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Key message Plombage is a historical treatment in which a cavity is created surgically in the upper chest wall and the space is filled with inert material, such as fat, paraffin wax, rubber balloons, oil or methyl‐methacrylate (Lucite) balls, and it also promotes lung collapse.

• Tuberculosis is an important clinical and public health issue worldwide. • Old TB therapies aimed to improve hygiene conditions, strengthen immune system, achieve the rest of the affected lungs. • New options based on old therapies have been explored: their potential implementation may be useful for drug resistant TB. Tuberculosis (TB) is an important clinical and public health issue worldwide. Despite improved treatment success rates following the introduction of antibiotics in daily clinical practice, the expected decline in incidence has been hampered by HIV epidemics and multi- and extensively drug-resistant TB. During the pre-antibiotic era, TB therapies were mainly based on improving hygiene conditions, strengthening the immune system, and targeting the rest of the affected lungs with invasive techniques. Detailed knowledge of old non-pharmacological therapies might support physicians and researchers in the identification of new solutions for difficult-to-treat patients. We performed a narrative literature review on the main old therapeutic options prescribed for patients with TB. The main recommendations and contraindications of sanatorium therapies (i.e., bed rest, fresh air, sunlight) and pulmonary collapse techniques are reviewed, evaluating their physiological basis and their impact on patient outcomes. We report studies describing new interventional pulmonary and surgical techniques and assess new perspectives based on old medical and surgical treatments, whose potential implementation could help complicated patients. [ABSTRACT FROM AUTHOR]

As a large span structure that might serve many occupants, the deflation behavior of an air-supported membrane structure under emergency deflation is of critical importance for safety assessment on occupants' evacuation but has received few studies. This paper presents experimental field tests and numerical simulations on deflation behaviors of a real-life air-supported membrane structure. A numerical model is employed in deflation simulation which considers tension-only membrane based on the vector form intrinsic finite element method for membrane motion analysis and pressure change due to air loss in deflation according to the classic thermodynamics. The correctness and the applicability of the model are verified by good correlation of prediction in response of pressure, displacement, and wrinkling formation and development of the structure with those measured and observed in deflation tests. The study shows that the structure in emergency deflation will lose its high pressure quickly first, and then sustain deflating under low residual pressure for a long time. The model is further used in parametrical analysis on factors that affect deflation progress and a complete deflation simulation to predict the whole collapse process, which is accordingly characterized by two typical phases, the tender deflation stage and the severe deflation stage. In tender stage the structure holds a relatively plump form, while in the severe stage the structure bears low decreasing residual pressure, membrane losses most tension stress so that many elements wrinkle and the structure experiences instability. Due to wrinkling, the residual pressure is found to approximately balance with its vertical loads. As a result, the feasible method proposed based on the residual pressure in deflation is very simple and reliable to predict the deflation duration and evaluate maximum escape area for deflation assessment of the studied structure. [ABSTRACT FROM AUTHOR]

Purpose: Sclerostin is an osteocyte-derived protein that has a potent inhibitory effect on osteoblast activity. The osteocyte apoptosis induced by various causes of osteonecrosis of the femoral head (ONFH) plays a key role in the promotion of femoral head collapse. But the effect of altering sclerostin level on the collapse of ONFH has not been studied. Our aim was to assess the role of sclerostin level in the collapse of ONFH.Methods: Between May 2016 and November 2016, 236 subjects were enrolled in the present study. The patients were classified according to the Association Research Circulation Osseous (ARCO) classification. The clinical bone histomorphology, the expression position, and level of sclerostin as well as the plasma sclerostin level were evaluated.Results: The sclerostin level was significantly lower in the non-traumatic ONFH group than those in the healthy control group (P = 0.002). The sclerostin level was negatively associated with ARCO stages (r = - 0.239, P = 0.009) and significantly lower in the postcollapse group (P = 0.025).Conclusions: The reduced expression of sclerostin may play a key role in the collapse process of ONFH and be predictive of the disease progression of ONFH. [ABSTRACT FROM AUTHOR]

