발표 논문
| 이달의 논문 2024년 10월 | ||
|---|---|---|
| 등록일 : 2024.12.13 | ||
The effect of preoperative botulinum toxin a injection on traction force during hernia repair: a prospective, single-blind study, intra-patient comparison using contralateral side as a controlAffiliations
AbstractPurpose: Ventral hernias are a common complication of laparotomy, posing challenges particularly when primary fascial closure is unattainable. Although chemical component separation using preoperative botulinum toxin A (BTX) injections has emerged as a promising adjunct, objective evidence of its efficacy remains limited. This study aimed to objectively assess the effect of preoperative BTX on traction force during ventral hernia repair. Methods: A prospective, single-blind study was conducted on patients with midline incisional hernias following liver transplantation. BTX was administered unilaterally, and the traction force required to medially advance the anterior rectus sheath was measured intraoperatively. Pre- and post-injection CT scans were analyzed for changes in hernia size and LAW muscle measurements. Statistical analyses were performed to evaluate traction force differences between BTX-injected and uninjected sides. Results: Ten patients underwent hernia repair with primary fascial closure achieved in all cases. Comparison of pre- and post-injection CT scans showed no significant changes in hernia size. LAW muscle length increased by 1.8 cm, while thickness decreased by 0.2 cm. Intraoperative traction force measurements revealed a significant reduction on the BTX-injected side compared to the uninjected side (p < 0.0001). The traction force ratio on the BTX-injected to the uninjected side averaged 57%, indicating the efficacy of BTX in reducing tension. Conclusion: Preoperative BTX significantly reduces traction force during ventral hernia repair, highlighting its potential as an adjunctive therapy in complex cases. While challenges remain in patient selection and outcome assessment, BTX offers a promising avenue for enhancing abdominal wall reconstruction outcomes and reducing surgical complications. Keywords: Abdominal wall; Botulinum toxins, type A; Hernia, ventral; Herniorrpaphy.
Color-Contrast Technique Using Fluorescein and Blue Marker to Maximize Visualization during Lymphaticovenous AnastomosisAffiliations
AbstractLymphatic vessel wall and lumen visualization during anastomosis is challenging. Different techniques with variable efficacy have been described. Double-opposing color contrast is created using 10% fluorescein sodium, which stains lymphatic fluid yellow, causing a clear contrast to the blue marker-painted lymphatic wall, improving intralumen visualization during the anastomosis process. In this retrospective study, the authors evaluated the success rate of performing anastomosis between the side of the lymphatic vessel and the end of the vein (S-to-E LVA) in 281 patients. The LVA assessment showed mean lymphatic diameter of 0.44 ± 0.09 mm and mean vein diameter of 0.57 ± 0.14 mm with S-to-E success rate of 100% confirmed by postanastomosis indocyanine green lymphography. No adverse events were encountered. Fluorescein sodium was not used in 2 patients because of positive skin allergy test results. This method has the advantages of not needing an additional device, allowing clear visualization, and not staining the surrounding structures. This approach using opposing color contrast between fluorescent yellow and blue marker improved vessel edge identification, which translated into higher visualization and patency with 100% success rate in S-to-E LVA performance.
Gearing Effect in Clockwise Rotational Orthognathic SurgeryAffiliations
AbstractBackground: The standard procedure for managing skeletal class III malocclusion is maxillary advancement with mandibular setback. Occlusal plane-altering orthognathic surgery, such as jaw rotation, is useful as well. Although clockwise jaw rotation is a common procedure, its mechanism has not been well investigated. With this study, the authors aim to introduce the gearing effect to correct class III malocclusion in Asians by maxillary posterior impaction using clockwise rotation without advancing the maxilla. Methods: Patients with class III correction with clockwise rotation of the maxillomandibular complex without maxillary advancement were included; those who underwent genioplasty were excluded. Various facial skeletal cephalometric landmarks were measured using artificial intelligence-based cephalometric analysis software. The gearing effect was determined by dividing the lower anterior facial height (LAFH) in relatively short and long groups compared with those in the anterior nasal spine to posterior nasal spine length. Results: In a total of 29 patients, the amount of menton setback between group 1 ( n = 15; short LAFH) and group 2 ( n = 14; long LAFH) was 1.67 ± 0.66 and 2.74 ± 0.99 mm per 1 mm of posterior nasal spine impaction, respectively ( P = 0.002), and 1.58 (interquartile range, 0.78) and 1.95 (interquartile range, 1.05) mm per 1 degree of clockwise rotation of the palatal angle, respectively ( P = 0.007). The convexity of the A point was improved without any significant change in the sella-nasion-A point angle before and after surgery. Conclusions: This article addresses the scientific evidence regarding the impact of clockwise rotational orthognathic surgery based on the gearing effect. The mandibular setback turned out to be more effective in patients with a long LAFH.
