed to prevention of inflammatory processes in 97% [1, 2] of cases. Thus, the natural position of the eyeball and visual function were preserved in 100% [1, 3, 4] of patients. The use of the TiNi implants in reconstructive surgery for patients with nasal cavity and paranasal sinus cancer led to reduced time of surgery and rehabilitation, increased level of social adaptation of patients and improved cosmetic and functional results.

  16. A multicenter prospective trial evaluating fetal bovine dermal graft (Xenform? Matrix) for pelvic reconstructive surgery

    OpenAIRE

    Aguirre Oscar A; Naughton Martin J; Maccarone Joseph; Goldstein Howard B; Patel Rakesh C

    2010-01-01

    Abstract Background A prospective multicenter clinical study was performed to evaluate the safety and efficacy of a bovine dermal graft (Xenform® Matrix, Boston Scientific, Natick, MA, USA) during vaginal reconstructive surgery. Methods Forty-five women with ICS stage 2 or higher pelvic organ prolapse (POP) were enrolled at 4 centers. POP-Q, pelvic floor function (PFDI-20), sexual function (PISQ-12), and patient satisfaction tools were used to assess subjects at baseline, and at 2 and 6 weeks...

  17. The understanding of plastic and reconstructive surgery amongst Queensland medical students

    OpenAIRE

    Conyard, Christopher; Schaefer, Nathan; Williams, Daniel; Beem, Henry; McDougall, James

    2016-01-01

    The field of plastic and reconstructive surgery is a unique and poorly understood surgical subspeciality. There is a misunderstanding about the scope of the speciality amongst both the public and professionals. Medical schools provide a unique opportunity to educate future medical practitioners on the role of surgical subspecialities. Medical students at the Griffith University in Queensland, Australia, were invited to participate in a 30-question electronic survey to analyse their underst...

  18. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    OpenAIRE

    Lodders, Johannes N.; Parmar, Satyesh; Stienen, Niki L.M.; Martin, Timothy J.; Karagozoglu, K.H.; Heymans, Martijn W.; Nandra, Baljeet; Forouzanfar, Tymour

    2015-01-01

    Background The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used...

  19. A new instrument for hemostatic vascular management in endoscopic surgery: diode laser (STATLase-SDL) and its handpiece (dual hook).

    Science.gov (United States)

    Morita, T; Okamura, Y; Ookubo, K; Tanaka, K; Hirayama, R; Daikuzono, N

    1999-04-01

    The authors described experimental data in hemostatic vascular transection using a STATLase-SDL with a 780-865 nm GaA/As diode wavelength and its handpiece, Dual Hook (DH). The STATLase-SDL and DH are newly developed devices for endoscopic surgery. It seems that the device has improved hemostatic cutting ability. The DH was applied to the abdominal aorta (SDL and DH have good hemostatic cutting ability and might be suitable for endoscopic surgery.

  20. MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Magerkurth, Olaf [Dept. of Radiology, Hospital Baden, Baden (Switzerland); Girish, Gandikota; Jacobson, Jon A.; Kim, Sung Moon; Brigido, Monica; Dong, Qian; Jamadar, David A. [Dept. of Radiology, University of Michigan Hospitals, Ann Arbor (United States)

    2015-02-15

    MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

  1. Role of Leukocyte-Platelet-Rich Fibrin in Endoscopic Endonasal Skull Base Surgery Defect Reconstruction.

    Science.gov (United States)

    Soldatova, Liuba; Campbell, Raewyn G; Elkhatib, Ahmad H; Schmidt, Thomas W; Pinto, Nelson R; Pinto, Jaime M; Prevedello, Daniel M; Ditzel Filho, Leo F; Otto, Bradley A; Carrau, Ricardo L

    2017-02-01

    Objective Advancements in endoscopic endonasal approaches have increased the extent and complexity of skull base resections, in turn demanding the development of novel techniques for skull base defect reconstruction. The objective of this pilot study was to investigate the effect of leukocyte-platelet-rich fibrin (L-PRF) on the postoperative healing after endoscopic skull base surgery. Methods Between January and May of 2015, 47 patients underwent endoscopic endonasal resection of sellar, parasellar, and suprasellar lesions with the application of L-PRF membranes during the skull base reconstruction at two surgical centers. Early postoperative records were retrospectively reviewed. Results We found that 21 days following the surgery, 17/41 patients (42%) demonstrated improvement in the crusting score as compared with their 7 day postoperative examination. Ten of these patients (23%) showed no crusting. Fourteen (34%) patients had no change in the crusting score. Six patient records were incomplete. A total of 4/47 cases (8.5%) had postoperative cerebrospinal fluid leak requiring surgical repair. Conclusion This study demonstrates the potential utility of L-PRF membranes for skull base defect reconstruction. Future studies will be conducted to better assess the role of L-PRF in endoscopic skull base surgery.

  2. 3D Printing: current use in facial plastic and reconstructive surgery.

    Science.gov (United States)

    Hsieh, Tsung-Yen; Dedhia, Raj; Cervenka, Brian; Tollefson, Travis T

    2017-08-01

    To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery. Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs SUMMARY: The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.

  3. Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

    Science.gov (United States)

    Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

    2013-11-01

    Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All

  4. Systematic identification and management of barriers to vascular surgery patient discharge time of day.

    Science.gov (United States)

    Sharma, Gaurav; Wong, Danny; Arnaoutakis, Dean J; Shah, Samir K; O'Brien, Alice; Ashley, Stanley W; Ozaki, C Keith

    2017-01-01

    Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and postanesthesia care unit, delayed time to treatment, increased in-hospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics. The study was divided into three periods: preintervention, "wash-in," and postintervention. During the preintervention phase, barriers to patient flow were quantified by an interdisciplinary team. Suboptimal provider communication emerged as the key barrier. An enhanced communication intervention consisting of face-to-face and mobile application-based education on key patient flow metrics, explicit discussion of individual patient barriers to progression at rounds and interdisciplinary huddles, and communication of projected discharge and potential barriers via e-mail was developed with input from all stakeholders. Following a 4-week wash-in implementation phase, data collection was repeated. The pre- and postintervention patient cohorts accounted for 244.3 and 238.1 inpatient days, respectively. Both groups had similar baseline demographic, clinical characteristics, and procedures performed during hospitalization. The postintervention group was discharged 78 minutes earlier (14:00:32 vs 15:18:37; P = .03) with a trend toward increased discharge by noon (94% vs 88%; P = .09). Readmission rates did not differ (P = .44). Implementation of a focused, interdisciplinary, frontline provider-driven, enhanced communication program can be feasibly incorporated into existing specialty surgical workflow. The program resulted in improved timeliness of discharge and projected cost savings

  5. Fibrin sealant improves hemostasis in peripheral vascular surgery: a randomized prospective trial.

    Science.gov (United States)

    Schenk, Worthington G; Burks, Sandra G; Gagne, Paul J; Kagan, Steven A; Lawson, Jeffrey H; Spotnitz, William D

    2003-06-01

    To evaluate the efficacy and safety of an investigational fibrin sealant (FS) in a randomized prospective, partially blinded, controlled, multicenter trial. Upper extremity vascular access surgery using polytetrafluorethylene (PTFE) graft placement for dialysis was chosen as a reproducible, clinically relevant model for evaluating the usefulness of FS. The FS consisted of pooled human fibrinogen (60 mg/mL) and thrombin (500 NIH U/mL). Time to hemostasis was measured, and adverse events were monitored. Consenting adult patients (n = 48) undergoing placement of a standard PTFE graft were randomized in a 2:1:1 ratio to the treatment group using FS (ZLB Bioplasma AG, Bern, Switzerland), oxidized regenerated cellulose (Surgicel, Johnson & Johnson, New Brunswick, NJ), or pressure. Patients received heparin (3,000 IU IVP) before placement of vascular clamps. If the treatment was FS, clamps were left in place for 120 seconds after the application of study material to permit polymerization. If treatment was Surgicel, clamps were left in place until the agent had been applied according to manufacturer's instructions. If the treatment was pressure, clamps were released as soon as the investigator was ready to apply compression. Immediately after release of the last clamp, the arterial and venous suture lines were evaluated for bleeding. The time to hemostasis at both the venous and arterial sites was recorded. Significant (P < or =.005) reduction in time to hemostasis was achieved in the FS group. Thirteen (54.2%) patients randomized to FS experienced immediate hemostasis at both suture lines following clamp removal compared to no patients using Surgicel or pressure. Only one patient (7.1%) in the Surgicel group and no patients in the pressure group experienced hemostasis at 120 seconds from clamp removal, compared to 13 (54.2%) patients for FS. Adverse events were comparable in all groups. There were no seroconversions. FS achieved more rapid hemostasis than traditional

  6. Efficacy of communication amongst staff members at plastic and reconstructive surgery section using smartphone and mobile WhatsApp

    National Research Council Canada - National Science Library

    Wani, Shabeer Ahmad; Rabah, Sari M; Alfadil, Sara; Dewanjee, Nancy; Najmi, Yahya

    2013-01-01

    The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility...

  7. Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review.

    Science.gov (United States)

    Aitken, Sarah Joy; Blyth, Fiona M; Naganathan, Vasi

    2017-10-01

    Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, pdelirium included increased age (OR 1.04, pdelirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.

  8. A Regional Quality Improvement Effort to Increase Beta Blocker Administration Before Vascular Surgery

    Science.gov (United States)

    Goodney, Philip P.; Eldrup-Jorgensen, Jens; Nolan, Brian W.; Bertges, Daniel J.; Likosky, Donald S.; Cronenwett, Jack L.

    2011-01-01

    Objective To determine if a regional quality improvement effort can increase beta-blocker utilization prior to vascular surgery and decrease the incidence of post-op myocardial infarction (POMI). Methods A quality improvement effort to increase peri-operative beta blocker utilization was implemented in 2003 at centers participating in the Vascular Study Group of New England (VSGNE). A 90% target was set and feedback given at bi-annual meetings. Beta blocker utilization (beta blocker administration and POMI were analyzed over time, and across strata of patient risk based on a multivariate model. Results Peri-operative beta blocker treatment increased from 68% of patients in the first three months of 2005 to 88% by the last 3 months of 2008 (pbeta blockers were treated with pre-operative beta blockers; by 2008, 78% of patients not on chronic beta blockers were started peri-operatively on these medications (pBeta blocker utilization increased across all centers and surgeons participating during the study period, and increased in patients of low, medium, and high cardiac risk. However, the rate of POMI did not change over time (5.2% in 2003, 5.5% in 2008, p=0.876), although a trend towards lower POMI rate was seen in patients on pre-operative beta blockers (4.4% in 2003-2005, 2.6% in 2006-2008, p=0.43). In multivariable modeling we found that age >70 (OR 2.1), positive stress test (OR 2.2), CHF (OR 1.7), chronic beta blocker administration (OR 1.7), resting heart rate (HR) beta blockers (70) (p=0.521). Conclusions Our regional quality improvement effort successfully increased peri-operative beta blocker utilization. However, this was not associated with reduced rates of POMI or resting heart rate. While this demonstrates the effectiveness of regional quality improvement efforts in changing practice patterns, further work is necessary to more precisely identify those patients who will benefit from beta blockade at the time of vascular surgery. PMID:21334166

  9. Hip dislocation in cerebral palsy: evolution of the contralateral side after reconstructive surgery

    Directory of Open Access Journals (Sweden)

    João Caetano Munhoz Abdo

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution. METHODS: This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty. The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI, acetabular angle (AA and the continuity of Shenton's line. RESULTS: Among the 17 patients evaluated, eight presented dislocation (group I and nine did not (group II. Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow-up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI < 30% and AA < 25°, only one presented dislocation during the follow-up. Contralateral subluxation occurred within the first two years after the surgery. CONCLUSION: Hips presenting REI < 30° and AA < 25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non- operated hips. The critical period for subluxation is the first two

  10. A new mild hyperthermia device to treat vascular involvement in cancer surgery.

    Science.gov (United States)

    Ware, Matthew J; Nguyen, Lam P; Law, Justin J; Krzykawska-Serda, Martyna; Taylor, Kimberly M; Cao, Hop S Tran; Anderson, Andrew O; Pulikkathara, Merlyn; Newton, Jared M; Ho, Jason C; Hwang, Rosa; Rajapakshe, Kimal; Coarfa, Cristian; Huang, Shixia; Edwards, Dean; Curley, Steven A; Corr, Stuart J

    2017-09-12

    Surgical margin status in cancer surgery represents an important oncologic parameter affecting overall prognosis. The risk of disease recurrence is minimized and survival often prolonged if margin-negative resection can be accomplished during cancer surgery. Unfortunately, negative margins are not always surgically achievable due to tumor invasion into adjacent tissues or involvement of critical vasculature. Herein, we present a novel intra-operative device created to facilitate a uniform and mild heating profile to cause hyperthermic destruction of vessel-encasing tumors while safeguarding the encased vessel. We use pancreatic ductal adenocarcinoma as an in vitro and an in vivo cancer model for these studies as it is a representative model of a tumor that commonly involves major mesenteric vessels. In vitro data suggests that mild hyperthermia (41-46 °C for ten minutes) is an optimal thermal dose to induce high levels of cancer cell death, alter cancer cell's proteomic profiles and eliminate cancer stem cells while preserving non-malignant cells. In vivo and in silico data supports the well-known phenomena of a vascular heat sink effect that causes high temperature differentials through tissues undergoing hyperthermia, however temperatures can be predicted and used as a tool for the surgeon to adjust thermal doses delivered for various tumor margins.

  11. Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Andersen, P E; Larsen, K E

    2014-01-01

    AIM: Para-anastomotic aneurysms, leakage due to anastomotic failure, aorto- and arterioenteric fistulas are some of the serious complications after aorto-iliac surgical reconstructions. Treatment of these complications is challenging and is either done by open surgery or by endovascular therapy...... endoprosthesis was implanted in one case and in two cases aortic cuff was used. Fluency periphery stent grafts were used in four cases. There was a 100% technical success. Intervention related early mortality was 8%. One patient with pseudoaneurysm died 28 months after endovascular treatment because of cardiac...... infarct and one patient with previously infected arterio-enteric fistula and advanced malignancy died 7 months after second endovascular treatment. Overall the mortality was 25%. There was no procedure related morbidity or complications during hospitalization and follow-up of mean 12, 3 months (range 1...

  12. Reconstruction of nongrowing hemifacial microsomia patient with custom-made unilateral temporomandibular joint total joint prosthesis and orthognathic surgery.

    Science.gov (United States)

    Farzad, Payam

    2017-01-01

    A case of hemifacial microsomia in a young male is presented. The ascending ramus and condyle was reconstructed utilizing virtual 3D planning with a custom-made total TMJ device (TMJ Concepts, USA) in combination with conventional orthognathic surgery. The alternative available reconstructive options are discussed and the advantages and disadvantages of the technique selected.

  13. Renal Function Interferes with Copeptin in Prediction of Major Adverse Cardiac Events in Patients Undergoing Vascular Surgery

    Science.gov (United States)

    Sahlmann, Bianca; Meinders, Antje; Larmann, Jan; Wilhelmi, Mathias; Aper, Thomas; Rustum, Saad; Lichtinghagen, Ralf; Theilmeier, Gregor; Teebken, Omke E.

    2015-01-01

    Objective Precise perioperative risk stratification is important in vascular surgery patients who are at high risk for major adverse cardiovascular events (MACE) peri- and postoperatively. In clinical practice, the patient’s perioperative risk is predicted by various indicators, e.g. revised cardiac index (RCRI) or modifications thereof. Patients suffering from chronic kidney disease (CKD) are stratified into a higher risk category. We hypothesized that Copeptin as a novel biomarker for hemodynamic stress could help to improve the prediction of perioperative cardiovascular events in patients undergoing vascular surgery including patients with chronic kidney disease. Methods 477 consecutive patients undergoing abdominal aortic, peripheral arterial or carotid surgery from June 2007 to October 2012 were prospectively enrolled. Primary endpoint was 30-day postoperative major adverse cardiovascular events (MACE). Results 41 patients reached the primary endpoint, including 63.4% aortic, 26.8% carotid, and 9.8% peripheral surgeries. Linear regression analysis showed that RCRI (PCopeptin (PCopeptin level change (P= .001) were associated with perioperative MACE, but CKD remained independently associated with MACE and Copeptin levels. Multivariate regression showed that increased Copeptin levels added risk predictive information to the RCRI (P= .003). Especially in the intermediate RCRI categories was Copeptin significantly associated with the occurrence of MACE. (PCopeptin was significantly associated with CKD stages (PCopeptin measurements could not predict MACE in patients with more severe CKD stages. Conclusion Preoperative Copeptin loses its risk predictive potential for perioperative MACE in patients with chronic kidney disease undergoing vascular surgery. PMID:25875814

  14. Male Sex Associated with Increased Long-term Cardiovascular Mortality after Peripheral Vascular Surgery for Atherosclerosis Despite Optimal Medical Treatment.

    Science.gov (United States)

    Budtz-Lilly, J W; Petersen, C N; Pedersen, T F; Eldrup, N

    2015-12-01

    The cardiovascular burden and consequences of peripheral atherosclerosis appear to differ between men and women. Data regarding long-term outcomes, including the impact of medical prophylactic treatment, are insufficient. This study examined long-term outcomes according to sex following primary vascular surgery, adjusted for multiple variables as well as recommended medical prophylaxis. All Danish patients who underwent peripheral vascular surgery from January 2000 to December 2007 were stratified into five procedural groups: (a) aorto-iliac bypass or thromboendarterectomy, (b) femoro-femoral crossover, (c) thromboendarterectomy of the femoral arteries, (d) infrainguinal bypass, or (e) axillo- uni-, and bifemoral bypass. Data were analyzed according to sex for differences in myocardial infarction, stroke, and death, individually and combined, after surgery. A total of 11,234 patients were included: 6,289 males and 4,945 females. The overall adjusted hazard ratio for male patients compared with female patients for death was 1.11 (95% CI 1.06-1.17), for MI was 1.16 (95% CI 1.04-1.29), for stroke was 0.99 (95% CI 0.89-1.11), and for any major adverse cardiovascular event was 1.10 (95% CI 1.05-1.16). These findings show that, despite indication, severity, and concomitant medical treatment of peripheral artery disease, men have a higher risk of mortality and adverse cardiovascular events following surgery for peripheral arterial disease. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Blood loss and transfusion requirements with epsilon-aminocaproic acid use during cranial vault reconstruction surgery.

    Science.gov (United States)

    Thompson, Mark E; Saadeh, Charles; Watkins, Phillip; Nagy, Laszlo; Demke, Joshua

    2017-02-01

    To determine whether epsilon-aminocaproic acid (EACA) load of 50 mg∙kg -1 before skin incision, and infusion of 25 mg∙kg -1 ∙h -1 until skin closure during cranial vault reconstruction (CVR) were associated with decreased estimated blood loss and transfusion requirements. Antifibrinolytic medications decrease bleeding and transfusion requirements during cardiothoracic and orthopedic surgeries with high blood loss, but practical reductions in blood loss and transfusion requirements have not been consistently realized in children undergoing CVR. Current dosing recommendations are derived from adult extrapolations, and may or may not have clinical relevance. Retrospective case-controlled study of 45 consecutive infants and children undergoing primary craniosynostosis surgery at Covenant Children's Hospital during years 2010-2014. Exclusion criteria included revision surgery, and chromosomal abnormalities associated with bleeding disorders. Blood loss and blood transfusion volumes as a percent of estimated blood volume were compared in the presence of EACA while controlling for age, suture phenotype, use of bone grafting, and length of surgery. Secondary outcomes measures included volume of crystalloid infused, length of hospital stay, and any postoperative intubation requirement. When analyzed based on length of surgery, EACA did reduce blood loss and blood transfusion (R 2 =0.19, P=.005 and R 2 =0.18, P=.010, respectively) with shorter surgeries. Using a standardized dosing regimen of EACA during craniosynostosis surgery, we found statistical significance in blood loss and transfusion requirements in surgeries of the shortest duration. We suspect this may be due to our selected dosing regimen, which may be lower than recently recommended. This study contributes to the growing body of evidence supporting EACA in CVR for craniosynostosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Neuropathic Minimally Invasive Surgeries (NEMESIS):: Percutaneous Diabetic Foot Surgery and Reconstruction.

    Science.gov (United States)

    Miller, Roslyn J

    2016-09-01

    Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot. It may potentially reduce the risk associated with large wounds and bony correction in this patient group. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery.

    Science.gov (United States)

    Frey, Jordan D; Poudrier, Grace; Thomson, Jennifer E; Hazen, Alexes

    2017-08-01

    Gender dysphoria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is characterized by a marked discrepancy between one's birth-assigned sex and one's gender identity and is sometimes addressed by gender-affirming surgery. As public visibility and institutional support for the transgender and gender non-conforming population continue to increase, the demand for competent multidisciplinary teams of medical professionals equipped to care for this population is expected to rise-including plastic surgeons, urologists, gynecologists, endocrinologists, and breast surgeons, among others. Genital reconstruction procedures for the male-to-female and female-to-male transgender patient present unique surgical challenges that continue to evolve from their respective origins in the 19th and 20th centuries. A historical review of surgical techniques and standards of care attendant to gender-affirming medicine is presented, with foremost emphasis placed on how techniques for genital reconstruction in particular continue to evolve and advance. In addition, the current status of transition-related health care in the United States, including research gaps and contemporary clinical challenges, is reviewed. Frey JD, Poudrier G, Thomson JE, Hazen A. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. J Sex Med 2017;14:991-1002. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  18. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction.

    Science.gov (United States)

    Lodders, Johannes N; Parmar, Satyesh; Stienen, Niki L M; Martin, Timothy J; Karagozoglu, K Hakki; Heymans, Martijn W; Nandra, Baljeet; Forouzanfar, Tymour

    2015-11-01

    The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations.

  19. Gender-specific 30-day outcomes after carotid endarterectomy and carotid artery stenting in the Society for Vascular Surgery Vascular Registry.

    Science.gov (United States)

    Jim, Jeffrey; Dillavou, Ellen D; Upchurch, Gilbert R; Osborne, Nicholas H; Kenwood, Christopher T; Siami, Flora S; White, Rodney A; Ricotta, Joseph J

    2014-03-01

    Although the optimal treatment of carotid stenosis remains unclear, available data suggest that women have higher risk of adverse events after carotid revascularization. We used data from the Society for Vascular Surgery Vascular Registry to determine the effect of gender on outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS). There were 9865 patients (40.6% women) who underwent CEA (n = 6492) and CAS (n = 3373). The primary end point was a composite of death, stroke, and myocardial infarction at 30 days. There was no difference in age and ethnicity between genders, but men were more likely to be symptomatic (41.6% vs 38.6%; P gender, there were no statistically significant differences in the primary end point for CEA (women, 4.07%; men, 4.06%) or CAS (women, 6.69%; men, 6.80%). There remains no difference after stratification by symptomatology and multivariate risk adjustment. In this large, real-world analysis, women and men demonstrated similar results after CEA or CAS. These data suggest that, contrary to previous reports, women do not have a higher risk of adverse events after carotid revascularization. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  20. Noninvasive Vascular Displacement Estimation for Relative Elastic Modulus Reconstruction in Transversal Imaging Planes

    Directory of Open Access Journals (Sweden)

    Chris L. de Korte

    2013-03-01

    Full Text Available Atherosclerotic plaque rupture can initiate stroke or myocardial infarction. Lipid-rich plaques with thin fibrous caps have a higher risk to rupture than fibrotic plaques. Elastic moduli differ for lipid-rich and fibrous tissue and can be reconstructed using tissue displacements estimated from intravascular ultrasound radiofrequency (RF data acquisitions. This study investigated if modulus reconstruction is possible for noninvasive RF acquisitions of vessels in transverse imaging planes using an iterative 2D cross-correlation based displacement estimation algorithm. Furthermore, since it is known that displacements can be improved by compounding of displacements estimated at various beam steering angles, we compared the performance of the modulus reconstruction with and without compounding. For the comparison, simulated and experimental RF data were generated of various vessel-mimicking phantoms. Reconstruction errors were less than 10%, which seems adequate for distinguishing lipid-rich from fibrous tissue. Compounding outperformed single-angle reconstruction: the interquartile range of the reconstructed moduli for the various homogeneous phantom layers was approximately two times smaller. Additionally, the estimated lateral displacements were a factor of 2–3 better matched to the displacements corresponding to the reconstructed modulus distribution. Thus, noninvasive elastic modulus reconstruction is possible for transverse vessel cross sections using this cross-correlation method and is more accurate with compounding.

  1. Noninvasive Vascular Displacement Estimation for Relative Elastic Modulus Reconstruction in Transversal Imaging Planes

    Science.gov (United States)

    Hansen, Hendrik H.G.; Richards, Michael S.; Doyley, Marvin M.; de Korte, Chris L.

    2013-01-01

    Atherosclerotic plaque rupture can initiate stroke or myocardial infarction. Lipid-rich plaques with thin fibrous caps have a higher risk to rupture than fibrotic plaques. Elastic moduli differ for lipid-rich and fibrous tissue and can be reconstructed using tissue displacements estimated from intravascular ultrasound radiofrequency (RF) data acquisitions. This study investigated if modulus reconstruction is possible for noninvasive RF acquisitions of vessels in transverse imaging planes using an iterative 2D cross-correlation based displacement estimation algorithm. Furthermore, since it is known that displacements can be improved by compounding of displacements estimated at various beam steering angles, we compared the performance of the modulus reconstruction with and without compounding. For the comparison, simulated and experimental RF data were generated of various vessel-mimicking phantoms. Reconstruction errors were less than 10%, which seems adequate for distinguishing lipid-rich from fibrous tissue. Compounding outperformed single-angle reconstruction: the interquartile range of the reconstructed moduli for the various homogeneous phantom layers was approximately two times smaller. Additionally, the estimated lateral displacements were a factor of 2–3 better matched to the displacements corresponding to the reconstructed modulus distribution. Thus, noninvasive elastic modulus reconstruction is possible for transverse vessel cross sections using this cross-correlation method and is more accurate with compounding. PMID:23478602

  2. Vascularized bone graft for oncological reconstruction of the extremities: review of the biological advantages.

    Science.gov (United States)

    Muramatsu, Keiichi; Hashimoto, Takahiro; Tominaga, Yasuhiro; Taguchi, Toshihiko

    2014-06-01

    Vascularized bone graft (VBG) is a form of vascularized bone marrow transplant in which the bone marrow is surgically grafted with its microenvironment intact. Due to the preservation of cellular viability, VBG have significant advantages over non-vascularized bone grafts. Free vascularized fibula grafts have superior material properties and tolerate infection. Bone healing can be accomplished in a shorter period, even in an irradiated bed. In addition to these properties, VBG has other biological advantages that are not always familiar to oncological surgeons. Hypertrophic change can be divided into reactive and adaptive hypertrophy. Early hypertrophy is associated with donor-derived cells, whereas later remodeling is associated with recipient-derived cells. VBG has significant advantages in enhancing neo-revascularization of necrotic bone. We reviewed VBG from a novel viewpoint that stems from our basic research. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  3. The Use of Prostheses in Pelvic Reconstructive Surgery: Joy or Toy?

    Directory of Open Access Journals (Sweden)

    Ming-Ping Wu

    2008-06-01

    Full Text Available The high recurrence rate of pelvic organ prolapse (POP of up to 30% after pelvic reconstructive surgery makes a more refined surgery imperative, as well as the need for either biological or synthetic prostheses as adjuvant treatment. Patients with recurrence risks may benefit from the adjuvant treatment: (1 to substitute for the lack of supportive tissue; (2 to reinforce inadequate tissue; (3 to induce new supportive tissue; and (4 to consolidate and complement the insufficient surgical techniques. However, some debatable issues in use of the prosthetics remain. The use of prosthetics enables the simultaneous repair of all vaginal defects of POP and concomitant anti-incontinence surgery to be faster, easier and more precise. Nevertheless, great care should be devoted to the actual and theoretical short- and long-term risks, many of which have not been fully elucidated. Despite the lack of various ideal characteristics, the type I monofilament, macroporous polypropylene, has been suggested to have the lowest incidence of infection and erosion among the nonabsorbable prostheses. There is good evidence to support the use of nonabsorbable synthetic mesh for abdominal sacrocolpopexy, while the use of prostheses for repairing isolated anterior and posterior compartment defects remains controversial. There have been no long-term studies with sufficient patient numbers to prove whether synthetic or biological prostheses are superior during vaginal surgery. Tension-free vaginal mesh techniques with procedural kits are being adopted increasingly, despite the paucity of data. Although short-term follow-up studies have shown tension-free vaginal mesh to be a safe and effective technique to correct POP, anatomic and functional results of long-term follow-up studies, however, have not yet confirmed the effectiveness and safety. Mesh erosion remains a concern, with variable rates according to different materials and approaches. Newly developed prostheses offer

  4. The role of rehabilitative camouflage after cervicofacial reconstructive surgery: a preliminary study

    Directory of Open Access Journals (Sweden)

    Nicoletti G

    2014-01-01

    Full Text Available Giovanni Nicoletti,1–3 Andrea Sasso,1 Alberto Malovini,4,5 Luisa Ponchio,6 Silvia Scevola,2 Angela Faga,1–3 Aldo Pontone1 1Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, 2Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Centre, University of Pavia, Pavia, Italy; 3Plastic and Reconstructive Surgery Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy; 4Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy; 5Laboratory of Informatics and Systems Engineering for Clinical Research, 6Oncology Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy Abstract: A randomized, prospective, controlled study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy, to evaluate the psychological benefits from corrective medical camouflage (CMC following surgical treatment for skin cancer of the face. Twenty-four female patients, following recovery from facial skin cancer surgery, were enrolled in the study over a period of 1 year. The study was performed using two health-related quality of life tests, the Satisfaction Profile (SAT-P test and the Body Uneasiness Test (BUT. The patients were randomized into two groups: group A, patients undergoing CMC; and group B, controls. Both the SAT-P and BUT demonstrated statistically significant better results in the treated patients versus the controls in the following functional parameters: Psychological Functionality (PsF, Physical Functionality (PhF, and Work Performance (WP for the SAT-P test and Compulsive Self-Monitoring (CSM for the BUT. The PsF demonstrated a better result 6 months post-treatment. Such a difference was particularly significant when comparing the performance at 6 months versus that at 3 months. The PhF demonstrated a better outcome at 6 months post

  5. Immediate soft-tissue reconstruction for complex defects of the spine following surgery for spinal neoplasms.

    Science.gov (United States)

    Garvey, Patrick B; Rhines, Laurence D; Dong, Wenli; Chang, David W

    2010-05-01

    Innovations in surgical approaches and instrumentation for spinal stabilization have allowed radical resections of advanced spinal neoplasms. Wounds that expose instrumentation and vital neural structures can have devastating consequences. In this study, the authors present a paradigm shift in the way complex wounds of the spine are managed, where immediate, prophylactic muscle-flap reconstruction is provided, particularly for those patients identified to be at high risk for wound-healing complications. The purpose of this study was to determine the outcomes of this new prophylactic approach to managing complex spine wounds. The authors retrospectively reviewed spine tumor patients who underwent immediate reconstruction for complex wounds of the spine from 2004 to 2008. From the prospectively maintained database and medical records, the authors collected information regarding reconstructive methods, defect location, patient conditions, complications, and revision operations. Of the 52 patients, 34 (65 percent) had undergone prior irradiation, 17 (33 percent) had undergone prior surgery to the spine, and 44 (85 percent) had undergone spine instrumentation. Overall, six patients (12 percent) had major complications that required surgical intervention. The instrumentation did not need to be removed in any of the patients. All patients had a closed wound at their last clinic visit. Complex wounds of the spine benefit from immediate prophylactic reconstruction with muscle flaps. This approach has a high rate of success in achieving a stable, closed wound while minimizing major wound complications, even in the presence of adverse conditions such as prior irradiation, prior operations, and the presence of hardware.