Surgical interventional has been key in the treatment of tuberculosis (TB) for a long time. Its importance diminished after the emergence of chemotherapy. However, the spread of rapid multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has led us to return to surgery to treat TB. Today, every second patient in Russia with destructive TB has either MDR or XDR TB, which is the reason for the low efficacy of conservative treatment. In 2015, treatment with drugs resulted in clinical recovery in only 29.8% of new cases of destructive TB acid-fast bacilli (AFB)+. METHODS: The author’s data from 1999 to 2016 have been analysed. The author performed 5599 surgeries on patients with pulmonary TB aged from 1 to 87 years (mean age 34.6 years). The most common reasons for surgical treatment were fibrotic cavitary and cavitary pulmonary TB, tuberculoma with destruction, tuberculous pleural empyema, caseous pneumonia and intrathoracic lymph nodes. The strategy of early collapse therapy and the use of surgery to treat TB was proposed in the Penza region of Russia; the results were analysed to estimate the long-term outcomes of treatment. RESULTS: In 5599 surgeries, the full clinical effect was achieved in 93% of operated patients with MDR TB, in 92.1% of those with XDR TB and in 98% of patients without MDR or XDR resistance. According to the data from the Penza region, 3 years after surgery, 93.9% (149 of 159 cases) of the operated patients exhibited clinical recovery. CONCLUSIONS: Taking into account the data from the World Health Organization on the insufficient level of therapeutic success in the treatment of MDR and XDR pulmonary TB, surgical treatment is necessary in regions with a high frequency of drug-resistant cases. [ABSTRACT FROM AUTHOR]

Key message: Plombage is a historical treatment in which a cavity is created surgically in the upper chest wall and the space is filled with inert material, such as fat, paraffin wax, rubber balloons, oil or methyl‐methacrylate (Lucite) balls, and it also promotes lung collapse. [ABSTRACT FROM AUTHOR]

Following return of spontaneous circulation (ROSC) after cardiac arrest, the challenge is to institute measures that ensure a higher likelihood of neurologically intact survival. Regardless of the cause of collapse, multiple organ systems may be affected secondary to post-cardiac arrest syndrome. Interventions required for post-ROSC care are bundled into a care regimen: prompt identification and treatment of the cause of cardiac arrest; and treatment of electrolyte abnormalities. It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimise haemodynamic management via judicious intravenous fluids and vasoactive drugs. Targeted temperature management after ROSC confers neuroprotection and leads to improved neurological outcomes. Glycaemic control of blood glucose levels at 6-10 mmol/L, adequate seizure management and measures to optimise neurological functions should be integrated into the care bundle. The interventions outlined can potentially lead to more patients being discharged from hospital alive with good neurological function. [ABSTRACT FROM AUTHOR]

Background Four-corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure. Methods We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow-up period was 44.5 months (range, 22–68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion–extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded. Results Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion–extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies. Conclusion Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain-free wrist. Moreover, these results were maintained at follow-up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four-corner fusion for advanced degenerative osteoarthritis of wrists. [ABSTRACT FROM AUTHOR]

Introduction: Magnetic resonance imaging (MRI) is the modality of the first choice for evaluation of vertebral compression/collapse. Many MRI qualitative features help to differentiate benign from malignant collapse. We conducted this study to look for a quantitative difference in chemical shift values in benign and malignant collapse using dual-echo gradient echo in-phase/out-phase imaging. Materials and Methods: MRI examinations of a total of 38 patients were retrospectively included in the study who had vertebral compression/collapse with marrow edema in which final diagnosis was available at the time of imaging/follow-up. Signal intensity value in the region of abnormal marrow signal and adjacent normal vertebra was measured on in phase/out phase images. Signal intensity ratio (SIR) was measured by dividing signal intensity value on opposite phase images to that on in phase images. SIR was compared in normal vertebrae and benign and malignant vertebral collapse. Results: There were 21 males and 17 females with mean age of 52.4 years (range 28-76 years). Out of total 38 patients, 18 were of benign vertebral collapse and 20 of malignant vertebral collapse. SIR in normal vertebrae was 0.30 ± 0.14, 0.67 ± 0.18 in benign vertebral collapse, and 1.20 ± 0.27 in malignant vertebral collapse with significant difference in SIR of normal vertebrae versus benign collapse (P < 0.01) and in benign collapse versus malignant collapse (P < 0.01). Assuming a cutoff of <0.95 for benign collapse and ≥0.95 for malignant collapse, chemical shift imaging had a sensitivity of 90% and specificity of 94.4%. Conclusion: Chemical shift imaging is a rapid and useful sequence in differentiating benign from malignant vertebral collapse with good specificity and sensitivity. [ABSTRACT FROM AUTHOR]

Tunnel collapse remains a serious problem in practice. Effective prediction methods on tunnel collapse are necessary for tunnel engineering. In this study, systematic study on the pressure arch was presented to predict tunnel collapse. Multiple factors under different conditions were considered. First, the pressure arch was described as a certain scope in comparison with the lowest pressure arch line. Then, a deep-buried circular tunnel was selected as the investigated object. Its collapse scope was analyzed using the lowest pressure arch line. Meanwhile, the main influence from the ground stress field was considered. Different modes of ground stress fields were investigated in detail. The results indicate that the collapse scope varies with different ground stress fields. Determination on the collapse scope is strongly affected by the judgment standard of the pressure arch. Furthermore, a selected case was analyzed with the pressure arch. The area and the height of tunnel collapse were calculated with multiple factors, including ground stress field, judgment standard, and lateral pressure coefficient. Finally, selected results were compared with relevant previous researches, and reasonable results were obtained. The present results are helpful for further understanding of the tunnel collapse and could provide suitable guidance for tunnel projects. [ABSTRACT FROM AUTHOR]

