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Global Spine Journal May 2024Retrospective review of a prospectively-collected multicenter database.
STUDY DESIGN
Retrospective review of a prospectively-collected multicenter database.
OBJECTIVES
The objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF.
METHODS
134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported.
RESULTS
Before revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = -.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (<5°) and small extensions (<4 levels) experienced moderate rates of recurrent PJK (19.1%) and PJF (9.5%). Patients with large reductions (>30°) and extensions <8 levels had the highest rate of recurrent PJK (31.8%) and PJF (16.0%).
CONCLUSION
While the degree of focal PJK correction must be determined by the treating surgeon based upon clinical goals, recurrent PJK may be minimized by limiting reduction to <30°. If larger PJA correction is required, more extensive proximal fusion constructs may mitigate recurrent PJK/PJF rates.
PubMed: 38736317
DOI: 10.1177/21925682241254805 -
Microsurgery Mar 2022Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone...
BACKGROUND
Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone vascularization.
PATIENTS AND METHODS
Surgery was performed between 64 and 499 days after the initial bone osteosynthesis. The average age was 27.6 (range 16-32) years. Nonunion was caused by excessive periosteal removal in two patients, extensive open trauma in three. Four nonunions were diaphyseal, one metaphyseal. A periosteal medial femoral condyle free flap was raised on the descending genicular artery for four patients, the superomedial genicular artery for one. After osteosynthesis with a plate, the flap was wrapped around the metacarpal, overlapping the bone proximally and distally. The recipient vessel were the dorsal branch of the radial artery and a vena comitans in the anatomical snuffbox in four patients, at the base of the first webspace in one.
RESULTS
The flap size ranged from 5 × 3.5 cm to 8 × 4 cm. No postoperative complication occurred. Radiological bone union was achieved 3 to 8 months after surgery. One patient had a full range of motion, one a slight extension lag of the proximal interphalangeal joint, two moderate joint stiffness of the proximal interphalangeal or metacarpophalangeal joint (one requiring plate removal and extensor tenolysis), one severe stiffness that allowed using a hook grip which was the aim of the surgery.
CONCLUSION
In case of metacarpal nonunion with impaired bone vascularization, the periosteal medial femoral condyle free flap provides an effective and biomimetic approach to bone healing.
Topics: Adolescent; Adult; Femur; Fractures, Ununited; Free Tissue Flaps; Humans; Metacarpal Bones; Range of Motion, Articular; Young Adult
PubMed: 34636060
DOI: 10.1002/micr.30826 -
Analysing debranching techniques in Frozen Elephant Trunk procedures: a narrative literature review.Cardiovascular Diagnosis and Therapy Apr 2023Since 2003, the Frozen Elephant Trunk (FET) technique has attained rising popularity for treating extensive aortic arch pathologies such as acute and chronic aortic... (Review)
Review
BACKGROUND AND OBJECTIVE
Since 2003, the Frozen Elephant Trunk (FET) technique has attained rising popularity for treating extensive aortic arch pathologies such as acute and chronic aortic dissection, as well as thoracic aortic aneurysm. Conventionally, the FET procedure included a complete resection of the aortic arch and, subsequently, a distal aortic anastomosis of the prosthetic part of the hybrid graft in arch zone 3. Simultaneous to the introduction of the FET technique, the traditional Elephant Trunk technique was simplified by adding debranching techniques which allows for proximalization of the distal aortic anastomosis. Nowadays, modern concepts of aortic arch surgery combine the FET technique with proximalization of the distal anastomosis in arch zone 2 or further proximal, achieved by using different debranching techniques. This review describes different debranching techniques to facilitate arch reconstruction, and aims to critically assess the outcomes and potential clinical advantages of proximalization using debranching in FET surgery.
METHODS
We conducted a search using the PubMed and Google Scholar electronic databases to evaluate published outcomes of different debranching techniques. An overview of the data synthesis of 21 included studies is reported.
