المؤلفون: Chen H; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China., Lai P; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China., Lu H; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China., Zhu J; Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, China., Sang W; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China., Wang C; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China., Zhong Y; Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China., Zhu L; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China. libozhu2018@163.com., Ma J; Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China. majinzhong1963@sina.com.

المصدر: Journal of orthopaedic surgery and research [J Orthop Surg Res] 2024 Jun 24; Vol. 19 (1), pp. 374. Date of Electronic Publication: 2024 Jun 24.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101265112 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-799X (Electronic) Linking ISSN: 1749799X NLM ISO Abbreviation: J Orthop Surg Res Subsets: MEDLINE

مواضيع طبية MeSH: COVID-19*/complications , COVID-19*/epidemiology , Arthroplasty, Replacement, Hip*/adverse effects , Groin* , Cross-Over Studies*, Humans ; Male ; Female ; Middle Aged ; Aged ; Pain, Postoperative/etiology ; Pain, Postoperative/epidemiology ; Length of Stay ; Time Factors ; Adult ; Aged, 80 and over ; Risk Factors

مستخلص: Background: The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19.
Methods: Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay.
Results: The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259-39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03-1.55, p = 0.027).
Conclusion: This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).
(© 2024. The Author(s).)

المؤلفون: Wang N; Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan., Taliat G; Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan., Lin TS; Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan. Electronic address: tslin51@yahoo.com.tw.

المصدر: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2024 Jun; Vol. 93, pp. 149-156. Date of Electronic Publication: 2024 Apr 10.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101264239 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-0539 (Electronic) Linking ISSN: 17486815 NLM ISO Abbreviation: J Plast Reconstr Aesthet Surg Subsets: MEDLINE

مواضيع طبية MeSH: Finger Injuries*/surgery , Surgical Flaps* , Groin*/surgery , Plastic Surgery Procedures*/methods, Humans ; Male ; Adult ; Female ; Middle Aged ; Young Adult ; Retrospective Studies ; Adolescent ; Reoperation/methods

مستخلص: Background: Pedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility, and sensation, especially while providing strict thin skin coverage still exist.
Patients and Methods: A total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full-thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat were debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow-up.
Results: The average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5 cm of digit was preserved for the non-replantable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6 mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients' satisfactory outcomes of the reconstructed digits was judged as "very satisfying" in 12 patients (75 %) and "good" in 4 patients (25 %).
Conclusions: One-stage secondary debulking procedure resulted in excellent functional and esthetic outcomes for digits according to different structures of the dorsal and volar sides.
Level of Evidence: IV, Retrospective.
Competing Interests: Declaration of Competing Interest No financial conflicts of interest exists with any commercial entity whose products are described, reviewed, evaluated, or compared in the manuscript.
(Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

المؤلفون: Woo KP; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. Wook2@ccf.org., Ellis RC; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Maskal SM; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Remulla D; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Shukla P; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Rosen AJ; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Wetzka I; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Osei-Koomson W; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Phillips S; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Miller BT; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Beffa LR; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Petro CC; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Krpata DM; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Prabhu AS; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Menzo EL; Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston Hospital, Weston, FL, USA., Rosen MJ; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.

المصدر: Surgical endoscopy [Surg Endosc] 2024 Jun; Vol. 38 (6), pp. 3433-3440. Date of Electronic Publication: 2024 May 06.

نوع المنشور: Journal Article; Randomized Controlled Trial; Comparative Study

بيانات الدورية: Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE

مواضيع طبية MeSH: Hernia, Inguinal*/surgery , Laparoscopy*/methods , Laparoscopy*/adverse effects , Herniorrhaphy*/methods , Herniorrhaphy*/adverse effects , Pain, Postoperative*/etiology , Surgical Mesh* , Absorbable Implants* , Groin*/surgery , Chronic Pain*/etiology, Humans ; Male ; Middle Aged ; Female ; Aged ; Quality of Life ; Follow-Up Studies ; Adult

مستخلص: Introduction: Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up.
Methods: This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up.
Results: A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]).
Conclusion: Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship.
(© 2024. The Author(s).)

المؤلفون: Cho MC; Department of Urology, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, 07061, Korea., Lee J; Seoul National University Hospital, Seoul, 03080, Korea., Kim SW; Department of Urology, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea. swkim@snu.ac.kr.

