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Purpose: The aims of the study were to evaluate the clinical performance and the complications of combined tooth-/implant-supported three-unit fixed partial dentures (FPDs) in the posterior mandible. Materials and Methods: A total of 78 partially edentulous patients in the posterior mandible were recruited for the study (n = 26/group). Group 1 served as the control group and received two dental implants to support a three-unit FPD. Groups 2 and 3 were the experimental groups in which one implant was placed in conjunction with support from an adjacent tooth to support a three-unit FPD. Standard implants (= 8 mm) were included in Group 2, while short implants (< 8 mm) were included in Group 3. Periapical radiographs were taken for evaluation of crestal bone loss (CBL). Modified plaque index (MPI), bleeding index (BI), and sulcus depth values of the abutment teeth were recorded at the time of FPD delivery, 6 months after FPD delivery, and annually thereafter. Recorded complications included abutment tooth intrusions, cementation failures of the restorations, porcelain chipping/delamination, framework fracture, abutment screw loosening, abutment and abutment screw fracture, and implant fracture. Results: Statistically significant differences were observed between Group 1 (0.06 ± 0.17) and Group 2 (0.18 ± 0.32) and between Group 1 and Group 3 (0.17 ± 0.30) in terms of MPI (P = .05). No difference was observed between Group 2 (0.11 ± 0.34) and Group 3 (0.14 ± 0.36) or between Group 1 (0.04 ± 0.22) and Group 2 in terms of BI. There were statistically significant differences in terms of CBL between Group 1 (0.259 ± 0.05 mm) and Group 3 (0.11 ± 0.03 mm) and between Group 2 (0.03 ± 0.03 mm) and Group 3 (P = .05). The mean abutment tooth sulcus depth was 1.11 ± 0.31 mm for Group 2 and 1.20 ± 0.46 mm for Group 3. Conclusions: Within the limitations of the current study, it was concluded that combined tooth/implant-supported prostheses (CTISPs) are a predictable treatment choice in the posterior mandible. When a CTISP is planned, it is more predictable to use a short implant than a standard-length implant. [ABSTRACT FROM AUTHOR]

The socket shield technique has been proposed as a surgical method to prevent the collapse of the buccal plate following tooth extraction, leading to excellent soft tissue stability and long-term esthetic outcomes. Despite its success, this technique is still not without potential risks. One of the most common complications is internal exposure of the socket shield, which can present as inner soft tissue inflammation with or without exposure of a portion of the shield. This case series discusses this complication's etiology, diagnosis, treatment, management, and prevention. Data from 10 patients with 12 internally exposed sites are presented. [ABSTRACT FROM AUTHOR]

Purpose: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. Materials and Methods: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (= 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. Results: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. Conclusions: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk. Materials and Methods: Electronic searches on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases were conducted for publications up to February 2021. All included articles reported SMPs submitted for repair. The proportion of implant loss in repaired SMP sites was calculated using a random-effects model meta-analysis. Results: A total of 130 studies reporting SMP repair protocols were included in the systematic review, with 20 selected for meta-analysis. A total of 1,972 sinuses that were perforated and repaired during sinus elevation using different approaches were included in the qualitative analysis. The resorbable collagen membrane was the most commonly reported treatment. The presence of sinusitis was the most frequently described complication. Regarding bone parameters, the majority of studies described no differences between perforated and repaired sinuses and intact membranes. No difference in the implant loss proportion was observed between sites with repaired SMP compared to undetected SMP. The proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was 4% (95% CI: 2.0 to 8.0). In meta-regression analysis, no association was observed between the SMP size and implant loss proportion (P = .86). Conclusions: The materials and techniques indicated for SMP management seem to securely seal the maxillary sinus, without a negative effect on the ultimate survival of the implants placed in the affected sinuses. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical performance of a two-piece zirconia implant system, with a focus on biologic complications. Materials and Methods: A total of 39 patients received 91 two-piece zirconia implants. The patients were recruited from two private clinics and were monitored for 5 to 12 years (median: 5.6 years). The primary outcomes were biologic complications, such as peri-implant infections (peri-implant mucositis and peri-implantitis), and the secondary outcome was radiographically evident marginal bone loss (MBL). Results: Three patients (7.7%) with 9 total implants (9.9%) presented with peri-implant mucositis. MBL that did not exceed the first thread was evident at 32 mesial sites (35%) and 25 distal sites (27.4%). MBL exceeding the first thread but not the third thread was evident at 6 mesial and 5 distal sites (thread pitch: 0.7 mm). Only one peri-implant pocket deepened (4 mm) and showed bleeding; however, the estimated MBL did not exceed 1.65 mm. No peri-implantitis occurred, and no implant was lost. Conclusions: This prospective study shows high survival rates and a seemingly low prevalence of biologic and prosthetic complications for this two-piece zirconia implant system over an observation period of up to 12 years. [ABSTRACT FROM AUTHOR]

Purpose: To comparatively evaluate transcrestal sinus floor elevation (tSFE) and lateral sinus floor elevation (lSFE) at sites with different residual bone heights (RBHs). Materials and Methods: A re-analysis of data from a parallel-arm, randomized trial comparatively evaluating tSFE and lSFE was performed. Within each RBH interval (< 4 mm or ≥ 4 mm), tSFE and lSFE groups were compared for chair time, surgery-related costs, morbidity, and radiographic parameters (including the proportion of the implant surface in direct contact with the radiopaque area [totCON%]). Results: The intention-to-treat (ITT) population consisted of 29 and 28 patients in the tSFE and lSFE groups, respectively. Irrespective of RBH, both tSFE and lSFE lead to a median totCON% of 100%. At sites with RBH < 4 mm, pain severity was significantly higher at days 0 and 1 in the tSFE group, with no intergroup difference in the dose of analgesics. LSFE was associated with a significantly higher frequency of bruising and greater cost. At sites with RBH ≥ 4 mm, a significantly lower frequency of postoperative signs/symptoms, less chair time, and lower costs were observed in the tSFE group. Conclusions: The selection of tSFE or lSFE within the investigated RBH intervals seems to be supported by differences in chair time, costs, and morbidity between the two techniques. At sites with RBH < 4 mm, clinicians preferring tSFE should encourage the administration of analgesics according to a predefined plan in the early postoperative phase. At sites with RBH ≥ 4 mm, tSFE should be preferred to lSFE due to reduced chair time, costs, and morbidity. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical efficacy of the coronally advanced lingual flap (CALF) technique in terms of the extent of lingual and buccal flap advancement, the maintenance of primary wound closure, and safety in comparison to buccal flap advancement alone during horizontal ridge augmentation in the posterior mandible. A total of 14 patients were randomly allocated to two different groups: buccal flap advancement without the CALF technique (control), referred to as the NO-CALF group, and buccal flap advancement with the CALF technique (test), referred to as the CALF group. Wound healing was monitored weekly for the first 4 weeks, then at 2, 4, 6, and 9 months postoperatively for any sod tissue dehiscence (titanium mesh [TM] exposure) along the incision line. The extent of lingual and buccal flap advancement was measured, and any intraoperative and postoperative CALF-related complications were reported. The difference between groups was statistically significant (P < .0001) in terms of (1) TM exposure: 83.3% of cases in the NO-CALF group showed early Class П exposures, whereas the CALF group showed no exposure; (2) mean lingual flap advancement: 3.9 ± 1.1 mm and 14.4 ± 3.8 mm for the NO-CALF and CALF groups, respectively; and (3) mean buccal flap advancement: 15.8 ± 2.1 mm and 10.5 ± 1.4 mm for the NO-CALF and CALF groups, respectively. There were no reported complications related to the CALF technique. Tension-free primary wound closure was facilitated and maintained during the healing period by applying the CALF technique, which is a reliable technique to safely advance the lingual flap coronally. [ABSTRACT FROM AUTHOR]

