American Journal of Surgical Research and Reviews 2021-07-24T23:08:22+00:00 American Journal of Surgical Research and Reviews AJSRR@ESCIPUB.ORG Open Journal Systems <p>ISSN:2637-5087<br />DOI:10.28933/AJSRR</p> Facial Fat Grafting in reconstructive maxillofacial surgery 2021-07-08T23:14:21+00:00 Luigi Clauser*, Floria Bertolini <p>Aim: Facial Fat Grafting(FFG) was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion and retention. FFG was initially used as a technique to improve facial aesthetics. Over the years the technique&nbsp; has evolved into more complex reconstructive and regenerative procedures and new clinical applications.</p> <p>Methods: In the last two decades the indications of FFG have been extended into cranio-maxillofacial reconstructive surgery. This includes post-traumatic soft tissue defects,&nbsp; aesthetics,congenital and other postsurgical volume deficits.</p> <p>Results: While several approaches were suggested for fat harvesting and grafting, the results were rather unsatisfactory due to the degeneration of many adipocytes that occurred during these manipulations. The technique of autologous fat transfer has then been perfectioned becoming an augmentation-regenerative process that can be used to treat a wide range of difficult and challenging reconstructive problems. The procedure&nbsp; described herein has been performed in different patients with various pathology sequelae with sactisfactory morpho-aesthetic results and a low complication rate.</p> <p>Conclusion: FFG can be used in any facial area where is lack,of soft tissue or where there is scarring,producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine because of their ability to differentiate into a variety of specialized cells. However more definitive studies are still needed in order to answer specific questions regarding the best technique to be used and the role of ADSC’s.Clinical cases with volume paucity or deficiencies are presented with a long-term outcome in augmentation and regeneration.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Clinical Manifestations of Cholelithiasis in Quito, Ecuador. A Cohort Study 2021-07-08T23:20:12+00:00 Montalvo-Burbano Mario1, Cabrera-Villa Mayra2, Pacheco-Ojeda Luis3 <p>Introduction: A prospective study was carried out, with the aim of establishing the clinical manifestations of cholelithiasis in the population of Quito, Ecuador.</p> <p>Methods: During the period from January 2012 to October 2017, 534 patients were referred from different outpatient clinics of the Ecuadorian Institute of Social Security to the Batan Medical Center with the diagnosis of cholelithiasis after a clinical assessment and abdominal ultrasound, to be treated surgically.</p> <p>Results: Sixty-nine percent of patients were female with a male-female ratio of 1:2.21. Mean age was 44.9 years. Pain was the most common symptom in our study: 95.7%. Among these patients, pain was located in the epigastrium in 49.8%, in the right hypochondrium in 45.1% and only 0.8% had low back pain. Pain ranged from moderate and even severe. The remaining 4.3% of patients had dyspepsia or were asymptomatic.</p> <p>Conclusions: This finding highlights the fact that epigastric pain must be always considered as a clinical manifestation on cholelithiasis.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Efficacy of cholecystectomy in patients with positive HIDA Scans with typical or atypical biliary pain: A retrospective study 2021-07-08T23:21:52+00:00 Amin Tanveer1*, David Soon1, Rajavel Senthikumar Sundaramurthy MBBS2, Charles Pilgrim3, Peter Evans3 <p>Introduction: Our investigation aimed to discover the benefits of performing cholecystectomy in patients who had a positive or negative HIDA scan result, presented with either typical or atypical biliary pain.</p> <p>Methods: We performed a retrospective analysis of medical records of patients who had a HIDA scan at Peninsula Health between 2012 and 2017, those who had a HIDA scan and cholecystectomy for biliary pain were selected for this study, and prospective analysis of patient reported outcome post cholecystectomy included.</p> <p>Results: In the past five years, 190 patients had had a HIDA scan to investigate biliary pain without a structural cause. Of those 190, 65 had a positive HIDA result and 20 of these patients went on to have a cholecystectomy. Of the latter, 17 who reported typical biliary pain had their pain resolved post-surgery but 2 out of 3 patients with atypical biliary pain had ongoing pain despite surgery (1 did not respond). Of the 125 patients with a negative HIDA scan, 14 proceeded with a cholecystectomy. Twelve patients had pre-operative typical biliary pain and 5 of these continued to have pain post-operatively. Finally, 1 of the 2 patients with atypical pain continued to have ongoing pain post-surgery.