المصدر: World journal of urology [World J Urol] 2024 May 22; Vol. 42 (1), pp. 342. Date of Electronic Publication: 2024 May 22.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer International Country of Publication: Germany NLM ID: 8307716 Publication Model: Electronic Cited Medium: Internet ISSN: 1433-8726 (Electronic) Linking ISSN: 07244983 NLM ISO Abbreviation: World J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Urethral Stricture*/surgery , Skin Transplantation*/methods , Urologic Surgical Procedures, Male*/methods , Urethra*/surgery , Groin*/surgery, Humans ; Male ; Retrospective Studies ; Middle Aged ; Adult ; Treatment Outcome ; Aged ; Young Adult

مستخلص: Purpose: To describe outcomes of staged-urethroplasty in complex anterior urethral strictures using full-thickness-skin-graft (FTSG) harvested from the hairless groin area, and to identify factors influencing successful outcomes.
Methods: Through retrospective chart review, we identified a total of 67 men who underwent the first-stage operation (grafting) using groin-FTSG for staged-urethroplasty to treat complex anterior urethral strictures unsuitable for one-stage urethroplasty. Among these, 59 underwent the second-stage operation (tubularization) at a median duration of 5.1-months after grafting. Patients were assessed for outcomes as scheduled after tubularization outcomes were analyzed only for 48 patients for whom ≥ 1-year follow-up data after tubularization were available. Their mean follow-up duration was 27.1 months. Success was defined as achieving physiologic voiding without requiring further procedures.
Results: Median stricture-length was 5.5 cm in all 67 patients. After grafting, neourethral-opening-narrowing occurred in 18. Partial graft-loss occurred in 8, of whom only 3 underwent re-grafting. The percentage of patients who achieved successful outcomes was 81.3%. Improvements in maximum-urine-flow-rate and post-void-residual-urine-volume were maintained until the last follow-up visit. A urethrocutaneous-fistula occurred in one patient, while meatal-stenosis occurred in two. On multivariate-regression-analysis, the presence of neourethral-opening-narrowing was the only predictor of non-success after tubularization. Furthermore, the presence of hypertension, longer stricture-length, and a history of prior direct-vision-internal-urethrotomy were predictors of the occurrence of neourethral-opening-narrowing.
Conclusion: Staged-urethroplasty using groin-FTSG is well worth considering as a useful therapeutic option for complex anterior urethral strictures, with an acceptable success rate and low morbidity. The absence of neourethral-opening-narrowing after the first-stage operation leads to success.
(© 2024. The Author(s).)

المؤلفون: Waters GC; Orthopaedic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia., Jones C; Orthopaedic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia., D'Alessandro P; Orthopaedic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia., Yates P; University of Western Australia, Fremantle Hospital and Health Service, Perth, WA, Australia.

المصدر: Hip international : the journal of clinical and experimental research on hip pathology and therapy [Hip Int] 2024 May; Vol. 34 (3), pp. 336-343. Date of Electronic Publication: 2023 Oct 20.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: SAGE Publishing Country of Publication: United States NLM ID: 9200413 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1724-6067 (Electronic) Linking ISSN: 11207000 NLM ISO Abbreviation: Hip Int Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Hip*/adverse effects , Arthroplasty, Replacement, Hip*/methods , Groin* , Hip Prosthesis* , Pain, Postoperative*/etiology , Pain, Postoperative*/diagnosis , Reoperation*/methods , Acetabulum*/surgery , Acetabulum*/diagnostic imaging, Humans ; Male ; Female ; Aged ; Middle Aged ; Pain Measurement ; Retrospective Studies ; Tomography, X-Ray Computed ; Aged, 80 and over ; Adult ; Cohort Studies

مستخلص: Background: Persisting groin pain post total hip arthroplasty (THA) is a common and complex issue that can be difficult to diagnose and manage. Acetabular component positioning is often implicated.
Aims and Methods: We used a previously well described and validated functional positioning protocol to determine if functional acetabular malpositioning was a factor in groin pain post THA and hence to determine if acetabular revision would be indicated. We compared patient-specific functional acetabular positioning to traditional CT evaluation of cup position and assessment of anterior cup overhang.
Results: 39 patients with groin pain post-THA were investigated. Functional acetabular malpositioning was diagnosed in 31% (12/39). Revision THA was performed in those 12 patients, resulting in resolution of functional malpositioning (100%), with an overall accuracy of 5.6° (range 1-12), and resolution of groin pain in 67% (8/12). 33% (4/12) of the revised implants had functional positioning located outside the traditional "40/20 zone". Comparison with CT indicated that 40% (4/10) of implants with anterior overhang were well positioned, however only 50% (6/12) of functionally malpositioned implants had CT evidence of anterior cup prominence. Of the 8/12 revision patients who had resolution of their groin pain, only 1 had cup prominence.
Conclusions: This study suggests that the utilisation of a patient specific functional positioning algorithm in the analysis of persistent groin pain following THA can assist in identifying the underlying cause of pain and help to guide treatment. For a functionally malpositioned acetabulum, revision surgery offers a potential resolution of groin pain.
Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

المؤلفون: Ahuja R; All authors are affiliated with the Department of Dermatology and Venereology , AIIMS , New Delhi, India., Jain A, Gupta S

المصدر: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] [Dermatol Surg] 2024 Jul 01; Vol. 50 (7), pp. 685-686. Date of Electronic Publication: 2024 Mar 20.

