Frontiers in Surgery最新文献

Background: Carotid artery occlusion, whether therapeutic, iatrogenic, atherosclerotic, or congenital, induces profound hemodynamic changes in the cerebral circulation. Collateral channels within the circle of Willis compensate to maintain cerebral perfusion; however, the resulting increases in flow velocity, wall shear stress, and pressure gradients are believed to ultimately contribute to aneurysm formation. While de novo aneurysms after hunterian ligation have been described, they typically occur years after treatment. The early occurrence of multiple aneurysms following parent artery occlusion combined with extracranial-intracranial (EC-IC) bypass has seldom been reported. Here, we report a unique case of multiple, non-anastomotic MCA aneurysms developing early after double-barrel bypass and proximal clipping.

Case description: A 27-year-old male with severe headache was found to have a partially thrombosed giant serpentine aneurysm (GSA) of the left M2 inferior trunk. The patient underwent double-barrel superficial temporal artery-middle cerebral artery (STA-MCA) bypass followed by proximal clipping. Postoperative imaging confirmed complete exclusion of the aneurysm and excellent bypass patency. Three months later, acute aphasia and right hemiparesis developed. Angiography revealed two newly formed aneurysms along the left MCA bifurcation point and the M2 superior trunk, which were successfully treated with endovascular coil embolization and parent artery occlusion. At nine-month follow-up, the patient remained neurologically intact with patent bypass grafts and no aneurysm recurrence.

Conclusions: This case illustrates an unusual pattern of early, multiple, non-anastomotic de novo MCA aneurysms developing after double-barrel STA-MCA bypass and proximal clipping. The findings highlight how revascularization can alter local pressure gradients and redistribute flow in ways that relieve hemodynamic stress on classic collateral pathways yet create new regions of focal wall shear stress along the ipsilateral MCA.

Introduction: Glomerular hemangioma is a rare vascular tumor characterized by capillary loops that resemble glomeruli within dilated vascular spaces. While primarily reported in the skin and soft tissues, its occurrence in the external jugular vein is extremely unusual. We present a case of a 32-year-old male with a glomeruloid hemangioma located in the left external jugular vein.

Case presentation: The patient presented with a small, non-tender, non-pulsatile subcutaneous nodule on the left side of the neck. There were no associated symptoms such as skin redness, swelling, or systemic signs like fever. The patient's medical history was unremarkable, with no hypertension, diabetes, or other significant conditions. Routine laboratory tests, including blood counts, electrolytes, coagulation profile, thyroid hormones, and tumor markers, were all within normal ranges. Imaging studies, including neck computed tomography, chest x-ray, and ultrasound, were performed. Ultrasound revealed a well-defined mass within the left external jugular vein with abundant blood flow and a detectable arterial blood flow spectrum. The patient underwent surgical excision of the mass, followed by histopathological examination. Ultrasound imaging showed a mass measuring 8.6 mm × 5.3 mm within the left external jugular vein, slightly hyperechoic to surrounding muscle tissue, with clear borders and regular shape. Color Doppler imaging detected abundant blood flow, indicating a vascular lesion. Histopathological analysis of the excised mass revealed capillary loops within a dilated vascular lumen, resembling glomerular structures. These findings confirmed the diagnosis of glomeruloid hemangioma.

Conclusion: This case highlights a rare presentation of glomeruloid hemangioma in the external jugular vein, emphasizing the importance of considering vascular tumors in the differential diagnosis of subcutaneous neck masses. Surgical resection was successful, and histopathology provided a definitive diagnosis. This case adds to the limited reports of glomeruloid hemangiomas, particularly in atypical locations, expanding the understanding of its clinical manifestations and diagnostic approach.

Complex metacarpal fractures with segmental bone loss and joint involvement pose significant challenges for the hand trauma surgeon. When traditional techniques are inadequate, microsurgical reconstruction and joint arthroplasty may offer a viable alternative. We report the case of a 32-year-old male who sustained a high-energy injury to the right hand, resulting in a comminuted fracture of the second metacarpal head and extensive dorsal soft tissue loss. After initial management, reconstruction of the second metacarpal was performed using a free osteocutaneous fibula flap. Although the vascularized bone graft was sculpted to settle in the metacarpophalangeal joint, mobility was not preserved. A staged silicone MCP arthroplasty then was later performed to improve joint mobility. At 18 months follow-up, the patient showed good soft tissue coverage, restored grip strength and proximal interphalangeal joint motion, but improvement in MCP range of motion remained partial despite arthroplasty. This article highlights the potential and limitations of combining vascularized bone transfer with prosthetic joint replacement in high-demand patients following trauma.

Background: Usually affecting the medial prominence of the first metatarsophalangeal (MTP) joint, hallux valgus is a complicated malformation of the first ray that causes deformed joint structure, dysfunction, and increasing stiffness. The most common methods for treating hallux valgus malformation are scarf osteotomy and chevron osteotomy. Due to the inconsistent and contradictory findings among the studies, we conducted this systematic review and meta-analysis to compare chevron and scarf osteotomies in the management of hallux valgus deformity.

