Frontiers in Surgery最新文献

The most complicated nerve injuries occur in the spinal nerves. Following traumatic injury at the nerve root attachment to the spinal cord (avulsion), there is degeneration of nerve fibres in the root and spinal cord. The result for the patient is paralysis with sensory loss and typical excruciating severe pain. An obvious fundamental surgical treatment for such injuries is to re-create continuity for the ruptured spinal nerve and the roots detached from the spinal cord. Reimplanting motor spinal roots leads to neuronal growth within the spinal cord and distally in the peripheral nerves, resulting in recovery of shoulder and proximal arm muscles. Sensory function cannot be restored surgically from dorsal root to spinal cord replantation due to the impediment of regrowing sensory fibres at the spinal cord glial scar. However, when a ganglionectomised dorsal root-in effect a peripheral nerve conduit-is implanted into the spinal cord sensory system, intramedullary (secondary) sensory neurons extend distally, resulting in recovery of some sensory function. Patients have profited from this surgery with better functional performance without movement synkinesis and reduced pain. Full functional restoration after a nerve injury cannot be achieved by means of surgery alone due to the impediment of regrowing sensory fibres at the spinal cord glial scar. Embryonic axogenesis was studied to identify pathways required for adult spinal cord injury repair. From this, a key regulator, the retinoic acid receptor β, was identified. This signalling cascade can be reactivated in the injured adult nervous system with the orally available drug KCL-286. This drug has been shown to be safe and tolerated in humans at doses predicted to be used in human spinal cord injuries to provide functional recovery. Therefore, the combination of surgical root implantation and KCL-286 represents a promising therapeutic strategy to improve the quality of life for patients with root avulsions and the broader population of patients with spinal cord injuries.

Background: Spinal artery aneurysms are a rare type of aneurysm, and their diagnosis and treatment are challenging. In this case report, we describe a patient in whom congenital descending aorta coarctation was complicated by subarachnoid hemorrhage secondary to the rupture of a multilevel spinal artery aneurysm, which was treated with endovascular surgery.

Case description: A 54-year-old man presented with head and neck pain, nausea, and vomiting. He had congenital descending aorta coarctation, which was untreated. Imaging was notable for subarachnoid hemorrhage (SAH) (Modified Fisher grade 3), severe congenital descending aorta coarctation, and multiple aneurysms of the anterior spinal artery and left middle cerebral artery (MCA). One month after external ventricular drainage (EVD) and lumbar drainage (LD), his clinical status gradually stabilized. Owing to the poor general condition and the presence of multiple aneurysms, open surgery was deemed unsuitable, and endovascular treatment was performed. The patient had achieved partial recovery at the15 days operative follow-up.

Conclusion: This case indicates that foramen magnum SAH with no identifiable source on conventional DSA warrants further investigation via cervical and thoracic myelography, CTA or MRI. Endovascular treatment may be considered for patients with multilevel spinal artery aneurysms and poor surgical candidacy due to frailty.

Up to 20% of rectal cancer patients experience complications that result in an emergency presentation at diagnosis, the more frequent scenarios being represented by large bowel obstruction or perforation and tumor bleeding. The treatment of emergency rectal cancer depends both on patients' clinical conditions and risk factors, and on tumor's characteristics, primarily its intra- or extraperitoneal location. This article will address the different clinical presentations and the corresponding available treatments, with a particular focus on surgical techniques and multimodal chemoradiotherapy. In addition, it will address the prognosis of emergency rectal cancers and discuss healthcare policy strategies aimed at minimizing its occurrence.

Objective: To establish a clinical nursing practice guideline for Accelerated Rehabilitation in Hepatobiliary Surgery (ERAS) based on the Ottawa research application model.

Methods: Using the Ottawa research application model as the guide, the obstacle factors were analyzed through focus group interview, and the comprehensive intervention strategy was developed by expert consultation.

Results: 10 barrier factors were identified from three aspects: evidence, adopters and practice environment, and multi-dimensional intervention strategies were constructed, including the Manual of ERAS Nursing Management in Hepatobiliary Surgery, telemedicine platform and multidisciplinary collaboration process.

Conclusion: The Ottawa model provides a systematic framework for the application of guidelines, and leadership support and technology integration are the keys to practice. This study provides reference for standardization of ERAS nursing practice and resource optimization.

