Popliteal artery patency is an indicator of ambulation and healing after below-knee amputation in vasculopaths

Background The posterior flap is a conventional technique for closing a below-knee amputation (BKA) that uses the gastrocnemius and soleus muscle and relies on the popliteal and posterior compartment arteries. If the prior mentioned arterial blood supply is compromised, this flap likely relies on collateral flow. The purpose of this study is to identify and differentiate any significant associations between preoperative popliteal and tibial arterial flow and BKA outcomes and patient-reported function. Methods A retrospective review identified patients from a single tertiary wound care center who received BKAs and angiogram between 2010 and 2017 by a single surgeon. BKA complications, wound healing, and amputee ambulatory status at latest follow-up were all stratified for differences according to baseline tibial vessel run-off (VRO) status, popliteal artery patency, and popliteal angioplasty outcome. Chi-square, Fisher’s exact, and Wilcoxon rank sum tests were used with significance defined as p ≤ 0.05 . Results BKAs were performed on 313 patients, of which, 167 underwent preoperative angiography. Thirty-two were excluded due to lack of adequate follow-up leaving a total of 135 patients in the studied population. Diabetes was present in 87%, and 36% had end-stage renal disease. By the study’s conclusion, 92% of BKAs had fully healed, with median time-to-healing of 79 days (range 19–1314 days). 60% of patients were ambulatory at 9.5 months. Higher VRO was associated with higher healing rates and lower complications and time-to-healing. The conversion rate of BKA to above-knee amputation (AKA) was 4%. Preoperative popliteal patency was associated with higher postoperative ambulation rates when compared to patients without popliteal flow preoperatively (patent: 71/109, 65%; occluded: 10/26, 40%; p = 0.02) and independently increased the likelihood of postoperative ambulation. Conclusions The posterior flap design for BKA works even in the setting of popliteal occlusion. Complication rates are higher in patients with more compromised blood flow, which may ultimately lead to AKA. Given poor ambulation rates in patients who undergo AKA, the results of this study should encourage surgeons to consider a more functional BKA, even in instances when the popliteal artery is occluded.

A novel technique to avoid intraoperative giant tear slippage: the bimanual double aspiration technique

Background The aim of this paper is to present a novel bimanual double aspiration technique to avoid intraoperative giant tear slippage. The major problem of giant retinal tears (GRT) surgery is the mobility of the posterior flap (slippage), which has been classically solved by the use of intraoperative perfluorocarbon liquid (PFCL). However, avoiding slippage of the posterior flap can be a serious technical challenge when the PFCL is removed, especially when a GRT circumference is > 180°. Methods Conventional three-port 23-gauge pars plana vitrectomy (PPV) plus chandelier was performed in three patients with giant retinal tears (GRT), using the “bimanual double aspiration technique” with non-contact wide field viewing systems. All surgeries were performed by the same surgeon. Results None of the three cases presented with a retinal slippage after the bimanual aspiration technique. Discussion GRT are full thickness retinal tears that extend circumferentially more than 90° of the retina. Management of GRT is a challenge for the vitreoretinal surgeons because the higher risk of proliferative vitreoretinopathy (PVR), re-detachment and increased risk of retinal slippage; this last can occur intraoperative or postoperative. Retinal slippage is not uncommon but far under-reported and can lead to various complications such as hypotony, retinal folds, and may exacerbate PVR formation. We performed bimanual double aspiration technique to avoid intraoperative giant tear slippage. We believe that this maneuver may avoid slippage by drying the posterior edge of the GRT. There were no complications related with the technique, and no additional equipment was needed. Conclusion In summary, “bimanual double aspiration technique”, is a simple, effective, safe and economic maneuver that could be a good option to avoid intraoperative slippage in giant retinal detachment surgery, thus achieving the stabilization of the posterior retinal flap.

Preservation of the left ventricle contractility while performing of the combined mitral-aortal failure correction

Objective. The studying of possibilities of procedures, directed on preservation of left ventricle while doing a mitral valve prosthesis in operative correction of combined mitral-aortal failure. Materials and methods. In the analysis the results of surgical treatment of 340 patients, suffering combined mitral-aortal failure and a left-sided ventriculomegaly, who were operated in N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, were included. In all the patients a mitral valve prosthesis in combination with the aortal failure correction (prosthesis) was performed. In 83 patients the mitral valve prosthesis with complete preservation of posterior flap (Group A) was conducted, in 97 - with translocation of chords with papillar muscles of anterior flap in combination with posterior flap (Group B), in 160 - without preservation of the undervalvular apparatus (Group C). Definitely-systolic index of left ventricle in Groups A, B and C have constituted (87.4 ± 10.5), (88.4 ± 11.1) and (89.4 ± 11.5) ml/m2 accordingly; left ventricular ejection fraction have constituted 0.51 ± 0.03, 0.5 ± 0.03 and 0.51 ± 0.03 accordingly. Results. In Group A on a hospital stage 2 (2.5%) patients died, in Group B - 2 (2.1%) patients, and in Group C - 5 (3.1%). Definitely-systolic index of left ventricle on the tenth-eleventh postoperative day in Groups A, B and C have constituted (74.3 ± 9.8), (69.4 ± 8.2) and (76.4 ± 9.2) ml/m2 accordingly, while in late follow-up period - (55.4 ± 8.4), (49.4 ± 7.2) and (62.4 ± 7.2) ml/m2 accordingly. The left ventricle ejection fraction on the tenth-eleventh postoperative day in Groups A, B and C have constituted 0.54 ± 0.03, 0.55 ± 0.03 and 0.53 ± 0.03 accordingly, and in late follow-up period - 0.55 ± 0.03, 0.57 ± 0.03 and 0.54 ± 0.03 accordingly. Conclusion. In the left-sided ventriculomegaly and combined mitral-aortal failure the a maximal preservation of undervalvular structures of mitral valve, while its prosthesis performance, constitutes a serious component, which leads to improvement of morphometric indices of left ventricle on hospital stage and in follow-up period as well.

