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AbstractBackgroundAims/ObjectivesMaterial and methodsResultsConclusions and significanceEndoscopic sphenopalatine artery cauterization (ESPAC) has become an important method to manage posterior epistaxis.To investigate the application of plasma knife and lateral nasal wall incision in ESPAC in the treatment of posterior epistaxis.A retrospective study of 32 cases who underwent ESPAC for epistaxis was conducted. A vertical incision was made on the lateral nasal well to expose the sphenopalatine artery (SPA). The main branches of SPA were cauterized with a plasma knife or bipolar coagulation forceps. Cases were divided into plasma knife group (group PK) and bipolar group (group BP). The re-bleeding rates, operation time and the incidence of serious complication were compared between the two groups.ESPAC was successfully completed via a lateral nasal wall incision without maxillary antrostomy in all cases. All the patients were followed-up for 3 months, no serious complication was reported. There was no significant difference in re-bleeding rates and incidence of serious complication between the two groups. The operation time of group PK was shorter than group BP.Lateral nasal well incision without maxillary antrostomy is feasible for ESPAC. The application of a plasma knife may help to shorten the operation time. [ABSTRACT FROM AUTHOR]

As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed. [ABSTRACT FROM AUTHOR]

Background: Longitudinal incision is the commonly used incision for entry into the submucosal space during peroral endoscopic myotomy (POEM) for esophageal motility disorders. Transverse incision is another alternative for entry and retrospective data suggest it has less operative time and chance of gas-related events. Methods: This was a single-center, randomized trial conducted at a tertiary care hospital. Patients undergoing POEM for esophageal motility disorders were randomized into group A (longitudinal incision) and group B (transverse incision). The primary objective was to compare the time needed for entry into the submucosal space. The secondary objectives were to compare the time needed to close the incision, number of clips required to close the incision, and development of gas-related events. The sample size was calculated as for a non-inferiority design using Kelsey method. Results: Sixty patients were randomized (30 in each group). On comparing the 2 types of incisions, there was no difference in entry time [3 (2, 5) vs 2 (1.75, 5) min, p = 0.399], closure time [7 (4, 13.5) vs 9 (6.75, 19) min, p = 0.155], and number of clips needed for closure [4 (4, 6) vs 5 (4, 7), p = 0.156]. Additionally, the gas-related events were comparable between the 2 groups (capnoperitoneum needing aspiration—5 vs 2, p = 0.228, and development of subcutaneous emphysema—3 vs 1, p = 0.301). Conclusion: This randomized trial shows comparable entry time, closure time, number of clips needed to close the incision, and gas-related events between longitudinal and transverse incisions. Registration number: CTRI/2021/08/035829. [ABSTRACT FROM AUTHOR]

Introduction: Conjunctival cysts are usually asymptomatic but they can cause foreign body sensation and contribute to dry eye disease. The purpose of this case report is to describe the presentation and treatment of an infected inclusion cyst of a conjunctival nevus in a healthy 36-year-old patient. Case Presentation: A healthy 36-year-old man presented to the emergency department for redness and pain in his left eye for 1 day. Slit-lamp examination revealed a conjunctival hyperemia and a conjunctival nevus with 4 inclusion cysts, one of which was filled with purulent material. Fluorescein staining of the conjunctival epithelium was negative. Α mini-incision of the white cyst was performed using a 30 G needle, followed by bimanual drainage and topical treatment with tobramycin and moxifloxacin drops every 3 h for a week. A swab of the purulent drainage was positive for gram-positive flora. One week after the drainage of the cyst, the patient was asymptomatic and on slit-lamp examination, the 4 inclusion cysts were filled with a transparent liquid, there was not any vessel dilation and fluorescein staining was negative. Conclusion: Conjunctival inclusion cysts, although considered benign, can become infected and form a conjunctival abscess. A mini-incision on the slit lamp combined with bimanual drainage and followed by topical antibiotic drops seems to be a safe and effective treatment.

Study Design: Review. Objective: Unilateral Biportal Endoscopy (UBE) is a minimally invasive surgery that is gaining recognition and being employed in clinical practice. Nevertheless, the precise method for determining UBE portals' location varies depending on the originator's preferences or the anatomical structure's proximity to the portal positions. Consequently, the relationship among UBE portals' locations is messy. This study aims to elaborate on the specific portal localization and explore the positional association and commonality among different UBE approaches' portals. Methods: The following keywords are used to search in the PubMed, Ovid, Web of Science, ScienceDirect, SpringerLink, Scopus, CNKI, and Wanfang database: "Biportal endoscopic spinal surgery", "Two portal endoscopic spinal surgery", "Percutaneous biportal endoscopic decompression", "Unilateral biportal endoscopy", "Irrigation endoscopic discectomy", "UBE" and "BESS". Results: After screening, 29 pieces of literature are included. The study summarizes different UBE approach portal localizations, categorized by fusion or non-fusion surgery and pathological classification. The study presents an inaugural method for categorizing the lumber into four surgical intervals based on bone landmarks and assigns different UBE approaches to the appropriate intervals based on their characteristics, making the selection of UBE surgical approaches' portal locations more flexible. Additionally, the study provides an overview of the indications, complications, and distinct benefits associated with each interval, further refining the novel UBE portal interval localization method. Conclusion: The study clarifies the interrelationship and commonality between the portals of different UBE approaches and proposes a new UBE portal interval localization method to enhance surgeons' understanding and proficiency in UBE procedures. [ABSTRACT FROM AUTHOR]