  6. Decision-Making Styles and Levels of Involvement Concerning Breast Reconstructive Surgery: An Israeli Study.

    Science.gov (United States)

    Kadmon, Ilana; Noy, Sigal; Billig, Allan; Tzur, Tomer

    2016-01-01

    To address decision-making styles among breast cancer survivors considering breast reconstruction.
. A primary analysis of a cross-sectional sample among survivors who chose to have breast reconstruction to examine correlations among patient age, decision-making style, and the level of involvement of decision making.
. Hadassah Medical Center in Jerusalem, Israel.
. 70 women who had undergone breast reconstruction surgery in the past five years.
. Participants completed decision-making style and demographic questionnaires and an assessment of their level of involvement in the decision-making process. 
. Level of involvement in decision making, decision-making model between provider and patient, and decision-making styles were examined.
. No correlation was found between four main decision-making styles and patient age or the extent of patient decision-making involvement and age. A statistically significant correlation was found between the level of involvement in decision making and the decision-making style of the patient.
. Nurses should assess patient decision-making styles to ensure maximum patient involvement in the decision-making process based on personal desires regardless of age.
. Nurses working in breast cancer care must address the decision-making process of patients diagnosed with breast cancer, including the choice to undergo breast reconstruction after mastectomy. Nurses should understand the complex factors that influence a woman's decision-making style to best help with the decision.

  7. Comparison of mammographic image quality in various methods of reconstructive breast surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lindbichler, F. [University Hospital, Graz (Austria). Dept. of Radiology; Hoflehner, H. [University Hospital, Graz (Austria). Dept. of Plastic and Reconstructive Surgery; Schmidt, F. [University Hospital, Graz (Austria). Dept. of Radiology; Pierer, G.R. [University Hospital, Graz (Austria). Dept. of Plastic and Reconstructive Surgery; Raith, J. [University Hospital, Graz (Austria). Dept. of Radiology; Umschaden, J. [University Hospital, Graz (Austria). Dept. of Plastic and Reconstructive Surgery; Preidler, K.W. [University Hospital, Graz (Austria). Dept. of Radiology

    1996-12-01

    The purpose of our study was to evaluate mammographic image quality of various methods of reconstructive breast surgery with specific reference to the possibility of diagnosis of recurrent tumors. A total of 39 patients who underwent breast reconstruction following modified radical mastectomy were subject to clinical and mammographic examination. Three groups were formed: (a) autonomous tissue reconstruction (TRAM-flap; n=9), (b) submuscular silicon gel prostheses (n=21), and (c) supramuscular silicon gel prostheses (n=9). Mammographic images quality of the groups was compared by two radiologists working together using a point system where five specific criteria were valued and scored. The result was tabulated into three quality levels: good, acceptable, and limited. Mammograms were assessed as good, acceptable, or limited, respectively, as follows: group I: 7 (77.8%), 1 (11.1%), 1 (11.1%); group II; 4 (19%), 11 (52.4%), 6 (28.6%); group III: 3 (33.3%), 4 (44.5%), 2 (22.2%). The TRAM-flap method of reconstruction displays a high degree of mammographic image quality and therefore is preferable with respect to early diagnosis of recurrent tumors. (orig.)

  8. Comparison of mammographic image quality in various methods of reconstructive breast surgery.

    Science.gov (United States)

    Lindbichler, F; Hoflehner, H; Schmidt, F; Pierer, G R; Raith, J; Umschaden, J; Preidler, K W

    1996-01-01

    The purpose of our study was to evaluate mammographic image quality of various methods of reconstructive breast surgery with specific reference to the possibility of diagnosis of recurrent tumors. A total of 39 patients who underwent breast reconstruction following modified radical mastectomy were subject to clinical and mammographic examination. Three groups were formed: (a) autonomous tissue reconstruction (TRAM-flap; n = 9), (b) submuscular silicon gel prostheses (n = 21), and (c) supramuscular silicon gel prostheses (n = 9). Mammographic image quality of the groups was compared by two radiologists working together using a point system where five specific criteria were valued and scored. The result was tabulated into three quality levels: good, acceptable, and limited. Mammograms were assessed as good, acceptable, or limited, respectively, as follows: group I: 7 (77.8%), 1 (11.1%), 1 (11.1%); group II: 4 (19%), 11 (52.4%), 6 (28.6%); group III: 3 (33.3%), 4 (44.5%), 2 (22.2%). The TRAM-flap method of reconstruction displays a high degree of mammographic image quality and therefore is preferable with respect to early diagnosis of recurrent tumors.

  9. Endoscopic Ear Surgery: Critical Review of Anatomy and Physiology of Normal and Reconstructive Middle Ear.

    Science.gov (United States)

    Udagatti, Vithal D; Dinesh Kumar, Rajendran

    2016-06-01

    Middle ear anatomy is complex hence it is difficult to study the microscopic vibration of tympanic membrane and ossicles. The basic research has been done in few centres. Our experience is based on clinical data. The lack of quantitative understanding of structural and functional relationship in the mechanical response of the normal and reconstructed middle ear is major factor in poor hearing results after surgery (Merchant et al. in J Laryngol Otol 112:715-731, 1998). The vibration pattern of tympanic membrane changes with different frequencies. It depends upon shape, position and tension of tympanic membrane. Sometimes reconstructed tympanic membrane loses its shape and tension and thus its vibratory response (Pusalkar and Steinbach in Transplants and implants in otology II, 1992). Then what should be the shape, position, tension of the tympanic membrane and the ossicles. In order to have a serviceable hearing, dry and safe ear, there is a necessity of answering all these queries by us.

  10. Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT

    Directory of Open Access Journals (Sweden)

    Paulo Palma

    2010-04-01

    Full Text Available PURPOSE: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. MATERIALS AND METHODS: A total of 30 female patients with stress urinary incontinence (SUI, anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. RESULTS: In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. CONCLUSION: Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.

  11. Challenges and future prospects for tissue engineering in female pelvic medicine and reconstructive surgery.

    Science.gov (United States)

    Chen, Bertha; Dave, Bhumy

    2014-08-01

    With advances in material engineering there is now a wide array of new materials for augmentation of tissue repairs in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). However, clinical outcomes are discrepant and long term complications debilitating. In this manuscript, we describe the molecular and cellular host environments and biomechanical considerations that affect optimal integration of implant materials. There is growing interest in biodegradable scaffolds with cellular implants. It is thought that the cellular component could regenerate host tissue while the scaffold provides temporary mechanical properties. Current findings are promising, but detailed in vivo and long term testing is needed before clinical applications.

  12. Anaesthetic management in a child with an atypical triad for reconstructive scoliosis surgery

    Directory of Open Access Journals (Sweden)

    Jasveer Singh

    2013-01-01

    Full Text Available Scoliosis may be of varied aetiology and may be associated with severe congenital anomalies. It often poses a challenge in its anaesthetic management. We present anaesthetic management of a child who underwent scoliosis reconstruction with a rare triad of cerebral palsy, glucose-6-phosphate dehydrogenase deficiency and severe mitral regurgitation. Anaesthetic management in these patients should focus primarily on associated co-morbidities and congenital anomalies affecting the course of the perioperative management and thereafter comprehensive pre-operative strategies must be executed to enhance the safety profile during the surgery.

  13. The applications and research progresses of nickel-titanium shape memory alloy in reconstructive surgery.

    Science.gov (United States)

    Li, Qiang; Zeng, Yanjun; Tang, Xiaoying

    2010-06-01

    In spite of some good successes and excellent researches of nickel-titanium shape memory alloy (NiTi-SMA) in reconstructive surgery, there are still serious limitations to the clinical applications of NiTi alloy today. The potential leakage of elements and ions could be toxic to cells, tissues and organs. This review discussed the properties, clinical applications, corrosion performance, biocompatibility, the possible preventive measures to improve corrosion resistance by surface/structure modifications and the long-term challenges of using SMAs.

  14. Efficacy of an Intra-Operative Imaging Software System for Anatomic Anterior Cruciate Ligament Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Xudong Zhang

    2012-01-01

    Full Text Available An imaging software system was studied for improving the performance of anatomic anterior cruciate ligament (ACL reconstruction which requires identifying ACL insertion sites for bone tunnel placement. This software predicts and displays the insertion sites based on the literature data and patient-specific bony landmarks. Twenty orthopaedic surgeons performed simulated arthroscopic ACL surgeries on 20 knee specimens, first without and then with the visual guidance by fluoroscopic imaging, and their tunnel entry positions were recorded. The native ACL insertion morphologies of individual specimens were quantified in relation to CT-based bone models and then used to evaluate the software-generated insertion locations. Results suggested that the system was effective in leading surgeons to predetermined locations while the application of averaged insertion morphological information in individual surgeries can be susceptible to inaccuracy and uncertainty. Implications on challenges associated with developing engineering solutions to aid in re-creating or recognizing anatomy in surgical care delivery are discussed.

  15. Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery.

    Science.gov (United States)

    Miceli, Ana Lucia Carpi; Pereira, Livia Costa; Torres, Thiago da Silva; Calasans-Maia, Mônica Diuana; Louro, Rafael Seabra

    2017-12-01

    Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.

  16. Disclosure of Financial Conflicts of Interest in Plastic and Reconstructive Surgery.

    Science.gov (United States)

    Luce, Edward A; Jackman, Carye A

    2017-09-01

    Recent articles in the scientific literature have expressed concerns about financial conflicts of interest in the profession of medicine in general and the specialty of plastic surgery in particular. Disclosure of financial ties to industry has been regarded as an address of a possible bias. The policies of medical journals places responsibility on authors for self-reporting of financial conflicts of interest, yet underreporting of conflicts of interest has occurred. The investigative hypothesis was that authors in the plastic surgery literature, in particular, Plastic and Reconstructive Surgery, underreported financial conflicts of interest. A review of articles published in Plastic and Reconstructive Surgery from July of 2015 through April of 2016 for author disclosures was accomplished. The disclosure statements were compared to the information available in the Open Payments database for 2015. The lack of disclosure on the part of an author, when present, was individually examined for relevance of the corporate conflicts of interest to the subject matter of the involved article. A total of 302 articles authored by 1262 individuals were reviewed. One hundred thirty-nine (45.5 percent) had neither a disclosed nor an actual conflict of interest. In 61 articles (20.2 percent), one or more authors disclosed; 105 articles (34.8 percent) did not provide disclosure of a financial conflict of interest. In assessment of relevance, 10 undisclosed conflicts of interest (9.5 percent) were determined relevant, and one-third of that total were non-plastic surgeons. Nondisclosure of financial conflicts of interest is common, but only a small minority pose a potential for harm from bias.

  17. The registration of surgical site infections: a comparison of two different methods in vascular surgery.

    Science.gov (United States)

    Donker, Jeroen M W; Kluytmans, Jan A J W; Veen, Eelco J; Ho, Gwan H; Hendriks, Yvonne J A M; van der Laan, Lijckle

    2013-08-01

    Registration of complications of treatment is an important instrument for measuring the quality of health care. Reliable registration depends on definitions, the case-finding method that is used, and the registration method itself. We conducted a comparative study of two different methods of registration for the surveillance of surgical site infections (SSIs) in a single hospital. The study included all patients in both the surgical database and the microbiology and infection-prevention database of the hospital who underwent surgery on the abdominal aorta or peripheral vascular procedures from March 1, 2009 to March 1, 2010. The surgical database included positive scores for SSI in cases of positive wound swabs, the need for incision drainage, or the need for antibiotic treatment. The microbiology and infection-prevention database used criteria from the U.S. Centers for Disease Control and Prevention (CDC), and based positive scores on redness, heat, swelling, or pain in the area of a surgical incision within 30 d after a procedure, and on a positive swab, drainage from an incision, or the presence of pus following a diagnostic puncture. The surgical complication database included 218 patients, of whom 20 (9.2%) had a SSI. The microbiology and infection-prevention database included 236 patients, of whom 33 (14%) had a SSI. The databases were merged and all infections were ascertained by an expert team. The surgical database had a sensitivity of 57% for SSIs, whereas the microbiology and infection-prevention database had a sensitivity of 93% (pcare.

  18. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

    Directory of Open Access Journals (Sweden)

    Shagun Bhatia Shah

    2017-01-01

    Full Text Available Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.

  19. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

    Science.gov (United States)

    Shah, Shagun Bhatia; Hariharan, Uma; Bhargava, Ajay Kumar; Darlong, Laleng M.

    2017-01-01

    Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors’ personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search. PMID:28757834

  20. Bacterial antigen induced release of soluble vascular endothelial growth factor (VEGF) and VEGFR1 before and after surgery

    DEFF Research Database (Denmark)

    Svendsen, Mads N; Lykke, J; Werther, Kim

    2005-01-01

    OBJECTIVE: The influence of surgery on release of soluble vascular endothelial growth factor (sVEGF) and the soluble inhibitory receptor (sVEGFR1) is unknown. The effect of major and minor surgery on variations in sVEGF and sVEGFR1 concentrations in vivo was studied, and on bacterial antigen...... concentrations in plasma changed during surgery. In vitro stimulation of blood samples with bacteria-derived antigens resulted in a significant increase in sVEGF (p Bacterial antigen-induced release of sVEGF correlated...... significantly with neutrophil cell counts (0.53 Bacterial antigen-induced sVEGFR1 release did not correlate with cell counts. CONCLUSIONS: Plasma sVEGF and sVEGFR1 concentrations did not change during surgery. In vitro bacterial stimulation led to increased release of sVEGF, which...

  1. Dense soft tissue 3D reconstruction refined with super-pixel segmentation for robotic abdominal surgery.

    Science.gov (United States)

    Penza, Veronica; Ortiz, Jesús; Mattos, Leonardo S; Forgione, Antonello; De Momi, Elena

    2016-02-01

    Single-incision laparoscopic surgery decreases postoperative infections, but introduces limitations in the surgeon's maneuverability and in the surgical field of view. This work aims at enhancing intra-operative surgical visualization by exploiting the 3D information about the surgical site. An interactive guidance system is proposed wherein the pose of preoperative tissue models is updated online. A critical process involves the intra-operative acquisition of tissue surfaces. It can be achieved using stereoscopic imaging and 3D reconstruction techniques. This work contributes to this process by proposing new methods for improved dense 3D reconstruction of soft tissues, which allows a more accurate deformation identification and facilitates the registration process. Two methods for soft tissue 3D reconstruction are proposed: Method 1 follows the traditional approach of the block matching algorithm. Method 2 performs a nonparametric modified census transform to be more robust to illumination variation. The simple linear iterative clustering (SLIC) super-pixel algorithm is exploited for disparity refinement by filling holes in the disparity images. The methods were validated using two video datasets from the Hamlyn Centre, achieving an accuracy of 2.95 and 1.66 mm, respectively. A comparison with ground-truth data demonstrated the disparity refinement procedure: (1) increases the number of reconstructed points by up to 43 % and (2) does not affect the accuracy of the 3D reconstructions significantly. Both methods give results that compare favorably with the state-of-the-art methods. The computational time constraints their applicability in real time, but can be greatly improved by using a GPU implementation.

  2. Portal vein thrombosis after reconstruction in 270 consecutive patients with portal vein resections in hepatopancreatobiliary (HPB) surgery.

    Science.gov (United States)

    Miyazaki, Masaru; Shimizu, Hiroaki; Ohtuka, Masayuki; Kato, Atsushi; Yoshitomi, Hiroyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Takano, Shigetsugu; Suzuki, Daisuke; Higashihara, Taku

    2017-07-01

    This study was aimed to evaluate the occurrence of portal vein thrombosis after portal vein reconstruction. The portal veins were repaired with venorrhaphy, end-to-end, patch graft, and segmental graft in consecutive 270 patients undergoing hepato-pancreto-biliary (HPB) surgery. Portal vein thrombosis was encountered in 20 of 163 of end-to-end, 2 of 56 of venorrhaphy, and 2 of 5 of patch graft groups, as compared with 0 of 46 of segmental graft group (p Portal vein thrombosis occurred more frequently after hepatectomy than after pancreatectomy (p portal vein blood flow was more sufficiently achieved in the early re-operation within 3 days after surgery than in the late re-operation over 5 days after surgery (p portal vein reconstruction. The revision surgery for portal vein thrombosis should be performed within 3 days after surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Effects of weight loss after bariatric surgery for morbid obesity on vascular endothelial growth factor-A, adipocytokines, and insulin.

    Science.gov (United States)

    García de la Torre, Nuria; Rubio, Miguel A; Bordiú, Elena; Cabrerizo, Lucio; Aparicio, Eugenio; Hernández, Carmen; Sánchez-Pernaute, Andrés; Díez-Valladares, Luis; Torres, Antonio J; Puente, Montserrat; Charro, Aniceto L

    2008-11-01

    Adipocytes regulate blood vessel formation, and in turn endothelial cells promote preadipocyte differentiation through the expression of proangiogenic factors, such as vascular endothelial growth factor (VEGF)-A. Some adipocytokines and hormones also have an effect on vascular development. Our objectives were to analyze the relationship between weight and circulating VEGF-A in morbidly obese subjects before and after bariatric surgery, and investigate the relationship between circulating VEGF-A and certain adipocytokines and hormones regulating adipocytes. A total of 45 morbidly obese women and nine lean females were included in the study. Patients underwent bariatric surgery: vertical banded gastroplasty (n=17), gastric bypass (n=17), and biliopancreatic diversion (n=11). Serum samples for VEGF-A, adiponectin, leptin, ghrelin, and insulin were obtained preoperatively and 9-12 months after surgery. Obese patients showed significantly higher VEGF-A levels than controls (306.3+/-170.3 vs. 187.6+/-91.9 pg/ml; P=0.04), decreasing to 246.1+/-160.4 after surgery (Pghrelin (r=-0.85; PGhrelin was higher in controls than obese patients, decreasing after gastric bypass and biliopancreatic diversion, but not after vertical banded gastroplasty. Serum VEGF-A levels are significantly higher in obese patients than in lean controls, decreasing after weight loss with bariatric surgery, behaving similarly to other hormones related to adipose mass like leptin and insulin.

  4. Vascular Endothelial-Targeted Therapy Combined with Cytotoxic Chemotherapy Induces Inflammatory Intratumoral Infiltrates and Inhibits Tumor Relapses after Surgery

    Directory of Open Access Journals (Sweden)

    Brendan F. Judy

    2012-04-01

    Full Text Available Surgery is the most effective therapy for cancer in the United States, but disease still recurs in more than 40% of patients within 5 years after resection. Chemotherapy is given postoperatively to prevent relapses; however, this approach has had marginal success. After surgery, recurrent tumors depend on rapid neovascular proliferation to deliver nutrients and oxygen. Phosphatidylserine (PS is exposed on the vascular endothelial cells in the tumor microenvironment but is notably absent on blood vessels in normal tissues. Thus, PS is an attractive target for cancer therapy after surgery. Syngeneic mice bearing TC1 lung cancer tumors were treated with mch1N11 (a novel mouse chimeric monoclonal antibody that targets PS, cisplatin (cis, or combination after surgery. Tumor relapses and disease progression were decreased 90% by combination therapy compared with a 50% response rate for cis alone (P = .02. Mice receiving postoperative mch1N11 had no wound-related complications or added systemic toxicity in comparison to control animals. Mechanistic studies demonstrated that the effects of mch1N11 were associated with a dense infiltration of inflammatory cells, particularly granulocytes. This strategy was independent of the adaptive immune system. Together, these data suggest that vascular-targeted strategies directed against exposed PS may be a powerful adjunct to postoperative chemotherapy in preventing relapses after cancer surgery.

  5. The incidence of transfusion and associated risk factors in pelvic reconstructive surgery.

    Science.gov (United States)

    Pandya, Lopa K; Lynch, Courtney D; Hundley, Andrew F; Nekkanti, Silpa; Hudson, Catherine O

    2017-11-01

    Almost 400,000 female pelvic reconstructive operations were performed in 2010 for urinary incontinence and pelvic organ prolapse in the United States, and it is likely that this will continue to increase each year. There is a lack of population-based data evaluating the risk of blood transfusion after urogynecologic procedures. We sought to assess the incidence of blood transfusion related to pelvic reconstructive surgery in a large national surgical quality database and to identify transfusion-associated risk factors. This retrospective cohort study was performed using the National Surgical Quality Improvement Program database from the years 2010 through 2014. All women undergoing surgery for pelvic floor disorders were identified by Current Procedural Terminology code. Demographic and clinical variables were abstracted. The incidence of blood transfusion was determined. A multivariate logistic regression analysis was performed to identify clinical factors independently associated with blood transfusion. A total of 54,387 women underwent pelvic reconstructive surgery from 2010 through 2014 in the National Surgical Quality Improvement Program database. Of these subjects, 686 (1.26%) received a blood transfusion. The median age was 57 (range 28-89) years. Of the population, 0.81% was underweight (body mass index <18.5), 27.0% was normal weight (body mass index 18.5-24.9), 35.6% was overweight (body mass index 25-29.9), and 36.7% was obese (body mass index ≥30). The majority of subjects in the study cohort were Caucasian (91.4%) followed by African Americans (4.6%); the remainder included Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander. Hispanic ethnicity was reported in 9.3% of the population. American Society of Anesthesiologists class 1 and 2 represented a majority of the sample (76.5%). Concomitant hysterectomy was performed in 20,735 (38.1%) of the population. In the multivariate analysis, preoperative hematocrit <30% (odds ratio, 13

  6. Pancreaticojejuno-jejunostomy during reconstruction of the afferent loop in surgery of radiation-induced afferent loop obstruction following pancreaticoduodenectomy with Roux-en-Y reconstruction.

    Science.gov (United States)

    Blouhos, Konstantinos; Boulas, Konstantinos A; Tsiomita, Evridiki; Papageorgiou, Irene; Ioannidis, Konstantinos; Hatzigeorgiadis, Anestis

    2014-03-01

    Radiation-induced afferent loop obstruction is a rare complication following pancreaticoduodenectomy and adjuvant radiotherapy. As in the setting of Roux-en-Y reconstruction endoscopic approaches are limited, surgery of this complication becomes inevitable. This study provides a new classification/management system of the radiation-induced obstruction of the afferent loop based on the extent and location of radiation injury, and describes the Pancreaticojejuno-jejunostomy, a novel technique to avoid revision of the pancreatic anastomosis during reconstruction of the afferent loop. Data were analyzed from nine patients who developed radiation-induced afferent loop obstruction after pancreaticoduodenectomy with single Roux limb reconstruction. One patient had type I obstruction and treated with by-pass surgery, seven patients had type II obstruction and treated with reconstruction including revision of the hepaticojejunostomy and Pancreaticojejuno-jejunostomy, and one patient had type III obstruction and treated with reconstruction including revision of the hepaticojejunostomy and the pancreatic anastomosis. Reconstruction along with Pancreaticojejuno-jejunostomy performed in six patients with type II radiation-induced afferent loop obstruction; reconstruction was not feasible for one patient. The median operative time was 149 min. No intraoperative complication was observed. By performing Pancreaticojejuno-jejunostomy we managed efficiently to convert a pancreatic anastomosis to an enteric anastomosis as one case of Grade B pancreatic fistula and no case of Pancreaticojejuno-jejunostomy stricture were observed, regarding short- and long-term results, respectively. The above technique may have a useful application in the surgical management of the radiation-induced afferent loop obstruction when endoscopy fails and by-pass surgery is inappropriate.

  7. Magnitude of Myocutaneous Flaps and Factors Associated With Loss of Volume in Oral Cancer Reconstructive Surgery.

    Science.gov (United States)

    Sakamoto, Yuki; Yanamoto, Souichi; Ota, Yoshihide; Furudoi, Shungo; Komori, Takahide; Umeda, Masahiro

    2016-03-01

    Myocutaneous flaps are often used to repair oral and maxillofacial defects after surgery for oral cancer; however, their volume decreases during the postoperative period. To facilitate treatment planning, the authors measured the extent of such postoperative flap volume loss and identified associated factors in patients who underwent oral reconstruction with myocutaneous flaps. The authors designed and performed a retrospective observational study of patients who underwent reconstructive procedures involving rectus abdominal myocutaneous (RAM) or pectoralis major myocutaneous (PMMC) flaps at Tokai University Hospital, Kobe University Hospital, or Nagasaki University Hospital from April 2009 through March 2013. Flap type and other clinical variables were examined as potential predictors of flap loss. The primary outcome was flap loss at 6 months postoperatively. Correlations between each potential predictor and the primary outcome were examined using multiple regression analysis. The subjects were 75 patients whose oral defects were reconstructed with RAM flaps (n = 57) or PMMC flaps (n = 18). RAM flaps exhibited a mean volume shrinkage of 22% at 6 months postoperatively, which was less than the 27.5% displayed by the PMMC flaps, but the difference was not important. Renal failure, previous surgery of the oral region, postoperative radiotherapy, and postoperative serum albumin level were found to be meaningful risk factors for postoperative flap volume loss. The results of this study suggest that larger flaps should be used in patients who possess these risk factors or are scheduled to undergo postoperative radiotherapy. Future studies should examine the utility of postoperative nutritional management for preventing flap volume loss. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  8. [Treatment and outcome of polypropylene mesh or tape related pain after reconstructive pelvic surgery].

    Science.gov (United States)

    Wang, Y Q; Yang, X; Wang, J L

    2016-12-25

    Objective: To investigate clinical treatment and outcome of mesh-related pain after pelvic floor reconstruction. Methods: Twelve patients were referred to Peking University People's Hospital for post-operation pain related to polypropylene mesh or tape used in pelvic floor reconstruction and received reoperation from January 2007 to December 2014. The demographic characteristics, clinical manifestation, operation method and follow-up outcome were retrospectively analyzed, and current literature was also reviewed. Results: (1) General information: the median age was 54 years old (range 43-74 years old). The median vaginal delivery times was 2 (range 1-5). Initial pelvic floor operation procedures included 4 cases vaginal mesh, 5 cases vaginal mesh plus tension-free vaginal tape (TVT), 1 case rectal surface mesh implantation, and 2 cases sacrocolpopexy. (2) Related complications: all 12 patients had pain-related post-operation symptoms including dyspareunia, perineal pain, urination and defecation difficulty. Seven patients also complicated with other symptoms including discharge and bleeding. Mean time from first operation to medical consultation was 30 months (range 1-72 months). (3) Reoperation results: all 12 patients received reoperation on mesh revision or tape, 10 cases of them reoperated by vaginal approach, while the other 2 cases by laparoscopy. The range of the mesh or tape depended on tender or firm tissue and scar by palpation. The visual analogue scale (VAS) was significantly improved, which was 7.1 ± 2.2 pre-operation, and 0.9 ± 1.9 post-operation (95% CI: 4.48-7.86, P<0.01). Conclusions: Pain is one of the reason why patients was removal of the mesh or tape after pelvic floor reconstruction operation. The surgery procedure may be considered as partial or entire mesh or tape excision by vaginal or abdominal way. Mesh or tape removal surgery could relieve related pain and other complications, and the VAS score was significantly improved after surgical

  9. Robot-assisted reconstructive surgery of the distal ureter: single institution experience in 16 patients.

    Science.gov (United States)

    Musch, Michael; Hohenhorst, Lukas; Pailliart, Anne; Loewen, Heinrich; Davoudi, Yadollah; Kroepfl, Darko

    2013-05-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Open reconstructive surgery of the lower ureteric segment in adults often requires large incisions, as the basic prerequisite for such complex procedures is wide exposure. Published experience on minimally invasive techniques in this challenging surgical field, e.g. conventional laparoscopy or robot-assisted laparoscopy, still remains limited. We report our experience from one of the largest single institution series on robot-assisted reconstructive surgery of the distal ureter in adults, with a special focus on technical aspects of the different surgical procedures. To describe the feasibility of and operative techniques used during different daVinci® robot-assisted laparoscopic reconstructive procedures of the distal ureter, and to report the short-term outcome of such procedures. Between June 2009 and October 2011, 16 patients underwent robot-assisted operations of the distal ureter because of various underlying pathological conditions. We present a description of each procedure, the incidence of perioperative complications and the results of follow-up examination. The data were collected retrospectively using the patients' records and questionnaires sent to the patients and the referring urologists. The follow-up examinations were done at the discretion of the referring urologists. The surgical indications and operative techniques were as follows: seven distal ureteric resections [DUR] with psoas hitch procedures (+/- Boari flap; four), extravesical reimplantation (two) or end-to-end anastomosis (one) because of benign distal ureteric stricture; four DUR with psoas hitch procedure (+/- Boari flap) and pelvic lymphadenectomy for urothelial carcinoma of the ureter; one DUR with psoas hitch procedure and Boari flap because of unexpected locally recurrent prostate cancer; one extravesical reimplantation because of vesico-ureteric reflux; one bilateral intravesical reimplantation of ectopic ureters (as part

  10. Validation of the Caprini Risk Assessment Model in Plastic and Reconstructive Surgery Patients

    Science.gov (United States)

    Pannucci, Christopher J.; Bailey, Steven H.; Dreszer, George; Fisher, Christine; Zumsteg, Justin W.; Jaber, Reda M.; Hamill, Jennifer B.; Hume, Keith M.; Rubin, J. Peter; Neligan, Peter C.; Kallianen, Loree K.; Hoxworth, Ronald E.; Pusic, Andrea L.; Wilkins, Edwin G.

