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The British Journal of Oral &... Feb 2017To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015.... (Review)
Review
To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015. A total of 9499 mandibular defects were reconstructed with 6178 fibular, 1380 iliac crest, 1127 composite radial, 709 scapular, 63 serratus anterior and rib, 32 metatarsal, and 10 lateral arm flaps including humerus. The failure rate was higher for the iliac crest (6.2%, 66/1059) than for fibular, radial, and scapular flaps combined (3.4%, 202/6018) (p<0.001). We evaluated rates of osteotomy, non-union, and fistulas. Implant-retained prostheses were used most often for rehabilitation after reconstruction with iliac crest (44%, 100/229 compared with 26%, 605/2295 if another flap was used) (p<0.001). There were no apparent changes in the choice of flap or in the complications reported. Although we were able to show some significant differences relating to the types of flap used, we were disappointed to find that fundamental outcomes such as the need for osteotomy, and rates of non-union and fistulas were under-reported. This review shows the need for more comprehensive and consistent reporting of outcomes to enable the comparison of different techniques for similar defects.
Topics: Bone Transplantation; Free Tissue Flaps; Humans; Mandibular Reconstruction; Time Factors
PubMed: 28065645
DOI: 10.1016/j.bjoms.2016.12.010 -
European Journal of Trauma and... Aug 2019Many studies report on outcomes of analgesic therapy for (suspected) traumatic rib fractures. However, the literature is inconclusive and diverse regarding the... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
Many studies report on outcomes of analgesic therapy for (suspected) traumatic rib fractures. However, the literature is inconclusive and diverse regarding the management of pain and its effect on pain relief and associated complications. This systematic review and meta-analysis summarizes and compares reduction of pain for the different treatment modalities and as secondary outcome mortality during hospitalization, length of mechanical ventilation, length of hospital stay, length of intensive care unit stay (ICU) and complications such as respiratory, cardiovascular, and/or analgesia-related complications, for four different types of analgesic therapy: epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks.
METHODS
PubMed, EMBASE and CENTRAL databases were searched to identify comparative studies investigating epidural, intravenous, paravertebral and intercostal interventions for traumatic rib fractures, without restriction for study type. The search strategy included keywords and MeSH or Emtree terms relating blunt chest trauma (including rib fractures), analgesic interventions, pain management and complications.
RESULTS
A total of 19 papers met our inclusion criteria and were finally included in this systematic review. Significant differences were found in favor of epidural analgesia for the reduction of pain. No significant differences were observed between epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks, for the secondary outcomes.
CONCLUSIONS
Results of this study show that epidural analgesia provides better pain relief than the other modalities. No differences were observed for secondary endpoints like length of ICU stay, length of mechanical ventilation or pulmonary complications. However, the quality of the available evidence is low, and therefore, preclude strong recommendations.
Topics: Administration, Intravenous; Adolescent; Adult; Aged; Analgesia, Epidural; Analgesics; Critical Care; Epidemiologic Methods; Humans; Length of Stay; Middle Aged; Musculoskeletal Pain; Nerve Block; Pain Measurement; Rib Fractures; Young Adult
PubMed: 29411048
DOI: 10.1007/s00068-018-0918-7 -
The Journal of Craniofacial Surgery Oct 2022The objective of this study was to perform a systematic review of the literature to assess the clinical outcomes and safety profile of autologous cartilage grafts...
OBJECTIVE
The objective of this study was to perform a systematic review of the literature to assess the clinical outcomes and safety profile of autologous cartilage grafts (A-CGs) in nasal tip remodeling (NTR).
METHODS
The protocol was developed following the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols guidelines. A multistep search of the PubMed, MEDLINE, Embase, Scopus database, and Cochrane databases has been performed to identify papers on A-CGs use in NTR. Of the 253 articles initially identified, only 39 articles providing either retrospective (n = 35) or prospective (n = 4) data about outcomes, descriptions, and complications of the A-CGs use in NTR were selected. Of these, 3 articles focused on alloplastic grafts were excluded.