نوع المنشور: Journal Article; Letter; Case Reports

بيانات الدورية: Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 9504371 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4725 (Electronic) Linking ISSN: 10760512 NLM ISO Abbreviation: Dermatol Surg Subsets: MEDLINE

مواضيع طبية MeSH: Groin*/surgery , Pemphigus, Benign Familial*/surgery , Radiofrequency Ablation*/methods, Humans ; Treatment Outcome ; Female ; Middle Aged ; Male ; Adult

المؤلفون: Mathieu T; Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Physical and Rehabilitative Medicine, Antwerp University Hospital, Edegem, Belgium. Electronic address: Thomasmathieu.5@hotmail.com., Van Glabbeek F; Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Edegem, Belgium., Denteneer L; Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, University of Antwerp, Antwerp, Belgium; Education department, Horacio Oduber Hospital, Oranjestad, Aruba., Van Winckel L; Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Schacht E; Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., De Vlam B; Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Van Nassauw L; Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

المصدر: Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft [Ann Anat] 2024 Jun; Vol. 254, pp. 152238. Date of Electronic Publication: 2024 Feb 24.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: G. Fischer Country of Publication: Germany NLM ID: 100963897 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1618-0402 (Electronic) Linking ISSN: 09409602 NLM ISO Abbreviation: Ann Anat Subsets: MEDLINE

مواضيع طبية MeSH: Groin*/anatomy & histology , Cadaver* , Ligaments*/anatomy & histology , Ligaments*/pathology, Humans ; Male ; Female ; Aged, 80 and over ; Aged ; Muscle, Skeletal/anatomy & histology ; Tendons/anatomy & histology ; Pubic Symphysis/anatomy & histology ; Dissection ; Pain

مستخلص: Objective: Pubis-related groin pain remains a difficult topic in orthopedic and sports medicine. A better understanding of the anatomy of the adductors and the pubic ligaments is necessary. The aim of this study is to map all the musculotendinous attachments to the pubic ligaments and to investigate in detail all the possible inter-adductor fusions.
Methods: The pubic symphyses were dissected in eight male and fourteen female embalmed cadavers (mean age 85 years), focusing on the fusion between the adductors, pubic ligaments, and musculotendinous attachments at the pubic ligaments. The 95% confidence intervals for the prevalence of the different conjoint tendons and tendon attachment to ligament were calculated.
Results: The presence of three types of conjoint tendons was found: adductor brevis and gracilis (AB/G) 90.9 [72.2 - 97.5]%; adductor brevis and adductor longus (AB/AL) 50.0 [30.7 - 69.3]%; adductor longus and gracilis (AL/G) 50.0 [30.7 - 69.3]%. The AL, AB and G were in every cadaver attached to the anterior pubic ligament (APL). 64% of the AB and 100% of the G were attached to the inferior pubic ligament (IPL).
Conclusion: The proximal anatomy of the adductors is more complex than initially described. This study identified three possible conjoint tendons between the proximal adductors. The AB/G conjoint tendon was significantly more present than the AB/AL or AL/G conjoint tendon. The IPL has attachments only from the AB and G. Rectus Abdominis (RA) and AL were not attached to IPL. Mapping the musculotendinous attachments on the pubic ligaments creates more clarity on the pathophysiology of lesions in this area.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier GmbH. All rights reserved.)

المؤلفون: Lilja C; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark caroline.lilja@rsyd.dk., Thomsen JB; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark., Sørensen JA; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.

المصدر: BMJ case reports [BMJ Case Rep] 2024 May 14; Vol. 17 (5). Date of Electronic Publication: 2024 May 14.