    2010-01-01

    Background The VTEPS Network is a consortium of five tertiary referral centers established to examine venous thromboembolism in plastic surgery patients. We report our mid-term analyses of the study’s control group to 1) evaluate the incidence of VTE in patients who receive no chemoprophylaxis and 2) validate the Caprini Risk Assessment Model (RAM) in plastic surgery patients. Study Design Medical record review was performed at VTEPS centers for all eligible plastic surgery patients between March 2006 and June 2009. Inclusion criteria were Caprini score ≥ 3, surgery under general anesthesia, and post-operative hospital admission. Patients who received chemoprophylaxis were excluded. Dependent variables included symptomatic DVT or PE within the first 60 post-operative days and time to DVT or PE. Results We identified 1126 historic control patients. The overall VTE incidence was 1.69%. Approximately one in nine (11.3%) patients with Caprini score >8 had a VTE event. Patients with Caprini score >8 were significantly more likely to develop VTE when compared to patients with Caprini score of 3–4 (OR 20.9, p8, VTE risk was not limited to the immediate post-operative period. Conclusions The Caprini RAM effectively risk-stratifies plastic and reconstructive surgery patients for VTE risk. Among patients with Caprini score >8, 11.3% have a post-operative VTE when chemoprophylaxis is not provided. In higher risk patients, there was no evidence that VTE risk is limited to the immediate post-operative period. PMID:21093314

  11. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study.

    Science.gov (United States)

    O'Neil-Callahan, Kristin; Katsimaglis, George; Tepper, Micah R; Ryan, Jason; Mosby, Carla; Ioannidis, John P A; Danias, Peter G

    2005-02-01

    We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery. Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter. A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect. Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p = 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p = 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins. Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.

  12. Dermatofibrosarcoma Protuberans: The role of tissue expansion in reconstructive surgery of the scalp.

    Science.gov (United States)

    Maguire, Richard; Nikolorakos, Dimitrios; Lam, Alfred

    2016-01-01

    Dermatofibrosarcoma Protuberans is an uncommon tumour, making up less than 0.1% of all malignancies. With regards to soft tissue tumours; this pathology is thought to make up less than 2% of the sum total. Traditionally treatment has been wide local excision, with or without adjuvant radiotherapy. We present a case of a 42 year old man referred by his GP with a lump on the right parietal region of the scalp. An USS done by his GP revealed a complex hypoechoic cystic mass, some 2cm×1cm×2cm. Excision biopsy was performed and on review of the pathology it was noted that the lesion was a Dermatofibrosarcoma Protuberans. Due to the relatively low grade of this sarcoma, it was decided to treat with wide local excision with 2-4cm margins. The expected residual scalp defect would be difficult to close with local flaps. To facilitate closure tissue expansion was undertaken for 6 weeks prior to definitive surgery. With regards to tumours of the head and neck, use of a tissue expander has been recommended to improve cosmetic outcomes following respective surgery with wide margins. Ultimately the timing of tissue expansion i.e. before/after resection of the tumour, must weight the risk of delayed resective surgery on prognosis against the benefits of this reconstructive technique. Head and neck tumours requiring careful reconstruction may benefit from tissue expansion to provide adequate volumes of matching soft tissue, as shown in this case. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  13. Postoperative bowel function, symptoms, and habits in women after vaginal reconstructive surgery.

    Science.gov (United States)

    Ballard, Alicia; Parker-Autry, Candace; Lin, Chee Paul; Markland, Alayne D; Ellington, David R; Richter, Holly E

    2015-06-01

    The objective was to characterize postoperative bowel symptoms in women undergoing vaginal prolapse reconstructive surgery randomized to preoperative bowel preparation vs a regular diet. Subjects (N = 121) completed two bowel diaries: a 7-day bowel diary immediately before surgery and a 14-day diary postoperatively. Self-reported bowel diary data and symptoms included the time to first bowel movement (BM), daily number of BMs, Bristol Stool Form Scale score, pain, and urgency associated with BM, episodes of fecal incontinence, and use of laxatives. Antiemetic use was abstracted from medical records. Outcomes of groups were compared using Chi-squared/Fisher's exact test or Student's t test as appropriate. Mean time to first postoperative BM was similar in the bowel preparation (n = 60) and control groups (n = 61), 81.2 ± 28.9 vs 78.6 ± 28.2 h, p = 0.85. With the first BM, there were no significant differences between bowel preparation and control groups regarding pain (17.2 vs 27.9 %, p = 0.17), fecal urgency with defecation (56.9 vs 52.5 %, p = 0.63), fecal incontinence (14.0 vs 15.0 %, p = 0.88) and >1 use of laxatives (93.3 vs 96.7 % p = 0.44) respectively. Antiemetic use was similar in both groups (48.3 vs 55.7 % respectively, p = 0.42). There were no differences in the return of bowel function and other bowel symptoms postoperatively between the randomized groups. Lack of bowel preparation does not have an impact on the risk of painful defecation postoperatively. This information may be used to inform patients regarding expectations for bowel function after vaginal reconstructive surgery.

  14. Renal function interferes with copeptin in prediction of major adverse cardiac events in patients undergoing vascular surgery.

    Directory of Open Access Journals (Sweden)

    Claudia Schrimpf

    Full Text Available Precise perioperative risk stratification is important in vascular surgery patients who are at high risk for major adverse cardiovascular events (MACE peri- and postoperatively. In clinical practice, the patient's perioperative risk is predicted by various indicators, e.g. revised cardiac index (RCRI or modifications thereof. Patients suffering from chronic kidney disease (CKD are stratified into a higher risk category. We hypothesized that Copeptin as a novel biomarker for hemodynamic stress could help to improve the prediction of perioperative cardiovascular events in patients undergoing vascular surgery including patients with chronic kidney disease.477 consecutive patients undergoing abdominal aortic, peripheral arterial or carotid surgery from June 2007 to October 2012 were prospectively enrolled. Primary endpoint was 30-day postoperative major adverse cardiovascular events (MACE.41 patients reached the primary endpoint, including 63.4% aortic, 26.8% carotid, and 9.8% peripheral surgeries. Linear regression analysis showed that RCRI (P< .001, pre- (P< .001, postoperative Copeptin (P< .001 and Copeptin level change (P= .001 were associated with perioperative MACE, but CKD remained independently associated with MACE and Copeptin levels. Multivariate regression showed that increased Copeptin levels added risk predictive information to the RCRI (P= .003. Especially in the intermediate RCRI categories was Copeptin significantly associated with the occurrence of MACE. (P< .05 Kruskal Wallis test. Subdivision of the study cohort into CKD stages revealed that preoperative Copeptin was significantly associated with CKD stages (P< .0001 and preoperative Copeptin measurements could not predict MACE in patients with more severe CKD stages.Preoperative Copeptin loses its risk predictive potential for perioperative MACE in patients with chronic kidney disease undergoing vascular surgery.

  15. A Scientometric Analysis of 20 Years of Research on Breast Reconstruction Surgery: A Guide for Research Design and Journal Selection

    Directory of Open Access Journals (Sweden)

    Mehrdad Moghimi

    2013-03-01

    Full Text Available Background Breast reconstruction refers to the rebuilding of a woman’s breast usingautologous tissue or prosthetic material to form a natural-looking breast. It is increasinglyoffered to women undergoing mastectomy for breast cancer. However, there is no systematicanalysis available for the expanding area of research on breast reconstruction.Methods A bibliometric method was used to obtain a view of the scientific production aboutbreast reconstruction by data extracted from the Institute for Scientific Information (ISI.Specific parameters were retrieved from the ISI. Articles about breast reconstruction wereanalyzed to obtain a view of the topic’s structure, history, and document relationships usingHistCite software. Trends in the most influential publications and authors were analyzed.Results The number of articles was constantly increasing. Most highly cited articles describedthe methods of flap construction in the surgery. Other highly cited articles discussed thepsychological or emotional aspects of breast reconstruction, skin sparing mastectomy, andbreast reconstruction in the irradiated breast.Conclusions This was the first breast reconstruction scientometric analysis, representing thecharacteristics of papers and the trends of scientific production. A constant increase in thenumber of breast reconstruction papers and also the increasing number of citations showsthat there is an increasing interest in this area of medical science. It seems that most of theresearch in this field is focused on the technical aspects of surgery.

  16. Fondaparinux for intra and perioperative anticoagulation in patients with heparin-induced thrombocytopenia candidates for peripheral vascular surgery: Report of 4 cases

    Directory of Open Access Journals (Sweden)

    Giulio Illuminati, MD

    2016-01-01

    Conclusions: These preliminary results seem to justify the off-label use of fondaparinux for intra and perioperative anticoagulation in patients with HIT, candidates for peripheral vascular surgery interventions.

  17. Vascular blood flow reconstruction from tomographic projections with the adjoint method and receding optimal control strategy

    Science.gov (United States)

    Sixou, B.; Boissel, L.; Sigovan, M.

    2017-10-01

    In this work, we study the measurement of blood velocity with contrast enhanced computed tomography. The inverse problem is formulated as an optimal control problem with the transport equation as constraint. The velocity field is reconstructed with a receding optimal control strategy and the adjoint method. The convergence of the method is fast.

  18. Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery.

    Science.gov (United States)

    O'Connell, Rachel L; Stevens, Roger J G; Harris, Paul A; Rusby, Jennifer E

    2015-08-01

    Three-dimensional surface imaging (3D-SI) is being marketed as a tool in aesthetic breast surgery. It has recently also been studied in the objective evaluation of cosmetic outcome of oncological procedures. The aim of this review is to summarise the use of 3D-SI in oncoplastic, reconstructive and aesthetic breast surgery. An extensive literature review was undertaken to identify published studies. Two reviewers independently screened all abstracts and selected relevant articles using specific inclusion criteria. Seventy two articles relating to 3D-SI for breast surgery were identified. These covered endpoints such as image acquisition, calculations and data obtainable, comparison of 3D and 2D imaging and clinical research applications of 3D-SI. The literature provides a favourable view of 3D-SI. However, evidence of its superiority over current methods of clinical decision making, surgical planning, communication and evaluation of outcome is required before it can be accepted into mainstream practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Individual prefabricated titanium implants and titanium mesh in skull base reconstructive surgery. A report of cases.

    Science.gov (United States)

    Schipper, J; Ridder, G J; Spetzger, U; Teszler, C B; Fradis, M; Maier, W

    2004-05-01

    Titanium implants can be shaped by traditional hand forming, press shaping, modular construction by welding, construction on full-size models shaped from CT coordinates and, most recently, by computer-assisted design and computer-assisted manufacturing (CAD/CAM) that consist in the direct prefabrication of individual implants by milling them out of a solid block of titanium. The aim of our study was to present a set of preliminary cases of an ongoing program of reconstructive procedures of the skull base using titanium implants. The subjects underwent ablative procedures of the skull base with reconstruction either by titanium mesh or individual prefabricated CAD/CAM implants. Six patients have been operated on successfully since 2000: two received prefabricated CAD/CAM titanium plates and four others underwent reconstruction with titanium mesh. The stability of CAD/CAM plates is superior to that of mesh, thus it is more useful in reconstructing large lesions of the frontal skull base and the temporal and occipital bones. Titanium mesh was successfully used for defects smaller than 100 cm(2) or where selected viscerocranial defects are complicated in design and less reproducible by CAD/CAM. The intraoperative design, shaping and adjustment characteristic of titanium mesh can be dispensed with when CAD/CAM implants are used. The 3-D data set used in the CAD/CAM process also operates in the navigated simulation and planning of the ablation contours, the latter being of great assistance in establishing the optimal future defect. As a disadvantage, CAD/CAM technology is more expensive than titanium mesh, and the process is time-consuming as it is carried out in advance of surgery.

  20. Association Between Hospital Financial Distress and Immediate Breast Reconstruction Surgery After Mastectomy Among Women With Ductal Carcinoma In Situ.

    Science.gov (United States)

    Richards, Catherine A; Rundle, Andrew G; Wright, Jason D; Hershman, Dawn L

    2017-12-06

    Hospital financial distress (HFD) is a state in which a hospital is at risk of closure because of its financial condition. Hospital financial distress may reduce the services a hospital can offer, particularly unprofitable ones. Few studies have assessed the association of HFD with quality of care. To examine the association between HFD and receipt of immediate breast reconstruction surgery after mastectomy among women diagnosed with ductal carcinoma in situ (DCIS). This retrospective cohort study assessed data from the Nationwide Inpatient Sample of 5760 women older than 18 years (mean [SD] age: 57.5 [13.2]) with DCIS who underwent mastectomy in 2008-2012 at hospitals categorized by financial distress. Women treated at 1156 hospitals located in 538 different counties across Arkansas, Arizona, California, Colorado, Connecticut, Florida, Iowa, Kentucky, Massachusetts, Maryland, Missouri, North Carolina, New Hampshire, New Jersey, Nevada, New York, Oregon, Pennsylvania, Rhode Island, Utah, Virginia, Vermont, Washington, Wisconsin, West Virginia, and Wyoming were included. Of these, 2385 women (41.4%) underwent immediate breast reconstruction surgery. Women with invasive cancer were excluded. The database included unique hospital identification variables, and participants were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Data were analyzed from January 1, 2012, to February 28, 2014. The primary outcome was the adjusted association between HFD and receipt of immediate breast reconstruction surgery after mastectomy. In this analysis of database information, 2385 of 5760 women (41.4%) received immediate breast reconstruction surgery. Of these, 693 (36.7%) were treated at a hospital under high HFD and received immediate breast reconstruction surgery compared with 863 (44.0%) treated at a hospital under low HFD (P financial strength of the hospital where a patient receives treatment is associated with receipt of

  1. Efficacy of a hyperglycemia treatment program in a Vascular Surgery Department supervised by Endocrinology.

    Science.gov (United States)

    Caimari, Francisca; González, Cintia; Ramos, Analía; Chico, Ana; Cubero, José M; Pérez, Antonio

    2016-01-01

    The aim of this study was to evaluate the strategy and efficacy of a hyperglycemia treatment program supervised by Endocrinology. All patients with type 2 diabetes hospitalized at the vascular surgery department over a 12 month period were retrospectively reviewed. Clinical characteristics and hyperglycemia treatment during hospitalization, at discharge and 2-6 month after discharge were collected. Glycemic control was assessed using capillary blood glucose profiles and HbA1c at admission and 2-6 months post-discharge. A total of 140 hospitalizations of 123 patients were included. The protocol to choose the insulin regimen was applied in 96.4% of patients (22.8% correction dose, 23.6% basal-correction dose and 50% basal-bolus-correction dose [BBC]). Patients with BBC had higher HbA1c (7.7±1.5% vs. 6.7 ±0.8%; P<.001) and mean glycemia on the first day of hospitalization (184.4±59.2 vs. 140.5±31.4mg/dl; P<.001). Mean blood glucose was reduced to 162.1±41.8mg/dl in the middle and 160.8±43.3mg/dl in the last 24h of hospitalization in patients with BBC (P=.007), but did not change in the remaining patients. In 22.1% patients with treatment changes performed at discharge, HbA1c decreased from 8.2±1.6 to 6.8±1.6% at 2-6 months post-discharge (P=.019). The hyperglycemia treatment protocol applied by an endocrinologist in the hospital, allows the identification of the appropriate therapy and the improvement of the glycemic control during hospitalization and discharge, supporting its efficacy in clinical practice. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Free jejunal graft for esophageal reconstruction using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.

    Science.gov (United States)

    Lee, Hyun-Sung; Park, Seong Yong; Jang, Hee-Jin; Kim, Moon Soo; Lee, Jong Mog; Zo, Jae Ill

    2012-06-01

    Pharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy. The jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG. The mean age was 61.5±9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5±8.1 and 15.8±4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy. Our technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Preoperative planning of thoracic surgery with use of three-dimensional reconstruction, rapid prototyping, simulation and virtual navigation.

    Science.gov (United States)

    Heuts, Samuel; Sardari Nia, Peyman; Maessen, Jos G

    2016-01-01

    For the past decades, surgeries have become more complex, due to the increasing age of the patient population referred for thoracic surgery, more complex pathology and the emergence of minimally invasive thoracic surgery. Together with the early detection of thoracic disease as a result of innovations in diagnostic possibilities and the paradigm shift to personalized medicine, preoperative planning is becoming an indispensable and crucial aspect of surgery. Several new techniques facilitating this paradigm shift have emerged. Pre-operative marking and staining of lesions are already a widely accepted method of preoperative planning in thoracic surgery. However, three-dimensional (3D) image reconstructions, virtual simulation and rapid prototyping (RP) are still in development phase. These new techniques are expected to become an important part of the standard work-up of patients undergoing thoracic surgery in the future. This review aims at graphically presenting and summarizing these new diagnostic and therapeutic tools.

  4. Periosteal ossification of the vascular pedicle after reconstruction of continuity defects of the mandible and the maxilla with fibular free flaps: a retrospective study

    NARCIS (Netherlands)

    Karagozoglu, K.H.; Winters, H.A.H.; Forouzanfar, T.; Schulten, E.A.J.M.

    2013-01-01

    Periosteal ossification of the vascular pedicle of a fibular free flap after reconstruction of mandibular and maxillary continuity defects has been thought to be rare. The purpose of this study was to evaluate its incidence and contributory factors to its development.

  5. A Prospective and Controlled Clinical Trial on Stromal Vascular Fraction Enriched Fat Grafts in Secondary Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    L. A. L. Tissiani

    2016-01-01

    Full Text Available Background. Fat grafting is a tremendous tool in secondary breast reconstruction. Stromal vascular fraction (SVF enriched fat grafts have been presenting promising results regarding volume maintenance. Methods. We developed a method that produces a superior SVF enrichment rate (2 : 1 in the operating theatre. This prospective and controlled trial analyzed quantitatively and qualitatively fat grafts with (stem cells group, SG and without (control group, CG SVF enrichment in secondary breast reconstruction, through MRI-based volumetry, immunophenotyping, and cell counting. Also, patient satisfaction, aesthetic outcomes, and complications were analyzed. Results. Volumetric persistence in the SG was 78,9% and 51,4% in the CG; however it did not reach statistical significant difference. CD90 was the only marker highly expressed in the SG and showed a positive correlation with volumetric persistence (r=0.651, p=0.03. Fat necrosis occurred in 4 patients in the SG and in none in the CG. Patients in the CG showed a trend to be more satisfied. Considering aesthetics, both groups presented improvements. No locoregional recurrences were observed. Conclusions. Results are encouraging despite the fact that SVF enrichment in a higher supplementation rate did not improve, with statistical significance, fat graft volumetric persistence. Enriched fat grafts have proven to be safe in a 3-year follow-up.

  6. Craniofacial approaches and reconstruction in skull base surgery: techniques for the oral and maxillofacial surgeon.

    Science.gov (United States)

    Treasure, Trevor E; Dean, Jeffrey S; Gear, Robert D

    2013-12-01

    Skull base surgery (SBS) is considered the standard of care in treating benign and malignant lesions of the cranial base. SBS is a multidisciplinary team approach used to treat these complex lesions that may have intracranial extension. SBS can be broken down into 3 steps. Transfacial access is performed, followed by resection with sound oncologic principles, and then reconstruction of the cranial base and facial structures. Functional and esthetic concerns must be addressed by the surgeons. Oral and maxillofacial surgeons frequently perform elective facial osteotomies and treat victims of cranial base trauma. These same principles can be applied to SBS as a part of the skull base team. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality.

    Science.gov (United States)

    Oda, Seitaro; Weissman, Gaby; Vembar, Mani; Weigold, Wm Guy

    2015-01-01

    The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality--graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality--was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. • Cardiac CT before redo surgery may mitigate increased risk • Iterative model reconstruction is the next generation in iterative reconstruction • Iterative model reconstruction improves the image quality in cardiac CT.

  8. [Application of posterior spinal canal reconstruction in surgery of intraspinal tumor].

    Science.gov (United States)

    Ye, Qing; Huang, Wu; He, Yunsong; Nong, Mingshan; Liang, Tiansen; Tan, Suzhen; Yang, Xing

    2014-08-01

    that at preoperation (47.83 ± 7.25). The results of symptom improvement were excellent in 36 cases, good in 10 cases, fair in 1 case, and poor in 1 case; the excellent and good rate was 95.83%. At last follow-up, Frankel grade was improved significantly (Z = 13.32, P = 0.00) when compared with preoperative grade except 1 recurrent patient. The application of the H-shaped allogeneic bone graft combined with spinous process replantation can well reconstruct the posterior spinal canal, and also can effectively avoid iatrogenic spinal stenosis, so it is worthy of promoting in the clinical treatment of intraspinal tumor surgery.

  9. Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis.

    Science.gov (United States)

    Iyer, Rajiv R; Wu, Adela; Macmillan, Alexandra; Musavi, Leila; Cho, Regina; Lopez, Joseph; Jallo, George I; Dorafshar, Amir H; Ahn, Edward S

    2018-01-01

    Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and

  10. Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

    Science.gov (United States)

    Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao

    2014-05-23

    The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of

  11. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part II--Breast reconstruction after total mastectomy.

    Science.gov (United States)

    Blondeel, Phillip N; Hijjawi, John; Depypere, Herman; Roche, Nathalie; Van Landuyt, Koenraad

    2009-03-01

    This is Part II of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. This part describes how one can optimize results with breast reconstructions after complete mastectomy. For both primary and secondary reconstructions, the authors explain how to analyze the mastectomized breast and the deformed chest wall, before giving step-by-step guidelines for rebuilding the entire breast with either autologous tissue or implants. The differences in shaping unilateral or bilateral breast reconstructions with autologous tissue are clarified. Regardless of timing or method of reconstruction, it is shown that by breaking down the surgical strategy into three easy (anatomical) steps, the reconstructive surgeon will be able to provide more aesthetically pleasing and reproducible results. Throughout these four parts, the three-step principle will be the red line on which to fall back to define the problem and to propose a solution.

  12. Growing skin: A computational model for skin expansion in reconstructive surgery

    Science.gov (United States)

    Buganza Tepole, Adrián; Joseph Ploch, Christopher; Wong, Jonathan; Gosain, Arun K.; Kuhl, Ellen

    2011-10-01

    The goal of this manuscript is to establish a novel computational model for stretch-induced skin growth during tissue expansion. Tissue expansion is a common surgical procedure to grow extra skin for reconstructing birth defects, burn injuries, or cancerous breasts. To model skin growth within the framework of nonlinear continuum mechanics, we adopt the multiplicative decomposition of the deformation gradient into an elastic and a growth part. Within this concept, we characterize growth as an irreversible, stretch-driven, transversely isotropic process parameterized in terms of a single scalar-valued growth multiplier, the in-plane area growth. To discretize its evolution in time, we apply an unconditionally stable, implicit Euler backward scheme. To discretize it in space, we utilize the finite element method. For maximum algorithmic efficiency and optimal convergence, we suggest an inner Newton iteration to locally update the growth multiplier at each integration point. This iteration is embedded within an outer Newton iteration to globally update the deformation at each finite element node. To demonstrate the characteristic features of skin growth, we simulate the process of gradual tissue expander inflation. To visualize growth-induced residual stresses, we simulate a subsequent tissue expander deflation. In particular, we compare the spatio-temporal evolution of area growth, elastic strains, and residual stresses for four commonly available tissue expander geometries. We believe that predictive computational modeling can open new avenues in reconstructive surgery to rationalize and standardize clinical process parameters such as expander geometry, expander size, expander placement, and inflation timing.

  13. Spatial Registration for a Three-Arm Robot Assisted Mandible Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Yonggui Wang

    2015-01-01

    Full Text Available The three-arm surgical robot system assisted mandible reconstruction surgery (TMR-MRS is developed to repair the mandible defects caused by congenital defect, trauma, or acquired disease. The surgical robot system is divided into four parts, including 3D reconstructed image subsystem, robotic subsystem, optical measurement subsystem, and patient subsystem. The spatial registration based on quaternion is proposed to obtain the transformation relationship between four surgical subsystems. A method of hand-eye coordination is presented to control the end-effector of the robot arm to target position according to surgical planning. A least square error criterion is developed to optimize and compensate the hand-eye coordination method. In addition, the position of fibular implant in the robot space is calculated when it is grasped by end-effector of robot middle arm. Finally, the positioning accuracy tests and skull model experiments were conducted to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.

  14. Reconstructive methods in Mohs micrographic surgery in Uruguay: A bidirectional descriptive cohort analysis.

    Science.gov (United States)

    Navarrete, J; Magliano, J; Martínez, M; Bazzano, C

    2017-12-14

    The primary goal of Mohs micrographic surgery (MMS) is to completely excise a cancerous lesion and a wide range of reconstructive techniques of varying complexity are used to close the resulting wound. In this study, we performed a descriptive analysis of patients who underwent MMS, with a focus on wound closure methods. We conducted a bidirectional descriptive cohort analysis of all MMS procedures performed by a single surgeon between November 2013 and April 2016. Cosmetic outcomes were photographically assessed by a dermatologist after a minimum follow-up of 90 days. We analyzed 100 MMS procedures in 71 patients with a median age of 73 years. The tumors were basal cell carcinoma (70%), squamous cell carcinoma (29%), and dermatofibrosarcoma protuberans (1%); 75% were located on the head and neck. The reconstructive techniques used were flap closure (48%), simple closure (36%), closure by second intention (11%), and other (5%). Cosmetic outcomes were assessed for 70 procedures (47 patients) and the results were rated as excellent in 20% of cases, very good in 40%, good in 20%, moderate in 17%, and bad/very bad in 2.9%. No significant associations were observed between cosmetic outcome and sex, Fitzpatrick skin type, hypertension, diabetes mellitus, or smoking. Worse outcomes, however, were significantly associated with larger tumor areas and defects, location on the trunk, and flap and second-intention closure. Although there was a tendency to use simple wound closure for lesions located on the trunk and surgical defects of under 4.4cm2, the choice of reconstructive technique should be determined by individual circumstances with contemplation of clinical and tumor-related factors and the preference and experience of the surgeon. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Vaginal reconstructive surgery for severe pelvic organ prolapses: a 'uterine-sparing' technique using polypropylene prostheses.

    Science.gov (United States)

    De Vita, D; Araco, F; Gravante, G; Sesti, F; Piccione, E

    2008-08-01

    The Ulmsten's "Integral Theory" for pelvic floor dysfunctions is based on the need to reinforce fascias and ligaments with prostheses to obtain a reconstitution of the pelvic floor's anatomy. In September 2004 we developed a "uterine-sparing" surgical technique to correct such pathologies and in this paper we present results obtained. Primary outcome was to evaluate the technique's efficacy, secondary outcomes the resolution of stress urinary incontinence, postoperative pain (VAS scale), safety and complications. This prospective study included patients affected by stage 3 and 4 uterine-vaginal prolapse who wished to conserve their uterus. Those with (1) minor degrees of severity, (2) unfit for surgery, (3) with a clear indication to hysterectomy (i.e. endometrial cancer), (4) with an elevated operative risk (American Society of Anaesthesiologists-ASA score III and IV), (5) previous vaginal surgeries and (6) with moderate/severe defecation problems were excluded. The technique consisted in a sacrospinous colposuspension with polypropylene mesh. The pelvic status was classified according to the international Pelvic Organ Prolapse staging system (POP-Q). Postoperative pain was scored with the VAS Scale. All patients were given the King's Health questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Wexner questionnaire. From September 2004 to November 2006 we treated 80 patients. Polypropylene prostheses (Gynemesh-Soft PS, 10cmx15cm - GyneMesh, Gynecare Ethicon - Somerville, NJ, USA) were used to reconstruct the pubo-cervix or the recto-vaginal fascia. We performed an anterior-central vaginal reconstruction in 35 (43.8%) patients, central-posterior in 25 (31%) and total reconstruction in 20 (25%). The median follow-up was 21 months (range 18-26). The severe pelvic prolapse, evaluated with the POP-Q System, was completely treated in all the patients and no recurrences were observed. The urodynamic examination showed a

  16. Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery

    Science.gov (United States)

    2011-01-01

    Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH) data set were prepared and used in the study. Three-dimensional (3D) computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP). All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical operations by its relative

  17. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society.

    Science.gov (United States)

    Dort, Joseph C; Farwell, D Gregory; Findlay, Merran; Huber, Gerhard F; Kerr, Paul; Shea-Budgell, Melissa A; Simon, Christian; Uppington, Jeffrey; Zygun, David; Ljungqvist, Olle; Harris, Jeffrey

    2017-03-01

    Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative

  18. Transfusion Requirements in Microsurgical Reconstruction in Maxillofacial Surgery: Ethical and Legal Problems of Patients Who Are Jehovah's Witnesses.

    Science.gov (United States)

    Martin, Lorena Pingarron; Arias-Gallo, Javier; Perez-Chrzanowska, Hanna; Seco, Pilar Ruiz; Moro, Javier Gonzalez M; Burgueño-Garcia, Miguel

    2013-03-01

    Objective To study transfusion requirements in patients with cancer undergoing head and neck reconstructive surgery and to discuss surgical and anesthetic strategies to reduce blood loss when the patient is a Jehovah's Witness. Material and Methods A descriptive study to expose the percentage of blood transfusions performed in patients with cancer undergoing microsurgical reconstructions in the department of oral and maxillofacial surgery of the referred hospital in the past 9 years. Results Two hundred thirty-seven microsurgical reconstructions were performed in head and neck tumors between January 2001 and December 2009. Statistical analysis shows a significant decrease (p = 0.035) in the number of patients needing transfusions patients in recent years. Conclusions The treatment of patients who are Jehovah's Witnesses is an ethical and moral dilemma for the clinician and in particular for surgeons.

  19. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery.