The management of complex tibial plateau fractures is ever evolving. The severity of the injury to the surrounding soft tissues influences the timing and the method of fixation. Minimal invasive techniques continue to dominate our philosophy of reduction and reconstruction whereas augmentation of depressed intra-articular fragments remains an accepted strategy to maintain reduction and prevent secondary collapse. Locking plates, conventional plates and fine wire fixators all have been used successfully with satisfactory outcomes. In this article we report on the latest advances made in the management of these complex injuries. [ABSTRACT FROM AUTHOR]

Background: Almost all surgeries for ulcerative colitis (UC) are performed under immunosuppressive conditions. Immunomodulators or biologics, with the exception of corticosteroids, do not appear to be risk factors for post-operative infectious complications. However, many patients are on multiagent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressives on the occurrence of surgical site infection (SSI) in UC. Methods: We reviewed surveillance data from 181 patients who underwent restorative proctocolectomy between January 2012 and March 2014. The incidences of SSI and the possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed. Results: The incidence of incisional (INC) SSI was 13.3% and that of organ/space (O/S) SSI was 7.2%. The number of immunosuppressives did not significantly correlate with each incidence. Total prednisolone administration ≥12,000 mg (OR 2.6) and an American Society of Anesthesiologists score ≥3 (OR 2.8) were shown to be independent risk factors for overall SSI, whereas corticosteroid use in INC SSI (OR 17.4) and severe disease (OR 5.2) and a large amount of blood loss (OR 3.9) in O/S SSI were identified as risk factors. Conclusion: Although a correlation between multiple immunosuppressive therapy and SSIs was not found, it is not recommended that all patients be treated with multiple immunosuppressive therapy. Treatment strategy should be applied based on the patient's condition. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the clinical outcomes of the memory plates for four-corner fusion (FCF) of scaphoid non-union advanced collapse (SNAC). From 2005-2010, 11 cases of SNAC received FCF with the memory plate designed by the authors. At an average follow-up of 21 months, there were no non-unions and postoperative infections. One patient complained of dorsal impingement. The pain relief rate was 100% and the average grip strength increased from 11.3% preoperatively to 56.3% postoperatively of the contralateral side. The primary results of FCF with memory plates are promising. By its compressive property, the memory plate facilitates the arthrodesis with a lower complication rate. [ABSTRACT FROM AUTHOR]

Abstract: Transesophageal echocardiography (TEE) is not only an invaluable diagnostic tool for cardiac patients, but also is essential for cardiac monitoring in critically ill patients in cardiac and non-cardiac surgery settings and in the differential diagnosis of unexplained hemodynamic collapse. The advantage of TEE over transthoracic echocardiography (TTE) is usually clearer images, especially when viewing structures that are difficult to see transthoracically. TEE is essential in monitoring adult and congenital heart surgery perioperatively. The adequacy of the repair can be ensured immediately through a review of TEE images directly after surgery. Although TEE is considered to be relatively safe and noninvasive, TEE-associated complications, such as esophageal laceration, must be taken seriously. Recently, real-time three-dimensional (3D) TEE imaging has played an important role defining valvular and congenital abnormalities and aiding in operative and percutaneous repair. [Copyright &y& Elsevier]

Highlights: [•] Brown snake-induced early cardiovascular collapse is a cause of mortality following snake envenoming in Australia. [•] Brown snake venom produces cardiovascular collapse in anaesthetized rats. [•] This is prevented by prior administration of small priming doses of venom from snakes from a different family or genus. [•] A commercial polyvalent antivenom inhibits this effect. [ABSTRACT FROM AUTHOR]

The article offers information related to acute collapse among cats. It mentions that acute collapse among cats is the failure to maintain their normal posture and can be evidenced by the loss of consciousness. It also cites the differences between the total collapse among dogs and among cats such as being subtle for the latter.