RESULTS
The nasal septum, concha, and ribs have been the main donor sites to build A-CGs to be used in NTR. Septal cartilage turned out to a specific and versatile, useful for many types of grafts tools, presenting a low rate of resorption, extrusion, and warping. Auricular concha cartilage has been used to correct both the internal and external nasal valve collapse, whereas rib chondral grafts have been used to improve the structural support when septal cartilage was not available. Crushed cartilage, minced cartilage, and diced cartilage have been used in noses with thinner soft tissues.
CONCLUSIONS
Eighty percent of the analyzed studies focused on the description of the adopted surgical technique and A-CGs procedures of preparation, displaying encouraging aesthetic and functional outcomes with generally low levels of complications. Collected data confirmed the safety and efficacy of A-CGs-related interventions in NTR without major side effects.
Topics: Ear Cartilage; Esthetics, Dental; Humans; Nasal Septum; Prospective Studies; Retrospective Studies; Rhinoplasty; Transplantation, Autologous
PubMed: 36201698
DOI: 10.1097/SCS.0000000000008494 -
The Journal of Sports Medicine and... Jun 2016Rib stress fractures (RSFs) are injuries frequently sustained by elite rowers with an injury rate of 8-16% over the course of a rowing career, resulting in negative... (Review)
Review
INTRODUCTION
Rib stress fractures (RSFs) are injuries frequently sustained by elite rowers with an injury rate of 8-16% over the course of a rowing career, resulting in negative effects on training and performance. For clinical management, the aim of this review was to describe time to return to sports, summarize potentially preventive measures and appraise the evidence on risk factors.
EVIDENCE ACQUISITION
A search strategy was performed in PubMed, SportDiscus, Web of Science and Embase till June 1st 2015. All studies were graded on their quality.
EVIDENCE SYNTHESIS
The search resulted in 124 studies, of which 17 were included: Ten reported on return to sports, 17 reported on risk factors and nine on preventive measures. For return to sports, nine studies mentioned a loss of training of 4-6 weeks. The shortest period was one week and the longest 16 weeks. For risk factors, insufficient or conflicting evidence was found for changes in the training program, incorrect rowing technique, female gender, low bone mineral density, inadequate equipment, and training type. For prevention, gradual changes in the training program, alertness on the part of coaches and clinicians, and supplementation of diet and hormones are suggested as effective measures. However, no effect studies have been found.
CONCLUSIONS
The main outcome of this review on RSFs is that little evidence is available on return to sports, risk factors and preventive measures. Coaches and clinicians should carefully guide and assist rowers suffering from RSFs in off training and in the subsequent training period to regain their pre-injury level.
Topics: Female; Fractures, Stress; Humans; Male; Return to Sport; Ribs; Risk Factors; Sports
PubMed: 26173790
DOI: No ID Found -
Archives of Orthopaedic and Trauma... May 2024Rib fractures commonly occur in trauma patients with varying presentations. Though the literature in recent years has moved toward favoring more early intervention of... (Review)
Review
INTRODUCTION
Rib fractures commonly occur in trauma patients with varying presentations. Though the literature in recent years has moved toward favoring more early intervention of acute rib fractures, little has been reported on the matter of surgical fixation for symptomatic rib fracture nonunions.
MATERIALS AND METHODS
We performed a review of PubMed and Cochrane databases for articles published since 2000. Inclusion criteria were studies with greater than six months of follow-up, while case studies were excluded. A thorough analysis was performed on patient outcomes, complications reported, operative techniques utilized, and fixation systems used, among other parameters reported by the articles.
RESULTS
One hundred and thirty-nine studies resulted from our review, and a total of nine studies met our inclusion criteria with a combined total of 182 patients who underwent open reduction and internal fixation for symptomatic rib fracture nonunions. All studies reported a significant reduction of pain with increased satisfaction in the majority of patients. There were a total of 71 postoperative complications, the most common of which included surgical site infections, hardware failure, and hematoma. The most serious complications were insulting injury to the lung parenchyma or pleura; however, these were extremely rare based off the current literature. The use of bone grafting was common with eight of the nine studies mentioning the benefits of grafting.
CONCLUSION
Surgical stabilization of rib fracture nonunions appears to be an appropriate treatment alternative, and various techniques and approaches may be used with similar success. Further studies with higher level of evidence are recommended on the subject.