    Science.gov (United States)

    Ardern, Clare L; Webster, Kate E; Taylor, Nicholas F; Feller, Julian A

    2011-03-01

    An athlete's desire to return to sport after anterior cruciate ligament (ACL) injury is a major indication for ACL reconstruction surgery. Typical clearance to return is 6 to 12 months postoperatively. To investigate the return-to-sport rate and participation level of a large cohort at 12 months after ACL reconstruction surgery. Case series; Level of evidence, 4. Data were analyzed for 503 patients who participated in competitive-level Australian football, basketball, netball, or soccer after ACL reconstruction surgery using a quadruple-strand hamstring autograft. Inclusion criteria included participation in competitive sport before the ACL injury and clearance from the orthopaedic surgeon to return to sport postoperatively. Patients completed a self-report questionnaire regarding preoperative and postoperative sports participation and the Cincinnati Sports Activity Scale. The International Knee Documentation Committee (IKDC) knee evaluation form and hop tests were used to evaluate knee function. Sixty-seven percent of patients attempted some form of sports activity by 12 months postoperatively; 33% attempted competitive sport. Of those who did not attempt any sports activity by 12 months, 47% indicated that they were planning to return. Men were significantly more likely than women to return. Patients who played sports with a seasonal competition, versus a year-round competition, were significantly more likely to return by 12 months. Patients with normal postoperative knee function (IKDC category A), versus those with nearly normal function (IKDC category B), were no more likely to return, but patients with good hop test results (≥85% limb symmetry index) were more likely to return than patients with poor results (rehabilitation period than that typically advocated to facilitate a successful return to competitive sport after ACL reconstruction surgery. The relationship between postoperative knee function and return-to-sport outcomes at 12 months after surgery

  20. What are the decision-making preferences of patients in vascular surgery? A mixed-methods study.

    Science.gov (United States)

    Santema, T B Katrien; Stoffer, E Anniek; Kunneman, Marleen; Koelemay, Mark J W; Ubbink, Dirk T

    2017-02-10

    Shared decision-making (SDM) has been advocated as the preferred method of choosing a suitable treatment option. However, patient involvement in treatment decision-making is not yet common practice in the field of vascular surgery. The aim of this mixed-methods study was to explore patients' decision-making preferences and to investigate which facilitators and barriers patients perceive as important for the application of SDM in vascular surgery. Patients were invited to participate after visiting the vascular surgical outpatient clinic of an Academic Medical Center in the Netherlands. A treatment decision was made during the consultation for an abdominal aortic aneurysm or peripheral arterial occlusive disease. Patients filled in a number of questionnaires (quantitative part) and a random subgroup of patients participated in an in-depth interview (qualitative part). A total of 67 patients participated in this study. 58 per cent of them (n=39) indicated that they preferred a shared role in decision-making. In more than half of the patients (55%; n=37) their preferred role was in disagreement with what they had experienced. 31 per cent of the patients (n=21) preferred a more active role in the decision-making process than they had experienced. Patients indicated a good patient-doctor relationship as an important facilitator for the application of SDM. The vast majority of vascular surgical patients preferred, but did not experience a shared role in the decision-making process, although the concept of SDM was insufficiently clear to some patients. This emphasises the importance of explaining the concept of SDM and implementing it in the clinical encounter. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Patients experiences of negative pressure wound therapy at home for the treatment of deep perivascular groin infection after vascular surgery.

    Science.gov (United States)

    Monsen, Christina; Acosta, Stefan; Kumlien, Christine

    2017-05-01

    To explore experiences of negative pressure wound therapy at home, in patients with deep perivascular groin infection after vascular surgery and management in daily life. Deep surgical site infection after vascular surgery with exposed vessels often requires long-term treatment with negative pressure wound therapy, and continued therapy at home has become routine. An explorative qualitative study. Nine men and six women with a deep surgical site infection in the groin after vascular surgery, treated in their home with negative pressure wound therapy, were interviewed. The interviews were analysed using manifest and latent content analysis. Undergoing negative pressure wound therapy at home meant a transition from being a dependent patient to a person who must have self-care competence and be involved in their own care. A need to feel prepared for this before discharge from hospital was expressed. Lack of information and feelings of uncertainty prolonged the time before feeling confident in managing the treatment. The informants gradually accepted the need to be tied up to a machine, became competent in its management and found solutions to perform everyday tasks. Overall, it was a relief to be treated at home. Several benefits of negative pressure wound therapy at home were expressed. However, unnecessary stress and anxiety were experienced due to a lack of information on the treatment and instruction concerning the equipment. Adequate information and education must therefore be provided to facilitate the transition from a patient to a person with self-care competence and ability to manage this treatment at home. The findings revealed a need for more support and knowledge in their transition from hospital care to home care with negative pressure wound therapy. Routines must be established that ensure patient safety and security in treatment at home. © 2016 John Wiley & Sons Ltd.

  2. Incidence of new cardiovascular events in patients with and without peripheral arterial disease seen in a vascular surgery clinic.

    Science.gov (United States)

    Chhabra, Amit; Aronow, Wilbert S; Ahn, Chul; Duncan, Kurt; Patel, Jay D; Papolos, Alexander I; Sateesh, Babu

    2012-03-01

    To investigate the incidence of death and of new cardiovascular events at long-term follow-up of patients with and without PAD seen in a vascular surgery clinic. We investigated the incidence of death, new stroke/transient ischemic attack, new myocardial infarction, new coronary revascularization, new carotid endarterectomy, new peripheral arterial disease (PAD) revascularization, or at least one of the above outcomes at long-term follow-up of patients with and without PAD followed in a vascular surgery clinic. At least one of the above outcomes occurred in 259 of 414 patients (63%) with PAD at 33-month follow-up and in 21 of 89 patients (24%) without PAD at 48-month follow-up (pPAD and in 10 of 89 patients (11%) without PAD (p=0.002). Stepwise Cox regression analysis for the time to at least one of the 6 outcomes showed that significant independent risk factors were men (hazard ratio =1.394; 95% CI, 1.072-1.813; p=0.013), estimated glomerular filtration rate (hazard ratio =0.992; 95% CI, 0.987-0.997; p=0.003), and PAD (hazard ratio =3.520; 95% CI, 2.196-5.641; ptime to death showed that significant independent risk factors were age (hazard ratio =1.024; 95% CI, 1.000-1.049; p=0.048), estimated glomerular filtration rate (hazard ratio =0.985; 95% CI, 0.974-0.996; p=0.007), and PAD (hazard ratio =2.157; 95% CI, 1.118-4.160; p=0.022). Patients with PAD have a significantly higher incidence of cardiovascular outcomes, especially death, new PAD revascularization, and new carotid endarterectomy, than patients without PAD followed in a vascular surgery clinic.

  3. The Effect of Two Different Hand Exercises on Grip Strength, Forearm Circumference, and Vascular Maturation in Patients Who Underwent Arteriovenous Fistula Surgery

    OpenAIRE

    Kong, Sangwon; Lee, Kyung Soo; Kim, Junho; Jang, Seong Ho

    2014-01-01

    Objective To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. Methods We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength ...

  4. How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease.

    Science.gov (United States)

    Thiney, Martina; Della Schiava, Nellie; Feugier, Patrick; Lermusiaux, Patrick; Ninet, Jacques; Millon, Antoine; Long, Anne

    2017-04-01

    All patients with lower extremity peripheral arterial disease (LE-PAD) should benefit from recommended pharmacologic therapies including antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs), and hydroxy-methyl-glutaryl-coenzyme A reductase inhibitors (statins). In the present study, this triple therapy was defined as the best medical treatment. This study was designed to determine the number of patients who received best medical treatment at admission and at discharge from a vascular surgery department. We also examined the number of patients who received adapted medical treatment and every pharmacologic class separately. Finally, we investigated whether there were differences in prescribing rates according to patient characteristics and cardiovascular history, clinical grade of LE-PAD, and the type of surgery practiced. This study is a retrospective chart analysis of 140 consecutive patients admitted to the vascular surgery department of our university hospital, between January 1, 2013, and June 30, 2013. To be included, patients required a vascular surgery for peripheral arterial disease with atherosclerosis. Data from guideline-recommended classes of medications (antiplatelet agents, ACE, ARBs, and statins) at the time of admission and discharge were collected and compared. Best medical treatment was prescribed in 44% patients before hospital admission and in 50% at discharge (P = 0.10). Before hospital admission, 84% of patients had antiplatelet therapy compared with 96% at discharge (P = 0.0004); 73% had a statin, compared with 83% at discharge (P = 0.001); 64% had an ACE inhibitor or ARB, compared with 63% at the time of discharge (P = 1).The proportion of patients receiving best medical treatment at admission and discharge increased in case of coronary artery disease (P = 0.004). There was no difference in prescriptions of best medical treatment and best or adapted treatments at admission and

  5. A novel method of defective vascular reconstruction using 2-octyl-cyanoacrylate and homemade prosthetic component.

    Science.gov (United States)

    Liang, Xiangdang; Cai, Hongfei; Sun, Geng; Liu, Zihao; Chen, Wen; Tang, Peifu

    2014-01-01

    Currently, adhesive technique is popular in vascular repair but not widely used for defective vessels. This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component. Homemade prosthetic component consisting of expanded polytetrofluoroethylene (ePTFE), terylene film, and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels, can fix vessels better using the stent without occlusive bleeding. Forty male mongrel dogs were used, 20 for biomechanical tests and 20 for animal experiments. In the biomechanical test, dogs were randomly divided into two groups (n = 10 each), one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE. Of the 40 specimens, 10 were used for adhesive and 10 for suture specimens for tension strength test, whereas the remaining specimens were used for bursting pressure test. In animal experiments, dogs were also divided into adhesive and suture groups (n = 10), only of the left carotid artery. Recording the operational time, bleeding or not. Vessels were tested using color Doppler ultrasound, the inner diameter was measured, and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography (DSA) were also performed. Specimens were then analyzed histologically. In the adhesive and suture groups, the specimens could afford atension strength of (23.80 ± 1.51) N versus (24.60 ± 1.08) N (P > 0.05), the bursting pressure was (52.03 ± 2.43) kPa versus (50.04 ± 3.51) kPa (P > 0.05), and the mean time of anastomosis was (15.20 ± 0.55) minutes versus (25.97 ± 0.58) minutes (P dog in the adhesive group was bleeding from the suture. One dog from each group presented with thrombosis at 1 week. After measuring using ultrasound, the stenosis degree of all dogs were no more than 30

  6. Association of Program Directors in Vascular Surgery (APDVS) survey of program selection, knowledge acquisition, and education provided as viewed by vascular trainees from two different training paradigms.

    Science.gov (United States)

    Dalsing, Michael C; Makaroun, Michel S; Harris, Linda M; Mills, Joseph L; Eidt, John; Eckert, George J

    2012-02-01

    Methods of learning may differ between generations and even the level of training or the training paradigm, or both. To optimize education, it is important to optimize training designs, and the perspective of those being trained can aid in this quest. The Association of Program Directors in Vascular Surgery leadership sent a survey to all vascular surgical trainees (integrated [0/5], independent current and new graduates [5 + 2]) addressing various aspects of the educational experience. Of 412 surveys sent, 163 (∼40%) responded: 46 integrated, 96 fellows, and 21 graduates. The survey was completed by 52% of the integrated residents, 59% of the independent residents, and 20% of the graduates. When choosing a program for training, the integrated residents are most concerned with program atmosphere and the independent residents with total clinical volume. Concerns after training were thoracic and thoracoabdominal aneurysm procedures and business aspects: 40% to 50% integrated, and 60% fellows/graduates. Integrated trainees found periprocedural discussion the best feedback (79%), with 9% favoring written test review. Surgical training and vascular laboratory and venous training were judged "just right" by 87% and ∼71%, whereas business aspects needed more emphasis (65%-70%). Regarding the 80-hour workweek, 82% felt it prevented fatigue, and 24% thought it was detrimental to patient care. Independent program trainees also found periprocedural discussion the best feedback (71%), with 12% favoring written test review. Surgical training and vascular laboratory/venous training were "just right" by 87% and 60% to 70%, respectively, whereas business aspects needed more emphasis (∼65%-70%). Regarding the 80-hour workweek, 62% felt it was detrimental to patient care, and 42% felt it prevented fatigue. A supportive environment and adequate clinical volume will attract trainees to a program. For "an urgent need to know," the integrated trainees are especially turning to

  7. Editor's Choice - Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry.

    Science.gov (United States)

    Loftus, I M; Paraskevas, K I; Johal, A; Waton, S; Heikkila, K; Naylor, A R; Cromwell, D A

    2016-10-01

    Guidelines recommend that patients suffering an ischaemic transient ischaemic attack (TIA) or stroke caused by carotid artery stenosis should undergo carotid endarterectomy (CEA) within 14 days. The degree to which UK vascular units met this standard was examined and whether rapid interventions were associated with procedural risks. The study analysed patients undergoing CEA between January 2009 and December 2014 from 100 UK NHS hospitals. Data were collected on patient characteristics, intervals of time from symptoms to surgery, and 30-day postoperative outcomes. The relationship between outcomes and time from symptom to surgery was evaluated using multilevel multivariable logistic regression. In 23,235 patients, the median time from TIA/stroke to CEA decreased over time, from 22 days (IQR 10-56) in 2009 to 12 days (IQR 7-26) in 2014. The proportion of patients treated within 14 days increased from 37% to 58%. This improvement was produced by shorter times across the care pathway: symptoms to referral, from medical review to being seen by a vascular surgeon, and then to surgery. The spread of the median time from symptom to surgery among NHS hospitals shrank between 2009 and 2013 but then grew slightly. Low-, medium-, and high-volume NHS hospitals all improved their performance similarly. Performing CEA within 48 h of symptom onset was associated with a small increase in the 30-day stroke and death rate: 3.1% (0-2 days) compared with 2.0% (3-7 days); adjusted odds ratio 1.64 (95% CI 1.04-2.59) but not with longer delays. The delay from symptom to CEA in symptomatic patients with ipsilateral 50-99% carotid stenoses has reduced substantially, although 42% of patients underwent CEA after the recommended 14 days. The risk of stroke after CEA was low, but there may be a small increase in risk during the first 48 h after symptoms. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Release of soluble vascular endothelial growth factor receptor-1 (sFlt-1 during coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Orsel Isabelle

    2007-09-01

    Full Text Available Abstract Background This study was conducted to follow plasma concentrations of sFlt-1 and sKDR, two soluble forms of the vascular endothelial growth factor (VEGF receptor in patients undergoing coronary artery bypass graft (CABG surgery with extracorporeal circulation (ECC. Methods Plasma samples were obtained before, during and after surgery in 15 patients scheduled to undergo CABG. Levels of sFlt-1 and KDR levels were investigated using specific ELISA. Results A 75-fold increase of sFlt-1 was found during cardiac surgery, sFlt-1 levels returning to pre-operative values at the 6th post-operative hour. In contrast sKDR levels did not change during surgery. The ECC-derived sFlt-1 was functional as judge by its inhibitory effect on the VEGF mitogenic response in human umbilical vein endothelial cells (HUVECs. Kinetic experiments revealed sFlt-1 release immediately after the beginning of ECC suggesting a proteolysis of its membrane form (mFlt-1 rather than an elevated transcription/translation process. Flow cytometry analysis highlighted no effect of ECC on the shedding of mFlt-1 on platelets and leukocytes suggesting vascular endothelial cell as a putative cell source for the ECC-derived sFlt-1. Conclusion sFlt-1 is released during CABG with ECC. It might be suggested that sFlt-1 production, by neutralizing VEGF and/or by inactivating membrane-bound Flt-1 and KDR receptors, might play a role in the occurrence of post-CABG complication.

  9. Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Gharedaghi

    2016-07-01

    Full Text Available Background: Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences. Methods: In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period. Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy. Results: Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients and in this regard, we found a significant difference among the three groups, such that most

  10. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Seitaro [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Kumamoto University, Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto (Japan); Weissman, Gaby; Weigold, W. Guy [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Vembar, Mani [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States)

    2015-01-15

    The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality - graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality - was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. (orig.)

  11. Pico Lantern: Surface reconstruction and augmented reality in laparoscopic surgery using a pick-up laser projector.

    Science.gov (United States)

    Edgcumbe, Philip; Pratt, Philip; Yang, Guang-Zhong; Nguan, Christopher; Rohling, Robert

    2015-10-01

    The Pico Lantern is a miniature projector developed for structured light surface reconstruction, augmented reality and guidance in laparoscopic surgery. During surgery it will be dropped into the patient and picked up by a laparoscopic tool. While inside the patient it projects a known coded pattern and images onto the surface of the tissue. The Pico Lantern is visually tracked in the laparoscope's field of view for the purpose of stereo triangulation between it and the laparoscope. In this paper, the first application is surface reconstruction. Using a stereo laparoscope and an untracked Pico Lantern, the absolute error for surface reconstruction for a plane, cylinder and ex vivo kidney, is 2.0 mm, 3.0 mm and 5.6 mm, respectively. Using a mono laparoscope and a tracked Pico Lantern for the same plane, cylinder and kidney the absolute error is 1.4 mm, 1.5 mm and 1.5 mm, respectively. These results confirm the benefit of the wider baseline produced by tracking the Pico Lantern. Virtual viewpoint images are generated from the kidney surface data and an in vivo proof-of-concept porcine trial is reported. Surface reconstruction of the neck of a volunteer shows that the pulsatile motion of the tissue overlying a major blood vessel can be detected and displayed in vivo. Future work will integrate the Pico Lantern into standard and robot-assisted laparoscopic surgery. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. CORE STABILIZATION EXERCISES AFTER ACL RECONSTRUCTION SURGERY PROVIDES BETTER OUTCOMES: A RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Dilpreet Kaur

    2015-12-01

    Full Text Available Background: Decreased core stability displaces center of gravity away from base of support reducing activity participation of athlete. Present study was conducted to study the effect of core stabilization exercises after reconstruction surgery of ACL on functional outcomes. Methods: 30 subjects following 5 months of ACL reconstruction were randomly assigned to either group that performed (study group or did not performed (control group additional core stabilization exercises in conjugation with standard rehabilitation protocol. Outcome measures were: activity level using Tegnar activity level scale and functional performance using triple hop test. Outcome measures were compared at day 1 and day 42 of the treatment. Result: Significant improvement was seen in the study group for Tegnar score with mean difference changing from 4.5 to 1.5 from day 1 to day 42 of treatment (p=0.039 while the control group showed improvement in mean difference changing from 3.8 to 1.4 (p=.045 from day 1 to day 42 of treatment. Highly significant improvement was seen in the study group for triple hop test with mean difference changing from 25 to 6.7 (p<.001 compared to the control group with mean difference changing from 15.2 to 9.7(p=.005 from day 1 to day 42 of treatment. Conclusions: Both the groups showed improvement for activity level and functional performance but highly significant improvement was seen in the study group for functional performance. Core stabilization exercises in conjugation with the standard ACL rehabilitation protocol results better improvement in the triple hop test.

  13. Effect of statin withdrawal on frequency of cardiac events after vascular surgery

    NARCIS (Netherlands)

    Schouten, Olaf; Hoeks, Sanne E.; Welten, Gijs M. J. M.; Davignon, Jean; Kastelein, John J. P.; Vidakovic, Radosav; Feringa, Harm H. H.; Dunkelgrun, Martin; van Domburg, Ron T.; Bax, Jeroen J.; Poldermans, Don

    2007-01-01

    The discontinuation of statin therapy in patients with acute coronary syndromes has been associated with an increase of adverse coronary events. Patients who undergo major surgery frequently are not able to take oral medication shortly after surgery. Because there is no intravenous formula for

  14. Utility of melatonin to treat surgical stress after major vascular surgery - a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc...

  15. Utility of melatonin to treat surgical stress after major vascular surgery--a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc...

  16. Therapeutic efficacy of vacuum-assisted-closure therapy in the treatment of lymphatic complications following peripheral vascular interventions and surgeries.

    Science.gov (United States)

    Aydin, Ufuk; Gorur, Alper; Findik, Orhan; Yildirim, Abdullah; Kocogullari, Cevdet Ugur

    2015-02-01

    Lymphatic complications, lymphocele and lymphorrhea being the leading, are generally encountered after vascular interventions and surgeries. The present study aimed to evaluate the outcomes of vacuum-assisted-closure (VAC) therapy, which we frequently prefer as the first-choice treatment for such complications. Among patients undergoing peripheral vascular intervention or surgery between January 2008 and February 2012, the medical files of 21 patients who received VAC therapy or other treatment due to symptomatic lymphatic complications were retrospectively analyzed and the results were discussed. Group I consisted of 10 patients (three with lymphocele and seven with lymphorrhea) who underwent VAC therapy as the first-choice treatment, Group II consisted of 11 patients of which 7 patients received various therapies before VAC therapy and 4 patients received other treatments alone. The patients who received VAC therapy as the primary therapy demonstrated more rapid wound healing, early drainage control, and shorter hospital stay. The mean hospital medical cost was €1038 (range, €739-1826) for the patients who primarily underwent VAC therapy; it was calculated to be €2137 (range, €1610-3130) for the other patients (p=0.001). In addition to its safety and good clinical outcomes, VAC therapy also has economic advantages and should be the primary method for the treatment of lymphatic complications. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. A comparison of the quality of the information available on the internet on interventional radiology, vascular surgery, and cardiology.

    Science.gov (United States)

    Alsafi, A; Kaya, G; Patel, H; Hamady, M S

    2013-01-01

    Internet use is rapidly expanding and increasingly plays a substantial role in patient education. We sought to evaluate and compare the quality of information available to patients online on three closely linked specialties: Interventional radiology (IR), cardiology, and vascular surgery. We searched the leading three search engines for the terms: "Interventional Radiology", "cardiology," and "vascular surgery," collating the top 50 hits from each search. After excluding duplicates and irrelevant sites, 43, 25, and 36 sites remained, respectively. Sites were analyzed using the LIDA instrument (an online tool for assessing health-related websites) and Fleisch Reading Ease Scores (FRES) were compared across the different search terms and correlated with the country of origin and certification by the Health on the Net (HON) Foundation. There was no significant difference ( P>0.05) in the total LIDA, accessibility, usability or reliability scores between the three specialties. HONCode certification was associated with higher LIDA (83.1±1.6 vs. 71.53±0.8 ( Pinformation, there is a disparity in knowledge of IR; this may be due to low web-traffic figures of IR sites. Wikipedia's user-generated content, ranks highly in major search engines, as such; this could serve as means of disseminating reliable health information to patients.

  18. Evaluation of Donor Site Morbidity Associated with Iliac Crest Bone Harvest in Oral and Maxillofacial, Reconstructive Surgery.

    Science.gov (United States)

    Sudhakar, K N V; Mohanty, Rajat; Singh, Vaibhav

    2017-06-01

    Iliac crest is the most common donor site for autogenous bone grafting as cortical bone, cancellous bone or combination of both can be harvested in abundance depending upon the need. Ilium provides highest concentration of osteo-component cells and greater quality of bone with less morbidity. The study was conducted to evaluate the donor site morbidity associated with autogenous iliac crest bone grafting for reconstruction in maxillofacial surgery. Around 12 patients, who had undergone iliac crest bone harvesting for various maxillofacial and reconstructive surgical procedures like cleft alveolus repair, malar augmentation, mandibular reconstruction following tumour resection and cyst enucleation and other surgical procedures performed in the Department of Oral and Maxillofacial Surgery, over a span of two years. The donor site was evaluated for the following factors: pain, neuropraxia, abnormal gait and scar evaluation. None of the 12 patients had intraoperative complications like haemorrhage, damage to the muscles/ligaments, fracture of the ilium and damage to the acetabular fossa/femur head. Any major postoperative complications were also not recorded. Minor postoperative complications like pain, contour defect, walking difficulty were present, which gradually got resolved by the time of discharge. Anterior iliac crest provides an adequate harvest of cancellous, corticocancellous or bicortical grafts for reconstruction of various osseous defects in the maxillofacial region with least morbidity and should be considered as a major reservoir of bone for bony reconstructive procedures.

  19. Determinative factors in surgical planning of eyebrow cosmetic and reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Rajabi MT

    2017-07-01

    Full Text Available Mohammad Taher Rajabi, Ali Makateb, Narges Hassanpoor, Seyedeh Simindokht Hosseini, Fatameh Bazvand, Syed Ziaeddin Tabatabaie, Mohammad Bagher Rajabi Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran, Iran Purpose: The purpose of this study was to identify the different factors that an oculoplastic surgeon should consider while practicing cosmetic or reconstructive eyebrow surgery in order to have the final patient’s satisfaction.Subjects and methods: In an observational case series study, five photographs were taken from each of 60 females to show ideal eyebrow positioning with fingers. Eyebrow landmarks, including tarsal plate show (TPS and eyebrow height, were measured in the ideal position. Brow apex position and brow apex angle were evaluated in the desired position of eyebrow.Results: The mean desired apex angle of eyebrow was measured as 135±9 mm. In all, 48.33% of our subjects preferred a wider brow angle, 28.33% a narrower one, and 23.33% a brow angle without any change. The location of brow peak was transferred to the lateral canthus in the desired position. The ideal brow peak in the lateral canthus and between lateral canthus and lateral limbus was assigned to 33.3% and 66.6% of cases, respectively. The desired eyebrow apex angle in two age groups of our subjects (>40 years and ≤40 years was not statistically different.Conclusion: Landmarks of the eyebrow and its desired position are somehow different between different studies, which may be explained by the variation in race, gender, culture, and age. As there is not any uniform rule in planning of cosmetic surgeries of eyebrow, oculoplastic surgeons should consider the difference in culture, race, age, and desire of the patients and have their surgical plans for every individual patient distinctively. Keywords: eyebrow, tarsal plate show, brow apex angle, desired brow position, brow height

  20. Determinative factors in surgical planning of eyebrow cosmetic and reconstructive surgery.

    Science.gov (United States)

    Rajabi, Mohammad Taher; Makateb, Ali; Hassanpoor, Narges; Hosseini, Seyedeh Simindokht; Bazvand, Fatameh; Tabatabaie, Syed Ziaeddin; Rajabi, Mohammad Bagher

    2017-01-01

    The purpose of this study was to identify the different factors that an oculoplastic surgeon should consider while practicing cosmetic or reconstructive eyebrow surgery in order to have the final patient's satisfaction. In an observational case series study, five photographs were taken from each of 60 females to show ideal eyebrow positioning with fingers. Eyebrow landmarks, including tarsal plate show (TPS) and eyebrow height, were measured in the ideal position. Brow apex position and brow apex angle were evaluated in the desired position of eyebrow. The mean desired apex angle of eyebrow was measured as 135±9 mm. In all, 48.33% of our subjects preferred a wider brow angle, 28.33% a narrower one, and 23.33% a brow angle without any change. The location of brow peak was transferred to the lateral canthus in the desired position. The ideal brow peak in the lateral canthus and between lateral canthus and lateral limbus was assigned to 33.3% and 66.6% of cases, respectively. The desired eyebrow apex angle in two age groups of our subjects (>40 years and ≤40 years) was not statistically different. Landmarks of the eyebrow and its desired position are somehow different between different studies, which may be explained by the variation in race, gender, culture, and age. As there is not any uniform rule in planning of cosmetic surgeries of eyebrow, oculoplastic surgeons should consider the difference in culture, race, age, and desire of the patients and have their surgical plans for every individual patient distinctively.

  1. Application of Hydrogel in Reconstruction Surgery: Hydrogel/Fat Graft Complex Filler for Volume Reconstruction in Critical Sized Muscle Defects

    Directory of Open Access Journals (Sweden)

    Y. F. Lui

    2016-01-01

    Full Text Available Autogenic fat graft usually suffers from degeneration and volume shrinkage in volume reconstruction applications. How to maintain graft viability and graft volume is an essential consideration in reconstruction therapies. In this presented investigation, a new fat graft transplantation method was developed aiming to improve long term graft viability and volume reconstruction effect by incorporation of hydrogel. The harvested fat graft is dissociated into small fragments and incorporated into a collagen based hydrogel to form a hydrogel/fat graft complex for volume reconstruction purpose. In vitro results indicate that the collagen based hydrogel can significantly improve the survivability of cells inside isolated graft. In a 6-month investigation on artificial created defect model, this hydrogel/fat graft complex filler has demonstrated the ability of promoting fat pad formation inside the targeted defect area. The newly generated fat pad can cover the whole defect and restore its original dimension in 6-month time point. Compared to simple fat transplantation, this hydrogel/fat graft complex system provides much improvement on long term volume restoration effect against degeneration and volume shrinkage. One notable effect is that there is continuous proliferation of adipose tissue throughout the 6-month period. In summary, the hydrogel/fat graft system presented in this investigation demonstrated a better and more significant effect on volume reconstruction in large sized volume defect than simple fat transplantation.

  2. Thirty-day readmission and mortality among Medicare beneficiaries discharged to skilled nursing facilities after vascular surgery.

    Science.gov (United States)

    Fernandes-Taylor, Sara; Berg, Stephen; Gunter, Rebecca; Bennett, Kyla; Smith, Maureen A; Rathouz, Paul J; Greenberg, Caprice C; Kent, K Craig

    2018-01-01

    Readmission within 30 d of an acute hospital stay is frequent, costly, and increasingly subject to penalties. Early readmission is most common after vascular surgery; these patients are often discharged to skilled nursing facilities (SNFs), making postacute care an essential partner in reducing readmissions. We characterize 30-day readmissions among vascular surgery patients discharged to SNF to provide evidence for this understudied segment of readmission after specialty surgery. We utilize the Centers for Medicare & Medicaid Services Chronic Conditions Warehouse, a longitudinal 5% national random sample of Medicare beneficiaries to study 30-day readmission or death after discharge to SNF following abdominal aortic aneurysm repair or lower extremity revascularization from 2005-2009. Descriptive statistics and logistic regression with Least Adaptive Shrinkage and Selection Operator were used for analysis. Two thousand one hundred ninety-seven patients underwent an abdominal aortic aneurysm procedure or lower extremity revascularization at 686 hospitals and discharged to 1714 SNFs. Eight hundred (36%) were readmitted or had died at 30 d. In adjusted analysis, predictors of readmission or death at 30 d included SNF for-profit status (OR [odds ratio] = 1.2; P = 0.032), number of hospitalizations in the previous year (OR = 1.06; P = 0.011), number of comorbidities (OR = 1.06; P = 0.004), emergent procedure (OR = 1.69; P < 0.001), renal complication (OR = 1.38; P = 0.003), respiratory complication (OR = 1.45; P < 0.001), thromboembolic complication (OR = 1.57; P = 0.019), and wound complication (OR = 0.70; P = 0.017). Patients discharged to SNF following vascular surgery have exceptionally high rates of readmission or death at 30 d. Many factors predicting readmission or death potentially modify decision-making around discharge, making early detection, discharge planning, and matching patient needs to SNF capabilities essential to

  3. Fibrotic changes after postmastectomy radiotherapy and reconstructive surgery in breast cancer. A retrospective analysis in 109 patients

    Energy Technology Data Exchange (ETDEWEB)

    Classen, Johannes [Tuebingen Univ. (Germany). Dept. of Radiation Oncology; St. Vincentius-Kliniken, Karlsruhe (Germany). Dept. of Radiation Oncology; Nitzsche, Sibille [St. Vincentius-Kliniken, Karlsruhe (Germany). Dept. of Radiation Oncology; Wallwiener, Diethelm; Brucker, Sara [Tuebingen Univ. (Germany). Dept. of Gynecology; Kristen, Peter [Kreiskliniken Reutlingen (Germany). Dept. of Gynecology; Souchon, Rainer; Bamberg, Michael [Tuebingen Univ. (Germany). Dept. of Radiation Oncology

    2010-11-15

    The purpose of this study was to analyze the probability and time course of fibrotic changes in breast reconstruction before or after postmastectomy radiotherapy (PMRT). Between 1995 and 2004, 109 patients were treated with PMRT at Tuebingen University and underwent heterologous (HL) or autologous (AL) breast reconstruction prior or subsequent to radiation therapy. Fibrosis of the reconstructed breast after radiotherapy was assessed using the Baker score for HL reconstructions and the Common Terminology Criteria for Adverse Events (CTCAE) for all patients. Actuarial rates of fibrosis were calculated for the maximum degree acquired during follow- up and at the last follow-up visit documented. Median time to follow-up was 34 months (3-227 months). Radiotherapy was applied with a median total dose of 50.4 Gy. A total of 44 patients (40.4%) received a boost treatment with a median dose of 10 Gy. Breast reconstruction was performed with AL, HL, or combined techniques in 20, 82, and 7 patients, respectively. The 3-year incidence of {>=} grade III maximum fibrosis was 20% and 43% for Baker and CTCAE scores, respectively. The corresponding figures for fibrosis at last follow-up visit were 18% and 2%. The 3-year rate of surgical correction of the contralateral breast was 30%. Initially unplanned surgery of the reconstructed breast was performed in 39 patients (35.8%). Boost treatment and type of cosmetic surgery (HL vs. AL) were not significantly associated with the incidence of fibrosis. We found severe fibrosis to be a frequent complication after PMRT radiotherapy and breast reconstruction. However, surgical intervention can ameliorate the majority of high grade fibrotic events leading to acceptable long-term results. No treatment parameters associated with the rate of fibrosis could be identified. (orig.)