نوع المنشور: Case Reports; Journal Article

بيانات الدورية: Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101526291 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-790X (Electronic) Linking ISSN: 1757790X NLM ISO Abbreviation: BMJ Case Rep Subsets: MEDLINE

مواضيع طبية MeSH: Lymphocele*/surgery , Anastomosis, Surgical*/methods , Robotic Surgical Procedures*/methods , Groin*/surgery , Lymphatic Vessels*/surgery , Lymphatic Vessels*/diagnostic imaging , Microsurgery*/methods, Humans ; Male ; Lymphography/methods ; Middle Aged ; Veins/surgery ; Treatment Outcome

مستخلص: We present the first-in-human robot-assisted microsurgery on a lymphocele in the groin involving a man in his late 60s who had been coping with the condition for 12 months. Despite numerous efforts at conservative treatment and surgical intervention, the lymphocele persisted, leading to a referral to our clinic.Diagnostic techniques, including indocyanine green lymphography and ultrasound, identified one lymphatic vessel draining into the lymphocele. The surgical intervention, conducted with the assistance of a robot and facilitated by the Symani Surgical System (Medical Microinstruments, Calci, Italy), involved a lymphovenous anastomosis and excision of the lymphocele. An end-to-end anastomosis was performed between the lymphatic and venous vessels measuring 1 mm in diameter, using an Ethilon 10-0 suture.The surgery was successful, with no postoperative complications and a prompt recovery. The patient was discharged 3 days postoperatively and exhibited complete recovery at the 14-day follow-up. This case marks the first use of robot-assisted microsurgical lymphovenous anastomosis to address a groin lymphocele, highlighting the benefit of advanced robotic technology in complex lymphatic surgeries.
Competing Interests: Competing interests: None declared.
(© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

المؤلفون: Yin R; From the School of Medicine, University of California San Francisco, San Francisco, CA., Gursky A; Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY., Falade I; From the School of Medicine, University of California San Francisco, San Francisco, CA., Knox J; Division of Plastic and Reconstructive Surgery., Gomez-Sanchez C; Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA., Soroudi D; From the School of Medicine, University of California San Francisco, San Francisco, CA., Piper M; Division of Plastic and Reconstructive Surgery., Hoffman W; Division of Plastic and Reconstructive Surgery., Hansen SL; Division of Plastic and Reconstructive Surgery.

المصدر: Annals of plastic surgery [Ann Plast Surg] 2024 May 01; Vol. 92 (5S Suppl 3), pp. S331-S335.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Little, Brown And Company Country of Publication: United States NLM ID: 7805336 Publication Model: Print Cited Medium: Internet ISSN: 1536-3708 (Electronic) Linking ISSN: 01487043 NLM ISO Abbreviation: Ann Plast Surg Subsets: MEDLINE

مواضيع طبية MeSH: Negative-Pressure Wound Therapy*/methods , Groin*/surgery , Ischemia*/surgery , Ischemia*/etiology , Wound Healing*, Humans ; Male ; Retrospective Studies ; Female ; Aged ; Middle Aged ; Vascular Surgical Procedures/methods ; Cohort Studies ; Postoperative Complications/epidemiology

مستخلص: Background: Incisional negative pressure wound therapy (iNPWT) is an adjunctive treatment that uses constant negative pressure suction to facilitate healing. The utility of this treatment modality on vascular operations for critical limb-threatening ischemia (CLTI) has yet to be elucidated. This study compares the incidence of postoperative wound complications between the Prevena Incision Management System, a type of iNPWT, and standard wound dressings for vascular patients who also underwent plastic surgery closure of groin incisions for CLTI.
Method: We performed a retrospective cohort study of 40 patients with CLTI who underwent 53 open vascular surgeries with subsequent sartorius muscle flap closure. Patient demographics, intraoperative details, and wound complications were measured from 2015 to 2018 at the University of California San Francisco. Two cohorts were generated based on the modality of postoperative wound management and compared on wound healing outcomes.
Results: Of the 53 groin incisions, 29 were managed with standard dressings, and 24 received iNPWT. Patient demographics, comorbidities, and operative characteristics were similar between the 2 groups. Patients who received iNPWT had a significantly lower rate of infection (8.33% vs 31.0%, P = 0.04) and dehiscence (0% vs 41.3%, P < 0.01). Furthermore, the iNPWT group had a significantly lower rate of reoperation (0% vs 17.2%, P = 0.03) for wound complications within 30 days compared with the control group and a moderately reduced rate of readmission (4.17% vs 20.7%, P = 0.08).
Conclusions: Rates of infection, reoperation, and dehiscence were significantly reduced in patients whose groin incisions were managed with iNPWT compared with standard wound care. Readmission rates were also decreased, but this difference was not statistically significant. Our results suggest that implementing iNPWT for the management of groin incisions, particularly in patients undergoing vascular operations for CLTI, may significantly improve clinical outcomes.
Competing Interests: Conflicts of interest and sources of funding: none declared.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