</p> <p>Conclusion: In summary, in patients without a structural cause for biliary pain HIDA scans and patient’s symptoms greatly aid in the decision-making process whether to proceed with a cholecystectomy, as a negative scan should prompt further clinical investigation before proceeding with surgery.</p> <p>&nbsp;</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 A novel technique to prevent the breast implant from exposure after mastectomies 2021-07-09T02:14:43+00:00 Atif Rafique, Ambreen Arshad; Fuad Hashem <p>Introduction</p> <p>After mastectomies, we do our reconstruction, either immediately or delayed. In both ways of reconstruction for post mastectomies defect, the most commonly performed reconstruction is by using breast prosthesis [1]. For many years, surgeons have been trying to find out any solution to reduce the rate of implant exposure and develop some new techniques and modifications. However, once the infection develops or implant expose the only permanent solution is to remove the implant [2-3].</p> <p>Although there is less evidence found in the literature regarding the salvage of implant once the infection occurs and when implant becomes expose in implant-based reconstruction [4]. Radiation also plays additional role in post-operative complication rates following implant-based breast reconstruction, as it is well documented that the incidence of complications is to be higher in radiated breasts compare to similar non-radiated breasts [5]. With the new advancement in radiation therapy the number of patients have been increasing who are receiving radiation therapy after immediate breast reconstruction [5].</p> <p>Description of the Technique</p> <p>For more than 15 years we have been reconstructing the breasts deformities after different types of mastectomies, ranging from skin sparing, nipple areola sparing to different types of lumpectomies, by immediate insertion of breast implants.</p> <p>The main problem which we face during post-reconstruction, is the exposure of implant in addition to infection. With the advent of ADM (Artificial Dermal Matrix) [6], serratus anterior muscle [7], rectus fascial flap [7] and inferior dermal flaps [8] although they do an addition to thickness of skin envelop over the implant after mastectomy, but still the rate of implant exposure has not changed noticeably. It has been well understood that of ADM expose in air it dries immediately which later on results in implant exposure.</p> <p>Meanwhile we have developed a novel tech- nique to augment the soft tissue coverage under the incision line over the ADM and implant. By this way, if there is any dehiscence over suture line, there will be no implant exposure as there is additional soft tissue layer of dermal flap. These dermal flaps are actually a de-epithelialized dermal flap from the inferior half of the breast skin, which we used to excise and throw it to the garbage, particularly in skin sparing mastectomies. In this technique we suture the inferior based dermal flap over the artificial dermal matrix in a way that suture lines of skin flaps of mastectomy lie over the de-epithelialized dermal flap, which actually in- crease the survivability of ADM as well as increase the thickness of soft tissue over the implant (figure 1 and 2).</p> <p>By addition of this layer of de-epithelialized dermal flaps over the artificial dermal matrix and breast implants have promising reduction effect over implant exposure as well as it provides the additional vascularized soft tissue layer over the implant.</p> <p>Although we are using dermal flap with ADM frequently in most of our skin spring mastectomies but we did this new technique in 2 patients till now with the mean follow up of 8 weeks till now there is not a single case report of implant exposure in those patients (figure 3).</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Modified Putti Procedure for the Surgical Management of Patients with Adult Acquired Cavo-Varus Resulting from Peroneal Tendon Rupture 2021-07-09T02:16:51+00:00 Joseph Anderson1*; G. Parker Peresko; Sara Grzywa3; Emily Keeter3; Brooke Lynn Anderson4 <p>Background: Peroneal pathology, including trauma, can result in Cavovarus-Drop Foot type deformity, precluding patients from functioning in or attempting bracing. Lateral ankle stabilization and other associated procedures sometimes are not enough to address the resultant deformity, thus many CavoVarus-Dropfoot patients still have gait abnormalities, function minimally in a brace and still have secondary ambulatory pain and loss of function even when braced. We review the results of 9 patients meeting this criteria and electing for a Modified Putti Procedure and lower extremity reconstruction.