This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05). [ABSTRACT FROM AUTHOR]

The aim of this case series was to evaluate the clinical performance of a new volume-stable collagen matrix (VCMX) in combination with the modified coronally advanced tunnel technique (MCAT) for the treatment of gingival recessions. Thirteen patients with a total of 33 maxillary RT1 single and multiple gingival recessions were included in the study. Probing pocket depth (PPD), recession width (RECW), recession depth (REC), height of keratinized tissue (HKT), and gingival thickness (GT) were assessed at baseline and at the 12-month follow-up. Postoperative healing was uneventful in all cases without any complications. At 12 months, mean root coverage (MRC) was 92.88%, with complete root coverage (CRC) in 87.88% of treated sites. The present findings suggest that VCMX in combination with MCAT results in predictable coverage of maxillary RT1 gingival recessions. Further studies with larger sample sizes and control groups are needed to support these preliminary outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty. METHODS: The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups. RESULTS: The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P

Purpose: To assess the implant survival rate in mandibles reconstructed with free fibula flap after oral tumor resection after 1 year of prosthetic loading. A secondary objective was to compare immediate or delayed implant placement protocols in this population. Materials and Methods: Electronic and manual searches were performed on different databases for controlled and prospective trials that indicated implant survival rate. This systematic review followed PRISMA guidelines. Risk of bias was evaluated using Cochrane Collaboration tools. Meta-analyses heterogeneity source assessment and GRADE evaluation were performed among studies with identical follow-ups. Results: Among 305 primarily selected articles, 109 were eligible after reading the title and abstract, and 8 were included after full-text reading: 2 randomized controlled trials and 6 prospective studies comprising 140 patients and 507 implants. Meta-analyses estimated an overall survival rate of 97% (95% CI: 94% to 99%) after 1 year of prosthetic loading. The survival rate was 98% (95% CI: 94% to 100%) with immediate implantation and 97% (95% CI: 90% to 99%) with delayed implantation. Only 3 studies reported radiotherapy treatment, with no real impact on implant survival rate. Overall, 69% of tumors were benign. Conclusions: Implant placement in vascularized fibula flaps in the mandible is recommended for patients undergoing segmental mandibular reconstruction after tumor resection. Within the limitations of this study, no significant difference in survival rates was found between immediate and delayed implant placement. [ABSTRACT FROM AUTHOR]

The article discusses research published in the 2021 issue of the "International Journal of Environmental Research and Public Health" which evaluated the use of short dental implants compared to standard dental implants. The research reviewed studies on short implants and standard-length implants placed in augmented and nonaugmented edentulous sites, short implant survival, stability and marginal bone levels, and implants placed in the posterior maxilla and in medically compromised patients.

Purpose: To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary. Materials and Methods: A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated. Results: A total of 35 studies were included in the metaanalysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%). Conclusions: ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications. [ABSTRACT FROM AUTHOR]

Objectives: Although nonsurgical and surgical management of knee arthrofibrosis has been reported in the literature, there is little information on the effect of procedural treatment modalities of refractory arthrofibrosis on clinical outcomes. The purpose of this case report is to describe the intervention of refractory knee arthrofibrosis after anterior cruciate ligament reconstruction and investigate long-term clinical outcomes after procedural intervention. Methods: A 27-year-old male presented with decreased range of motion (ROM), patellar mobility, strength, and knee joint function following anterior cruciate ligament reconstruction of his left knee. After failed conservative management, the patient underwent manipulation under anesthesia (MUA) to release scar tissue. Following MUA, the emphasis of comprehensive physiotherapy was on decreasing inflammation, relieving pain, and maintaining patellar mobility while increasing knee joint ROM and strength. Knee ROM, patellofemoral motion, gait, and quadriceps recruitment were measured 3, 6, 12, and 24 months after MUA. Results: At 2-year follow-up after MUA, the patient continued to present with decreased ROM and quadriceps strength compared to the contralateral knee, but had returned to a running program and reported knee joint dysfunction no longer interfered with his daily activities. Conclusions: This case report demonstrates signs and symptoms that could indicate knee arthrofibrosis and introduces procedural intervention for refractory arthrofibrosis after anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: To compare glycated multilayered membranes (OV) to a commercially available thin-layer membrane (OP) in a lateral ridge augmentation model in dogs. Materials and Methods: This was designed as a three-arm study, where one negative control (empty defect) was compared to two test arms: alveolar bone defects grafted with a mixture of 90% deproteinized bovine bone mineral and 10% porcine collagen, then covered with either a thick- (OV) or thin-layered (OP) membrane. Animals were randomly divided into three groups corresponding to the final sacrifice times of 4 weeks, 12 weeks, and 24 weeks. Sections underwent microCT, histology, histopathology, and histomorphometry. Results: No statistical differences were observed for OV compared to OP regarding the percentage of mineral volume and mean mineral density, amount of bone maturation, percentage of bone graft and membrane remaining in the grafted area, alveolar ridge width measurements, membrane mineralization, or ossification. Test groups presented significantly higher values compared to the empty control for all the endpoints. Conclusions: Within its limitations, this in vivo study highlighted that multilayered thick glycated membranes can serve as effective occlusive barriers for up to 6 months. [ABSTRACT FROM AUTHOR]

Purpose: To assess, using CBCT, the volume and height of bone formation after open maxillary sinus elevation without the use of grafts. Materials and Methods: The study was retrospective and included 24 patients with a total of 67 implants. CBCT examinations were conducted at baseline (0 to 43 days postsurgery) and after an average healing period of 6.2 months (range: 5.1 to 7.8 months). The image analysis included metal artifact reduction, registration, and a standardized protocol for segmenting the anatomical structures of the maxillary sinus, including calculating the 3D volumetric changes after bone formation. Conventional manual 2D measurement of vertical bone formation was executed for comparison. Clinical factors assumed to be relevant for bone formation were obtained from patient medical records. Results: One implant was lost before prosthetic loading, representing an early implant loss rate of 1.5%. Differences in intra- and interexaminer reproducibility were registered for the conventional 2D method (P < .05). The average vertical bone formation measured with the 2D method was 4.8 mm (4.6 to 5.0 mm), covering 60.2% of the implant height within the sinus. The average volumetric bone formation measured with the developed 3D image-analysis method was 801 mm3 in total and 195 mm3 in a restricted region around each implant. Bone formation was registered in 62% of the volume of the restricted region. A correlation regarding bone formation was found between the two methods (R2 = 0.705). Clinical factors such as age, smoking, general health, and postoperative complications did not correlate with the amount of bone formed. Conclusion: CBCT image analysis is a promising method for objective 3D evaluation of bone formation after sinus elevation. A correlation was seen between the manually measured bone height (2D) and the bone volume in a restricted region around each implant using the developed method (3D). Reducing visual interpretation minimizes errors related to examiner reliability. Clinical factors did not significantly affect the volumetric bone formation. [ABSTRACT FROM AUTHOR]

