Innovative Surgical Sciences最新文献

Objective: Computer assistance has become indispensable in the reconstruction of the orbit and midface. Although these are key areas of an individual's esthetic appearance, defects or deformities of the midface, especially those of the orbit, are treated diversely.

Methods: The aim of this article is to present the wide utility of computer-assistance in modern craniomaxillofacial surgery, including virtual planning, computer-aided design, guided surgery, navigational control, patient-specific implants, and quality control via image fusion.

Results: There have been rapid advances in both digital planning and manufacturing processes, with continual improvements.

Conclusions: Patient-specific implants have pushed the boundaries of reconstructive surgery in all surgical specialties.

Objectives: Soft tissues defects can extend into the fat layer or even deeper and can cause significant clinical disadvantages like pain, infections, and loss of function. In particular, chronic wounds are difficult to treat, as split-thickness skin grafts (STSGs) have varying success rates. To improve wound healing in chronic wounds, the authors have studied the application of platelet-mediator concentrate (PMC) in a human keratinocyte culture model in vitro and of autologous platelet concentrates (PRP) in a combination with surgical procedures in vivo as second line therapy in patients with initially failed wound closure.

Methods: For in vitro testing on keratinocytes, a PMC was processed with a commercially available bedside system (ATR^®, Curasan, Germany). In a clinical, nonrandomized study, five in-house patients with chronic wounds were treated using a combination of surgical debridement and autologous PRP. Time of healing as determined by epithelization as well as laser Doppler imaging to visualize blood flow was analyzed. Additionally, changes in ease of surgical wound closure were determined. Finally, the quality of life of patients was assessed using a validated questionnaire (clinicaltrials.gov # NCT03667638).

Results: In vitro testing shows a significant effect of PMC on keratinocyte proliferation in cell culture. Clinical studies showed that patients treated with PRP had initiation of wound closure, higher blood flow after PRP injection, and easier wound closure as well as improved quality of life.

Conclusions: The injection of platelet concentrates to treat chronic wound defects presents a favorable addition to treatment where single surgical procedures have failed and may improve current therapy options.

Objectives: The purpose of this study was to investigate the value of PET/CT in the preoperative staging of non-small cell lung cancer in predicting long-term survival and diagnostic performance, validated by histopathology following surgical resection.

Methods: Between 02/2009 and 08/2011, 255 patients with non-small cell lung cancer were included in this single-center prospective study. All underwent 18F FDG-PET/CT for pre-operative staging, and in 243 patients complete surgical resection was possible. Regarding lymph node involvement and extrathoracic metastases, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the histopathological staging as reference. Median follow-up for censored patients was 9.1 years.

Results: Overall 5-year survival rate of all patients was 55.6%, and of patients who had complete surgical resection it was 58.2%. In multivariate analysis of all surgically resected patients lymph node involvement (p=0.029) and age >61 years (p=<0.001) were significant independent prognostic factors. SUVmax and SUVmean cut-offs between SUV 2 and 11, however, were not associated with better or ;worse survival. The PET-CT sensitivity, specificity, positive predictive value and negative predictive value for predicting lymph node involvement were 57, 95, 88, and 76%, respectively. Furthermore, sensitivity, specificity, positive predictive value, and negative predictive value for detecting extrathoracic metastases were 100, 58, 98, and 100%, respectively.

Conclusions: In this study, tumor 18F FDG-uptake values did not provide additional prognostic information. Age>61 years and lymph node metastasis were associated with worse long-term survival in surgically resected patients. 18F FDG-PET/CT scans allow for improved patient selection. However, in staging mediastinal lymph nodes, there is a high rate of false positives and false negatives, suggesting that tissue biopsy is still indicated in many cases.

Objectives: The best treatment for displaced, intra-articular fractures of the calcaneus remains controversial and it is generally agreed, that there is no single method that is suitable for all patients.

Case presentation: Here we report a rare case of bilateral calcaneal osteomyelitis with fistula formation following open reduction and plate fixation via an extensile lateral approach that could be salvaged with an interdisciplinary approach including orthopedic and plastic surgeons. We are not aware of a similar case in the literature. Abductor digit minimi flaps is a well-established procedure in plastic and reconstructive surgery with a minimal functional defect and morbidity at the donor site. This treatment protocol resulted in minimal donor-site morbidity and good bone remodeling in the further course. We believe that it may be of use for complicated courses even with limited resources.

Conclusions: Abductor digit minimi flaps is a well-established procedure in plastic and reconstructive surgery with a minimal functional defect and morbidity at the donor site.

Skull base surgery has evolved significantly since Harvey Cushing's first descriptions in the early 1900s. Computer aided surgery (CAS) applications continue to expand; they include virtual surgical planning, augmented and virtual reality, 3D printing of models/cutting guides/implants, surgical navigation, and intraoperative imaging. The authors will review the current skull base CAS literature and propose a computer aided surgical workflow categorizing these applications into 3 phases: 1) Virtual planning, 2) Surgical execution, 3) Intraoperative verification.

Objectives: Hand-sewn and stapled intestinal anastomoses are both daily performed routine procedures by surgeons. Yet, differences in micro perfusion of these two surgical techniques and their impact on surgical outcomes are still insufficiently understood. Only recently, hyperspectral imaging (HSI) has been established as a non-invasive, contact-free, real-time assessment tool for tissue oxygenation and micro-perfusion. Hence, objective of this study was HSI assessment of different intestinal anastomotic techniques and analysis of patients' clinical outcome.

Methods: Forty-six consecutive patients with an ileal-ileal anastomoses were included in our study; 21 side-to-side stapled and 25 end-to-end hand-sewn. Based on adsorption and reflectance of the analyzed tissue, chemical color imaging indicates oxygen saturation (StO₂), tissue perfusion (near-infrared perfusion index [NIR]), organ hemoglobin index (OHI), and tissue water index (TWI).