</p> <p>Materials and Methods: The charts of 9 patients with adult-acquired CavoVarus deformity foot type after peroneal rupture were reviewed, all but 1 had failed previous AFO/bracing. These patients underwent surgical correction all consisting of the Modified Putti procedure, along with other ancillary procedures and the results and outcomes were collected. Additionally, surgical technique was documented.</p> <p>Results: The mean VAS score improved from 9.1 to 2.4 pre- and post-operatively, respectively. The average time to weight bearing was 7.2 weeks. Four of 9 (44.44%) patients experienced some form of complication. Eight of 9 (88.88%) patients relayed the surgery was a success and would opt to undergo it again, given the choice.</p> <p>Conclusion: The Modified Putti Procedure showed promising results, great patient satisfaction and marked improvement in pre-operative and post-operative pain rating. This technique, utilized after severe peroneal trauma and resultant deformity is present, is a considerable option to have in the foot and ankle surgeon’s armament.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Modifications of Paramedian Forehead Flap 2021-07-09T02:19:06+00:00 Faisal Ashfaq1; Atif Rafique2; Ambreen Arshad3 <p>Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them.</p> <p>Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded.</p> <p>Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction.</p> <p>Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Evaluation of Total Mesorectal Excision With or Without Lateral Pelvic Lymph Nodes Dissection for Middle and Lower Rectal Cancer 2021-07-09T02:21:08+00:00 Mohamed Abdo Etman; Ayman Ahmad Albatanony; Mohammed Sabry Ammar; Mohammed A. Elbalshy <p>Background: The most important prognostic factor in colorectal cancer is nodal status, and lymph node metastasis is a determining factor for adjuvant chemotherapy and subsequently key to predicting disease free and overall survival.</p> <p>Methods: A descriptive prospective study was conducted on 40 patients presenting with middle and low rectal cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study will require resection of their tumors by total mesorectal excision by open and laparoscopic techniques. Patients will be divided into 2 groups: Group A: was operated without lateral pelvic lymph nodes dissection. Group B: was operated with lateral pelvic lymph nodes dissection during the period between November 2018 and November 2020.</p> <p>Results: The main presentation of patients was bleeding per rectum 12 (30%), 12 (30%) patients have constipation. 28 patients with adenocarcinoma (70%) and 8 mucinous (20 %) and 4 (10%) with signet ring. Sixteen patients undergo Low ant resection (40%), 16 patients with AP. resection (40 %) and 8 patients with Intersphencteic resection (20%). Regarding intraoperative data, with a mean operative time was (90.00 ± 3.84 min.) for without Lateral pelvic L.N dissection and (122.91±4.89 min.) for with Lateral pelvic L.N dissection.</p> <p>Conclusion: Surgical mortality of LPLD is low, but there is an increase of morbidities in the form of prolonged operative time, intraoperative blood loss and genito-urinary malfunction. For avoiding the drawbacks of LPLD extended lymphadenectomies with sparing of the pelvic nerves is recommended. Lateral pelvic lymph node involvement is a regional disease that is curable. LPLD was effective to control recurrence at lateral nodes sites.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Intra-Operative Rupture of Giant Ascending Aorta and Aortic Arch Aneurysm In Open Heart Surgery: A Successful Peri-operative Management 2021-07-09T02:22:48+00:00 Issaka Zallé , Mohamed El-Alaoui, Djeinaba Kane, Drissi Boumzebra <p>Introduction: Giant thoracic aortic aneurysms are rare. Most of the reported cases are not a known complication of aortic coarctation repair. Otherwise intra-operative aneurysm ruptures are rare cases but a potentially fatal complication in open heart surgery.