Purpose: To compare the risk of sinus membrane perforation (SMP) among lateral window sinus floor elevation (LSFE) and transcrestal sinus floor elevation (TSFE) techniques in prospective and retrospective studies for patients who underwent sinus augmentation for dental implant placement. Materials and Methods: A database search was conducted to screen the literature published from January 1960 to August 2021. The associations between SMP and surgical techniques as well as other clinical factors were evaluated via network meta-analysis. The impact of SMP on vertical ridge gain and implant survival was also evaluated. Results: Eighty-five studies with 5,551 SFE procedures were included. In LSFE techniques, using rotary burs showed the highest risk of SMP (surface under the cumulative ranking area [SUCRA] = 0.0745). In TSFE techniques, using reamers had the lowest risk of SMP (SUCRA = 0.9444). Increased SMP prevalence was significantly associated with reduced implant survival rate (odds ratio [OR] = 0.45 per 10% increase of SMP rate [95% credible interval (CreI): 0.21, 0.71], P < .001). Conclusions: With the inherent limitations, this network meta-analysis suggested that some techniques within either the LSFE or TSFE group may reduce SMP risk. Additional randomized controlled trials and better assessment of SMP are required to directly compare the risk of SMP between LSFE and TSFE. [ABSTRACT FROM AUTHOR]

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are techniquesensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure--including lateral window sinus augmentation and guided bone regeneration--allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess changes in the horizontal dimension of the alveolar ridge using the autogenous bone block (ABB) or periosteal pocket flap (PPF) techniques prior to implant placement. This randomized trial study was conducted on 25 patients in need of horizontal bone augmentation who were randomly divided into two groups as follows: 13 underwent ridge augmentation with ABB in combination with allograft and collagen membrane, and 12 underwent ridge augmentation with the PPF technique. Radiographic examination via CBCT was conducted on all patients before and 26 weeks after the operation. Dimensional changes in the ridge width following surgery were measured within each group and also between the two groups in three regions: 0, 3, and 5 mm from the top of the alveolar crest. Eleven patients in the ABB group and all 12 patients in the PPF group successfully completed the study. Statistical analysis showed that the increase in alveolar ridge width in each group was significant, but the difference between the groups was not significant at any of the measured spots (0 mm from the crest, P = .25; 3 mm, P = .38; 5 mm, P = .73). However, more postoperative complications were observed with the ABB technique. According to the results of this study, there was no statistically significant difference between PPF and ABB techniques in terms of horizontal bone gain. [ABSTRACT FROM AUTHOR]

This study aims to compare the incidence of biologic and mechanical complication rates and the survival rates after at least 5 years of implants and implant-supported fixed complete dental prostheses (IFCDPs) placed during second-stage surgery using four and six implants. A total of 77 patients (33 men, 44 women) with a mean age of 60.6 ± 8.8 years (range: 39 to 80 years) were included, and the total of 92 IFCDPs were classified into two groups: 51 received four implants, and 41 received six implants. No implant failed in the four-implant group (0/204), and one implant failed in the six-implant group (1/246), with no statistically significant differences (P > .05). One prosthetic failure occurred in the four-implant group (1/51), and one failure occurred in the six-implant group (1/41). Both groups experienced some technical and biologic complications, with no statistically significant differences between the groups (P > .05). For both groups, veneer or resin fracture was the most frequent mechanical complication, and mucositis was the most frequent biologic complication. The use of four or six implants may represent a predictable treatment option in the rehabilitation of completely edentulous patients with IFCDPs in the medium-term. [ABSTRACT FROM AUTHOR]

À l'ère de la microchirurgie et avec l'avènement plus récent des lambeaux, il est intéressant de mettre en évidence l'intérêt du lambeau musculaire de serratus dans la reconstruction microchirurgicale. Au total, 100 lambeaux ont été réalisés dans notre service entre 2001 et 2022 avec 85 % des cas, en contexte post-traumatique (aiguë ou septique). Il y avait 83 patients du sexe masculin et 17 du sexe féminin. L'âge moyen était de 40,5 ans pour des extrêmes allant de 11 à 76 ans. L'origine des pertes de substance était la suivante : traumatisme en aiguë 73 cas ; plaie chronique/septique 19 cas ; purpura fulminans 2 cas ; tumeur 6 cas. La taille des pertes de substance variait de 15 à 200 cm2 pour une moyenne de 90 cm2. Quatre différents types de lambeaux ont été réalisés : lambeau musculaire (78 cas), lambeau musculocutané (5 cas), lambeau costo-ostéomusculaire (13 cas), lambeau costo-ostéomusculocutané (4 cas). Dans tous les cas où la côte a été prise, il s'agissait de la 8e côte et parfois de la 7e. Ces lambeaux de côtes vascularisées ont été réalisés pour des pertes de substance osseuse s'étendant de 5 à 12 cm. On reportait dans notre série un taux de 6 % de complications au niveau du site receveur (3 hématomes, 2 pneumothorax et un cas de douleurs chroniques). Le taux de réussite global de notre série est de 82,8 % avec seulement 20 % de complications chirurgicales générales et 6 % de complications sur le site donneur avec un très faible préjudice esthétique cicatriciel et fonctionnel sur le site de prélèvement. Ce lambeau, peu utilisé, est particulièrement intéressant en reconstruction des membres puisque tous ses paramètres sont ajustables en fonction de la perte de substance, la longueur de son pédicule lui permet également de réaliser des anastomoses à distance de la zone traumatisée, il présente également la possibilité de reconstruire une perte de substance osseuse avec un prélèvement composite costal. In the era of microsurgery and with the more recent advent of flaps, it is interesting to highlight the value of the serratus muscle flap in microsurgical reconstruction. A total of 100 flaps were performed in our department between 2001 and 2022, with 85% of cases in a post-traumatic context (acute or septic). There were 83 male and 17 female patients. The mean age was 40.5 years, with extremes ranging from 11 to 76 years. The origin of the tissue loss was as follows: acute trauma 73 cases; chronic/septic wound 19 cases; purpura fulminans 2 cases; tumour 6 cases. The size of the loss of substance varied from 15 to 200 cm2, with an average of 90 cm2. Four different types of flap were used: muscle flap (78 cases), musculocutaneous flap (5 cases), costo-osteomuscular flap (13 cases), costo-osteomusculocutaneous flap (4 cases). In all cases where the rib was taken, it was the 8th rib and sometimes the 7th. These vascularised rib flaps were performed for bone loss ranging from 5 to 12 cm. In our series, there was a 6% complication rate at the recipient site (3 haematomas, 2 pneumothoraxes and one case of chronic pain). The overall success rate in our series was 82.8%, with only 20% of general complications and 6% of donor site complications, with very little aesthetic scarring or functional damage to the donor site. This flap, which is rarely used, is particularly interesting for limb reconstruction, as all its parameters can be adjusted according to the defect, and the length of its pedicle means that it can also be used to perform anastomoses at a distance from the traumatised area. It also offers the possibility of reconstructing a bony defect with a composite costal harvest. [ABSTRACT FROM AUTHOR]