Channel incision is an evident trend for river evolution in many European rivers and notably the Western Carpathians, whose former braided and multichannel wandering river system is transforming into a single‐thread channel, but it is often difficult to separate drivers and determine if incision is finished or is still ongoing. To overpass these research gaps, this paper presents an innovative approach to assess the multidecadal incision of the Belá River in the Western Carpathians since 1949 by LiDAR‐based analyses of floodplain surfaces above the river channel dated from historical aerial images. Detailed analyses of ongoing incision were also calculated based on DEM of differences (DoD) using Structure‐from‐Motion (SfM) photogrammetry‐derived topo‐bathymetric models. The study applied the BACI (Before‐After‐Control‐Impact) approach that compared pre‐state (Before), post‐state (After) and reach (Control) that is not affected by potential external effects with degraded (impacted) reach to be able to distinguish the driver effects. Floodplain channel surface analyses indicate the maximum incision up to 4 m and incision rate of 5.7 cm/year that occurred in the most degraded reach. Moreover, cross‐section profiles point to accelerated incision of 24.5 cm/year in the last 10 years (2011–2021) by the propagation of incision upstream. Overall, the net changes from the UAV survey pointed to 22 759 m3 of gravel sediments, constituting outwash from the 1.6 km long channel system (2015–2022) by incision, whereas analyses of historical channel surfaces estimated erosion of 573 303 m3 from impacted reaches between 1949 and 2020. Incision evidence is only observed in the downstream part below the control section due to local drivers (channel regulation, comprising embankment and gravel mining that activated a backward erosion of the system with knickpoint migration upstream). This analysis shows the benefits of combining different sources of data to separate long‐term and ongoing channel responses and the BACI‐approach to better target cause–effect relationships in space and time. [ABSTRACT FROM AUTHOR]

Objective: To review our single-institution experience in the surgical management of foramen magnum tumors via a far-lateral approach using an oblique straight incision. Methods: From October 2023 to January 2024, four cases of tumors in the foramen magnum area treated at the Capital Medical University-affiliated XuanWu hospital neurosurgery department were involved in this study. All cases were managed with a far-lateral approach using an oblique straight incision. We retrospectively reviewed the clinical and imaging data, as well as the surgical strategies employed. Results: Three cases of foramen magnum meningiomas and one case of glioma of the ventral medulla. All cases underwent a far-lateral approach using an oblique straight incision; all cases had a gross total resection, and the wounds healed well without cerebral fluid leakage or scalp hydrops. Except for one case of right foramen magnum meningioma, which had dysphagia and pneumothorax, the other cases were without any postoperative complications. Conclusion: A far-lateral approach using an oblique straight incision can preserve muscle integrity and minimize subcutaneous exposure, allowing for complete anatomical reduction of muscles. This craniectomy method is simple and replicable, making it worthy of further clinical practice. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSI) are one of the common complications following spinal fusion surgery. Unfortunately, several studies had shown conflicting results regarding optimal timing of surgical antimicrobial prophylaxis (SAP) administration. Due to limitations in population homogeneity and sample size, these studies have not provided significant statistical correlations or clear practical recommendations. The purpose of the study was to investigate the impact of timing of cefuroxime SAP on the risk of SSI in patients undergoing spinal fusion surgery, and to determine the optimal timing of administration. Retrospective nested case-control study. We retrospectively analyzed consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021. In the current study, the primary outcome measure was SSI. This was a retrospective nested case-control study. All consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021 formed a retrospective cohort. For each SSI case, 2 controls free of SSI at the time of the index date of their corresponding case were selected, matched by age, sex, and calendar year. Electronic record and radiographic data were reviewed retrospectively in electronic database. SAP related data included timing of administration, preoperative dose, intraoperative second dose, and postoperative use. To examine the effects of mismatched variables, we further adjusted for possible confounding factors using conditional logistic regression models. Subsequently, subgroup analyses were conducted to assess the robustness of the statistical associations. According to the preplanned statistical scheme and matching factors, we matched 236 controls for these SSI cases, and the subsequent statistical analysis was performed on these 354 patients. After adjusting for confounding factors, the results indicated that the risk of SSI was 70% higher in the group receiving SAP 31 to 60 minutes before incision compared to the group receiving SAP 0 to 30 minutes before incision (OR=1.732, 95%CI 1.031–2.910, p=.038). Additionally, the risk of SSI was 150% higher in the group receiving SAP 61 to 120 minutes before incision compared to the group receiving SAP 0 to 30 minutes before incision (OR=2.532, 95%CI 1.250–5.128, p=.010). In subgroup analysis, this statistical trend persisted for both deformity surgeries and different SSI classifications. Administering cefuroxime SAP within 30 minutes before skin incision significantly reduces the risk of SSI, whether they are deep or superficial, in spinal fusion surgery. This pattern remains consistent among spinal deformity patients. [ABSTRACT FROM AUTHOR]

Dengue is humans' most prevalent and crucial arthropod-borne viral illness. The majority of dengue fever patients have no symptoms, but certain individuals may progress to dengue shock syndrome or dengue hemorrhagic fever. Spontaneous auricular hematoma is a rare complication of dengue fever. We report a unique case of spontaneous pinna hematoma in a young, healthy patient who presented with an unprovoked pinna swelling while being treated for dengue fever. The patient underwent aspiration, drainage, and compression dressing over the auricular hematoma with antibiotic coverage and was discharged well. Early identification of this potential warning symptom may avoid permanent ear deformity. [ABSTRACT FROM AUTHOR]

