Frontiers in Surgery最新文献

Background: One-Hole Split Endoscopic (OSE) discectomy is an emerging minimally invasive technique for lumbar degenerative disease. While OSE offers advantages such as reduced tissue dissection, it is not exempt from complications inherent to spinal surgery. Postoperative spinal epidural hematoma (POSEH), though rare, is a serious complication that can lead to significant neurological deterioration if not managed promptly. Although POSEH has been documented with other endoscopic lumbar procedures, no cases of delayed POSEH (DPOSEH) following OSE have been reported in the literature to date.

Case presentation: A 69-year-old male underwent OSE discectomy at L4-L5 for symptomatic disc herniation. The initial postoperative course was uneventful, with improvement in radicular symptoms and intact neurological function. However, on postoperative day 5, he developed acute back pain, bilateral lower limb weakness, saddle anesthesia, and fecal incontinence. Emergency MRI confirmed a compressive epidural hematoma extending from L4 to L5. During the urgent surgical evacuation, multiple organized blood clots of varying sizes were identified and removed. Through postoperative rehabilitation therapy, the patient's left lower limb muscle strength gradually improved, though bowel and bladder dysfunction persisted.

Conclusions: The present case highlights that, despite the absence of prior literature on this complication in OSE, the risk of symptomatic epidural hematoma exists similarly to other endoscopic spinal techniques. Early recognition, prompt imaging, and immediate surgical intervention are critical to optimizing neurological recovery. Surgeons should maintain a high index of suspicion for POSEH in OSE patients presenting with acute neurological decline, even beyond the typical 72-h postoperative window.

Severe acute subdural hematoma (ASDH) secondary to human parvovirus B19 (B19V) infection is exceptionally rare in adults and presents unique neurocritical care challenges. We report a previously healthy 35-year-old woman with a history of two cesarean sections and no chronic diseases, who developed a sudden headache followed by rapid neurological deterioration. Head computed tomography (CT) revealed a massive right fronto-temporo-parietal ASDH with marked midline shift. Notably, one week prior to admission, she traveled to Guangzhou with her children, two of whom developed fever three days and confirmed B19V infection before her symptoms, suggesting possible household transmission. The association between ASDH and B19V infection was established by excluding other common causes (such as trauma, vascular malformations, coagulopathies, and other infections) through detailed history, imaging, and laboratory investigations. The association between ASDH and B19V infection was established by: (1) exclusion of other common etiologies (trauma, vascular malformations, coagulopathies, and other infections) through detailed history, imaging, and laboratory investigations; (2) confirmation of acute B19V infection by serological and molecular testing; (3) clear temporal relationship with household exposure. Emergency hematoma evacuation and decompressive craniectomy were performed. Specialized neurocritical nursing included automated quantitative pupillometry for early detection of intracranial hypertension, and strict hemodynamic control, with continuous arterial blood pressure monitoring and antihypertensive therapy to maintain systolic blood pressure within 110-130mmHg, minimizing the risk of rebleeding and further neurological injury. Ultra-early rehabilitation was initiated. Immediate postoperative extubation was deferred due to the timing of surgery (early morning), limited night staffing, and the need for close postoperative neurological and respiratory monitoring. The patient was safely weaned from mechanical ventilation on postoperative day 1 after confirming stable neurological and respiratory function. Muscle strength was evaluated using the manual muscle testing (MMT) scale, which improved to grade IV in all limbs. She was transferred for rehabilitation on postoperative day 23. To our knowledge, this represents one of the first reports of favorable neurological recovery in an adult with life-threatening B19V-associated intracranial hemorrhage. This case demonstrates that rapid surgical intervention combined with monitoring, targeted infection control, and intensive early rehabilitation can achieve favorable outcomes in this exceedingly rare condition.

Objectives: Prolonged air leak (PAL) remains a significant surgical challenge after pulmonary resections and secondary spontaneous pneumothorax. Ventilation single-photon emission computed tomography combined with computed tomography (vSPECT/CT) has emerged as a promising tool for air leak localization. This study evaluates the impact of preoperative vSPECT/CT on surgical management of PAL.

Methods: This single-center study compared a prospectively enrolled vSPECT/CT cohort (February 2021-December 2025) with retrospective historical controls (January 2015-January 2021). Propensity score matching generated two matched groups: with and without vSPECT/CT. Primary outcome was vSPECT/CT accuracy in detecting air leaks; secondary outcomes included chest tube duration, persistent PAL, reoperation rates, and hospital stay. Wilcoxon signed-rank and McNemar tests were used for comparisons.

Results: A total of 122 patients were included (52 vSPECT/CT; 70 non-vSPECT/CT). vSPECT/CT showed a 95.3% concordance with intraoperative air leak localization. After matching, 86 patients (43 per group) were analyzed. The vSPECT/CT group had shorter chest tube duration (median 2 vs. 4 days; P = 0.01) and hospital stay (median 3 vs. 5 days; P = 0.036). Rates of persistent PAL and reoperation were similar between groups (P = 0.057 and P = 0.375, respectively).