Some risk factors for breast reduction complications are well known but for others the results are contradictory in scientific literature. The choice between superior pedicle and superomedial pedicle as a risk factor has been rarely studied. We aim to better identify the risk factors for breast reduction complications, including the choice between these two pedicles, in order to better prevent their occurrence. We performed a retrospective analysis of the medical records of patients who underwent a bilateral breast reduction from august 2020 to august 2023 in our center. Patient data were obtained and correlated with postoperative complications using statistical tests and a literature search was carried out to compare our results to the current evidence. We included 216 patients. The complication rate was 24.07%. The most frequent complication was wound dehiscence (17.59%), followed by partial Nipple-Areola-Complex necrosis or peroperative suffering requiring conversion to Nipple-Areola-Complex free graft (5.56%). Increased Body Mass Index, superomedial pedicle and resection weight ≥ 650 g were associated with an increased probability of complication occurrence (P = 0.048, P = 0.005 and P = 0.044). The superomedial pedicle and the resection weight ≥ 650 g were associated with an increased probability of wound dehiscence (P = 0.005 and P = 0.037). The difference between the preoperative and the postoperative Sternal-Notch-Nipple distance was associated with an increased probability of partial Nipple-Areola-Complex necrosis or Nipple-Areola-Complex free graft (P = 0.014). Correcting modifiable preoperative risk factors and mastering both techniques, enabling the surgeon to choose the one best suited to each patient's clinical situation, reduces the complication rate. [ABSTRACT FROM AUTHOR]

BACKGROUND: Improving the quality of care is a priority for health systems to obtain better care and reduce costs. One of the tools for measuring quality is benchmarking (BM). We presented a 1- country prospective study of distal pancreatectomies (DPs) and determined BM. STUDY DESIGN: Prospective, multicenter, observational snapshot study of DP carried out at Spanish hepatopancreatobiliary centers for a year (February 1, 2022, to January 31, 2023). Hepatopancreatobiliary centers were defined as high volume if they performed more than 10 DPs per year. Inclusion criteria include any scheduled DP for any diagnosis and age older than 18 years. The low-risk group was defined following the criteria given by Durin and colleagues and major complications as Clavien-Dindo ≥III. RESULTS: A total of 313 patients from 42 centers and 46.6% from high-volume centers were included. Median DP by center was 7 (interquartile range 5 to 10), median age was 65 years (interquartile range 55 to 74), and 53.4% were female. The surgical approach was minimally invasive in 69.3%. Major complications were 21.1%. Postoperative pancreatic fistula grade B/C rate was 20.1%, and 90-day mortality was 1.6%. One hundred forty-three patients were in low-risk group (43.8%). Compared with previous BM data, an increasing MIS rate and fewer hospital stay were obtained. CONCLUSIONS: We present the first determination of DP-BM in a prospective series, obtaining similar results to the previous ones, but our BM values include a shorter hospital stay and a higher percentage of minimally invasive surgery probably related to Enhanced Recovery after Surgery protocols and prospective data collection. BM is a multiparameter valuable tool for reporting outcomes, comparing centers, and identifying the points to improve surgical care. [ABSTRACT FROM AUTHOR]

BACKGROUND: The direct association between procedure risk and outcomes in elderly patients who undergo emergency general surgery (EGS) has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly patients who undergo EGS is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly patients who undergo EGS compared with frailty. STUDY DESIGN: Elderly patients (age >65 years) undergoing EGS operative procedures were identified in the NSQIP database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5-Item Frailty Index (mFI-5; mFI 0 nonfrail, mFI 1 to 2 frail, and mFI ≥3 severely frail) and based on procedure risk. Multivariable regression models and receiving operative curve analysis were used to determine risk factors associated with outcomes. RESULTS: A total of 59,633 elderly patients who underwent EGS were classified into nonfrail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group. Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared with frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly patients who underwent EGS compared with frailty. CONCLUSIONS: Assessing frailty in the population of elderly patients who undergo EGS without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to improve the efficiency of daytime surgery for gastrointestinal polyp and ensure the safety of patients. We tried an information management method based on WeChat platform in patients undergoing daytime gastrointestinal polypectomy and to explore the feasibility and effectiveness of a full management model. Methods: Five hundred and ninety‐three patients were randomly divided into two groups: the control group was treated with traditional management methods and the experimental group was treated with the whole‐process management mode based on the WeChat platform. The WeChat platform‐based full management model included establishing a day surgery management WeChat group, developing multidisciplinary, full‐management protocols and processes for day surgery, establishing an information‐based surgical scheduling system and adopting diverse forms of day surgery education and continuity of care. This feature included illustrated brochures, vivid verbal presentations, WeChat public numbers and Internet management platforms. The treatment time, hospitalization cost and patient satisfaction of the two groups were counted. Results: In the experimental group, 408 patients were enrolled. The preoperative waiting time and patients' length of stay were 3 days and 1 day, respectively. The medical and nursing intake time was 7 min. The procedure cancellation rate and postoperative complications rate was 0.07% and 0.02%. In the control group, 185 patients were enrolled in the study, The preoperative waiting time and patients' length of stay was 7 days and 3 days. The medical and nursing intake time was 28 min. The procedure cancellation rate and postoperative complications rate were 0.13% and 0.05%, respectively. The hospitalization costs were reduced by an average of $140/person and the satisfaction scores were higher than the control group. In summary, the preoperative waiting time, medical reception time, surgical cancellation rate, length of hospital stay and hospitalization cost in the observation group were less than those in the control group (p < 0.05). Patient satisfaction scores were significantly higher than those in the control group (p < 0.05). Conclusion: Through the full management model based on WeChat, the preoperative waiting time, medical reception time, surgical cancellation rate, length of hospital stay and hospitalization cost in the experimental group were less than those in the control group. Patient satisfaction scores were significantly higher than those in the control group and the difference was statistically significant. [ABSTRACT FROM AUTHOR]

Growing rod (GR) systems require periodical surgical intervention and may cause associated complications, as well as worsened sagittal plane deformity. Generally, the risk of complications decreases with an increment in age at the time of the index surgery with GR construct placement. However, the optimal timing to begin GR treatment has not reached a consensus yet. This study was performed to investigate the effect of age at the index GR surgery on the complication rates and formulate clinical guidelines for the optimal timing to begin GR treatment for EOS patients. Kaplan-Meier analysis was used to determine complication occurrence as a function of the age at the index surgery and to determine the survival rates for the procedures. The receiver operator characteristic (ROC) curve was used to determine optimal cut-off values for the optimal timing of index surgery based on whether complications occurred or not. 54 patients who met the criteria were enrolled in this study. The following spinal parameters were measured: major coronal Cobb angle, global kyphosis (GK), and coronal balance (CB). CB was defined as the horizontal distance from the C7 plumb line to the center sacral vertical line. All patients had completed GR treatment and had a minimum 1-year follow-up duration after the final surgical intervention. Patient data were collected as follows: age at the index surgery, gender, diagnosis, type of GR construct, and the number of lengthening procedures. The standing full-spine radiographs were obtained before and after the index surgery, before and after each lengthening procedure, before and after the final surgical intervention, and at the latest follow-up. Complications were categorized as implant, alignment, and general. Kaplan-Meier analysis of complications demonstrated a declining trend in complication rates with increasing age at the index surgery. The absence of perioperative complications was targeted, we constructed the ROC curve and the cut-off value was 71.0 months. Age at the index surgery was therefore categorized into two groups: younger-age group (≤ 71.0 months) and advanced-age group (> 71.0 months). There was a higher complication rate for the younger-age group than versus the advanced-age group (61.5% vs 22.0%, p=.011). PJK as a major alignment-related complication, was more frequent in the younger-age group than in the advanced-age group (30.8% vs 4.9%, p=.025). But the advanced-age group exhibited significantly more severe deformities before GR surgery compared to the younger-age group. This study shows that the elevated risk of complications observed in the younger-age group, which can be attributed to the younger age at the index surgery and the increased number of lengthening procedures during treatment. We suggest deferring the initiation of GR treatment until after the age of six years for EOS patients. We hope it will serve as a basis for GR technique in the treatment of EOS, with the ultimate goal of enhancing treatment outcomes for this challenging disorder. [ABSTRACT FROM AUTHOR]