Background: Ludwig's angina is a potentially life-threatening disease characterized by diffuse bilateral cellulitis with an odontogenic origin. This unique infection is now rare owing to the antibiotic era. Case: This patient presented to the emergency room with trismus, jaw and neck swelling, mild respiratory distress with tachypnea, hyperthermia, and panic. Clinical examination and radiographic evaluation confirmed the diagnosis of Ludwig's angina. As it is a quickly spreading infection, the patient was taken up for immediate surgical decompression leading to pus drainage, removal of the offending tooth, bacterial culture and sensitivity, and administration of empirical antibiotics. As we had operated promptly, there was no need for emergency airway intervention, and the patient had immediate relief from airway distress. Conclusions: Early accurate diagnosis with conservative surgical decompression, thereby negating the need for airway intervention, was vital to avoiding mortality which is always possible in such an expeditious infection.

Purpose: To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. Methods: We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. Results: The total incidence in the 84 studies was 4.8% (95% CI 3.7% – 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%—11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%—3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%—4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%—6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% – 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. Conclusion: The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate if delivering multiple doses of N-acetylcysteine (NAC) post-surgery in addition to pre-incisional administration significantly impacts the wound healing process in a rat model. Full-thickness skin incisions were carried out on the dorsum of 24 Sprague-Dawley rats in six locations. Fifteen minutes prior to the incision, half of the sites were treated with a control solution, with the wounds on the contralateral side treated with solutions containing 0.015%, 0.03% and 0.045% of NAC. In the case of the NAC treated group, further injections were given every 8 h for three days. On days 3, 7, 14 and 60 post-op, rats were sacrificed to gather material for the histological analysis, which included histomorphometry, collagen fiber organization analysis, immunohistochemistry and Abramov scale scoring. It was determined that scars treated with 0.015% NAC had significantly lower reepithelization than the control at day 60 post-op (p = 0.0018). Scars treated with 0.045% NAC had a significantly lower collagen fiber variance compared to 0.015% NAC at day 14 post-op (p = 0.02 and p = 0.04) and a lower mean scar width than the control at day 60 post-op (p = 0.0354 and p = 0.0224). No significant differences in the recruitment of immune cells and histological parameters were found. The results point to a limited efficacy of multiple NAC injections post-surgery in wound healing. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Since its Food and Drug Administration (FDA) approval in 2018, Intuitive Surgical DaVinci single port (SP) robotic platform has been an effectively used technology for multiple urologic procedures. The purpose of this study is to share our early intraoperative and perioperative outcomes and potential benefits for performing a lower anterior access (LAA) incision for SP robot-assisted partial nephrectomy (SP-RAPN). The LAA incision enables performing a trans- or retroperitoneal (RP) approach through the same incision and eases the transition to a RP approach. Methods: This study is a prospective review of 78 SP-RAPN cases between March 2021 and January 2023 by an experienced robotic surgeon. A single 2–3 cm oblique incision parallel to the external oblique muscle, one-third of the distance between the iliac crest and umbilicus, was used to insert the multichannel port to perform the RAPN. We extracted intra- and perioperative data of these patients to share the outcomes of this approach. Results: SP-RAPN was effectively completed in 78 patients (38 females and 40 males) without conversion to open or laparoscopic techniques. The mean age was 61.2 ± 12.1 years. The mean tumor size was 3.0 ± 1.2 cm, 43 were right-sided masses, and 35 were left sided. The R.E.N.A.L Nephrometry score ranged from (4–11) with an average of 7.0 ± 1.9. Average operating room time was 90.5 ± 24.6 minutes, estimated blood loss was 88.3 ± 134 mL, and length of stay of 1.07 ± 0.7 days. Of the 78 cases, 40 required clamping of the renal artery with average warm ischemia time of 19.4 ± 6.7 minutes in patients who underwent clamping. No complications in all of 78 patients. Conclusions: This study demonstrates the feasibility and reproducibility of SP-RAPN using a LAA incision. This incision provides a standardized approach for surgeons to transition to the RP approach using the SP platform. [ABSTRACT FROM AUTHOR]

Summary: Background: Incisional complications following ventral midline celiotomy represent a challenge for equine surgeons. Preventative measures to minimise risks of incisional complications are continuously being investigated. This includes the search for an ideal surgical closure method. Objective: To compare the incidence of incisional complications after skin closure with nylon sutures versus stainless‐steel skin staples (SSS) following ventral midline celiotomy for colic surgery in horses and to assess additional risk factors for incisional complications. Study design: Prospective blinded randomised study (2012–2014). Methods: One hundred and twenty‐three horses that underwent colic surgery between May 2012 and May 2014 and survived for >2 weeks were included in the study. Horses were allocated randomly to two groups—65 horses were closed with skin staples, and 58 horses were closed with skin sutures (nylon‐0). Patient records and a follow‐up questionnaire were used to record incisional complications that occurred during hospitalisation and after discharge. Results: Follow‐up information was available in 119 of 123 horses. Four horses without follow‐up were excluded. With strict inclusion criteria, incisional drainage was recorded in 43% (49/115) of the horses, including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group. Pregnancy and large colon intestinal lesions were risk factors for incisional complications. Surgeon 3 was found to decrease the incidence of incisional infection. No association was detected between incisional complications and hernia development. Main limitations: The non‐uniformity of the follow‐up examination; reliance on owners or caregiver of the horse for follow‐up information, horses lost to follow‐up, incomplete data. Another limitation was the single‐centre design of the study. Conclusions: Although not significantly superior, the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure. [ABSTRACT FROM AUTHOR]

