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"Reconstructive Surgical Procedures methods."
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Plastic surgery
\"This book provides a complete history of plastic surgery, a description of the modern techniques and choices available, and an overview of the controversies surrounding the choice to voluntarily change your physical appearance\"--Provided by publisher.
Book
Dermatologic Surgery
This manual offers detailed, step-by-step guidance to dermatologic surgical procedures. The coverage provides three main sections - General Dermatologic Surgery, Cosmetic Surgery, Lasers and Miscellaneous topics - over 60 chapters with a concise templated format. Each chapter features five sections: pre-operative care, step by step surgical technique, post operative care and follow up, complications, and prevention and management of complications. Filled with clear descriptions and illustrations (5-10 per procedure), this manual and accompanying DVD provides physicians with updated and easy-to-read information for quick review and reference.
CD-ROM/DVD and other supplementary materials are not included as part of the e-book file, but are available for download after purchase.
eBook
Pediatric robotic and reconstructive urology : a comprehensive guide
Robotic urological surgery is one of the most significant urological developments in recent years. It allows for greater precision than laparoscopic methods while retaining quicker recovery time and reduced morbidity over classical open surgical techniques. For children, where the room for error is already reduced because of smaller anatomy, it takes on even more importance for urologists. As a result, robotic surgery is rightly considered one of the most exciting contemporary developments in pediatric urology.
Pediatric Robotic and Reconstructive Urology: A Comprehensive Guide provides specialist and trainees with an innovative text and video guide to this dynamic area, in order to aid mastery of robotic approaches and improve the care of pediatric patients.
Full-color throughout and including over 130 color images, this comprehensive guide covers key areas including:
* Training, instrumentation and physiology of robotic urologic surgery
* Surgical planning and techniques involved
* Adult reconstructive principles applicable to pediatrics
* Management of complications, outcomes and future perspectives for pediatric urologic surgery
Also included are 30 high-quality surgical videos illustrating robotic surgery in action, accessed via a companion website, thus providing the perfect visual tool for the user.
With chapters authored by the leading names in the field, and expertly edited by Mohan Gundeti, this ground-breaking book is essential reading for all pediatric urologists, pediatric surgeons and general urologists, whether experienced or in training.
Of related interest
Smith's Textbook of Endourology, 3E
Smith, ISBN 9781444335545
Pediatric Urology: Surgical Complications and Management
Wilcox, ISBN 9781405162685
eBook
Genital Reconstructive Surgery in Females With Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis
Females with congenital adrenal hyperplasia (CAH) and atypical genitalia often undergo complex surgeries; however, their outcomes remain largely uncertain.
We searched several databases through 8 March 2016 for studies evaluating genital reconstructive surgery in females with CAH. Reviewers working independently and in duplicate selected and appraised the studies.
We included 29 observational studies (1178 patients, mean age at surgery, 2.7 ± 4.7 years; mostly classic CAH). After an average follow-up of 10.3 years, most patients who had undergone surgery had a female gender identity (88.7%) and were heterosexual (76.2%). Females who underwent surgery reported a sexual function score of 25.13 using the Female Sexual Function Index (maximum score, 36). Many patients continued to complain of substantial impairment of sensitivity in the clitoris, vaginal penetration difficulties, and low intercourse frequency. Most patients were sexually active, although only 48% reported comfortable intercourse. Most patients (79.4%) and treating health care professionals (71.8%) were satisfied with the surgical outcomes. Vaginal stenosis was common (27%), and other surgical complications, such as fistulas, urinary incontinence, and urinary tract infections, were less common. Data on quality of life were sparse and inconclusive.
The long-term follow-up of females with CAH who had undergone urogenital reconstructive surgery shows variable sexual function. Most patients were sexually active and satisfied with the surgical outcomes; however, some patients still complained of impairment in sexual experience and satisfaction. The certainty in the available evidence is very low.
Journal Article
Subperiosteal vs Subdural Drain After Burr-Hole Drainage of Chronic Subdural Hematoma: A Randomized Clinical Trial (cSDH-Drain-Trial)
Abstract
BACKGROUND
The use of a subdural drain (SDD) after burr-hole drainage of chronic subdural hematoma (cSDH) reduces recurrence at 6 mo. Subperiosteal drains (SPDs) are considered safer, since they are not positioned in direct contact to cortical structures, bridging veins, or hematoma membranes.