Results: StO₂ as well as NIR of the region of interest (ROI) was significantly higher in stapled anastomoses as compared to hand-sewn ileal-ileal anastomoses (StO₂ 0.79 (0.74-0.81) vs. 0.66 (0.62-0.70); p<0.001 NIR 0.83 (0.70-0.86) vs. 0.70 (0.63-0.76); p=0.01). In both groups, neither anastomotic leakage nor abdominal septic complications nor patient death did occur.

Conclusions: Intraoperative HSI assessment is able to detect significant differences in tissue oxygenation and NIR of hand-sewn and stapled intestinal anastomoses. Long-term clinical consequences resulting from the reduced tissue oxygenation and tissue perfusion in hand-sewn anastomoses need to be evaluated in larger clinical trials, as patients may benefit from further refined surgical techniques.

Objectives: Mucinous cystadenomas are among the most common benign adnexal masses. The peak incidence of mucinous cystadenoma appears between the third and fifth decades of life, but rare cases in younger and older women have also been reported. Ovarian cystic formations are usually asymptomatic at early stages, until they grow in size and various compression symptoms appear, such as abdominal discomfort, distention, nausea, vomiting, and increased urination.

Case presentation: This is a case of an 86-year-old woman with partial bowel obstruction due to a sizeable adnexal mass. The patient was submitted to exploratory laparotomy due to intestinal obstruction symptoms, the mass was removed and the final histopathological report indicated a benign mucinous cystadenoma (maximum diameter 25 cm). Physical examination was remarkable due to the large size of the mass. Computed tomography revealed the sizeable abdominal mass in contact with the uterus and the ovaries resulting in bowel compression. Exploratory laparotomy due to bowel obstruction symptoms confirmed the imaging results. The abdominal mass was removed without being ruptured, and total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy were done.

Conclusions: Our case report highlights the clinical suspicion that is required for the diagnosis and appropriate treatment of this clinical entity. These tumors are uncommon in postmenopausal women, and when they do appear, they can be difficult to differentiate from cancer.

Objectives: To investigate the risk factors for early recurrence after curative pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma.

Methods: All data were retrospectively collected from patients with resectable pancreatic ductal adenocarcinoma who had undergone pancreatoduodenectomy at the Department of Surgery, Phramongkutklao Hospital, from January 2015 to December 2020. The preoperative and perioperative risk factors were included into the analysis.

Results: In total, 34 patients were included in the study. The median time for recurrence and median survival time were 17 and 20 months, respectively. The 1, 3, and 5 year disease-free survival rates were 59.6%, 23.87%, and 23.87%, respectively, while the 1, 3, and 5 year overall survival rates were 81%, 24.7%, and 12.4%, respectively. Seventeen patients (50%) from a total of 34 patients had recurrence, and ten patients (29.41%) had recurrence within 12 months. The independent preoperative risk factor associated with adverse disease-free survival was tumor size > 4 cm (hazard ratio [HR], 14.34, p=0.022). The perioperative risk factors associated with adverse disease-free survival were pathological lymphovascular invasion (HR, 4.31; p=0.048) and non-hepatopancreatobiliary surgeon (HR, 5.9; p=0.022). Risk factors associated with poor overall survival were microscopical margin positive (R1) resection (HR, 3.68; p=0.019) and non-hepatopancreatobiliary surgeon (HR, 3.45; p=0.031).

Conclusions: Tumor size > 4 cm from the preoperative imaging study was a poor prognostic factor for early recurrence after curative pancreatoduodenectomy for resectable pancreatic adenocarcinoma indicated that they may have radiological occult metastasis, thus, staging laparoscopy may reduce the number of unnecessary laparotomies and avoid missing radiologically negative metastases.

Objectives: Pneumatosis intestinalis is a rare condition with subserosal or submucosal gas-filled cysts of the gastrointestinal tract. It is often associated with acute mesenteric ischemia, but also non-ischemic causes are described.

Case presentation: A 27-year-old male patient with severe congenital spastic tetraparesis presented to the emergency room with fever and reduced general condition. The patient was hypotonic and tachycardic, had a fever up to 39.7 °C and reduced peripheral oxygen saturation. The laboratory analyses revealed leukocytosis (16.7 G/L) and elevated CRP (162 mg/L).The patient was admitted to the intensive care unit (ICU) for invasive ventilator treatment because of global respiratory insufficiency and antibiotic therapy due to acute pneumonia and severe acute respiratory distress syndrome (ARDS). In addition, he suffered from colonic pseudo-obstruction but with persistent stool passage. After pulmonary recovery, he was transferred to the normal ward of internal medicine, but signs of colonic pseudo-obstruction were still present.Under therapy with diatrizoic acid and neostigmine, the abdomen was less distended, and the patient had regular bowel movements. After four days, the patient developed sudden acute abdominal pain and suffered sudden pulseless electrical activity. Immediate cardiopulmonary resuscitation was provided. After the return of spontaneous circulation, the patient underwent computed tomography (CT) and was re-admitted to the ICU. The CT scan showed massive dilatation of the colon, including pneumatosis coli, extensive gas formation within the mesenteric veins and arteries, including massive portal gas in the liver, the splenic vein, the renal veins, and disruption of abdominal aortic perfusion. The patient was then first presented for surgical evaluation, but due to futile prognosis, treatment was ceased on the ICU.

Conclusions: In conclusion, colonic pseudo-obstruction might have led to colonic necrosis and consecutive massive gas formation within the mesenteric vessels. Therefore, intestinal passage should be restored as soon as possible to avoid possible mortality.