Objectives: Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. Results: The total standardized incidence rate of MSI-associated procedures in the observational period 2005—2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI – related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. Conclusions: Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. Clinical relevance: Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support. [ABSTRACT FROM AUTHOR]

Background: During anterior cruciate ligament (ACL) reconstruction, there are various autograft options. Donor-site morbidity is an important consideration while deciding the type of the autograft. Gracilis and semitendinosus autografts are commonly used in ACL reconstruction, resulting in weakness of the hamstring muscle. Hypothesis: We hypothesized that if we preserved the tibial insertion site of the sartorial fascia (SF) during hamstring tendon harvest, there would be better recovery of knee flexor strength. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective study, 34 patients (aged 20-59 years) underwent ACL reconstruction using hamstring tendon autograft with 2 different incision techniques on the SF. The tibial attachment site of the SF was preserved in 17 patients. The insertion site of the muscle was incised transversely in 17 patients. The follow-up duration was ≥2 years. Patients were recalled to the institute for examination and muscle strength assessment. The results were compared between the groups in terms of flexor and extensor knee isokinetic muscle strength at 60 and 180 deg/s. Results: There was no statistical difference between the groups in terms of age, sex, or body mass index. When compared with patients whose SF attachment site was incised, patients with a preserved SF tibial insertion were found to have a higher flexion peak torque at the angular speed of 180 deg/s (P < 002). No statistically significant difference was noted at 60 deg/s. Conclusion: During collection of gracilis and semitendinosus autografts, preserving the SF tibial attachment site was associated with better knee flexion peak torque. [ABSTRACT FROM AUTHOR]

The geomorphological impact of base-level lowering on ephemeral alluvial streams has been extensively investigated through fieldwork, experimentation, and modeling. Yet, the understanding of hydrological parameters governing the dynamics of the stream's geometry during discrete flood events is lacking due to limited direct measurements of flood-scale erosion/deposition. The emergence of novel remote sensing methods allows for quantifying morphological modifications caused by floods in alluvial streams. This study utilizes drone surveys and hydrological data to quantitatively investigate the relation between channel evolution in alluvial tributaries draining to the receding Dead Sea and the hydrological characteristics of flash floods. Drone-based photogrammetric surveys were conducted before and after 25 floods, over a period of four years, to generate centimeter-scale Digital Elevation Models (DEM) and orthophoto maps of two major streams. The outcomes of these DEMs are maps of ground elevation changes (erosion/deposition), thalweg longitudinal profiles, and channel cross sections, revealing the incision/aggradation along and across the streams. Statistical comparison of results with flow hydrographs identified potential relations linking the hydrological characteristics of each flood and the corresponding geomorphological modifications. Peak discharge emerged as the primary factor influencing sediment removal, leading to more efficient sediment evacuation and a negative sediment budget with increased discharge. Water volumes of floods also exhibited a secondary effect on the sediment budget. The chronological order of floods, whether first or later in the season, was identified as the primary factor determining incision magnitude. Knickpoints formed at the streams' outlets during the dry period, when lake-level drops, amplifying the impact of the first flood. These findings have potential implications for infrastructure planning and environmental management in the context of climate change and altered water runoff. The research highlights the efficiency of drone-based photogrammetry for cost-effective and timely data collection, providing invaluable flexibility for field research. [ABSTRACT FROM AUTHOR]

Hyperselective neurectomy is used to treat spastic arm paralysis. The aim of the study was to analyze the nerve branching patterns of elbow and wrist flexors/pronator to inform hyperselective neurectomy approached. Eighteen upper extremities of fresh cadaver specimen were dissected. The number of motor branches from the musculocutaneous nerve to biceps brachii and brachialis, median nerve to pronator teres, flexor carpi radialis and ulnar nerve to flexor carpi ulnaris were counted. The origin site of each primary motor branch was documented. Either biceps or brachialis was innervated by one or two primary motor branches. Pronator teres was innervated by one to three motor trunks and the pattern for flexor carpi radialis was a common trunk with other branches. The origin of the biceps and brachialis nerve trunk was located approximately 30% to 60% of the length of the arm. The median nerve branched to pronator teres and flexor carpi radialis at the region about 34mm (SD 18.8mm) above and 50mm (SD 14.9mm) below the medial epicondyle. Flexor carpi ulnaris was innervated by one to three motor trunks and the mean distance from the medial epicondyle to the origin of flexor carpi ulnaris nerve on ulnar nerve was 18.7 mm (SD 6.5mm). Primary motor branches to elbow flexors, wrist flexors and pronators were various, while the regions of their origins were relatively settled. It was recommended the incisions be designed according to the location of the primary motor trunks. [ABSTRACT FROM AUTHOR]