Wilms tumor has been selected as an index tumor by the WHO Global Initiative for Childhood Cancer with the aim to improve cure rates worldwide. Nevertheless, there is a scarcity of published data on outcomes beyond those of the major cooperative groups. Therefore, we conducted a retrospective analysis including all patients with Wilms tumor treated at our referral center in Uruguay between 1995 and 2020. Treatment consisted of North American (NA) strategies in 23 cases (1995–2004), followed by the SIOP strategy in 35 cases thereafter. Staging included: I-II = 28, III = 7, IV = 14, and V = 9. There were no major surgical or medical complications; however, a delay in the administration of local radiotherapy was observed (median of 21 days after surgery). There were no cases of toxicity- or surgery-related deaths or treatment abandonment. Five-year probability of overall survival was 0.72 and 0.92 for the NA and SIOP groups, respectively. We conclude that outcomes were better for the SIOP strategy with no unexpected toxicities and high treatment compliance in both strategies. Timely implementation of radiotherapy was challenging. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. This study compares reoperation rates and complications following single-level anterior lumbar interbody fusion (ALIF)/lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF)/posterior lumbar interbody fusion (PLIF). Summary of Background Data. ALIF, LLIF, TLIF, and PLIF are widely used for degenerative disc disease. Lumbar interbody fusions have high rates of reoperation, primarily related to adjacent segment pathology and pseudarthrosis. Materials and Methods. The PearlDiver database was queried for patients (2010-2021) who had single-level ALIF/LLIF or TLIF/PLIF with same-day, single-level posterior instrumentation. ALIF/LLIF were combined, and similarly, TLIF/PLIF were combined, given how these operations are indistinguishable from Current Procedural Terminology coding. All patients were followed for ≥ 2 years and excluded if they had spinal traumas, fractures, infections, or neoplasms before surgery. The two cohorts, ALIF/LLIF and TLIF/PLIF, were matched 1:1 based on age, sex, Elixhausercomorbidity index, smoking status, and diabetes. The primary outcome was the incidence of all-cause subsequent lumbar operations. Secondary outcomes included 90-day surgical complications. Results. After 1:1 matching, each cohort contained 14,070 patients. All-cause subsequent lumbar operations were nearly identical at five-year follow-up (9.4% ALIF/LLIF vs. 9.5% TLIF/PLIF, P=0.91). Survival analysis using all-cause subsequent lumbar operations as the endpoint showed an equivalent 10-year survival rate of 86.0% (95%CI: 85.2-86.8). Within 90 days, TLIF/PLIF had more infections (1.3% vs. 1.7%, P=0.007) and dural injuries (0.2% vs. 0.4%, P=0.001). There was no difference in wound dehiscence, hardware complications, or medical complications. Conclusion. As utilized in real-world clinical practice, singlelevel anterolateral versus posterior approaches for interbody fusion have no effect on long-term reoperation rates. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective analysis of prospectively collected data. Objective. Evaluate the impact of correcting normative segmental lordosis values on postoperative outcomes. Background. Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remain unclear. Patients and Methods. Patients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort's mean offset, less than or over 10% were undercorrected and overcorrected. Surgical technique, patient-reported outcome measures, and surgical complications were compared across groups at baseline and two years. Results. In total, 510 patients with a mean age of 64.6, a mean Charlson comorbidity index 2.08, and a mean follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; undercorrected, U: 32.2% vs. matched, M: 21.7% vs. overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative Oswestry disability index was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P=0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P=0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P<0.001) and had greater posterior inclination of the upper instrumented vertebrae (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P<0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P=0.025). Conclusions. Patients undergoing fusion for adult spinal deformity suffer higher rates of proximal junctional failure with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis. [ABSTRACT FROM AUTHOR]

Gender medicine is also becoming increasingly more important in the field of surgery of endocrine and neuroendocrine diseases. Gender differences in the incidence, symptoms and disease progression are common to all (neuro)endocrine diseases. Understanding these special features, which include socioeconomic aspects as well as different anatomical and biological factors, is essential for the selection of optimal diagnostics and treatment but in some cases further scientific research is required. To date, there is a paucity of gender-specific recommendations in established guideline recommendations. There is an enormous potential in all areas of endocrine surgery to take advantage of differences between men and women in the diagnostics, surgical treatment and perioperative management. Individualized approaches could lead to improved surgical outcomes, reduced perioperative complications and improved follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Medullary thyroid carcinoma constitutes 5% to 10% of all thyroid cancers. Metastatic adenopathies may pose challenges in intricate anatomical locations, such as the parapharyngeal space. A rare case of metastatic medullary thyroid carcinoma in the parapharyngeal space has been treated in our unit using combined trans-cervical trans-oral robotic surgery. Our objective was to provide a detailed description of the surgery performed on this patient. Method: We reported a singular case report worth of interest. Result: A 42-year-old woman was addressed in our unit for the management of a medullary thyroid carcinoma adenopathy located in the right parapharyngeal space. A parapharyngeal 40.0 mm × 25.0 mm × 12.0 mm adenopathy was removed using a combined trans-cervical and trans-oral robotic approach without sacrifice or injury of vascular or nervous structure. Neither the tracheostomy nor the feeding tube was implemented. Feeding was resumed on postoperative day 1 and hospitalization spanned 7 days. Conclusion: An innovative combined trans-cervical and trans-oral robotic surgery approach was conducted to address a metastatic medullary thyroid carcinoma in the parapharyngeal space. This surgical technique allowed us to circumvent the need for a trans-mandibular approach, tracheostomy, and feeding tube and enabling successful tumor removal without fragmentation. Postoperative care was significantly eased. The sole complication observed was dysphonia, likely resulting from intra-operative stretching of the vagus nerve during the dissection of the carotid artery. [ABSTRACT FROM AUTHOR]