المؤلفون: Jamjoum G; From Gerald Bronfman Department of Oncology (Jamjoum) McGill University, Montréal, Que. (Jamjoum); Department of Surgery (Jamjoum), King Abdul-Aziz University, Jeddah, Saudi Arabia; Faculty of Medicine and Health Sciences (Araji), McGill University, Montréal, Que.; McGill University Health Centre Research Institute (Nguyen, Meguerditchian), Montréal, Que.; Department of Surgery (Meguerditchian), McGill University, Montréal, Que.; St. Mary's Research Centre (Meguerditchian), Montréal, Que., Araji T; From Gerald Bronfman Department of Oncology (Jamjoum) McGill University, Montréal, Que. (Jamjoum); Department of Surgery (Jamjoum), King Abdul-Aziz University, Jeddah, Saudi Arabia; Faculty of Medicine and Health Sciences (Araji), McGill University, Montréal, Que.; McGill University Health Centre Research Institute (Nguyen, Meguerditchian), Montréal, Que.; Department of Surgery (Meguerditchian), McGill University, Montréal, Que.; St. Mary's Research Centre (Meguerditchian), Montréal, Que., Nguyen D; From Gerald Bronfman Department of Oncology (Jamjoum) McGill University, Montréal, Que. (Jamjoum); Department of Surgery (Jamjoum), King Abdul-Aziz University, Jeddah, Saudi Arabia; Faculty of Medicine and Health Sciences (Araji), McGill University, Montréal, Que.; McGill University Health Centre Research Institute (Nguyen, Meguerditchian), Montréal, Que.; Department of Surgery (Meguerditchian), McGill University, Montréal, Que.; St. Mary's Research Centre (Meguerditchian), Montréal, Que., Meguerditchian AN; From Gerald Bronfman Department of Oncology (Jamjoum) McGill University, Montréal, Que. (Jamjoum); Department of Surgery (Jamjoum), King Abdul-Aziz University, Jeddah, Saudi Arabia; Faculty of Medicine and Health Sciences (Araji), McGill University, Montréal, Que.; McGill University Health Centre Research Institute (Nguyen, Meguerditchian), Montréal, Que.; Department of Surgery (Meguerditchian), McGill University, Montréal, Que.; St. Mary's Research Centre (Meguerditchian), Montréal, Que. ari.meguerditchian@mcgill.ca.

المصدر: Canadian journal of surgery. Journal canadien de chirurgie [Can J Surg] 2024 May 01; Vol. 67 (3), pp. E198-E205. Date of Electronic Publication: 2024 May 01 (Print Publication: 2024).

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 0372715 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1488-2310 (Electronic) Linking ISSN: 0008428X NLM ISO Abbreviation: Can J Surg Subsets: MEDLINE

مواضيع طبية MeSH: Lymph Node Excision*/adverse effects , Postoperative Complications*/epidemiology , Postoperative Complications*/etiology , Groin*/surgery, Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Risk Factors ; Aged ; Adult ; Melanoma/surgery

مستخلص: Background: Inguinal lymphadenectomy (ILND) has historically been associated with substantial morbidity. The objective of this study was to obtain contemporary ILND morbidity rates and to identify potentially preventable risk factors.
Methods: We carried out a retrospective review of medical records for all superficial, deep, and combination groin dissections performed at a single, high-volume academic centre between January 2007 and December 2020. We collected data points for patient, disease, and surgery characteristics, and cancer outcomes. The outcome of interest was any complication within 30 days of surgery. Complications included wound infection, wound necrosis or disruption, seroma, drainage procedure, hematoma, and lymphedema. We performed multivariate logistic regression using SAS version 9.4.
Results: We identified 139 patients having undergone 89 superficial, 12 deep, and 38 combined dissection types, respectively. Melanoma accounted for 84.9% of cases. Of these patients, 56.1% had an adverse postoperative event within 30 days. Increasing age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07, p < 0.01) and number of positive lymph nodes harvested (OR 1.22, 95% CI 1.00-1.50, p = 0.05) were associated with more complications. Patients with deep dissection showed a lower likelihood of complications than those with superficial dissection (OR 0.15, 95% CI 0.03-0.84, p < 0.05).
Conclusion: Complication rates after ILND remain high. We identified a number of risk factors, providing opportunities for better selection and prevention.
Competing Interests: Competing interests:: Ari Meguerditchian reports serving as secretary and treasurer of the Canadian Society of Surgical Oncology, and scientific director, St.Mary’s Research Centre. No other competing interests were declared.
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