Incisional scarring is a factor of cosmetic appearance evaluated after breast reconstruction, along with the shape, position, and size of the breast. This study aimed to examine the effect of the incision scar location on patient satisfaction after breast reconstruction. Using the Japanese version of the SCAR‐Q, we assessed the scar appearance, symptoms and psychosocial effects. Plastic surgeons performed assessments using the Manchester Scar Scale. The patients were divided into two groups: those with scars on the margins of the breast (MB group) and those with scars in the breast area (IB group). The results revealed that patients in the MB group reported significantly higher satisfaction with the scar appearance and psychological impact than those in the IB group. However, assessments using the Manchester Scar Scale did not reveal any significant differences between the two groups. In conclusion, this study underscores the importance of patient‐reported outcomes in the evaluation of scar satisfaction after breast reconstruction. Patients tend to prefer and have higher satisfaction with scars along the breast margin, which offers valuable insights into surgical decisions. Further studies with larger and more diverse sample sizes are required for validation. [ABSTRACT FROM AUTHOR]

Background: Ludwig's angina is a potentially life-threatening disease characterized by diffuse bilateral cellulitis with an odontogenic origin. This unique infection is now rare owing to the antibiotic era. Case: This patient presented to the emergency room with trismus, jaw and neck swelling, mild respiratory distress with tachypnea, hyperthermia, and panic. Clinical examination and radiographic evaluation confirmed the diagnosis of Ludwig's angina. As it is a quickly spreading infection, the patient was taken up for immediate surgical decompression leading to pus drainage, removal of the offending tooth, bacterial culture and sensitivity, and administration of empirical antibiotics. As we had operated promptly, there was no need for emergency airway intervention, and the patient had immediate relief from airway distress. Conclusions: Early accurate diagnosis with conservative surgical decompression, thereby negating the need for airway intervention, was vital to avoiding mortality which is always possible in such an expeditious infection.

Introduction: The effectiveness of the uterine tourniquet alone for securing hemostasis during abdominal myomectomy remains debatable; however, its combination with uterine compression though popular has very scanty documented evidence of hemostatic efficacy. Aim: To determine the effect of uterine incision compression (UIC) combined with tourniquet on operative blood loss associated with abdominal myomectomy. Materials and Methods: A multicenter randomized double blind, controlled trial involving 184 participants randomized into two groups: 92 in the UIC and 92 in the control arm. UIC was administered in the interval from release of the uterine tourniquet to palpation of contraction. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21. Results: The mean intraoperative blood loss was lower in the UIC group (951.41 ± 362.32 mL) than in the control group (1051.30 ± 427.77 mL), but did not reach statistical significance (p = 0.125). The observed mean duration of myomectomy was, however, longer among the controls (152.95 ± 32.67 min, compared with 119.70 ± 23.96 min, p = 0.001). The control group also had significantly higher rates of deployment of additional hemostatic measures (OR = 4.68, 95% CI = 2.304–12.784, p = 0.001), occurrence of postoperative pyrexia (OR = 1.65, 95% CI = 1.256–2.154, p = 0.002), and greater mean postoperative blood loss (p = 0.003). Conclusion: Although no statistically significant difference occurred in intraoperative blood loss, adjunctive UIC was useful in reducing operating time and postoperative blood loss.

Gland-preserving surgery has gained popularity for treating benign parotid tumors, offering potential benefits by preserving facial nerve function and salivary secretion while reducing complications. This study aims to evaluate the functional, cosmetic, and disease control outcomes of gland-preserving surgery via a postauricular sulcus incision. An observational longitudinal investigation encompassed 46 patients undergoing gland-preserving surgery for benign parotid tumors via the postauricular sulcus incision approach. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. Predominantly, tumors were situated in the superficial lobe, with successful application observed in 8 instances (17%) within the deep lobe. Notably, no tumor recurrences were detected during the follow-up period. Postoperative pain remained minimal, accentuated by high patient satisfaction regarding the incision scar and facial symmetry. Furthermore, preservation of facial nerve functionality and salivary secretion was observed. Gland-preserving surgery via the postauricular sulcus incision technique exemplifies advantageous functional and cosmetic outcomes when addressing benign parotid tumors. This approach presents a secure and efficient alternative, facilitating effective local management. [ABSTRACT FROM AUTHOR]

Introduction: The effectiveness of the uterine tourniquet alone for securing hemostasis during abdominal myomectomy remains debatable; however, its combination with uterine compression though popular has very scanty documented evidence of hemostatic efficacy. Aim: To determine the effect of uterine incision compression (UIC) combined with tourniquet on operative blood loss associated with abdominal myomectomy. Materials and Methods: A multicenter randomized double blind, controlled trial involving 184 participants randomized into two groups: 92 in the UIC and 92 in the control arm. UIC was administered in the interval from release of the uterine tourniquet to palpation of contraction. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21. Results: The mean intraoperative blood loss was lower in the UIC group (951.41 ± 362.32 mL) than in the control group (1051.30 ± 427.77 mL), but did not reach statistical significance (p = 0.125). The observed mean duration of myomectomy was, however, longer among the controls (152.95 ± 32.67 min, compared with 119.70 ± 23.96 min, p = 0.001). The control group also had significantly higher rates of deployment of additional hemostatic measures (OR = 4.68, 95% CI = 2.304-12.784, p = 0.001), occurrence of postoperative pyrexia (OR = 1.65, 95% CI = 1.256--2.154, p = 0.002), and greater mean postoperative blood loss (p = 0.003). Conclusion: Although no statistically significant difference occurred in intraoperative blood loss, adjunctive UIC was useful in reducing operating time and postoperative blood loss. [ABSTRACT FROM AUTHOR]