Objectives: Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients. Methods and Methods: In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria. Results: From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (P =.009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups. Conclusion: Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI. Methods: A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of relevant keywords encompassing "multi-ligament knee injury," "knee dislocation," "reconstruction," "repair," "surgery," and "timing," and their synonyms, along with appropriate Boolean operators. Selection of articles (systematic reviews and meta-analyses) adhered to predefined inclusion and exclusion criteria. Furthermore, a meta-analysis was conducted utilizing data extracted from primary studies. Results: Early surgery for MLKI demonstrated a significant advantage over delayed surgery, reflected by significantly higher Lysholm scores (Mean Difference [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22), IKDC objective scores (Mantel–Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69), Tegner activity scores (MD 0.38; 95% CI 0.08, 0.69), and Mayer's ratings (MH-OR 5.47; 95% CI 1.27, 23.56). In addition, we found a significantly reduced risk of secondary chondral lesions (MH-OR 0.33; 95% CI 0.23, 0.48), lower instrumented anterior tibial translation in the early surgery group (MD −0.92; 95% CI −1.83, −0.01), but no significant difference was observed in the secondary meniscal tears, between the two groups. However, the early surgery group also exhibited a significantly increased risk of knee stiffness (MH-OR 2.47; 95% CI 1.22, 5.01) and a greater likelihood of requiring manipulation under anaesthesia (MH-OR 3.91; 95% CI 1.10, 13.87). Conclusion: Early surgery for MLKI improves function, and stability, and reduces further articular cartilage damage, but increases the risk of stiffness. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Peroneus longus (PL) graft harvest has gained popularity in recent years for a variety of ligament surgeries. One of the common apprehensions regarding its more widespread usage has been the risk of injury to the common peroneal nerve or the sural nerve during graft harvest. The purpose of the current study is to assess the rate of injury to the peroneal and sural nerve following PL harvest using our technique in a large cohort of patients. Materials and Methods: A prospective cohort of 600 consecutive patients undergoing PLG harvest over a period from January 2022 to December 2022 at a single tertiary referral centre were included for analysis. Patients had baseline screening of nerve function prior to surgery and were regularly followed up at 3 weeks, 6 weeks, 3 months and 6 months post-harvest. Grouped variables for the sural and peroneal nerve were completed and analysis was carried out using Cochrane's Q test and McNemar's test. Results: We found that only 0.01% of patients had any nerve complications at 6 months follow-up, and three times more patients had sural nerve complaints than peroneal nerve complaints at the end of the 6 months follow-up. Conclusion: Peroneus longus harvest is a safe and reproducible technique with low complication rate. The rate of nerve complications post-harvest is grossly overestimated in the literature secondary to low-powered and low evidence studies. We believe that using our safe surgical technique for PL harvest with respect to surface landmarks allows for PL harvest with a low nerve complication rate. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (mMO-TLIF) via posterior midline incision for "targeted limited dissection" versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) via Wiltse approach in lumbar degenerative diseases. Methods: A total of 60 consecutive patients in our center from January 2019 to March 2020 were enrolled, including 30 patients who were treated with mMO-TLIF via posterior midline incision and 30 treated with MIS-TLIF through the Wiltse approach. Perioperative parameters were recorded. The questionnaires of Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were conducted before the operation and after the operation (3 days, 1 week, and 2 years). CT and MRI radiological outcomes were evaluated before the operation and at a 2-year follow-up. Results: There were no significant differences in the general data, gender, age, and BMI between the two groups. All patients were successfully operated without intraoperative complications. There were significant differences between the two groups in the operation time (p < 0.001) and intraoperative bleeding (p < 0.05). There was no difference in ODI and VAS scores between groups pre- and post-operatively, but they were both significantly improved compared to those before the operation (p < 0.01). At a 2-year follow-up, the paraspinal muscle atrophy and fat infiltration were increased comparing to pre-operation, but the difference was also not statistically significant (p > 0.05). In addition, both the two groups' fusion rates were more than 90% at a 2-year follow-up, however, no difference was detected between the two groups. Conclusion: mMO-TLIF via midline incision for "targeted limited dissection" could achieve similar clinical and radiological outcomes as MIS-TLIF for lumbar degenerative disease. [ABSTRACT FROM AUTHOR]

Objective: The relationship between spontaneous osteonecrosis of the knee (SONK) and ipsilateral meniscus tear remains to be established, and the possible causes are clarified and summarized. Methods: We conducted a search in Pubmed, Web of Science, Embase, and the Cochrane Library to include all English articles published from the establishment of the database until April 2023. The odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the relationship between SONK and ipsilateral meniscus lesions. Results: A total of 405 patients were included in eight articles, including 157 males and 248 females, with an average age of 63.94 years and an average BMI of 26.36 kg/m2. In patients with medial SONK, the prevalence of ipsilateral meniscus tear was 0.8982, 95% CI (0.7389, 0.9648), and the prevalence of ipsilateral posterior root tear was 0.6198, 95% CI (0.5169, 0.7118). The prevalence of ipsilateral meniscus tears in patients with lateral SONK was 0.2188, 95% CI (0.1150, 0.3711), and the prevalence of ipsilateral posterior root tears was 0.1667, 95% CI (0.1071, 0.2424). Conclusions: SONK is significantly associated with meniscus or root tears, which limit meniscus function and lead to changes in the stress environment between the knee and the tibiofemur, increasing the chance of incomplete fracture. We suggest that the expression of SONK can be replaced with subchondral insufficiency fracture of the knee. [ABSTRACT FROM AUTHOR]

Background and aims: Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. Methods: A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. Results: The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p <.001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40–64 years (OR 1.63 (95% CI 1.06–2.52); compared to age 18–39), age more than 64 years (OR 2.84 (95% CI 1.18–6.80); compared to age 18–39), loss of appetite (OR 2.86 (95% CI 1.64–4.98)), fever (OR 1.66 (95% CI 1.08–2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15–3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32–3.53)). Age 40–64 years (OR 2.41 (95% CI 1.50–3.88)), age more than 64 years (OR 8.79 (95% CI 2.19–35.36)), fever (OR 1.83 (95% CI 1.15–2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14–3.14)) were also risk factors for complicated appendicitis. Conclusions: Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of cerebrovascular MRI markers in unselected patients hospitalized for COVID-19 (Coronavirus disease 2019), we compared these with healthy controls without previous SARS-CoV-2 infection or hospitalization and subsequently, investigated longitudinal (incidental) lesions in patients after three months. Methods: CORONIS (CORONavirus and Ischemic Stroke) was an observational cohort study in adult hospitalized patients for COVID-19 and controls without COVID-19, conducted between April 2021 and September 2022. Brain MRI was performed shortly after discharge and after 3 months. Outcomes included recent ischemic (DWI-positive) lesions, previous infarction, microbleeds, white matter hyperintensities (WMH) and intracerebral hemorrhage and were analysed with logistic regression to adjust for confounders. Results: 125 patients with COVID-19 and 47 controls underwent brain MRI a median of 41.5 days after symptom onset. DWI-positive lesions were found in one patient (1%) and in one (2%) control, both clinically silent. WMH were more prevalent in patients (78%) than in controls (62%) (adjusted OR: 2.95 [95% CI: 1.07–8.57]), other cerebrovascular MRI markers did not differ. Prevalence of markers in ICU vs. non-ICU patients was similar. After three months, five patients (5%) had new cerebrovascular lesions, including DWI-positive lesions (1 patient, 1.0%), cerebral infarction (2 patients, 2.0%) and microbleeds (3 patients, 3.1%). Conclusion: Overall, we found no higher prevalence of cerebrovascular markers in unselected hospitalized COVID-19 patients compared to controls. The few incident DWI-lesions were most likely to be explained by risk-factors of small vessel disease. In the general hospitalized COVID-19 population, COVID-19 shows limited impact on cerebrovascular MRI markers shortly after hospitalization. [ABSTRACT FROM AUTHOR]

Purpose: Spontaneous direct carotid-cavernous fistula (CCF) are usually caused by a ruptured carotid cavernous aneurysm. We studied treatment of spontaneous direct CCFs in a single-center cohort of a high-volume tertiary referral center, reporting anatomical details, technical approaches of treatment, and outcomes. Methods: Adult patients with a spontaneous direct CCF treated between 2010–2022 with follow-up MRI and/or DSA imaging available were retrospectively analyzed. We studied age, sex, clinical presentation, angiographic findings, treatment techniques, outcomes, and complications. Results: Out of 80 patients with CCFs, twelve patients were treated for a non-traumatic direct CCF (15%) in 13 sessions. Median age was 65 years. Two patients had an underlying connective tissue disorder. In 10 cases, the direct CCF was caused by a ruptured cavernous carotid aneurysm. The direct CCFs were treated by endovascular transarterial embolization (10 cases), transvenous embolization (1 case), or surgery (1 case). Selective closure of the shunt was possible in 10 patients. Two patients were treated with parent vessel occlusion (PVO; one endovascular; one surgical, with bypass). Complications occurred in 2 / 12 patients (17%), with permanent morbidity in two patients (17%): trigeminal neuralgia after PVO and new infarct after surgical PVO and bypass. Selective closure of CCF resulted in no morbidity. There was no mortality in our series. Conclusion: Spontaneous direct CCFs are caused by rupture of a cavernous carotid aneurysm in most cases. Selective closure of the shunt, usually feasible transarterially with coils, achieves good results. Reconstructive endovascular techniques are preferred to minimize treatment related neurological complications. [ABSTRACT FROM AUTHOR]