Abstract: Objective: Pulmonary fissures completeness predicts efficacy in endobronchial valves (EBV) implantation, a new lobar volume reduction therapy for severe emphysematous patients. We assessed the incidence of incomplete fissures and the interobserver agreement in its evaluation with MDCT, in severe emphysematous patients prior to EBV implantation. Materials and Methods: Volumetric thin-section CT scans of 35 patients (CODP GOLD 3/4, heterogeneous emphysema) were retrospectively reviewed by 2 pneumologists, 1 general and 2 experienced chest radiologists, independently and blinded for treatment outcome, and the pulmonary fissures were classified as either complete or incomplete. Interobserver agreement was assessed with Kappa index (KI). Results: Agreement between all readers for the left oblique, right oblique and horizontal fissure was, respectively, moderate (KI=0.53), fair (KI=0.37) and moderate (KI=0.42). Highest agreement (99/105 fissures) was observed among experienced radiologists, being for left oblique, right oblique and horizontal, respectively, almost perfect (KI=0.79), perfect (KI=1.0) and moderate (KI=0.52). These 2 reviewers found that all of 35 patients had at least one incomplete fissure, with a proportion of incomplete fissures assigned as 74/65%, 85/85% and 91/88%, respectively for the left oblique, right oblique and horizontal fissures. Conclusions: Pneumologists and radiologists agreed fairly to moderately in fissures analysis, while the experienced chest radiologists reached the highest clinically adequate agreement of 94%. We believe that clinical routine visual analysis of the fissures integrity can be done with a good degree of confidence in MDCT images, and experienced readers might be required. Also, a higher than expected incidence of incomplete fissures was described in our studied population. [Copyright &y& Elsevier]

Background: Neuropathy due to ulnar nerve compression at the elbow level is the second most frequent neuropathy. The scratch collapse test is useful to diagnose compression neuropathies. This test helps us rank compression sites and decide the type of treatment to use. Methods: From May to July 2011, 34 patients, mostly females, were preoperatively analyzed with this test. Ethyl chloride was also used to show other compression sites. Results: The main compression site was found to be at the level of Osborne's ligament, contrary to the idea that it was located at the medial epicondyle. Another finding was that at the hand and wrist level it is more common to find compression in the proximal fascia of the forearm than in Guyon's canal. After surgery, CRP became negative in all patients. Discussion and conclusions: When the primary collapse point is Osborne's ligament, the patient will require ulnar nerve transposition. When the primary collapse point is located at the level of the medial epicondyle, decompression is enough. In case of several simultaneous collapse points before applying ethyl chloride, a surgical procedure will not necessarily be required for each one of them. [ABSTRACT FROM AUTHOR]

Background: Locking plate constructs for proximal humeral fractures can fail due to varus collapse, especially in osteoporotic bone with medial cortex comminution. Augmentation, using a fibular allograft as an intramedullary bone peg, may strengthen fixation preventing varus collapse. This study investigated the ability of the augmented locking plate construct to withstand repetitive varus stresses relative to the nonaugmented construct. Materials and methods: Proximal humeral fractures with medial comminution were simulated by performing wedge-shaped osteotomies at the surgical neck in cadaveric specimens. For each cadaver (n = 8), 1 humeral fracture was fixated with the locking plate construct alone and the other with the locking plate construct plus ipsilateral fibular autograft augmentation. The humeral head was immobilized and a repetitive, medially directed load was applied to the humeral shaft until construct collapse or until 25000 cycles were completed. Results: No augmented construct collapsed. In comparison, 6 of 8 nonaugmented constructs collapsed (P < .05). Collapse in the 6 nonaugmented constructs occurred after an average ±SD of 6604 ± 1984 cycles. Screw penetration of the articular surface was found in only 1 of the nonaugmented constructs. Conclusion: Fibular allograft augmentation increased the ability of the locking plate to withstand repetitive varus loading. Clinically, this may assist proximal humeral fracture fixation in osteoporotic bone with medial cortex comminution. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the characteristics of the secondary bubble cluster produced by an electrohydraulic lithotripter using high-speed imaging and passive cavitation detection techniques. The results showed that (i) the discrepancy of the collapse time between near a flat rigid boundary and in a free field of the secondary bubble cluster was not as significant as that by the primary one; (ii) the secondary bubble clusters were small but in a high bubble density and nonuniform in distribution, and they did not expand and aggregate significantly near a rigid boundary; and (iii) the corresponding bubble collapse was weaker with few microjet formation and bubble rebound. By applying a strong suction flow near the electrode tip, the production of the secondary shock wave (SW) and induced bubble cluster could be disturbed significantly, but without influence on the primary ones. Consequently, stone fragmentation efficiency was reduced from 41.2 ± 7.1% to 32.2 ± 3.5% after 250 shocks (p < 0.05). Altogether, these observations suggest that the secondary bubble cluster produced by an electrohydraulic lithotripter may contribute to its ability for effective stone fragmentation. [Copyright &y& Elsevier]

We report a unique case of type B aortic dissection occurring 11 weeks after endovascular repair of an abdominal aortic aneurysm. This resulted in severe organ and limb malperfusion with collapse and occlusion of the endograft. Successful endovascular salvage is described along with a brief review of the literature. [Copyright &y& Elsevier]