Conclusion: In this prospectively enrolled cohort, preoperative vSPECT/CT reliably localizes PAL, enabling focused surgical intervention and supporting more efficient postoperative recovery. Its use is associated with shorter chest tube duration and hospital stay, highlighting its value as a preoperative tool in the management of PAL.

Objective: The objective of this study was to evaluate the efficacy and safety of intra-articular injection of the "triple injection" in the treatment of early and middle-stage knee osteoarthritis (KOA).

Materials and methods: A total of 120 patients with unilateral KOA, recruited from October 2021 to December 2023, were randomly divided into two groups with 60 cases in each group. The control group received intra-articular injection of 2 mL sodium hyaluronate once a week for 5 consecutive weeks. The experimental group received intra-articular "triple injection" (0.3 mL betamethasone + 0.7 mL lidocaine + 2 mL sodium hyaluronate) in the first week, followed by intra-articular injection of 2 mL sodium hyaluronate once a week for 4 consecutive weeks. The clinical efficacy was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS), Hospital for Special Surgery (HSS) knee score, and flexion range of motion (ROM) before treatment, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after treatment.

Results: Comparisons of WOMAC scores, VAS scores, HSS scores, and ROM before treatment revealed no statistically significant differences between the two groups (all P > 0.05). In contrast, statistically significant differences in WOMAC scores, VAS scores, HSS scores, and ROM between the two groups were observed at different time points after treatment (all P < 0.05). Additionally, the comparison of overall efficacy in K-L grade III patients between the two groups showed a statistically significant difference (P < 0.05), and no complications were observed in any of the patients.

Conclusion: Intra-articular injection of sodium hyaluronate and the "triple injection" are both effective therapeutic modalities for the early and mid-stage of KOA. Compared with sodium hyaluronate, the "triple injection" can more effectively relieve pain and improve knee joint function.

Clinical trial registration: Identifier ChiCTR2100048131 with a registration date of 04/07/2021.

Peripheral nerve injury can result in potentially devastating neurological deficits and often disproportionately impacts young workers. Recovery of motor function after peripheral nerve injury requires the regeneration of the nerve from the site of injury to the neuromuscular junction (NMJ), where signals must be transduced effectively across the synapse, resulting in target muscle contraction. For reasons that are not fully understood, after about 18 months of denervation, functional NMJs fail to recapitulate. This, in combination with the slow velocity of axon regeneration, significantly limits both the window of opportunity for intervention and surgical reconstruction options. Here, we review what is currently known with respect to NMJ physiology, anatomy, development, and changes after injury. We also highlight knowledge gaps and opportunities for study with the goal of developing novel, NMJ-focused avenues of treatment for patients after peripheral nerve injury.

Background: The association between endoscopic sinus surgery and orbital complications is a complex and multifaceted one. While the precise relationship between the two is not fully elucidated, there is increasing evidence indicating a significant correlation between endoscopic sinus surgery and orbital complications.

Objectives: To comprehensively examine the orbital complications that can arise from endoscopic sinus surgery, including their incidence, etiology, clinical manifestations, management strategies, and outcomes.

Methods: An extensive search was conducted across multiple relevant databases to identify studies meeting the established inclusion criteria. The databases examined included PubMed, MEDLINE, and Embase, and the following search terms were used: ("Endoscopic sinus surgery" OR "FESS" OR "ESS") AND ("Orbital complications" OR "Ocular injury" OR "Periorbital hemorrhage"). The search was limited to English-language publications from 2011 to 2023 and no restrictions were applied regarding study design during the search. Duplicate entries were removed, and the Rayyan QRCI tool was employed to streamline the selection and screening of studies. Due to heterogeneity in study designs, populations, and definitions of orbital complications among the included studies, a formal meta-analysis was not performed. Instead, a narrative synthesis was undertaken. The overall incidence of orbital complications was calculated by pooling the total number of reported complications across all included studies and dividing this by the total number of patients.

Results: A total of eight studies, encompassing a combined population of 204,286 patients, were included in our final analysis. Of this population, 118,567 individuals (58%) were male. All patients underwent surgery for chronic rhinosinusitis. The reported orbital complication rates varied widely across studies, ranging from 0% in image-guided ESS to 27.6% in conventional ESS. Across the included studies, a total of 358 orbital complications were reported among 204,286 patients The most frequently reported orbital complications following sinus surgery were orbital injury, orbital hematoma, and orbital subcutaneous emphysema.

Conclusion: ESS orbital complications are uncommon but have the potential to be dangerous. The available evidence suggests an association between the use of image-guided ESS and lower reported complication rates. Future prospective and randomized trials are required to determine the safest approach to ESS to avoid complications.

Systematic review registration: Prospero CRD42024546806.

Background: Anterior cruciate ligament (ACL) injury increases the risk of post-traumatic osteoarthritis. Although ACL reconstruction (ACLR) restores mechanical stability, cartilage matrix abnormalities may persist and can be detected using quantitative and compositional magnetic resonance imaging (MRI).

Objectives: To synthesize MRI evidence on tibiofemoral cartilage compositional changes after ACLR, identify factors associated with worse cartilage outcomes, and summarize methodological quality and limitations of the evidence.