Objective: We aim to report the epidemiology, surgical outcomes, and survival rates of pediatric patients with posterior fossa tumors in a large single-center case series. Methods: A retrospective analysis was conducted on pediatric patients who underwent surgical treatment for posterior fossa tumors between January 2011 and January 2019. Results: A total of 135 pediatric patients, with an average age of 7.5 years at diagnosis and a mean follow-up of 35.7 months, were included in the study. Most tumors were located within the midline, with ventriculomegaly observed in 71.4% of the patients. Pilocytic astrocytomas encompassed the majority of tumors (34.1%), followed by medulloblastomas (27.4%) and ependymomas (11.8%). Gross total resection (GTR) was achieved in 71.8% of the patients, with a recurrence rate of 20%. Surgical complications were observed in 25.9% of the patients. GTR significantly impacted 5-year overall survival (OS) and 4-year progression-free survival (PFS) in patients with posterior fossa tumors. Patients who underwent GTR had a 5-year OS of 89.7%, compared to 72.7% for near-total resection and 70.8% for subtotal resection. The 4-year PFS for patients who underwent GTR was 82.5%, whereas it was 63.6% for patients who underwent near-total resection and 54.2% for patients who underwent subtotal resection. Conclusion: Surgical resection remains the main treatment for pediatric posterior fossa tumors, and higher resection rates are linked to better survival outcomes. Despite limited resources for molecular diagnosis, our institution has demonstrated that a specialized neurooncological center with a high surgical volume can still achieve favorable survival outcomes for these patients. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Safety and effectiveness of Evicel® fibrin sealant as an adjunct to sutured dural repair in children undergoing cranial neurosurgery." The correction involves updating Tables 1, 2, 3, 4, 5, and 6 of the article to include indentations for reader clarity. The updated tables provide information on patient characteristics, procedural characteristics, treatment parameters, and intra-operative outcomes. The correction notice includes the updated tables for reference. The article presents the results of a study comparing different surgical treatments for achieving watertight closure in brain surgery. The study found that Tisseel® had a higher success rate compared to sutures, particularly in supratentorial surgeries. The study also reported no adverse events related to the study products. [Extracted from the article]

Purpose: Sagittal synostosis is the most common isolated craniosynostosis. Surgical treatment of this synostosis has been extensively described in the global literature, with promising outcomes when it is performed in the first 12 months of life. However, in some cases, patients older than 12 months arrive at the craniofacial center with this synostosis. A comprehensive study on efficacy and perioperative outcomes has yet to be fully explored in this population. This systematic review and meta-analysis aimed to assess the available evidence of surgical outcomes for the treatment of sagittal synostosis among older patients to analyze the efficacy and safety of synostosis surgery in this unique population. Methods: PubMed, Embase, and Scopus were searched for studies published from inception to March 2024 reporting surgical outcomes of synostosis surgery in older patients (> 12 months) with isolated sagittal synostosis. The main outcome was the reoperation rate, with secondary endpoints including transfusion rates, aesthetic outcomes, and surgical complications. Results: Nine studies were included in the final analysis. The pooled proportion of the reoperation rate was 1%. The rate of excellent aesthetic results was 95%. The need for transfusion associated with the procedures was 86%, and finally, surgical complications attained a pooled ratio of 2%, indicating minimal morbidity associated with the surgical repair. Conclusion: Sagittal synostosis surgery is a safe and effective procedure to perform in older patients; this meta-analysis suggests that open surgery confers a significant rate of excellent aesthetic results with a low reoperation rate and minimal complications associated with the intervention. Future research with direct comparisons among different techniques will validate the findings of this study, which will all contribute to the rigor of synostosis management. [ABSTRACT FROM AUTHOR]

Purpose: Cerebrospinal fluid (CSF) leakage is a challenging complication of intradural cranial surgery, and children are particularly at risk. The use of dural sealants confers protection in adults, but pediatric studies are scarce. We evaluated the safety and efficacy of Evicel® fibrin sealant as an adjunct to primary dural suturing in children undergoing cranial surgery. Methods: A multicenter trial prospectively enrolled pediatric subjects (< 18 years) undergoing cranial neurosurgery who, upon completion of primary sutured dural repair, experienced CSF leakage. As agreed by the EMA Evicel® Pediatric Investigation Plan, 40 subjects were intra-operatively randomized 2:1 to Evicel® or additional sutures ('Sutures'). Data analysis was descriptive. The efficacy endpoint was treatment success rate, with success defined as intra-operative watertight closure after provocative Valsalva maneuver (primary endpoint). Safety endpoints were postoperative CSF leakage (incisional CSF leakage, pseudomeningocele or both) and surgical site complications (secondary endpoints). Results: Forty subjects (0.6–17 years) were randomized to Evicel® (N = 25) or Sutures (N = 15) (intention-to-treat). Intracranial tumor was the most common indication and procedures were mostly supratentorial craniotomies. Success rates were 92.0% for Evicel® and 33.3% for Sutures, with a 2.76 estimated ratio of success rates (Farrington-Manning 95% CI [1.53, 6.16]). Sensitivity analyses in per-protocol and safety sets showed similar results. Despite a higher rescue treatment rate, the frequencies of postoperative CSF leakage and wound complications were higher for Sutures than for Evicel®. Conclusion: This small-scale prospective study shows Evicel® treatment to be safe and effective as an adjunct to primary sutured dura mater closure in a pediatric population. Compared to additional sutures, Evicel® was associated with reduced postoperative CSF leakage and surgical site complications. (Trial registration: The trial was registered as NCT02309645 and EudraCT 2013-003558-26). [ABSTRACT FROM AUTHOR]

