scholarly journals Against all odds: traumatic thumb amputation following ring avulsion injury

2020 ◽  
Vol 8 (1) ◽  
pp. 95-100
Author(s):  
Muhammad Izzuddin Hamzan ◽  
Mohamad J. Jeffrey ◽  
Ahmad S. Halim ◽  
Arman Z. Mat Saad
Keyword(s):  
Pediatric Population ◽  
Management Strategies ◽  
Surgical Techniques ◽  
Surgical Reconstruction ◽  
Soft Tissue Coverage ◽  
Avulsion Injury ◽  
Aesthetic Appearance ◽  
Surgical Tactics ◽  
The Right ◽  
Ring Avulsion

Background. Replantation of an avulsed digit often poses a surgical challenge even to an experienced microsurgeon. Therefore, it is often difficult to choose the treatment path for traumatic amputation of digit following ring avulsion injury, be it completion amputation or replantation. We discuss the surgical challenges encountered and management strategies used in this case of an unfortunate child who sustained an amputation of his dominant thumb. Clinical case. We present the case of a 10-year-old boy who sustained a complete amputation of his right thumb following a ring avulsion injury which was reconstructed with multiple approaches and surgical techniques to address difficulties at different stages. We replanted the avulsed thumb, reconstructed the tendon, soft tissue coverage with the use of allograft skin and local flap, and improvised surgical tactic to overcome complications encountered intra- and post-operative states such as thrombosis of arterial anastomosis and venous congestion. Discussion. There is scarce literature on the management of ring avulsion injury of the thumb and to the authors best knowledge, there was only one reported case in children. In the case described here, we report a good outcome with complex reconstructive surgery despite all odds in an attempt to salvage the thumb, especially in a pediatric population. Post-surgical reconstruction, the boy achieved a successful and acceptable outcome in terms of function and aesthetic appearance. Conclusion. The journey through replantation of an amputated digit following avulsion injury poses various challenges both to the microsurgeon and patient. The decision of surgical tactics must be tailored and thoroughly reason based on the knowledge, experience, and good microsurgical skill. A good surgical outcome can be achieved even in a complex injury in the pediatric population with careful planning and the right intervention in each complication peri-operative.

Aortic arch replacement and elephant trunk procedure: an interdisciplinary approach to surgical reconstruction, perfusion strategies and blood management

Perfusion ◽  
2010 ◽  
Vol 25 (6) ◽  
pp. 369-379 ◽  
Author(s):  
Christine McKay ◽  
Peter Allen ◽  
Philip M Jones ◽  
Michael WA Chu
Keyword(s):  
Circulatory Arrest ◽  
Management Strategies ◽  
Surgical Techniques ◽  
Interdisciplinary Approach ◽  
Deep Hypothermic Circulatory Arrest ◽  
Surgical Reconstruction ◽  
Blood Management ◽  
Elephant Trunk ◽  
Transverse Arch ◽  
Elephant Trunk Procedure

Surgical treatment of patients who present with large aneurysms of the ascending aorta, transverse arch and descending aorta, including the thoracic and abdominal aorta typically consists of a two-staged elephant trunk procedure. Typically, these operations are lengthy, requiring long cardiopulmonary bypass times, deep hypothermic circulatory arrest and multiple anastamotic suture lines, which increases the risks for coagulopathic bleeding and the need for massive transfusions. The purpose of this report is to describe our approach, involving advanced surgical techniques and the innovative perfusion considerations as well as modified blood management strategies to minimize perioperative blood loss and the need for transfusions. All of the above will highlight critical cardiac team communications. An ever-evolving case requires forward thinking, revised judgments, open discussion and the continued involvement of all team members. In turn, this ensures evidence-based medical and perfusion practices that lead to achieving a positive peri-operative course, with optimal blood conservation.