S. K. Olenin. - To the pathology of the hymen. - (Archpriest Tambov. Med. General 1894, 1-12. Tambov, 1895. Page 109).

1st case. 20 years old, recently married. Coitus has never been successful. Besides fleshy, with a small hole, hymen in the usual place, sntm. 1-2 higher, in the vaginal cavity, there is a transverse septum with a hole that barely passes the end of the little finger. Lateral cuts of the outer septum were made and the posterior flap formed in this way was cut out; the wound was closed with knotty sutures. The ring is scattered on the narrowed place of the vagina. Systematic expansion of iodoforms. gauze. Convalescence.2nd case. 45 years old, nulliparous. Coitus was never accompanied by pain, but the patient almost constantly suppresses the secretion from the vagina. The hymen, thick, with a very small opening, is pressed into the vaginal cavity, thanks to 29 years of married life, but not torn. Haematocolpos. Two side cuts; the edges are cut and sewn.

The valve-preserving operations on a chordo-papillary continuum in a mitral valve prosthesis

Objective. Studying of morphometric indices and contractility of left ventricle in various variants of preservation of chordo-papillary continuum in late period after the mitral valve prosthesis. Materials and methods. Analysis in 634 patients with isolated mitral valve failure, who were surgically treated from Sept. 1 2005 till Jan. 1 2007, was conducted. While the mitral valve prosthesis the chordo-papillary continuum was conducted, using preservation of the mitral valve posterior flap (41 patients) and simultaneous translocations of chordo-papillary muscles of anterior flap and preservation of posterior flap of a mitral valve (57 patients). Results. While comparing morphometric indices of left ventricle in left ventriculomegaly on a hospital stage and in late postoperative period when complete excision of a mitral valve in its prosthesis was performed, and when posterior flap was preserved, and simultaneously the posterior and anterior mitral valve flaps the improvement of the indices was observed, as well as normalization of a contractile function of left ventricle if a subvalvular space is preserved. Conclusion. Preservation of chordo-papillary continuum while performing the mitral valve prosthesis improves morphometric indices and contractility of left ventricle on a hospital stage and in late follow-up period.

Hip disarticulation with pedicled total leg fillet flap for recurrent fungating sarcoma

Soft tissue sarcomas may be treated with limb-sparing procedures in the majority of cases; however, certain cases involving significant tumor spread and fungation may call for amputation. In the thigh, hip disarticulation typically involves a pedicled gluteus maximus flap or a pedicled anterior quadriceps flap. In this case report, we describe a rare situation in which the anterior flap, posterior flap, and adductor flap musculature were contaminated with tumor; therefore, a hip disarticulation was performed applying a pedicled total leg fillet flap for closure. Eighteen months after treatment, the patient continues to have no local recurrence of disease, a stable flap site, and ambulates with a walker. We present this amputation and closure method as a potentially effective modality in treating extensive oncologic disease of the proximal lower extremity.

External dacryocystorhinostomy

Aim: To analyse the epidemiological data, surgical technique, success rate, and complications of patients who underwent external DCR in Hospital Selayang from January 2015 to December 2016. Method: Retrospective case series. Results: A total of 21 eyes of 20 patients who underwent external DCR from January 2015 to December 2016 were identified and reviewed. There were 15 females (75%) and 5 males (25%). Age ranged from 5 to 75 years old, with a median age of 56 years old (IQR 23). Twelve patients presented with epiphora while eight patients presented with symptoms of dacryocystitis. One case was congenital, two were secondary nasolacrimal duct obstruction and the rest were primary nasolacrimal duct obstruction. All patients underwent external DCR under general anaesthesia. Silicone tube were inserted in 21 eyes, of which all were removed 3 months after the surgery except one patient whom had his tube dislodged accidentally. The overall success rate was 90.5% (n = 19), which was defined as no or minimal intermittent epiphora or no reflux on lacrimal irrigation at 12 months postoperative. There was one patient who had a cerebrospinal fluid leak treated successfully with intravenous antibiotics. Conclusion: The surgical success rate for external dacryocystorhinostomy was comparable to that of the global success rate of external DCR. This is attributed to the application of surgical technique such as anterior suspended flap modification and posterior flap excision.

Synodus cresseyi Prokofiev, 2008, an unnecessary replacement for S. macrocephalus Cressey, 1981, and a description of a new species from the Western Indian Ocean (Teleostei: Synodontidae)

Synodus cresseyi Prokofiev, 2008 is an unnecessary replacement name for S. macrocephalus Cressey, 1981 according to Article 23.9.5 of the International Code of Zoological Nomenclature. The material used for the description of S. cresseyi includes two species. One of them represents a new species which differs from its congeners in the following combination of characters: anterior palatine teeth not longer than posterior teeth; preopercle scaled posterior to corner of mouth; membranous posterior flap of anterior nostril slender, with a pointed tip, reaching to above posterior nostril when laid back; pectoral fins reaching a line connecting dorsal and pelvic fin origins; pelvic process broad; color in alcohol without any marking, deep brown on dorsal surface restricted to central two-third of head and body, about two scale rows above lateral line, lateral and ventral surface uniformly silver white without blotches.