KEY CONTENT AND FINDINGS
Most studies report numeric, but not statistically significant improved outcomes after debranching in FET surgery for mortality, neurological complications, spinal cord injury, kidney failure, bowel ischemia and recurrent nerve palsy. Some studies report statistically significant improved results in isolated endpoints such as neurological, bowel ischemia, and recurrent nerve palsy. Most studies report debranching to be technically easier, but this is difficult to objectively assess and measure.
CONCLUSIONS
There is an improved numeric outcome of different debranching techniques with proximalization of the distal anastomosis, but without reaching statistical significance. This review shows marked heterogeneity across included studies and highlights the scarce use of existing guidelines in clinical research of open aortic arch surgery as proposed by the International Aortic Arch Surgery Study Group. Furthermore, this review demonstrates the urgent need for multicenter registries or studies to be able to compare the outcome of different surgical techniques for various aortic arch pathologies.
PubMed: 37583690
DOI: 10.21037/cdt-22-502 -
Differentiation; Research in Biological... 2020Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features...
Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features that were associated with preputial development, namely the appearance of epidermal aggregates that appeared to be associated with formation of the preputial fold. Transverse and sagittal sections revealed that the epidermis of the glans is considerably thicker than that of the penile shaft. We described a novel morphogenetic mechanism of formation of the preputial lamina, namely the splitting of the thick epidermis of the glans into the preputial lamina and the epidermis via the intrusion of mesenchyme containing red blood cells and CD31-positive blood vessels. This process begins at 10-11 weeks of gestation in the proximal aspect of the glans and extends distally. The process is likely to be androgen-dependent and mediated via androgen receptors strategically localized to the morphogenetic process, but signaling through estrogen receptor may play a role. Estrogen receptor alpha (ESR1) has a very limited expression in the developing human glans and prepuce, while estrogen receptor beta (ESR2) is expressed more broadly in the developing preputial lamina, epidermis and urethra. Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally over several weeks to eventually reach the distal aspect of the glans and prepuce by 14-16 weeks of gestation.
Topics: Humans; Male; Microscopy, Electron, Scanning; Morphogenesis; Penis; Receptors, Androgen; Receptors, Estrogen; Urethra
PubMed: 31654825
DOI: 10.1016/j.diff.2019.10.002 -
PloS One 2024Predating Darwin's theory of evolution, the holotype of Saurodesmus robertsoni is a long-standing enigma. Found at the beginning of 1840s, the specimen is a damaged...
Predating Darwin's theory of evolution, the holotype of Saurodesmus robertsoni is a long-standing enigma. Found at the beginning of 1840s, the specimen is a damaged stylopodial bone over decades variably assigned to turtles, archosaurs, parareptiles, or synapsids, and currently nearly forgotten. We redescribe and re-assess that curious specimen as a femur and consider Saurodesmus robertsoni as a valid taxon of a derived cynodont (?Tritylodontidae). It shares with probainognathians more derived than Prozostrodon a mainly medially oriented lesser trochanter and with the clade reuniting tritylodontids, brasilodontids, and mammaliaforms (but excluding tritheledontids) the presence of a projected femoral head, offset from the long axis of the femoral shaft; a thin, plate-like greater trochanter; a distinct dorsal eminence proximal to the medial (tibial) condyle located close to the level of the long axis of the femoral shaft and almost in the middle of the width of the distal expansion; and a pocket-like fossa proximally to the medial (tibial) condyle. Saurodesmus robertsoni is most similar to tritylodontids, sharing at least with some forms: the relative mediolateral expansion of the proximal and distal regions of the femur, the general shape and development of the greater trochanter, the presence of a faint intertrochanteric crest separating the shallow intertrochanteric and adductor fossae, and the general outline of the distal region as observed dorsally and distally. This makes Saurodesmus robertsoni the first Triassic cynodont from Scotland and, possibly, one of the earliest representatives of tritylodontids and one of the latest non-mammaliaform cynodonts worldwide. Moreover, it highlights the need for revisiting historical problematic specimens, the identification of which could have been previously hampered by the lack of adequate comparative materials in the past.