  4. Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries.

    Science.gov (United States)

    Alqahtani, Saad M; Alzahrani, Mohammad M; Tanzer, Michael

    2016-06-01

    Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons. A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey. Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Postoperative vascular complications in unrecognised Obstructive Sleep apnoea (POSA) study protocol: an observational cohort study in moderate-to-high risk patients undergoing non-cardiac surgery

    OpenAIRE

    Chan, Matthew T. V.; Wang, Chew-Yin; Seet, Edwin; Tam, Stanley; Lai, Hou-Yee; Walker, Stuart; Short, Timothy G; Halliwell, Richard; Chung, Frances

    2014-01-01

    Introduction Emerging epidemiological data suggest that obstructive sleep apnoea (OSA) is common in the general surgical population. Unfortunately, the majority of these patients are unrecognised and untreated at the time of surgery. There is substantial biological rationale to indicate that patients with unrecognised OSA are at a higher risk of postoperative vascular events. However, the extent of this morbidity is currently unknown. We have initated the postoperative vascular complications ...

  6. Lead, Follow, or Get out of the Way-How Bold Young Surgeons Brought Vascular Surgery into Clinical Practice from the Korean War Battlefield.

    Science.gov (United States)

    Baker, Michael S

    2016-05-01

    The maturation of vascular surgery into widespread clinical practice was accelerated by events that took place in Korea during the conflict of 1950-1953. Early research and anecdotal clinical trials were just then resulting in publication of cases of the successful vascular repairs and replacements. Noncrushing vascular clamps were being developed and limited manufacture begun. The stage was set for a major advance in the treatment of arterial injury, just as war commenced in Korea, which provided a clinical laboratory. When the war on the Korean Peninsula erupted in June 1950, the policy of the Army Medical department was to ligate all arterial injuries unless a simple transverse or end-to-end anastomosis could be performed, and repair was "contrary to policy and orders." Despite pressure and threats of "courts martial for vascular repairs" from the senior military medicine leaders-clinical experiments in arterial repair were carried out at Mobile Army Surgical Hospital facilities at battlefield locations across Korea. The young surgeons, mostly draftees and reservists, resisted rigid doctrine and orders to desist, and in the face of threatened punishment, were committed to do the right thing, and ultimately went on to change military medicine and vascular surgery. The "on-the-job" training in vascular surgery that was carried out in Korea by military surgeons who demonstrated substantially higher limb salvage rates energized the field from the battlefield laboratory. Many wounded soldiers had limbs saved by the new techniques in vascular repair pioneered by surgeons in the Korean War, and countless thousands who entered civilian hospitals for emergency vascular surgery in subsequent years also ultimately benefited from their work. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques.

    Science.gov (United States)

    Capanna, Rodolfo; Campanacci, Domenico A; Belot, Nicolas; Beltrami, Giovanni; Manfrini, Marco; Innocenti, Marco; Ceruso, Massimo

    2007-01-01

    In 1988, the excellent results obtained with the use of vascularized fibular autograft as a salvage procedure in massive allograft failures caused by non-union or massive resorption prompted a trial of an original reconstructive technique for intercalary defects based on the primary combination of the two types of graft. The authors believe the excellent final results and the ability to avoid further salvage surgical procedures justify the primary application of this more complicated technique despite longer surgical times.

  8. The approach of general surgeons to oncoplastic and reconstructive breast surgery in Turkey: a survey of practice patterns.

    Science.gov (United States)

    Emiroğlu, Mustafa; Sert, İsmail; İnal, Abdullah; Karaali, Cem; Peker, Kemal; İlhan, Enver; Gülcelik, Mehmet; Erol, Varlık; Güngör, Hilmi; Can, Didem; Aydın, Cengiz

    2014-12-01

    Oncoplastic Breast Surgery (OBS), which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS) undertaken by general surgeons specializing in breast surgery in Turkey. Cross-sectional study. Between December 2013 and February 2014, an eleven-question survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS), the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS) and informing patients about ORBS preoperatively. Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon). 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques.

  9. Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin Fails to Improve Inguinal Surgical Site Infection Rate After Vascular Surgery.

    Science.gov (United States)

    Hasselmann, Julien; Kühme, Tobias; Acosta, Stefan

    2015-01-01

    Surgical site infections (SSIs) and their prevention continue to be a major point of focus in all surgical specialties today. Antibiotic prophylaxis is one of the mainstays in their prevention. Due to the consistently high proportion of infections caused by intestinal flora from the start of our wound surveillance registry in 2005, we conducted a change in prophylactic antibiotic therapy from cloxacillin in 2012 to trimethoprim/sulfamethoxazole (TMP-SMX) in 2013. The study included all patients undergoing vascular surgery with groin incisions between March 1 and June 30 in 2012 and 2013, respectively, whereby the antibiotic regime was changed in between the 2 sampling periods. The diagnosis of SSI was based on clinical examination and microbiological results. Two hundred nineteen patients with inguinal incisions were included in the analysis: 105 in the cloxacillin group of which 19% had SSI and 114 in the TMP-SMX group with an SSI rate of 18% (P = .77), without differences between the 2 groups regarding age, gender, proportion of emergency surgery, type of surgery, or frequency of concomitant foot ulcers. The high proportion of infections caused by intestinal flora between time periods was unchanged (67% vs 81%, P = .34). There was no difference between the 2 groups, suggesting that the choice of antibiotic prophylaxis had a limited role in preventing SSI at our center. Despite this, the lower cost and ease of the administration of TMP-SMX can be seen as convincing advantages. © The Author(s) 2015.

  10. The importance of complete follow-up for results after femoro-infrapopliteal vascular surgery

    DEFF Research Database (Denmark)

    Jensen, L P; Nielsen, O M; Schroeder, T V

    1996-01-01

    postoperatively and 100% follow-up was obtained. After completion of the trial we calculated the patency and survival rates using life-table methods and compared the results based on the vascular registry with those achieved in the clinical trial. RESULTS: Comparing the results from the two databases revealed...... to follow-up according to the vascular registry database and the fact that these patients turned out to have a significantly increased rate of graft thrombosis, limb amputation and death, respectively. CONCLUSIONS: Life-table statistics may inadvertently become unreliable if a large proportion of patients...... is lost to follow-up, since failure to examine the patient for any reason may be related to the patients health. In addition to the number of patients at risk, it is suggested, that life-table plots should be supplemented with information on the number of patients lost to follow-up....

  11. An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy.

    LENUS (Irish Health Repository)

    O'Brien, G

    2012-03-01

    The incidence of arterial disease increases with age. Increasing life expectancy in the western world will intensify demands on vascular surgeons with regard to increasing caseload, expanding patient selection criteria, and more complex and minimally-invasive treatment options. We analysed our arterial cases over the past 31 years (n = 6,144) and compared our methods of intervention and complication rates in the elderly population (>75) with the younger cohort, in order to determine whether age should influence our management strategies.

  12. Comparative study of locking plates in mandibular reconstruction after ablative tumor surgery: THORP versus UniLOCK system.

    Science.gov (United States)

    Gellrich, Nils-Claudius; Suarez-Cunqueiro, Maria Mercedes; Otero-Cepeda, Xose Luis; Schön, Ralf; Schmelzeisen, Rainer; Gutwald, Ralf

    2004-02-01

    This retrospective study compared 2 types of rigid locking plates (THORP and UniLOCK; Stratec Medical, Oberdorf, Switzerland) in 107 patients undergoing reconstruction for bridging mandibular defects following ablative tumor surgery. From January 1993 to December 2000, 107 patients were reconstructed following ablative tumor surgery with 57 THORP plates and 50 UniLOCK plates. Study follow-up ranged from 18 to 87 months (average, 32 months). Complications were categorized into delayed wound healing, infection, plate exposure, and plate fracture, taking into account the type and timing of reconstruction. Overall type and number of complications show no statistically significant differences between THORP and UniLOCK groups. Infection was the most frequent type of complication (THORP, 30; UniLOCK, 32). Others included delayed wound healing (THORP, 13; UniLOCK, 12), plate exposure (THORP, 8; UniLOCK, 7), and plate fracture (THORP, 5; UniLOCK, 1). Plates were removed in 22 THORP and 11 UniLOCK plates. The most frequent reason for plate removal in both groups was infection. Other reasons for plate removal include tumor recurrence, plate fracture, plate exposure, or a combination of reasons. THORP and UniLOCK plates do not present statistically significant differences in the parameters studied. Nevertheless, the UniLOCK group had slightly better results. Considering that the THORP system is much bulkier and its screws bigger, our results lead to the conclusion that bridging osteosynthesis with a 2.4 UniLOCK system is adequate for plate reconstruction of mandibular defects.

  13. Risk factors for mesh erosion after female pelvic floor reconstructive surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Deng, Tuo; Liao, Banghua; Luo, Deyi; Shen, Hong; Wang, Kunjie

    2016-02-01

    To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. A systematic literature search of the PubMed, Embase, Cochrane Library, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI) and Chinese Science and Technology Periodical (VIP) databases was performed to identify studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the strength of associations between the factors and mesh erosion. In all, 25 studies containing 7,084 patients were included in our systematic review and meta-analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in older vs younger patients (OR 0.96, 95% CI 0.94-0.98), more parities vs less parities (OR 1.27, 95% CI 1.07-1.51), the presence of premenopausal/oestrogen replacement therapy (ERT) (OR 1.36, 95% CI 1.03-1.79), diabetes mellitus (OR 1.87, 95% CI 1.35-2.57), smoking (OR 2.35, 95% CI 1.80-3.08), concomitant pelvic organ prolapse (POP) surgery (OR 0.37, 95% CI 0.16-0.84), concomitant hysterectomy (OR 1.46, 95% CI 1.03-2.07), preservation of the uterus at surgery (OR 0.22, 95% CI 0.08-0.63), and surgery performed by senior vs junior surgeons (OR 0.42, 95% CI 0.30-0.58). Our study indicates that younger age, more parities, premenopausal/ERT, diabetes mellitus, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  14. Current Trends in Upper and Lower Eyelid Blepharoplasty Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members.

    Science.gov (United States)

    Kossler, Andrea L; Peng, Grace L; Yoo, Donald B; Azizzadeh, Babak; Massry, Guy G

    To assess current practice patterns for management of upper and lower eyelid blepharoplasty by active American Society of Ophthalmic Plastic and Reconstructive Surgery members. An invitation to participate in a web-based anonymous survey was sent to the active American Society of Ophthalmic Plastic and Reconstructive Surgery membership via email. The survey consists of 34 questions, both multiple choice and free response, regarding upper and lower eyelid blepharoplasty surgery. Practice patterns for both aesthetic and functional blepharoplasty are assessed. Thirty-four percent (161/472) of American Society of Ophthalmic Plastic and Reconstructive Surgery members polled responded to the survey. Members perform an average of 196 upper eyelid, 46 lower eyelid, and 53 four-eyelid blepharoplasty procedures per year, with 70% of cases being functional and 30% purely aesthetic. Most members prefer monitored care (71%) to local (21%) or general (8%) anesthesia. Eighty-nine percent of surgeons use topical antibiotics after surgery, erythromycin being the most common (51%). Fourteen percent of members use postoperative oral antibiotics, with cephalexin (81%) being most common. In upper eyelid blepharoplasty, orbicularis muscle is excised by 86% of respondents. Orbital fat is excised, when deemed appropriate, in 97% of cases, with nasal fat excised most commonly (88%). Less commonly, fat repositioning (36%) and adjunctive fat grafting (33%) are performed. In lower eyelid blepharoplasty, surgeons report using one or more of the following approaches: transconjunctival (96%), transcutaneous (82%), and both transconjunctival and transcutaneous (51%). Common adjunctive procedures include orbital fat excision (99%), fat repositioning (80%), and lateral canthal suspension (96%). Less common adjunctive procedures include laser skin resurfacing (36%) and chemical peels (29%). This report outlines contemporary practice patterns among active American Society of Ophthalmic Plastic and

  15. [Surgery and function reconstruction of laryngeal cancer involved supraglottic and glottis area].

    Science.gov (United States)

    Song, Xi-cheng; Zhang, Qing-quan; Zhang, Hua; Sun, Yan; Wang, Qiang; Liu, Zhong-lu; Wang, Li; Wang, Yan; Chen, Xiu-mei; Song, Yi-peng

    2013-03-01

    To investigate the surgery preserving epiglottis, the repair and the postoperative functions in laryngeal carcinoma involving supraglottic and glottic areas. A total of 97 cases with laryngeal cancer involving both supraglottic and glottic areas with normal epiglottis underwent surgery between June 2005 and December 2010 was reviewed. Of them 37 cases were stage II, 41 cases were stage III, and 19 cases were stage IV. Vertical partial laryngectomy (VPL) or extended VPL with the repair and functional reconstruction was carried out in 86 cases and cricohyoidoepiglottopexy (CHEP) in 11 cases. Postoperative survival rate, laryngeal functions and quality of life were evaluated. The 3-year and 5-year total cumulative survival rate (Kaplan-Meire survival analysis) were 87.1% and 69.6% in the 97 cases; 86.6% and 68.3% in VPL/EVPL group; 90.0% and 78.8% in CHEP group, respectively, with no significant difference between VPL/EVPL and CHEP groups (P > 0.05). Of 97 cases, 86(88.7%) cases were decannulated postoperatively. The rates of decannulation were 87.2% (75/86) in VPL/EVPL group and 100% (11/11) in CHEP group, with no significant difference (P > 0.05). Average oral diet recovery time of VPL/EVPL group and CHEP group was (5.2 ± 1.3) and (15.7 ± 5.2) days, respectively, with a significant difference (P 0.05). Voice handicap index-10 (VHI-10) scores of VPL/EVPL and CHEP groups were 29.5 ± 4.7 and 31.6 ± 6.3, respectively, no significant difference (P > 0.05). For patients with the laryngeal carcinoma involving both supraglottic and glottic areas, VPL has better anatomical and functional outcomes than CHEP. The preservation of at least 2/3 of the lamina of thyroid cartilage on one side and shift-down of epiglottis were key to successful VPL and postoperative decannulation.

  16. The benefit of non contrast-enhanced magnetic resonance angiography for predicting vascular access surgery outcome: a computer model perspective.

    Science.gov (United States)

    Merkx, Maarten A G; Huberts, Wouter; Bosboom, E Mariëlle H; Bode, Aron S; Bescós, Javier Oliván; Tordoir, Jan H M; Breeuwer, Marcel; van de Vosse, Frans N

    2013-01-01

    Vascular access (VA) surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD) patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative flow enhancement was developed. The purpose of this study is to assess the benefit of non contrast-enhanced magnetic resonance angiography (NCE-MRA) data as patient-specific geometrical input for the model-based prediction of surgery outcome. 25 ESRD patients were included in this study. All patients received a NCE-MRA examination of the upper extremity blood vessels in addition to routine ultrasound (US). Local arterial radii were assessed from NCE-MRA and converted to model input using a linear fit per artery. Venous radii were determined with US. The effect of radius measurement uncertainty on model predictions was accounted for by performing Monte-Carlo simulations. The resulting flow prediction interval of the computer model was compared with the postoperative flow obtained from US. Patients with no overlap between model-based prediction and postoperative measurement were further analyzed to determine whether an increase in geometrical detail improved computer model prediction. Overlap between postoperative flows and model-based predictions was obtained for 71% of patients. Detailed inspection of non-overlapping cases revealed that the geometrical details that could be assessed from NCE-MRA explained most of the differences, and moreover, upon addition of these details in the computer model the flow predictions improved. The results demonstrate clearly that NCE-MRA does provide valuable geometrical information for VA surgery planning. Therefore, it is recommended to use this modality, at least for patients at risk for local or global narrowing of the blood vessels as well as for patients for whom an US-based model prediction would not overlap with surgical choice, as the

  17. Plasma N‐terminal pro‐B‐type natriuretic peptide as long‐term prognostic marker after major vascular surgery

    Science.gov (United States)

    Feringa, Harm H H; Schouten, Olaf; Dunkelgrun, Martin; Bax, Jeroen J; Boersma, Eric; Elhendy, Abdou; de Jonge, Robert; Karagiannis, Stefanos E; Vidakovic, Radosav; Poldermans, Don

    2007-01-01

    Objective To assess the long‐term prognostic value of plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) after major vascular surgery. Design A single‐centre prospective cohort study. Patients 335 patients who underwent abdominal aortic aneurysm repair or lower extremity bypass surgery. Interventions Prior to surgery, baseline NT‐proBNP level was measured. Patients were also evaluated for cardiac risk factors according to the Revised Cardiac Risk Index. Dobutamine stress echocardiography (DSE) was performed to detect stress‐induced myocardial ischaemia. Main outcome measures The prognostic value of NT‐proBNP was evaluated for the endpoints all‐cause mortality and major adverse cardiac events (MACE) during long‐term follow‐up. Results In this patient cohort (mean age: 62 years, 76% male), median NT‐proBNP level was 186 ng/l (interquartile range: 65–444 ng/l). During a mean follow‐up of 14 (SD 6) months, 49 patients (15%) died and 50 (15%) experienced a MACE. Using receiver operating characteristic curve analysis for 6‐month mortality and MACE, NT‐proBNP had the greatest area under the curve compared with cardiac risk score and DSE. In addition, an NT‐proBNP level of 319 ng/l was identified as the optimal cut‐off value to predict 6‐month mortality and MACE. After adjustment for age, cardiac risk score, DSE results and cardioprotective medication, NT‐proBNP ⩾319 ng/l was associated with a hazard ratio of 4.0 for all‐cause mortality (95% CI: 1.8 to 8.9) and with a hazard ratio of 10.9 for MACE (95% CI: 4.1 to 27.9). Conclusion Preoperative NT‐proBNP level is a strong predictor of long‐term mortality and major adverse cardiac events after major non‐cardiac vascular surgery. PMID:16914484

  18. Robotic NOTES (Natural Orifice Translumenal Endoscopic Surgery) in reconstructive urology: initial laboratory experience.

    Science.gov (United States)

    Haber, Georges-Pascal; Crouzet, Sebastien; Kamoi, Kazumi; Berger, Andre; Aron, Monish; Goel, Raj; Canes, David; Desai, Mihir; Gill, Inderbir S; Kaouk, Jihad H

    2008-06-01

    To present an initial experience with robotic natural orifice translumenal surgery (R-NOTES) in reconstructive urology using the da Vinci surgical system. In 10 female farm pigs (mean weight, 34.5 kg), 10 pyeloplasties (right 5, left 5), 10 partial nephrectomies (right 5, left 5), and 10 radical nephrectomies (right 5, left 5) were performed. The robot telescope and the first robotic arm were placed through a single 2-cm umbilical incision, and the second robotic arm was placed through the vagina. All 30 R-NOTES procedures were performed successfully without any addition of laparoscopic port or open conversion. Mean length of the umbilical incision was 2.6 cm. Mean operative time was 154 minutes, and mean estimated total blood loss was 72 mL. Mean warm ischemia time in the partial nephrectomy group was 25.4 minutes. There were no intraoperative complications. There were no robotic system failures during the entire experiment. We did not find any significant difference when comparing right-side and left-side procedures. When analyzing the learning curve, only robot preparation time reached a statistically significant inverse correlation with increasing number of cases (r = -0.72, P = .018). Robotic NOTES pyeloplasty, partial nephrectomy, and radical nephrectomy are feasible and safe in the porcine model. This approach has the potential for a less morbid and scarless outcome. Intracorporeal suturing is significantly enhanced using the robot, especially through the challenging translumenal natural orifice approach. Further development of robots adaptive to NOTES would boost efforts toward clinical NOTES applications.

  19. Population pharmacokinetics of epsilon-aminocaproic acid in infants undergoing craniofacial reconstruction surgery.

    Science.gov (United States)

    Stricker, P A; Zuppa, A F; Fiadjoe, J E; Maxwell, L G; Sussman, E M; Pruitt, E Y; Goebel, T K; Gastonguay, M R; Taylor, J A; Bartlett, S P; Schreiner, M S

    2013-05-01

    Understanding the clinical pharmacology of the antifibrinolytic epsilon-aminocaproic acid (EACA) is necessary for rational drug administration in children. The aim of this study is to determine the pharmacokinetics (PKs) of EACA in infants aged 6-24 months undergoing craniofacial reconstruction surgery. Cohorts of six infants were enrolled sequentially to one of the three escalating loading dose-continuous i.v. infusion (CIVI) regimens: 25 mg kg(-1), 10 mg kg(-1) h(-1); 50 mg kg(-1), 20 mg kg(-1) h(-1); 100 mg kg(-1), 40 mg kg(-1) h(-1). Plasma EACA concentrations were determined using a validated high-performance liquid chromatography-tandem mass spectrometry assay. A population non-linear mixed effects modelling approach was used to characterize EACA PKs. Population PK parameters of EACA were estimated using a two-compartment disposition model with weight expressed as an allometric covariate and an age effect. The typical patient in this study had an age of 38.71 weeks and a weight of 8.82 kg. PK parameters for this typical patient were: pre-/postoperative plasma drug clearance of 32 ml min(-1) (3.6 ml kg(-1) min(-1)), inter-compartmental clearance of 42.4 ml min(-1) (4.8 ml min(-1) kg(-1)), central volume of distribution of 1.27 litre (0.14 litre kg(-1)), and peripheral volume of distribution of 2.53 litre (0.29 litre kg(-1)). Intra-operative clearance and central volume of distribution were 89% and 80% of the pre-/postoperative value, respectively. EACA clearance increased with weight and age. The dependence of clearance on body weight supports weight-based dosing. Based on this study, a loading dose of 100 mg kg(-1) followed by a CIVI of 40 mg kg(-1) h(-1) is appropriate to maintain target plasma EACA concentrations in children aged 6-24 months undergoing these procedures.

  20. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Teschke, Marcus; Wolford, Larry M

    2013-12-01

    Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Application of artificial palpation in vascular surgeries for detection of peripheral arterial stenosis.

    Science.gov (United States)

    Abouei Mehrizi, A; Moini, M; Afshari, E; Kadkhodapour, J; Sadjadian, A; Najarian, S

    2014-05-01

    Palpation is one of the applied methods that surgeons usually use during surgery in order to verify the health condition of a tissue/organ. In fact, most of surgical assessments are based on analysis of the force feedback received from tissue/organ via palpation. Although palpation has a key role in efficient progress of surgery operations, it depends very much on the experience and skill of the surgeons. This limits the application of this technique in some cases to a large extent. In this regard, an artificial tactile sensing approach is an innovative technology that tries to make tactile data more available for surgeons, especially in situations where doing the palpation is not possible or is too difficult. In this paper, having considered the present problems of artery bypass surgery in peripheral arterial occlusive disease (PAOD), applicability of a new tactile sensory system capable of detecting arterial stenosis during surgery was evaluated. Presenting the modelling and numerical solution of the problem, it was demonstrated that the artificial tactile sensing approach is not only capable of detecting the presence of an arterial stenosis in an artery, but also its type. Furthermore, it was shown that the new tactile sensory system (previously designed, fabricated and tested in laboratory) is efficiently capable of detecting the simulated artery in the simulated biological tissue as well as diagnosis of the stenosis occurred inside it.

  2. Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery

    OpenAIRE

    Lam, D L; Mitsumori, L M; Neligan, P C; Warren, B H; Shuman, W P; Dubinsky, T J

    2012-01-01

    Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases pat...

  3. Dacron® vs. PTFE as bypass materials in peripheral vascular surgery – systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Eidt Daniela

    2008-12-01

    Full Text Available Abstract Background In peripheral vascular bypass surgery different synthetic materials are available for bypass grafting. It is unclear which of the two commonly used materials, polytetrafluoroethylene (PTFE or polyester (Dacron® grafts, is to be preferred. Thus, the aim of this meta-analysis and systematic review was to compare the effectiveness of these two prosthetic bypass materials (Dacron® and PTFE. Methods We performed a systematic literature search in MEDLINE, Cochrane-Library – CENTRAL, EMBASE and other databases for relevant publications in English and German published between 1999 and 2008. Only randomized controlled trials were considered for inclusion. We assessed the methodological quality by means of standardized checklists. Primary patency was used as the main endpoint. Random-effect meta-analysis as well as pooling data in life table format was performed to combine study results. Results Nine randomized controlled trials (RCT were included. Two trials showed statistically significant differences in primary patency, one favouring Dacron® and one favouring PTFE grafts, while 7 trials did not show statistically significant differences between the two materials. Meta-analysis on the comparison of PTFE vs. Dacron® grafts yielded no differences with regard to primary patency rates (hazard ratio 1.04 (95% confidence interval [0.85;1.28], no significant heterogeneity (p = 0.32, I2 = 14%. Similarly, there were no significant differences with regard to secondary patency rates. Conclusion Systematic evaluation and meta-analysis of randomized controlled trials comparing Dacron® and PTFE as bypass materials for peripheral vascular surgery showed no evidence of an advantage of one synthetic material over the other.

  4. Feasibility study on robot-assisted retinal vascular bypass surgery in an ex vivo porcine model.

    Science.gov (United States)

    Chen, Yi Qi; Tao, Ji Wei; Li, Liang; Mao, Jian Bo; Zhu, Chen Ting; Lao, Ji Meng; Yang, Yang; Shen, Li-Jun

    2017-09-01

    To describe a new robot-assisted surgical system for retinal vascular bypass surgery (RVBS) and to compare the success rate with freehand RVBS. A robot-assisted system for retinal microsurgery was constructed to include two independent robotic arms. A 23-gauge light probe and an intraocular forceps were affixed to the arm end effectors to perform the intraocular manipulation. Harvested porcine eyes were introduced to be established animal models of closed-sky eyeballs after that pars plana vitrectomy using temporary keratoprosthesis was performed by a skilful surgeon. Retinal vascular bypass surgery (RVBS) was performed by an inexperienced ophthalmologist to test the ease of use. A stainless steel wire (45-μm pipe diameter) was used as an artificial vessel. Before RVBS, the wires were prepositioned at the retinal surface of the eyes. The Control group (n = 20) underwent freehand RVBS, and the Experimental group (n = 20) underwent robot-assisted RVBS. To create the simulated bypass, the distal end of the wire was inserted into the selected vessel and advanced ~4 mm away from the optic disc. If successful, then the proximal wire end was inserted and advanced ~2 mm towards the optic disc. The difference in the success rate for the freehand and robot-assisted procedures was analysed by the chi-square test. The success rate for the freehand RVBS was 5% (1/20 eyes). In contrast, the robot-assisted success rate was 35% (7/20) of eyes (p robot-assisted RVBS in ex vivo porcine eyes. The robotic system increased the accuracy and stability of manipulation by eliminating freehand tremor, leading to a higher surgical success rate. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  5. A comparison of the quality of the information available on the internet on interventional radiology, vascular surgery, and cardiology

    Directory of Open Access Journals (Sweden)

    A Alsafi

    2013-01-01

    Full Text Available Context and Aims: Internet use is rapidly expanding and increasingly plays a substantial role in patient education. We sought to evaluate and compare the quality of information available to patients online on three closely linked specialties: Interventional radiology (IR, cardiology, and vascular surgery. Materials and Methods: We searched the leading three search engines for the terms: "Interventional Radiology", "cardiology," and "vascular surgery," collating the top 50 hits from each search. After excluding duplicates and irrelevant sites, 43, 25, and 36 sites remained, respectively. Sites were analyzed using the LIDA instrument (an online tool for assessing health-related websites and Fleisch Reading Ease Scores (FRES were compared across the different search terms and correlated with the country of origin and certification by the Health on the Net (HON Foundation. Results: There was no significant difference ( P>0.05 in the total LIDA, accessibility, usability or reliability scores between the three specialties. HONCode certification was associated with higher LIDA (83.1±1.6 vs. 71.53±0.8 ( P<0.0001, reliability (75.7±3.6 vs. 49.0±1.6 ( P<0.0001 and FRES (37.4±4.0 vs. 29.7±1.4 ( P=0.0441. Conclusion: Websites are generally well designed and easy to use; the majority however, lacks currency and reliability. Despite similarity in quality of online information, there is a disparity in knowledge of IR; this may be due to low web-traffic figures of IR sites. Wikipedia′s user-generated content, ranks highly in major search engines, as such; this could serve as means of disseminating reliable health information to patients.

  6. Post-operative acute kidney injury in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension

    Science.gov (United States)

    Moodley, Yoshan; Biccard, Bruce M.

    2015-01-01

    Hypertension is an independent predictor of acute kidney injury (AKI) in non-cardiac surgery patients. There are a few published studies which report AKI following non-suprainguinal vascular procedures, but these studies have not investigated predictors of AKI, including anti-hypertensive medications and other comorbidities, in the hypertensive population alone. We sought to identify independent predictors of post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension. We performed univariate (chi-squared, or Fisher's exact testing) and multivariate (binary logistic regression) statistical analysis of prospectively collected data from 243 adult hypertensive patients who underwent non-suprainguinal vascular surgery (lower limb amputation or peripheral artery bypass surgery) at a tertiary hospital between 2008 and 2011 in an attempt to identify possible associations between comorbidity, acute pre-operative antihypertensive medication administration, and post-operative AKI (a post-operative increase in serum creatinine of ≥ 25 % above the pre-operative measurement) in these patients. The incidence of post-operative AKI in this study was 5.3 % (95 % Confidence Interval: 3.2-8.9 %). Acute pre-operative β-blocker administration was independently associated with post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension (Odds Ratio: 3.24; 95 % Confidence Interval: 1.03-10.25). The acute pre-operative administration of β-blockers should be carefully considered in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension, in lieu of an increased risk of potentially poor post-operative renal outcomes. PMID:26966428

  7. Use of a glucose management service improves glycemic control following vascular surgery: an interrupted time-series study.

