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Journal of the Turkish German... Jun 2023To describe the technique and assess long term effects of neurovascular bundle-sparing adult clitoroplasty on clitoral functions in patients.
OBJECTIVE
To describe the technique and assess long term effects of neurovascular bundle-sparing adult clitoroplasty on clitoral functions in patients.
MATERIAL AND METHODS
A case series study enrolling three patients diagnosed with adult clitoromegaly who underwent neurovascular bundle-sparing ventral clitoroplasty operation. All of the patients were examined at the first, third, sixth, twelfth and twenty-fourth months post-operatively to evaluate clitoral functions.
RESULTS
Three patients diagnosed with adult clitoromegaly, aged 17, 21 and 24 years, were enrolled in the study. The primary complaint of all patients was unpleasant enlarged appearance and hypersensitive clitoris. Mean calculated clitoral index was 143 mm, 150 mm, and 120 mm. Operation time was 90, 140 and 120 minutes, respectively. No major complication occurred during the operation but moderate ecchymosis and edema of the vulva occurred in all patients, lasting up to three weeks. On follow up examination, partial sensorial loss was noted at the first month in one patient, which completely resolved by the third month and beyond. Two patients who were sexually active reported that they were very comfortable with intercourse and cosmetic appearance. No clitoral enlargement or pain were reported by patients through the 24-month follow up period.
CONCLUSION
Neurovascular bundle-sparing ventral clitoroplasty is a safe and cosmetically acceptable procedure, which effectively preserves the neurovascular bundle and long-term clitoral functions.
PubMed: 36992297
DOI: 10.4274/jtgga.galenos.2023.2022-12-14 -
JSES International May 2024We aimed to retrospectively compare the clinical outcomes of endoscopy-assisted first-rib resection for thoracic outlet syndrome (TOS) between overhead athletes and...
BACKGROUND
We aimed to retrospectively compare the clinical outcomes of endoscopy-assisted first-rib resection for thoracic outlet syndrome (TOS) between overhead athletes and nonathletes and investigate the return to same-level sports rate in overhead athletes.
METHODS
We retrospectively reviewed 181 cases with TOS (75 women, 106 men; mean age, 28.4 years; range, 12-57 years) who underwent endoscopy-assisted first-rib resection. We divided into two groups: 79 overhead athletes and 102 nonathletes groups. A transaxillary approach for first-rib resection and neurovascular decompression was performed under magnified visualization. Endoscopic findings related to the neurovascular bundle, interscalene distance, and scalene muscle were evaluated intraoperatively. We assessed the Roos and Disability of the Arm, Shoulder, and Hand scores, return to same-level sports rate, and ball velocity.
RESULTS
Overhead athletes were significantly more likely to be men, younger, used the dominant side more frequently, and have a larger physique, more shoulder and elbow pain, and shorter symptom duration. The outcomes of the Roos score revealed significant differences in excellent or good results between overhead athletes (91.1%) and nonathletes (62.8%). The two groups significantly differed in preoperative and postoperative Disability of the Arm, Shoulder, and Hand and recovery rate scores ( = .007, < .001, < .001).
CONCLUSION
Overhead athletes with TOS were more likely to be men, younger, dominant side more frequently, and have more shoulder and elbow pain, and a shorter symptom duration. Endoscopy-assisted transaxillary first-rib resection and neurolysis provided superior clinical outcomes in overhead athletes with TOS compared with nonathletes and a high return-to-same-level-play rate in sports.
PubMed: 38707577
DOI: 10.1016/j.jseint.2023.12.004 -
Journal of Hand Surgery Global Online Jul 2023Thoracic outlet syndrome (TOS) is caused by entrapment of the neurovascular bundle in the interscalene, costoclavicular, or subpectoral minor space. Compression in the... (Review)
Review
Thoracic outlet syndrome (TOS) is caused by entrapment of the neurovascular bundle in the interscalene, costoclavicular, or subpectoral minor space. Compression in the interscalene or costoclavicular space with the first rib and scalene muscle leads to vascular and neurogenic TOS, whereas compression in the subpectoral minor space leads to pectoralis minor syndrome. Various surgical approaches exist for the treatment of TOS. The introduction and development of surgical approaches have minimized surgical invasiveness and complications. The reported approaches include transaxillary, supraclavicular, infraclavicular, posterior, combined transaxillary and supraclavicular, combined supraclavicular and infraclavicular (paraclavicular), endoscopic-assisted transaxillary, and video-assisted thoracoscopic approaches. In this review, we summarize the reported surgical approaches for TOS treatment, in terms of the history of the approach, surgical procedure, advantages and disadvantages, clinical outcomes, and complications. An adequate excision of compression structures, including the first rib and scalene muscles, provides satisfactory outcomes regardless of the approach selected, whereas an inadequate release of compression structures leads to failed or recurrent outcomes. Reducing the risk of complications is the most important aspect of TOS management. Surgery should be performed safely, with sufficient resection of compression structures. Additionally, the approach should be selected based on the surgeon's skill, surgeon's preferences, surgical invasiveness, cosmetic appearance, and the presence of special equipment, as well as other advantages and disadvantages of each approach.
PubMed: 37521542
DOI: 10.1016/j.jhsg.2022.04.007