Surgical Reconstruction of the Iliac Arteries Prior to Endovascular Aortic Aneurysm Repair

1997 ◽  
Vol 4 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Timothy A.M. Chuter ◽  
Linda M. Reilly
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Iliac Artery ◽  
Surgical Techniques ◽  
Surgical Reconstruction ◽  
Common Trunk ◽  
Aortic Blood Flow ◽  
Iliac Arteries ◽  
The Right

Purpose: To explore a method of combined endovascular/conventional treatment of abdominal aortic aneurysm (AAA), in which the iliac arteries are reconstructed by conventional surgical techniques to provide the anatomic substrate for subsequent endovascular repair of the aortic aneurysm. Method: A 77-year-old patient with severe cardiac disease was found to have a 6.5-cm AAA, bilateral common iliac artery (CIA) aneurysms, and diffusely narrowed, tortuous external iliac arteries. The left internal iliac artery was occluded. At operation, the right CIA was exposed through a transverse retroperitoneal incision under epidural anesthesia. An iliobifemoral bypass was constructed using a preformed bifurcated graft. A stent-graft was delivered through the right limb of the bifurcated iliobifemoral graft. The proximal end of the stent-graft was implanted in the neck of the aneurysm, and the distal end was deployed in the common trunk of the iliobifemoral graft, thereby excluding the AAA and both native iliac arteries from prograde arterial flow. Results: Completion angiography and follow-up contrast computed tomography showed the aneurysm to be excluded from the circulation. The patient was not intubated, was never hemodynamically unstable, and had aortic blood flow interrupted for no more than 20 seconds. In addition, he was able to resume his usual diet on the first postoperative day. He continues to be well and without evidence of endoleak at 6-month follow-up. Conclusions: This case demonstrates that iliac artery stenosis, tortuosity, and aneurysmal dilatation are not impediments to endovascular AAA exclusion. Any necessary surgical modifications of pelvic arterial anatomy can be performed before stent-graft insertion to minimize aortic occlusion time.

scholarly journals Long term follow-up of inguinal endometriosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
BoRan Mu ◽  
ZhiQiang Zhang ◽  
Chongdong Liu ◽  
Kunning Zhang ◽  
ShuHong Li ◽  
...  
Keyword(s):  
Management Strategies ◽  
Uterosacral Ligament ◽  
Round Ligament ◽  
Pelvic Endometriosis ◽  
Ovarian Endometriosis ◽  
Hernia Sac ◽  
Peritoneal Endometriosis ◽  
Long Term Follow Up ◽  
The Right

Abstract Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.

Reoperative surgery in calves with a total artificial heart

1980 ◽  
Vol 3 (1) ◽  
pp. 24-29
Author(s):  
H. Fukumasu ◽  
D.B. Olsen ◽  
J.H. Lawson ◽  
A. Mochizuki ◽  
N. Daitoh ◽  
...  
Keyword(s):  
Artificial Heart ◽  
Surgical Techniques ◽  
Total Artificial Heart ◽  
Reoperative Surgery ◽  
Left Thoracotomy ◽  
Right Thoracotomy ◽  
The Right

Two surgical techniques have been developed in our laboratory to deal with identifiable problems in long-term artificial heart experiments. A right thoracotomy is used to deal with problems such as extensive bleeding, which occur in the immediate postoperative stage of the experiment, while a left thoracotomy is used in cases in Which the original implantation is preceded by more than one week, since extensive adhesions complicate the right thoracotomy at that stage. Pulmonary problems have been eliminated as a primary cause of difficulties after reoperation, but infection remains a serious problem.

Prevention of Paediatric Ring Avulsions – A Cadaveric Study

2008 ◽  
Vol 33 (3) ◽  
pp. 373-376
Author(s):  
E. ZETLITZ ◽  
J. R. SCOTT ◽  
J. SHAW-DUNN ◽  
J. DABERNIG
Keyword(s):  
Cadaveric Study ◽  
Avulsion Injury ◽  
Fresh Cadaver ◽  
Ring Avulsion