</p> <p>Case report: In this article, we report the case of a 23-year-old patient with a giant ascending and arch aneurysm associated with a Standford type A chronic aortic dissection. In the patient’s history a coarctation repair at age of five years old was noted. During an open heart surgery for ascending aorta and hemi-arch replacement under cardiopulmonary bypass, aneurysm rupture occurred before aortic cross-clamp. A successful intraoperative and post-operative management was performed. The course was uneventful. The patient was extubated without neurological damage. Moreover, there were no kidney function deterioration, no digestive and limbs ischemia.</p> <p>Conclusion: Intra-operative aneurysm rupture is rare but is a major operative complication whose successful repair depends on an integrated intra-operative management. Cerebrovascular and heart protection are the main determinants of patient survival. Also, the surgical team’s prompt response is the key to the successful execution of the procedure.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 The Feasibility of Early Closure of Defunctioning Loop Ileostomy after Low Anterior Resection for Rectal Cancer 2021-07-09T02:25:37+00:00 Ahmed S. Elgammal1*, Ahmed Gaber1, Ahmed Fawzy1 <p>Background: The advantages of defuctioning loop ileostomy in some cases of rectal carcinoma is not questionable, but many patients experience serious stoma related complications and impaired quality of life. Early closure of the defunctioning ileostomy could mitigate these problem.</p> <p>Methods: This is a controlled randomized study done on 100 patients suffering of rectal cancer who had low anterior resection of the rectum and covering ileostomy at Menofiya University Hospital between April 2016 to august 2019. The patients were randomly divided (by closed envelope method) in two equal groups, Group A (Early group) and Group B (Late group).</p> <p>Results: As regards the pre-closure ileostomy complications: skin infection and maceration occurred in 4 pts. In early group and in 15 late group while dehydration and electrolyte imbalance occurred in 3 pts. In early group and in11 pts. In the late one, with both complications were significantly higher in late group (P value; 0.009 and 0,04 respectively). The health related quality of life was found to be higher in early group at 2 and 6 months than that in late group, but this did not yet reach significant difference, and at 12 month, the results were almost the same.</p> <p>Conclusion: Early ileostomy closure is safe, and not associated with higher complication rates in patients with an uncomplicated postoperative course and radiologically verified intact distal loopogram study.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Facial Lipostructure: an Overview 2021-07-09T02:27:12+00:00 Luigi Clauser, Maria Elena de Notariis ,Carolina SanninO, Antonio Lucchi <p>Aim: Facial lipostructure (FLS) is not a new procedure. In the past, many surgeons steered clear of it because the results were poor and unpredictable . In the 80’s however FLS emerged with precise indications, improved techniques, foreseeable and stable results. Its use has become widespread because it produces natural, long-lasting outcomes with minimal donor site morbidity . FLS usually represents the last procedure or retouch in many reconstructive procedures and protocols. Moreover adipose-derived stems cells (ADSCs) represent a promising source of autologous cells for tissue repair and regeneration.</p> <p>Methods: In the maxillofacial area, FLS is indicated primarily to restore and rejuvenate the zygomas, periorbital region, cheeks, nose, lips, chin, mandible and jawline. Recently, it has been applied to correct localized tissue atrophy, burns, hemifacial atrophy (Parry-Romberg syndrome, scleroderma, anophthalmic orbit), and loss of substance resulting from trauma, tumor excision, and congenital craniofacial deformity sequelae.</p> <p>Orthognathic surgery and fat grafting represent a new application and an appropriate indication. It is well known that this surgery moves the skeletal bases (maxilla, mandible, chin) but often this leads to a lack of soft tissue coverage. Some patients, particularly women, complain about this lack of soft tissue volume after bony surgery.</p> <p>Conclusion: FLS was launched as a means to improve volumes and facial aesthetics. Recently, it has been applied in more complex reconstructive and regenerative procedures. It can especially be used on any facial area lacking soft tissue due to posttraumatic outcomes, post tumor deformities, and as a refinement in for many acquired and congenital maxillofacial deformities. The proposed uses for ADSCs in tissue repair and regeneration are quite impressive. Recent works on ADSCs would suggest that adult cells may prove to be an equally powerful regenerative tool in treating congenital and acquired maxillofacial disorders. More importantly, physicians, researchers and international associations need to work to inform clinicians about what practices are evidence based and to encourage support of additional research. Today tissue engineering and regenerative medicine are a multidisciplinary science that is evolving along with biotechnologic advances.