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Background: Abdominoperineal resection (APR)—the standard surgical procedure for low-lying rectal cancer (LRC)—leads to significant perineal defects, posing considerable reconstruction challenges that, in selected cases, necessitate the use of plastic surgery techniques (flaps). Purpose: To develop valuable decision algorithms for choosing the appropriate surgical plan for the reconstruction of perineal defects. Methods: Our study included 245 LRC cases treated using APR. Guided by the few available publications in the field, we have designed several personalized decisional algorithms for managing perineal defects considering the following factors: preoperative radiotherapy, intraoperative position, surgical technique, perineal defect volume, and quality of tissues and perforators. The algorithms have been improved continuously during the entire period of our study based on the immediate and remote outcomes. Results: In 239 patients following APR, the direct closing procedure was performed versus 6 cases in which we used various types of flaps for perineal reconstruction. Perineal incisional hernia occurred in 12 patients (5.02%) with direct perineal wound closure versus in none of those reconstructed using flaps. Conclusion: The reduced rate of postoperative complications suggests the efficiency of the proposed decisional algorithms; however, more extended studies are required to categorize them as evidence-based management guide tools.

Background: Abdominoperineal resection (APR)—the standard surgical procedure for low-lying rectal cancer (LRC)—leads to significant perineal defects, posing considerable reconstruction challenges that, in selected cases, necessitate the use of plastic surgery techniques (flaps). Purpose: To develop valuable decision algorithms for choosing the appropriate surgical plan for the reconstruction of perineal defects. Methods: Our study included 245 LRC cases treated using APR. Guided by the few available publications in the field, we have designed several personalized decisional algorithms for managing perineal defects considering the following factors: preoperative radiotherapy, intraoperative position, surgical technique, perineal defect volume, and quality of tissues and perforators. The algorithms have been improved continuously during the entire period of our study based on the immediate and remote outcomes. Results: In 239 patients following APR, the direct closing procedure was performed versus 6 cases in which we used various types of flaps for perineal reconstruction. Perineal incisional hernia occurred in 12 patients (5.02%) with direct perineal wound closure versus in none of those reconstructed using flaps. Conclusion: The reduced rate of postoperative complications suggests the efficiency of the proposed decisional algorithms; however, more extended studies are required to categorize them as evidence-based management guide tools. [ABSTRACT FROM AUTHOR]

Background Isolated coronary sinus atrial septal defect (CSASD) is a rare congenital cardiac anomaly, comprising <1% of atrial septal defects. Elderly patients with this anomaly are even more uncommon and sometimes overlooked. Case summary A 73-year-old man with a history of electrical defibrillation therapy for atrial flutter presented with worsening exertional dyspnoea. Cardiac examination revealed CSASD without persistent left superior vena cava, showing only moderate tricuspid regurgitation. Surgical repair of the defect and regurgitant valve improved symptoms dramatically. Discussion Elderly patients with atrial arrhythmias might show uncommon presentations of congenital heart disease. Cardiologists should pay attention to enlarged right ventricle, pulmonary artery, and, in particular, enlarged coronary sinus. Direct closure with interrupted sutures secured with pledgets is effective in some case of terminal type of CSASD. [ABSTRACT FROM AUTHOR]