Topics: Humans; Rib Fractures; Fractures, Ununited; Fracture Fixation, Internal; Postoperative Complications; Bone Transplantation
PubMed: 38492065
DOI: 10.1007/s00402-024-05264-y -
The Cochrane Database of Systematic... Nov 2014Thoracic outlet syndrome (TOS) is one of the most controversial diagnoses in clinical medicine. Despite many reports of operative and non-operative interventions,... (Review)
Review
BACKGROUND
Thoracic outlet syndrome (TOS) is one of the most controversial diagnoses in clinical medicine. Despite many reports of operative and non-operative interventions, rigorous scientific investigation of this syndrome leading to evidence-based management is lacking. This is the first update of a review first published in 2010.
OBJECTIVES
To evaluate the beneficial and adverse effects of the available operative and non-operative interventions for the treatment of TOS a minimum of six months after the intervention.
SEARCH METHODS
On 23 June 2014 we searched the Cochrane Neuromuscular Disease Group Trials Specialized Register, CENTRAL, The Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL Plus and AMED. We also searched reference lists of the identified trials.
SELECTION CRITERIA
We selected randomized or quasi-randomized studies involving participants with the diagnosis of TOS of any type (neurogenic, vascular, and 'disputed'), without limitations as to language of publication.We accepted studies that examined any intervention aimed at treating TOS.The primary outcome measure was change in pain rating, measured on a validated visual analog or similar scale at least six months after the intervention.The secondary outcomes were change in muscle strength, disability, experiences of paresthesias (numbness and tingling sensations), and adverse effects of the interventions.
DATA COLLECTION AND ANALYSIS
Three authors independently selected the trials to be included and extracted data. Authors rated included studies for risk of bias, according to the methods recommended in the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS
This review was complicated by a lack of generally accepted criteria for the diagnosis of TOS and had to rely exclusively on the diagnosis of TOS by the investigators in the reviewed studies. We identified one study comparing natural progression with an active intervention. We found three randomized controlled trials (RCTs), but only two of them had a follow-up of six months or more, which was the minimum required follow-up for inclusion in the review. The first trial that met our requirements involved 55 participants with the 'disputed type' of TOS and compared transaxillary first rib resection (TFRR) with supraclavicular neuroplasty of the brachial plexus (SNBP). The trial had a high risk of bias. TFRR decreased pain more than SNBP. There were no adverse effects in either group. The second trial that met these requirements analyzed 37 people with TOS of any type, comparing treatment with a botulinum toxin (BTX) injection into the scalene muscles with a saline placebo injection. This trial had a low risk of bias. There was no significant effect of treatment with the BTX injection over placebo in terms of pain relief or improvements in disability, but it did significantly improve paresthesias at six months' follow-up. There were no adverse events of the BTX treatment above saline injection.
AUTHORS' CONCLUSIONS
This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty, but no randomized evidence that either is better than no treatment. There is moderate evidence to suggest that treatment with BTX injections yielded no great improvements over placebo injections of saline. There is no evidence from RCTs for the use of other currently used treatments. There is a need for an agreed definition for the diagnosis of TOS, especially the disputed form, agreed outcome measures, and high quality randomized trials that compare the outcome of interventions with no treatment and with each other.
Topics: Botulinum Toxins; Brachial Plexus; Cervical Rib; Follow-Up Studies; Humans; Neurotoxins; Randomized Controlled Trials as Topic; Thoracic Outlet Syndrome; Time Factors
PubMed: 25427003
DOI: 10.1002/14651858.CD007218.pub3 -
Acta Anaesthesiologica Scandinavica Jul 2015Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients... (Review)
Review
BACKGROUND
Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures.
METHODS
We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration of mechanical ventilation.
RESULTS
A total of six trials (n = 223) were included; all were judged as having a high risk of bias. In the conventional meta-analyses, there was no statistically significant difference in mortality (RR 2.18, 95% CI 0.21-22.42; P = 0.51; I(2) = 0%), duration of mechanical ventilation (MD -7.53, 95% CI -16.32 to 1.26; P = 0.09; I(2) = 91%) or pneumonia (RR 0.49, 95% CI 0.19-1.25; P = 0.13; I(2) = 0%) between CEA and other analgesic interventions. Subgroup analyses and sensitivity analyses, including TSA confirmed the results.