Background: Distal biceps tears are uncommon injuries, typically leading to significant loss of elbow flexion and supination strength; surgical repairs restore muscular strength and endurance. The aim of this study was to compare the complication rate of early (< 21 days) vs delayed (> 21 days) repair and the effect of types of incision and fixation methods used in the repair. Methods: A total of 86 cases were retrospectively reviewed, and 66 cases were included in the study after exclusion. Different preoperative and intraoperative variables and postoperative outcome measures were recorded. We analysed the effects of early and delayed repair, types of incision and fixation methods on the complications. Results: 31 had an early, and 35 had delayed distal biceps repair. The mean follow-up was 14.92 weeks. 13.6% had major, and 40.9% had minor complications. No significant difference was noted in complications between the two groups (54.8% vs 54.3%). Higher complications were observed when surgery was done using a single anterior incision compared to 2 anterior incisions (68.8% vs 16.7%, p=0.0002). Overall, higher (76.3% vs 25.9%, p=0.0001) complications were noted in patients where fixation was done using a cortical button & interference screw in comparison to the cortical button alone. Conclusion: No significant difference in complication was noted between early and delayed repair. However, more complications were noted in the single anterior incision compared to the two anterior incision technique. Higher complications were also observed with the cortical button and interference screw fixation method compared to the cortical button alone. [ABSTRACT FROM AUTHOR]

Ameloblastoma is a benign but locally invasive tumour. Early diagnosis of ameloblastoma and formulating an appropriate treatment plan play a crucial role in reducing the postoperative recurrence rate. The imaging features of ameloblastoma are similar to those of other odontogenic diseases; thus, the diagnosis of ameloblastoma remains challenging. This review summarises the diagnostic techniques used for the detection of ameloblastoma and the methods for differentiating it from other benign odontogenic tumours to aid in the clinical diagnosis. A comprehensive review was conducted by searching the database of PubMed for studies published up to May 2023. Panoramic radiography, computed tomography, and magnetic resonance imaging have been used to detect ameloblastoma, whereas fine-needle aspiration cytology and biopsies have been used to enhance diagnostic precision and clinical diagnosis. 18F-fluorodeoxyglucose (FDG) and FDG positron emission tomography( PET) have been used to detect metastasis of ameloblastoma to determine the prognosis of the disease. Laboratory tests are more suitable for detecting genetic alterations and identifying certain markers. Different diagnostic techniques aid in differentiating ameloblastoma from other odontogenic diseases. Combining these techniques may increase the diagnostic accuracy in patients with suspected ameloblastoma. [ABSTRACT FROM AUTHOR]

Sagni Hanbisa,1 Wondmagegn Tamiru Tadesse,2 Teferra Abula2 1Department of Pharmacy, Institute of Health Science, Wallaga University, Nekemte, Ethiopia; 2Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Wondmagegn Tamiru Tadesse, Tel +251 911637599, Email mail2wondm@gmail.com; wondmagegn.tamiru@aau.edu.etPurpose: Prunus africana is a well-known plant that is used in Ethiopian traditional medicine for the treatment of wounds and other ailments, although there is no scientific evidence to back up the claims of its wound-healing properties. Thus, the objective of this study is to evaluate the wound-healing potential of P. africana bark extract in mice.Methods: The bark of the plant was extracted by successive maceration using 80% methanol and then fractionated with aqueous, n-butanol, and chloroform. The crude extract and solvent fractions were formulated as an ointment. Wound healing activity was evaluated using excision and incision wound models. Total phenol, flavonoid, and alkaloid contents of the crude extract, aqueous, and n- butanol fractions of the plant were determined.Results: In both models, mice treated with 5% (w/w) and 10% (w/w) crude extract ointment exhibited a significant (p < 0.001) wound healing activity compared with control as evidenced by the increased rate of wound contraction and hydroxyproline content, the reduced epithelialization time, and the higher skin breaking strength. Mice treated with aqueous fraction ointment exhibited a high percentage of wound healing effect among all solvent fractions. The aqueous fraction consisted of higher phenolic (49.71 ± 0.73 mg/g) and flavonoid (39.58 ± 0.27 mg/g) content, while alkaloid (3.89 ± 0.55 mg/g) content was the lowest.Conclusion: Prunus africana stem bark extract demonstrated wound healing activity in mice model which supports the acclaimed use by Ethiopian traditional medicine.Keywords: wound healing, mice, P. africana, extract, fraction, incision, excision