OBJECTIVE
To investigate whether the recurrence rate after insertion of a SPD is noninferior to the insertion of a more commonly used SDD.
METHODS
Multicenter, prospective, randomized, controlled, noninferiority trial analyzing patients undergoing burr-hole drainage for cSDH aged 18 yr and older. After hematoma evacuation, patients were randomly assigned to receive either a SDD (SDD-group) or a SPD (SPD-group). The primary endpoint was recurrence indicating a reoperation within 12 mo, with a noninferiority margin of 3.5%. Secondary outcomes included clinical and radiological outcome, morbidity and mortality rates, and length of stay.
RESULTS
Of 220 randomized patients, all were included in the final analysis (120 SPD and 100 SDD). Recurrence rate was lower in the SPD group (8.33%, 95% confidence interval [CI] 4.28-14.72) than in the SDD group (12.00%, 95% CI 6.66-19.73), with the treatment difference (3.67%, 95% CI -12.6-5.3) not meeting predefined noninferiority criteria. The SPD group showed significantly lower rates of surgical infections (P = .0406) and iatrogenic morbidity through drain placement (P = .0184). Length of stay and mortality rates were comparable in both groups.
CONCLUSION
Although the noninferiority criteria were not met, SPD insertion led to lower recurrence rates, fewer surgical infections, and lower drain misplacement rates. These findings suggest that SPD may be warranted in routine clinical practice
Graphical Abstract
Graphical Abstract
Journal Article
Graft tears after arthroscopic superior capsule reconstruction (ASCR): pattern of failure and its correlation with clinical outcome
IntroductionArthroscopic superior capsule reconstruction (ASCR) using fascia lata autograft is a new surgical technique developed to overcome irreparable rotator cuff tears. There is little information about graft tear after ASCR and its impact on clinical outcome. This study is to investigate the graft tear rate, pattern of failure, and its correlation with clinical outcomes after arthroscopic superior capsule reconstruction (ASCR).Materials and methodsFrom June 2013 to June 2016, 31 shoulders in 31 consecutive patients (mean 65.3 years) underwent ASCR using fascia lata autograft for irreparable large-to-massive tears. Magnetic resonance imaging (MRI) was performed before surgery and at mean 12.8 months (12–24 months) after surgery to assess fatty infiltration progression and graft integrity. Graft tear was defined as the loss of graft continuity and was categorized as medial and lateral rows according to the failure location. Acromiohumeral distance (AHD) was pre- and postoperatively measured with the standard radiograph. Pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, and physical examination were used to assess clinical outcomes. Average follow-up was 15 months (range 12–24 months) after surgery.ResultsMean active forward elevation increased from 133° to 146° (P = 0.011). Mean VAS score, ASES score, and constant score significantly improved: from 6 to 2.5, 54.4 to 73.7, and 51.7 to 63.7, respectively (P < 0.001). There was no remarkable progression of fatty infiltration after surgery. AHD increased from 5.3 mm preoperatively to 6.4 mm postoperatively (P < 0.016). Nine patients (29%) showed graft tear on follow-up MRI: 7 and 2 at the medial and lateral rows, respectively. Although the intact graft group showed better outcomes than the graft tear group (pain VAS score 2.3 vs. 3.0; ASES score 74.1 vs. 69.8; constant score 63.4 vs. 57.9), the results were not statistically significant.ConclusionsGraft tear rate after ASCR assessed by MRI was 29%, and failures mostly occurred at the medial row. The graft tear group showed clinical improvement despite the recurred superior capsule defect.Level of evidenceIV, case series, treatment study.