Pyothorax-associated lymphoma (PAL) is a lymphoproliferative disorder developing in the pleural cavity after a longstanding history of pyothorax. It usually develops in patients who have undergone artificial pneumothorax for the treatment of pulmonary tuberculosis. While recent pathological studies have established the nature of PAL as a distinct entity, the optimal approach for management of PAL remains unclear. Recent clinical studies showed that PAL is responsive to chemotherapy and radiotherapy, but the overall prognosis is poor, with a 5-year survival of 20% to 30%. In this review article, we discuss its optimal management based on a review of its clinical and pathological features. [ABSTRACT FROM AUTHOR]

BACKGROUND Extramammary Paget's disease (EMPD) is an uncommon tumor that usually occurs on the genitalia. It almost always extends beyond clinically apparent margins and has a high rate of recurrence. OBJECTIVE To establish treatment guidelines for EMPD in Asian patients. METHODS A retrospective review was done on pertinent demographic data, tumor data, treatment characteristics, and follow-up data of 35 patients between 1996 and 2006. Review of literature for treatment modalities and recurrence rates of EMPD was also performed. RESULTS Thirty-four of the 35 patients (30 men and 5 women) had lesions in the genital area and one patient in the axilla. Mean follow-up duration was 62.7 months (8–156 months) and two of 11 (18.2%) recurred after Mohs micrographic surgery (MMS), compared with eight recurrences of 22 (36.4%) after standard wide excision. Two patients treated with nonsurgical modalities did not achieve complete remission. Estimated 5-year tumor-free rate using Kaplan-Meier graph was 69.7% in all patients, with a rate of 81.8% for MMS and 63.6% for wide excision. CONCLUSIONS MMS is more effective, with lower recurrence rate than wide excision, and should be regarded as the first-line treatment for nonmetastatic EMPD. [ABSTRACT FROM AUTHOR]

This report aims to describe an effective endovascular technique to repair a stent graft collapse in the distal aortic arch. We report a case of a stent graft collapse after off-label endovascular treatment of a traumatic aortic transection using a Gore TAG endoprosthesis (oversizing 12%). The collapse was treated by off-label stent-protected angioplasty (Palmaz stent, Cordis, Miami, Fla) over a stiff guidewire, which was passed from the right femoral artery through the collapsed stent graft and out at the right brachial artery. We believe that this technique enables more precise stent deployment and is safer than the regular guidewire position in the ascending aorta. [Copyright &y& Elsevier]

Abstract: Background context: Limited data are available regarding incidence of proximal junctional acute collapse after multilevel lumbar spine fusion. There are no data regarding the cost of prophylactic vertebral augmentation adjacent to long lumbar fusions compared with the costs of performing revision fusion surgery for patients suffering with this complication. Purpose: To perform a cost analysis of prophylactic vertebral augmentation for prevention of proximal junctional acute collapse after multilevel lumbar fusion. Study design: Retrospective chart review and cost analysis. Patient sample: All female patients older than 60 years undergoing extended lumbar fusions were reviewed to establish the incidence of proximal junctional acute collapse. Outcome measures: Cost estimates for two-level vertebroplasty, two-level kyphoplasty, and revision instrumented fusion were calculated using billing data and cost-to-charge ratios. Methods: Cost comparisons of prophylactic vertebral augmentation versus extension of fusion for patients suffering from proximal junctional acute collapse were performed. Results: Twenty-eight female patients older than 60 years underwent lumbar fusions from L5 or S1 extending to the thoracolumbar junction (T9–L2). Fifteen of the 28 patients had prophylactic vertebroplasty cranial to the fused segment. Proximal junctional acute collapse requiring revision surgery occurred in 2 of the 13 patients (15.3%) treated without prophylactic vertebroplasty. None of the 15 patients undergoing cement augmentation experienced this complication. Assuming a 15% decrease in the incidence of proximal junctional acute collapse, the estimated cost to prevent a single proximal junctional acute collapse was $46,240 using vertebroplasty and $82,172 using kyphoplasty. Inpatient costs associated with a revision instrumented fusion averaged $77,432. Conclusions: Prophylactic vertebral augmentation for the prevention of proximal junctional acute collapse may be a cost effective intervention in elderly female patients undergoing extended lumbar fusions. Further efforts are needed to determine more precisely the incidence of proximal junctional acute collapse and the effects of various risk factors on increasing this incidence, as well as methods of prevention. [Copyright &y& Elsevier]

