Surgical Research and Reviews

  • MODIFIED PUTTI PROCEDURE FOR THE SURGICAL MANAGEMENT OF PATIENTS WITH ADULT ACQUIRED CAVO-VARUS RESULTING FROM PERONEAL TENDON RUPTURE

    Background: Peroneal pathology, including trauma, can result in Cavovarus-Drop Foot type deformity, precluding patients from functioning in or attempting bracing. Lateral ankle stabilization and other associated procedures sometimes are not enough to address the resultant deformity, thus many CavoVarus-Dropfoot patients still have gait abnormalities, function minimally in a brace and still have secondary ambulatory pain and loss of function even when braced. We review the results of 9 patients meeting this criteria and electing for a Modified Putti Procedure and lower extremity reconstruction. Materials and Methods: The charts of 9 patients with adult-acquired CavoVarus deformity foot type after peroneal rupture were reviewed, all but 1 had failed previous AFO/bracing. These patients underwent surgical correction all consisting of the Modified Putti procedure, along with other ancillary procedures and the results and outcomes were collected. Additionally, surgical technique was documented. Results: The mean VAS score improved from 9.1 to 2.4 pre- and post-operatively, respectively. The average time to weight bearing was 7.2 weeks. Four of 9 (44.44%) patients experienced some form of complication. Eight of 9 (88.88%) patients relayed the surgery was a success and would opt to undergo it again, given the choice. Conclusion: The Modified Putti Procedure showed promising results, great patient satisfaction and marked improvement in pre-operative and post-operative pain rating. This technique, utilized after severe peroneal trauma and resultant deformity is present, is a considerable option to have in the foot and ankle surgeon’s armament.

  • A NOVEL TECHNIQUE TO PREVENT THE BREAST IMPLANT FROM EXPOSURE AFTER MASTECTOMIES

    Introduction After mastectomies, we do our reconstruction, either immediately or delayed. In both ways of reconstruction for post mastectomies defect, the most commonly performed reconstruction is by using breast prosthesis [1]. For many years, surgeons have been trying to find out any solution to reduce the rate of implant exposure and develop some new techniques and modifications. However, once the infection develops or implant expose the only permanent solution is to remove the implant [2-3]. Although there is less evidence found in the literature regarding the salvage of implant once the infection occurs and when implant becomes expose in implant-based reconstruction [4]. Radiation also plays additional role in post-operative complication rates following implant-based breast reconstruction, as it is well documented that the incidence of complications is to be higher in radiated breasts compare to similar non-radiated breasts [5]. With the new advancement in radiation therapy the number of patients have been increasing who are receiving radiation therapy after immediate breast reconstruction [5]. Description of the Technique For more than 15 years we have been reconstructing the breasts deformities after different types of mastectomies, ranging from skin sparing, nipple areola sparing to different types of lumpectomies, by immediate insertion of breast implants. The main problem which we face during post-reconstruction, is the exposure of implant in addition to infection. With the advent of ADM (Artificial Dermal Matrix) [6], serratus anterior muscle [7], rectus fascial flap [7] and inferior dermal flaps [8] although they do an addition to thickness of skin envelop over the implant after mastectomy, but still the rate of implant exposure has not changed noticeably. It has been well understood that of ADM expose in air it dries immediately which later on results in implant exposure. Meanwhile we have developed a novel tech- nique to augment the soft tissue…

  • EFFICACY OF CHOLECYSTECTOMY IN PATIENTS WITH POSITIVE HIDA SCANS WITH TYPICAL OR ATYPICAL BILIARY PAIN: A RETROSPECTIVE STUDY

    Introduction: Our investigation aimed to discover the benefits of performing cholecystectomy in patients who had a positive or negative HIDA scan result, presented with either typical or atypical biliary pain. Methods: We performed a retrospective analysis of medical records of patients who had a HIDA scan at Peninsula Health between 2012 and 2017, those who had a HIDA scan and cholecystectomy for biliary pain were selected for this study, and prospective analysis of patient reported outcome post cholecystectomy included. Results: In the past five years, 190 patients had had a HIDA scan to investigate biliary pain without a structural cause. Of those 190, 65 had a positive HIDA result and 20 of these patients went on to have a cholecystectomy. Of the latter, 17 who reported typical biliary pain had their pain resolved post-surgery but 2 out of 3 patients with atypical biliary pain had ongoing pain despite surgery (1 did not respond). Of the 125 patients with a negative HIDA scan, 14 proceeded with a cholecystectomy. Twelve patients had pre-operative typical biliary pain and 5 of these continued to have pain post-operatively. Finally, 1 of the 2 patients with atypical pain continued to have ongoing pain post-surgery. Conclusion: In summary, in patients without a structural cause for biliary pain HIDA scans and patient’s symptoms greatly aid in the decision-making process whether to proceed with a cholecystectomy, as a negative scan should prompt further clinical investigation before proceeding with surgery.

