Indian Journal of Surgery最新文献

The increasing number of patients have been electing to undergo breast-conserving surgery via immediate, one-stage direct-to-implant breast reconstruction. Conventionally, this implant-based breast reconstruction is conducted utilizing a surgical methodology in which the pectoralis major muscle is incised to create two distinct planes. However, achieving satisfactory implant coverage remains a significant challenge, primarily due to the supplementary financial implications associated with the use of an acellular dermal matrix patch. There is a pressing necessity to discover an innovative surgical technique to address this limitation. The primary objective of this research is to investigate the potential advantages of employing a flap comprising the pectoralis major and serratus anterior muscle fascia for implant coverage during the process of breast reconstruction. The implant was encapsulated within a lateral tissue pocket, crafted from the fascia of the pectoralis major and serratus anterior muscles. This novel surgical technique maintained the original boundaries of the pectoralis major and serratus anterior muscles and substituted the high-cost acellular dermal matrix with an autologous fascial flap. After the operation, all patients exhibited a diminished rate of complications, with no occurrences of severe post-operative issues. Patient satisfaction surveys were administered to evaluate the esthetic effects of the reconstructed breast shape. All patients successfully underwent the surgical procedure. The aggregate complication rate, specifically for seroma and hematoma, was observed to be a minimal 5.41%, with no instances of capsular contracture recorded. Feedback obtained from the administered BREAST-Q questionnaires indicated good satisfaction and aesthetic outcomes among all the patients with reconstructed breasts. The utilization of a flap composed of the pectoralis major and serratus anterior muscle fascia to craft a lateral tissue pocket encapsulating the implant represents a reliable, secure, and economically efficient surgical methodology. Moreover, this technique can yield aesthetically pleasing outcomes.

To introduce an experience of an anterolateral thigh flap combined with an ilioinguinal flap (ALT-SCIA) for treating severe skin trauma. Retrospective cohort data of 13 cases with complicated lower leg wounds admitted between June 2017 and October 2018 who underwent the ALT-SCIA were studied. The conjoined flap was designed according to the descending branch of the superficial circumflex iliac artery and the lateral circumflex femoral artery. The baseline data and operative details were collected from electronic medical records. These enrolled cases included eleven men and two women, aging from 24 to 55 years old. They underwent an average follow-up of 26.3 months. All flaps survived during the first stage and had good blood circulation, a plump appearance, soft texture, similar color to the receiving area, and no pigmentation. The eventual review presented those four cases acquired bone grafting treatments due to bone defect. The ALT-SCIA method provides adequate composite soft tissue coverage of large defects in the lower leg. Our study found that the flaps could provide abundant tissue and a relatively well-concealed donor area, and showed a relatively good clinical efficacy.

We report a case of appendico-vesical fistula (AVF) in a 12-year-old boy presenting with a 2-month history of solely recurrent painless macroscopic haematuria. Ultrasound and MRI scans were suggestive of an urachus remnant with a calculus in the bladder dome. Cystoscopy showed a bladder diverticulum with mucosal inflammation. Open laparotomy eventually revealed the AVF, as a complication of a clinically ‘silent’ acute appendicitis. AVF is a rare complication of acute appendicitis. A literature review identified 17 further paediatric cases. Whilst faecaluria and pneumaturia are pathognomonic for AVF, these were present in only 24% of patients. Most patients presented with recurrent urinary tract infections or urinary symptoms, and most had a history of abdominal pain and vomiting. Imaging studies and cystoscopy were often inconclusive, and most diagnoses were made at surgery. A high index of clinical suspicion helps to guide diagnosis and treatment.

Omental infarction is an infrequent cause of acute abdominal pain and there is no consensus on whether conservative or surgical treatment is the best strategy. The clinical diagnosis remains challenging without complementary imaging investigations, due to its clinical similarity with other more frequent causes of acute abdominal pain. We herein report a case of infarction of the greater omentum mimicking acute pancreatitis.

Levonorgestrel-releasing intrauterine device is widely used in the treatment of adenomyosis and heavy menstrual bleeding. For patients with large uterine cavity or abnormal uterine cavity, they might encounter the problem of downward displacement and expulsion of the device during treatment. Herein, this study reported an easy minimally invasive method using GyneFix intrauterine device system to fix levonorgestrel-releasing intrauterine device into the uterine fundal muscle layer. The two ends of the intrauterine devices were firstly bundled together tightly. The suction sheath was inserted into the uterine cavity until reaching the fundus. Then, the bundled intrauterine devices were inserted into the sheath and fixed the GyneFix knot at the uterine fundus following the GyneFix IUD installation method. In this way, the LNG-IUD could be fixed well in the uterine cavity. This outpatient procedure does not require any special preparation or training.