Journal Article
Long-term outcome of vaginal mesh or native tissue in recurrent prolapse: a randomized controlled trial
Introduction and hypothesisOur aim was to evaluate clinically relevant long-term outcomes of transvaginal mesh or native tissue repair in women with recurrent pelvic organ prolapse (POP).MethodsWe performed a 7-year follow-up of a randomized controlled trial on trocar-guided mesh placement or native tissue repair in women with recurrent POP. Primary outcome was composite success, defined as absence of POP beyond the hymen, absence of bulge symptoms, and absence of retreatment for POP. Secondary outcomes were adverse events, pain, and dyspareunia. Multiple imputation was used for missing data of composite success and pain; estimates are presented with 95% confidence intervals (CI).ResultsBetween August 2006 and July 2008, 194 women were randomized; 190 underwent surgery. At 7 years, 142 (75%) were available for analysis, of whom, the primary outcome could be calculated in 127. Composite success was 53% (95% CI 41, 66) for mesh and 54% (95% CI 42, 65) for native tissue. Repeat surgery for POP was 25% for mesh and 16% for native tissue (difference 9%; 95% CI −5, 23) and occurred in untreated compartments in the mesh group and treated compartments in the native tissue group. Mesh exposure rate was 42%; pain with mesh 39% and native tissue 50% (difference − 11%, 95% CI −27, 6); dyspareunia with mesh 20% and native tissue 17% (difference 3%, 95% CI −9, 17).ConclusionsSeven-year composite success rates appeared similar for mesh and native tissue. Mesh did not reduce long-term repeat surgery rates due to de novo POP in nonmesh-treated vaginal compartments. Mesh exposure rates were high, though significant differences in pain and dyspareunia were not detected.Clinical trial registration. ClinicalTrials.gov, NCT00372190.
Journal Article
Amniotic membrane: from structure and functions to clinical applications
Amniotic membrane (AM) or amnion is a thin membrane on the inner side of the fetal placenta; it completely surrounds the embryo and delimits the amniotic cavity, which is filled by amniotic liquid. In recent years, the structure and function of the amnion have been investigated, particularly the pluripotent properties of AM cells, which are an attractive source for tissue transplantation. AM has anti-inflammatory, anti-bacterial, anti-viral and immunological characteristics, as well as anti-angiogenic and pro-apoptotic features. AM is a promoter of epithelialization and is a non-tumorigenic tissue and its use has no ethical problems. Because of its attractive properties, AM has been applied in several surgical procedures related to ocular surface reconstruction and the genito-urinary tract, skin, head and neck, among others. So far, the best known and most auspicious applications of AM are ocular surface reconstruction, skin applications and tissue engineering. However, AM can also be applied in oncology. In this area, AM can prevent the delivery of nutrients and oxygen to cancer cells and consequently interfere with tumour angiogenesis, growth and metastasis.
Journal Article
A Retrospective Comparative Analysis of Titanium Mesh and Custom Implants for Cranioplasty
Abstract
BACKGROUND
Autologous bone removed during craniectomy is often the material of choice in cranioplasty procedures. However, when the patient's own bone is not appropriate (infection and resorption), an alloplastic graft must be utilized. Common options include titanium mesh and polyetheretherketone (PEEK)-based custom flaps. Often, neurosurgeons must decide whether to use a titanium or custom implant, with limited direction from the literature.
OBJECTIVE
To compare surgical outcomes of synthetic cranioplasties performed with titanium or vs custom implants.
METHODS
Ten-year retrospective comparison of patients undergoing synthetic cranioplasty with titanium or custom implants.
RESULTS
A total of 82 patients were identified for review, 61 (74.4%) receiving titanium cranioplasty and 21 (25.6%) receiving custom implants. Baseline demographics and comorbidities of the 2 groups did not differ significantly, although multiple surgical characteristics did (size of defect, indication for craniotomy) and were controlled for via a 2:1 mesh-to-custom propensity matching scheme in which 36 titanium cranioplasty patients were compared to 18 custom implant patients. The cranioplasty infection rate of the custom group (27.8%) was significantly greater (P = .005) than that of the titanium group (0.0%). None of the other differences in measured complications reached significance. Discomfort, a common cause of reoperation in the titanium group, did not result in reoperation in any of the patients receiving custom implants.
CONCLUSION
Infection rates are higher among patients receiving custom implants compared to those receiving titanium meshes. The latter should be informed of potential postsurgical discomfort, which can be managed nonsurgically and is not associated with return to the operating room.
Journal Article