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation 2021-07-09T02:37:54+00:00 Issaka Zalle1*, Moussa Son1, Mouhcine El Mardouli1, Mohamed EL-Alaoui1, Macedoine Nijimbere1, Abdoulaziz Thiombiano1, Drissi Boumzebra1 <p>Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables.</p> <p>Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed.</p> <p>Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P &lt;.01), shorter ICU stay 1.36 [1-6] vs 3.6 [2-8] days, p&lt;.01. Length of hospital stay and chest tube stay were found to be shorter, respectively 6.9 [6-16] vs 7, 7 [7-13] and (1.38 [1-2] days vs 2.64 [2-4], P &lt;.01). Wound infections were not found in both groups.</p> <p>Conclusion: Although the controversy interest of minimally invasive mitral valve surgery, it may be associated with less blood loss, faster post-operative recovery but increases operation time.</p> <p>&nbsp;</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 New Trends In Treacher Collins Syndrome: Bony Reconstruction And Regenerative Therapy 2021-07-09T02:39:36+00:00 Luigi Clauser1, Chiara Gardin2, Letizia Ferroni2, Antonio Lucchi1, Carolina Sannino1, Maria Elena de Notariis1 and Barbara Zavan2 <p>Aim:Treacher Collins syndrome is a rare congenital disorder of craniofacial development with a highly variable pheonotype. This syndrome occurs with an incidence of 1:50,000, and more than 60% of the cases have no previous family history and arise as the result of de novo mutations. The disorder displays an intricate underlying dysmorphology. Affected patients may suffer life-threatening airway complications and functional difficulties involving sight, hearing, speech, and feeding. Deformation of facial structures produces a characteristic appearance that includes malar-zygomatic hypoplasia, periorbital soft tissue anomalies, maxillomandibular hypoplasia, and ear anomalies. Management requires a specialized craniofacial team, as comprehensive care starts at birth and may require life-long follow-up. Standard craniofacial procedures for bony and soft tissue reconstruction are used. This article outlines current treatment strategies and future concepts for surgical and regenerative management.</p> <p>Methods:The new field of regenerative medicine and therapy offers the promise to improve some of these treatments. In particular, Structural Fat Grafting (lipostructure) seems to be a good strategy to restore the normal volume and contour of the face, and to provide a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. In this work, we present the case of a young girl with Treacher Collins Syndrome who underwent serial sessions of fat grafting in addition to other surgical bony reconstructive techniques. ADSCs have been isolated from the patient’s lipoaspirate, and compared for their stemness properties with those of a healthy subject.</p> <p>Conclusion:Screening of the genome of the Treacher Collins patient using array-Comparative Genomic Hybridization (array-CGH) allowed us to identify some chromosomal imbalances that are probably associated with the syndrome.Correction of these imbalances and asymmetries by modulating ADSCs could be an innovative approach to improve and stabilize the results of the surgical treatment of Treacher Collin Syndrome.</p> <p>&nbsp;</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 A comparative study between laparoscopic hernia repair and open herniotomy of inguinal hernia in paediatric age group: A prospective randomized controlled study 2021-07-09T02:43:34+00:00 Dr.Arti Mitra1, Dr.Unmed Chandak1, Dr.Yuvraj Pawaskar1*, Dr.Shiv Kumar Sahu1, Dr. Sanskriti Sinha1, Dr. Prasad Bansod1, Dr. Nilesh Nagdeve2, Dr. Akanksha Waldia3 <p>Background: Inguinal hernia in children remains one of the most common congenital anomaly observed by surgeons. Prompt diagnosis and early treatment of the inguinal hernia continues to be the mainstay to avoid the complications. The present study was undertaken to compare the effectiveness of laparoscopic hernia repair and open herniotomy of inguinal hernia in paediatric age group.