  • CLINICAL MANIFESTATIONS OF CHOLELITHIASIS IN QUITO, ECUADOR. A COHORT STUDY

    Introduction: A prospective study was carried out, with the aim of establishing the clinical manifestations of cholelithiasis in the population of Quito, Ecuador. Methods: During the period from January 2012 to October 2017, 534 patients were referred from different outpatient clinics of the Ecuadorian Institute of Social Security to the Batan Medical Center with the diagnosis of cholelithiasis after a clinical assessment and abdominal ultrasound, to be treated surgically. Results: Sixty-nine percent of patients were female with a male-female ratio of 1:2.21. Mean age was 44.9 years. Pain was the most common symptom in our study: 95.7%. Among these patients, pain was located in the epigastrium in 49.8%, in the right hypochondrium in 45.1% and only 0.8% had low back pain. Pain ranged from moderate and even severe. The remaining 4.3% of patients had dyspepsia or were asymptomatic. Conclusions: This finding highlights the fact that epigastric pain must be always considered as a clinical manifestation on cholelithiasis.

  • FACIAL FAT GRAFTING IN RECONSTRUCTIVE MAXILLOFACIAL SURGERY

    Aim: Facial Fat Grafting(FFG) was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion and retention. FFG was initially used as a technique to improve facial aesthetics. Over the years the technique  has evolved into more complex reconstructive and regenerative procedures and new clinical applications. Methods: In the last two decades the indications of FFG have been extended into cranio-maxillofacial reconstructive surgery. This includes post-traumatic soft tissue defects,  aesthetics,congenital and other postsurgical volume deficits. Results: While several approaches were suggested for fat harvesting and grafting, the results were rather unsatisfactory due to the degeneration of many adipocytes that occurred during these manipulations. The technique of autologous fat transfer has then been perfectioned becoming an augmentation-regenerative process that can be used to treat a wide range of difficult and challenging reconstructive problems. The procedure  described herein has been performed in different patients with various pathology sequelae with sactisfactory morpho-aesthetic results and a low complication rate. Conclusion: FFG can be used in any facial area where is lack,of soft tissue or where there is scarring,producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine because of their ability to differentiate into a variety of specialized cells. However more definitive studies are still needed in order to answer specific questions regarding the best technique to be used and the role of ADSC’s.Clinical cases with volume paucity or deficiencies are presented with a long-term outcome in augmentation and regeneration.

  • SHORTTERM FOLLOW UP OF EVLA: COMPLICATIONS AND MANAGEMENTS, A SINGLE CENTER EXPERIENCE OF BANGLADESH

    Dodd and Cockett defined varicose veins, saying “a varicose vein is one which has permanently lost its valvular efficiency.” [1] Varicose veins constitute a progressive disease, remission of the disease does not occur, except after pregnancy and delivery. [2] The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. [3]Greek philosopher Hippocrates (460-377 B.C.) described the use of compressive bandages and was advisor of small punctures in varicose veins. First patient who underwent operation for his varicose vein appears to be Canus Marius, the Roman tyrant. Giovanni Rima (1777-1843) introduced mid thigh ligation of the saphenous vein. Ligation of the sapheno-femoral junction as it is practiced today was first described by John Homans in his paper in 1916. [2] The Mayo Brothers, postulating that there would be additional benefit in removing the saphenous vein, pursued excision of the GSV through an incision extending from the groin to below the knee. The final technologic leap was introduction of the intraluminal stripper by Babcock. [2] In the era of minimally invasive surgery, the first documented case of Endovenous Laser Ablasion was published in 1999 using 810 nm Diode Laser. Since then several wavelengths were introduced; 810, 940, 980, 1064, 1320, 1470 and newly introduced 1940 nm. [4, 5] It is generally agreed that varicose veins affect from 40 to 60% of women and 15 to 30% men. [6] During the 1930s to 1960s, several large studies reported the prevalence of varicose veins to roughly average 2% in the general population. [7] However, more recently, large population studies such as Edinburgh Vein Study demonstrated an age-adjusted prevalence of truncal varices of 40% in men and 32% in women. [8] Vein ablation is the most modern treatment option for superficial venous disease. Several endovenous modalities…