Objective: To investigate the long-term surgical outcome of Brown syndrome using an intraoperative adjustable superior oblique (SO) tendon suture spacer. Design: Retrospective case series. Participants: Thirteen patients with congenital unilateral Brown syndrome operated on at the Wolfe Eye Clinic from 2001 through 2007. Methods: Retrospective analysis of consecutive patients managed with the SO suture spacer followed up for at least 10 months. Main Outcome Measures: Surgical intervention for patients having severe or moderate forms of Brown syndrome. Postoperative effect on abnormal head posture, vertical strabismus in primary gaze, vertical strabismus into affected side gaze, and elevation in adduction. Results: The mean duration of follow-up was 30 months (range, 10–72 months). Abnormal head posture improved from 13° (range, 0°–30°) to 0.4° (range, 0°–5°). Vertical strabismus in primary gaze improved from −10Δ (range, 0Δ to −35Δ) to 2.8Δ (range, −16Δ to 16Δ). Vertical in side gaze improved from −20Δ (range, −35Δ to −8Δ) to −1.5Δ (range, −20Δ to 18Δ). Elevation in adduction improved from −3.5 (range, −4 to −2) to −0.4 (range, −2 to 4). Four patients had an overcorrection and 2 patients experienced an increasing late effect. In no patient did a late under correction develop. Conclusions: The SO suture spacer procedure alleviated abnormal head positions in patients with Brown syndrome by improving vertical strabismus in primary position and in the affected field of gaze while avoiding overcorrection in contralateral gaze. The benefits of the procedure persisted over time. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Summary: Posterior wall fractures are the commonest type of acetabular fracture. Nonoperative management is associated with significant complications and poor outcome. Consequently, open reduction and internal fixation has become increasingly common. In this article, inaugurating the new section of “how do I do it”, we present our current approach to the treatment of posterior wall fractures of the acetabulum, including the preoperative planning, the details of the operative procedure in terms of patient''s positioning and draping, surgical approach, osteosynthesis and wound closure. [Copyright &y& Elsevier]

Zygomycosis is a rare but very aggressive fungal infection mainly seen in immunocompromised patients. Immediate diagnosis and treatment with antifungal therapy, control of underlying disease, and early surgical debridement is essential. We present two cases of head zygomycosis treated with systemic liposomal amphotericin B, surgical debridement, and immediate free flap reconstruction. A retrospective chart review of two cases of zygomycosis was performed; one with rhino-sino-orbital-cerebral and the other with scalp/cranial zygomycosis. Both patients were treated with systemic liposomal amphotericin B, aggressive debridement, and immediate reconstruction following local control. The multidisciplinary team approach and the surgical technique are discussed. Patient 1 (with rhino-sino-orbital-cerebral zygomycosis) died 2 weeks after diagnosis, and patient 2 (with scalp/cranial zygomycosis) was disease free at 1-year follow-up. Both patients' flaps survived, although patient 2 needed to undergo an arterial revision with an interpositional vein graft within 24 hours of surgery. We concluded that to treat zygomycosis effectively, a multidisciplinary team approach is needed, focusing on immediate diagnosis, empirical antifungal therapy, reversal of underlying predisposing factors, and early surgical debridement. When definitive debridement results in critical structures being exposed, then early wound closure with healthy vascularized tissue is indicated. In these two patients with exposed dura after definitive debridement, immediate closure was performed to minimize the risk of meningeal and cerebral infections. [ABSTRACT FROM AUTHOR]

The objective of this study was to introduce the vertical mattress (VM) suture technique and compare its patency and postoperative healing with other commonly used suture techniques. Thirty-two Sprague-Dawley rats were randomly assigned to one of four suture techniques to be applied to both femoral arteries: continuous (C), interrupted (I), VM, and VM with flap (VMF) sutures. The operating time and the degree of postanastomotic leakage were recorded. The milking test was employed 5 and 15 minutes and 14 days after the operation to attain patency. Blood flow velocity was determined using ultrasonography at 1 hour and on days 1 and 14 postoperation. Rats then were sacrificed, and anastomotic lining tissues were harvested for histopathologic examination. Anastomoses by C and I were executed in 12.06 and 18.31 minutes. Modified suture techniques took longer to execute anastomosis (23.09 minutes for VM and 32.44 minutes for VMF). VM suture technique was superior to other suture techniques in terms of anastomotic leakage, quality of filling, and blood flow velocity. Also, absence of the luminal closure or constriction, intimal injury and hyperplasia, foreign body inflammation, and inversion were noted in histopathology. In conclusion, the VM suture technique could be considered for microvascular surgery. [ABSTRACT FROM AUTHOR]

Fractures of the scaphoid waist that fail to heal tend to collapse into a flexed posture. The so-called “humpback deformity” of the bone is accompanied by collapse of the proximal carpal row with dorsal tilt of the lunate. It is possible to restore scaphoid height and carpal alignment by insertion of a tricortical wedge of graft from the iliac crest. In this article, we demonstrate the surgical technique of volar wedge grafting for scaphoid nonunion. [Copyright &y& Elsevier]