    Science.gov (United States)

    Wallaert, Jessica B; Chaidarun, Sushela S; Basta, Danielle; King, Kathryn; Comi, Richard; Ogrinc, Greg; Nolan, Brian W; Goodney, Philip P

    2015-05-01

    The optimal method for obtaining good blood glucose control in noncritically ill patients undergoing peripheral vascular surgery remains a topic of debate for surgeons, endocrinologists, and others involved in the care of patients with peripheral arterial disease and diabetes. A prospective trial was performed to evaluate the impact of routine use of a glucose management service (GMS) on glycemic control within 24 hours of lower-extremity revascularization (LER). In an interrupted time-series design (May 1, 2011-April 30, 2012), surgeon-directed diabetic care (Baseline phase) to routine GMS involvement (Intervention phase) was compared following LER. GMS assumed responsibility for glucose management through discharge. The main outcome measure was glycemic control, assessed by (1) mean hospitalization glucose and (2) the percentage of recorded glucose values within target range. Statistical process control charts were used to assess the impact of the intervention. Clinically important differences in patient demographics were noted between groups; the 19 patients in the Intervention arm had worse peripheral vascular disease than the 19 patients in the Baseline arm (74% critical limb ischemia versus 58%; p = .63). Routine use of GMS significantly reduced mean hospitalization glucose (191 mg/dL Baseline versus 150 mg/dL Intervention, p control did not significantly decrease for the 19 postintervention patients. Routine involvement of GMS improved glycemic control in patients undergoing LER. Future work is needed to examine the impact of improved glycemic control on clinical outcomes following LER.

  8. [Electronic data processing data bank for vascular surgery as a multiple site system with network connection].

    Science.gov (United States)

    Sauer, J; Fraunhofer, S; von Sommoggy, S

    1991-01-01

    A clinical database, using FileMaker Pro and a network of APPLE Macintosh computers, were created for a vascular surgical unit. The databank presented here is based on proven, routine working procedures of the department. An easily learnable entry facility with hands-on, screen-oriented users' guide and help data file provide easy operability and highly efficient databank capability, along with great flexibility. This criterial and user-friendly features make staff acceptance and compliance readily achievable, thus assuring comprehensive data entry.

  9. [Three-stage surgery of combining auricle reconstruction, meatoplasty and tympanoplasty for patients with congenital microtia-atresia].

    Science.gov (United States)

    Lichun, Zhang; Ying, Chen; Tianyu, Zhang

    2015-03-01

    To investigate the validity and feasibility of consecutive three-stage surgical technique of combining auricle reconstruction with external auditory canal atresia reconstruction in patients with congenital microtia-atresia, and to assess the post-surgery results by cosmetic and hearing aspects. From Sep. 2007 to Jun. 2011, all 74 patients (79 ears) with congenital microtia-atresia treated in our department were enrolled in this study. They consecutively accepted the following three-stage surgical technique: The first stage was Brent' s technique as follows, rib cartilage graft harvest, framework fabrication, and implantation. The second stage combined transfer of the lobule with meatoplasty and tympanoplasty. The third stage was the elevation of the reconstructed auricle. Both the cosmetic and functional hearing results were recorded at follow-ups. Among these patients, 60 patients (78.5%), 62 ears, acquired extremely satisfactory cosmetic results; 10 patients (16.5%), 13 ears, acquired acceptable cosmetic results; while the remaining 4 patients (5.1%) acquired unsatisfactory cosmetic results. However, the height of elevation of the newly performed auricle framework was not enough due to the existence of newly formed external ear canal. Regarding the hearing results, there were 69 ears with followup audiograms. An air-bone gap (ABG) improvement of 12.5 dB was achieved. The air-conduction hearing threshold improved (10.9 ± 8.2) dBHL, 37 ears (53.6%) achieved serviceable hearing after surgery, with ABG less than 30 dB. There were multiple complications occurred after surgery with the incidence of 49.4% (39/79). The combined three-stage surgical microtia and canal atresia reconstruction technique is a viable choice for some suitable patients with microtia-atresia. However, the incidence of complication after meatoplasty is very high and the hearing restoration is not good enough, which need further investigation for the better results.

  10. Vaginal and perineal reconstruction using rectus abdominis myocutaneous flap in surgery for locally advanced rectum carcinoma and locally recurrent rectum carcinoma : Dynamic article

    NARCIS (Netherlands)

    Holman, F.A.; Martijnse, I.S.; Traa, M.J.; Boll, D.; Nieuwenhuijzen, G.A.P.; Rutten, H.J.M.D.

    2013-01-01

    Background: Surgery for locally advanced and recurrent rectal carcinoma sometimes requires partial resection of the perineum and/or vagina necessitating subsequent reconstruction. Objective: The aim of this study was to describe the surgical and functional outcomes of reconstructing the vagina

  11. Vascular anatomy of canine hepatic venous system: a basis for liver surgery.

    Science.gov (United States)

    Mari, L; Acocella, F

    2015-06-01

    Detailed knowledge of the vascular anatomy is important for improving surgical approaches to the liver. Twelve canine livers were skeletonized to describe the anatomy of their portal and hepatic veins in details. Our data suggest that the liver can be divided into two sections, three divisions, seven lobes and two to four sub-lobes. This differs from the classic division into four lobes, four sub-lobes and two processes. The right section was perfused by the right portal branch and drained by independent hepatic veins, while most of the left section, perfused by the left portal branch, was drained by the main hepatic vein deriving from the middle and the left hepatic vein confluence. Part of the right medial lobe, and in some cases the papillary process of the caudate lobe, drained directly into the caudal vena cava. A proper right hepatic vein draining blood from more than one lobe was never observed. Portal connections between the quadrate and the left medial lobe were frequently recorded. Two sub-lobes with different portal blood supply and venous drainage could be identified in the right lateral (33.3% of cases) and the left lateral (100% of cases) lobes. From our results, the classic nomenclature of the liver lobes does not reflect their vascularization. Based on similarities between canine lobes and human segments, a new nomenclature is possible and may be less confounding in surgical settings. © 2014 Blackwell Verlag GmbH.

  12. Breast reconstruction - implants

    Science.gov (United States)

    Breast implants surgery; Mastectomy - breast reconstruction with implants; Breast cancer - breast reconstruction with implants ... to make reconstruction easier. If you will have breast reconstruction later, your surgeon will remove enough skin ...

  13. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations

    NARCIS (Netherlands)

    J. Darling (Jeremy); J.C. McCallum (John C.); P.A. Soden (Peter A.); Guzman, R.J. (Raul J.); Wyers, M.C. (Mark C.); Hamdan, A.D. (Allen D.); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

    2017-01-01

    markdownabstract__Objective:__ The Society for Vascular Surgery (SVS) Wound, Ischemia and foot Infection (WIfI) classification system was proposed to predict 1-year amputation risk and potential benefit from revascularization. Our goal was to evaluate the predictive ability of this scale in a

  14. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system following infrapopliteal endovascular interventions for critical limb ischemia

    NARCIS (Netherlands)

    J. Darling (Jeremy); J.C. McCallum (John C.); P.A. Soden (Peter A.); Meng, Y. (Yifan); Wyers, M.C. (Mark C.); Hamdan, A.D. (Allen D.); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

    2016-01-01

    textabstractObjective The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee has composed a new threatened lower extremity classification system that reflects the three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI).

  15. Suprapubic versus transurethral bladder drainage following reconstructive pelvic surgery: a comparison of patient satisfaction and quality of life.

    Science.gov (United States)

    Takase-Sanchez, Michelle M; Thompson, Jennifer C; Hale, Douglass S; Heit, Michael H

    2017-05-01

    To assess the differences in patient-reported, catheter-specific satisfaction and quality of life with either suprapubic or transurethral postoperative bladder drainage following reconstructive pelvic surgery. This was a prospective study of all eligible women who were scheduled to undergo reconstructive surgery requiring bladder drainage during the study period November 2013 to March 2015. Women who did not undergo the planned procedure(s) or did not require bladder drainage were excluded. The primary outcome was patient-reported quality of life using catheter-specific instruments including the Catheter-related Quality of Life (CIQOL) instrument, and a modified version of the Intermittent Self-Catheterization Questionnaire (ISC-Q), designed to evaluate aspects of catheter-related quality of life and satisfaction specific to the needs of the individual. A total of 178 women were analyzed, 108 in the transurethral catheter group and 70 in the suprapubic group. Women with suprapubic bladder drainage had higher quality of life and satisfaction scores than women with transurethral bladder drainage as measured by the ISC-Q (68.31 ± 16.87 vs. 54.04 ± 16.95, mean difference 14.27, 95 % CI 9.15 - 19.39). There was no difference in quality of life by the CIQOL. After regression analysis, women with suprapubic bladder drainage were more satisfied with their catheter-specific needs despite longer duration of catheter use, more concurrent continence surgery, and higher trait anxiety. Differences in catheter-specific quality of life and patient satisfaction scores favoring suprapubic bladder drainage support its continued use in appropriately selected women for treatment of temporary postoperative urinary retention after reconstructive pelvic surgery.

  16. From WWII to Kingston, Ontario: The History of Queen's University School of Medicine, Division of Plastic and Reconstructive Surgery.

    Science.gov (United States)

    Chung, Karen; Wyllie, Kenneth; Davidson, John

    2016-01-01

    To describe the origin and development of the Division of Plastic and Reconstructive Surgery at the Queen's University School of Medicine (Kingston, Ontario). Resarch ethics board approval and privacy agreements from the Kingston General Hospital (KGH, Kingston, Ontario) medical archives were obtained. Primary and secondary data sources were identified. A systematic examination of newspaper archives, research literature, KGH medical advisory committee meeting minutes, and testimonies from Dr Kenneth Wyllie and Dr John Davidson were obtained. In 1949, Dr Albert Ross Tilley arrived at Queen's University in Kingston, Ontario. There, Tilley initiated the Burn Unit at the KGH and began monthly teaching during the academic semester. Ken Wyllie (Meds '55), Lloyd Carlson (Meds '57) and John Emery (Meds '57) were the notable progeny of his early initiatives. In 1963, Kenneth Wyllie founded the Division of Plastic and Reconstructive Surgery in Kingston, Ontario, having completed plastic surgery training in Toronto and Edinburgh with experiences in Stockholm (Sweden), Paris (France) and Baltimore (Maryland, USA). He was shortly joined by Pat Shoemaker (Meds '66). John Davidson (Meds '82) arrived in 1989, bringing an interest in microsurgery and critical inquiry to the division. Five notable surgeons, Cartotto (Meds '88), Watkins, Watters, Meathrel (Meds '03) and McKay, further enhanced the Division's clinical and academic mission. The collective activity of the Division of Plastic and Reconstructive Surgery at Queen's School of Medicine in its 66-year history has encouraged more than 40 others to pursue distinguished careers in the specialty throughout North America, including three past presidents of the Canadian Society of Plastic Surgeons.

  17. A comparison of results of carotid endarterectomy in octogenarians and nonagenarians to younger patients from the Mid-America Vascular Study Group and the Society for Vascular Surgery Vascular Quality Initiative.

    Science.gov (United States)

    Schneider, Joseph R; Jackson, Cheryl R; Helenowski, Irene B; Verta, Michael J; Wilkinson, Julia B; Kim, Stanley; Hoel, Andrew W

    2017-06-01

    Carotid endarterectomy (CEA) reduces stroke risk in selected patients. However, CEA risk profile may be different in older patients. We compared characteristics and outcomes of octogenarians and nonagenarians with those of younger patients. Deidentified data from CEA patients were obtained from the Society for Vascular Surgery Vascular Quality Initiative (VQI) database. Prior CEA, carotid artery stent, or combined CEA and coronary artery bypass were excluded, yielding 7390 CEAs in octogenarians and nonagenarians (≥80 years of age) and 35,303 CEAs in younger patients (<80 years of age). We compared post-CEA outcomes, including periprocedural cerebral ischemic events and death, and details such as operative time, bleeding, and return to surgery. Octogenarians and nonagenarians were more likely to have pre-CEA neurologic symptoms (51.4% vs 45.6%; P < .001) and to have never smoked (37.8% vs 22.0%; P < .001), and they were slightly more likely to have required urgent CEA (16.1% vs 13.4%; P < .001). Stenosis ≥70% was similar (octogenarians and nonagenarians, 94.2%; younger patients, 94.4%; P = .45). Perioperative ipsilateral neurologic events and ipsilateral stroke were slightly more common among octogenarians and nonagenarians (1.6% vs 1.1% [P < .001] and 1.2% vs 0.8% [P = .002]). Multivariate modeling (logistic regression) showed that pre-CEA neurologic symptoms (odds ratios, 1.35 [P = .005] and 1.42 [P = .007]), pre-CEA ipsilateral cortical ischemic event (odds ratios, 1.18 [P < .001] and 1.20 [P < .001]), and urgency (odds ratios, 1.75 [P < .001] and 1.67 [P < .001]) remained strong predictors of any ipsilateral neurologic event and any ipsilateral stroke, respectively. However, age ≥80 years remained a significant predictor of these outcomes (odds ratios, 1.37 [P = .003] and 1.44 [P = .004]). Kaplan-Meier estimated survival was lower for octogenarians and nonagenarians at 30 days and 1 year (98.6% vs 99.4% and 93.7% vs 97.0%; log-rank, P

  18. A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction.

    Science.gov (United States)

    Setacci, C; Sirignano, A; Ricci, G; Spagnolo, A G; Pugliese, F; Speziale, F

    2015-08-01

    Patients undergoing major surgery are at risk for postoperative cognitive dysfunction (POCD). The consciousness of the POCD arises new ethical and medico-legal issues that should be identified, managed and, if possible, prevented. Elderly patients still represent a real challenge for physicians and medical science. This challenge can be surmounted not only through technical progress but also by safeguarding the correct ethical behavior at the base of each relationship between a patient and his physician. Effective communication with the elderly patient is a prerequisite for clear and complete information, involving family members and caregivers when necessary. In every case, the identification of patients with pre-existing risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication play an important role in decreasing the incidence of neurocognitive deficits in the elderly.

  19. Impact of aspirin and clopidogrel interruption on platelet function in patients undergoing major vascular surgery.

    Directory of Open Access Journals (Sweden)

    Yannick Le Manach

    Full Text Available AIMS: To investigate functional platelet recovery after preoperative withdrawal of aspirin and clopidogrel and platelet function 5 days after treatment resumption. METHODS/RESULTS: We conducted an observational study, which prospectively included consecutive patients taking aspirin, taking clopidogrel, and untreated controls (15 patients in each group. The antiplatelet drugs were withdrawn five days before surgery (baseline and were reintroduced two days after surgery. Platelet function was evaluated by optical aggregation in the presence of collagen, arachidonic acid (aspirin and ADP (clopidogrel and by VASP assay (clopidogrel. Platelet-leukocyte complex (PLC level was quantified at each time-point. At baseline, platelet function was efficiently inhibited by aspirin and had recovered fully in most patients 5 days after drug withdrawal. PLC levels five days after aspirin reintroduction were similar to baseline (+4±10%; p = 0.16, in line with an effective platelet inhibition. Chronic clopidogrel treatment was associated with variable platelet inhibition and its withdrawal led to variable functional recovery. PLC levels were significantly increased five days after clopidogrel reintroduction (+10±15%; p = 0.02, compared to baseline. CONCLUSIONS: Aspirin withdrawal 5 days before high-bleeding-risk procedures was associated with functional platelet recovery, and its reintroduction two days after surgery restored antiplaletet efficacy five days later. This was not the case of clopidogrel, and further work is therefore needed to define its optimal perioperative management.

  20. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  1. Radiotherapy and Smoking History Are Significant Independent Predictors for Osteosynthesis-Associated Late Complications in Vascular Free Fibula Reconstruction of Mandible.

    Science.gov (United States)

    Chen, YiMing; Wu, JiaLing; Gokavarapu, Sandhya; Shen, Qingcheng; Ji, Tong

    2017-09-01

    The vascular fibula flap is an ideal choice for function and appearance reconstruction of mandible. Despite the high success rate, "late complications" such as Ti plate exposure and local infection related to osteosynthesis are not uncommon. A retrospective cohort of patients who received vascular fibula reconstruction for mandible from January 2011 to December 2013 from the Department of Oral and Maxillofacial Oncology in a tertiary hospital were charted: clinical, pathological, and therapeutic factors were analyzed for late complications in univariate and multivariate analyses. One hundred forty-two patients were finally analyzed with median follow-up time of 47 months; 19 of them had "late complications," which occurred at a median of 8 months. Preoperative or postoperative radiotherapy (P = 0.02), type of Ti plate (P = 0.019), and the disease characteristics (P = 0.02) were significant factors on univariate. Cox regression suggested postoperative radiation (P = 0.009) and smoking history (P = 0.037) were independent significant factors for late complications. Secondary reconstruction (P = 0.069) and preoperative radiotherapy (P = 0.086) were borderline significant. Postoperative radiation and smoking history are associated with late complications. Mini Ti plate should be less used. Patients with risk factors need to be observed for at least 6 to 16 months before further management.

  2. The use of multimedia as an adjunct to the informed consent process for ankle ligament reconstruction surgery.

    Science.gov (United States)

    Batuyong, Eldridge; Birks, Christopher; Beischer, Andrew D

    2012-06-01

    Obtaining "informed consent" is an integral aspect of surgery that can be fraught with difficulty. This study assessed the efficacy of a multimedia education tool in improving patients' understanding when used as an adjunct to the traditional verbal consent process regarding ankle lateral ligament reconstruction surgery. A total of 56 patients (28 males and 28 females) were recruited with a mean age of 36 years. A standardized verbal discussion regarding surgical treatment was provided to each patient. Understanding was then assessed using a knowledge questionnaire. Subsequently, each patient observed a multimedia educational program following which the knowledge questionnaire was repeated. Additional supplementary questions were then given regarding the ease of understanding and satisfaction with the 2 methods of education delivery. The patients answered 75% of the questions correctly before the multimedia module compared with 88% after it (P multimedia tool performed as well as the treating surgeon. Multimedia tools used in sequence after a verbal consent resulted in improved patient understanding of pertinent information regarding ankle lateral ligament reconstruction surgery. Therapeutic Level II.

  3. Minimal distal pressure rise after reconstructive arterial surgery in patients with multiple obstructive arteriosclerosis

    DEFF Research Database (Denmark)

    Noer, Ivan; Tønnesen, K H; Sager, P

    1980-01-01

    Forty-one reconstructive procedures were carried out in thirty-five consecutive patients. Average age was 63 years (range 46-75). Thrombendarterectomy or by-pass procedures were carried out in twenty-nine proximal and twelve femoropopliteal reconstructions. Twenty-three patients had rest pain fif...

  4. Trans-oral robotic cleft surgery (TORCS) for palate and posterior pharyngeal wall reconstruction: A feasibility study.

    Science.gov (United States)

    Khan, Khurram; Dobbs, Tom; Swan, Marc C; Weinstein, Gregory S; Goodacre, Tim E E

    2016-01-01

    Robot-assisted surgery has become increasingly routine, replacing open and laparoscopic techniques in certain domains, with recent extension to head and neck surgery through trans-oral access. Some advantages of the robot-assisted surgery include the ability to access confined spaces, enhanced dexterity instrumentation with intuitive movement, motion scaling, tremor elimination and three-dimensional (3D) endoscopic viewing with true depth perception. The aim of this study was to investigate the technical feasibility of trans-oral robotic cleft surgery (TORCS) to access the posterior pharyngeal wall and palate for potential use in the cleft population. All possible permutations of patient and robotic instrument configurations were used with the daVinci Si Surgical System® (Intuitive Surgical, USA) 0° and 30° 3D endoscopes and 8-mm training instruments to determine the optimal visualization and surgical access to the palate and posterior pharynx in a paediatric airway manikin, and to simulate posterior pharyngeal wall surgery. A full robot-assisted cadaveric Hynes pharyngoplasty was performed using 5-mm training instruments. Experiments were recorded with still and video photography. TORCS is technically feasible in the paediatric cleft population. We predict a short learning curve due to the intuitive instrumentation, easier dissection and the potential to limit secondary insult compared with traditional surgery, as well as improved ergonomics for the operating surgeon. The as-yet unreported use of robotic-assisted cleft palate surgery may considerably enhance a surgeon's ability to perform difficult procedures of the palate and posterior pharynx in selected patients with limited access as well as lay the foundation for potential novel techniques. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

    Directory of Open Access Journals (Sweden)

    N. Lumen

    2008-01-01

    Full Text Available Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF or the pedicled anterolateral thigh flap (ALTF has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4–49 months. Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula. Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.

  6. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study.

    Science.gov (United States)

    Howes, Benjamin H L; Watson, David I; Xu, Chris; Fosh, Beverley; Canepa, Maximiliano; Dean, Nicola R

    2016-09-01

    Patient-reported outcomes and quality of life following mastectomy are not well understood. This study evaluates the quality of life following surgery for breast cancer and compares outcomes following breast-conserving surgery versus total mastectomy with or without reconstruction. A case-controlled cross-sectional study was conducted using the validated BREAST-Q™ questionnaire and a study-specific questionnaire to determine patient's views about surgical outcomes. Questionnaires were completed by patients following breast-conserving surgery and total mastectomy with or without reconstruction and by controls without breast cancer. A one-way ANOVA was used to compare mean BREAST-Q™ scores between groups and post hoc analysis using Tukey's and Kruskal-Wallis tests. BREAST-Q™ questionnaires were completed by 400 women (123 controls, 97 breast conservations, 93 mastectomies without reconstruction, 87 mastectomies with reconstruction). Women who had undergone mastectomy and reconstruction had higher scores in satisfaction with breast and sexual well-being domains compared with women who had breast-conserving surgery, and women who had total mastectomy without reconstruction had the lowest scores in these two domains. There was no difference in psychosocial well-being between the groups. Women who had undergone breast-conserving surgery scored the lowest in the physical well-being chest domain and the majority reported breast asymmetry. Our study suggests that women who undergo total mastectomy and breast reconstruction for cancer achieve a quality-of-life outcome that is at least as good as that following breast-conserving surgery. Furthermore, breast conservation has been found to be associated with lower physical well-being (i.e., more pain and discomfort) in the chest area and poorer sexual well-being outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

  7. Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial.

    Science.gov (United States)

    Meloni, Silvio Mario; Tallarico, Marco; De Riu, Giacomo; Pisano, Milena; Deledda, Alessandro; Lolli, Francesco Maria; Massarelli, Olindo; Tullio, Antonio

    2015-10-01

    The aim of this prospective clinical study is to assess the 4-year outcomes of implant-supported restorations performed using a computer-guided template-assisted flapless implant surgery approach in patients reconstructed with fibula or iliac crest free flaps. Twelve jaws in 10 patients were reconstructed with osteomyocutaneous free flap after tumour resection or gunshot wound, after complete healing computer-assisted template-based flapless implant placement, based on prosthetic and aesthetic analysis, was performed using a customized protocol. Treatment success was evaluated using the following parameters: survival of implants/prostheses, prosthetic and biologic complications, marginal bone remodelling, soft tissue parameters and patient satisfaction. A total of 56 implants were placed; the implants ranged between 8 and 16 mm in length and were either 3.5, 4.3 or 5 mm wide. All the patients have reached the 4-year follow-up. Three implants were lost accounting for an overall implant survival rate of 94.6%. No prosthesis were lost. Some complications were recorded. Four years after loading the mean marginal bone loss was 1.43 ± 0.49 mm at the palatal/lingual site and 1.48 ± 0.46 mm at the vestibular site. All the patients showed healthy soft tissues with stable probing depth (4 .93 ± 0.75%) and successful bleeding on probing values (12 ± 5.8%); 90% of patients were satisfied of the treatment at the 4-year follow-up. Computer-guided template-assisted flapless implant surgery seems to be a viable option for patients undergoing reconstruction with free flaps after tumour resection or gunshot trauma, although many challenges remain. A high degree of patient satisfactorily was reported. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications.

    Science.gov (United States)

    Rac, Goran; Younger, Austin; Clemens, James Q; Kobashi, Kathleen; Khan, Aqsa; Nitti, Victor; Jacobs, Ilana; Lemack, Gary E; Brown, Elizabeth T; Dmochowski, Roger; MacLachlan, Lara; Mourtzinos, Arthur; Ginsberg, David; Koski, Michelle; Rames, Ross; Rovner, Eric S

    2017-04-01

    To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States. Surgical volume for procedures performed primarily by FPMRS surgeons at eight academic institutions across the US was collected using Current Procedural Terminology (CPT) codes for stress urinary incontinence repair and revision surgeries from 2007 to 2013. SAS statistical software was used to assess for trends in the data. There was a decrease in the use of synthetic mesh sling for the treatment of SUI at academic tertiary care centers over the past 7 years; however, this was not statistically significant. While the total number of surgical interventions for SUI remained stable, there was an increase in the utilization of autologous fascia pubovaginal slings (AFPVS). The number of mesh sling revision surgeries, including urethrolysis and removal or revision of slings, increased almost three-fold at these centers. These observed trends suggest a possible effect of the FDA Public Health Notifications regarding TVM on surgical practice for SUI in academic centers, even though they did not specifically warn against the use of synthetic mesh for this indication. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study. However, such data may provide alternative insights into reasons for the observed trends. Neurourol. Urodynam. 36:1155-1160, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. MR imaging of the knee following cruciate ligament reconstruction and meniscal surgery; MRT des Kniegelenks nach Kreuzband- und Meniskusoperationen

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, K. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Inst. fuer Roentgendiagnostik

    2009-03-15

    Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications. (orig.)

  10. Tailored Double-Barrel Bypass Surgery Using an Occipital Artery Graft for Unstable Intracranial Vascular Occlusive Disease.

    Science.gov (United States)

    Chung, Yeongu; Lee, Sung Ho; Ryu, Jiwook; Kim, Johnho; Chung, Sang Bong; Choi, Seok Keun

    2017-05-01

    This report describes the need for a tailored approach for intracranial vascular occlusive disease and introduces the usefulness of the OA as a donor artery for interposition graft. A 65-year-old male patient suffered from repeated transient ischemic attack (TIA). Imaging studies revealed complete occlusion of the proximal left side of the internal carotid artery (ICA) and multiple infarction in the watershed zone. We planned superficial temporal artery-middle cerebral artery (STA-MCA) bypass to restore cerebral blood flow and to prevent the progression of infarction. However, the parietal branch of the STA was too small in diameter and not suitable as a single donor for the bypass in order to supply sufficient blood flow. Moreover, the frontal branch of the STA had collateral channels through the periorbital anastomosis into the cerebral cortex that could result in infarction during clamping for anastomosis. We determined that tailored treatment planning was necessary for successful revascularization under these conditions. Thus, we performed a bypass between the parietal branch of the STA and a cortical branch of the MCA as an "insurance bypass." Then we performed another bypass between the frontal branch of the STA and a cortical branch of the MCA using an ipsilateral occipital artery (OA) interposition graft. The patient had no perioperative complications, and postoperative imaging confirmed the restoration of cerebral blood flow. When end-to-side anastomosis in single-branch bypass is not appropriate for cerebral revascularization, a tailored double-barrel "insurance bypass" with an OA interposed graft could be a good alternative treatment modality. In addition, an OA interposition graft is a useful option for double-barrel bypass surgery in such cases of intracranial vascular occlusive disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. The effects of vasoactive agents on flow through saphenous vein grafts during lower-extremity peripheral vascular surgery.

    Science.gov (United States)

    Maslow, Andrew D; Bert, Arthur; Slaiby, Jeffrey; Carney, William; Marcaccio, Edward

    2007-06-01

    The purpose of this study was to assess the effects of hemodynamic alterations on vein graft flow during peripheral vascular surgery. It was hypothesized that vasopressors can be administered without compromising flow through the vein grafts. Tertiary care center, university medical center. Randomized placebo-controlled double-blinded study. The effects of phenylephrine, epinephrine, milrinone, intravenous fluid, and placebo on newly constructed peripheral vein grafts were assessed in 60 patients (12 patients in each of 5 groups). Systemic and central hemodynamics were measured by using intra-arterial and pulmonary artery catheters. Vein graft flow was measured by using a transultrasonic flow probe (Transultrasonic Inc, Ithaca, NY). Phenylephrine increased systemic mean blood pressure (mBP) (68.2-94.0 mmHg, p < 0.01), systemic vascular resistance (SVR) (1,091-1,696 dynes x sec x cm(-5), p < 0.001), and vein graft flow (39.5-58.9 mL/min, p < 0.01), whereas cardiac output remained unchanged. Epinephrine resulted in increased cardiac output (4.4-6.9 L/min, p < 0.01) and mBP (72.7-89.1 mmHg, p < 0.01), whereas vein graft flow was reduced in 6 of 12 patients. Intravenous fluid administration resulted in a relatively smaller increase in graft flow (37.6-46.0 mL/min, p < 0.05), an increase in cardiac output, and an insignificant decrease in SVR. Other treatments had either little or no effect on vein graft flow. The study hypothesis was partly supported. Although both phenylephrine and epinephrine increased blood pressure, only the former increased vein graft flow in all patients. In conjunction with increases in graft flow after fluid administration, these data suggest that factors affecting vein graft flow are not just simply related to systemic hemodynamics.

  12. The radial forearm free flap as a "vascular bridge" for secondary microsurgical head and neck reconstruction in a vessel-depleted neck.

    Science.gov (United States)

    Ciudad, Pedro; Agko, Mouchammed; Date, Shivprasad; Chang, Wei-Ling; Manrique, Oscar J; Huang, Tony C T; Lo Torto, Federico; Trignano, Emilio; Chen, Hung-Chi

    2017-11-04

    In a vessel-depleted neck, distant recipient sites may be the only option for secondary free flap reconstruction. While interposition vein grafts and arteriovenous loops can bridge the gap between the recipient and donor pedicle, they are not without risks. In these scenarios, we examinate the reliablity of a radial forearm free flap (RFFF) as an alternative vascular conduit. A retrospective review of cases between March 2005 and May 2016 was performed. Demographic data, prior surgical history, intraoperative details and outcomes were recorded. A total of ten patients, eight male and two female, with a mean age of 54.2 years (range, 39-74) were identified. The RFFF was initially anastomosed to either the thoracoacromial (n = 6) or internal mammary vessels (n = 4) and subsequently served as the recipient pedicle for the second "main" flap, an anterolateral thigh (n = 4), jejunum (n = 3) or fibula flap (n = 3). The average RFFF dimensions were 13.8 cm by 5.8 cm. All twenty flaps, ten RFFF and ten "main' flaps survived completely with only one case of minimal epidermal loss. One patient with esophageal reconstruction with jejunum developed a fistula that required closure with a local falp. At a mean follow-up of 18.4 months (range 8-29), the reconstructive goals had been achieved in all cases. The RFFF serves as a reliable "vascular bridge" that extends the reach of distant recipient sites to free flaps in secondary head and neck reconstruction. © 2017 Wiley Periodicals, Inc.