Finger ring avulsion injuries can be functionally, cosmetically and emotionally devastating for the patient. This cadaveric study assessed a simple way to prevent ring avulsion injuries. Fresh cadaver fingers were used to test the incidence of avulsion injury with ordinary rings and when a single slot was cut in the ring. Intact rings mostly produced significant digital injuries, while the rings with slots did not.

scholarly journals Ear Reconstruction Simulation: From Handcrafting to 3D Printing

2019 ◽  
Vol 6 (1) ◽  
pp. 14 ◽  
Author(s):  
Elisa Mussi ◽  
Rocco Furferi ◽  
Yary Volpe ◽  
Flavio Facchini ◽  
Kathleen S. McGreevy ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Surgical Reconstruction ◽  
Ear Reconstruction ◽  
Autologous Tissue ◽  
Aesthetic Appearance ◽  
History Of ◽  
Common Clinical Practice ◽  
The Aesthetic ◽  
Manufacturing Technologies ◽  
High Level

Microtia is a congenital malformation affecting one in 5000 individuals and is characterized by physical deformity or absence of the outer ear. Nowadays, surgical reconstruction with autologous tissue is the most common clinical practice. The procedure requires a high level of manual and artistic techniques of a surgeon in carving and sculpting of harvested costal cartilage of the patient to recreate an auricular framework to insert within a skin pocket obtained at the malformed ear region. The aesthetic outcomes of the surgery are highly dependent on the experience of the surgeon performing the surgery. For this reason, surgeons need simulators to acquire adequate technical skills out of the surgery room without compromising the aesthetic appearance of the patient. The current paper aims to describe and analyze the different materials and methods adopted during the history of autologous ear reconstruction (AER) simulation to train surgeons by practice on geometrically and mechanically accurate physical replicas. Recent advances in 3D modelling software and manufacturing technologies to increase the effectiveness of AER simulators are particularly described to provide more recent outcomes.

scholarly journals Use of Integra dermal substitute to prevent implantable device extrusion in an Olympic athlete

2018 ◽  
pp. bcr-2018-226181
Author(s):  
Felicity Page ◽  
Krupali Patel ◽  
Wayne Jaffe
Keyword(s):  
Management Strategies ◽  
Spastic Paraparesis ◽  
Operative Management ◽  
Soft Tissue Coverage ◽  
Dermal Substitute ◽  
Quick Recovery ◽  
Hereditary Spastic Paraparesis ◽  
First Case ◽  
Olympic Athlete ◽  
Intrathecal Medication

We present a challenging case of imminent metallic implant extrusion in a Paralympic athlete managed with a single-stage procedure using ‘Integra’ dermal substitute. The patient had hereditary spastic paraparesis, for which a baclofen pump delivering intrathecal medication was vital in the management of his condition. The device had been most recently implanted into the thigh after previous complications. Integra provided robust soft-tissue coverage over the implanted baclofen pump in the thigh. Different operative management strategies were considered but the use of Integra was felt to offer the least morbidity and a quick recovery. The patient was able to successfully compete in a Paralympic canoeing qualifying event the week following surgery and achieve medal success. To the authors’ knowledge, this is first case in which Integra has been used in such circumstances.

scholarly journals Stiffness of the Masseter Muscle in Children—Establishing the Reference Values in the Pediatric Population Using Shear-Wave Elastography

2021 ◽  
Vol 18 (18) ◽  
pp. 9619
Author(s):  
Cyprian Olchowy ◽  
Anna Olchowy ◽  
Aleksander Pawluś ◽  
Mieszko Więckiewicz ◽  
Luca Maria Sconfienza
Keyword(s):  
Shear Wave ◽  
Masseter Muscle ◽  
Pediatric Population ◽  
Shear Wave Elastography ◽  
Total Sample ◽  
Healthy Children ◽  
Significant Difference ◽  
The Right ◽  
The Impact ◽  
Masseter Muscles