David A Ammar,1 Eric Porteous,2 Malik Y Kahook3 1Research Department, Lions World Vision Institute, Tampa, FL, USA; 2New World Medical, Rancho Cucamonga, CA, USA; 3Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USACorrespondence: Malik Y Kahook, Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA, Tel +1 720 848 2501, Email Malik.Kahook@cuanschutz.eduPurpose: To evaluate incisional or excisional tissue-level effects of ab interno goniotomy techniques on human trabecular meshwork (TM).Methods: The TM from human cadaveric corneal rim tissue was treated using three devices: (1) Kahook Dual Blade (KDB) GLIDE, (2) iAccess, and (3) SION. Two human corneal rims were used for each of the iAccess and SION devices and one with the KDB GLIDE, with 360 degrees of TM treated in each case. Sections were then prepared for analysis and comparison between devices. Tissue samples underwent standard histologic processing with H&E stain, followed by comparative analyses.Results: Areas treated with the KDB GLIDE device resulted in nearly complete excision of TM overlying the canal of Schlemm without injury to surrounding tissues. The iAccess device can be used as a focal trephine to create holes or dragged for TM disruption. When used to create holes, iAccess punched through the full thickness of the TM and also disrupted the anterior scleral tissue. It caused some incisional openings through the TM but with significant leaflets remaining and minimal true “hole-punch” effect. When the device tip was dragged, iAccess incised the TM and left debris behind with little, if any, excision of tissue. SION led to both incision and excision of TM with incision predominating over excision.Conclusion: The various methods evaluated to perform ab interno goniotomy resulted in varying degrees of TM incision or excision. Only the KDB GLIDE device resulted in reliable excision of TM, while the other devices produced incision or minimal excision of tissue with residual leaflets and debris. Use of iAccess resulted in focal disruption of the anterior scleral wall. Because incisional approaches that leave longer residual leaflets may be more prone to fibrosis and closure compared to excisional treatments, clinical correlation will be necessary to better understand the significance of these findings with respect to relative effectiveness of intraocular pressure lowering in eyes with glaucoma.Keywords: glaucoma, goniotomy, excision, incision, trabecular meshwork

Full-thickness wounds to the eye can lead to serious vision impairment. Current standards of care (from suturing to tissue transplantation) usually require highly skilled surgeons and use of an operating theater. In this study, we report the synthesis, optimization, and in vitro and ex vivo testing of photocrosslinkable hydrogel-based adhesive patches that can easily be applied to globe injuries or corneal incisions. According to the type and concentration of polymers used in the adhesive formulations, we were able to finely tune the physical properties of the bioadhesive including viscosity, elastic modulus, extensibility, ultimate tensile strength, adhesion, transparency, water content, degradation time, and swellability. Our in vitro studies showed no sign of cytotoxicity of the hydrogels. Moreover, the hydrogel patches showed higher adhesion on freshly explanted pig eyeballs compared to a marketed ocular sealant. Finally, ex vivo feasibility studies showed that the hydrogel patches could seal complex open-globe injuries such as large incision, cruciform injury, and injury associated with tissue loss. These results suggest that our photocrosslinkable hydrogel patch could represent a promising solution for the sealing of open-globe injuries or surgical incisions. STATEMENT OF SIGNIFICANCE: Current management of severe ocular injuries require advanced surgical skills and access to an operating theater. To address the need for emergent management of wounds that cannot be handled in the operating room, surgical adhesives have gained popularity, but none of the currently available adhesives have optimal bioavailability, adhesive or mechanical properties. This study describes the development, optimization and testing of a light-sensitive adhesive patch that can easily be applied to the eye. After solidification using visible light, the patch shows no toxicity and is more adherent to the tissue than a marketed sealant. Thus this technology could represent a promising solution to stabilize ocular injuries in emergency settings before definitive surgical repair.

Background: Progress in obstetrics has been associated with an increased incidence of cesarean section (CS). Primary CS in a multipara means the first CS performed in woman who has delivered vaginally at least once previously and it is associated with a number of maternal and foetal indications. Objectives: The present research was undertaken to study the incidence and indications of primary CS in multigravida. Method: This prospective observational study was conducted in total 510 booked cases of multigravida reported to antenatal OPD with gestational age >28 weeks and previous vaginal deliveries and no cesarean delivery or any other scar on uterus. Results: Primary CS was performed in 75(14.7%) multigravida women. Majority of cases (48%) with primary CS belonged to 26-30 years age group. The incidence of primary CS in emergency and elective cases was 74.7% and 25.3% respectively. Maternal and fetal indications contributed 44% and 56% of the total cases respectively. Fetal distress (26.7%), malpresentation (18.7%) and failed induction (14.7%) for various co-morbidities were the commonest indications of primary CS. Conclusion: Fetal distress is a major contributor to primary CS in multigravida. Proper antenatal evaluation with early detection and management of high risk cases can reduce the likelyhood of intrapartum fetal distress.

Background: Approximately 10 000 patients undergo cystectomy/ileal conduit annually in the USA, of whom over 70% subsequently develop a parastomal hernia (PSH). Still, no well-established “best” practice for stoma creation to prevent a PSH exists. Objective: To measure the relationship between incision size/type/material and axial tension force (ATF) as a surrogate for herniation force, using several models to mimic abdominal fascia. Design, setting, and participants: Abdominal fascia models included silicone membrane, ex vivo porcine, and embalmed human cadaveric fascia. A dynamometer pulled a Foley catheter (20 mm/min) with the balloon inflated to 125% incision (linear, cruciate, and circular) diameter using a motorized positioning system. The maximum ATF before herniation was recorded. The study was repeated in unused silicone/tissue for suture reinforcement. We evaluated silicone, ex vivo porcine, and human abdominal fascia. Intervention: Incision sizes (1–3 cm) in 0.5-cm increments were evaluated in silicone. A 3-cm incision was used in porcine/human tissue. Outcome measurements and statistical analysis: ATF for herniation was recorded/compared across incision types/sizes using Mann-Whitney U and Kruskal-Wallis tests as appropriate, with α = 0.05. Results and limitations: Linear incision ATF was significantly greater than cruciate and circular incisions. A cruciate incision had significantly greater ATF than a circular incision. In cadaveric tissue, incisions were significantly greater for linear (34.5 ± 12.8 N) versus cruciate (15.3 ± 2.9 N, p = 0.004) and for cruciate versus circular (p = 0.023) incisions. Results were similar in ex vivo porcine fascia and silicone. Reinforcement with a suture significantly increased ATF in all materials/incision sizes/types. The ex vivo nature is this study’s main limitation. Conclusions: This study suggests that urostomy fascial incision type may influence ATF required for herniation. Linear incisions may be preferable. Urostomy reinforcement may significantly increase ATF required for a PSH. These data may help establish best practices for PSH risk reduction. Patient summary: The results of this study illustrate that urostomy fascia incision type may influence the force required to create a parastomal hernia. Linear incisions may be preferable.