  13. A multicenter prospective trial evaluating fetal bovine dermal graft (Xenform® Matrix) for pelvic reconstructive surgery.

    Science.gov (United States)

    Goldstein, Howard B; Maccarone, Joseph; Naughton, Martin J; Aguirre, Oscar A; Patel, Rakesh C

    2010-12-13

    A prospective multicenter clinical study was performed to evaluate the safety and efficacy of a bovine dermal graft (Xenform® Matrix, Boston Scientific, Natick, MA, USA) during vaginal reconstructive surgery. Forty-five women with ICS stage 2 or higher pelvic organ prolapse (POP) were enrolled at 4 centers. POP-Q, pelvic floor function (PFDI-20), sexual function (PISQ-12), and patient satisfaction tools were used to assess subjects at baseline, and at 2 and 6 weeks, and 3, 6 and 12 months post surgery. The significance of symptom score changes at 6 months and 1 year were determined by the t-test for paired data. Forty-three of the 45 patients completed the 12 month study. The majority of the subjects had cystocele (98%) and/or rectocele (84%) defects at study entry. At 12 months, 74% of the defects had improved to a stage 0 or 1. Mean PFDI-20 scores improved by 72% (p constipation) was deemed by the study physician to be unrelated to Xenform®. One subject had severe pyelonephritis resulting in dialysis. This subject had a previous history of pyelonephritis, sepsis and acute renal failure. The third subject had a reported recurrent cystocele of moderate severity, possibly related to the device. No graft related erosions or pain lasting more than 30 days were reported. No subjects withdrew due to an adverse event. This study is the first to investigate the use of Xenform® Matrix in vaginal reconstructive surgery among patients with POP. Significant improvement was maintained at 12 months utilizing both objective and subjective assessment tools, confirming the safety and efficacy of this material in vaginal surgery. ClinicalTrials.gov NCT01244165.

  14. A multicenter prospective trial evaluating fetal bovine dermal graft (Xenform® Matrix for pelvic reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Aguirre Oscar A

    2010-12-01

    Full Text Available Abstract Background A prospective multicenter clinical study was performed to evaluate the safety and efficacy of a bovine dermal graft (Xenform® Matrix, Boston Scientific, Natick, MA, USA during vaginal reconstructive surgery. Methods Forty-five women with ICS stage 2 or higher pelvic organ prolapse (POP were enrolled at 4 centers. POP-Q, pelvic floor function (PFDI-20, sexual function (PISQ-12, and patient satisfaction tools were used to assess subjects at baseline, and at 2 and 6 weeks, and 3, 6 and 12 months post surgery. The significance of symptom score changes at 6 months and 1 year were determined by the t-test for paired data. Forty-three of the 45 patients completed the 12 month study. Results The majority of the subjects had cystocele (98% and/or rectocele (84% defects at study entry. At 12 months, 74% of the defects had improved to a stage 0 or 1. Mean PFDI-20 scores improved by 72% (p ®. One subject had severe pyelonephritis resulting in dialysis. This subject had a previous history of pyelonephritis, sepsis and acute renal failure. The third subject had a reported recurrent cystocele of moderate severity, possibly related to the device. No graft related erosions or pain lasting more than 30 days were reported. No subjects withdrew due to an adverse event. Conclusion This study is the first to investigate the use of Xenform® Matrix in vaginal reconstructive surgery among patients with POP. Significant improvement was maintained at 12 months utilizing both objective and subjective assessment tools, confirming the safety and efficacy of this material in vaginal surgery. Trial Registration ClinicalTrials.gov NCT01244165

  15. Successful reconstruction of nongrowing hemifacial microsomia patients with unilateral temporomandibular joint total joint prosthesis and orthognathic surgery.

    Science.gov (United States)

    Wolford, Larry M; Bourland, T Campbell; Rodrigues, Daniel; Perez, Daniel E; Limoeiro, Evelin

    2012-12-01

    Traditionally, patients with hemifacial microsomia (HFM) and significant ipsilateral hypoplasia or absence of the condyle and ramus undergo reconstruction on the ipsilateral side with autogenous tissues such as rib grafts, often with compromised results. This study analyzed the surgical treatment outcomes of nongrowing patients with HFM and reconstruction of the ipsilateral temporomandibular joint (TMJ) and advancement of the mandible with a patient-fitted TMJ total joint prosthesis (TMJ Concepts, Inc, Ventura, CA), a contralateral mandibular ramus sagittal split osteotomy, and maxillary osteotomies performed in 1 operation. All nongrowing patients with HFM treated with this surgical protocol from 1997 to 2010 in a single private practice were included in this study and subjectively evaluated before surgery and at the longest postsurgical follow-up for pain, diet, jaw function, and disability using a visual numerical scale (0 to 10). Surgical changes and postsurgical stability were analyzed using lateral cephalograms before surgery, immediately after surgery, and at the longest follow-up. Six patients (4 female and 2 male) were included in this study, with an average age at surgery of 23.5 years (range, 14 to 39 yrs) and an average follow-up of 6 years 3 months (range, 1 yr to 11 yrs 4 mo). For all subjective parameters, all patients improved or remained the same. Incisal opening improved or remained the same in 4 of the 6 patients, with 2 patients having decreased opening. Excursive movements decreased. The maxillomandibular complex was surgically rotated counterclockwise, advanced, and transversely leveled, with the anterior maxillary reference points (anterior nasal spine, point A) undergoing relative small movements. The mandibular incisor tips (lower incisor tips) advanced a mean of 8.9 mm, point B 14.8 mm, pogonion 18.6 mm, menton 17.5 mm and the occlusal plane angle decreased -12.3°. Postsurgical long-term stability indicated that the anterior maxillary

  16. Telemedicine in vascular surgery: feasibility of digital imaging for remote management of wounds.

    Science.gov (United States)

    Wirthlin, D J; Buradagunta, S; Edwards, R A; Brewster, D C; Cambria, R P; Gertler, J P; LaMuraglia, G M; Jordan, D E; Kvedar, J C; Abbott, W M

    1998-06-01

    promise for improving outpatient vascular wound care.

  17. Magnetic resonance angiographic assessment of upper extremity vessels prior to vascular access surgery: feasibility and accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Planken, Nils R. [Maastricht University Hospital, Department of Vascular Surgery, Maastricht (Netherlands); Maastricht University Hospital, Department of Radiology, Maastricht (Netherlands); Maastricht University Medical School, Cardiovascular Research Institute Maastricht, Maastricht (Netherlands); Tordoir, Jan H. [Maastricht University Hospital, Department of Vascular Surgery, Maastricht (Netherlands); Maastricht University Medical School, Cardiovascular Research Institute Maastricht, Maastricht (Netherlands); Duijm, Lucien E.; Bosch, Harrie C. van den [Catharina Hospital, Department of Radiology, Eindhoven (Netherlands); Sande, Frank M. van der; Kooman, Jeroen P. [Maastricht University Hospital, Department of Nephrology, Maastricht (Netherlands); Maastricht University Medical School, Cardiovascular Research Institute Maastricht, Maastricht (Netherlands); Haan, Michiel W. de; Leiner, Tim [Maastricht University Hospital, Department of Radiology, Maastricht (Netherlands); Maastricht University Medical School, Cardiovascular Research Institute Maastricht, Maastricht (Netherlands)

    2008-01-15

    A contrast-enhanced magnetic resonance angiography (CE-MRA) protocol for selective imaging of the entire upper extremity arterial and venous tree in a single exam has been developed. Twenty-five end-stage renal disease (ESRD) patients underwent CE-MRA and duplex ultrasonography (DUS) of the upper extremity prior to hemodialysis vascular access creation. Accuracy of CE-MRA arterial and venous diameter measurements were compared with DUS and intraoperative (IO) diameter measurements, the standard of reference. Upper extremity vasculature depiction was feasible with CE-MRA. CE-MRA forearm and upper arm arterial diameters were 2.94 {+-} 0.67 mm and 4.05 {+-} 0.84 mm, respectively. DUS arterial diameters were 2.80 {+-} 0.48 mm and 4.38 {+-} 1.24 mm; IO diameters were 3.00 {+-} 0.35 mm and 3.55 {+-} 0.51 mm. Forearm arterial diameters were accurately determined with both techniques. Both techniques overestimated upper arm arterial diameters significantly. Venous diameters were accurately determined with CE-MRA but not with DUS (forearm: CE-MRA: 2.64 {+-} 0.61 mm; DUS: 2.50 {+-} 0.44 mm, and IO: 3.40 {+-} 0.22 mm; upper arm: CE-MRA: 4.09 {+-} 0.71 mm; DUS: 3.02 {+-} 1.65 mm, and IO: 4.30 {+-} 0.78 mm). CE-MRA enables selective imaging of upper extremity vasculature in patients requiring hemodialysis access. Forearm arterial diameters can be assessed accurately by CE-MRA. Both CE-MRA and DUS slightly overestimate upper arm arterial diameters. In comparison to DUS, CE-MRA enables a more accurate determination of upper extremity venous diameters. (orig.)

  18. Animal models in plastic and reconstructive surgery simulation-a review.

    Science.gov (United States)

    Loh, Charles Yuen Yung; Wang, Aline Yen Ling; Tiong, Vincent Tze Yang; Athanassopoulos, Thanassi; Loh, Meiling; Lim, Philip; Kao, Huang-Kai

    2018-01-01

    The use of live and cadaveric animal models in surgical training is well established as a means of teaching and improving surgical skill in a controlled setting. We aim to review, evaluate, and summarize the models published in the literature that are applicable to Plastic Surgery training. A PubMed search for keywords relating to animal models in Plastic Surgery and the associated procedures was conducted. Animal models that had cross over between specialties such as microsurgery with Neurosurgery and pinnaplasty with ear, nose, and throat surgery were included as they were deemed to be relevant to our training curriculum. A level of evidence and recommendation assessment was then given to each surgical model. Our review found animal models applicable to plastic surgery training in four major categories namely-microsurgery training, flap raising, facial surgery, and hand surgery. Twenty-four separate articles described various methods of practicing microsurgical techniques on different types of animals. Fourteen different articles each described various methods of conducting flap-based procedures which consisted of either local or perforator flap dissection. Eight articles described different models for practicing hand surgery techniques. Finally, eight articles described animal models that were used for head and neck procedures. A comprehensive summary of animal models related to plastic surgery training has been compiled. Cadaveric animal models provide a readily available introduction to many procedures and ought to be used instead of live models when feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Biological reconstruction after resection of bone tumors of the proximal tibia using allograft shell and intramedullary free vascularized fibular graft: long-term results.

    Science.gov (United States)

    Innocenti, Marco; Abed, Yasser Y; Beltrami, Giovanni; Delcroix, Luca; Manfrini, Marco; Capanna, Rodolfo

    2009-01-01

    Reconstruction after excision of bone tumor of the proximal tibia is a challenging issue for the reconstructive surgeon. The combined use of a free fibular flap and allograft can provide a reliable reconstructive option in this location. This article describes the authors' long-term follow-up using this technique. Twenty-seven patients that had resection of proximal tibia bone tumors underwent reconstruction using this technique. Only 21 patients that had primary reconstruction were included in this study. All patients had their surgeries performed at least 24 months before the end of the study. The average age at time of operation was 18.1 years. The average follow-up time was 139.3 months. Limb salvage was 82.7%. The average length of the resected tibial segment was 15.3 cm and that of the residual proximal tibia remaining after resection was 2.7 cm. The average time of union of fibula was 5.4 months and for union of allograft was 19.1 months. Primary union of the allograft was achieved in 90.5% of cases. Full weight-bearing was achieved at an average of 21.6 months. Ten patients (47.6%) had 14 local complications. The (MTSRS) average score at final follow-up was 27.3. Local recurrences occurred in two patients (9.5%). Distant metastasis to the lung occurred in three patients (14.3%). One patient died of disease. This technique provides good long-term results in reconstruction of proximal tibia. The viability of the fibula is a cornerstone in both success of reconstruction as well as successful management of complications.

  20. Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy.

    Science.gov (United States)

    Doménech Juan, Ivan; Tornero, Jordi; Cruz Toro, Paula; Ortiz Laredo, Nuria; Vega Celiz, Jorge; Junyent, Josefina; Maños Pujol, Manel

    2014-01-01

    Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  1. Vascular quality of care pilot study: how admission to a vascular surgery service affects evidence-based pharmacologic risk factor modification in patients with lower extremity peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Steenhof N

    2014-06-01

    Full Text Available Naomi Steenhof,1,2 Francesca Le Piane,1 Kori Leblanc,1–3 Naomi R Eisenberg,4 Yvonne Kwan,1 Christine Malmberg,1,6 Alexandra Papadopoulos,5,7 Graham Roche-Nagle4,7,8 1Department of Pharmacy, University Health Network, 2Leslie Dan Faculty of Pharmacy, University of Toronto, 3Centre for Innovation in Complex Care, University Health Network, 4Division of Vascular Surgery, University Health Network, 5Faculty of Nursing, University of Toronto, Toronto, ON, 6Victoria General Hospital, Vancouver Island Health Authority, Victoria, BC, 7Peter Munk Cardiac Centre, University Health Network, 8Faculty of Medicine, University of Toronto, Toronto, ON, Canada Background: Peripheral arterial disease (PAD guidelines recommend aggressive risk factor modification to improve cardiovascular outcomes. Recommended pharmacologic therapies include antiplatelets, angiotensin converting enzyme (ACE inhibitors, and HMG-CoA-reductase inhibitors (statins. Purpose: We studied the degree to which patient admission to a vascular surgery service increased the use of these therapies. Patients and methods: The authors conducted a retrospective chart review of 150 patients with PAD admitted to the vascular surgery service at a large Canadian tertiary care hospital. The use of recommended pharmacologic therapies at the time of admission and discharge were compared. A multidisciplinary clinical team established criteria by which patients were deemed ineligible to receive any of the recommended therapies. Angiotensin receptor blockers (ARBs were considered an alternative to ACE inhibitors. Results: Prior to hospital admission, 64% of patients were on antiplatelet therapy, 67% were on an ACE inhibitor or ARB, and 71% were on a statin. At the time of discharge, 91% of patients were on an antiplatelet (or not, with an acceptable reason, 77% were on an ACE inhibitor or an ARB (or not, with an acceptable reason, and 85% were on a statin (or not, with an acceptable reason. While new

  2. Evaluation of central venous pressure monitoring in children undergoing craniofacial reconstruction surgery.

    Science.gov (United States)

    Stricker, Paul A; Lin, Elaina E; Fiadjoe, John E; Sussman, Emily M; Pruitt, Eric Y; Zhao, Huaqing; Jobes, David R

    2013-02-01

    Massive hemorrhage during craniofacial surgery is common and often results in hypovolemia and hypotension. We conducted this study to assess the effect of the addition of routine central venous pressure (CVP) monitoring on the incidence of intraoperative hypotension and to evaluate the relationship between CVP and hypotension in this population. Data from our prospective craniofacial perioperative registry for children 6 to 24 months of age undergoing cranial vault reconstruction with CVP monitoring were compared with data from a historical cohort without CVP monitoring. The incidence and duration of hypotension in the 2 cohorts were compared. In the cohort of subjects with CVP monitoring who experienced hypotension, CVP at the onset of hypotension (T0) was compared with CVP 5 minutes before (T-5) and 5 minutes after (T+5) the onset of hypotension and with the baseline CVP. The amount of time spent at various CVP levels below the baseline, and the associated incidence of hypotension were also determined. Data from 57 registry subjects were compared with data from 115 historical cohort subjects. The median total duration of hypotension in subjects experiencing hypotension was 278 seconds in the CVP cohort versus 165 seconds in the historical cohort; the median difference was 98 seconds (95% confidence interval [CI], -45 to 345 seconds). The incidence of hypotension was 18% in the CVP cohort versus 21% in the historical cohort; the difference in the incidence of hypotension was -3% (95% CI, -10% to 15%). Analysis using a linear mixed effects model showed a significant decrease in CVP from T-5 to T0 (95% CI, -0.9 to -2.2 mm Hg), a significant increase in CVP from T0 to T+5 (95% CI, 1.0-2.4 mm Hg), no significant difference in CVP between T-5 and T+5 (95% CI, -0.9 to 0.9 mm Hg), and a significant decrease in CVP from baseline to T0 (95% CI, -3.4 to -2.1 mm Hg). CVP at T0 was less than the baseline CVP in 97% of hypotensive episodes. When all cases were examined, CVP

  3. Indications and Results of Reconstructive Techniques with Flaps Transposition in Patients Requiring Complex Thoracic Surgery: A 12-Year Experience.

    Science.gov (United States)

    Gaucher, Sonia; Lococo, Filippo; Guinet, Claude; Bobbio, Antonio; Magdeleinat, Pierre; Bouam, Samir; Regnard, Jean-François; Alifano, Marco

    2016-10-01

    Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition. We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013. Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20-87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case). Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.

  4. Three-dimensional virtual reality simulation of periarticular tumors using Dextroscope reconstruction and simulated surgery: a preliminary 10 case study.

    Science.gov (United States)

    Shi, JingSheng; Xia, Jun; Wei, YiBing; Wang, SiQun; Wu, JianGuo; Chen, FeiYan; Huang, GangYong; Chen, Jie

    2014-03-01

    Dextroscope three-dimensional (3D) imaging has been extensively applied for generation of virtual reality (VR) workspaces for in neurosurgery and laparoscopy, though few applications in orthopedic surgery have been reported. Patients undergoing surgery for periarticular tumors (n = 10) from Oct. 2008 to Jun. 2010 were enrolled and presurgically subjected to computed tomography (CT), magnetic resonance imaging (MRI), and MRI angiography (MRI-A). Imaging data was transferred and integrated in Dextroscope, producing a VR simulation. Resultant presurgical 3D anatomical reconstructions and intraoperative anatomical characteristics (virtual vs. actual data) and surgical approach (virtual vs. actual situation) measurement and subjective appearance were compared. Anatomical characteristics in the area of interest and tumor diameters were consistent between virtual and actual data. However, the virtual surgical situations remained inconsistent with the actual intraoperative situation in many cases, leading to complications. The resolution of original CT, MRI, and MRI-A images directly correlated with the quality of 3D simulations, with soft tissues most poorly represented. Tumor tissue imaging quality in 3D varied extensively by tumor type. Anatomical structures of periarticular tumors can be reconstructed using the Dextroscope system with good accuracy in the case of simple fenestration, increasing individualization of treatment, surgical competence level, and potentially reducing intraoperative complications. However, further specialization of VR tools for use in orthopedic applications that involve specialized tools and procedures, such as drilling and implant placement, are urgently required.

  5. Bone-anchored hearing aid (BAHA: indications, functional results, and comparison with reconstructive surgery of the ear

    Directory of Open Access Journals (Sweden)

    Bento, Ricardo Ferreira

    2012-01-01

    Full Text Available Introduction: The bone-anchored hearing aid (BAHA is a bone conduction hearing device that transmits sound directly into the inner ear. It is mainly used in patients with conductive hearing loss associated with aural atresia, but it is also used in those with mixed and sensorineural hearing loss. Goals: To review the main indications for BAHA, to analyze the audiometric results and its benefits for patients and compare them with other treatment modalities, and to compare the literature data with our sample of 13 patients. Method: The research was performed using a database covering works in English, Spanish, and Portuguese, with no limitations in the years when the procedures were performed. We compared the literature data with our results for the 13 patients who underwent BAHA implantation between the years 2000 and 2009. Results: Most of the studies showed that BAHA has great advantages over reconstructive surgery in terms of hearing results, complications, and disease recurrence. The postoperative results for our 13 patients were satisfactory and comparable with the results from the literature, with closure of the air-bone gap in 7 patients and achieving an air-bone gap of 10 dB in 6 patients. No postoperative complications were observed. Conclusion: BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness. It is a relatively simple surgical procedure with few complications and good hearing results. Recent studies have examined its use in conductive and unilateral sensorineural hearing loss.

  6. Bone-anchored hearing aid (BAHA): indications, functional results, and comparison with reconstructive surgery of the ear.

    Science.gov (United States)

    Bento, Ricardo Ferreira; Kiesewetter, Alessandra; Ikari, Liliane Satomi; Brito, Rubens

    2012-07-01

     The bone-anchored hearing aid (BAHA) is a bone conduction hearing device that transmits sound directly into the inner ear. It is mainly used in patients with conductive hearing loss associated with aural atresia, but it is also used in those with mixed and sensorineural hearing loss.  To review the main indications for BAHA, to analyze the audiometric results and its benefits for patients and compare them with other treatment modalities, and to compare the literature data with our sample of 13 patients.  The research was performed using a database covering works in English, Spanish, and Portuguese, with no limitations in the years when the procedures were performed. We compared the literature data with our results for the 13 patients who underwent BAHA implantation between the years 2000 and 2009.  Most of the studies showed that BAHA has great advantages over reconstructive surgery in terms of hearing results, complications, and disease recurrence. The postoperative results for our 13 patients were satisfactory and comparable with the results from the literature, with closure of the air-bone gap in 7 patients and achieving an air-bone gap of 10 dB in 6 patients. No postoperative complications were observed.  BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness. It is a relatively simple surgical procedure with few complications and good hearing results. Recent studies have examined its use in conductive and unilateral sensorineural hearing loss.

  7. A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement.

    Science.gov (United States)

    Aiello, Francesco A; Judelson, Dejah R; Messina, Louis M; Indes, Jeffrey; FitzGerald, Gordon; Doucet, Danielle R; Simons, Jessica P; Schanzer, Andres

    2016-08-01

    Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes

  8. Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery.

    Science.gov (United States)

    Goei, Dustin; van Kuijk, Jan-Peter; Flu, Willem-Jan; Hoeks, Sanne E; Chonchol, Michel; Verhagen, Hence J M; Bax, Jeroen J; Poldermans, Don

    2011-02-15

    Plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels improve preoperative cardiac risk stratification in vascular surgery patients. However, single preoperative measurements of NT-pro-BNP cannot take into account the hemodynamic stress caused by anesthesia and surgery. Therefore, the aim of the present study was to assess the incremental predictive value of changes in NT-pro-BNP during the perioperative period for long-term cardiac mortality. Detailed cardiac histories, rest left ventricular echocardiography, and NT-pro-BNP levels were obtained in 144 patients before vascular surgery and before discharge. The study end point was the occurrence of cardiovascular death during a median follow-up period of 13 months (interquartile range 5 to 20). Preoperatively, the median NT-pro-BNP level in the study population was 314 pg/ml (interquartile range 136 to 1,351), which increased to a median level of 1,505 pg/ml (interquartile range 404 to 6,453) before discharge. During the follow-up period, 29 patients (20%) died, 27 (93%) from cardiovascular causes. The median difference in NT-pro-BNP in the survivors was 665 pg/ml, compared to 5,336 pg/ml in the patients who died (p = 0.01). Multivariate Cox regression analyses, adjusted for cardiac history and cardiovascular risk factors (age, angina pectoris, myocardial infarction, stroke, diabetes mellitus, renal dysfunction, body mass index, type of surgery and the left ventricular ejection fraction), demonstrated that the difference in NT-pro-BNP level between pre- and postoperative measurement was the strongest independent predictor of cardiac outcome (hazard ratio 3.06, 95% confidence interval 1.36 to 6.91). In conclusion, the change in NT-pro-BNP, indicated by repeated measurements before surgery and before discharge is the strongest predictor of cardiac outcomes in patients who undergo vascular surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Vascular ring

    DEFF Research Database (Denmark)

    Schmidt, Anne Mette S; Larsen, Signe H; Hjortdal, Vibeke E

    2018-01-01

    BACKGROUND: Vascular ring is a rare cause of recurrent respiratory infections, dysphagia and stridor. Surgical repair is considered safe but the long-term outcomes are unclear. The purpose of this study was to investigate the mortality and morbidity following vascular ring surgery in a single...... age of 1.4 years (range 0.008-64 years) were operated for vascular ring. Median follow-up was 6.8 years (range 2.4-34 years). Presenting symptoms were stridor (52%), dysphagia or vomiting (52%) and recurrent respiratory infections (48%). There were no early or late deaths. Three months postoperatively...

  10. The Inframammary Fold (IMF): A Poorly Appreciated Landmark in Prosthetic/Alloplastic Breast Aesthetic and Reconstructive Surgery-Personal Experience.

    Science.gov (United States)

    Atiyeh, Bishara; Ibrahim, Amir; Saba, Salim; Karamanoukian, Raffy; Chahine, Fadl; Papazian, Nazareth

    2017-08-01

    The inframammary fold (IMF) is the most critical visual landmark that affects final aesthetic outcome of augmentation mammoplasty and even post-mastectomy alloplastic breast reconstruction. Unfortunately, structural integrity of this landmark is greatly overlooked and very often neglected. Excessive undermining of the lower breast pole with aggressive disruption/lowering and subsequent poor reconstitution of the IMF scaffold combined with imbalanced implant-tissue dynamics may result in downward implant displacement with creep bottoming and upward tilt of the nipples. The current report reviews the experience of the senior author (BA) over 30 years in breast aesthetic and reconstructive surgery with IMF reconstruction and fixation to the chest wall at the inferior border of the implant. Illustrative cases are presented. 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 .

  11. Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women

    Directory of Open Access Journals (Sweden)

    Yiap Loong Tan

    2014-09-01

    Conclusion: This study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.

  12. Preliminary results using a newly developed projection method to visualize vascular anatomy prior to DIEP flap breast reconstruction

    NARCIS (Netherlands)

    Hummelink, S.L.; Hameeteman, M.; Hoogeveen, Y.L.; Slump, C.H.; Ulrich, D.J.O.; Schultze Kool, L.J.

    2015-01-01

    INTRODUCTION: In a deep inferior epigastric perforator (DIEP) flap breast reconstruction, computed tomography angiography (CTA) is currently considered as the gold standard in preoperative imaging for this procedure. Unidirectional Doppler ultrasound (US) is frequently used; however, this method

  13. Preliminary results using a newly developed projection method to visualize vascular anatomy prior to DIEP flap breast reconstruction

    NARCIS (Netherlands)

    Hummelink, S.; Hofer, S.; Hameeteman, M.; Hoogeveen, Y.; Slump, Cornelis H.; Ulrich, D.J.O.; Schultze Kool, L.J.

    Introduction: In a deep inferior epigastric perforator (DIEP) flap breast reconstruction, computed tomography angiography (CTA) is currently considered as the gold standard in preoperative imaging for this procedure. Unidirectional Doppler ultrasound (US) is frequently used; however, this method

  14. Reconstructive surgery of the medial zygomatic region of the cheek: presentation of 5 cases.

    Science.gov (United States)

    Pérez-Paredes, M G; González-Sixto, B; Otero-Rivas, M M; Rodríguez-Prieto, M Á

    2014-05-01

    The cheek is the largest anatomical subunit of the face. It is a bilateral structure and symmetry must therefore be preserved. Peripherally it is related to important natural orifices whose location must also be maintained during surgical reconstructions. This is particularly important in the medial zygomatic subunit, whose delicate junction with the lower eyelid means that care must be taken to avoid ectropion. We present 5 options for the reconstruction of surgical defects secondary to the excision of tumors in this region. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

  15. Technology-Enabled Remote Monitoring and Self-Management ? Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol

    OpenAIRE

    McGillion, Michael; Yost, Jennifer; Turner, Andrew; Bender, Duane; Scott, Ted; Carroll, Sandra; Ritvo, Paul; Peter,Elizabeth; Lamy, Andre; Furze, Gill; Krull, Kirsten; Dunlop, Valerie; Good, Amber; Dvirnik, Nazari; Bedini, Debbie

    2016-01-01

    Background Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, w...

  16. Fondaparinux for intra and perioperative anticoagulation in patients with heparin-induced thrombocytopenia candidates for peripheral vascular surgery: Report of 4 cases.

    Science.gov (United States)

    Illuminati, Giulio; Calio', Francesco G; Pizzardi, Giulia; Amatucci, Chiara; Masci, Federica; Palumbo, Piergaspare

    2016-01-01

    Intra and perioperative anticoagulation in patients with heparin induced thrombocytopenia (HIT), candidates for peripheral vascular surgery remains a challenge, as the best alternative to heparin has not yet been established. We evaluated the off-label use of fondaparinux in four patients with HIT, undergoing peripheral vascular surgery procedures. Four patients of whom 3 men of a mean age of 66 years, with proven heparin induced thrombocytopenia (HIT) underwent two axillo-femoral bypasses, one femoro-popliteal bypass and one resection of a splenic artery aneurysm under fondaparinux. No intra or perioperative bleeding or thrombosis of new onset was observed. In the absence of a valid alternative to heparin for intra and perioperative anticoagulation in HIT, several other anticoagulants can be used in an off-label setting. However, no general consensus exist on which should be the one of choice. In this small series fondaparinux appeared to be both safe and effective. These preliminary results seem to justify the off-label use of fondaparinux for intra and perioperative anticoagulation in patients with HIT, candidates for peripheral vascular surgery interventions. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. RECONSTRUCTIVE PLASTIC SURGERIES IN PATIENTS WITH MALIGNANCIES OF TONGUE AND FLOOR OF THE MOUTH. TYPES OF PLASTICS

    Directory of Open Access Journals (Sweden)

    Z. A. Radjabova

    2015-01-01

    Full Text Available Issues of tissue defects replacement after radical surgery for tumors of the head and neck do not lose their relevance. The article presents the results of plastics and replacement of the perforating combined defects of the floor of the mouth, portion of the upper and lower lips, the angle of the mouth, cheeks, neck lateral parts with simultaneous reduction of the configuration and function of the operated organs. Depending on the depth and nature of the existing tissue defect various methods of plastics were applied using arterialized flaps on the vascular pedicle in a free and non-free version. Satisfactory cosmetic and functional results were achieved in patients allowing to improve life quality and to adapt socially.