Background: To evaluate the diagnostic performance of high-frequency ultrasound combined with Superb Microvascular Imaging (SMI) and Shear Wave Elastography (SWE) for carpal tunnel syndrome (CTS), and to develop an individualized diagnostic approach using a body surface area (BSA)-adjusted median nerve CSA at the pisiform level.

Materials and methods: This retrospective study included 47 wrists with carpal tunnel syndrome (CTS) and 94 control wrists. Median nerve cross-sectional area (CSA) was measured at four anatomical sites. Superb Microvascular Imaging (SMI) and Shear Wave Elastography (SWE) were used to assess intraneural vascularity and stiffness, respectively. A linear regression model was developed to estimate the expected CSA at the pisiform level based on body surface area (BSA), and a BSA-based Z-score was calculated accordingly. Receiver operating characteristic (ROC) analyses were performed to compare the diagnostic performance of (i) a fixed CSA cutoff at the pisiform level, (ii) the BSA-based Z-score, and (iii) a combined SMI + SWE logistic regression model.

Results: Ultrasound parameters differed significantly between the CTS and control groups (P < 0.05). The BSA-based Z-score derived from the CSA at the pisiform level yielded an AUC of 0.924 (95% CI 0.879-0.969) and improved specificity (83%; 95% CI 0.738-0.899) compared with the fixed CSA cutoff (75%; 95% CI 0.644-0.829). In multivariable analysis, SMI- and SWE-derived parameters remained independent predictors of CTS (P < 0.001). The combined SMI + SWE logistic regression model demonstrated the best diagnostic performance (AUC 0.944; 95% CI 0.906-0.982), with 83% sensitivity (95% CI 0.692-0.924) and 90% specificity (95% CI 0.826-0.955).

Conclusion: High-frequency ultrasound combined with Superb Microvascular Imaging (SMI) and Shear Wave Elastography (SWE) enables accurate, noninvasive evaluation of CTS. A BSA-based CSA Z-score improves specificity in CSA-based diagnosis, and integrating SMI and SWE further enhances overall diagnostic performance.

Objective: To explore the feasibility, safety and clinical efficacy of closed Kirschner wire prying reduction technique in the treatment of Gartland Type IV supracondylar humeral fractures in children.

Methods: A retrospective analysis was conducted on the clinical data of 24 children with intraoperatively confirmed Gartland Type IV supracondylar humeral fractures admitted to Gannan Prefecture People's Hospital from January 2018 to May 2025. After the failure of closed manual reduction, all children underwent closed reduction using percutaneous Kirschner wire prying technique, followed by cross or double lateral Kirschner wire fixation. The operation time, reduction success rate, occurrence of complications and postoperative functional recovery were collected. In addition, 2 representative cases were selected to display typical imaging data.

Results: Among the 24 children, 22 achieved successful reduction without open surgery; the average operation time was 42 min. One child had mild re-displacement after surgery, and one child had transient ulnar nerve palsy. All cases achieved good fracture healing, and the excellent and good rate of Flynn score at the last follow-up was 86.4%. The postoperative imaging of typical cases showed good alignment, and the elbow joint function was completely restored.

Conclusion: For children with Gartland Type IV supracondylar humeral fractures, closed Kirschner wire prying reduction technique is a safe and effective minimally invasive reduction method, which may effectively reduce the need for open reduction, and has good clinical application value.

Background: Pedicle screw (PS) fixation provides superior biomechanical stability compared with lateral mass screw (LMS) fixation for unstable cervical spine fractures (CS-Fx) but is associated with a risk of neurovascular injury. Navigation systems have improved PS placement accuracy, although most published studies remain small and underpowered to assess rare complications.

Objective: To evaluate the accuracy and safety of navigation-assisted PS fixation for unstable CS-Fx in a population-based cohort.

Methods: All consecutive patients with unstable CS-Fx who underwent navigated PS fixation at Oslo University Hospital between 2015 and 2024 were included in this study. Navigation was performed using preoperative CT-based surface matching. Postoperative CT scans obtained within 24 h were used to grade PS accuracy as Grade 1 (<2 mm breach), Grade 2 (2-4 mm), or Grade 3 (>4 mm). Complications related to PS placement were recorded.