Proper surgical technique is crucial for optimizing wound healing and reducing scar tissue formation. There are numerous measures a surgeon can take to improve wound healing; however, the angle of the incision made at the surgical site has been suggested to potentially play a role in wound healing, particularly between beveled and perpendicular incisions. Objectives: The goal of this study was to analyze the literature and observe whether a discrepancy exists between using beveled vs perpendicular incisions in surgical procedures, as well as to understand the relationship between incision angles and physiologic wound healing. Methods: Google Scholar, Pubmed, and MEDLINE searches regarding incision techniques were made to find relevant articles in the fields of plastic surgery, dermatologic surgery, periodontal surgery, and ophthalmic surgery which included studies from 2004 to 2023. The exclusion criteria consisted of studies that did not have a comparative design and/or were not revolved around incision angle. Results: After filtering out irrelevant studies, we selected six studies that addressed the dichotomy between beveled and perpendicular incisions. Out of the six studies, four were in favor of beveled incisions, and the remaining studies either found no significant difference or reported benefits to some degree of using perpendicular cuts. Discussion: The literature seems to suggest that beveled incisions have an advantage over perpendicular incisions in wound healing, particularly in the aspects of esthetic and accelerated wound healing. This is potentially due to the increased surface area of the dermis, preservation of hair follicles, and decreased incidence of infection. Conclusion: Although the literature seems to favor beveled incisions, a definitive conclusion cannot be made as there is not sufficient evidence to support the superiority of one incision type over the other.

The CXCR2 chemokine receptor is known to have a significant impact on the initiation and control of inflammatory processes. However, its specific involvement in the sensation of itch is not yet fully understood. In this study, we aimed to elucidate the function of CXCR2 in the trigeminal ganglion (TG) by utilizing orofacial itch models induced by incision, chloroquine (CQ), and histamine. Our results revealed a significant up-regulation of CXCR2 mRNA and protein expressions in the primary sensory neurons of TG in response to itch stimuli. The CXCR2 inhibitor SB225002 resulted in notable decrease in CXCR2 protein expression and reduction in scratch behaviors. Distal infraorbital nerve (DION) microinjection of a specific shRNA virus inhibited CXCR2 expression in TG neurons and reversed itch behaviors. Additionally, the administration of the PI3K inhibitor LY294002 resulted in a decrease in the expressions of p-Akt, Akt, and CXCR2 in TG neurons, thereby mitigating pruritic behaviors. Collectively, we report that CXCR2 in the primary sensory neurons of trigeminal ganglion contributes to orofacial itch through the PI3K/Akt signaling pathway. These observations highlight the potential of molecules involved in the regulation of CXCR2 as viable therapeutic targets for the treatment of itch. [ABSTRACT FROM AUTHOR]

FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage-related maternal deaths in many low-and middle-income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence-based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta. [ABSTRACT FROM AUTHOR]

The retroauricular (RA) incision has several theoretical benefits compared with the reverse question mark (RQM) incision for decompressive hemicraniectomy (DHC), but limited data comparing the 2 exist. Consecutive patients who underwent DHC between 2016 and 2022 and survived ≥30 days at a single institution were included. The primary outcome was wound complication within 30 days (30dWC) requiring reoperation. Secondary outcomes included 90-day wound complication (90dWC), craniectomy size in anterior-posterior (AP) and superior-inferior dimensions, distance from the inferior craniectomy margin to the middle cranial fossa (MCF), estimated blood loss (EBL), and operative duration. Multivariate analyses were performed for each outcome. A total of 110 patients (RA group: 27, RQM group: 83) were included. The incidence of 30dWC was 1.2% and 0 in the RQM and RA groups, respectively. The incidence of 90dWC was 2.4% and 3.7% in the RQM and RA groups, respectively. There was no difference in mean AP size (RQM: 15 cm, RA: 14.4 cm; P = 0.18), superior-inferior size (RQM: 11.8 cm, RA: 11.9 cm; P = 0.92), and distance from MCF (RQM: 15.4 mm, RA: 18 mm; P = 0.18). Mean EBL (RQM: 418 mL, RA: 314 mL; P = 0.36) and operative duration (RQM: 103 min, RA: 89 min; P = 0.14) were similar. There was no difference in cranioplasty wound complications, EBL, or operative duration. Wound complications are comparable between the RQM and RA incisions. The RA incision does not compromise craniectomy size or temporal bone removal. [ABSTRACT FROM AUTHOR]

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