  18. Speech and swallowing following tongue cancer surgery and free flap reconstruction--a systematic review.

    Science.gov (United States)

    Lam, Lisetta; Samman, Nabil

    2013-06-01

    This was a systematic review of the current research on speech and swallowing outcomes and the factors affecting these outcomes after primary resection of tongue cancer and free flap reconstruction. A structured search in various electronic databases and relevant journals was performed. Retrieved articles were critically appraised in three rounds according to the level of evidence, the methodological quality, and the specific domain of speech and swallowing. A total of 21 articles were in the final review and the findings were categorized according to the area of tongue resection. For patients with resection and free flap reconstruction limited to either the oral tongue or the base of tongue (BOT), significant decline in speech and swallowing function was evident in the early postoperative phase, but the majority recovered close to preoperative level after 1 year. Poorer speech and swallowing outcomes were found following resections involving both oral and base of tongue (OBOT) regardless of the type of free flap reconstruction. Results overall were influenced by multiple factors including tumor size, area of resection, method of reconstruction and the use of adjuvant therapy. The use of free flaps in the immediate reconstruction of the tongue after tumor resection should aim at the maintenance of the mobility of the residual tongue and restoration of tongue bulk in order to optimize the recovery of speech and swallowing function. Future research in this field should employ standardized and reliable evaluation of speech and swallowing outcomes using multiple modalities in well-designed cohort studies with longer follow-up. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Decellularized omentum as novel biologic scaffold for reconstructive surgery and regenerative medicine

    Directory of Open Access Journals (Sweden)

    A. Porzionato

    2013-01-01

    Full Text Available Homologous tissues, such as adipose tissue, may be an interesting source of acellular scaffolds, maintaining a complex physiological three-dimensional (3D structure, to be recellularized with autologous cells. The aim of the present work is to evaluate the possibility of obtaining homologous acellular scaffolds from decellularization of the omentum, which is known to have a complex vascular network. Adult rat and human omenta were treated with an adapted decellularization protocol involving mechanical rupture (freeze-thaw cycles, enzymatic digestion (trypsin, lipase, deoxyribonuclease, ribonuclease and lipid extraction (2-propanol. Histological staining confirmed the effectiveness of decellularization, resulting in cell-free scaffolds with no residual cells in the matrix. The complex 3D networks of collagen (azan-Mallory, elastic fibers (Van Gieson, reticular fibers and glycosaminoglycans (PAS were maintained, whereas Oil Red and Sudan stains showed the loss of lipids in the decellularized tissue. The vascular structures in the tissue were still visible, with preservation of collagen and elastic wall components and loss of endothelial (anti-CD31 and -CD34 immunohistochemistry and smooth muscle (anti-alpha smooth muscle actin cells. Fat-rich and well vascularized omental tissue may be decellularized to obtain complex 3D scaffolds preserving tissue architecture potentially suitable for recellularization. Further analyses are necessary to verify the possibility of recolonization of the scaffold by adipose-derived stem cells in vitro and then in vivo after re-implantation, as already known for homologus implants in regenerative processes.

  20. Esthetic plastic surgery: Experiencies concerning corporal (reconstructions and implications for nursin

    Directory of Open Access Journals (Sweden)

    Carla Fernanda Voese

    2015-05-01

    Full Text Available Objective: to identify reasons which lead healthy subjects to search, for the first time, surgical methods for corporal modifications. Methods: it is a descriptive, exploratory and qualitative study. Data were collected through semi-structured interviews which were recorded. The interviews were made with eight women and resulted into four analytic categories. Results: the reasons which took healthy subjects to face surgical risks are regarding the improvement of the satisfaction with their own corporal image aiming at reaching a higher social insertion. It was observed that dissatisfaction concerning physical appearance was generated by inherited characteristics or by marks left after pregnancy. Financial cost, fear and family support, can make the decision to undergo the surgery difficult. Conclusion: the plastic surgery can promote the regain of self-esteem in the subject who makes the surgery.

  1. Length of time between surgery and return to sport after ulnar collateral ligament reconstruction in Major League Baseball pitchers does not predict need for revision surgery.

    Science.gov (United States)

    Erickson, Brandon J; Chalmers, Peter N; Bach, Bernard R; Dines, Joshua S; Verma, Nikhil N; Bush-Joseph, Charles A; Cohen, Steven B; Romeo, Anthony A

    2017-04-01

    Pitchers who return to sport (RTS) sooner will have a higher risk of revision ulnar collateral ligament reconstruction (UCLR) than those who return later. All professional (major and minor league) baseball pitchers who underwent UCLR between 1974 and 2016 were identified. Date of the index UCLR was recorded. The date of the first game back at any professional level after surgery and the date the pitcher returned to the same level of play (if applicable) were recorded. Length of time between these dates was compared for pitchers who required a revision UCLR and those who did not. Overall, 569 pitchers (average age, 24.8 ± 4.1 years) underwent UCLR and had reliable game logs after surgery. No statistically significant difference existed in the length of time to RTS at any professional level or at the same professional level between those pitchers who did not require a revision UCLR and those who did (P = .442, P = .238). Pitchers who required revision UCLR returned to any level of play almost 2 months earlier (14.7 vs. 16.5 months) and returned to the same level of play >2 months earlier (15.2 vs. 17.7 months) than matched controls who did not require revision UCLR, although this was not statistically significant (P = .179, P = .204). No statistically significant difference existed in the length of time to RTS after UCLR in professional baseball players who required a revision UCLR and those who did not. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register.

    Science.gov (United States)

    Desai, Neel; Andernord, Daniel; Sundemo, David; Alentorn-Geli, Eduard; Musahl, Volker; Fu, Freddie; Forssblad, Magnus; Samuelsson, Kristian

    2017-05-01

    To investigate the association between surgical variables and the risk of revision surgery after ACL reconstruction in the Swedish National Knee Ligament Register. This cohort study was based on data from the Swedish National Knee Ligament Register. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon were included. Follow-up started with primary ACL reconstruction and ended with ACL revision surgery or on 31 December, 2014, whichever occurred first. Details on surgical technique were collected using an online questionnaire. All group comparisons were made in relation to an "anatomic" reference group, comprised of essential AARSC items, defined as utilization of accessory medial portal drilling, anatomic tunnel placement, visualization of insertion sites and pertinent landmarks. Study end-point was revision surgery. A total of 108 surgeons (61.7%) replied to the questionnaire. A total of 17,682 patients were included [n = 10,013 males (56.6%) and 7669 females (43.4%)]. The overall revision rate was 3.1%. Older age as well as cartilage injury evident at index surgery was associated with a decreased risk of revision surgery. The group using transtibial drilling and non-anatomic bone tunnel placement was associated with a lower risk of revision surgery [HR 0.694 (95% CI 0.490-0.984); P = 0.041] compared with the anatomic reference group. The anatomic reference group showed no difference in risk of revision surgery compared with the transtibial drilling groups with partial anatomic [HR 0.759 (95% CI 0.548-1.051), n.s.] and anatomic tunnel placement [HR 0.944 (95% CI 0.718-1.241), n.s.]. The anatomic reference group showed a decreased risk of revision surgery compared with the transportal drilling group with anatomic placement [HR 1.310 (95% CI 1.047-1.640); P = 0.018]. Non-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery after ACL reconstruction. The risk of revision surgery

  3. Impact of cleft lip and/or palate in children on family quality of life before and after reconstructive surgery.

    Science.gov (United States)

    Macho, P; Bohac, M; Fedeles, J; Fekiacova, D; Fedeles, J

    2017-01-01

    The aim of the study was to evaluate the impact of cleft lip/palate children together with consequent treatment on quality of family life using standardized questionnaire. Different to previous studies the evaluation of quality of family life by questionnaire was realized twice in the same group of families (before the reconstructive surgery and several months after palatoplasty). The study was conducted in 40 families divided in two groups: 20 families with children with cleft lip (CL), 20 families with children with cleft lip and palate (CLP). The questionnaire of the Impact on Family Scale was used for evaluation of the influence of orofacial clefts on parent´s quality of life. Evaluations were made at the second month of child´s life and at one year of child´s life with reciprocally comparison. The higher impact of children with CLP on quality of family life was noted at 2 months and 1 year of child's age as compared to the impact of children with CL. The reduction of impact on quality of life after surgical correction was observed in families of children with CL at one year of child's age. This decrease of influence on family quality of life was due to significantly lower impact in strain and economic dimensions in families with CL children after operation. However, in the group of families with CLP children no significant changes in the impact on family quality of life were noted when compared to the values before and shortly after the reconstructive surgery. This study showed that orofacial clefts in children influence markedly the quality of their family life. The higher impact of children with CLP on quality of family life as compared to children with CL was noted and this impact in CLP group was not influenced shortly after reconstructive surgery. It is suggested that appropriate medical care in Cleft Centre with special psychological support may lead to improvement in quality of life for families with cleft lip and palate children (Tab. 2, Fig. 2, Ref

  4. Postoperative abnormal response of C-reactive protein as an indicator for infectious complications after oral oncologic surgery with primary reconstruction

    OpenAIRE

    Akashi, Masaya; Furudoi, Shungo; Hashikawa, Kazunobu; Sakakibara, Akiko; Hasegawa, Takumi; Shigeta, Takashi; Minamikawa, Tsutomu; KOMORI, TAKAHIDE

    2015-01-01

    Background C-reactive protein (CRP) screening has been reported to be reliable for detection of infectious complications. Postoperative abnormal response of CRP can predict wound infection in colorectal surgery. This study aimed to determine the efficacy of CRP monitoring to detect infectious complications in oral oncologic surgery. Methods One hundred patients who underwent oral cancer resection with primary reconstruction were enrolled. Postoperative kinetics of CRP were classified into a n...

  5. Evaluation of protocol-guided scheduled basal-nutritional-correction insulin over standard care for vascular surgery patients.

    Science.gov (United States)

    Harbin, Megan; Dossa, Anar; de Lemos, Jane; Drummond, Isla; Paty, Breay; Taylor, Bobby

    2015-06-01

    Practice guidelines have recommended scheduled basal, nutritional and correction insulin to manage hyperglycemia in the hospital setting. For many decades, however, the primary practice has been sliding scale insulin. To evaluate the efficacy and safety of an institution-specific basal-nutritional-correction insulin preprinted order (BNC-PPO). A retrospective, single-centre chart review was conducted on patients admitted to a vascular surgery service to compare inpatient glycemia control before and after implementation of the BNC-PPO. Patients were included if they were aged 19 years or more, admitted between June 2009 and December 2010 (for pre-BNC-PPO) or between April 2011 and August 2012 (for post-BNC-PPO), required insulin before admission for their diabetes mellitus (type 1 or 2) and were prescribed insulin during their admission. For the primary outcome, the mean (±SD) daily blood glucose during hospital stay was 9.83±1.74 mmol/L for the pre-BNC-PPO group and 8.79±1.60 mmol/L for the post-BNC-PPO group (p=0.005). Mean (±SD) severe hyperglycemia episodes per patient per day had decreased in the BNC-PPO group: 1.13±0.73 and 0.80±1.02 for the before and after groups, respectively (p=0.008). Hypoglycemia (blood glucose insulin-dependent diabetes patients. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  6. Should blunt segmental vascular renal injuries be considered an American Association for the Surgery of Trauma Grade 4 renal injury?

    Science.gov (United States)

    Malaeb, Bahaa; Figler, Brad; Wessells, Hunter; Voelzke, Bryan B

    2014-02-01

    Renal segmental vascular injury (SVI) following blunt abdominal trauma is not part of the original American Association for the Surgery of Trauma (AAST) renal injury grading system. Recent recommendations support classifying SVI as an AAST Grade 4 (G4) injury. Our primary aim was to compare outcomes following blunt renal SVI and blunt renal collecting system lacerations (CSLs). We hypothesize that renal SVI fare well with conservative management alone and should be relegated a less severe renal AAST grade. We retrospectively identified patients with SVI and G4 CSL admitted to a Level 1 trauma center between 2003 and 2010. Penetrating trauma was excluded. Need for surgical intervention, length of stay, kidney salvage (>25% renal preservation on renography 6-12 weeks after injury), and delayed complication rates were compared between the SVI and CSL injuries. Statistical analysis used χ, Fisher's exact, and t tests. A total of 56 patients with SVI and 88 patients with G4 CSL sustained blunt trauma. Age, Injury Severity Score (ISS), and length of stay were similar for the two groups. Five patients in each group died of concomitant, nonrenal injuries. In the G4 CSL group, 15 patients underwent major interventions, and 32 patients underwent minor interventions. Only one patient in the SVI group underwent a major intervention. The renal salvage rate was 85.7% following SVI versus 62.5% following CSL (p = 0.107). Overall, surgical interventions are significantly lower among the SVI cohort than the G4 CSL cohort. Further analysis using a larger cohort of patients is recommended before revising the current renal grading system. Adding SVI as a G4 injury could potentially increase the heterogeneity of G4 injuries and decrease the ability of the AAST renal injury grading system to predict outcomes, such as nephrectomy rate. Epidemiologic study, level IV.

  7. Update and validation of the Society for Vascular Surgery wound, ischemia, and foot infection threatened limb classification system.

    Science.gov (United States)

    Mills, Joseph L

    2014-03-01

    The diagnosis of critical limb ischemia, first defined in 1982, was intended to delineate a patient cohort with a threatened limb and at risk for amputation due to severe peripheral arterial disease. The influence of diabetes and its associated neuropathy on the pathogenesis-threatened limb was an excluded comorbidity, despite its known contribution to amputation risk. The Fontaine and Rutherford classifications of limb ischemia severity have also been used to predict amputation risk and the likelihood of tissue healing. The dramatic increase in the prevalence of diabetes mellitus and the expanding techniques of arterial revascularization has prompted modification of peripheral arterial disease classification schemes to improve outcomes analysis for patients with threatened limbs. The diabetic patient with foot ulceration and infection is at risk for limb loss, with abnormal arterial perfusion as only one determinant of outcome. The wound extent and severity of infection also impact the likelihood of limb loss. To better predict amputation risk, the Society for Vascular Surgery Lower Extremity Guidelines Committee developed a classification of the threatened lower extremity that reflects these important clinical considerations. Risk stratification is based on three major factors that impact amputation risk and clinical management: wound, ischemia, and foot infection. This classification scheme is relevant to the patient with critical limb ischemia because many are also diabetic. Implementation of the wound, ischemia, and foot infection classification system in critical limb ischemia patients is recommended and should assist the clinician in more meaningful analysis of outcomes for various forms of wound and arterial revascularizations procedures required in this challenging, patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Depression Induced by Total Mastectomy, Breast Conserving Surgery and Breast Reconstruction: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zhang, Chengjiao; Hu, Guangfu; Biskup, Ewelina; Qiu, Xiaochun; Zhang, Hongwei; Zhang, Haiyin

    2018-02-09

    To carry out a systematic review and meta-analysis of the literature to determine whether different type of surgery induces different depression occurrence in female breast cancer at mean time more than 1-year term postoperatively. A systematic literature search of PubMed, Web of Science, EMBASE, OvidSP, EBSCO and PsycARTICLES was conducted. Observational clinical studies that compared the depression incidence in different surgery groups and presented empirical findings were selected. Sixteen studies met the inclusion criteria, including 5, 4, 2 and 5 studies compared depression between total mastectomy (TM) and breast conserving therapy (BCS), TM and breast reconstruction (BR), BCS and BR, or among all three groups (TM, BCS and BR), respectively. Only 1 of 5 studies, which subjected to multivariate analysis of depression in female breast cancer, reported a statistically significant effect of type of surgery on depression occurrence. Our meta-analysis showed no significant differences among the three types of surgery, with BCS patients versus TM patients (relative risk [RR] = 0.89, 95% confidence interval [CI] 0.78-1.01; P = 0.06), BR patients versus TM patients (RR = 0.87, 95% CI 0.71-1.06; P = 0.16) and BCS patients versus BR patients (RR = 1.10; 95% CI 0.89-1.35; P = 0.37), respectively. Our study showed that there were no statistically significant differences concerning the occurrence of depressive symptoms in breast cancer patients as a consequence of TM, BCS or BR at mean time more than 1-year term postoperatively.

  9. Evaluation of safety and efficacy of radiation-sterilized bone allografts in reconstructive oral surgery

    OpenAIRE

    Krasny, Marta; Krasny, Kornel; Kami?ski, Artur; Zadurska, Ma?gorzata; Piekarczyk, Piotr; Fiedor, Piotr

    2012-01-01

    Bone grafting allows reconstruction of the atrophied or destroyed alveolar process. In orthopaedics and traumatology allogeneic grafting has been used to restore defects of osseous tissue for over 60?years. In order to improve safety of the graft recipient, sterilized allogeneic grafts have been use. The aim of the study was to assess the direct and long-term outcomes following augmentation of atrophied alveolar processes with the use of radiation-sterilized allogeneic bone grafts. Sixty-eigh...

  10. The utility of CT angiography in planning perineal flap reconstruction following radical pelvic surgery.

    Science.gov (United States)

    Rosich-Medina, A; Ariyaratnam, J; Koo, B; Turner, W H; Fearnhead, N S; Durrani, A; Davies, R J

    2012-01-01

    Closure of the perineum following radical excision of pelvic tumours can prove to be a complex surgical problem. A number of pedicled flaps have been used for perineal reconstruction in order to reduce post-operative complications such as infection and abscess formation. The aim of this case series was to analyse the use of pre-operative computer tomography (CT) angiography to guide flap selection for perineal reconstruction following radical excision of pelvic tumours. We conducted a retrospective review to identify all patients who underwent CT angiography prior to radical excision of pelvic tumours and planned flap reconstruction over an 18 month period. Six patients were identified and are presented in this case series. Patients' medical records, histology reports, pre-operative investigations and CT angiograms, complications and follow-up were reviewed. The mean patient age was 58.3 years, with a male to female ratio of 1:2. Four out of six patients (66.6%) underwent pre-operative radiotherapy. The deep inferior epigastric arteries (DIEA) were visualised in all six cases (100%) and the pre-operative CT angiography helped guide flap choice in all cases (100%). In one case, narrowing of the DIEA vessels was noted precluding the use of a DIEA-based flap. One patient had a minor superficial wound dehiscence. Pre-operative CT angiography allows accurate visualisation of the DIEA system including perforator vessels. CT angiography is a useful tool, providing the surgical team with significant additional information to aid pre-operative planning and optimise reconstructive choice and outcome. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Evaluating vertebral artery dominancy before T4 lung cancer surgery requiring subclavian artery reconstruction.

    Science.gov (United States)

    Sekine, Yasuo; Saitoh, Yukio; Yoshino, Mitsuru; Koh, Eitetsu; Hata, Atsushi; Inage, Terunaga; Suzuki, Hidemi; Yoshino, Ichiro

    2017-08-02

    To evaluate vertebral artery (VA) dominancy and the risk of brain infarction in T4 lung cancer patients with tumor invasion into the subclavian artery. We reconstructed the subclavian artery in 10 patients with T4 non-small cell lung cancer. The histological stages were IIIA in eight patients and IIIB in two patients. We evaluated the VA dominancy by performing a four-vessel study preoperatively and investigated the relationship between the methods of VA treatment and postoperative brain complications, retrospectively. Seven patients had a superior sulcus tumor (SST) and three had direct invasion into the mediastinum. Based on the tumor location, a transmanublial approach was used in five patients and a posterolateral hook incision was used in the other five. All subclavian artery (SA) reconstructions were done using an artificial woven graft. Preoperative angiography of the VA revealed poor development of the contralateral side in two patients. One of these patients suffered a severe brain infarction on postoperative day 2, which proved fatal. In the other patient, the VA was connected to the left SA graft by a side-to-end anastomosis and there was no postoperative brain complication. Preoperative SA and VA angiography is mandatory for identifying the need for VA reconstruction in lung cancer patients with major arterial invasion.

  12. Video-assisted thoracoscopic surgery with posterior spinal reconstruction for the resection of upper lobe lung tumors involving the spine.

    Science.gov (United States)

    Stoker, Geoffrey E; Buchowski, Jacob M; Kelly, Michael P; Meyers, Bryan F; Patterson, G Alexander

    2013-01-01

    Video-assisted thoracoscopic surgery (VATS) is associated with less morbidity and recovery time compared with traditional open thoracotomy (OT) for the resection of early stage non-small cell lung cancer (NSCLC). Local invasion of NSCLC into adjacent vertebrae confers a TNM T status of T4. Anatomical lobectomy by VATS with simultaneous posterior spinal reconstruction (PSR), as a single procedure, offers advantages to selected patients judged as suitable candidates for resection. To report the preliminary results of a novel, multidisciplinary surgical technique for the treatment of upper lobe lung cancers with direct extension to the spine. Consecutive case series. Eight adults who underwent PSR with either VATS or OT for the treatment of a T4 (vertebral body invasion) NSCLC. Total operative time, estimated blood loss, length of hospital stay, postoperative tumor recurrence and metastasis, survival, reoperations, and any other intraoperative or postoperative complication. Eight consecutive patients who underwent instrumented PSR with corpectomy for the treatment of an upper lobe NSCLC at a single institution were identified. Either VATS (n=4) or OT (n=4) was performed at the time of the reconstruction in each patient. All tumors were stage III NSCLC without metastasis. Patients who underwent VATS and OT were aged 54±11 and 54±2.9 years, respectively. Mean operative time and blood loss were similar between the groups: VATS: 367±117 minutes versus OT: 518±264 minutes; VATS: 813±463 mL versus OT: 1,250±1,500 mL. Mean follow-up was 16±13 months after surgery. Complications occurred in all eight patients. One OT patient had wound dehiscence requiring a tissue flap, and another suffered from a septic shock. No wound complications developed after VATS. Death secondary to tumor recurrence occurred once in each group. For the six surviving patients, 23±15 months (range, 4.5-43 months) have elapsed since surgery. Video-assisted thoracoscopic surgery with PSR is a

  13. Effect of Roux-en-Y Bariatric Surgery on Lipoproteins, Insulin Resistance, and Systemic and Vascular Inflammation in Obesity and Diabetes

    Directory of Open Access Journals (Sweden)

    Rahul Yadav

    2017-11-01

    Full Text Available PurposeObesity is a major modifiable risk factor for cardiovascular disease. Bariatric surgery is considered to be the most effective treatment option for weight reduction in obese patients with and without type 2 diabetes (T2DM.ObjectiveTo evaluate changes in lipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction following Roux-en-Y bariatric surgery in obese patients with and without diabetes.Materials and methodsLipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction were measured in 37 obese patients with (n = 17 and without (n = 20 T2DM, before and 6 and 12 months after Roux-en-Y bariatric surgery. Two way between subject ANOVA was carried out to study the interaction between independent variables (time since surgery and presence of diabetes and all dependent variables.ResultsThere was a significant effect of time since surgery on (large effect size weight, body mass index (BMI, waist circumference, triglycerides (TG, small-dense LDL apolipoprotein B (sdLDL ApoB, HOMA-IR, CRP, MCP-1, ICAM-1, E-selectin, P-selectin, leptin, and adiponectin. BMI and waist circumference had the largest impact of time since surgery. The effect of time since surgery was noticed mostly in the first 6 months. Absence of diabetes led to a significantly greater reduction in total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol although the effect size was small to medium. There was a greater reduction in TG and HOMA-IR in patients with diabetes with a small effect size. No patients were lost to follow up.ConclusionLipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction improve mostly 6 months after bariatric surgery in obese patients with and without diabetes.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT02169518. https

  14. Simultaneous Computer-Aided Design/Computer-Aided Manufacture Bimaxillary Orthognathic Surgery and Mandibular Reconstruction Using Selective-Laser Sintered Titanium Implant.

    Science.gov (United States)

    Hatamleh, Muhanad M; Bhamrah, Gurprit; Ryba, Francine; Mack, Gavin; Huppa, Chrisopher

    2016-10-01

    This patient report describes simultaneous bimaxillary orthognathic surgery and mandibular reconstruction by means of three-dimensional (3D) planning, 3D printed biocompatible surgical wafers, and 3D selective-laser sintered titanium implant. A 26-year-old male patient presented with a left mandibular defect secondary to trauma. The whole body of the mandible on the left hand side was deficient with a narrow connection with the remaining left condyle. He had undergone orthodontic treatment for 18 months and was ready to undergo bimaxillary orthognathic surgery. Advanced cranio-maxillofacial software was used in processing his cone beam computer tomography scan data, and e-casts of his upper and lower dental arches. Bimaxillary surgery was planned with Le Fort 1 maxillary impaction and mandibular advancement to achieve a class 1 incisor relationship. Intermediate and final surgical wafers were designed following the planned movements and printed using biocompatible resin. The deficient left side of the mandible was reconstructed by means of mirror imaging the contra-lateral right side into the deficient left side with the aim of restoring normal facial symmetry. Biomedical software was then used in designing a reconstruction plate that connected the condylar head and the mandible following the planned bimaxillary surgery and mandibular continuity symmetry reconstruction. The plate was printed in titanium following state-of the-art selective laser sintering technology. The bimaxillary surgery and mandibular reconstruction were done simultaneously as planned along with an iliac-crest bone graft. This patient confirms the advantages of 3D computer-aided design/computer-aided manufacture technologies in optimizing clinical outcomes for cranio-maxillofacial reconstruction, especially when conducting two simultaneous clinical procedures.

  15. Pediatric vascularized composite allotransplantation.

    Science.gov (United States)

    Doumit, Gaby; Gharb, Bahar Bassiri; Rampazzo, Antonio; Papay, Francis; Siemionow, Maria Z; Zins, James E

    2014-10-01

    Vascularized composite allotransplantation (VCA) has experienced a growing acceptance, which has led to a debate centered on extending the indications of the procedure to include pediatric patients. The aim of this article was to discuss such indications based on the evidence in pediatric solid organ transplantation, reconstructive surgery in children, and VCA in adult patients. Papers published on the outcomes of pediatric solid organ transplantation, growth after replantation of extremities, vascularized autologous tissue transfer, craniofacial surgery, orthognathic procedures, facial fractures, and outcomes after repair of peripheral nerves in children were reviewed. Although the outcomes of solid organ transplantation in children have improved, the transplanted organs continue to have a limited lifespan. Long-term immunosuppressive therapy exposes the patients to an increased lifetime risk of infections, diabetes, hypertension, dyslipidemia, cardiovascular disease, and malignancy. Growth impairment and learning disabilities are other relevant drawbacks, which affect the pediatric recipients. Nonadherence to medication is a common cause of graft dysfunction and loss among the adolescent transplant recipients. Rejection episodes, hospitalizations, and medication adverse effects contribute negatively to the quality of life of the patients. Although normal growth after limb transplantation could be expected, pediatric facial transplant recipients may present with arrest of growth of transplanted midfacial skeleton. Considering the non-life-threatening nature of the conditions that lead to eligibility for VCA, it is suggested that it is premature to extend the indications of VCA to include pediatric patients under the currently available immunosuppressive protocols.

  16. [Surgical management of limb prosthetic vascular graft exposure].

    Science.gov (United States)

    Wu, Hao; Wu, Wei-wei; Bai, Ming; Zeng, Rong; Song, Xiao-jun; Chen, Yu; Liu, Chang-wei

    2012-12-01

    To investigate the risk factors and surgical management of limb prosthetic vascular graft exposure. The clinical data of 17 patients suffering from limb prosthetic vascular graft exposure in Peking Union Medical College Hospital from August 2006 to December 2011 were retrospectively analyzed. Among 17 cases, 5 suffered from prosthetic vascular graft exposure after vascular bypass for the lower limb ischemia, whereas 12 were affected after the artificial graft arteriovenous fistula construction in the upper limbs for hemodialysis. The surgical procedures mainly included the local debridement as well as the local flap and transferred muscle-cutaneous flap reconstruction to preserve the prosthetic vascular graft. All 17 patients underwent local flap or muscle-cutaneous flap coverage procedure. After the surgery, the prosthetic vascular graft was successfully salvaged in 14 cases. The total successful rate was 82.4%. The surgery failed in three patients, in whom the prosthetic vascular grafts were finally removed. Local flap and transferred muscle-cutaneous flap reconstruction is an effective surgical management to salvage the exposed grafts.

  17. ADMINISTRATION OF LACTULOSE IN COMPLEX PEHABILITATION TREATMENT AFTER RADICAL AND RECONSTRUCTIVE RESTORATIVE SURGERY OF BOWELS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    I.V. Kirgizov

    2009-01-01

    Full Text Available The results of treatment of children (n = 64 of 1,5–17 years old, receiving rehabilitation course after reconstructive — restorative surgery of bowels are presented in this article. It was shown, that prolonged (1 month and more administration of lactulose (Duphalac results in improvement of motor and evacuation function of bowel, and decreases «sensor inability» of reduced parts of bowel. As a result, lactulose stimulates functioning of «obturative apparatus of neoampula» (voluntary evacuation, retention of intestinal contents, that favors to increase of quality of life and social rehabilitation of children in outlying post surgical period.Key words: children, post surgical rehabilitation, «idiopathic megacolon»syndrome, Hirschsprung's disease, anorectal malformations,lactulose.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(2:34-37

  18. Efficacy of communication amongst staff members at plastic and reconstructive surgery section using smartphone and mobile WhatsApp

    Directory of Open Access Journals (Sweden)

    Shabeer Ahmad Wani

    2013-01-01

    Full Text Available Objective: The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility. Materials and Methods: From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements. Results: During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication. Conclusions: This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate.

  19. Efficacy of communication amongst staff members at plastic and reconstructive surgery section using smartphone and mobile WhatsApp.

    Science.gov (United States)

    Wani, Shabeer Ahmad; Rabah, Sari M; Alfadil, Sara; Dewanjee, Nancy; Najmi, Yahya

    2013-09-01

    The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility. From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements. During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication. This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate.

  20. Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?

    Science.gov (United States)

    Keller, Robert A; Moutzouros, Vasilios; Dines, Joshua S; Bush-Joseph, Charles A; Limpisvasti, Orr

    2017-09-01

    Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States. Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery. Survey. Surveys were emailed to the alumni networks of 4 large ACGME-accredited sports medicine fellowship programs. Questions were focused on their current use of chemical and nonchemical VTE prophylaxis. Surveys were completed by 142 surgeons in the United States, yielding a response rate of 32%. Of those who responded, 50.7% stated that they routinely use chemical prophylaxis, with 95.5% of those using aspirin (acetylsalicylic acid [ASA]). There was no standardized dosing protocol, with respondents using ASA 325 mg once (46%) or twice daily (26%) or ASA 81 mg once (18%) or twice (10%) daily. The most common reason for not including chemical prophylaxis within the reconstruction procedure was that it is unnecessary given the low risk of VTE. Physicians also based their prophylaxis regimen more on their own clinical experience than concern for litigation. Half of all sports medicine fellowship-trained surgeons surveyed routinely use chemical VTE prophylaxis after ACL reconstruction, with more than 90% of those using ASA. Of those using ASA, there was no prevailing dosing protocol. For those not using chemical prophylaxis, the most important reason was that it was felt to be unnecessary due to the risks outweighing the benefits. Those who do not regularly use chemical prophylaxis would be willing to, however, if a patient had a personal or family history of clotting disorder or is currently on birth control. Additionally, clinical experience was the primary driver for a current prophylaxis protocol