Results: A total of 345 patients (median age 68 years; 75% males) underwent fixation with 1,347 navigated PSs. Screw accuracy was Grade 1 in 90% of cases, Grade 2 in 8% of cases, and Grade 3 in 2% of cases. Surgery-related complications occurred in 23 patients (6.7%), of whom 11 experienced complications directly related to PS placement. The per-screw complication risk was 0.8%, increasing with decreasing accuracy: 0.1% (Grade 1), 6% (Grade 2), and 14% (Grade 3). Vertebral artery injury occurred in seven patients; two patients experienced new-onset nerve root injury, one had a misplaced screw breaching the atlanto-occipital joint, and one developed significant perioperative bleeding. No cases of new-onset spinal cord injury or screw pull-out were observed. Surgical site infections occurred in 3.5% of patients and were successfully treated with debridement and antibiotics in all cases, without the need for implant removal.

Conclusion: Navigated cervical PS fixation is accurate and associated with a low rate of serious complications. Meticulous planning and surgical technique remain essential despite the use of navigation assistance.

[This corrects the article DOI: 10.3389/fsurg.2026.1726401.].

Background: Totally Implantable Venous Access Ports (TIVAPs) are long-term subcutaneous venous infusion devices widely used in patients requiring prolonged venous therapy, particularly those with cancer. The choice of left- vs. right-sided implantation during TIVAP implantation is a key clinical decision, as anatomical and hemodynamic differences between sides may influence the risk of catheter-related thrombosis (CRT). However, existing literature remains controversial regarding the association between implantation side and CRT incidence. This meta-analysis aims to systematically evaluate the impact of left- vs. right-sided TIVAP implantation on CRT risk, providing evidence-based support for clinical prevention strategies.

Methods: Literature searches were conducted in PubMed, Web of Science, Embase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database to identify studies investigating the effect of left- vs. right-sided TIVAP implantation on CRT incidence. The search spanned from database inception to October 2025. Two independent researchers screened literature, extracted data, and assessed the risk of bias of the included studies. A meta-analysis was conducted using RevMan 5.3 software.

Results: A total of 21 studies involving 10,778 patients were included. Meta-analysis revealed no statistically significant difference in CRT incidence between left- and right-sided chest ports [OR = 1.28, 95%CI (0.97-1.68), P = 0.08] or arm port [OR = 1.19,95% CI (0.86-1.66), P = 0.29].

Conclusions: Current evidence indicates no overall difference in CRT incidence between left- and right-sided TIVAPs. However, the observed sample size-dependent association suggests that left-sided implantation may carry a slightly higher CRT risk in large cohorts. Clinicians may select the implantation side based on individual patient characteristics. However, large-sample, multi-center randomized controlled trials are needed to further validate these findings, particularly given the observed sample size-dependent differences.

Purpose: To evaluate the outcomes of flap reconstruction following extralevator abdominoperineal excision (ELAPE) compared to abdominoperineal resection (APR) in the treatment of locally advanced and recurrent rectal cancer, in the context of demonstrating the feasibility of performing ELAPE with flap reconstruction for rectal cancer in a large public (non-tertiary) hospital. The primary outcome was the assessment of postoperative complication rates to determine whether outcomes fell within acceptable standards for complex pelvic reconstruction. Secondary outcomes included flap-specific complications, operative parameters, postoperative length of stay, and correlations between flap complexity, operative duration, complication grade, and recovery metrics.

Methods: This retrospective cohort study analysed 39 patients who underwent reconstructive ELAPE or APR at a secondary referral centre between April 2018 and August 2024. Data were collected from a prospectively maintained database and validated using clinical records and MDT meeting summaries. Patient demographics, surgical details, flap types, postoperative outcomes, and complication rates were evaluated. Statistical analyses included descriptive statistics and correlation assessments.

Results: Twenty-seven patients underwent ELAPE with flap reconstruction, utilizing vertical rectus abdominis myocutaneous (VRAM), inferior gluteal artery (IGAM), gracilis, and V-Y advancement flaps. Outcomes, including complication rates and length of hospital stay, were comparable to those reported by tertiary centres. Major complications (Clavien-Dindo grade III and above) occurred in 33.3% of ELAPE cases, with flap-specific complications such as superficial infections (14.8%) and dehiscence requiring intervention (7.4%). Median length of stay for ELAPE was 18 days. No cases of complete flap failure were observed.

Conclusion: This study demonstrates that ELAPE with flap reconstruction can be safely and effectively performed in a large public hospital setting, with outcomes comparable to high-volume tertiary centres. The findings underscore the importance of multidisciplinary collaboration in achieving high-quality surgical and reconstructive outcomes, and how these can be achieved in a large public hospital.