Topics: Animals; Fossils; Femur; Scotland; Biological Evolution; Phylogeny
PubMed: 38809839
DOI: 10.1371/journal.pone.0303973 -
Plastic and Reconstructive Surgery.... Jul 2014There is a dearth of detailed published work on the anatomy of ulnar artery perforators. The objective of this study was to fully document the vascular basis of the free...
BACKGROUND
There is a dearth of detailed published work on the anatomy of ulnar artery perforators. The objective of this study was to fully document the vascular basis of the free proximal ulnar artery perforator flap and report its use in reconstruction of the hand.
METHODS
(1) The ulnar artery perforators were studied in 25 fresh cadavers and 10 cast preparations. Cadavers were injected with lead oxide for 3-dimensional reconstruction. The origin, course, and distribution of the ulnar artery perforators were comprehensively documented. (2) Between August 2011 and January 2013, 29 free proximal ulnar artery perforator flaps were utilized for reconstruction of soft-tissue defects of the hand in 25 patients. Flap size varied from 3.5 × 2.0 cm to 24.0 × 4.0 cm, with a consistent thickness of approximately 3 mm.
RESULTS
(1) There were 7 ± 2.0 ulnar artery perforators. The average external diameter was 0.6 ± 0.2 mm. Each perforator supplied an average area of 26 ± 7.0 cm(2). Extensive anastomoses were found between the ulnar artery perforators and multiple adjacent source arteries. (2) All flaps survived. The clinical results were satisfactory after 10.2 ± 5.3 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors.
CONCLUSIONS
The main advantage of the proximal ulnar artery perforator flap is that it is a thin flap that is ideal for upper extremity reconstruction, either as proximally or distally based local perforator flap or as a free flap. The donor site is excellent, and the vascular anatomy is very consistent.
PubMed: 25426362
DOI: 10.1097/GOX.0000000000000113 -
Journal of Hand and Microsurgery Sep 2023Spastic joint contractures remain a complex and challenging condition. For patients with upper extremity spastic dysfunction, improving the muscle balance is...
Spastic joint contractures remain a complex and challenging condition. For patients with upper extremity spastic dysfunction, improving the muscle balance is essential to maximize their hand function. Multiple procedures, including proximal row carpectomy (PRC) and wrist arthrodesis (WA), are considered among the different surgical alternatives. However, the biomechanical consequences of these two procedures have not been well described in current literature. Hence, the objective of our study is to assess the change in the extrinsic digit flexor tendon resting length after proximal row carpectomy and wrist arthrodesis. Six fresh-frozen cadaver upper extremities (four females and two males) with no obvious deformity underwent dissection, PRC, and WA. All the flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and flexor pollicis longus (FPL) tendons were marked proximally 1-cm distal to their respective myotendinous junction and cut distally at the marked point. The overlapping segment of each distal flexor tendon from its proximal mark was considered the amount of flexor tendon resting length change after PRC and WA. A descriptive evaluation was performed to assess the increment in tendon resting length. Additionally, a regression analysis was performed to evaluate the relation between the tendon resting length and the proximal carpal row height. Following PRC and WA, the mean digit flexor tendon resting length increment achieved across all tendons was 1.88 cm (standard deviation [SD] = 0.45; range: 1.00-3.00 cm). A weak direct relationship ( = 0.0334) between the increment in tendon resting length and proximal carpal row height was initially suggested, although no statistical significance was demonstrated ( = 0.811). This study provides an anatomic description of the increased extrinsic digit flexor tendon resting length after PRC and WA in cadaveric specimens. Findings provide a useful framework to estimate the amount of extrinsic digit flexor resting length increment achieved after wrist fusion and the proximal carpal row removal.