Objective: To compare drainage and healing by secondary intention with drainage, delayed excision and direct closure (DE/DC). Methods: Between January 2003 and January 2010, 130 patients admitted with an acute pilonidal abscess were randomized to undergo either elliptical incision and drainage (I and D) and healing by secondary intention (Group 1, n=66) or I and D and DE/DC (Group 2, n=64). Data regarding patient and sinus characteristics, hospital stay, healing time, postoperative complications, and recurrence were prospectively collected. Patients were followed-up for a mean of 62.4 months. Results: Ninety percent of patients were men and 10% were women, with a mean age of 26.4 years and a mean body mass index of 31.5. There was no difference in hospital stay between both groups. Mean healing time was significantly (p=0.035) longer for patients in group 1 (32.2 days), compared to those in group 2 (10.7 days). Group 1 patients had significantly fewer postoperative complications (4.5% versus 17.2%, respectively) (p=0.020). The 2 groups had a similar recurrence rate of a pilonidal abscess (6.1% versus 6.3%, p=0.984), and a rate of development of a chronic pilonidal sinus (PNS) (25.8% versus 23.4%, p=0.840). Conclusions: Although there is more rapid healing and fewer visits for dressing with I and D and DE/DC of an acute pilonidal abscess, this is accompanied by a significantly higher overall complication rate than with I and D and secondary healing. Recurrence of an acute abscess or development of a chronic pilonidal sinus is similar with both procedures. [Arch Clin Exp Surg 2012; 1(1.000): 8-13]

The use of thoracoscopy and laparoscopy in the treatment of congenital diaphragmatic hernias (CDHs) has been recently reported; however, the use of these procedures still remains controversial due to CO insufflation and limited working space. In addition, because of difficult techniques, it has not been widely accepted. Among CDH patients, mild cases whose lung is not hypoplastic, and not associated with persistent pulmonary hypertension of the neonate (PPHN) often develop small defects in the diaphragm that can be repaired using 'direct closure.' Because direct closure does not require as wide an operative field as that needed for patch closure, we repaired CDH through umbilical skin windows in two neonates with mild CDH to minimize the wounds. With the creation of additional radical small incisions, the surgeries were successfully performed without any intra- or postoperative complications, and the wounds were cosmetically pleasing. The repair of CDHs through umbilical skin windows is a feasible and useful approach in neonates with mild CDH. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical and functional results of a technical procedure used in the surgical treatment of congenital constriction ring (CCR) in children. Materials and methods: This was a retrospective study undertaken to evaluate the results of surgical techniques performed from January 1995 to December 2005 on 95 patients with 134 congenital constriction bands. Due to the drop-out of nine patients during follow-up, data on 86 patients (121 congenital constriction rings; average age at surgery 1 year 2 months) were analyzed. The extent of the constrictions was classified by according to the Patterson criteria. All patients were treated by two-stage sine plasty combined with removal of the fibrous groove and fasciotomy, with one-half of the ring removed during the first stage and the other half removed 1 week later during the second state. The surgical outcomes were assess according to the Moses criteria. Results: Three types of CCR (Patterson criteria) were identified among the 86 patients (121 constriction rings): types I (5 patients, 4.1 %), II (107, 88.5 %), III (9, 7.4 %). Of the 121 constriction rings, good results were attained in 73.6 % and fair results in 26.4 %. Sensory deficits were seen in six patients immediately after the surgery but all six had improved to a normal condition at the final follow-up examination. There were no skin necrosis or wound healing problems. Conclusion: The combined sine plasty/removal of fibrous groove and fasciotomy method reported here is a simple and safe surgical technique for treating CCR in children. [ABSTRACT FROM AUTHOR]

Though many techniques have been described for the correction of syndactyly, current methods result in skin deficiency that requires skin grafting, especially at the finger bases. We discuss the technical aspects and document our experience with the dorsal pentagonal metacarpal island flap for reconstruction of the web commissure in a series of 12 patients (22 webs) with syndactyly of varying complexity. In appropriately selected cases, this technique can improve reconstruction of the web commissure, facilitating direct closure, minimising the need for skin grafts and offers the potential for continued growth. This reduces operative time significantly and simplifies post-operative wound care. In this series, all our cases healed primarily in two to three weeks with minimal donor site morbidity. There were no post-operative complications, although the prominent dorsal scar remains a concern. At an average follow-up of 33.7 months, no cases of contracture or web creep after correction were noted. [ABSTRACT FROM AUTHOR]