Methods: Embase, PubMed, Web of Science, Scopus, and Cochrane Library were searched for studies published between 2000 and 2025 that evaluated tibiofemoral cartilage after ACLR using quantitative or compositional MRI. Two reviewers performed screening, data extraction, and risk-of-bias assessment. Meta-analysis was restricted to outcomes with sufficient comparability across studies; other outcomes were synthesized narratively.

Results: Thirty-five studies were included. Across cohorts, ACLR knees generally demonstrated elevated cartilage T2 relaxation times and elevated T1ρ values compared with contralateral or healthy control knees, consistent with persistent cartilage matrix alteration. Abnormalities were most frequently reported in weight-bearing medial compartment regions and were more consistently observed at longer follow-up intervals. Meniscal pathology and altered biomechanics were repeatedly associated with less favorable compositional or structural cartilage outcomes. Evidence regarding graft type and rehabilitation strategy was limited and heterogeneous, and causal inferences could not be made. Meta-analysis was feasible only for a subset of T2 comparisons and suggested higher tibiofemoral T2 in ACLR knees, with substantial between-study heterogeneity.

Limitations: Considerable variability in MRI protocols, regions of interest, and reporting limited pooling. Several studies may represent overlapping cohorts, and many analyses were underpowered.

Conclusion: MRI evidence indicates that biochemical cartilage abnormalities commonly persist after ACLR, particularly in the medial tibiofemoral compartment. Standardized imaging protocols and long-term longitudinal studies linking MRI biomarkers to clinical outcomes are needed.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251156314, PROSPERO CRD420251156314.

Objective: This study aimed to evaluate the clinical efficacy of the posterior interosseous artery (PIA) perforator propeller flap for the repair of dorsal wrist and hand wounds.

Methods: From October 2018 to October 2022, 12 patients with dorsal defects of the wrist (n = 5) or hand (n = 7) underwent repair using the PIA perforator flap. The surgical technique involved preoperative Doppler ultrasound localization of perforators, flap design centered on the selected perforator, and rotation of the flap up to 180° to cover the defect. Surgical outcomes were assessed based on flap survival, complications, and changes in preoperative/postoperative visual analog scale scores and disability of the arm, shoulder, and hand (DASH) scores.

Results: Twelve cases of skin flaps were successfully harvested, and the donor sites were directly sutured. Postoperatively, 11 flaps survived completely, while one case developed a wound infection that resolved with debridement and dressing changes. Patients were followed for 6-18 months (mean 12 months). Flap texture and appearance were satisfactory, with no significant swelling observed. Patient satisfaction reached 91.67%. At the final follow-up, DASH scores ranged from 2 to 15, with a mean of 9.2. Mild scar hyperplasia was observed at the donor site in two cases and at the flap margin in one case.

Conclusion: For repairing soft tissue defects of the dorsal wrist, the posterior interosseous artery perforator flap provides a valuable and reliable clinical option due to its consistent vascular supply, preservation of major vessels, minimal surgical complexity, favorable aesthetic and tactile qualities, minimal donor-site trauma, and high flap survival rate.

Perianal necrotizing fasciitis (PNF) is a life-threatening soft tissue infection with high mortality. Despite the established role of radical debridement, outcomes are often hindered by late diagnosis and suboptimal postoperative care. While negative pressure wound therapy (NPWT) promotes complex wound healing, its synergistic application with radical debridement in PNF requires further validation. We report a case of extensive PNF that demonstrated the limitations of traditional interventions. By utilizing an integrated strategy of extended-incision radical debridement and early NPWT, we achieved rapid infection control and accelerated wound healing. This case suggests that such a combined technical framework can overcome clinical challenges and significantly improve PNF prognosis.

Objective: To quantitatively analyze the learning curve for thulium laser en bloc resection of bladder tumor (TL-ERBT) performed by a surgeon experienced in conventional transurethral resection of bladder tumor (TURBT).

Methods: In this single-surgeon, retrospective cohort study, the initial 86 consecutive TL-ERBT cases were reviewed. Operation time was used as the primary outcome. Learning curve analysis was performed using moving average and cumulative sum (CUSUM) methods.

Results: Among 79 successfully completed TL-ERBTs, the mean operation time was 31.6 ± 10.3 min. CUSUM analysis identified a turning point at case 32, separating the Learning phase (cases 1-32) from the Proficiency phase (cases 33-86). Operation time significantly decreased from 37.8 ± 9.2 min in the Learning phase to 27.8 ± 8.1 min in the Proficiency phase (P < 0.001). The conversion rate to conventional TURBT declined from 12.5% to 2.1% (P = 0.038). Detrusor muscle presence in specimens (87.3% overall) and major complication rates were comparable between phases.

Conclusion: For a surgeon experienced in conventional TURBT, preliminary evidence from this study suggests that proficiency in TL-ERBT, defined primarily by operative efficiency, may be achievable after approximately 32 procedures, with significant improvements in operative efficiency and technical success; while patient safety was not compromised. These findings provide a practical quantitative benchmark for surgical training and clinical implementation.