In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to date. This study aimed to measure the stiffness of the masseter muscle using shear-wave elastography in healthy children. We enrolled 30 healthy children (mean age 10.87 ± 3.38 years). The stiffness of masseter muscles was measured with shear wave elastography. Stiffness for the total sample was 6.37 ± 0.77 kPa. A comparison of the measurements did not show significant differences between the right and the left masseter muscles (left—6.47 ± 0.78 kPa; right—6.24 ± 0.76 kPa; p = 0.3546). A significant difference was seen between boys and girls (boys—5.94 ± 0.50 kPa; girls—6.63 ± 0.80; p = 0.0006). Shear-wave elastography is a promising diagnostic tool. It may help to detect changes in the stiffness of the masseter muscle and draw attention to pathological processes within the jaw muscles. Directions for further research shall include determining stiffness values in pathological conditions and the impact of biological and functional factors on the stiffness of the masseter muscle.

scholarly journals Uretero-transappendix-cystoneostomy as a technique for the reconstruction of the lower part of the ureter

2005 ◽  
Vol 62 (12) ◽  
pp. 931-933
Author(s):  
Novak Milovic ◽  
Pero Janjic ◽  
Vladimir Bancevic ◽  
Srdjan Kupresanin
Keyword(s):  
Renal Function ◽  
Case Report ◽  
Surgical Techniques ◽  
Large Defect ◽  
Boari Flap ◽  
Gun Shot ◽  
Psoas Hitch ◽  
The Right

Background. Any large missing part of the ureter may be replaced by transureteroureterostomy, psoas hitch, Boari flap, nephrectomy, renal autotransplanation or by the implementation of an intestinal graft. Case report. A patient with a defect of the lumbal- pelvic portion of the right ureter, after the management of a penetrating and perforating gun shot wound was presented. The missing part of the ureter was successfully replaced with an appendix. The technique of uretero-transappendixcystoneostomy complete with a Boari flap and a psoas hitch was used. Conclusion. By the use of an original combination of surgical techniques, a large defect of the ureter and the defect of the bladder, as well as the preservation of the renal function was achieved in a more successful manner.

scholarly journals Flexible bronchoscopy in foreign body removal in the pediatric population: A Systematic Review

2021 ◽  
Author(s):  
Anastasios-Panagiotis Chantzaras ◽  
Panagiota Panagiotou ◽  
Spyridon Karageorgos ◽  
Konstantinos Douros
Keyword(s):  
Systematic Review ◽  
Foreign Body ◽  
Pediatric Population ◽  
Bronchial Tree ◽  
Tracheobronchial Tree ◽  
Flexible Bronchoscopy ◽  
Safe Alternative ◽  
Gold Standard Method ◽  
Foreign Body Removal ◽  
The Right

Background: Foreign body aspiration (FBA) in the tracheobronchial tree is a common problem in the pediatric population. Rigid bronchoscopic procedure is currently the gold standard method for treatment in pediatric patients, whereas recent reports present flexible bronchoscopy as an alternative method. The aim of this study was to summarize all available evidence regarding the application and the success rate of flexible bronchoscopy in foreign body (FB) removal. Methods: Systematic review of the use of flexible bronchoscopy as the first-line treatment in FBA cases in PubMed from 2001 to 2021. Results: Out of 243 citations, 23 studies were included on the use of flexible bronchoscopic procedure as a treatment of choice in 2,587 children with FBA. The FBs were successfully removed in 2,254/2,587 (87.1%) patients with a low complication rate. The majority of FBs retrieved were organic materials 1,073/1,370 (78.3%), and they were most commonly lodged in the right bronchial tree 708/1,401 (50.5%). General anesthesia was applied in most studies (14/23) before proceeding to a flexible bronchoscopy and laryngeal mask airways (LMAs) were mostly used (10/23 studies) to secure the airway during the procedure. Ancillary equipment, usually forceps 1,544/1808 (85.4%) assisted in the FB retrieval. Conclusion: The use of flexible bronchoscopy is shown to be a feasible and safe alternative therapeutic procedure in FBA cases. There is a need for development of extraction equipment and techniques to assist the procedure. Finally, future studies focusing on the comparison between clinical outcomes of flexible and rigid bronchoscopies are necessary.

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