  • COEXISTENCE OF FIVE TYPES OF INTRACRANIAL HEMORRHAGIC LESIONS AFTER BRAIN INJURY IN A YOUNG ADULT

    Posttraumatic intracranial hemorrhage is an entity frequently encountered in neurosurgical daily practice. These haemorrhagic lesions are classified according to their location as: extradural haematoma, acute subdural haematoma, intraparenchymal haemorrhage, subarachnoid haemorrhage and contusion. A brain scan is the key examination for the diagnosis. The simultaneous presence of these hemorrhagic lesions in a single traumatic brain injury is rare. We are reporting an unusual case of a 24-year-old who suffered from a brain injury due to road traffic accident, and whose brain CT scan showed five types of post-traumatic intracranial lesions. He benefitted from medical treatment and neurological surveillance. The evolution was favorable with a setback of the signs of intracranial hypertension. The follow-up brain CT scan performed one month after the trauma showed a complete resorption of the lesions.

  • INCISIONAL HERNIA IN PREGNANCY A SILENT BUT POTENTIAL FATALITY – CASE REPORT

    Rupture of incisional hernia, with consequent emergency laparotomy and repair, is an uncommon complication of pregnancy. The risk to the mother and baby is enormous. We present an un-booked 29 year old G4P2+1 (1- alive) with one previous caesarean section at 29 weeks of gestation. She had a huge anterior abdominal wall incisional hernia with gravid uterus as content. She was admitted on conservative management on account of abdominal pain and preterm contractions, but subsequently developed spontaneous rupture from an ulcer with bowel evisceration. She had emergency laparotomy and repair but unfortunately had unavoidable bowels injury as they were morbidly adherent to the anterior abdominal wall with injury necessitating resection and re-anastomosis with caesarean section. The neonate suffered early neonatal death. The presence of ulceration may be a predictor of adverse maternal and foetal outcome

  • EXERESIS OF SIALOLYTIASIS ASSOCIATED WITH CHRONIC FIBROSIS IN THE RIGHT SUBMANDIBULAR REGION

    Introduction: Known as inflammation of the salivary glands, sialodenitis can be classified as acute, subacute or chronic. It has obstructive factors as its main causality concomitant with the rare occurrence of sialolithiasis. These, in turn, can have severe consequences such as salivary thickening, ductal ectasia and swelling, associated with pain in the affected region. It has an epidemiologically predilection for men and its diagnosis is made through imaging tests such as ultrasound and panoramic radiography as well as through the digit-palmar evaluation of the professional. Surgical exeresis has been studied as the best approach for these cases, avoiding loss of function or recurrence. Objective: To report the case of a 71-year-old female patient diagnosed by the Oral and Maxillofacial Surgery and Traumatology Service of the Federal University of Pernambuco of School Dentistry with sialolithiasis injury associated with chronic sialodenitis with fibrosis in the submandibular gland. Methodology: The methodology of the study was the search for articles on the subject, organization in a brief literature review and its comparison with the case report that was described. Results: The patient attended the service because she complained of increased volume in the right submandibular region and during anamnesis presented pain on palpation and presence of purulent secretion in the oral cavity. After analysis of the imaging exam, which resulted in well-defined radiopaque pathology in the right mandibular body region, the patient underwent general anesthesia for lesion excision. Postoperatively, the patient evolved without phlogistic signs and after 1 year showed perfect healing and absent recurrence. Conclusion: It is essential, based on the case presented, the good preparation of the Dentist so that the correct diagnosis and treatment choice corroborate for a better quality of life of patients with lesions that severely compromise their stomatognathic function.

  • A THOROUGHGOING ATTRIBUTE OF SURGICAL WOUND ENRICHMENTS

    Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. Surgical enrichment/dressings are applications for wounds, burns, and ulcers. They should be regarded as supportive of healing; are desirable but not essential in an emergency. There are currently plenty of dressings available in the market to aid in wound healing. Before choosing a dressing for a specific injury, a physician must assess carefully the needs of the wound to understand which dressing would ensure maximum interest. Basically, there is nothing called best choice, and it is crucial that the merits/demerits of each dressing system be understood. This article has provided a framework to assist in dressing assessment. This article reveals measurement of wound healing and the functions of wound dressings. A variety of dressings and their respective details are detailed. Purpose of the study: Discussion and projection of wound healing by market available surgical supplies. The present review traces the history of dressings from its earliest inception to the current status and also discusses the advantage and limitations of the dressing materials.Findings: There is an overwhelming amount of wound dressings available in the market. Modern world and technology gave rise to various way of wound healing with enrichments. Almost all sorts of enrichments are available in surgical outlets, a few of them are confined to hospital settings. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to “ideal” as possible. It is only after properly assessing the wound…