CONCLUSION
The quality and quantity of evidence for the use of CEA in patients with traumatic rib fractures is low, and there is no firm evidence for benefit or harm of CEA compared with other analgesic interventions. Well-powered RCTs with low risk of bias reporting clinically relevant patient-centred outcome measures are needed.
Topics: Analgesia, Epidural; Humans; Pain; Pneumonia; Randomized Controlled Trials as Topic; Respiration, Artificial; Rib Fractures
PubMed: 25683770
DOI: 10.1111/aas.12475 -
Journal of Orthopaedic Trauma Feb 2017Flail chest is a common injury sustained by patients who experience high-energy blunt chest trauma and results in severe respiratory compromise because of altered... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Flail chest is a common injury sustained by patients who experience high-energy blunt chest trauma and results in severe respiratory compromise because of altered mechanics of respiration. There has been increased interest in operative fixation of these injuries with the intention of restoring the mechanical integrity of the chest wall, and several studies have shown that ventilation requirements and pulmonary complications may be decreased with operative intervention. The purpose of this study was to evaluate fixation of rib fractures in flail chest injuries using cost-effectiveness analysis, supported by systematic review and meta-analysis.
METHODS
This was a 2-part study in which we initially conducted a systematic literature review and meta-analysis on outcomes after operative fixation of flail chest injuries, evaluating intensive care unit (ICU) stay, hospital length of stay (LOS), mortality, pneumonia, and need for tracheostomy. The results were then applied to a decision-analysis model comparing the costs and outcomes of operative fixation versus nonoperative treatment. The validity of the results was tested using probabilistic sensitivity analysis.
RESULTS
Operative treatment decreased mortality, pneumonia, and tracheotomy (risk ratios of 0.44, 0.59, and 0.52, respectively), as well as time in ICU and total LOS (3.3 and 4.8 days, respectively). Operative fixation was associated with higher costs than nonoperative treatment ($23,682 vs. $8629 per case, respectively) and superior outcomes (32.60 quality-adjusted life year (QALY) vs. 30.84 QALY), giving it an incremental cost-effectiveness ratio of $8577/QALY.
CONCLUSIONS
Surgical fixation of rib fractures sustained from flail chest injuries decreased ICU time, mortality, pulmonary complications, and hospital LOS and resulted in improved health care-related outcomes and was a cost-effective intervention. These results were sensitive to overall complication rates, and operations should be conducted by surgeons or combined surgical teams comfortable with both thoracic anatomy and exposures as well as with the principles and techniques of internal fixation.
LEVEL OF EVIDENCE
Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Computer Simulation; Cost-Benefit Analysis; Female; Flail Chest; Fracture Fixation, Internal; Health Care Costs; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Models, Economic; Pneumonia; Prevalence; Quality of Life; Rib Fractures; Risk Factors; Survival Rate; Tracheotomy; Treatment Outcome; Young Adult
PubMed: 27984449
DOI: 10.1097/BOT.0000000000000750 -
Journal of Clinical Medicine Oct 2023Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and... (Review)
Review
Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of TOS with a focus on the innovative approach of Robotic First Rib Resection (R-FRR). Traditional management of TOS includes conservative measures and surgical interventions, with various open surgical approaches carrying risks of complications. R-FRR, a minimally invasive technique, offers advantages such as improved exposure, reduced injury risk to neurovascular structures, and shorter hospital stays. A comprehensive literature review was conducted to assess the outcomes of R-FRR for TOS. Data from 12 selected studies involving 397 patients with nTOS, vTOS, and aTOS were reviewed. The results indicate that R-FRR is associated with favorable intraoperative outcomes including minimal blood loss and low conversion rates to traditional approaches. Postoperatively, patients experienced decreased pain, improved function, and low complication rates. These findings support R-FRR as a safe and effective option for medically refractory TOS.
PubMed: 37892829
DOI: 10.3390/jcm12206689 -
Annals of Medicine and Surgery (2012) Feb 2024Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if... (Review)
Review
INTRODUCTION
Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures.
METHODS
A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers.
RESULTS
Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (=23), infra-orbital para/anaesthesia (=27), and enophthalmos (=7). No failure of graft or donor site morbidity were observed in the studies.
CONCLUSION
Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.
PubMed: 38333240
DOI: 10.1097/MS9.0000000000001598