Methods: Using the following search strategy: "Chevron" AND "Scarf" AND "Osteotomy" AND "Hallux Valgus", and from inception until October 2024, we searched PubMed, Web of Science, and Scopus for relevant publications that needed to be screened to see if they could be included in our study. We performed a meta-analysis of the articles included using Review Manager version 5.4 software, pooling the mean difference (MD) of various outcomes at 95% confidence intervals (CI) and a p-value of 0.05.

Results: Chevron osteotomy was observed to lower the hallux valgus angle (HVA) with a significant difference compared with scarf osteotomy, showing a MD = -2.44 (95% CI: -4.57, -0.31, p = 0.03). However, no significant difference was observed between both osteotomies regarding the reduction of intermetatarsal angle (IMA), showing a MD = -0.33 (95% CI: -1.32, 0.66, p = 0.52). Chevron osteotomy was observed to be associated with higher American Orthopedic Foot and Ankle Society (AOFAS) compared with scarf osteotomy with MD = 2.21 (95% CI: 0.7, 3.71, p = 0.004) and I² = 0%, however, no significant difference was observed regarding their effect on pain with SMD = -0.07 (95% CI: -0.44, 0.31, p = 0.73).

Conclusion: Chevron osteotomy was observed to be superior to scarf osteotomy in lowering the HVA and improving functional outcomes presented by AOFAS measurements. However, they were comparable in their effect on IMA and pain measurements.

Objectives: The purpose of this study was to compare the clinical efficacy, safety and cost-effectiveness of hydrofiber dressings and standard dressings in the management of wounds after total knee or hip arthroplasty.

Methods: This meta-analysis was conducted according the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We searched PubMed, EMBASE, and the Cochrane Library from inception to January 2025 to identify English-language randomized controlled trials (RCTs) and comparative cohort studies. Studies were included if they compared hydrofiber dressings with traditional or other standard dressings and involved patients undergoing primary hip or knee arthroplasty with an expected postoperative hospital stay of four days or more. The included studies were assessed for methodological quality. A meta-analysis and systematic review were performed on data extracted from these studies.

Results: Nine RCTs with total 1,223 participants and three cohort studies with total 2,152 participants were included. The results showed that hydrofiber dressings significantly outperformed standard wound dressings in terms of blister formation (RR, 0.48; 95% CI, 0.27-0.87; P = 0.02; I², 51%), periprosthetic joint infection (PJI) rate (RR, 0.27; 95% CI, 0.09-0.75; P = 0.01; I², 0%), total complication rate (RR, 0.46; 95% CI, 0.29-0.75; P = 0.002; I², 61%), number of dressing changes (MD, -1.87; 95% CI, -2.76 to -0.98; P < 0.0001; I², 96%), and the need for dressing change within five days after surgery (RR, 0.55; 95% CI, 0.38-0.79; P = 0.001; I², 43%). The systematic review showed that hydrofiber dressings were superior to standard wound dressings in terms of comfort and average total cost.

Conclusion: The hydrofiber dressings were superior to standard wound dressings in terms of blistering, PJI rate, total complication rate, number of dressing changes, and need for dressing change within five days after surgery.

Background: Reliable assessment of spinal fusion remains a significant challenge due to the absence of universally accepted radiological criteria. Despite the widespread use of spinal arthrodesis and stabilization, substantial variability persists in how fusion is defined, assessed, and reported across studies. This systematic review evaluates current radiological methods for assessing spinal fusion outcomes, focusing on their reliability, reproducibility, and clinical applicability, and identifies existing limitations to inform future research and practice.

Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between 2014 and 2024. Following PRISMA guidelines, clinical studies reporting explicit radiological criteria for assessing spinal fusion at any vertebral level were included. Extracted data comprised study characteristics, imaging modalities, surgical techniques, fusion definitions, and use of validated scoring systems. Risk of bias was assessed using the ROBINS-I tool.

Results: Of 2,965 articles screened, 557 met the inclusion criteria. Only 36.8% of studies used standardized scoring systems-primarily Bridwell, Brantigan-Steffee-Fraser (BSF), and Lenke classifications. In contrast, 61.2% relied on non-standardized or author-defined criteria, contributing to significant methodological heterogeneity. Computed tomography (CT), alone or combined with conventional radiography (CR), was the predominant imaging method (74.5%), while magnetic resonance imaging (MRI) was used in only 2.0% of studies. Over 200 distinct fusion criteria were identified, underscoring the lack of consensus.

Conclusions: Significant heterogeneity persists in the radiological assessment of spinal fusion, largely due to inconsistent use and interpretation of fusion criteria, even among studies employing established scoring systems. This variability limits comparability across studies and underscores the need for consensus-based, validated guidelines. Future research should prioritize the development and standardization of objective radiological criteria to improve the reliability and clinical applicability of fusion assessment in spinal arthrodesis. Emerging technologies, such as Hounsfield unit-based CT metrics and AI-assisted imaging, appear promising for improving diagnostic accuracy.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251111767, PROSPERO CRD420251111767.