Conventional versus Robot-Assisted Immediate Breast Reconstruction: Reconstructive Outcome and Patient-Reported Outcome MeasuresAffiliations
AbstractBackground: In this study, the authors compared conventional and robot-assisted mastectomy and breast reconstruction. To the authors' knowledge, this study is the first to report the results of robot-assisted mastectomy and breast reconstruction and provide a comparison of patient-reported outcomes. Method: This retrospective study included 473 breasts of 423 patients who underwent conventional mastectomy and breast reconstruction and 164 breasts of 153 patients who underwent robot-assisted mastectomy and breast reconstruction from July of 2019 to October of 2021. Demographic and oncologic data, reconstructive outcomes, and patient-reported outcomes (BREAST-Q) were evaluated. The results of implant-based and autologous breast reconstruction were evaluated separately. Results: Skin necrosis requiring surgical débridement occurred significantly more frequently in the conventional group (8.0%) than in the robot-assisted group (2.0%) in implant-based reconstruction ( P = 0.035). At 6 to 12 months, patients who underwent robot-assisted breast reconstruction showed a higher Sexual Well-being score for implant-based reconstruction and a higher Physical Well-being score for autologous breast reconstruction than conventional breast reconstruction according to the BREAST-Q questionnaire. Conclusions: Robot-assisted mastectomy and breast reconstruction was associated with less skin necrosis and better patient-reported outcomes (Sexual Well-being for implant-based reconstruction and Physical Well-being for autologous breast reconstruction) than the conventional option. Robotic surgery could be a good option for mastectomy and breast reconstruction.
Color-Contrast Technique Using Fluorescein and Blue Marker to Maximize Visualization during Lymphaticovenous AnastomosisAffiliations
AbstractLymphatic vessel wall and lumen visualization during anastomosis is challenging. Different techniques with variable efficacy have been described. Double-opposing color contrast is created using 10% fluorescein sodium, which stains lymphatic fluid yellow, causing a clear contrast to the blue marker-painted lymphatic wall, improving intralumen visualization during the anastomosis process. In this retrospective study, the authors evaluated the success rate of performing anastomosis between the side of the lymphatic vessel and the end of the vein (S-to-E LVA) in 281 patients. The LVA assessment showed mean lymphatic diameter of 0.44 ± 0.09 mm and mean vein diameter of 0.57 ± 0.14 mm with S-to-E success rate of 100% confirmed by postanastomosis indocyanine green lymphography. No adverse events were encountered. Fluorescein sodium was not used in 2 patients because of positive skin allergy test results. This method has the advantages of not needing an additional device, allowing clear visualization, and not staining the surrounding structures. This approach using opposing color contrast between fluorescent yellow and blue marker improved vessel edge identification, which translated into higher visualization and patency with 100% success rate in S-to-E LVA performance.
Acellular Dermal Matrix without Basement Membrane in Immediate Prepectoral Breast Reconstruction: A Randomized Controlled TrialAffiliations
AbstractBackground: Acellular dermal matrix (ADM) has become popular in various reconstructive procedures of different anatomic regions. There are different needs depending on the clinical application, including breast, abdominal wall, and any other soft-tissue reconstruction. Removal of the basement membrane, which consists of collagen fibers, may help achieve natural and soft breast reconstruction, which requires highly elastic ADMs. Given the lack of knowledge of the effectiveness of ADM without the basement membrane, the authors compared the clinical outcomes of ADMs with and without basement membrane in breast reconstruction. Methods: The authors conducted a single-blind randomized controlled trial to evaluate differences in clinical outcomes. The patients were randomized into 2 groups: ADM with or without basement membrane. Both groups underwent immediate prepectoral direct-to-implant breast reconstruction. Demographic characteristics, surgical outcomes, and breast shape change using nipple position were compared between the 2 groups. Results: A total of 56 patients were divided into 2 groups: ADM with basement membrane (n = 30 [53.6%]) or ADM without basement membrane (n = 26 [46.4%]). Clinical and surgical characteristics were similar between the 2 groups. The authors detected no statistically significant differences in the overall rate of complications or breast shape change between the 2 groups. However, the rate of seromas was higher in the ADM with basement membrane group than in the ADM without basement membrane group (10% versus 0%; P = 0.09). Conclusions: The 2 groups showed similar surgical outcomes. ADM without basement membrane in implant-based breast reconstruction was safe, and had mechanical properties of lower tensile strength and higher elasticity.
Improved lymphangiogenesis around vascularized lymph node flaps by periodic injection of hyaluronidase in a rodent modelAffiliations
AbstractVascularized lymph node transfer (VLNT) is an advanced surgical approach for secondary lymphedema (SLE) treatment, but tissue fibrosis around the lymph node flap (VLNF) inhibiting lymphangiogenesis is the biggest challenge undermining its therapeutic efficacy. This study explored the effects of periodic hyaluronidase (HLD) injection in reducing fibrosis and promoting lymphangiogenesis in 52 Sprague-Dawley rats with a VLNF over 13 weeks. The results demonstrated that HLD administration significantly enhanced swelling reduction, lymphatic drainage efficiency, and lymphatic vessel regeneration, with up to a 26% decrease in tissue fibrosis around the VLNF. These findings suggest that combining VLNT with periodic injections of HLD could substantially improve SLE treatment outcomes in clinical settings. It offers a promising direction for future therapeutic strategies and drug development aimed at increasing the efficacy of surgical treatment for SLE patients. |
||
- 이전글
- 이달의 논문 2024년 9월
- 다음글
- 이달의 논문 2024년 11월