PURPOSE:. The recommended closure techniques for transsphincteric fistulas demonstrate divergent results for postoperative continence and recurrence rates. An incontinence rate of 35 percent and a recurrence rate of up to 54 percent has been reported after transanal advancement techniques. The authors hypothesize that a direct closure of the internal fistula opening without tissue mobilization is easier to facilitate and generally leads to better clinical and functional results. METHODS:. A prospective, observational study between 1995 and 1999 was undertaken in 90 patients with transsphincteric fistulas. A direct closure of the internal fistula opening without a flap was performed in all patients. A three-layer, nonstaggered closure of mucosa, submucosa, internal, and external anal sphincters was performed. The follow-up time periods ranged from one-half to six (median, 2.6) years and included assessment of fistula recurrence and continence using patients’ histories, physical examinations, proctoscopy, and continence scores. Statistical analysis was performed using Student’s t-test or chi-squared test. RESULTS:. Data from 90 patients with a total of 106 operations were analyzed (65 males and 41 females; average age 46 (range, 22–78) years). Sixty-six patients had previous anorectal abscess surgery, and 41 had a previous fistula operation. The mean number of previous fistula operations was 1.7. All patients were continent before surgery. Mean elapsed operative time period was 37 ± 11 minutes, and the mean anal retraction time was 20 ± 7 minutes. Suture line dehiscence was the main postoperative complication. It was found to occur between the fourth and tenth postoperative days in 15 patients (14 percent). In 12 of 15 patients (80 percent), the fistula persisted and operative treatment was necessary. In three patients (20 percent), spontaneous closure took place. A recurrent fistula after wound healing was observed in seven patients (6.6 percent). The risk of developing a suture line dehiscence leading to a persistent fistula or a recurrent fistula was 22.5 percent. Ninety-four percent of the patients were continent (continence score 0), 6 percent had a minimal disorder of continence (score 4). A continence level for all patients was determined by the international classification of continence disorders. CONCLUSIONS:. Direct closure for the treatment of transsphincteric fistulas is a safe and effective approach and achieves a good functional outcome; a small risk of suture line dehiscence, which may lead to a recurrent or persistent fistula, remains. [ABSTRACT FROM AUTHOR]

Objective: This study was performed to compare the modified direct closure method and traditional skin grafting for wounds at the anterolateral thigh (ALT) flap donor site., Methods: Among 29 consecutive patients with wounds at the ALT flap donor site, 14 underwent the modified direct closure method (MDC group) and 15 underwent traditional skin grafting (SG group). The operative time, follow-up time, complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score of the two groups were statistically analyzed., Results: The mean follow-up times in the MDC and SG group were 16.1 and 16.7 months, respectively. Two patients showed partial skin necrosis after skin grafting, but the remaining patients' wounds healed uneventfully. The operative time in the MDC group was an average of about 64 minutes shorter than that in the SG group. The average VSS and SCAR scores in the MDC group were 2.1 and 3.0 points lower, respectively, than those in the SG group., Conclusions: Compared with traditional skin grafting, the modified direct closure method is more efficient for repair of wounds at the ALT flap donor site because of its shorter operative time, better postoperative appearance of the donor site, and higher patient satisfaction.

Surgical repair of an atrial septal defect (ASD) is a safe and effective operation with little to no morbidity and mortality. In an effort to reduce the trauma of surgery, current approaches focus on less invasive surgical techniques, rather than the intracardiac repair. We will describe the different types of ASD, techniques for repair, and options for minimally invasive repair., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Congenital constriction band syndrome is a sporadic condition that may also be present in association with other congenital anomalies. It has an incidence varying from one in 1200 to one in 15,000 live births. There is a significant predilection for the upper extremities and distal limbs. The two main objectives for the treatment of congenital constriction band syndrome are improvement of function and improvement of cosmetic appearance. Different surgical techniques, such as Z-plasty, have been described and used for decades; however, direct closure after the excision of the constricting band seems to be the simplest and most appropriate, allowing the fatty tissue to naturally reposition itself under the skin. This technique is used in a two-stage approach to avoid affecting distal circulation to the limb.