Abstract: The healing of wounds is a complex process and the contraction of the resulting scar can have a negative impact on the neighbouring skin. A finite element model of skin simulating the contraction of a scar and deformation of the surrounding skin is presented. The skin is represented by an orthotropic–viscoelastic constitutive law, which is validated against experimental data in the literature. A simplified experimental model of a contracting scar in real skin is also developed. The pattern and size of the wrinkles formed around the contracting scar in the finite element model compare favourably with those formed in the experimental model. The orthotropic nature of skin plays a significant role in the behaviour of skin around scars—the wrinkles have a preferential orientation that corresponds to a direction perpendicular to the Langer''s lines in the skin. The pre-stress in skin (a property that is ignored in many skin models) is shown to be an important factor in wrinkle formation around scars. The proposed model can be used to analyse the suturing and closure of wounds of various shapes. [Copyright &y& Elsevier]

Photorefractive keratectomy (PRK) with mitomycin-C (MMC) was performed in 2 patients with visually significant, complicated laser in situ keratomileusis flap striae. These striae had been resistant to multiple treatments, including stretching, suturing, and PRK. The visual symptoms in both patients resolved after PRK with MMC, and both patients were stable 1 year later. Wavefront-guided PRK with MMC may be a viable treatment for patients who have complicated flap striae resistant to standard measures. [Copyright &y& Elsevier]

Abstract: Purpose: Z-plasty is a well-known and commonly used local flap technique in the treatment of contracture bands. Double opposing rectangular advancement is a new and alternate local flap design which can be used in the treatment of wide and linear postburn scar contractures. The technique consists of opposition of two adjacent rectangular flaps by advancement. This experimental study compares lengthening provided by Z-plasty and double opposing rectangular advancement. Materials and method: Lower extremities of 10 male Sprague–Dawley rats were strained by hanging 400g of weight to provide tension lines over both inguinal areas. We planned Z-plasty with 2cm central limb and with 60° angles to the inguinal tension line on one side. On the other side, we sketched double adjacent rectangular flaps with 2cm long axis and 1cm short axis over the tension line. Triangular flaps were elevated over the muscle, transposed and sutured in Z-plasty. Rectangular flaps were incised down to the muscle, advanced and opposed to each other before suturing. The final lengthening provided by both techniques were measured and the results were statistically analysed. Results: Both Z-plasty and double opposing rectangular advancement techniques were effective in relief of tension over both inguinal areas and in lengthening the tension lines. Z-plasties provided lengthening ranging between 4 and 4.6cm. The difference between pre- and post-operative (Δ) measurements in Z-plasty ranged between 2–2.6cm (mean±standard deviation=2.26±0.24cm). The lengthening provided by double opposing rectangular advancement were between 3.9 and 4.5cm and the Δ measurements ranged between 1.9 and 2.5cm (mean±S.D.=2.22±0.22cm). Statistical analysis revealed that the elongation provided by both techniques are not significantly different from each other (p >0.05). Conclusion: Double opposing rectangular advancement technique elongates a tension line as much as Z-plasty in the rat inguinal skin. [Copyright &y& Elsevier]

Summary: Infected nonunion is one of the most challenging orthopaedic complications to manage. There is considerable morbidity associated with infected nonunion. There is significant impact on the life of the patient; social, financial, physical, and mental. Infected nonunion may be a limb-threatening complication. Significant progress has been made in the management of infected nonunion in the last decade. There are clear guidelines for pre-operative evaluation and treatment strategy. The recommended strategy is the ‘infection-elimination first’ strategy. This strategy involves two steps: control of infection by local radical debridement of dead tissue followed by reconstruction. There are four operative techniques (with considerable overlap among them) which have been used in the past decade: Ilizarov, intramedullary devices with or without the use of external fixator, free tissue transfer, and in situ reconstruction. Bone results are, in general, better compared to functional results. Overall, the outcome following treatment of infected nonunion are good to excellent. [Copyright &y& Elsevier]

Abstract: Background: Although laparoscopic cardiomyotomy is considered to be the treatment of choice for achalasia, there is no consensus about how persistent or recurrent dysphagia after myotomy should be treated. In the current study we evaluated our experience with reoperation following previous cardiomyotomy. Methods: Between 1992 and 2006, 19 patients underwent re-myotomy: 7 for persistent dysphagia, 12 for recurrent dysphagia. Different operative approaches were used, depending on surgeon’s preference and the technique used for the first operation. Results: The mean interval between the cardiomyotomies was 81 months. In 12 patients, the alternative body cavity to that used for the first operation was used for access in the revision operation. This was associated with a shorter operation time. Mean follow-up after the revision operation was 3.6 years. Mean satisfaction score was 7 (out of 10), and 89% of patients had an improvement in symptoms. Conclusion: Reoperation for persistent or recurrent achalasia achieves a satisfactory outcome in most patients. Using the alternative body cavity to that used in the original procedure facilitates minimal access techniques, and gives easier access to the operative field. [Copyright &y& Elsevier]