</p> <p>Method: A total 104 healthy children of age &lt;12 years diagnosed with inguinal hernias were alternately randomized into two equal groups, 52 patients were treated by laparoscopic method and 52 patients were treated by open herniotomy method. The outcome of two techniques compare were operative time, recovery and discharge within 24 hours, post-operative pain assessment, cosmesis and complications.</p> <p>Results: The mean operating time for open herniotomy was significantly less (36.69) as compared to that for laparoscopic hernia group (66.98). Recovery and discharge within 24 hours of patients undergoing laparoscopic hernia repair were significantly more (78.85%) than the open herniotomy group (57.69%). The CHIPPS for post-operative pain assessment were 5.28 for open herniotomy Vs 5.07 for laparoscopic hernia repair. FLACC tool for postoperative and periprocedural pain assessment was 4.75 for open hernioromy Vs 4.61 for laparoscopic hernia repair. The excellent cosmesis after laparoscopic procedure, whereas good cosmesis after open procedure among all subjects from respective groups. The complications including scrotal edema, erythema, hydrocele and recurrence were not significantly different in the two groups.</p> <p>Conclusion: The study concludes that the well performed conventional herniotomy yields results similar to those of laparoscopic repair.</p> <p>&nbsp;</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Electrosurgical energy. Is it a risk factor for post-thyroidectomy hypocalcaemia? 2021-07-09T02:45:33+00:00 Hernán I Padilla1, Luis A Pacheco-Ojeda2*, ME Romero3, MC Mata4, Xavier Guarderas5 <p>Aim and objective: The aim of this study was to investigate a relationship between the different types of electrosurgical energy (monopolar, bipolar, and ultrasonic-harmonic scalpel) and postoperative hypocalcaemia after total thyroidectomy. Additionally, to analyze the frequency of postoperative hypocalcaemia, according to age group, gender, and pathological diagnosis.</p> <p>Materials and Methods: An observational, retrospective and correlational study was carried out in a series of patients who underwent total thyroidectomy in a public and a private hospital in Quito, Ecuador, South America, from January 2016 to July 2019.</p> <p>Results: Among 665 patients, post-thyroidectomy hypocalcaemia was observed in 127 (18.8%) patients. There was no significant difference between males and females. Hypocalcaemia was significantly higher in patients aged between 26 and 35 years, patients operated for malignant tumors and in patients in whom at least one parathyroid gland was removed. Postoperative hypocalcaemia occurred in 52.2% of patients (n = 24) [RR: 3.14; 95% CI: 2.26-4.36; p: 0.001] in the bipolar group, 29.2% (n = 7) [RR: 1.56; 95% CI: 0.82-2.97; p: 0.087] in the harmonic group, 17.3% (n = 34) [RR: 0.87; 95% CI: 0.61-1.24; p: 0.219] in the monopolar group, and 15.2% (n= 60) [RR: 0.61; 95% CI 0.45-0.84; p: 0.001] in the monopolar + harmonic group.</p> <p>Conclusions and clinical significance: The use of a bipolar device appears to be a risk factor for hypocalcaemia, while the use of monopolar + harmonic seems to be a protective factor. Although, when analyzing monopolar + harmonic vs monopolar alone, the addition of the harmonic scalpel didn’t provide statistically significant additional protection against hypocalcaemia.</p> <p>&nbsp;</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Kyrle’s disease (KD): “An Update with review of literature” A Spongebob Skin pores simulation 2021-07-09T02:47:03+00:00 Dr. UwaisRiazUlHasan* M.Med, Dr. Khathija Hasan M.Med, Dr. Victor Effiong Obong M.B.B.Ch, MWACS, Dr. Okorie Christian Chima M.B.BCh, FWACS, FMCS, Dr. Abdul Aziz Al Nami M.B.B.S, Dr. Abdullah Abdulmonem AlZarra M.B.B.S, Dr. Hassan A Al Wtayyan M.B.B.S, Dr. <p>Kyrle’s disease (KD) is a Chronic skin condition first described by Austrian pathologist Josef Kyrle in 1916. Kyrle referred to this condition as hyperkeratosis follicularis &amp; parafollicularis in cutem penetrans. These diseases are characterized by the phenomenon of transepidermal elimination of denatured dermis an acquired form of perforating dermatosis [14]. It is characterized by keratotic crater plugs that develop in hair follicles penetrating the epidermis and extending into the dermis [4]. This trans epithelial migration and elimination of proteinaceous components is associated with systemic disorders like renal, liver diseases, chronic heart failure and diabetes mellitus. We present two case scenarios of a young Males with multiple chronic papular eruptions along with a review of literature for Kyrle’s disease (KD).