Background: Evidence for acupotomy in managing advanced ankylosing spondylitis (AS) with extensive bony fusion, particularly in treatment-refractory cases, remains limited. This report details its application and outcomes in one such patient.

Case presentation: A 27-year-old male with advanced, active AS and bilateral sacroiliac joint fusion presented with severe low back pain, kyphosis, and markedly restricted mobility. His condition was refractory to prior conservative therapies, including NSAIDs and traditional acupuncture. He subsequently underwent five sessions of anatomy-guided acupotomy, targeting fascial adhesions in the thoracolumbar fascia, sacroiliac ligaments, and lumbar facet joints.

Results: The intervention yielded substantial and sustained improvements. Pain intensity (VAS) decreased from 7 to 2, while disease activity (BASDAI) and functional impairment (BASFI) scores reduced from 3.7 to 1.3 and 4.0 to 1.0, respectively. Spinal range of motion and postural alignment were largely restored. These functional benefits proved durable over a 2-year follow-up, during which follow-up imaging confirmed persistent structural fusion, underscoring that clinical improvement was attributable to restored soft-tissue function rather than structural reversal.

Conclusion: Acupotomy induced significant, long-term clinical improvement in this refractory AS case, likely through mechanical release of fascial restrictions. It represents a promising complementary, symptom- and function-modifying intervention for patients with limited response to conventional regimens.

Background: Enhanced recovery after surgery (ERAS) programs and laparoscopic techniques independently reduce hospital stays and postoperative complications in patients with colorectal cancer. However, evidence regarding whether the combination of ERAS protocols with laparoscopic surgery further improves postoperative outcomes remains limited.

Objective: The aim of the study was to compare the postoperative hospital stay (POHS) and perioperative outcomes between patients undergoing elective laparoscopic colorectal cancer surgery under the ERAS protocol and conventional care.

Methods: This ambispective cohort study included patients who underwent elective laparoscopic colorectal surgery for colorectal adenocarcinoma at Hatyai Hospital between June 2019 and May 2023. Patients were divided into a conventional group and an ERAS group. The primary outcome was POHS. Secondary outcomes included postoperative complications and 30-day readmission.

Results: A total of 140 patients were included (70 ERAS, 70 conventional). Baseline characteristics were similar between groups, though the ERAS group had more preoperative chemoradiotherapy (CCRT) (52.9% vs. 39.4%; p = 0.002) and diverting stomas (38.6% vs. 21.4%; p = 0.042). The ERAS group had significantly shorter POHS (median 5.0 vs. 5.5 days; p < 0.001), earlier oral intake (3 vs. 4 days; p = 0.001), and earlier Jackson-Pratt (JP) drain removal (p = 0.006). There were no significant differences in postoperative complications, readmission, or mortality. Multivariate analysis identified early JP drain removal, early discontinuation of intravenous fluids, nasogastric tube avoidance, and multimodal analgesia as significant predictors of POHS ≤5 days.

Conclusion: ERAS implementation in elective laparoscopic colorectal cancer surgery significantly reduces hospital stay without increasing complication or readmission rates. These findings support the safety and effectiveness of ERAS in a regional Thai hospital setting and advocate for broader protocol adoption.

Background: The use of traditional sacroiliac screws in the treatment of Day type II crescent fracture-dislocation of the pelvis (CFDP) is often associated with insufficient screw anchorage and compression due to the short iliac segment of the screw and the proximity of the entry point to the fracture line. This study aims to evaluate a modified sacroiliac screw technique designed to address these limitations.

Methods: In this retrospective comparative study, we analyzed 44 patients with Day type II CFDP who underwent surgical treatment between January 2019 and June 2023. Based on the sacroiliac screw technique applied, patients were divided into a modified group (n = 21) and a control group (n = 23). We compared the sacroiliac screw-related metrics, the quality of reduction assessed by Matta score, and clinical outcomes evaluated using the Majeed functional score and the visual analogue scale (VAS) for pain.

Results: All patients successfully underwent surgery. The modified group exhibited a significantly longer iliac segment of the sacroiliac screw compared to the control group (3.71 ± 0.85 cm vs. 2.12 ± 0.47 cm, P < 0.001). The distance from the screw entry point to the iliac fracture line was greater in the modified group (3.31 ± 0.88 cm vs. 1.22 ± 0.64 cm, P < 0.001). Reduction quality assessed by Matta score one week postoperatively was superior in the modified group: excellent in 12, good in 7, fair in 2, and poor in 0 cases; vs. excellent in 6, good in 12, fair in 5, and poor in 0 cases in the control group (P < 0.05). At the final follow-up, the modified group showed better VAS scores for sacroiliac joint pain than the control group (P < 0.05). No significant difference was observed in Majeed functional scores between the two groups (P = 0.568).

Conclusion: The modified sacroiliac screw technique significantly extends the iliac segment length, enhances cortical bone engagement, reduces the risk of entry point proximity to the fracture line, and improves screw stability and reduction quality. However, these findings require validation through larger prospective and biomechanical studies to further assess long-term efficacy and applicability.