Abstract: Suturing is still one of the most important procedures used in trauma and surgery environments. It does however rely on piercing other wise healthy tissue. In doing so channels are opened which may act as conduits for bacteria to enter the body or to allow material such as blood or intestinal bacteria to leak from vessels. This work shows by means of finite element analysis and physical modelling through the use of a phantom that the tension in the suture has a direct bearing on the opening of these channels. It was found that for the phantom the channel cross-sectional area was approximately proportional to the applied tension and suture thread deflection. Leakage channels of up to 0.1mm2 cross-section were achieved with suture tensions of 120grammes force. Channels of this size are significantly larger than the bacteria suggesting transmission is theoretically possible. [Copyright &y& Elsevier]

AIM: The management of long gap oesophageal atresia remains a major challenge for the paediatric surgeon. In this experimental study on neonatal lambs, a Silastic tube was used to bridge a gap in the oesophagus. The Silastic tube was not fixed to the oesophageal edges but half a centimetre from the edge of the oesophagus. The oesophageal edges were left free to grow over the Silastic tube and bridge the gap. The aim of the study was to see whether the oesophageal edges would grow over the Silastic tube and form a continuous oesophagus. METHODS: Twelve neonatal lambs were included in the study. They were divided into 3 groups: Group A (control group) included 3 lambs where the oesophagus was transacted and anastomosed without excision of an oesophageal segment. Group B included 6 lambs where a wedge of the oesophagus was excised and a Silastic tube fixed to the inner mucosa. The oesophageal edges were in contact on one side. In group C (3 lambs), a 2-cm cylinder of the oesophagus was excised, a Silastic tube was fixed to the inner mucosa and a gap of 2 cm was left between the oesophageal edges. The lambs were sacrificed at two weeks to five weeks postoperatively. RESULTS: There was no mortality, no anastomotic leakage and no wound infection in any of the lambs. The oesphageal edges grew and bridged the gap and formed a continuous tube. Histological examination showed new muscle fibres underneath the new mucosa. All lambs with Silastic tubes gained weight. Two lambs developed moderate to severe stricture. CONCLUSION: The present study demonstrated the possibility of oesophageal growth over a Silastic tube to form a continuous oesophagus. Histological examination confirmed oesophageal growth and not healing through fibrous tissue. Further studies are needed to evaluate the technique in the thoracic oesophagus with long-term follow-up. [ABSTRACT FROM AUTHOR]

Abstract  Data on preparation of chitin threads for the fabrication of absorbable suture materials, dressings, and biodegradable substrates for the growth of human skin cells (keratinocytes and fibroblasts) are analyzed. [ABSTRACT FROM AUTHOR]

BACKGROUND:: This paper aims at presentation of our surgical techniques and results of the lateral thoracic (LT) flaps for head and neck reconstructions. METHOD:: There were seven LT cutaneous, seven LT myocutaneous, and two LT conjoint myocutaneous flaps for reconstruction of head and neck mucosal or cutaneous defects. RESULTS:: The largest flap size was 22 cm × 13 cm. All donor sites were closed primarily. The highest point of reconstruction was in the nasopharynx internally and zygoma externally. All flaps survived without major complication. CONCLUSIONS:: The LT flap has the versatility of cutaneous, myocutaneous, and conjoint flaps with pectoralis major or latissimus dorsi myocutaneous flaps to reconstruct large surgical defects. It has a large, reliable surface area, a long pedicle to reach nasopharynx and zygoma, and has less bulky muscle to facilitate tubular reconstruction of circumferential pharyngeal defect, one-stage operation, esthetic hidden donor site scar in axillary region, and minimal donor site morbidity. It is an additional reliable pedicle flap in our armamentarium for reconstruction of both cutaneous and mucosal defects in the head and neck region. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patients. discomfort; controversy still exists regarding the best surgical technique for the treatment of the disease. We successfully treat it with a rotation flap technique (simple rotation and bilobed rotation flap). Materials and Methods: Sixty-two patients were randomized to receive surgical treatment in the form of either simple rotation or bilobed rotation flap by eccentric elliptical excision of the diseased tissues down to the sacral fascia and closure of the defect with the flap, then placing a closed suction drain at the base of the wound, with its tip being brought out in the gluteal region at least 5 cm laterally to the lower end of the suture. Results: All our patients healed completely without recurrence after a mean follow-up of about one year. Mean hospital stay 1.5 days (range 1–3) Mean time to complete healing 11.9 days (range 8–14). Mean time off work was 11.5 days (range 10–21), wound infection and breakdown, three (4.8%), recurrence (0%), and time to sitting on the toilet and walking without pain was 10–15 days. Conclusions: A tension-free suture and cleft left via the rotation flap, either the bilobed flap or monolobed, is the key to success without recurrence and low patient discomfort. [ABSTRACT FROM AUTHOR]