</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Impact of tumor size on depth of invasion and number of Lymph nodes infiltration in esophageal cancer 2021-07-09T02:49:53+00:00 Ahmed S Elgammal1, Ihab S Ahmed2, Walla Abdelgawad3, Essam Elshiekh4 <p>Introduction: Esophageal cancer (EC) is one of the deadliest malignancies worldwide and is often diagnosed in advanced stages. It is the 8th most common cancer in the world and is the 6th most common cause of cancer related deaths, having a 5-year survival rate of less than 20% despite advances in treatment. It has a poor prognosis due to the late diagnosis and the lack of early presenting symptoms. In the United States, stage IV is the most common stage at the time of diagnosis.</p> <p>Methods: Eighty-seven fit patients were recruited for this multi-institutional clinical prospective study in the period from the start of January 2014 to the end of December 2020, diagnosed as cancer esophagus in by endoscopic biopsy and underwent surgical treatment according to stage at the centers participating in this study.</p> <p>Results: In pre-operative biopsy, Adenocarcinoma was diagnosed in 39/87 cases (44.8%) distributed as (5 in GEJ and 34 diagnosed in lower esophagus) while squamous cell carcinoma (SCC) diagnosed in 48/87 cases (55.2%) distributed as (28 in lower part, 10 in middle part and 9 in upper esophagus respectively) and only one case out of 87 cases diagnosed as undifferentiated carcinoma of lower esophagus. We found significant association between the increased tumor size and the increase depth of invasion and thenumber of harvested lymph nodes.</p> <p>Conclusion: As the tumor size increased (cutoff point 3cm), the depth of invasion through the layers of esophagus and the number of the infiltrated lymph nodes will increase, and this is associated with poor prognosis and increase in mortality rate from the esophageal cancer.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Modern Diagnosis and Surgical Management of Thoracic Outlet Syndrome: A Comprehensive Review 2021-07-09T02:52:46+00:00 Farid Gharagozloo*,, Nabhan Atiquzzaman, Mark Meyer, Scott Werden <p>Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction. Compression of the vein results in venous hypertension in the upper extremity and resultant neurologic symptoms. With prolonged compression of the subclavian-innominate junction, the vein clots giving rise to Paget–Schroetter syndrome. Therefore, patients who have been previously classified as Disputed Neurogenic and Venous TOS represent a variable symptomatic presentation of the same pathologic entity, which affects the subclavian vein. Presently MRA of the thoracic outlet with arm maneuvers is the test of choice in patients suspected of having TOS. This test shows the abnormal bony tubercle on the first rib with extrinsic compression of the subclavian innominate junction, which is exacerbated with elevation of the arm above the shoulder. Robotic resection of the medial aspect of the first rib along with disarticulation of the costo-sternal joint has the best reported results to date.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 SMAS-flap transposition in Lower Face-lift 2021-07-09T02:54:39+00:00 Crescenzo D’Onofrio <p>The superficial musculoaponeurotic system is of fundamental importance in facial anatomy. One of its primary functions is to harmoniously integrate the facial mimic muscles by coordinating their movements with each other. The continuity of the superficial musculoaponeurotic system with the platysma also creates an effective unitary connection with the mandibular and cervical areas. For these areas, where the signs of aging are first shown with soft tissue ptosis and cervical bands, we propose our lower face-lift technique with SMAS-flap transposition. This technique is not characterized by the section of the aponeurosis at the earlobe or lower level and by its rotation, but it is characterized by an higher SMAS section at tragus level with transposition of the mobilized pre-parotid and platysma aponeurosis to the high mastoid area. This manoeuvrer allows us for an effective platysma extension-lift and for his secure fixation to the upper mastoid area, resulting in greater stability and duration of the treatment.