Inappropriate perioperative fluid load can lead to postoperative complications and death. This retrospective study was designed to investigate the association between intraoperative fluid load and outcomes in neonates undergoing non-cardiac surgery. From April 2020 to September 2022, 940 neonates who underwent non-cardiac surgery were retrospectively enrolled and their perioperative data were harvested for further analysis. According to recorded intraoperative fluid volumes defined as ml.kg−1 h−1, patients were mandatorily divided into quintile with fluid load as restrictive (quintile 1, Q1), moderately restrictive (Q2), moderate (Q3), moderately liberal (Q4), and liberal (Q5). The primary outcomes were defined as prolonged length of hospital stay (LOS) (postoperative LOS ≥ 14 days), complications beyond prolonged LOS, and 30-day mortality. Secondary outcomes included postoperative complications within 14 days of hospital stay. The intraoperative fluid load was in Q1 of 6.5 (5.3–7.3) (median and IQR); Q2: 9.2 (8.7–9.9); Q3: 12.2 (11.4–13.2); Q4: 16.5 (15.4–18.0); and Q5: 26.5 (22.3–32.2) ml.kg−1 h−1. The odd of prolonged LOS was positively correlated with an increase fluid volume (Q5 quintile: OR 2.602 [95% CI 1.444–4.690], P = 0.001), as well as complications beyond prolonged LOS (Q5: OR 3.322 [95% CI 1.656–6.275], P = 0.001). The overall 30-day mortality rate was increased with high intraoperative fluid load but did not reach to a statistical significance after adjusted with confounders. Furthermore, the highest quintile of fluid load (26.5 ml.kg−1 h−1, IQR [22.3–32.2]) (Q5 quintile) was significantly associated with longer postoperative mechanical ventilation time compared with Q1 (Q5: OR 2.212 [95% CI 1.101–4.445], P = 0.026). Conclusion: Restrictive intraoperative fluid load had overall better outcomes, whilst high fluid load was significantly associated with prolonged LOS and complications after non-cardiac surgery in neonates. Trial registration: Chictr.org.cn Identifier: ChiCTR2200066823 (December 19, 2022). What is Known: • Inappropriate perioperative fluid load can lead to postoperative complications and even death. What is New: • High perioperative fluid load was significantly associated with an increased length of stay after non-cardiac surgery in neonates, whilst low fluid load was consistently related to better postoperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate treatment options for older women with pelvic organ prolapse (POP) and postoperative outcomes based on their long‐term care (LTC) status. Methods: We used the medical and LTC insurance claims databases of Tochigi Prefecture in Japan, covering 2014 to 2019. We included women 65 years and older with POP and evaluated their care status and treatment, excluding women with an observation period <6 months. Among women with a postsurgical interval ≥6 months, we compared care level changes and deaths within 6 months and complications within 1 month postoperatively between those with and without LTC using Fisher exact test. Results: We identified 3406 eligible women. Of the 447 women with LTC and 2959 women without LTC, 16 (3.6%) and 415 (14.0%), respectively, underwent surgery. Among 393 women with a postsurgical interval ≥6 months, 19 (4.8%) required LTC at surgery. Two of the 19 women with LTC (10.5%) and eight of 374 women without LTC (2.1%) experienced worsening care–needs level. No deaths were recorded. Urinary tract infection (UTI) was significantly more frequent in women with LTC than in women without LTC (36.8% vs 8.6%). Other complications were rare in both groups. Conclusion: The proportion of patients who underwent surgery for POP was lower in women with LTC than in women without LTC. Postoperative UTI was common and 11% had a worsening care–needs level postoperatively, whereas other complications were infrequent. Further detailed studies would contribute to providing optimal treatment to enhance patients' quality of life. Synopsis: The proportion of patients who underwent surgery for pelvic organ prolapse was low in women requiring long‐term care. Postoperative urinary tract infection was common in this patient population. [ABSTRACT FROM AUTHOR]

Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age‐related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk–benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post‐surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery. [ABSTRACT FROM AUTHOR]

Introduction: This study introduces and compares a new intraperitoneal laparoscopic para‐aortic lymphadenectomy method to reach the level of the renal vein, the "tent‐pitching" antegrade approach with the retrograde approach in gynecological malignancy surgeries in terms of success rate, complication incidence, and the number of lymph nodes removed. It focuses on the feasibility, safety, and effectiveness. Meanwhile, this article reports on the vascular anatomical variations discovered in the para‐aortic region to enhance surgical safety. Material and Methods: This was a retrospective cohort study including patients undergone laparoscopic para‐aortic lymphadenectomy at a single center from January 2020 to December 2023 for high‐risk endometrial and early‐stage ovarian cancer. Patient charts were reviewed for mode of operation, perioperative complications, operative details, and histopathology. The patients were divided into anterograde group and retrograde group according to the operation mode. The two groups were further compared based on the success rate of lymph node clearance at the renal vein level, perioperative complications, and the number of removed lymph nodes. Quantitative data were analyzed using the t‐test, non‐normally distributed data using the rank‐sum test, and categorical data using Fisher's exact test and the chi‐square test, with statistical significance defined as P < 0.05. Results: Among 173 patients, the antegrade group showed higher surgery success (97.5% vs 68.82%), more lymph nodes removed (median 14 vs 7), and less median blood loss. The operation time was shorter in the antegrade group. Postoperative complications like lymphocele and venous thrombosis were lower in the antegrade group. Vascular abnormalities were found in 28.9% of patients, with accessory lumbar vein routing anomaly and accessory renal arteries being most common. Conclusions: The antegrade approach is feasible, safe, and effective, improving surgical exposure, reducing difficulty without additional instruments or puncture sites, and minimizing organ damage risk. It is effective in achieving better access to the renal vein and removing more para‐aortic lymph nodes than the retrograde method. Recognizing and carefully managing the diverse vascular abnormalities in the para‐aortic area, including variations in renal arteries, veins, and the inferior vena cava, is essential to reduce intraoperative bleeding and the likelihood of converting to open surgery. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating the effectiveness of various treatment strategies for managing cesarean scar ectopic pregnancies, highlighting the high success rates of surgical options compared to medical treatments. Topics include a comparative analysis of surgical and medical treatment outcomes, the safety and success rates of different methods, and recommendations for patient counseling and shared decision-making.

Cognitive impairment is a severe complication of acute respiratory distress syndrome (ARDS). Emerging studies have revealed the effects of pyrrolidine dithiocarbamate (PDTC) on improving surgery-induced cognitive impairment. The major aim of the study was to investigate whether PDTC protected against ARDS-induced cognitive dysfunction and to identify the underlying mechanisms involved. The rat model of ARDS was established by intratracheal instillation of lipopolysaccharide (LPS), followed by treatment with PDTC. The cognitive function of rats was analyzed by the Morris Water Maze, and pro-inflammatory cytokines were assessed by quantitative real-time PCR, enzyme-linked immunosorbent assay, and western blot assays. A dual-luciferase reporter gene assay was performed to identify the relationship between miR-181c and its target gene, TAK1 binding protein 2 (TAB2). The results showed that PDTC improved cognitive impairment and alleviated neuroinflammation in the hippocampus in LPS-induced ARDS model. Furthermore, we demonstrated that miR-181c expression was downregulated in the hippocampus of the ARDS rats, which was restored by PDTC treatment. In vitro studies showed that miR-181c alleviated LPS-induced pro-inflammatory response by inhibiting TAB2, a critical molecule in the nuclear factor (NF)-κB signaling pathway. PDTC improves cognitive impairment in LPS-induced ARDS by regulating miR-181c/NF-κB axis-mediated neuroinflammation, providing a potential opportunity for the treatment of this disease. [ABSTRACT FROM AUTHOR]

Objective: While connective tissue graft shrinkage is a well‐documented post‐transplantation reaction, there is a literature gap concerning hyperplastic tissue response. Despite its infrequent occurrence, investigation is warranted due to its capacity to compromise esthetics, disrupt lip dynamics, and promote food retention. Moreover, efforts to mitigate hyperplastic tissue response often prove challenging, and there is a potential risk of exacerbating gingival tissue rebound. Clinical Considerations: This report presents a potential solution to managing tissue overgrowth after connective tissue grafting in five clinical cases. The patients underwent corrective surgery involving internal excision of excessive tissue while preserving the overlying mucosa. The surgical approach was tailored to excise hyperplastic tissue with minimal trauma, aiming to optimize esthetic outcomes. Subsequent follow‐up assessments spanning 1–5 years demonstrated stable results, with no indications of relapse or recurrence of tissue overgrowth. Conclusions: Within the limitations of this case series, surgical internal excision holds promise as a viable treatment modality for addressing post‐transplantation hyperplastic tissue response. Clinical Significance: This case series addresses the challenge of uncontrolled tissue overgrowth following connective tissue grafting, a concern for which previous attempts have proven unsuccessful. Internal in‐toto excision emerges as a promising approach for effectively eliminating overgrown tissue, offering potential advancements in the clinical management of this complication. [ABSTRACT FROM AUTHOR]