PubMed: 37701311
DOI: 10.1055/s-0042-1742458 -
Clinical Epidemiology 2019We conducted a systematic review and meta-analysis aimed at evaluating the differences of diagnostic performance of fecal occult blood tests (FOBTs) in detecting... (Review)
Review
OBJECTIVE
We conducted a systematic review and meta-analysis aimed at evaluating the differences of diagnostic performance of fecal occult blood tests (FOBTs) in detecting advanced colorectal neoplasms located in the proximal versus distal colorectum.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible articles published before August 17, 2018. Two independent reviewers conducted study assessment and data extraction. Diagnosis-related indicators of FOBT for detecting proximal and distal colorectal neoplasms were summarized, and further stratified by the type of FOBT (guaiac-based FOBT (gFOBT) and immunochemical FOBT (iFOBT)). Pooled sensitivities and specificities were calculated using a random effect model. Summary receiver operating characteristic curves were plotted and area under the curves were calculated.
RESULTS
Overall, 31 studies meeting the inclusion criteria were included in this review. For gFOBT, we found no site-specific difference (proximally vs distally located) of pooled sensitivities observed in the colorectal cancer (CRC), advanced adenomas, and advanced neoplasms groups. As for iFOBT, pooled sensitivities for detecting CRC located in the distal colon/rectum were comparable with that in the proximal colon (proximal vs distal, 0.67, 95% CI 0.62-0.72 vs 0.72, 95% CI 0.68-0.75), while higher pooled sensitivities for detecting advanced adenomas and advanced neoplasms located in the distal colon/rectum than for detecting those in the proximal colon were observed for iFOBT with the values of 0.24 (95% CI 0.22-0.25) vs 0.32 (95% CI 0.30-0.34) and 0.25 (95% CI 0.23-0.28) vs 0.38 (95% CI 0.36-0.40), respectively. Summary receiver operating characteristic curve analyses showed similar patterns for both types of FOBT regarding the diagnostic accuracy for detecting colorectal neoplasms according to the anatomical sites of the colorectum.
CONCLUSION
iFOBT had higher sensitivity for detecting advanced adenomas and advanced neoplasia located in the distal colon/rectum than that for those in the proximal colon.
PubMed: 31695506
DOI: 10.2147/CLEP.S213677 -
Journal of Clinical Medicine Nov 2023Lower instrumented vertebra (LIV) selection is critical to avoid complications like adding-on. This study aims to determine the usefulness of the traction test (TR) in...
Lower instrumented vertebra (LIV) selection is critical to avoid complications like adding-on. This study aims to determine the usefulness of the traction test (TR) in selecting the LIV during surgery for adolescent idiopathic scoliosis (AIS). We analyzed 42 AIS patients with Lenke 1 curves who had preoperative, postoperative, and at least 12-month follow-up X-rays, as well as preoperative side bending (SB) and TR radiograms. Neutral vertebra (NV), stable vertebra (SV), lower instrumented vertebra (LIV), and Cobb angles were identified and compared on all radiographic images. In 23 cases, the TR resulted in SV proximalization compared to the preoperative X-rays, while in 8 cases, SV-TR was more distal. This distalization occurred in 50% of Lenke 1C curves, where a greater correction of the distal curve was found. NV-TR was proximal to NV-preop in 9 cases, while NV-SB was proximal in 22 cases. LIV was proximal to SV-TR in 8 cases, while it was proximal to SV-preop in 22. One patient with LIV proximal to SV-TR developed adding-on. In conclusion, the TR is crucial in AIS preoperative planning as it provides information distinct from that of standard X-rays and SB: (1) it better assesses gravitational stability than rotational stability; and (2) choosing LIV equal to or proximal to SV-TR may prevent adding-on, except in 'flexible' Lenke 1C curves where LIV should be equal or distal to SV-preop.
PubMed: 38002604
DOI: 10.3390/jcm12226986