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 The validity of Protein S 100B in Mild Pediatric Head Trauma 2021-07-09T02:56:17+00:00 Magdy A. Lolah1#, Khaled A. Khalifa2, Tarek M. E. Rageh3, Adel Hamed Elbaih4#, Mohamed A. Hussein5, Mai T. B. Meshhal6 <p>Background; S100B has been shown to be beneficial as a biomarker in the treatment of adults with mild traumatic brain injury (mTBI). The efficacy of S100B as a biomarker in children, on the other hand, has been a subject of debate. Aim and objectives; was to assess the validity of Protein S 100B in Mild Pediatric Head trauma. Subjects and methods; this was a prospective study, included 160 pediatric patients with mild head trauma presented to Emergency Department. Result; A highly significant correlation between Positive S100B protein and traumatic brain injury with S100B protein value 1554.1±84.0 ng/L. A100 had cutoff value for positive CT Brain finding above 987.5 ng/L, The sensitivity was 81.0%, the specificity was 75%%, the NPV was 86%, the PPV was 68%, and overall accuracy 77%. There was none statistical significant difference regarding severity of brain injury and S100 B (P = 0.225), Conclusion; Serum S100B levels cannot be used to substitute clinical examinations or CT scans in identifying pediatric patients with mild head injuries, but they can be used to identify low-risk kids to avoid excessive radiation exposure.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Treatment of “En Coupe De Sabre “ Linear Scleroderma. Soft Tissue Augmentation and Regeneration by Autologous Fat Transfer 2021-07-09T20:33:10+00:00 Luigi Clauser1, Antonio Lucchi1, Carolina Sannino1, Andrea Edoardo Bianchi1, 2 <p>Aim: Frontal linear scleroderma, also known as ‘‘en coup de sabre,’’ is a congenital deformity characterized by atrophy and furrowing of the skin of the front parietal area above the level of the eyebrows. In most cases it occurs as a single paramedian line that may be associated with hypoplasia of underlying structures and facial hemiatrophy. In case of a wide lesion many reconstructive strategies have been proposed. The modern approach is aimed at augmentation of the tissue deficiency by using lipostructure and tissue regeneration. Autologous fat transfer (AFT) seems to be an effective strategy to restore the normal volume and contour of the face while providing a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential.</p> <p>Methods: In this report, we present a rare case of linear scleroderma en coupe de sabre which was successfully managed with three stages of autologous fat grafting.</p> <p>Conclusion: The proposed uses for ADSCs in tissue repair and regeneration are quite impressive. Recent works on ADSCs would suggest that adult cells may prove to be an equally powerful regenerative tool in treating congenital and acquired maxillofacial disorders. More importantly, physicians, researchers and international associations need to cooperate in informing clinicians about what practices are based on evidence and to encourage support of additional research. There is increasing interest in a possible therapeutic effect of ADSCs from processed lipoaspirate for a wide spectrum of clinical applications in the facial and craniofacial area. AFT can be used in any facial area where soft tissue is lacking or where there is scarring, producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine. However, more definitive studies are needed to answer specific questions regarding the best technique to be used and the role of ADSCs. Autologous fat grafting provides a safe and easy approach for the treatment of linear scleroderma en coup de sabre, long-term clinically satisfactory results can be obtained.</p> 2021-06-18T00:00:00+00:00 Copyright (c) 2021 Blue Round Small Cell tumor: A Surgical Update of DSRCT with review of literature ‘A Grim Affair’ 2021-07-24T23:08:22+00:00 UwaisRiazUlHasan, Khathija Hasan, Farooq Ahmed Qureshi, Victor Effiong Obong, MWACS, Abdul Aziz Al Nami, Ali Ibrahim AlShaqaqiq, Mohammad AbdulMajeed Alghadeer, Marwan Ahmad AlRayhan, Mohammed Ali AlJummah, Baqer Ali Aldheen, Ali Hussain AlRufayi,ShehlaRi <p>Desmoplastic small round cell tumor (DSRCT) is a tumor derived from the Greek desmos referring to knot and plasis to formation an uncommon soft tissue malignant tumor, mesenchymal in origin and aggressive with a prelidiction for males and advanced at presentation. It was first described as a distinct clinical entity by Gerald WL and Rosai J (7). There are fewer than 200 reported to date. Depending on the primary site of location the Clinical manifestations vary. As most arise from the abdomen and pelvis they remain asymptomatic till they attain a huge size. Other reported sites are the skull, thorax, and paratesticular region (10,13). We report the case of a 19 yr old male who had non specific abdominal discomfort with asthenia for a period of six months and was referred to us for evaluation of left supraclavicular nodes. The prognosis of Desmoplastic small round cell tumor (DSRCT) is poor with few surviving less than two years.</p> 2021-07-24T00:00:00+00:00 Copyright (c) 2021